Terminal ileum duplication: an unusual case of small bowel obstruction.

Duplications of the alimentary tract are uncommon congenital anomalies that usually present during infancy and early childhood. The case of an adolescent presenting with small bowel obstruction secondary to a duplication cyst is presented and the challenges in the management described.

Radical prostatectomy outcomes at the University Hospital of the West Indies: 2000-2007.

OBJECTIVES: Prostate cancer is the commonest cancer in Jamaican men with an age-specific incidence of 65.5 per 100 000 and also the commonest cause of male cancer death. This study reports on the oncological outcome and morbidity after radical retropubic prostatectomy. SUBJECTS AND METHODS: The records of 116 patients with clinically localized prostate cancer (cT1c- T2) who underwent radical retropubic prostatectomy at the University Hospital of the West Indies from January 2000 to December 2007 were examined. Preoperative Prostate specific antigen (PSA), clinical stage and Gleason score were recorded. Operative time, blood loss, hospital stay and complications were assessed. Oncological outcome was assessed using biochemical progression. Disease progression was defined by PSA value of 0.4 ng/ml or greater. RESULTS: Mean patient age was 61 (43-75) years. The mean presenting PSA was 10.1 (2-25.1) ng/ml. Mean Gleason score on preoperative biopsy was 6. The commonest clinical stage was T1c (68%). Nodal involvement was seen in only one patient. The positive surgical margin rate was 15.5%. Mean operating time was 246 minutes and mean estimated blood loss was 1.44 L. The mean hospital stay was 6.9 days and 17% of patients developed minor complications, with no treatment or disease related deaths. Five-year biochemical-free survival was 78.4%. CONCLUSIONS: Oncological outcomes after radical retropubic prostatectomy in Jamaica appear to meet global standards with acceptable morbidity.

Radical prostatectomy outcomes at the university hospital of the West Indies: 2000-2007 / Evolución clínica de la prostatectomía radical en el hospital universitario de West Indies: 2000-2007

OBJECTIVES: Prostate cancer is the commonest cancer in Jamaican men with an age-specific incidence of 65.5 per 100 000 and also the commonest cause of male cancer death. This study reports on the oncological outcome and morbidity after radical retropubic prostatectomy. SUBJECTS AND METHODS: The records of 116 patients with clinically localized prostate cancer (cT1c-T2) who underwent radical retropubic prostatectomy at the University Hospital of the West Indies from January 2000 to December 2007 were examined. Preoperative Prostate specific antigen (PSA), clinical stage and Gleason score were recorded. Operative time, blood loss, hospital stay and complications were assessed. Oncological outcome was assessed using biochemical progression. Disease progression was defined by PSA value of 0.4 ng/ml or greater. RESULTS: Mean patient age was 61 (43-75) years. The mean presenting PSA was 10.1 (2-25.1) ng/ml. Mean Gleason score on preoperative biopsy was 6. The commonest clinical stage was T1c (68%). Nodal involvement was seen in only one patient. The positive surgical margin rate was 15.5%. Mean operating time was 246 minutes and mean estimated blood loss was 1.44 L. The mean hospital stay was 6.9 days and 17% of patients developed minor complications, with no treatment or disease related deaths. Five-year biochemical-free survival was 78.4%. CONCLUSIONS: Oncological outcomes after radical retropubic prostatectomy in Jamaica appear to meet global standards with acceptable morbidity.

OBJETIVOS: El cáncer de la próstata es el cáncer más común entre los hombres jamaicanos con una incidencia específica por edad de 65.5 por 100 000, y es también la causa más común de la muerte por cáncer entre los hombres. Este estudio reporta la evolución clínica oncológica y la morbilidad tras la prostatectomía radical retropúbica. MÉTODOS: Se examinaron las historias clínicas de 116 pacientes con cáncer de próstata clínicamente localizado (cT1c - T2), sometidos a prostatectomía radical retropúbica en el Hospital Universitario de West Indies de enero de 2000 a diciembre 2007. Se registraron el antígeno específico de próstata (AEP) preoperativo, la etapa clínica y la puntuación de Gleason. Se evaluaron el tiempo operativo, la pérdida de sangre, la estadía hospitalaria, y las complicaciones. Se evaluó la evolución clínica oncológica usando la progresión bioquímica. La progresión de la enfermedad se definió por el valor del AEP de 0.4 ng/ml o mayor. RESULTADOS: La edad promedio de los pacientes fue 61 (43-75) años. El AEP promedio fue PSA 10.1 (2-25.1) ng/ml. La puntuación promedio Gleason en la biopsia preoperativa fue 6. La etapa clínica más común fue T1c (68%). Se observó compromiso de nódulos en sólo un paciente. La tasa de márgenes quirúrgicos positivos fue 15.5%. El tiempo promedio de operación fue 246 minutos y la pérdida de sangre promedio estimada fue 1.44 L. La estadía hospitalaria promedio fue de 6.9 días y 17% de los pacientes desarrollaron complicaciones menores, sin tratamiento o enfermedad relacionados con muertes. La supervivencia quinquenal libre del uso de productos bioquímicos fue 78.4%. CONCLUSIONES: Los resultados oncológicos después de la prostatectomía retropúbica radical en Jamaica muestran estar en correspondencia con los estándares globales con una morbilidad aceptable.

Body mass index and prostate specific antigen levels in Jamaican men.

OBJECTIVE: To investigate the relationship between body mass index (BMI) and prostate specific antigen (PSA) levels in Jamaican men. METHODS: Men, 40-79 years old, attending public and private urology clinics in Kingston, Jamaica were recruited to a case-control study on the role of dietary and lifestyle factors on prostate cancer. Trained interviewers administered questionnaires and measured weight and height using standardized techniques. Blood samples for PSA were measured at a central laboratory using a micro-particle enzyme immunoassay method. Prostate biopsy was used to confirm prostate cancer. Multivariable linear regression was used to examine the relationship between BMI and PSA separately in the cases and controls. RESULTS: Data from 501 men (233 cases and 263 controls) were assessed. Thirty-five per cent of subjects were overweight and 13% were obese. Among cases, the median PSA was 35.3 ng/dL in normal weight, 26.1 ng/dL in overweight and 14.5 ng/dL in obese men (p = 0.02). For controls, median PSA was 2.0 ng/dL in normal weight, 1.3 ng/dL in overweight and 1.1ng/dl in obese men (p = 0.01). Among cases, BMI was negatively associated with PSA (B(SE) per 5 kg/m2 (BMI difference = -0.51 (0.13); p < 0.01) and remained significant after adjustment for age, sexual activity, smoking, use of statins and tumour grade. For controls, the BMI was also inversely related to the PSA (B(SE) per 5 kg/m2 difference -0.17 (0.07)) but the effect became of borderline significance after adjusting for age. CONCLUSIONS: Prostate specific antigen was inversely related to body mass index in Jamaican men with prostate cancer. Clinicians should consider this association when interpreting PSA results.

Actinomycosis of the colon with invasion of the abdominal wall: An uncommon presentation of a colonic tumour.

Actinomycosis is an uncommon chronic suppurative infectious disease that is caused by Actinomycetes organisms, which are gram-positive, microaerophilic, anaerobic bacteria. The most common type causing disease in humans is Actinomyces israelii. This organism is a commensal of the human mouth and is seldom pathogenic. When it does cause disease, however, three main clinical types of involvement are recognized including cervico-facial, thoracic and abdominal actinomycosis.Herein, we present the case of a 79-year-old male patient who underwent surgical exploration following presentation with abdominal pain and an abdominal mass, initially thought to be a malignancy. Pathologic examination confirmed this as a case of abdominal actinomycosis. This diagnosis should always be included in the differential diagnosis of patients who present with an infiltrative abdominal mass.

Angiomyolipoma of the kidney: the experience at the University Hospital of the West Indies.

OBJECTIVE: Angiomyolipoma (AML) of the kidney is an uncommon tumour that, until recently, was often misdiagnosed preoperatively as renal cell carcinoma (RCC). Newer radiological techniques have allowed more accurate preoperative diagnosis which can facilitate preoperative counselling and planning for conservative therapy. This study reviews the experience with these uncommon tumours at the University Hospital of the West Indies. METHODS: All cases of AML diagnosed during the period 1980 to 2007 were retrospectively identified from the files of the Department of Pathology. From these records, selected data were retrieved and analysed. These included patient demographics, clinical history, clinical diagnosis and pathologic characteristics of the specimen submitted. The total number of primary renal tumours diagnosed in adults during the same period was also determined for comparison. RESULTS: Eleven cases of AML were identified among 149 primary renal tumours in adults. Ten of these cases occurred in women. Amongst these, a single case of tuberous sclerosis was confirmed in a patient with bilateral lesions. Excluding this patient, who was 24-years-old, ages ranged from 24 to 86 years with a mean of 44 years (median 40.5 years) and an equal number of lesions was present on each side. Abdominal or flank pain were the most common clinical symptoms, present in six cases but in three cases, the tumours were discovered incidentally. The correct clinical diagnosis was made pre-operatively in a single case. By contrast, a diagnosis of RCC or other malignant tumour was proffered in eight cases. Pathologically, the maximum dimension of the seven excised tumours, in whom such information was recorded, ranged from 3.5 cm to 12 cm with a median of 7 cm. Spontaneous haemorrhage in the tumour was noted in three cases, all greater than 4.5 cm in maximum dimension. CONCLUSIONS: These data confirm that AML is uncommon at the University Hospital of the West Indies. There was an overwhelming female preponderance and patients presented, most commonly, in the 3rd to 4th decades. Tuberous sclerosis was identified in a solitary case. In this series, symptomatic lesions were > 4.5 cm in maximum dimension and haemorrhage complicated three cases. Most cases were incorrectly diagnosed preoperatively.

A review of granular cell tumours at the University Hospital of the West Indies: 1965-2006.

OBJECTIVE: Granular cell tumours are uncommon lesions that occur in a wide variety of sites. They are usually benign, but as they are infrequently diagnosed preoperatively, they may be confused clinically with malignant lesions. The objective of this study was to assess the relative frequency and the clinicopathologic characteristics of granular cell tumours identified at the University Hospital of the West Indies (UHWI) over a 41-year period. METHODS: The archives of surgical pathology reports in the Department of Pathology at the UHWI from 1965 to 2006 were searched for all cases of granular cell tumour. From these records, a number of demographic and other data were recorded and analyzed. RESULTS: One hundred and thirty cases of granular cell tumours were found in 122 patients. Of these, 99patients were female and 23 male, providing a male:female ratio of l to 4.3. The ages ranged from 5 days to 82 years with a mean age (excluding the 2 youngest cases) of 34.4 years. Lesions ranged in size from 0.2 cm to 10 cm in greatest dimension, the average size being 1.85 cm and were found in a diverse array of anatomic locations, the most common being the vulva, breast and tongue. The correct clinical diagnosis was proffered preoperatively in only one case. In contrast, a malignant diagnosis was suggested in 19 cases. CONCLUSIONS: Compared with other studies, there was a notable difference in the distribution of granular cell tumours in this series. In particular lesions of the tongue accounted for fewer than expected, while lesions of the breast and vulva were considerably increased. The well-recognized female predominance was also substantially higher than in other studies.

Admixture and population stratification in African Caribbean populations.

Throughout biomedical research, there is growing interest in the use of ancestry informative markers (AIMs) to deconstruct racial categories into useful variables. Studies on recently admixed populations have shown significant population substructure due to differences in individual ancestry; however, few studies have examined Caribbean populations. Here we used a panel of 28 AIMs to examine the genetic ancestry of 298 individuals of African descent from the Caribbean islands of Jamaica, St. Thomas and Barbados. Differences in global admixture were observed, with Barbados having the highest level of West African ancestry (89.6%+/- 2.0) and the lowest levels of European (10.2%+/- 2.2) and Native American ancestry (0.2%+/- 2.0), while Jamaica possessed the highest levels of European (12.4%+/- 3.5) and Native American ancestry (3.2%+/- 3.1). St. Thomas, USVI had ancestry levels quite similar to African Americans in continental U.S. (86.8%+/- 2.2 West African, 10.6%+/- 2.3 European, and 2.6%+/- 2.1 Native American). Significant substructure was observed in the islands of Jamaica and St. Thomas but not Barbados (K=1), indicating that differences in population substructure exist across these three Caribbean islands. These differences likely stem from diverse colonial and historical experiences, and subsequent evolutionary processes. Most importantly, these differences may have significant ramifications for case-control studies of complex disease in Caribbean populations.

Infective endocarditis at the University Hospital of the West Indies. A revisit.

Many countries have reported a change in the profile of infective endocarditis (IE) over the past three decades. The objective of this study was to evaluate the characteristics of IE from the autopsy service of the University Hospital of the West Indies (UHWI) during the last 15 years and to compare the results with that of an earlier study. There were 26 cases of IE during the period under review with a M:F ratio of 1.2:1. The ages ranged from 15 days to 74 years with a mean of 36.4 +/- 24.57 years. The largest number of cases (n = 7) occurred in the 10 to 19-year-age group. Cardiac predisposing factors were identified in 14 patients; nine with rheumatic heart disease, four with prosthetic valves and one with a bicuspid aortic valve. All vegetations were located on valves, the aortic being the most frequently involved followed by the mitral. Streptococcus species were the most common causative organisms followed by Staphylococcus aureus. Compared with the profile seen 15 years ago, there have been only minor changes in the characteristics of IE cases observed in the autopsy service at the UHWI.

Infective endocarditis at the University Hospital of the West Indies. A revisit

Many countries have reported a change in the profile of infective endocarditis (IE) over the past three decades. The objective of this study was to evaluate the characteristics of IE from the autopsy service of the University Hospital of the West Indies (UHWI) during the last 15 years and to compare the results with that of an earlier study. There were 26 cases of IE during the period under review with a M:F ratio of 1.2:1. The ages ranged from 15 days to 74 years with a mean of 36.4 +/- 24.57 years. The largest number of cases (n = 7) occurred in the 10 to 19-year-age group. Cardiac predisposing factors were identified in 14 patients; nine with rheumatic heart disease, four with prosthetic valves and one with a bicuspid aortic valve. All vegetations were located on valves, the aortic being the most frequently involved followed by the mitral. Streptococcus species were the most common causative organisms followed by Staphylococcus aureus. Compared with the profile seen 15 years ago, there have been only minor changes in the characteristics of IE cases observed in the autopsy service at the UHWI

Heart weight and heart weight/body weight ratio in a Jamaican adult autopsy population. A preliminary study.

The heart weight and heart weight/body weight (HW/BW) ratio were assessed in an adult autopsy population and compared with commonly used reference values. Examination of 127 adult post-mortem cases (80 males and 47 females, aged 17 to 91 years) revealed that the mean heart weight and the HW/BW ratios of both genders were significantly greater than the reference values, particularly so in the hypertensive patients. These findings suggest that the Jamaican adult heart is significantly heavier than values used from reference tables. In both genders, heart weight was significantly and positively correlated with body weight and body mass index but not height, for non-hypertensive and hypertensive subjects. The present data are preliminary and not comprehensive enough to establish definitive reference values for the Jamaican population. However, this information needs to be taken into consideration when making pathologic diagnoses using heart weight as a criterion in post-mortem diagnosis.

Heart weight and heart weight/body weight ratio in a Jamaican adult autopsy population. A preliminary study

The heart weight and heart weight/body weight (HW/BW) ratio were assessed in an adult autopsy population and compared with commonly used reference values. Examination of 127 adult post-mortem cases (80 males and 47 females, aged 17 to 91 years) revealed that the mean heart weight and the HW/BW ratios of both genders were significantly greater than the reference values, particularly so in the hypertensive patients. These findings suggest that the Jamaican adult heart is significantly heavier than values used from reference tables. In both genders, heart weight was significantly and positively correlated with body weight and body mass index but not height, for non-hypertensive and hypertensive subjects. The present data are preliminary and not comprehensive enough to establish definitive reference values for the Jamaican population. However, this information needs to be taken into consideration when making pathologic diagnoses using heart weight as a criterion in post-mortem diagnosis

Scleroderma with cardiac tamponade, hyperthyroidism and incidental papillary thyroid carcinoma.

Cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.

Multiple endocrine neoplasia type 2B. A case report and review of the syndrome

This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis

Scleroderma with cardiac tamponade, hyperthyroidism and incidental papillary thyroid carcinoma

Cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.

Prostate cancer at the University Hospital of the West Indies in Jamaica. A clinico-pathological profile at the time of needle biopsy diagnosis.

A prospective study of the clinico-pathological features of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should provide support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica.

Prostate cancer at the University Hospital of the West Indies in Jamaica. A clinico-pathological profile at the time of needle biopsy diagnosis

A prospective study of the clinico-pathological features of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should provide support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica.

Multiple endocrine neoplasia type 2B. A case report and review of the syndrome.

This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis.