Biomedical subjects
Publications and source records attributed to K Coard.
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.
Explore the source record for details and available documents.
Malignant soft tissue tumours are uncommon and the diagnosis is often difficult to make. This study of fifty-nine cases represents a pathological perspective of our experience with these tumours over a 10-year period. Malignant fibrous histiocytoma was the most frequent diagnosis made (36%) and the majority of these occurred in the lower limbs. In 11 (19%) cases, the sarcomas could not be further classified along histogenetic lines. We consider some of the reasons for this and discuss these findings in the light of an increasing trend towards the use of smaller samples for diagnosis.
We describe a case of rhabdomyoma of the heart in a newborn infant and present an overview of current knowledge about the natural history of these lesions, with implications for management. This is the only case of its kind seen at this hospital.
Explore the source record for details and available documents.
The Jamaican Perinatal Mortality Survey was designed to identify the true perinatal mortality rate, and assess the factors which could contribute towards a reduction in perinatal mortality on the island. All births in a 2-month period (n = 10527) were compared with all perinatal deaths occurring over a 12-month period (n = 2069). Over half the deaths (n = 1058) received a detailed post-mortem examination. Use of the Wigglesworth classification identifies the major component of perinatal death in this country to be associated with intrapartum asphyxia (44% of deaths). Deaths due to congenital malformations and miscellaneous causes contribute relatively little (< 10%) to the overall mortality rate. Over a quarter of deaths apparently occur before the onset of labour, and a fifth are prematurely liveborn but die of causes related to immaturity.
During the 12-month period from 1 September 1986 to 31 August 1987 an attempt was made to collect information on all perinatal deaths occurring on the island of Jamaica. Of the 2069 late fetal and early neonatal deaths identified, 19% fell into the Wigglesworth definition of 'deaths from immaturity'. Twins were 11 times more likely to die of immaturity than were singletons, and twins comprised 18% of all deaths in this group. Comparison of the singleton deaths from immaturity, with 9919 singletons born on the island during the 2-month period of September and October 1987 and who survived the first 7 days, revealed several strong risk factors. These included history of previous miscarriages, stillbirth, early neonatal death or preterm delivery, and complications of bleeding and hypertension (highest diastolic, proteinuria and eclampsia all having independent associations). None of these factors 'explained' a strong negative relationship with the number of young children in the household. There was an apparent protective effect of maternal folic acid ingestion which warrants further investigation.
The Jamaican Perinatal Mortality Survey compared all 2069 perinatal deaths occurring during the 12 months between 1 September 1986 and 31 August 1987 with 10,086 survivors born in the 2 months of September and October 1986. The Wigglesworth classification identified 44% of the deaths as attributable to intrapartum asphyxia (IPA), and this grouping was largely confirmed by post-mortem examination where it had been carried out. About half of these babies weighted 2500 g+ and death should have been largely preventable. Comparison of the 813 IPA singleton deaths with 9919 singleton survivors using logistic regression showed independent associations with maternal employment status, the number of children in the household, maternal height, whether or not the mother was trying to get pregnant, or had ever used an intrauterine contraceptive device. Medical conditions such as syphilis, untreated vaginal infection, bleeding < 28 weeks, bleeding 28+ weeks, highest diastolic and first diastolic blood pressures and eclamptic fits antenatally were all strongly associated. Mothers who commenced antenatal care in the first trimester were at reduced risk as were those who took iron during pregnancy. There were substantial reductions in mortality in areas where better medical facilities were available. To this model, features of previous obstetric history were offered, but the only variables which entered were those relating to prior perinatal deaths and immediately preceding miscarriage and termination. Examination of specific features in the management of labour and delivery is a logical basis for the introduction of changes in practice. Caesarean section is unlikely to be appropriate but it is suggested that more active interventions in terms of use of forceps and/or vacuum extraction may be useful.
A review of dermatofibrosarcoma protuberans diagnosed at the University Hospital of the West Indies over a 10-year period revealed 23 cases. The mean age of the patients was 36.3 years. There were 13 females and 10 males. The trunk was the most common site. The clinical diagnosis was commonly missed. The results of this study are compared with those from other countries.
Subacute intraperitoneal administration of the lipid portion of the unripe ackee arillus, referred to as "ackee oil", resulted in marked neutropenia (p less than 0.001) and increase in platelets (p less than 0.01) without anaemia, in rats. Blood urea, sodium and aspartate aminotransferase levels were significantly decreased but glucose and bilirubin levels were similar to those of controls. The lungs showed areas of petechial haemorrhages and a dose-related perivascular and peribronchial mononuclear cell infiltration. The pulmonary toxicity may be interpreted as a hypersensitive reaction to ackee oil. Further research is in progress on the neutropenic effects of ackee oil.
The pathological records of appendicectomy specimens from patients with suspected acute appendicitis at the University Hospital of the West Indies during the 5-year period 1984-1988 were studied. The numbers of cases, their ages, sex and seasonal incidence were similar to those of other studies. The overall false positive diagnosis rate was 25% (16% in males, 38% in females). The main diagnostic difficulty was in young females in whom surgery for suspected appendicitis often proved unnecessary.
Information was collected on 2,197 stillbirths and neonatal deaths on the island of Jamaica during the 12 month period September 1986 to August 1987 as part of the population based nationwide Jamaican Perinatal Morbidity and Mortality Survey. There were 14 cases of anencephalus giving an incidence of 0.26 per 1,000 total births. One of these cases was associated with the amniotic band syndrome; excluding this, the incidence would be even lower (0.24 per 1,000). There was no apparent association with social class, maternal age, or parity. The rate found in Jamaica is considerably lower than found in any other national population study.
1. Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12-month period between September 1986 and August 1987. 2. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated 54,400 total births. 3. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. 4. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop.
Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were found in 96 (8.6%) of 1112 perinatal and neonatal deaths coming to necropsy and in 28 (2.6%) of 1085 no so examined. The central nervous system was most commonly affected, followed by the renal, gastrointestinal, and cardiovascular systems in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malformation syndromes/sequences were identified. Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, their importance will increase when deaths from other causes, such as birth asphyxia, decline. The type of malformation currently fatal in a particular population is relevant when planning diagnostic and surgical services for neonates and infants. It is also important to any discussions about provision of prenatal diagnostic services.
Explore the source record for details and available documents.
Three patients had cerebral arteriovenous malformations (AVM) treated by occlusive embolotherapy using isobutyl-2-cyanoacrylate (IBC). At necropsy two had asymptomatic IBC pulmonary emboli. The numbers of emboli and the size of pulmonary vessels occluded correlated roughly with an increasing frequency and volume of injectate made in the cerebral tissue. The extent of pulmonary vascular occlusion in one case suggests that pulmonary vascular hypertension could develop as a complication of this form of treatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.