Biomedical subjects
Publications and source records attributed to N Jankey.
Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient.
This is the first report of dengue haemorrhagic fever and dengue shock syndrome in Trinidad. Dengue infection was confirmed serologically or by viral isolation in five patients, aged 15 to 53 years, who presented with fever, thrombocytopenia and haemoconcentration. Three patients developed dengue shock syndrome, which was fatal; although there was no haemorrhagic tendency among these patients, bleeding occurred shortly before death in one of them. Two patients who had dengue haemorrhagic fever survived. The co-circulation of dengue virus serotypes 1, 2, and 4 in the Caribbean facilitates the development of dengue shock syndrome (DSS) or dengue haemorrhagic fever (DHF). Clinicians should therefore be aware of their clinical features, laboratory diagnosis and clinical management. Appropriate public health interventions and improved surveillance should be implemented to reduce the risk of DHF/DSS associated mortality in Trinidad and Tobago.
Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. The largest series to date of non-drainage in thyroid surgery is presented, comprising 260 patients over a 15-year period. No case selection for non-drainage was employed. Two hundred and fifty-nine cases were not drained and included toxic goitres, and bilateral and redo procedures. There was one thyroid storm and two cases of subcutaneous fluid collection, treated by needle aspiration. No cases of recurrent laryngeal nerve injury, airway obstruction or death were recorded. This study strongly demonstrates the safety of non-drainage in routine thyroid surgery.
Adenomyosis was noted in 16% of 2,616 consecutive hysterectomy specimens examined during a 7-year period. Multiparas between the ages of 30 and 50 years were most commonly affected. Abnormal uterine bleeding was the common symptom. Myohyperplasia and leiomyomas were the usual associated lesions. Adenomyosis uteri was seen equally in women of African, Indian and mixed races in this West Indian population.
Three cases are reported of patients with the Acquired Immune Deficiency Syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised maculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for Histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned.
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Paracoccidioidomycosis is a systemic disease endemic to South America, but rarely recognised in other parts of the world. The patient we describe represents the first case of paracoccidioidomycosis observed in Trinidad.
A 27-year-old promiscuous male who denied homosexuality, intravenous drug abuse or having received blood transfusions, had disseminated Kaposi sarcoma. The aggressive nature of the tumor in a young man with the Acquired Immune Deficiency Syndrome (AIDS) presenting as lymphogranuloma venereum (LGV) is highlighted. The relation of the HTLV III virus to a diffuse membranoproliferative glomerulonephritis with sclerosis and associated hyaline degenerative changes in the juxtaglomerular apparatus are discussed.
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Thirty post-menopausal women with breast abscess were treated at Port of Spain General Hospital, Trinidad, between 1976 and 1980. In this age group, breast abscess can be confused with cancer due to a lack of inflammatory features. History and physical examination are often not helpful in differentiating an abscess from carcinoma. Although the usual treatment of an abscess is incision and drainage, in post-menopausal women, excision of the lesion is helpful for accurate histological diagnosis.
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Our analysis of 1051 breast biopsies in West Indian women under the age of 30 y revealed that 99% of the breast lumps were benign. Fibroadenoma was the commonest (67%) lesion and there was a steady increase in the frequency of fibrocystic disease with age. Carcinoma in this group is therefore rare. Thus most patients can be reassured with certainty of their benign disease and have biopsy at a convenient time.
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Sections of an adult filarial worm, probably Dirofilaria tenuis or related species were found within the breast tissue. This is the first human dirofilarial infection reported from Trinidad.