RESUMO
Between December 1984 and November 1996, 171 children under 12 years old presented to the University Hospital of the West Indies with nephrotic syndrome. Hepatitis B surface antigen (HBsAg) was found in ten (6%) of these children, eight of whom had membranous nephropathy (MN), and one each had mesangial proliferative glomerulonephritis (MesN) and minimal change nephrotic syndrome (MCNS). Only those children with MesN and MCNS were steroid-sensitive. The HBsAg-positive status was identified incidentally on screening. At a mean follow-up of 34 months, seven of ten children had experienced complete or partial remission and three had persistent nephrotic syndrome, although none was in renal failure. Six of the ten had biochemical hepatitis. All the children were still HBsAg-positive. Hepatitis B virus (HBV) is a factor contributory to nephrotic syndrome in Jamaican children. As diagnostic clinical markers for HBV-associated nephropathy are usually absent, all children presenting with nephrotic syndrome should be screened for HBsAg. A policy should be implemented in Jamaica for screening pregnant women and at-risk groups for HBsAg, as well as for immunising susceptible neonates, in order to reduce the incidence of HBV-associated pathology.
Assuntos
Hepatite B/complicações , Síndrome Nefrótica/virologia , Criança , Pré-Escolar , Seguimentos , Glomerulonefrite Membranoproliferativa/virologia , Glomerulonefrite Membranosa/virologia , Antígenos de Superfície da Hepatite B/sangue , Humanos , Nefrose Lipoide/virologiaRESUMO
This report documents the clinicopathological features in two Jamaican children who presented with infective dermatitis, glomerulonephritis, renal failure and human T-cell lymphotropic virus (HTLV-1) seropositivity. Severe hypertension with hypertensive encephalopathy was the most impressive clinical feature. Histological findings from renal biopsy specimens in both cases revealed significant glomerulosclerosis with fibrosis, chronic inflammatory cell infiltrates in the interstitium, and arteriolar hypertensive changes. Membranoproliferative glomerulonephritis (MPGN) was demonstrable in case 1 and marked focal glomerulosclerosis in case 2. Case 1 developed end stage renal failure and died within 3 years of diagnosis. Case 2 remains hypertensive and in chronic renal failure. Although a causal relationship between HTLV-1 infection and renal disease cannot be proven by these two cases, it appears that renal involvement in children with HTLV-1 infection is severe, with the potential for chronic renal failure and malignant hypertension. HTLV-1 nephropathy should be suspected in children with infective dermatitis and renal disease.
Assuntos
Glomerulonefrite Membranoproliferativa/patologia , Glomerulonefrite Membranoproliferativa/virologia , Glomerulosclerose Segmentar e Focal/virologia , Infecções por HTLV-I/complicações , Falência Renal Crônica/virologia , Criança , Dermatite/patologia , Dermatite/virologia , Evolução Fatal , Feminino , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Jamaica , Falência Renal Crônica/patologia , MasculinoRESUMO
We describe the clinico-pathological features and discuss the possible pathogenetic mechanism of thyroid papillary carcinoma arising in a branchial cleft cyst. This has been described only once previously in the literature.
Assuntos
Branquioma/complicações , Carcinoma Papilar/complicações , Carcinoma Papilar/patologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Adulto , Branquioma/ultraestrutura , Carcinoma Papilar/ultraestrutura , Humanos , Masculino , Glândula Tireoide/ultraestrutura , Neoplasias da Glândula Tireoide/ultraestruturaRESUMO
Idiopathic focal and segmental glomerulosclerosis (IFSGS) in a predominantly black population does not appear to behave any differently than in Caucasian patients. Response to steroid therapy and cyclophosphamide had favourable prognostic significance. There may be a subgroup of IFSGS which responds more slowly to steroids. The duration of steroid therapy should extend beyond four months.
Assuntos
Glomerulosclerose Segmentar e Focal/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Ciclofosfamida/uso terapêutico , Feminino , Glomerulosclerose Segmentar e Focal/diagnóstico , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Incidência , Jamaica/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Esteroides/uso terapêuticoRESUMO
Glomerulonephritis with proteinuria of sufficient degree to manifest the nephrotic syndrome followed aplastic crises induced by human parvovirus (B19) in seven patients with homozygous sickle-cell disease, within 7 days in five patients and 6-7 weeks in two. Segmental proliferative glomerulonephritis was found in all four patients who underwent acute renal biopsies and focal segmental glomerulosclerosis was found in the fifth patient who had a biopsy 4 months later. One patient recovered completely, one died in chronic renal failure after 3 months, and the others had impaired creatinine clearance, four with continuing proteinuria.
Assuntos
Anemia Falciforme/genética , Eritema Infeccioso/complicações , Glomerulosclerose Segmentar e Focal/etiologia , Adolescente , Adulto , Anemia Falciforme/complicações , Anticorpos Antivirais/análise , Biópsia , Criança , DNA Viral/análise , Feminino , Glomerulosclerose Segmentar e Focal/patologia , Homozigoto , Humanos , Rim/patologia , Masculino , Síndrome Nefrótica/etiologia , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Proteinúria/etiologiaRESUMO
A total of eleven (11) cases of non-parasitic splenic cysts have been studied at the University Hospital of the West Indies by routine haematoxylin and eosine and immunohistochemical staining, using epithelial markers (cytokeratin, low molecular weight keratin and epithelial membrane antigen). The majority (eight of eleven) were found to be epithelial or true cysts. This is in contrast to findings previously reported in the literature, based on light microscopic examination, that the majority of splenic cysts are non-epithelial in origin. We therefore suggest that immunohistochemical studies should be used routinely to accurately define the nature of all splenic cysts.
Assuntos
Cistos/patologia , Esplenopatias/patologia , Adolescente , Adulto , Criança , Cistos/etiologia , Feminino , Humanos , Imuno-Histoquímica , Jamaica , Masculino , Pessoa de Meia-Idade , Esplenopatias/etiologiaRESUMO
Of the twenty-nine children with solid renal tumours treated at the University Hospital of the West Indies (UHWI) between January, 1972 and December, 1991, there were twenty-eight cases of nephroblastoma and one of mesoblastic nephroma. Peak incidence was between the ages of two and four years. Twenty-five children had radical nephrectomy while one had bilateral partial nephrectomy. In thirteen cases, pre-operative chemotherapy +/- radiotherapy was used. Post-operative chemotherapy and radiotherapy were used in 24 and 13 cases, respectively. Stage of the tumour was the most decisive factor influencing the outcome. Whereas there was a 100% cure rate in Stages I and II, Stage III had only a 55.5% survival rate and none of the Stage IV survived. Bilateral (Stage V) tumours are curable if individual tumours are localised, as in one of the two cases. The benign mesoblastic nephroma, in a one-month-old infant, was cured by nephrectomy alone. While the present therapy of radical nephrectomy along with combination chemotherapy is satisfactory for early stages, more aggressive adjuvant therapy is needed for improving the results in Stages III and IV.
Assuntos
Países em Desenvolvimento , Neoplasias Renais/mortalidade , Nefroma Mesoblástico/mortalidade , Tumor de Wilms/mortalidade , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Humanos , Lactente , Jamaica/epidemiologia , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Masculino , Estadiamento de Neoplasias , Nefroma Mesoblástico/patologia , Nefroma Mesoblástico/terapia , Taxa de Sobrevida , Tumor de Wilms/patologia , Tumor de Wilms/terapiaRESUMO
A case of inflammatory pseudotumour of the spleen in a 34-year-old female patient is described. We have briefly reviewed the literature on the subject and discussed aetiopathogenesis, pre-operative differential diagnosis and treatment modalities.
Assuntos
Granuloma de Células Plasmáticas/diagnóstico , Esplenopatias/diagnóstico , Adulto , Feminino , Granuloma de Células Plasmáticas/patologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Baço/patologia , Esplenectomia , Esplenopatias/patologia , Esplenopatias/cirurgiaRESUMO
A 42-year-old man with chronic renal failure and homograft transplantation developed adult T cell lymphoma in one native kidney. The role of transfusion in the acquisition of human T-lymphotropic virus type I and its role in the early development of adult T cell lymphoma, particularly on the background of chronic immunosuppression, are discussed. To our knowledge, this is the first such case.
Assuntos
Hospedeiro Imunocomprometido , Transplante de Rim , Leucemia-Linfoma de Células T do Adulto/transmissão , Reação Transfusional , Adulto , Cadáver , Humanos , Terapia de Imunossupressão , Rim/patologia , Falência Renal Crônica/cirurgia , Transplante de Rim/imunologia , Leucemia-Linfoma de Células T do Adulto/imunologia , Leucemia-Linfoma de Células T do Adulto/patologia , Masculino , Fatores de TempoRESUMO
A retrospective study of all patients with systemic lupus erythematosus (SLE) who died at the University Hospital of the West Indies over a 14-year period is presented. The major cause of death was infection followed by renal failure. Gram-negative organisms were the major microbiological agents causing infections. Side-effects of therapy were common, in particular bone marrow depression and haemorrhage related to anticoagulants. It appears that controlling severe lupus activity without increasing the risk of lifethreatening complications remains an important goal in the treatment of SLE.