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Samples of jejunum from seven children dying from severe oedematous malnutrition were fixed with intralumenal glutaraldehyde in combination with external immersion, using a rapid autopsy protocol. Selected areas were post-fixed in osmium tetroxide, dehydrated with an ethanol series and critical point dried. After mounting on aluminium stubs, specimens were sputter-coated with a thin layer of gold and palladium. Scanning electron microscopy showed patterns ranging from subtotal villous atrophy, through partial villous atrophy with low ridges, to longer, taller ridges with cerebriform convolutions. In one case, villous height had been interpreted as normal on light microscopy. The scanning electron microscope revealed that the mucosa in this case was composed of ridges and leaf forms. Processing for scanning electron microscopy is simple. The specimens can be viewed and photographed in a relatively short time. In addition, the three-dimensional record provides clarification of ambiguities which often arise from routine histological sections.

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This paper is part of a study on the electron microscopy of protein-energy malnutrition, using a rapid autopsy protocol. Samples of voluntary muscle, obtained from eight children dying of severe oedematous malnutrition, were fixed in glutaraldehyde within 75 minutes of death. Atrophy of myofibres, increased prominence of satellite cells, and segmental necrobiosis were seen by light microscopy. Electron microscopy showed variable depletion of myofibrils. In the most severe case, there was focal absence of myofibrils, also disorganized Z lines, and absent M bands. Residual atrophic myofibrils measured less than 0.1 micron in width. Other specimens showed sarcomere disorganization, mitochondrial swelling, glycogen depletion, sarcoplasmic oedema, and focal contractions of sarcomeres. Though non-specific, rigor may be accelerated by free radical damage, calcium release into the cytosol, and low supplies of high-energy phosphates. These conditions may exist in severe malnutrition, complicated by terminal infection and metabolic disturbances.

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During the period 1988-1992, a total of 4,030 malignant neoplasms were recorded in Kingston and St. Andrew, Jamaica. These comprised 1,829 in males and 2,201 in females. Histological confirmation was obtained in 83.4%. The crude incidence rate for males was 128.5, and 136.2 for females. The age-standardized rates (ASR) were 179.9 for males and 166.1 for females. Age-specific rates by site, sex and age are tabulated. Attention is drawn to increased incidence for cancers of prostate, larynx, bronchus and non-Hodgkin's lymphoma in males. There was also an increase in female breast cancer (crude rate 36.0; ASR 47.1). Invasive cervix cancer has shown no significant change in incidence. Neoplasms of the body of the uterus have increased (crude rate 7.6; ASR 9.5). The rise in cancer of breast and body of uterus suggests that the influence of exogenous oestrogens should be considered.

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The autopsy records of 115 children with severe protein-energy malnutrition were reviewed. Sections of the lung histology showed evidence of bacterial pneumonia in 49% of cases. An additional 18% showed bronchitis, bronchiolitis or interstitial pneumonitis. Aspiration of gastric contents was evident in 10% of cases; 6% showed pulmonary oedema and congestion. In the remaining cases, no lung pathology was identified (17%). In 8 cases, rapid autopsy examination permitted fixation of lung tissue for electron microscopy. These included 4 cases of bronchopneumonia, one of which was associated with viral pneumonia. Another interstitial pneumonitis, probably of viral aetiology, was also studied. Both these virus-associated cases showed loss of type I pneumocytes and hyperplasia of type II pneumocytes. Another patient with herpes simplex hepatitis showed necrotic emboli in pulmonary capillaries with virions, as well as colonies of interstitial bacteria. One patient with acute pulmonary oedema displayed severe endothelial cell swelling on electron microscopy. In one case, there was no evidence of respiratory changes, apart from desquamation of type I pneumocytes. Useful information can be obtained on the fine structure of the lung, using samples taken soon after death.

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Liver specimens obtained immediately after death from eight severely malnourished children were examined by electron microscopy, and compared with seven liver biopsy specimens from children who had recovered from malnutrition. The liver cells from the fatal cases showed mitochondrial swelling, with coarse densities in the matrix, cholestasis, depletion of the endoplasmic reticulum and Golgi apparatus, diminished glycogen stores, prominent lipid deposits and focal cytoplasmic degradation. The nucleoli were enlarged. There was marked reduction in peroxisomes. In contrast, the biopsies from recovering children showed good cellular organisation, and a normal frequency of peroxisomes. Multiple factors, including sepsis, may lead to depletion of peroxisomes. Loss of peroxisomes may interrupt beta-oxidation of long-chain fatty acids and accentuate the accumulation of lipid. Moreover, a reduction in the concentration of catalase may remove one avenue for the detoxification of free radicals. As the concentration of other anti-oxidants, notably glutathione, is also reduced, free radical damage may occur, leading to lipid peroxidation of membranes, mitochondrial damage, pump failure and influx of water and electrolytes into the cell.

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Significant hormonal changes have been reported in childhood malnutrition, including high serum levels of growth hormone and cortisol, and low levels of circulating insulin. The ultrastructure of the endocrine pancreas in such patients has hitherto not been reported. A light microscopy survey of the pancreatic islets was carried out on 69 malnourished children dying from protein-energy malnutrition. In seven of these cases, a rapid autopsy protocol allowed tissues to be fixed for electron microscopy within 75 minutes of death. This paper presents the first ultrastructural observations on the Islets of Langerhans in childhood protein-energy malnutrition. In all cases, there was a variable degree of degeneration of all cell types with membrane damage, loss of ribosomes, vesiculation and mitochondrial swelling. In addition, the B-cells showed a high proportion of precursor granules compared to crystal forms, possibly accounting for low insulin serum levels reported by other workers. It is suggested that islet cell changes may be related to free radical damage secondary to depletion of glutathione and other antioxidants, as well as relative deficiencies of cysteine and zinc. In addition, the effects of agonal anoxia, and a short fixation delay after death must be considered.

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Samples of liver from eight children who died from malnutrition with its complications were studied by electron microscopy. Specimens were taken within one hour of death. These tissues had changes consistent with severe terminal illness, including mitochondrial swelling, with loss of matrix granules, disorganization of cristae, and evidence of calcium influx. Glycogen tended to be scanty. Lipid droplets were frequent. Endoplasmic membranes were depleted, and focal cytoplasmic degradation was frequent. Intracanalicular cholestasis was striking in four cases with loss of microvilli. Peroxisomes were depleted. This may be significant as peroxisomes are pivotal in the processing of very long-chain fatty acids, in cholic acid metabolism and in elimination of free radicals. The observations were compared with previous reports in the literature, and with seven biopsies taken in 1970 from malnourished children who recovered. One, obtained on the fourth day, from a child with marasmus, showed atrophy of cellular organelles. The other samples were biopsied during the recovery phase, and displayed considerable restoration to normal morphology. Mitochondria had prominent matrix granules. Peroxisomes were frequently seen. There was no evidence of cholestasis.

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Age-standardized rates for cancer in Kingston & St. Andrew, Jamaica are presented by site and sex, and compared with data from Registries in the Caribbean and adjacent regions. These comprise Costa Rica, Cuba, Cali (Colombia), Martinique, the Netherlands Antilles (excluding Aruba), New Orleans (Whites and Blacks) and Puerto Rico. There are significant differences which demand explanation. Overall, the reported rates are highest in New Orleans, which leads in breast cancer, tumours of bronchus, larynx, colon, rectum, pancreas, prostate and bladder. Lymphomas occur most frequently in Whites in New Orleans while Blacks in that city show similar rates to other Registries in the area. Cali (Colombia) and Costa Rica lead in cervical cancer, with Jamaica third. The lowest figure is for Whites in New Orleans. Cali (Colombia) and Costa Rica also have very high rates for gastric cancer, and low rates for colonic. Oesophageal cancer is highest in Blacks in New Orleans, followed by Martinique and the Netherlands Antilles. Jamaica has shown a steady decline for this site over 30 years. The rate in Whites in New Orleans is only one-fourth of that in Blacks.

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A case of small lymphocytic B-cell lymphoma occurring in the prostate gland of a 68-year-old man is reported. These tumours are rarely encountered in surgical specimens, and may be confused with an undifferentiated carcinoma. Differentiation is readily made, using immunohistochemical techniques.

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Histological sections of pancreas and liver from 65 cases of children dying from childhood malnutrition were reviewed. The extent of pancreatic atrophy and fibrosis was compared with fatty change in the liver. Pancreatic atrophy was common, and often associated with severe fatty change in the liver, but also occurred in marasmic children with scanty liver fat. Pancreatic fibrosis, when present, was only of mild degree. Among 16 patients with marasmus, fibrosis was only seen in one pancreas. Fibrosis was recorded in 8/25 cases of kwashiorkor, and in 7/24 cases diagnosed as marasmic-kwashiorkor. Electron microscopy of the pancreas was performed in seven cases, using tissue collected at immediate autopsy. Atrophy and variable amounts of degranulation of acinar cells were seen. There was often disorganization of the endoplasmic reticulum with intracisternal sequestration. Mitochondrial swelling was consistent with terminal anoxia. Centro-acinar cells were prominent. Some acini were dilated and contained fibrillar material. These findings support the pioneer paper by Blackburn and Vinijchaikul (1969) and underline the importance of pancreatic atrophy in the pathology of protein-energy malnutrition.

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We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells, with pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.

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Peroxisomes play a role in hepatic beta-oxidation of fat, a process that results in the production of hydrogen peroxide. The fatty infiltration of the liver that occurs in severely malnourished children remains unexplained. We observed an almost total absence of peroxisomes in the hepatocytes of these children. We suggest that lack of available peroxisomes could contribute to the development of fatty liver.

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A total of 3,396 malignant neoplasms were recorded in Kingston and St. Andrew, Jamaica during 1978 to 1982. There were 1,477 males and 1,919 females. Histological confirmation was achieved in 88.4%. The crude incidence rate for males for all age groups was 107.8 per 100,000 per year; in females, the figure was 123.0. The age-standardized rates (world population) were 157.9 for males and 159.1 for females. Age-specific rates by site, sex, and age are tabulated.

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The Jamaica Cancer Registry recorded 3,652 cases of cancer in Kingston and St. Andrew during the period 1983-1987. Histological confirmation was maintained at a high level (86.3%). For males, the crude rate was 103.1 and for females, 126.5 (per 100,000 per annum). The age-standardized rates for all ages were 148.3 for males, and 160.2 for females. The Tables contain age-specific rates for each site by age and sex.

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A total of 19,225 malignant neoplasms were recorded in Kingston & St. Andrew, Jamaica over the 30-year period 1958-1987. The most prevalent cancers in males were those of prostate (12.2%), stomach (10.9%) and lung (10.7%). In females 24.1% of cancers occurred in breast and 20% were recorded for invasive carcinoma of the cervix. There is a steady improvement in the diagnosis of in situ cervical lesions, and a relative decline in the incidence of invasive lesions. Lung cancer in women remains at a low level. A significant decline in cancer of the oesophagus and stomach in both sexes was noted, while neoplasms of colon and rectum maintained a stable pattern. The 30-year trends of lymphomas and leukaemias have shown no increase, although there are changes in classification patterns.

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The Jamaican Cancer Registry recorded 3,652 cases of cancer in Kingston and St. Andrew during the period 1983-1987. Histological confirmation was maintained at a high level (86.3%). For males, the crude rate was 103.1 and for females, 126.5 (per 100,000 per annum). The age-standardized rates for all ages were 148.3 for males and 160.2 for females. The tables contain age-specific rates for each site by age.

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A total of 19,225 malignant neoplasms were recorded in Kingston & St.Andrew, Jamaica over the 30-year period 1958-1987. The most prevalent cancers in males were those of prostate (12.2%), stomach (10.9%) and lung (10.7%). In females 24.1%of cancers occurred in breast and 20%were recorded for invasive carcinoma of the cervix. There is a steady improvement in the diagnosis of in situ cervical lesions, and a relative decline in the invasive lesions. Lung cancer in women remains at a low level. A significant decline in cancer of the oesophagus and stomach in both sexes was noted, while neoplasms of colon and rectum maintained a stable pattern. The 30-year trends of lymphomas and leukaemias have shown no increase, although there are changes in classification patterns.

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Warthin's tumour has traditionally had a strong male association, and has been said to be rare in Blacks. Current studies describe a new trend; a rise in females, strongly linked to cigarette smoking. The tumour has eosinophilic epithelial cells packed with distinctive mitochondria, and a lymphoid stroma. Immunological investigations have demonstrated polyclonal B cells, T cells and macrophages. Views differ as to whether B or T cells predominate. Between 1958 and 1989, the Jamaica Cancer Registry recorded 491 benign and malignant salivary gland tumours. There were 18 cases of Warthin's tumour (3.7%), with a male: female ratio of 5:1. The low proportion of females is similar to the trend for female lung cancer in Kingston & St. Andrew. A case of Warthin's tumour was studied by light and electron microscopy and immunoenzyme methods. The epithelial cells contained numerous mitochondria with stacked cristae, as previously described. Similar morphology occurs in oncocytic tumours; riboflavin-deficient rats and mice; rats given non-lethal doses of hypoglycin; dogs treated with annatto extracts; and hibernating or starving frogs. The mitochondrial changes may be an adaptive response. The immunoenzyme studies utilized newly available monoclonal antibodies: UCHL1, L26, 4KB5, MT1 and LN2. The reaction patterns indicate a distribution of B and T cells in a manner expected in a lymph node. The interaction between mitochondrial changes, adaptive metabolic pathways, the immune cells and tobacco raises some interesting questions.

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