Prevalence, epidemiology and geographical distribution of Sporothrix schenckii infections in Gauteng, South Africa

Forces exerted on the right and left lingual and buccal flanges of Kennedy Type I mandibular dentures were studied using an 8 channel recording technique, during resting, swallowing, talking, reading and simulated mastication. The effects of adaptation, head position and incremental thickening of the flanges were determined. Highest forces were recorded when swallowing, with smaller differences between the other activities. Lingual forces were higher than buccal, and posterior forces higher than anterior ones. There was a highly significant relationship between increases in flange thickness of 2 and 3mm and increases in peak forces. Evidence for adaptation and effects related to head position was weaker.     

Molecular epidemiology of an outbreak of Enterobacter cloacae in the neonatal intensive care unit of a provincial hospital in Gauteng, South Africa

An outbreak of Enterobacter cloacae in the neonatal intensive care unit of a provincial hospital in Gauteng, South Africa, resulting in nine deaths was investigated. Macrorestriction analysis using pulsed-field gel electrophoresis revealed that three isolates of E. cloacae from blood cultures of patients, six from environmental sources, and one from the hands of a staff member belonged to the same genotypic cluster.     

Raised agalactosyl IgG and antimycobacterial humoral immunity in Takayasu's arteritis

OBJECTIVE: Takayasu's arteritis is an inflammatory occlusive disease of the aorta and its main branches of unknown etiology. Some suggested causes include inapparent infection with Mycobacterium tuberculosis, or autoimmunity evoked by this organism. We have therefore sought links with mycobacterial disease. METHODS: We assayed the % agalactosyl IgG, antibody to a tuberculosis-specific 38 kDa protein, and antibody to the mycobacterial 65 kDa heat shock protein (HSP), in patients with active or inactive Takayasu's arteritis, in whom the diagnosis of tuberculosis was excluded. The results were compared with findings in tuberculosis (positive controls), normal donors and patients with Wegener's granulomatosis. RESULTS: The % agalactosyl IgG in patients with active arteritis was in the range previously seen only in rheumatoid arthritis, Crohn's disease, and the mycobacterioses. Similarly, significantly raised antibody to the purified 38-kDa protein of M. tuberculosis, and to the 65-kDa HSP of M. leprae, was found in 78% of patients with Takayasu's arteritis, and the levels were higher in those with active disease. CONCLUSION: These results suggest that Takayasu's arteritis particularly clearly illustrates the occasional relationship between mycobacteria and diseases of superficially autoimmune pathogenesis.     

Isolated pulmonary arteries involvement in a patient with Takayasu's arteritis

Pulmonary arteries involvement is well described in Takayasu's arteritis (TA), a condition which is mainly associated with involvement of the systemic arteries. We report a case of TA with documented isolated pulmonary arteries involvement. Symptoms were quite similar to those encountered in chronic thromboembolic disease. A pulmonary angiogram showed bilateral stenosis and occlusion of pulmonary arteries. Diagnosis of TA was suspected, and as such a complete aortogram was made but proved to be normal. Massive haemoptysis suddenly occurred, which resulted in death. Autopsy disclosed characteristic pathological lesions of TA in pulmonary arteries and confirmed the lack of involvement of the aorta and its branches. The frequency of such a clinical form could be underestimated, given the difficulties of diagnosis and features similar to those of chronic thromboembolic disease.     

Pan-valvular annular calcification in Takayasu's arteritis: report of 3 cases

Takayasu's arteritis is a chronic inflammatory arteriopathy. It mainly affects the aortic arch and its main branches. The aortic valve annulus and coronary and pulmonary arteries are rarely affected. Mitral and tricuspid annular calcification were not reported previously. We identified mitral annular calcification by using transthoracic echocardiography in 3 patients with Takayasu's arteritis, in whom none had any of the reported causes of mitral annular calcification. Two of them had concomitant tricuspid and aortic annular calcification.     

A case report of Takayasu's arteritis with aortic pseudoaneurysm caused by aortic perforation

A 47-year-old man presented with hemoptysis. From around June 20, 1995, he had symptoms of a common cold, but hemoptysis suddenly occurred on July 1 and he was brought to hospital. The chest X-ray film showed pleural effusion and enlargement of the mediastinum. CT scans showed calcification of the aorta, with a pseudoaneurysm 8 cm in diameter anterior to the descending aorta. When thoracotomy was performed under partial extracorporeal circulation, the thoracic cavity was found to be filled with bloody hydrothorax and hematoma, and the lower lobe of the left lung was adherent to the descending aorta. After a longitudinal incision was made in the aorta, a perforation 7 mm in diameter was identified in the posterior wall, and this was assumed to be the cause of the pseudoaneurysm. This part of the aorta was replaced with a Woven Dacron graft. Takayasu's arteritis was diagnosed by histological examination of the resected specimen, and the changes in the aortic wall at the site of perforation were considered to be chronic. About 30% of patients with this disease have aortic ectasia, but only a few pseudoaneurysms have been reported. Since the pseudoaneurysm occurred in our patient after reduction in the dose of medication, the development of perforation was suggested to be related to this change. In the future, this patient will require careful follow up for anastomotic aneurysm.     

Takayasu's arteritis as a cause of renovascular hypertension in a non-Asian population

Takayasu's disease (TD) is a chronic inflammatory arteritis which affects the aorta and its main branches and occasionally the pulmonary artery. Its cause is not known. Clinical manifestations are due to the intensity and location of arterial inflammation in the acute phase, as well as chronic arterial stenosis over time; 50% of patients have hypertension. Although TD appears to be more common in Asia, increasing numbers of patients of different races are observed in Western countries. The most important pathogenetic mechanism of hypertension seems to be through renal artery stenosis. We show here seven Caucasian hypertensive patients with TD and renovascular stenosis and arterial hypertension. One case was diagnosed in the acute phase of the disease, while in the others diagnosis was established in an advanced occlusive phase. Basic diagnosis was established by angiographic study, with biopsy confirmation in two cases. All patients had at least three of the six criteria listed as diagnostic of TD (by the American College of Reumatology). All patients had the following criteria: age of disease onset before 40 years (symptoms or findings related to TD), vascular bruits in different areas and all patients also had aortic and renal arterial stenosis with some lesions of the main aortic branches. Six of them had claudication of the extremities. We describe their clinical, analytical and angiographic features and also the therapeutic approach. We discuss the aetiopathogenic mechanisms of hypertension in this disease and suggest that TD is not an unusual cause of vasculorenal hypertension.     

A comparison of mebendazole and albendazole in treating children with Trichuris trichiura infection in Durban, South Africa

OBJECTIVE: To compare the efficacy of mebendazole 500 mg and albendazole 400 mg single-dose treatments of Trichuris trichiura infection in children in the Durban area of KwaZuluNatal, South Africa. DESIGN: A single-blind randomised trial in children with a documented moderate infection of T. trichiura. Ova were counted in stool specimens before and 10 days after treatment by the formal-ether concentration method. SETTING: Two shelters for abandoned and orphaned children in Durban. PARTICIPANTS: Ninety-six children aged between 2 and 12 years. OUTCOME MEASURES: The number of children who showed reduced T. trichiura ova counts after the treatments, and reductions in ova counts, both expressed as percentages. Statistical analysis using the Wilcoxon 2-sample test and the chi-square test. RESULTS: Eighty-two children completed the trial; 42 received mebendazole and 40 albendazole. Of the mebendazole group 85% showed a reduction in T. trichiura ova count, compared with 75% of children who received albendazole. Mebendazole treatment was associated with a median percentage reduction in ova count of 72.2%, which significantly exceeded the 44.1% reduction after albendazole (P = 0.024). CONCLUSION: The mebendazole 500 mg single-dose therapy was more efficacious than the albendazole 400 mg single-dose therapy in treating T. trichiura infection in these children.     

Lead poisoning of children in Africa, IV: Exposure to dust lead in primary schools in south-central Durban, South Africa

Hungarian mortality rate is one of the highest in Europe. We have investigated the association between poor living standards and ischemic heart disease by a detailed geographical comparison of infant mortality in 1920-1939 and death in adults from ischemic; heart disease and other leading causes of death in 1990-1994. Ischemic heart disease [r = 0.325] and malignant tumors of digestive apparatus [r = 0.562] are strongly correlated with infant mortality. A significant difference was observed in both infant and overall mortality rates between the western and eastern counties. Our results suggest that the geographical distribution of ischemic heart disease in Hungary reflects later dietary influences.     

Surgery in South Africa

The practice of surgery in South Africa ranges from full-time service in state-funded and academic hospitals serving a largely indigent population to a private sector for medically insured patients. Surgical training occurs at eight medical schools, and specialist registration is obtained after 4 to 5 years with either a university-conferred degree or a fellowship from the College of Surgeons of South Africa. The wide spectrum of First- to Third-World diseases and the high incidence of trauma provide comprehensive experience for practical training. Surgical standards are uniformly high, matching and sometimes pioneering the very best of Western medicine. The health care system is undergoing radical change to correct the imbalances of the apartheid era. Academic institutions are under pressure, and with incipient major financial cutbacks, there is concern that the proud record of service, teaching, and research excellence may be compromised. To facilitate the mission of broadening health care services, diploma training in surgery for rural practitioners is being developed. Outreach programs and closer liaisons with surgical societies in sub-Saharan African countries have also been initiated.     

A survey of professional activities of psychiatrists in South Africa

Targeted inactivation of genes in the tumor necrosis factor (TNF)/lymphotoxin (LT) ligand and receptor system has recently revealed essential roles forthese molecules in lymphoid tissue development and organization. Lymphotoxin-alpha beta (LT alpha beta)/lymphotoxin-beta receptor (LT beta-R) signaling is critical for the organogenesis of lymph nodes and Peyer's patches and for the structural compartmentalization of the splenic white pulp into distinct B and T cell areas and marginal zones. Moreover, an essential role has been demonstrated for TNF/p55 tumor necrosis factor receptor (p55TNF-R) signaling in the formation of splenic B lymphocyte follicles, follicular dendritic cell networks, and germinal centers. In contrast to a previously described essential role for the p55TNF-R in Peyer's patch organogenesis, we show in this report that Peyer's patches are present in both TNF and p55TNF-R knockout mice, demonstrating that these molecules are not essential for the organogenesis of this lymphoid organ. Furthermore, we show that in the absence of TNF/p55TNF-R signaling, lymphocytes segregate normally into T and B cell areas and a normal content and localization of dendritic cells is observed in both lymph nodes and Peyer's patches. However, although B cells are found to home normally within Peyer's patches and in the outer cortex area of lymph nodes, organized follicular structures and follicular dendritic cell networks fail to form. These results show that in contrast to LT alpha beta signaling, TNF signaling through the p55TNF-R is not essential for lymphoid organogenesis but rather for interactions that determine the cellular and structural organization of B cell follicles in all secondary lymphoid tissues.     

Race, life style and renal disease in South Africa

PURPOSE: Clinical evaluation of repairing old amalgam restorations using composite inlays cemented with two different bonding agents. MATERIALS AND METHODS: Occluso-proximal Class II inlay cavities were prepared in 50 old defective amalgam restorations. Extra oral system (EOS) composite inlays were cemented with two different bonding agents (All-Bond 2 or Geristore). After final finishing and polishing of each restoration, evaluation was carried out at baseline, 6 months, 12 months, and 24 months using US Public Health Service criteria. The data were collected and statistically analyzed using Chi-square test. RESULTS: No significant difference was found between the two bonding materials at any time interval.