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Although the life expectancy of men is commonly less than that of women, previous analyses of a longitudinal data set revealed a sub-sample of older men whose survival curves over twenty years are similar to those of the women in the sample. The main purpose of this research is to identify factors which differentiate this group of "successful" males from the other males in the sample. Data from the two groups of males (and two groups of females) were examined using analysis of variance, chi 2 analysis, and survival analysis. Data include measures in a variety of biomedical, functional, behavioral, and psychological areas collected during in-home and hospital examinations. Results show that "successful" males have significantly higher scores in both cognitive abilities and health, initially and at longitudinal follow-ups. The combination of overall high scores in the multiple domains evidently gives this group of men an advantage over the others. The results emphasize the importance of recognizing the sub-groups in the aging population with different developmental patterns, and tailoring both research and services to the uniqueness of these groups.

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Vertical banded gastroplasty (VBG) is today the most widely performed bariatric operation. The procedures used previously for the same purpose resulted in metabolic derangements and other pathologies during pregnancy. In a retrospective study we compared the reproductive performance of nine women prior to VBG and after it. Of eighteen pregnancies prior to the operation, seven ended with miscarriage, while only one of fourteen pregnancies conceived after the operation was aborted. The rate of spontaneous conception was greatly increased after the operation and there were fewer complications in the course of the pregnancies. From the obstetrician and gynecologist's point of view VBG seems to be a good treatment for morbid obesity.

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We describe a patient with chronic renal failure and transitional cell carcinoma, in whom a nephrogenic adenoma of the bladder was diagnosed after a course of intravesical thiotepa treatment.

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In a series of 115 black patients admitted to a chronic haemodialysis programme over a 4-year period, a definitive pathological diagnosis was made in 70 cases. Of these, 5 were made anatomically while in 65 the diagnosis was histological. The commonest single cause of end-stage renal disease was essential malignant hypertension which showed a peak incidence in males aged 40 - 50 years. Chronic pyelonephritis and other diseases prominent in series of White patients were conspicuously absent. The prevalence of malignant hypertension presents a challenge for the detection and treatment of such cases by the community health services.

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For Black patients in Johannesburg chronic haemodialysis has been associated with an extremely high mortality rate. A retrospective analysis has shown that the major factor contributing to this is the frequency of primary malignant hypertension, resulting in the death of patients from cardiac failure (sudden death and pulmonary oedema) and cerebrovascular accidents. Septic complications, tuberculosis and shunt complications also contributed to the high death rate. Possible measures to be taken to reduce this high mortality clearly emerge.

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Although widely recognized by physicians in Africa, the acute renal failure resulting from the use of herbal preparations obtained from witchdoctors and of non-proprietary preparations purchased over the counter from pharmacists has not been fully described in the past. Over a 4-year period at Baragwanath Hospital, 91 cases of this condition were encountered. The clinical spectrum of the disease is described and the problem is discussed, in the setting of the traditional beliefs of these patients. Steps which may be taken to eradicate the disease are suggested.

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Previous studies of gastric secretory function and serum gastrin levels in patients with chronic renal failure (CRF) have yielded conflicting results. In a study of 30 patients on regular hemodialysis, serum gastrin levels were higher than normal (p less than 0.05), and the gastric secretory response to pentagastrin was normal for the group as a whole. There were, however, 8 patients who were hypochlorhydric (4 achlorhydric) and 7 who were hyperchlorhydric. The patients with gastric hyposecretion were older, predominantly male and this group was associated with the highest gastrin levels as well as the highest incidence of gastrointestinal hemorrhage. Chronic gastritis is thus more common in CRF than generally believed and may be responsible for much of the morbidity from gastrointestinal complications during hemodialysis.

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A patient with a single functioning kidney presented with the nephrotic syndrome. On the basis of highly selective proteinuria, a diagnosis was made of lipoid nephrosis. Steroid therapy over a 2-year period did not control the disease. The patient eventually developed end-stage renal failure and malignant hypertension. Nephrectomy was performed to control the hypertension. Histological examination showed congenital dysplasia in one kidney and sclerosing glomerulonephritis, malignant nephrosclerosis, as well as dysplastic changes in the other.

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In a retrospective survey of renal amyloidosis in a large general hospital, only 7 cases were found. Patients generally presented with nephrotic syndrome and symptoms of fluid overload; hypertension on presentation was unusual. Renal failure was present in 5 out of 7 patients, and uraemia in 3. The disease was secondary in 5 patients and primary in 2, and the prognosis was uniformly bad.

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All patients considered for regular haemodialysis, as well as all nurses recruited to work in the haemodialysis unit of Baragwanath Hospital, were tested for the presence of hepatitis-associated antigen (HBAg) and for antibody to hepatitis-associated antigen (HBAb). Thereafter they were tested at intervals as long as they remained in the unit. The prevalence of HBAg was 1,7% in nurses and 5,1% in patients. HBAb was present in 27,2% of nurses and 35,1% of patients. HBAg is found less frequently among Black haemodialysis patients than is reported from Europe or the USA, but the prevalence is similar to that among healthy Blacks in South Africa. The prevalence of HBAb is similar to that in Europe or the USA. Follow-up studies showed no instance of hepatitis or seroconversions of HBAg, but there was a small number of conversions of HBAb from negative to positive.

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Large surface area, high mass transfer dialysers have recently come into widespread use, and it has been shown that they promote the loss of large amounts of bicarbonate when acetate is used in the dialysate. The present study was designed to confirm these metabolic consequences and quantitatively to compare two commonly used dialysers in this respect. Simultaneous measurement of arterial and venous blood gases has shown that there is a significant reduction in bicarbonate, carbon dioxide tension, and pH of blood returning to the patient from the dialyser. These changes were greatest with the 2,5-m2 hollow-fibre dialyser, and least with the 1,4-m2 coil dialyser. In the chronic dialysis patient in a steady state, these effects may be inconsequential but, in an acutely ill patient, the combination of a dialysate containing acetate and a high-efficiency dialyser may be extremely hazardous. A return to the use of bicarbonate as the source of base would avoid such hazards and would promote the more physiological correction of the metabolic acidosis of renal failure.

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Xipamide, hydrochlorothiazide, and furosemide were given to normal volunteers on a double-blind basis. During maximal water diuresis, there was a reduction in free water clearance and an increase in osmolar clearance after administration of xipamide and hydrochlorothiazide, but not in the case of furosemide. During maximal hydropenia, both xipamide and hydrochlorothiazide increased free water reabosorption in a linear relationship to osmolar clearance, while furosemide increased osmolar clearance with little change in free water reabsorption. It was concluded, therefore, that, as with hydrochlorothiazide, the site of action of xipamide was on the distal convoluted tubule, and that of furosemide on the loop of Henle.

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Xipamide (4-chloro-5-sulphamyl-salicylic acid 2', 6'-dimethylanilide) is a diuretic and antihypertensive agent. A clinical trial of the drug was performed in 11 patients, 8 with nephrotic syndrome, 1 with oedema and ascites due to hepatic cirrhosis, and 2 with congestive cardiac failure due to idiopathic cardiomyopathy. The drug proved to be potent, safe and efficacious. Side-effects were similar to those encountered with other thiazide-derived diuretics, but were not of a severe nature. Wider clinical usage of xipamide would appear to be warranted.

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Hypertension of recent onset in a 29-year-old woman was associated with low pain radiating to the right groin. Angiography showed the presence of a large aneurysm of the right renal artery. Resection of the aneurysm and nephrectomy cured the hypertension.

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Four years' experience with haemodialysis in South African Blacks has afforded an insight into their beliefs and superstitions about kidney function and kidney disease, the role of the extended family and the influence of traditional healers on the pattern of management of patients with chronic renal failure. Despite a vastly different cultural background and basic ignorance of biology, their reactions and adaptations to maintenance haemodialysis are closely similar to those reported from modern Western societies.

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The association of systemic amyloidosis with schistosomiasis is rare. This report concerns a 47-year-old Black woman who presented with the nephrotic syndrome, with some unusual features. Ova of Schistosoma haematobium were seen in a rectal biopsy specimen, and amyloid material was shown in renal and hepatic biopsy specimens.

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