RESUMEN

In order to explore the feasibility of home blood glucose monitoring (HBGM) in Type 1 diabetics in developing countries, we introduced the technique to Type 1 patients below the age of 30 yr attending the Diabetic Clinic serving Soweto in South Africa. Despite initial problems, HBGM with visually-read strips was applied to 45 of the 64 young Type 1 diabetics identified ("HBGM group"). The remaining 19 were continued on urine glucose monitoring only ("HUGM group"), usually because of attendance and compliance problems. After 4 months' follow-up, glycosylated haemoglobin (HbA1) fell from 10.5 +/- 2.6% (mean +/- SD) to 9.0 +/- 1.7 (p less than 0.001) in the HBGM group, but was unchanged (10.1 +/- 2.1 vs 9.9 +/- 1.9, pn.s.) in HUGM patients. HBGM can thus be introduced in adverse social conditions, and may be associated with improved diabetic control. Costs, in terms of finance and medical time, were not excessive. Unfortunately, a significant minority were excluded by attendance and other problems, and analysis of diabetic complication rates (before the programme began) showed that these patients had significantly more complications than those deemed suitable for HBGM (42.1% vs 15.5%, p less than 0.05).

Asunto(s)

RESUMEN

A case is described in which technetium-99m-di-isopropyl-iminodiacetic acid imaging was used to trace the passage of bile from its site of leakage into an amoebic liver abscess, through a fistulous tract connecting the liver abscess with an abscess in the right lower lobe of the lung, and into the upper respiratory tract.

Asunto(s)

RESUMEN

Black-insulin-dependent diabetics under the age of 30 years attending a busy South African diabetic clinic were intensively screened for a 4-month period. In the 66 patients studied, the following previously undiagnosed conditions were discovered: cataract (1), peripheral neuropathy (16), retinopathy (8), tuberculosis (4) and anaemia (3). In addition, 29 (43,9%) were on insulin regimens that were not ideal. Attempts were made to improve glycaemic control, especially in those patients with complications, and defective insulin regimens were corrected. The screening programme was carried out with normal manpower and investigative facilities, and the extra time involved was not excessive. This programme could be used (in either an expanded or a limited form) in any diabetic clinic, and would probably considerably improve the health of young insulin-dependent diabetic patients.

Asunto(s)

RESUMEN

Gestational choriocarcinoma frequently presents diagnostic difficulties as the first symptoms are often due to distant metastases, particularly to the lung. A case of choriocarcinoma is described; the main features were thyrotoxicosis and a solitary metastasis in the lung arising from a clinically normal uterus. It is emphasized that clinical evaluation of the uterus is unreliable in the diagnosis of choriocarcinoma, a disease which must always be suspected in females with atypical thyrotoxicosis.

Asunto(s)

RESUMEN

Intrathoracic hydatid disease is rarely seen in black patients hospitalized in the Johannesburg area. Eleven patients with pulmonary hydatid disease were treated during 4 years at a major referral center for black patients. The clinical features and management of these patients are described.

Asunto(s)

RESUMEN

Eighteen of 66 Black patients with type I (insulin-dependent) diabetes mellitus had limited joint mobility (LJM). The presence of LJM was related to the duration of diabetes but not to the total daily insulin dose or to the glycosylated haemoglobin percentage. The incidence of diabetic retinopathy was not increased in those patients with LJM, but this was probably because of the relatively small study population and the relatively short duration of diabetes in this group. Short stature was a feature of this group of patients.

Asunto(s)

Asunto(s)

RESUMEN

Sixty people with hyperglycaemia were admitted to Baragwanath Hospital as emergency patients during an 8-week study period in 1981, and one-quarter of them died in hospital. Many of these hyperglycaemic emergencies could have been prevented; 88% of the patients were known diabetics, one-third of whom required only oral hypoglycaemic agents for diabetic control. Sixty-one per cent of the patients had concomitant diseases, primarily infections. Earlier treatment might well have prevented deterioration of diabetic control, yet only 6% of the patients had attended the health services in the previous week in spite of recognizing that they were becoming progressively more ill. These patients were at high risk of subsequent admission, one-third of those discharged being readmitted within 3 months. Attendance compliance during a 3-month follow-up period was poor, and the discharged patients lacked the skills and knowledge necessary to maintain adequate diabetic control. One-quarter of those on insulin could not measure their dose correctly, most could not adequately test their urine and did not know what action to take if they had worsening symptoms of hyperglycaemia or developed intercurrent illness. Hyperglycaemic emergency admissions could be reduced by improving ambulatory diabetic services, thus saving costs of hospital care. Recommendations for improving the hospital service include maintaining a register of patients who have had hyperglycaemic emergencies and special care to ensure that they acquire the necessary knowledge and skills. Other methods of improving compliance regarding attendance and medication should be applied. These recommendations need to be implemented and their efficacy evaluated.

Asunto(s)

RESUMEN

We report a case of acute rhabdomyolysis following the abuse of opiates injected intravenously. The patient also developed mild renal failure as well as transient myocarditis. The pathogenesis and management of the condition are discussed.

Asunto(s)

Asunto(s)

RESUMEN

Six cases are presented in which tuberculosis (TB) was wrongly diagnosed. The patients were all Blacks from areas of high TB prevalence, and treatment for presumed TB was instituted without bacteriological confirmation. There were delays of up to 2 years before the correct diagnosis was made, involving much morbidity and unnecessary treatment. There was one potentially preventable death.

Asunto(s)

Asunto(s)

RESUMEN

Two patients with ankylosing spondylitis and fibrocavitating pulmonary disease are described. This rare extra-articular complication of spondylitis is briefly discussed.

Asunto(s)