Arterial oxygen saturation and posture in acute stroke.

Patients with acute stroke are at risk of hypoxaemia and the degree of oxygen desaturation may depend on posture. Using a fingertip pulse oximeter, we studied the effects of different nursing positions on arterial oxygen saturation (SaO2) in ten elderly patients within 48 hours of a hemiplegic stroke and 10 age-matched controls admitted to hospital with other acute illnesses. Mean SaO2 was consistently higher in the controls than the stroke patients in all recumbent positions, but when patients were propped up the difference between the groups was statistically insignificant. The difference between semirecumbent and lying SaO2 values was then tested in a further nine stroke patients. Overall the mean SaO2 was significantly higher and, in at least four cases, the duration of episodes of desaturation (SaO2 < 90%) was substantially less when the patients were propped up. We suggest that, wherever possible, acute stroke patients should be nursed sitting up to minimize the risk of oxygen desaturation and possible aggravation of ischaemic brain damage.

Atypical radiological presentations of pulmonary tuberculosis.

Unfamiliar manifestation of pulmonary tuberculosis found in Central and West Africa are presented. These include egg shell calcification in parenchyma and glands, calcification of the diaphragmatic pleura resembling asbestosis, honeycombing and B Kerley's lines with or without complicating bronchiectasis. There should be an index of suspicion of pulmonary tuberculosis even when other typical tuberculous lesions are not associated with these lesions not normally attributed to the disease.

Incidence of peptic ulcer in the Zambian African - a radiological study.

Five hundred and sixty-eight (568) consecutive barium meal examinations have been studied. 152 showed peptic ulcer. There were 146 duodenal and six gastric ulcers. Eight were post-bulbar ulcers, and multiple ulcers were seen in only 4. Clinically, none had pancreatic adenoma. The ratio of male to female was as follows:- referral 4.7 to 1.0; of those who had peptic ulcer, 4.1. The incidence of peptic ulcer was equally distributed in all social classes.

Tuberculosis of the liver presenting as peripheral vascular disease.

Peripheral vascular disease in African males may be associated with a tuberculous infection elsewhere in the body. The case history is described of a patient who presented with gangrenous lesions of both feet and was found to have tuberculosis of the liver. The lesions on the feet healed within 2 months of starting anti-tuberculosis chemotherapy.

A clinical trial with glipizide - a relative new sulphonylurea.

Glipizide is a relatively new sulphonylurea- antidiabetic agent. 24 maturity-onset diabetics were studied to determine the dosage required to produce adequate control and the safety and tolerance of the drug. It was concluded that glipizide is a safe and potent anti-diabetic agent and a suitable alternative in those patients poorly-controlled on standard oral hypoglycaemic drugs.

Tropical vasculitis and tuberculosis.

Attention is drawn to the association of Tropical aortitis, or vasculitis with active or previous tuberculous infection. This suggests that the two diseases may be related. It is recognised that environmental factors may be important since the incidence of this complex appears to be high in the indigenous populations of Southern and Central Africa and uncommon in people of African origin in industrialised nations. Unlike classical Takayasu's arteritis, there does not appear to be any preference for young people or for females.