Chronic liver disease. A case control study of the effect of previous blood transfusion.

A means of assessing hepatitis NANB virus infection, via blood transfusion, as a cause of chronic liver disease was investigated in a hospital in each of two cities in England. Patients with chronic liver disease were matched for age and sex with other patients in the same hospital and histories taken included details of previous operations and blood transfusions; if these were within ten years of the study enquiries were made of hospital records officers. All positive histories were found correct, but about one third of previous transfusions had been omitted by both case and control patients. Sixty-seven male and 35 female patients with chronic liver disease and their controls were included in analyses. The only clear difference which emerged related to residence for more than a year in the Middle or Far East by male case- (40%) or control- (21%) patients (P less than 0.05). The exclusion of patients with this history left only 34 pairs in which five (15%) of the case patients and one (3%) of the control patients had a transfusion history: this difference was not statistically significant. Although the study results have shown no clear evidence of blood transfusion as a major cause of chronic liver disease in Britain, the study method, with sufficient numbers to allow analyses of newly diagnosed patients with confirmed transfusion histories, could be used to provide an ongoing assessment of the risk.

An evaluation of the role of the intravenous urogram in the management of patients with epididymo-orchitis.

The purpose of this study was to evaluate the role of intravenous urography in patients presenting with symptoms of epididymo-orchitis. The intravenous urograms of 67 such patients were assessed retrospectively. The management of patients with acute epididymo-orchitis was not affected by intravenous urography, although a number of abnormalities were identified. Patients with additional symptoms not typical of acute epididymo-orchitis showed a higher incidence of abnormalities some of which affected management. It is concluded that urography is not warranted in the investigation of patients with uncomplicated acute epididymo-orchitis.

Hospital admissions for adverse reactions to drugs and deliberate self-poisoning.

In a prospective study of 300 patients, 14 admissions (4,6%) were considered to be related to adverse drug reactions. A further 29 admissions (9,6%) were due to self-poisoning with drugs prescribed for therapeutic purposes. Agents causing adverse reactions were predominantly cardio-active drugs and anticoagulants. Mean duration of hospital stay in this group of patients was 8,3 days (range 2-18 days); there were no deaths. Tranquilizers and antidepressants were most commonly used for self-poisoning. Duration of admission in these patients was much shorter than in the previous group--mean 1,8 days (range 1-5 days), and there was 1 death. To the best of our knowledge, this is the first reported series of such cases in South Africa. It shows that drugs are an important cause of morbidity in hospital patients in the RSA.

A hospital epidemic caused by gentamicin-resistant Klebsiella aerogenes.

In the 15 months, February 1976 to April 1977, more than 241 patients became colonized with a strain of Klebsiella aerogenes, capsular serotype K2, resistant to most antibiotics. Urinary tract infection was the most common clinical manifestation but bacteraemia and, occasionally, infections of other sites were encountered. The main reservoir of the epidemic klebsiella was the gut, urine and skin of colonized patients. Gut carriage among staff was very uncommon. The most susceptible patients were elderly males, with debilitating illnesses and urinary tract abnormalities, especially if they were catheterized or receiving antibiotics. Likely vehicles for spread were the hands of staff, and contaminated bedpans and urinals. Control measures were directed at these factors. At the end of April 1977 no new cases had occurred for 3 months in the ward in which the outbreak began, and which had been the main focus of infection, and only 5 patients in the affected hospitals were known to be colonized by the epidemic klebsiella.

Micrococcal urinary-tract infections in young women.

In a prospective study in young women, novobiocin-resistant subgroup-3 micrococci were the second commonest cause, after Escherichia coli; of acute urinary infections. Proteus mirabilis was the only other causative organism. Symptoms, pyuria, or possible aetiological factors were the same in micrococcal and coliform infections. The infecting micrococcus "biotype" was only rarely found among the normal flora of the genitourinary tract of young women, though other micrococci and staphylococci were commonly present. Evidently, the infecting micrococci are selectively pathogenic in the urinary tract. Micrococcal infections, like coliform infections; commonly followed sexual intercourse, but there was no evidence that the micrococci were sexually transmitted. The infecting biotype was rarely found in the male urethra or prepuce.