Sickle cell disease with orbital infarction and epidural hematoma.

Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels.

Evaluation of the "one-minute" test for detecting Helicobacter (Campylobacter) pylori infection.

The "one-minute" urease test to detect Helicobacter (Campylobacter) pylori infection was evaluated using histology and culture as the "gold standard". The test was performed in a blinded manner and compared with the conventional Christensen's urease test. Helicobacter pylori was detected in 88 of 100 consecutive patients attending the gastrointestinal clinic for upper endoscopy. Although the "one-minute" urease test was more sensitive [86% (76/88)] than the conventional Christensen's urease test [70% (62/88)], this difference was not statistically significant (P = 0.22). Histology was the most sensitive [97% (85/88)] whilst culture was 80% (70/88) sensitive. All tests exhibited specifications of 100%. The "one-minute" urease test is a simple, rapid and highly specific test to detect Helicobacter pylori which can be performed at endoscopy.

Evaluation of various laboratory techniques to diagnose Helicobacter pylori in patients with upper gastro-intestinal tract symptoms.

Helicobacter (Campylobacter) pylori is strongly associated with type B gastritis. The detection of H. pylori, which entails histological examination and culture of gastric biopsy specimens, takes several days. There has been much interest in developing more rapid tests, including non-invasive ones. Using histology and/or culture as the 'gold standard', several methods to detect H. pylori were compared and evaluated. The organism was detected in 84 of 100 consecutive patients attending the Gastrointestinal Unit of King Edward VIII Hospital for upper gastrointestinal tract endoscopy. Histological examination was the most sensitive (98%) and specific (100%) method used in detecting H. pylori in gastric biopsy specimens. An enzyme-linked immunosorbent assay to detect specific IgG antibodies to whole H. pylori organisms is a moderately sensitive (82%), non-invasive method but it is nonspecific (38%). Although culture was specific (100%), it was less sensitive (68%) than histological examination. The 'conventional' urease assays must be performed under controlled conditions (37 degrees C) for optimal results (sensitivity, 71%).

Profile of crescentic glomerulonephritis in Natal--a clinicopathological assessment.

Crescentic glomerulonephritis is invariably associated with a fulminant syndrome of rapidly progressive renal failure which generally progresses to end-stage renal failure within weeks or months of onset. A widely differing aetiological background has been reported from Western countries. Work from the African continent is sparse. In a study from the province of Natal in South Africa between 1981 and 1987, 27 cases of crescentic nephritis were identified from a total of 458 patients who underwent renal biopsy at King Edward VIII and Addington hospitals. Poststreptococcal nephritis was the commonest aetiological factor (n = 8). There were six black patients in this group. Nine patients were classified as idiopathic and of these five were black. Four patients (one black) had antiglomerular basement membrane disease. Of the 24 patients subjected to variable combinations of immunosuppression, antiplatelet agents, dialysis and plasmapheresis, 11 improved, observed over four months to four years. Oliguria and severe renal failure at presentation signified a poor prognosis.

Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver.

In an investigation to determine the influence of sampling variability on the diagnostic yield of liver biopsy, 3 consecutive samples were obtained from each of 75 patients by redirecting the biopsy needle through a single entry site. In 14.7% of patients all 3 specimens were normal, and in 36% there were similar abnormalities in all 3 specimens. In the other patients, sampling variability between specimens was present. In those patients with cirrhosis, hepatocellular carcinoma, metastatic carcinoma, or hepatic granulomas the histological abnormality was present in all 3 biopsy specimens in only 50%, 54.5%, 50%, and 18.8% of patients, respectively. No complications were recorded. These findings show that important pathology can be overlooked if only a single biopsy specimen is taken, and that the method of obtaining 3 consecutive specimens improves the diagnostic yield of liver biopsy without an associated increase in complications.

Bullous systemic erythematosus. A case report.

Bullous disease in patients with systemic lupus erythematosus (SLE) has been previously described but characterization has been difficult. A case of bullous eruption that is an unusual manifestation of SLE rather than a primary vesiculobullous eruption is described. The patient was successfully treated with dapsone.

A hospital outbreak of multiresistant Salmonella typhimurium belonging to phage type 193.

An outbreak of nosocomial infection was caused by strains of Salmonella typhimurium phage type 193 that were resistant to ampicillin, chloramphenicol, neomycin-kanamycin, streptomycin, spectinomycin, sulfonamides, tetracyclines, trimethoprim, and nalidixic acid. Resistances to drugs other than nalidixic acid were specified by plasmids, and, on the basis of phage typing and plasmid characterization studies, the multiresistant phage type 193 strains were determined to be clonal. In a two-year period, 488 patients infected with these bacteria were identified. An investigation in a pediatric surgical ward, where the outbreak was particularly severe, showed that patients exposed to antibiotics were more likely to be colonized with the epidemic strain and that young debilitated patients were more liable to show clinical signs of infection. Epidemiologic studies suggested that cross infection via the hands of the ward staff was the likely means of propagation of the epidemic.