Incidence of gestational diabetes at Northdale Hospital, Pietermaritzburg.

An incidence study for gestational diabetes was undertaken at Northdale Hospital, which serves a majority Indian and minority Coloured population in Pietermaritzburg. All patients presenting to the antenatal clinic were screened using a 75 g glucose load. If the 1-hour venous plasma glucose level was greater than or equal to 7.8 mmol/l an oral glucose tolerance test (OGTT) was performed. The screening procedure was repeated at 28 - 32 weeks gestation. The OGTT was done with a 75 g glucose load and patients were designated as having gestational diabetes if the 2-hour plasma glucose level was greater than or equal to 7.8 mmol/l. Subsequently, the patients were also evaluated by the 3rd trimester criteria of the Diabetes Pregnancy Study Group of the European Association for the Study of Diabetes (EASD): gestational diabetes being present if the fasting plasma glucose value was greater than or equal to 5.2 mmol/l and the 2-hour plasma glucose value was greater than or equal to 9.0 mmol/l after a 75 g glucose load. Between July 1987 and June 1988 1721 patients were seen. There were 4 pre-gestational diabetics. The remaining 1717 patients were screened for gestational diabetes. Forty-five patients had 2 OGTTs performed, while 251 patients had 1 OGTT in the 3rd trimester. Sixty-five patients had a 2-hour plasma glucose value of greater than or equal to 7.8 mmol/l on OGTT. Hence, the incidence of gestational diabetes using World Health Organisation criteria was 65/1717 (3.8%). Twenty-seven patients had 2-hour plasma glucose value of greater than or equal to 9 mmol/l on OGTT.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical spine fracture in diffuse idiopathic skeletal hyperostosis.

The occurrence of spinal fractures in ankylosing spondylitis is well documented but fractures are uncommon in patients with diffuse idiopathic skeletal hyperostosis (DISH). We report a 58-year-old Black male with DISH who developed quadriplegia after fracture dislocation of the cervical spine.

Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients.

In this prospective study of 240 black patients with liver enlargement admitted to the medical wards of King Edward VIII Hospital, Durban, a cause for the hepatomegaly was found in 92.5% of cases (63.8% without recourse to biopsy, 28.7% after liver biopsy). The commonest cause was congestive heart failure (36.7%), followed by amoebic liver abscess (7.1%), hepatocellular carcinoma (5.8%) and cirrhosis (5.4%). Liver biopsy provided the diagnosis in 90.8% of patients with initial unexplained hepatomegaly. The diagnostic yield of liver biopsy was increased by submitting 3 biopsy specimens for histological examination. The 3 specimens are obtained using a single intercostal entry site and redirecting the biopsy needle, without increasing the risk of complications. Hepatic tuberculosis was present in 9.2% of patients who underwent biopsy. There were no consistent clinical findings in these patients. Therefore, in communities in which tuberculosis is endemic, all patients with unexplained hepatomegaly require liver biopsy since it provides the only means of making this diagnosis.