Toxicity of Callilepis laureola.

Callilepis laureola, which has been found to cause fatal liver necrosis in the Black population of Natal, is widely used as a herbal medicine. Chemical extraction has yielded a product, identified as atractyloside, which is responsible for the nephrotoxic and hypoglycaemic effects of Callilepis laureola. The hepatotoxic principle has not yet been isolated.

Toxic hepatitis in black patients in natal.

The clinical and pathological features of toxic centrilobular zonal necrosis in Natal Blacks are described. It is suggested that this condition may be caused by the toxic action of Callilepis laureola (known to the Zulu as 'impila'). This plant and other herbs are used by many Blacks for self-medication or are prescribed by herbalists and witchdoctors.

Fatal adenovirus pneumonia: Clinical and pathological features.

A review of autopsies of 107 young children with pneumonia showed that 15 children (14%) had adenovirus infections, the diagnosis being based on characteristic histopathological and ultrastructural features in the lungs. Eleven (73%) of the cases of adenovirus infection followed on measles infection, and it is suggested that some became infected with adenovirus after admission to hospital. A review of clinical aspects revealed no unique features. Histopathological examination of tissues showed a common picture of necrotising bronchopneumonia, with minor degrees of rental tubular damage, infiltrates of large mononuclear cells in spleen and nodes, and an absence of lymphoid germinal centres. On light microscopy, "rosette" and "smudge" cells were seen in these cases, and two patterns of virus particle distribution in infected cells were seen ultrastructurally. It is postulated that "smudge" cells contain numerous crystalline viral arrays.

Severe measles-associated pneumonia treated with assisted ventilation.

Measles-associated pneumonia, which was severe enough to require mechanical ventilation, caused a mortality of 64%. The main indications for special respiratory care were severe infection and hypoxaemia. Complications of the disease occurred in 78% of the patients. The commonest were anaemia, enteritis and cardiac failure, and they contributed to the grave prognosis. Viral pneumonia was present in most of the patients who died; superinfection was rare. The characteristics of measles virus was present in 30% and of adenovirus in no less that 40%.

Immunological studies in children with chronic pulmonary infection.

Twenty-three children with chronic pulmonary symptoms following acute lower respiratory tract infection were investigated with a view to establishing their immune status. Cell-mediated immunity was depressed in the majority. Serial testing over some months showed improvement in some and fluctuation or non-recovery in others. The leucocyte function, gamma-globulin and immunoglobulin levels were normal.

A family with partial and total deficiency of complement C3.

A young White girl was found to have no detectable complement C3 or C1q. She suffered repeated attacks of pneumococcal meningitis and pneumococcal pneumonia. Her parents, and some of her siblings, had half the normal level of C3; other siblings were normal. She also had decreased IgG levels and increased IgM concentrations. These findings are correlated with a dysmorphic state of the germinal centres of the peripheral lymphoid tissues, seen after death.

Orthostatic hypotension due to Shy-Drager syndrome.

A case of orthostatic hypotension is presented, as well as postmortem neuropathological findings. The features of this case are consistent with those of the Shy-Drager syndrome, which comprises primary orthostatic hypotension and neurological manifestations caused by degenerative disease of the central nervous system.

Renal papillary necrosis associated with acute pancreatitis.

A case of acute renal failure with renal papillary necrosis due to acute pancreatitis is described. The association of renal papillary necrosis with acute pancreatitis has not been previously recorded, and the possible mechanisms for the production of renal papillary necrosis in this entity are discussed.

Smoking, drinking and oesophageal cancer in African males of Johannesburg, South Africa.

A study of the smoking and drinking habits of 196 oesophageal cancer cases and 1064 control patients was made. All subjects were African males aged 35 years or more, drawn from a mainly urbanized population.It was found that tobacco smoking was prevalent and that pipe tobacco (used in pipes or in hand rolled cigarettes) was used more frequently than has been found in westernized countries. The drinking of alcohol was also a prevalent habit. Tribal affiliations were examined and all three of these factors showed differences between cases and controls. Further analysis of smoking and drinking together showed that only smoking had a positive association with oesophageal cancer, and this was also true after tribal adjustment had been made. A comparable analysis of data on Durban African males yielded similar findings.It was concluded that tobacco smoking was a powerful oesophageal insult but the authors were not able to show that alcohol was important in the development of oesophageal cancer in these people. Cigarette tobacco does not appear to be a significant oesophageal insult but pipe tobacco does, and the use of both these types of tobacco together may have a synergistic effect. Tribal affiliation has bearing on the smoking pattern.