Long-term follow up of childhood tuberculous meningitis.

The purpose of the present study was to determine the long-term outcome of 76 children (40 females and 36 males) diagnosed and treated with modern antituberculosis drugs. The median age of the children on admission was 29.5 months and on follow-up 9 years. Antituberculosis therapy consisted of daily isoniazid (20 mg/kg), rifampicin (20 mg/kg), ethionamide (20 mg/kg), and pyrazinamide (40 mg/kg) for 6 months. Twenty-three children received daily prednisone (2-4 mg/kg) for the first month of treatment. Raised intracranial pressure was actively monitored and treated. Patients with non-communicating hydrocephalus received ventriculo-peritoneal shunts shortly after admission while communicating hydrocephalus was treated with oral acetazolamide (100 mg/kg/day) and furosemide (1 mg/kg/day) in 3-4 divided doses. Communicating hydrocephalus that did not respond to this regimen within the first month of treatment also underwent ventriculo-peritoneal shunting. Only 20% of children were functionally completely normal at follow-up. Main areas of functional deficit were cognitive impairment (80%), poor scholastic progress (43%), and emotional disturbance (40%). Twenty-five per cent of children had evidence of motor impairment, but all could walk and only 5 of 76 children (6% of total) were unable to run. One child was blind but no child had sensori-neural deafness. It was concluded that these disabilities in children from mainly deprived socioeconomic backgrounds have serious implications for their future social, academic, and career prospects. A high index of suspicion of TBM in high tuberculosis incidence communities will help prevent the morbidity documented in this study.

Gunshot injuries of the lower oesophagus.

We present seven cases of lower oesophageal gunshot injury cared for by one surgeon. Diagnosis was made clinically, with the help of chest X-rays and with oesophagography and oesophagoscopy. Five were treated with wide debridement and resection of the distal esophagus and oesophago-gastric anastomosis with a Nissen wrap to protect the anastomosis. Two lesser injuries were treated by primary repair. The five treated with resection and oesophago-gastric anastomosis did not leak and the patients were discharged after oesophagography 10 days postoperatively. Primary repairs in two patients were complicated by oesophageal leaks, one subclinical and one with an empyema. The oesophageal blood supply is segmental in areas and variable in the distal part. Injury due to a bullet wound may cause more damage than is evident at surgery. Additional mobilization can further devascularize the distal oesophagus and lead to anastomotic leaks. We advocate wide debridement of oesophageal gunshot injuries and resection of the distal oesophagus. Continuity is restored with a primary oesophago-gastric anastomosis (double layer) with a fundoplication to protect the anastomosis.

The outcome at 12 months of very-low-birth-weight infants ventilated at Tygerberg Hospital.

OBJECTIVE: To determine the outcome at 1 year of age of a group of very-low-birth-weight (VLBW) infants, from urban and rural communities, ventilated at Tygerberg Hospital, W. Cape. STUDY DESIGN: Prospective descriptive study in which the prevalence of bronchopulmonary dysplasia (BPD), sensorineural deafness, intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and abnormal motor developmental outcomes were determined in 153 ventilated VLBW infants from rural and urban areas. Of these, 69% were from lower socio-economic backgrounds. MAIN OUTCOME MEASURES: Attrition rates for rural and urban babies, BPD, ROP, IVH and abnormal motor development. STUDY POPULATION AND SETTING: All ventilated VLBW infants discharged from the neonatal intensive care unit at Tygerberg Hospital over a 1-year period were followed up at 3-monthly intervals for 12 months. RESULTS: BPD was diagnosed in 19% of the babies, with significantly more babies with birth weights under 1,000 g and gestational ages under 28 weeks having BPD. Of the babies with BPD, 25% had abnormal motor development at 1 year of age. Seven per cent of the babies had grade 3 or 4 ROP and 2.6% had sensorineural hearing loss. One hundred and seventeen (79%) of the infants attended the follow-up clinic until 12 months of age (corrected for prematurity). There were no significant differences in the number of babies followed up from rural or urban areas. Fourteen (11.9%) of the babies had abnormal motor development. A disturbing finding was that so many babies had spastic quadriplegia (8; 57%) versus diplegia (6; 43%). The incidence of abnormal motor development in the babies from the rural areas and in those with birth weights under 1,000 g from rural areas was high--a further cause for concern. CONCLUSION: The prevalence of the major complications associated with ventilated VLBW infants correlated well with those reported for similar infants from First-World countries. The poor motor developmental outcome of the babies from rural areas with birth weights under 1,000 g and high attrition rates for infants with serious complications such as BPD, IVH and ROP are distressing.

Hearing loss in the child following streptomycin administration during pregnancy.

The risk of deafness developing in the unborn child following the use of streptomycin (SM) during pregnancy remains uncertain. We have followed up 30 children whose mothers received SM during pregnancy. One child (3pc), whose mother received SM during the first trimester of pregnancy, had profound unilateral hearing loss which could possibly be ascribed to SM. This child had however, in addition, features of congenital hypotonia and a unilateral single crease. Two further children had conductive deafness which could not be due to SM, associated with serious otitis media. Although the risk to the foetus of hearing loss following the use of SM during pregnancy appears relatively low it should, where possible, be avoided during the first trimester of pregnancy.

Susceptibility of Agrobacterium tumefaciens Strains to Two Agrocin-Producing Agrobacterium Strains.

Sixty-five strains and isolates of Agrobacterium tumefaciens representing each of the known biotypes, were tested for in vitro and in vivo susceptibility to the agrocin-producing strains Agrobacterium radiobacter 84 and A. tumefaciens D286. No biotype 3 strain was susceptible to the effects of either of the agrocinogenic strains in vitro. On datura and tobacco, the best inhibition of tumor formation was obtained when the agrocinogenic strains were applied to wounds 24 h before the pathogens and by the concomitant application of agrocin producer and pathogen at cell ratios of 10:1 or 3:1; inhibition of infection tended to decrease progressively as the cell ratio decreased from 10:1 to 3:1 to 1:1. Generally, strain 84 was superior to D286 in inhibiting tumor formation. A combined cell suspension of 84 and D286 was as effective as 84 alone. The overall pattern of inhibition of tumor formation by biotype 1 and 2 pathogens resistant to the agrocinogenic strains in vitro was similar to that obtained with strains that were susceptible in vitro.

Analysis of the physical activity patterns of a rural Afrikaner population in the south-western Cape.

To determine whether low levels of energy expenditure at work or in leisure-time might contribute to the high prevalence of coronary heart disease among white rural Afrikaners, 7188 whites of both sexes in three rural communities were questioned about their physical activities. From these data, the percentage of the population at different ages participating in sedentary, moderate or vigorous activity at work or light, moderate or vigorous leisure-time activity was calculated. Total energy expenditure at work or in leisure-time was also calculated. At all ages, less than 1% of both men and women performed workday activities requiring high energy output. Beginning after the age of 24 years, there was a dramatic fall in the percentage of both men and women participating in either moderate or vigorous leisure-time physical activity. After the age of 44 years, less than 26% of men and 16% of women exceeded the coronary 'protective threshold' of 8400 kJ leisure-time energy expenditure per week. Thus the population studied is characterized by very low levels of energy expenditure particularly at work, but also during leisure-time.

The effect of frequency tolerance on audiometer accuracy.

Investigations into the methods used to calibrate audiometers reveal that the 6 000 Hz frequency is particularly liable to yield inconsistent results when calibrated in the usual way. It is shown that the TDH39 telephone receiver which is usually calibrated on a 9A coupler in accordance with the International Standards Organization recommendation R389 will depend to a considerable extent on the precise frequency used and may differ by as much as 7 db when the frequency is varied but still retained within the specified tolerance limits. A new telephone receiver, the TDH50, is much less sensitive to frequency variation. It is shown that this receiver should be calibrated with the same threshold figures as the TDH39.

Binaural speech discrimination.

The phenomenon of binaural summation in which the addition of signals presented to the two ears simultaneously takes place at a central level, has been known for many years. It is reasonable to assume that the pattern of summation differs between subjects with central lesions and those with lesions in the peripheral auditory tracts. Various tests have been proposed to aid in locating the site of the lesion which compare the monaural and binaural speech discrimination scores. In the present work, two of these tests have been examined. Three groups of subjects have been used: (1) a normally hearing group; (2) a group with hearing impairment resulting from cochlea pathology, and (3) a group with hearing impairment resulting from lesions at the level of the cochlear nuclei. The results showed that neither test differentiated between peripheral and cochlear nuclei lesions.

Effectivity of Rev 1 vaccine in rams against brucella ovis infection.

Vaccination with Rev 1 at four months of age protected rams against experimental infection with Brucella ovis. A double vaccination did not improve immunity whereas rams vaccinated later in life showed a decreased immunity to the infection. Lesions and complement fixation reactions were found to be inadequate criteria for the diagnosis of the disease in the individual ram.