Biomedical subjects
Publications and source records attributed to B Maharaj.
We report the successful use of a conservative regimen in the management of amoebic liver abscess with thoracic spread and present two illustrative case reports.
Forty-one black patients aged 21 to 75 years with hepatic tuberculosis diagnosed at liver biopsy were studied prospectively. The liver varied in size and consistency and was tender in 44 per cent of patients. Abdominal symptoms, weight loss, pyrexia, hepatomegaly, splenomegaly and anaemia were absent in 54, 39, 37, 5, 68 and 27 per cent of patients respectively. Twenty-two per cent of chest radiographs were normal. Liver function tests were of little diagnostic value and hepatic imaging techniques often gave normal results. Acid-fast bacilli, caseation and coexistent liver disease were detected in 59, 51 and 37 per cent of patients respectively. Since there was no consistent clinical pattern a high index of suspicion is necessary if this disease is to be detected in communities in which tuberculosis is endemic. In patients with unexplained hepatomegaly or hepatosplenomegaly or pyrexia of unknown origin liver biopsy provides the only means of making this diagnosis.
An indian woman with pulmonary alveolar proteinosis whose symptoms, chest radiograph and pulmonary function tests remain unchanged 3 years after diagnosis is described. A brief discussion of this rare disease is also presented.
A patient with multiple osteolytic metastases--ribs, pelvis, spine, skull and mandible--from carcinoma of the prostate is described.
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.
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.
Captopril (Capoten; Squibb) 100 mg was given as once-daily monotherapy in 20 patients with hypertension and hyperuricaemia. Ten patients (group A) maintained a low-sodium diet (60-100 mmol/d) throughout the study and 10 (group B) continued their usual high-sodium (200-300 mmol/d) diet. After 4 weeks of active treatment supine blood pressure in group A decreased from 192 +/- 5/119 +/- 3 mmHg to 144 +/- 3/95 +/- 3 mmHg (P less than 0,001), whereas pressures in group B varied between 168 +/- 5/115 +/- 3 mmHg and 160 +/- 6/113 +/- 4 mmHg (not significant). Serum urate values fell from 0,46 +/- 0,02 mmol/l to 0,35 +/- 0,02 mmol/l (P less than 0,001) and 0,53 +/- 0,02 mmol/l to 0,46 +/- 0,03 mmol/l (P less than 0,05) in the same groups. Captopril exerted an antihypertensive effect in patients receiving a low-sodium diet, suggesting a relationship with angiotensin II and/or aldosterone; effects on serum urate levels appeared to be independent of diet.
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A young Zulu man was admitted for investigation of anaemia, jaundice and fever. He had a haemolytic anaemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency and typhoid fever. Reports on haemolysis as a complication of typhoid fever in patients with G6PD deficiency are exceedingly rare in countries where the gene frequency of G6PD deficiency is low.
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This review discusses the use of antihypertensive drugs in acute and long term treatment of hypertensive disorders of pregnancy, including their placental transfer and adverse effects on the fetus. All antihypertensive agents cross the placental barrier and are present in varying concentrations in the fetal circulation, with varying resultant effects on fetal metabolism. Antihypertensive drugs that are lipid soluble will pass through the placental barrier with ease whereas the most polar will not. Placental transfer diminishes under conditions that decrease the surface area or increase the thickness of the placenta. Highly protein-bound drugs form complexes which impair placental transfer while unbound drugs cross the placenta easily. The ionised drug form is highly charged and cannot cross lipid membranes while the un-ionised form can easily cross the placenta. A decrease in placental blood flow can slow down the transfer of lipid soluble drugs to the fetus. Close monitoring of the fetal and maternal condition is necessary for the rest of the pregnancy after antihypertensive therapy is commenced. Methyldopa is the initial drug of choice for long term oral antihypertensive therapy in pregnancy. Neither short term nor long term use of methyldopa is associated with adverse effects. In the short term (<6 weeks) beta-receptor antagonists are effective and well tolerated provided there are no signs of intrauterine growth impairment. ACE (angiotensin converting enzyme) inhibitors are contraindicated in the second and third trimesters of pregnancy because they are teratogenic. Intravenous dihydralazine is widely used for rapid reductions of severely elevated blood pressure. The use of nifedipine concurrently with MgSO4 must be approached with caution because the combination is associated with severe hypotension, neuromuscular blockade and cardiac depression. In the last decade, knowledge of antihypertensive drugs used in pregnancy has improved and new drugs, e.g. calcium antagonists, which have been shown to have great potential for use in pregnancy, have been introduced. Safety for the fetus with newer drugs has not yet been adequately evaluated. Currently, well established and cost effective drugs such as methyldopa (long term use) and intravenous dihydralazine (rapid reduction) are the agents of choice to treat hypertensive disorders of pregnancy.