Autopsies and medical records.
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Biomedical subjects
Publications and source records attributed to H M Cameron.
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A survey of significant pathological abnormalities of liver in the first two decades of life is presented; this is based on biopsy and autopsy specimens received in the histopathology service in Nairobi over five years. It includes conditions which one might expect in a diagnostic service in any country, some of which are attributable to known local conditions, and others which show distinctive features in their occurrence of frequency. There is an unexpected number of cases of chronic aggressive hepatitis and cirrhosis and the latter is notable for its frequency in the first decade of life. Hepatocellular carcinoma also occurs rather commonly, although most often in the second decade and as a complication of cirrhosis. There is a marked male preponderance in chronic aggressive hepatitis, cirrhosis, hepatocellular carcinoma and schistosomiasis. It is unlikely that this is due to selection of cases and the series shows no indication of tribal influence. The possible role of infections and toxins, particularly in the genesis of chronic aggressive hepatitis and cirrhosis, is discussed. In the search for clues to pathogenesis, detailed systematic investigation of children with liver disease is advocated, paying particular attention to cultural background, and exposure to infections and toxic agents.
Fifty Kenyan patients with chronic liver disease or hepatocellular carcinoma were tested for hepatitis B surface antigenaemia by radioimmunoassay. The hepatitis B surface antigen was detected in 77% of the patients with chronic persistent or chronic aggressive hepatitis, or cirrhosis confirmed by liver biopsy, compared with 15% in a control group. All six patients with hepatocellular carcinoma had detectable hepatitis B surface antigen or antibody. 50% of the controls had hepatitis B surface antibody in their plasma detectable by haemagglutination. Auto-immune associated liver disease appeared infrequent. The possibility that the hepatitis B virus is an important cause of cirrhosis in Kenya is discussed.
One-hundred and eight blood donors found to have hepatitis B antigenaemia have been examined for evidence of liver disease. In five the liver was enlarged, and in six apparently normal donors there was histological evidence of disease. One or more tests of liver function were abnormal in an additional fifty-three donors without definite evidence of disease. Estimation of serum transaminases was the most reliable test and we recommmend that these be measured in all antigen-positive donors.
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The adult nephrotic syndrome as met with in Nairobi is predominantly encountered in young sophisticated African women, most of whom began to use skin-lightening creams containing mercury before the symptomatic onset of their illness. The particular form of mercury involved is well known to cause the nephrotic syndrome in other circumstances-for example, when applied to the skin in the treatment of psoriasis. In these circumstances the pathogenetic mechanism is thought to be of an idiosyncratic type. The use of mercury-containing skin-lightening creams in the patients studied seemed to be particularly associated with a "minimal-change" ("light-negative") renal glomerular lesion, this lesion being present in half of the patients. The prognosis in this group of patients seems remarkably good, with 50% entering remission, 77% of these doing so spontaneously on discontinuing the use of the creams.
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