Ulcerative colitis in the Indian population of Durban.

This study on ulcerative colitis in the Indian population of Durban between 1983 and 1987 revealed an incidence of 2,7/100,000 per year. Patients tended to have clinically mild-to-moderate disease, with macroscopic examination showing moderate severity and either extensive or total involvement. No relationship was found between clinical, macroscopic and laboratory indices of severity and extent of disease. The only relationship between laboratory tests and severity was that patients with low albumin values were more likely to have clinically severe disease. Extra-intestinal manifestations were rare, but many patients had liver involvement and colonic strictures. Ulcerative colitis was diagnosed more frequently than tuberculosis of the bowel during the study period, and amoebic dysentery was rarely diagnosed.

Gastric carcinoma in Durban's Indian population.

Histologically proven gastric carcinoma was studied to establish the incidence and pattern of the disease in the Indian population of Durban. The incidence in this population was found to be low, 6.9/100,000/year. Over a 7-year period (1980-1986) 115 patients were treated for gastric carcinoma at R. K. Khan Hospital. There was a male preponderance, and the average age at presentation was 56 years. The commonest presenting symptoms were dyspepsia and vomiting, and the majority of patients presented with advanced disease. Only a third underwent resection, a third had no treatment, and a third underwent palliative bypass or laparotomy only. The majority of patients who had a palliative bypass or no treatment died within 9 months. The 5-year survival rate for patients undergoing curative resection was 38% and for palliative resection 9%. To improve survival, emphasis must be on early diagnosis and it is recommended that any patient with dyspepsia who is over the age of 30 years should have an endoscopic investigation.

Sialidosis type I: first report in the Indian population. A clinical, biochemical and electrophysiological study.

Sialidosis type I has been described in several ethnic groups but to the best of our knowledge has not been reported in Indian families. We report on the clinical, biochemical and electrophysiological features in three siblings born to parents of South Indian origin. The diagnosis was missed for two years as they were labelled as cases of Ramsay-Hunt Syndrome.

Hepatocellular carcinoma in South African Indians resident in Natal.

Hepatoma is a rare disease in Natal Indians. It occurs in male patients in the fifth decade. They have no history of alcohol intake. The main presenting feature is abdominal pain, weight loss and hepatomegaly. Blood tests reveal a raised alkaline phosphatase, hypoalbuminaemia, hypergammaglobulinaemia and markedly raised gamma glutamyl transferase. The tumour is a single large expanding mass in the right lobe. The patient usually presents in a late stage of the illness and shows a progressive downhill course. Hepatitis B virus infection is emerging as the likeliest carcinogen.

Typhoid fever in the adult and paediatric Indian population of Durban.

The features of typhoid fever in Indian South Africans are described. In children the illness was usually uncomplicated. However, anaemia, thrombocytopenia and hypo-albuminaemia were found in both adults and children. The initial symptoms on presentation of diarrhoea and vomiting frequently led to a misdiagnosis of gastro-enteritis. The previous administration of antibiotics also resulted in failure to isolate Salmonella typhi in 41% of patients studied. Typhoid acquired in the microbiology laboratory and that seen in visitors returning from India and the Far East is emphasised. The S. typhi isolates were uniformly sensitive to all antibiotics tested. The disproportionately high number of Indians of south Indian ancestry presenting to the R. K. Khan Hospital needs to be investigated.

Dystonia and choreo-athetosis in Wernicke's encephalopathy. A case report.

An Indian man with Wernicke's encephalopathy had nystagmus, pupillary changes and confusion, but the unusual and prominent features in his presentation were marked dystonia and choreo-athetosis, which responded rapidly to thiamine. The possible pathogenesis is discussed.

Patterns of cirrhosis in Natal Indians.

A retrospective study was designed to analyse the mode of presentation, clinical signs, haematological, biochemical and histological features in 46 Indian patients admitted with cirrhosis to R. K. Khan and King Edward VIII Hospitals, Durban, between 1977-1981. The commonest presenting feature was swelling of the body followed by pain in the right upper quadrant, most patients had hepatomegaly, jaundice and ascites, and splenomegaly was detected in one-third of cases. Biochemical investigations indicated that most patients had a high globulin and low albumin concentration. Liver function tests revealed raised bilirubin and gamma-glutamyltransferase values in most cases. On histological examination, micronodular cirrhosis predominated (95%) with a high incidence of fat and iron deposition. Changes consistent with alcoholic hepatitis were superimposed in one-third of cases while immunological and viral markers were absent. This study suggests that alcohol is the predominant cause of cirrhosis in Natal Indians.