Coronary heart disease risk factors in a rural and urban Orange Free State black population.

OBJECTIVE: To determine and compare the prevalence of ischaemic heart disease (IHD) risk factors in a rural and an urban black population. DESIGN: A survey to determine the prevalence of hypertension, diabetes mellitus, smoking, obesity, central obesity and dyslipidaemia in black subjects 25 years and older. SETTING: The indigenous black populations of QwaQwa and Mangaung. PARTICIPANTS: A random sample of 950 households was selected from each area. From each household an unrelated male and/or female subject was selected in a standardised way. From QwaQwa 853 subjects (279 men and 574 women) and from Mangaung 758 subjects (290 men and 468 women) participated in the study. The response rate was 68% and 62% respectively for QwaQwa and Mangaung. MAIN OUTCOME MEASURES: Few urban-rural differences in the prevalence of IHD risk factors were found in this study. A low prevalence of clustering of major IHD risk factors was noted. RESULTS: The age- and sex-adjusted prevalences of hypertension were 29% in QwaQwa and 30.3% in Mangaung. Diabetes was present in 4.8% of the QwaQwa sample and 6% of the Mangaung sample. The prevalence of heavy smoking in the Mangaung sample was almost double that of the QwaQwa sample and mostly confined to men. High-risk hypercholesterolaemia was present in 12.5% of QwaQwa and 6% of Mangaung men in the 25-34-year age group. The corresponding figures for moderate-risk hypercholesterolaemia were 34% and 44.8% and both levels of risk declined with increasing age. The mean body mass index of women in both samples exceeded 25 kg/m2. CONCLUSION: All the elements for a potential epidemic of atherosclerotic cardiovascular disease are present in the study populations. The similarity of findings in the two samples may be indicative of the advanced stage of urbanisation and westernisation of the rural group. It is alarming that subjects in the younger age groups tended to have the highest prevalences of moderate and even high-risk hypercholesterolaemia.

Diabetes mellitus, pulmonary tuberculosis and chronic calcific pancreatitis revisited.

The prevalence of chronic calcific pancreatitis (CCP) was determined in 25 successive patients with both diabetes mellitus and newly diagnosed pulmonary tuberculosis. Twenty patients (80%) were alcoholics and all were black. Of these, 9 (45%) had CCP. In only 3 of these 9 patients was the history compatible with the condition diagnosed. Clinical steatorrhoea was absent in the patients with CCP. Pulmonary tuberculosis was extensive with major involvement of three or more lung zones in 36% of patients. Mainly basal involvement of the lungs was present in 8% of patients.

Ophthalmoscopy versus non-mydriatic fundus photography in the detection of diabetic retinopathy in black patients.

The contribution of non-mydriatic fundus photography in the detection of diabetic retinopathy before and after dilatation of the pupils in black diabetics was investigated and compared with direct ophthalmoscopy. Eighty-six patients were examined and good-quality photographs were obtained for 54.7% of eyes before and 86.6% of eyes after dilatation. Photographically documented retinopathy was detected by ophthalmoscopy in only 64.7% of eyes. The two methods were concordant for the presence of retinopathy in 62.2% of eyes before and 56.9% of eyes after dilatation. Photography through dilated pupils also improved the rate of detection of diabetic retinopathy from 24% to 30%. The 45 degrees non-mydriatic fundus camera was found to be a valuable adjunct in the detection of diabetic retinopathy in a busy diabetic clinic.

Autonomic neuropathy and atypical myocardial infarction in a diabetic clinic population.

The incidence of autonomic neuropathy in 52 insulin-dependent and 87 non-insulin-dependent diabetic subjects was studied as well as the relationship between the type and duration of diabetes, metabolic control and the association of atypical infarctions with autonomic neuropathy. No statistically significant relationship was found between any parameter and the presence of autonomic neuropathy. Atypical infarctions were not confined to subjects with autonomic neuropathy, but the incidence was considerably higher than that in the general population. Position of the infarction did not determine whether it was silent or not. It is suggested that physicians should be alert to the occurrence of silent infarctions in all diabetics and not only those with clinical evidence of autonomic neuropathy.

Systemic nodular panniculitis (Weber-Christian disease) in a black woman. A case report.

There are many causes of panniculitis and systemic nodular fat necrosis; Weber-Christian disease is one of the rarer forms. A 47-year-old black woman with Weber-Christian disease is described and the aetiology, pathology and clinical manifestations of the disease are discussed.

Ultrasonography in the localization of parathyroid adenomas.

The use of ultrasonography in the diagnosis of a parathyroid adenoma is described, and the limitations and advantages of this method are discussed.

Wermer's syndrome. A case report.

Wermer's syndrome (or multiple endocrine adenomatosis type I) is a hereditary condition characterized by tumours or hyperplasia involving multiple endocrine organs. Most commonly the pituitary and parathyroid glands and the pancreas are involved. We record a further case, the patient presenting with acromegaly due to a pituitary adenoma, hypercalcaemia due to a parathyroid adenoma and peptic ulceration.

Glycosylated haemoglobin, blood glucose and serum cholesterol levels in diabetics treated with guar gum.

The diet of 10 insulin-dependent diabetics was modified for 3 months by the addition of guar gum to buttermilk rusks. Control of glycaemia was assessed by serial determination of total glycosylated haemoglobin A1. The effect of guar on serum cholesterol levels was noted. Guar gum supplementation failed to improve the long-term diabetic control, but significantly reduced serum cholesterol levels (P less than 0,01). The effect of guar on lipoprotein levels should be investigated more fully.

Pituitary fossa volume in primary hypothyroidism.

Pituitary enlargement can occur in primary hypothyroidism. Pituitary volume determination in 20 cases of primary hypothyroidism showed pituitary fossa enlargement in 25% of the patients, with close correlation to highest serum thyrotropin (TSH) levels. Normalization of TSH serum levels should prevent hypertrophy of the thyrotropic cells.

Touraine-Solenti-Golé syndrome. A case report.

Touraine-Solenti-Golé syndrome, characterized by familial acromegaly without the implication of growth hormone in the genesis, and by pachydermia, is reported in a woman aged 62 years with the classic manifestations of acromegalic diabetes, but with no thyroid or lung diseases. The syndrome is discussed, and is followed by a clinical description of our patient.

Iodide-trapping defect of the thyroid. A case report.

We describe a grossly hypothyroid 50-year-old woman, mentally retarded since birth. On the basis of her history of recurrent goitre, absence of 131I neck uptake and a low saliva/plasma 131I ratio, congenital hypothyroidism due to a defect of the iodide-trapping mechanism was diagnosed. Other family members studied did not have the defect.

Failure of pyridoxine to suppress raised serum prolactin levels.

Pyridoxine has been reported as having an antilactogenic effect, presumably by suppressing prolactin secretion. We have measured serum prolactin levels during pyridoxine administration in two groups of hyperprolactinaemic subjects. In normal postpartum women, the postdelivery fall in serum prolactin levels did not differ significantly in treated and control subjects. In patients with chlorpromazine-induced hyperprolactinaemia and galactorrhoea, pyridoxine did not reduce the elevated levels. In neither group was milk production suppressed.