A survey of admissions and deaths in a black paediatric department

Patterns of paediatric illness in hospital were surveyed with a view to planning for improved community health services. High morbidity and early mortality from neonatal, nutritional, gastro-intestinal and respiratory disease reflected late referral to hospital of seriously ill children. Combined preventive, promotive and primary care clinics, health education and improved transport facilities for the sick are a high priority for the area.

Neonatal Listeria monocytogenes meningitis. A case report

The clinical presentation, bacteriological results, treatment, and outcome of Listeria monocytogenes meningitis in a newborn infant are described. The neonatal listeriosis was of the late-onset variety, and the infant survived the infection, but hydrocephalus, which necessitated operative relief, developed. Although 2 cases of Listeria meningitis have previously been described in South Africa, and opportunistic listeriosis is known to occur here, this is apparently the first documented case of neonatal listeriosis in this country.

Diffuse brain damage of immediate impact type. Its relationship to 'primary brain-stem damage' in head injury

In a neuropathological analysis of 151 fatal non-missile head injuries, there were 19 cases with focal lesions in the dorsolateral quadrant of the brain-stem in the corpus callosum, and histological evidence of diffuse damage to white matter. Eight of these cases had not experienced a high intracranial pressure during life. All 19 cases had been rendered unconscious at the moment of impact and had remained so or in the persistent vegetative state until death. It is therefore concluded that diffuse damage to white matter may occur as a primary event at the moment of impact, that is, it is one type of immediate impact damage to the brain. It is also concluded that this type of damage is the pathological basis of 'primary brain-stem injury' since in no patient thought clinically to have sustained 'primary brain-stem injury' were abnormalities confined to the brain-stem. Since no patient with this type of brain damage recovered consciousness after injury, it is probable that diffuse damage to white matter is the most important single factor governing the outcome in a patient who sustains a non-missile head injury.

Spectinomycin versus tetracycline for the treatment of gonorrhea

Spectinomycin and tetracycline are alternative drugs to penicillin in the treatment of gonorrhea. To compare the efficacy of these agents and their propensity to select resistant gonococci, we treated 4043 patients randomly with either 2 or 4 g of spectinomycin once or 9 g of oral tetracycline for four days. Minimum cure rate for anogenital gonorrhea was 94 per cent with either drug. Oropharyngeal infection responded poorly to spectinomycin in men, with failure of therapy in six of 11. Postgonococcal urethritis in men was less common after tetracycline than after spectinomycin (P less than 0.005). Spectinomycin failure was not related to drug resistance. Tetracycline failure correlated with resistance (P less than 0.0002); one fifth of the isolates resistant to 1.0 mug per milliter of tetracycline were not eradicated. For several reasons, including the appearance of beta-lactamase-producing gonococci, it is no longer clear that penicillin G is the "drug of choice" for gonorrhea. Spectinomycin and tetracycline are equally acceptable alternatives, each with distinct advantages and disadvantages.

Creutzfeldt-Jakob disease: further similarities with kuru

A typical case of Creutzfeldt-Jakob disease is described. Two unusual morphological features-namely, `kuru-like' plaques in the cerebellum and coarsely vacuolated neurones in the striatum-are further similarities between Creutzfeldt-Jakob disease and kuru.

The histological accuracy of the smear technique for neurosurgical biopsies

✓ The preparation of smears from neurosurgical biopsy material is one technique by which a rapid diagnosis may be made available to the neurosurgeon. This technique is particularly appropriate for the small soft pieces of tissue obtained by needle biopsy. The 190 consecutive smear biopsies examined in this Institute during 1971 were reviewed and compared with subsequent paraffin sections of the same biopsies. In 94% of cases the correct diagnosis was obtained from the smears. Most of the errors stemmed from failure to distinguish between different types of malignant tumor. It is suggested that the smear technique is the most appropriate available for rapid neurosurgical diagnosis.

"Idiopathic" thrombosis in the vertebrobasilar arterial system in young men

Two young men died as a result of cerebellar infarction due to thrombosis in the vertebrobasilar arterial system in the absence of atheromatous stenosis, other identifiable intrinsic arterial disease, or embolism. In each case the swollen cerebellar infarct had produced tonsillar herniation and hydrocephalus.