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In two ecologically dissimilar locations in Machakos District, Kenya, investigations were carried out on the nutritional state of infants, pre-school children and mothers in two different seasons. The methods applied and findings on the specific age groups are reported elsewhere. The results presented are observations made on factors conditioning the pattern of foods and food availability, food consumption, and household economy. In the year of study, harvests were fair. Corresponding, qualitatively good diets were observed in the two areas during both seasons. The relatively well-off households of small farmers in a mixed economy on the West side, consumed daily maize and beans only partly derived from their own fields. Household incomes, farm-and non-farm alike, were spent largely on the purchase of additional staple foods and milk, vegetables, fat and sugar. The poorer households in the Eastern part derived their daily foods (maize, legumes and milk) for the most part from own production; vegetables, fat and sugar were purchased and required a relatively large part of total income. In spite of the satisfactory food intake pattern, the latter people remain in a vulnerable situation; years of crop failure regularly occur and total income does not allow for increasing expenditure. Similarities and differences in respect of the food pattern now and half a century ago are described. Future prospects and constraints are discussed.

Breastmilk yields and its composition during the first 6 months of lactation were measured in 46 women with low weight-for-height during the third trimester of pregnancy (WH minus group) and in 52 mothers with good weight-for-height in the same period (WH plus group). On average WH minus mothers produced 695 g per 24 hours and WH plus mothers 790 g. In the WH minus group yield was affected by feeding frequency, season, mother's energy intake during lactation and infant's weight-for-age. In the WH plus group feeding frequence, parity and sex were the affecting variables (male infants consumed more milk). The difference in yield between WH minus and WH plus mothers corrected for feeding frequency, sex and season was significant but was only 80 g per 24 hours. Protein and lactose concentrations in milk were in both groups comparable with that of British mothers, fat concentrations were lower.

"Skip areas" in focal steatosis describes a newly proposed "subsegmental type" of focal steatosis, which differs in both extent and topography from the more classic "lobar or segmental type" of focal steatosis. In the subsegmental type of steatosis, fatty infiltration can be considered homogeneous throughout the liver, with the exception of small flattened portions of less affected parenchyma, called "skip areas." These regions are mainly located in the subcapsular areas or along the interlobar fissures or the gallbladder bed. Observations using ultrasound in vivo, as well as on postmortem in vitro angiograms, suggest that both the extent and topography of these skip areas can be explained by local differences in vascular anatomy.

The predictive value of piecemeal necrosis (PMN) in acute hepatitis was investigated in 62 patients (39 hepatitis B virus infection, 9 hepatitis A virus infection and 14 possible hepatitis NANB virus infection). The 62 initial biopsies were blindly recoded and classified into three groups: 1. Acute hepatitis with signs of possible transition to chronicity (AHTC) (n = 35) (i.e. a picture of acute hepatitis associated with PMN). 2. AHTC-borderline group (BL) (n = 15) (i.e. a picture of acute hepatitis with minimal PMN). 3. Uncomplicated acute hepatitis (AH) (n = 12) (i.e. a picture of acute hepatitis without PMN). Follow-up of the patients revealed an evolution to chronicity in a very high percentage of the AHTC-cases of hepatitis B (95%) and NANB (89%) etiology. Also 67% of the BL-cases of hepatitis B etiology developed chronic liver disease. In hepatitis B the immunohistochemical pattern of HBsAg is of additional help. In hepatitis A, PMN is often present (5/9) but no evolution to chronicity was observed. This study shows that PMN in acute hepatitis appears to be a useful prognostic feature for chronicity in hepatitis B and NANB.

The early occurrence of peritoneal signs and hyperamylasemia in a 14-year-old boy, who had fallen off his horse, urged us to perform a sonographic and computed tomographic study of the upper abdomen. Both examinations showed a complete pancreatic rupture. Distal pancreatectomy led to a rapid and uneventful recovery.

A patient is described who developed severe retrosternal pain and dysphagia immediately after sclerotherapy of esophageal varices. Extensive submucosal bleeding of the esophageal wall was demonstrated radiologically and endoscopically. This lesion resolved within 2 weeks of conservative treatment.

Infant feeding practices, breastmilk and food intake and post-natal growth in Madura, East Java, Indonesia and Machakos, Kenya are described. Breastfeeding is commonly practised. Additional foods are introduced the first week post-partum in Madura and at age 2-3 months in Machakos. Growth started to falter at 2-3 months in Madura but was acceptable during the first 6 months in Machakos. It was felt that apart from breastfeeding and morbidity, other factors pertaining to mother's perceptions about what infants should eat and her possibility to make suitable weaning foods, should be considered to understand the background of growth faltering.

Postoperative bile duct obstruction with subsequent stone formation and infection led to atrophy of the ipsilateral lobe and portal vein obstruction, which promoted further atrophic changes. The compensatory increase in hepatic arterial blood flow resulted in an early enhancement of the atrophic lobe on CT after intravenous contrast medium injection.

A simplified method, the Agar Immersion Plating and Contact (AIPC) slide technique was applied for the bacteriological examination of children's dishes and drinking water in Machakos District, Kenya. A total of 214 samples, collected from 106 households, were examined for degree of colonization by Enterobacteriaceae (E) and Staph. aureus (ST). Fourty four percent of the dishes and two percent of the water samples were unsafe with respect to Enterobacteriaceae. In 12% of the dishes and none of the water samples Staph. aureus occurred at levels above the threshold of acceptability. Colonization increased with storage time. Implications of these results in relation to diarrhoea morbidity patterns among young children are being investigated elsewhere.

A patient with biliary ascariasis was observed. The diagnosis was strongly suggested on endoscopic cholangiography. X-ray examination of the small bowel confirmed intestinal infestation and the stools were positive for ascaris lumbricoides. The incidence, symptomatology, diagnostic features, complications and therapy of biliary ascariasis are briefly discussed.

The effects of thyroidectomy and of thyroid hormone administration on the hepatic transport of endogenous bilirubin were investigated in the Wistar R/APfd rat. Hypothyroidism resulted in an enhanced hepatic bilirubin UDP-glucuronosyltransferase activity and in a decreased p-nitrophenol transferase activity. It caused a cholestatic condition with a 50% decrease in bile flow and bile salt excretion, and an increased proportion of conjugated bilirubin in serum. The biliary output of unconjugated and monoconjugated bilirubins decreased in parallel by about 65%, whereas the excretion rate of the diconjugate dropped by only 47%, resulting in an increased di- to monoconjugate ratio in bile. Hyperthyroidism was characterized by a decreased bilirubin and an increased p-nitrophenol transferase activity, and by an augmented bilirubin output in bile. The output of unconjugated and monoconjugated bilirubins increased in parallel by about 50 or 100%, whereas the excretion of the diconjugate increased by only 20 to 50%, depending on the dose of thyroxine administered; this resulted in a decreased di- to monoconjugate ratio in bile. A linear positive relationship was found between bilirubin UDP-glucuronosyltransferase activity and the ratio of bilirubin di- to monoconjugates present in bile or formed by in vitro incubation of liver homogenates at low concentration of bilirubin (10 to 15 microM), indicating that bile pigment composition is mainly determined by the conjugation activity in the liver. The inverse relationship observed between hepatic beta-glucuronidase activity and the ratio of di- to monoconjugates in bile warrants further investigation to analyze whether this enzyme activity also plays a possible role in the changes in bile pigment composition in hypo- and hyperthyroid rats.

A marked difference in echogenicity between the anterior and posterior parts of the pancreatic head was demonstrated by pancreatic ultrasound in 4 patients. This finding could not be related to local pancreatic or peripancreatic pathology. In all patients the dorsal portion of the head, including the uncinate process, appeared less echogenic than the ventral part of the head, body, and tail. The level of demarcation was identical in all 4 cases, coinciding with the expected fusion line of the embryological dorsal and ventral pancreatic origin. Pathology available in 1 patient showed an uneven lipomatosis as an explanation for this hitherto unreported observation.