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The levels of insulin antibodies were determined in 68 diabetic patients on insulin treatment and 30 normal subjects. Fifty (73.5%) of the patients had low levels of insulin antibodies (less than 20%), twelve (17.7%) had moderate levels (between 20 and 40%) while the remaining six (8.8%) had high antibody levels (greater than 40%). There was poor correlation of insulin antibody level with insulin dose (r = 0.16, p less than 0.1) and with duration of disease (r = 0.19, p less than 0.5). Where high levels of antibodies were detected the problems encountered in treating the patients with highly purified insulin preparations are discussed.

The insulin secretory capacity of three groups of Nigerian African diabetics was assessed by measuring the concentration of C-peptide before and after stimulation with oral glucose. Group 1 subjects had a history of keto-acidosis and were treated with insulin. Those in group 2 had no history of keto-acidosis but required insulin to normalize blood glucose while those in group 3 also had no history of keto-acidosis and were treated with diet alone or in combination with oral hypoglycaemic drugs. C-peptide levels (mean +/- s.e.m.) showed group 1 subjects to be insulin deficient (fasting 0.08 +/- 0.04 pmol/ml, peak 0.14 +/- 0.03 pmol/ml), group 2 to have reduced insulin secretion (fasting 0.16 +/- 0.01 pmol/ml, peak 0.35 +/- 0.01 pmol/ml) and group 3 to have a moderately reduced fasting insulin and a higher peak insulin secretion (fasting 0.27 +/- 0.03 pmol/ml, peak 1.49 +/- 0.4 pmol/ml) compared with a non-diabetic control group (fasting 0.30 +/- 0.03 pmol/ml, peak 1.16 +/- 0.1 pmol/ml). Although the aetiology of diabetes in the Nigerian African is unclear, a spectrum of the disease exists which is similar to that in Caucasian population.

Kallikrein excretion was measured by the esterase activity of precipitated urinary proteins. There was a highly significant correlation between sodium excretion and kallikrein excretion in normal subjects. The same was true of patients with essential hypertension adjusting to a low-salt diet. Patients with renal failure had a greatly increased excretion of kallikrein which was related to the sodium excretion per ml. of glomerular filtrate. During the escape from the sodium-retaining effect of fludrocortisone there was a sharp rise in kallikrein excretion. This may be the mechanism by which the " escape " is brought about. A water-load of one litre caused a pronounced rise in kallikrein excretion without a change in sodium excretion. The data show that the kidney has two relatively independent mechanisms related to kallikrein excretion: one in response to a water-load and the other in response to a salt-load. Kallikrein might be the intrarenal hormone released in response to changes in the pressure distal to the afferent arteriole which regulates sodium excretion per nephron.

Summary Developing countries like developed ones need highly skilled medical personnel, referred to as ‘specialists’. In the case of developing countries, the training of these specialists abroad is expensive to the sponsoring governments, imposes a lot of hardship on the doctors and, above all, the coursecontent of such training takes little or no cognizance of the environment in which these doctors would later practise. The developing countries also cannot afford the loss of years in valuable services which the training abroad entails. Attempts are now being made to train specialists wholly or partly at home, in some developing countries. The approach is still not much divorced from what obtains in Britain and North America, that is, one of being trained on the job, with the onus for self-education being placed on the prospective students. Such students in most developing countries of tropical Africa have little or no facilities for further education outside their places of work. It is proposed that purpose-designed postgraduate medical schools may provide a temporary solution to specialist training in developing countries of tropical Africa. Such schools would in addition provide highly skilled medical service as well as obviate the need and the expense for the setting up of government sponsored medical research and training institutes.

A prospective cross-sectional study of 84 foot lesions in 50 diabetic patients was done in a Nigerian teaching hospital over a three-year period (1982-1984) to assess factors that may influence the choice of treatment and treatment outcome. Age, gender, duration of diabetes, mode of treatment of diabetes and tobacco smoking did not influence whether or not a diabetic with a foot lesion will have major amputation, an unsatisfactory outcome of primary treatment, prolonged hospital stay or will die. Similarly, the presence of foot infections alone, microangiopathy (nephropathy, retinopathy), foot ischaemia alone or neuropathy alone had no relationship to poor prognostic indices. However, when these complications appeared in concert (neuropathy, ischaemia and infection) and when, at presentation, there was associated systemic disease (as shown by anaemia and leucocytosis), severe fasting hyperglycaemia, evident bone destruction and anaerobic superinfection, the outcome of treatment was adverse. In addition, hypertension and infection of the foot were related to need for major amputation. Poor long-term control did not influence prognosis adversely. We therefore suggest that the high morbidity seen with diabetic foot lesions could be reduced by optimizing glycaemic control, using combination antibiotic chemotherapy, vigorously correcting anaemia and encouraging early presentation of even mild lesions before underlying bone disease supervenes.

Summary A case of pulmonary avleolar microlithiasis is reported. This is of especial interest as it is the first case to be reported from Africa South of the Sahara. The clinical presentation of the patient follows a similar pattern as that of cases already described by other workers. The diagnosis in this case was made in life by a combination of radiological examination and a lung biopsy. The clinical presentat on and aetiology of the condition are briefly discussed.

The socio-economic aspects of diabetes mellitus were studied, on random basis, in a group of 147 patients attending the diabetic out-patients' clinic of the University College hospital, Ibadan. The majority belonged to the low socio-economic class. Ignorance about diabetes mellitus was rife among the patients and their relations. The needs for an intensive public health education as well as more financial assistance to diabetic patients by the government are stressed.

Cow's urine concoction of different compositions were prepared by varying the quantities of the active materials: tobacco leaves (nicotiana tobaccum): leaves of occimum viride; rock salt and juice of citrus medica. These modified concoctions were tested for their acute toxic effects in mice by observing how many died as a result of their administration. Log.dose/response curves were plotted and from these curves, the L.D.50 values were obtained and the potency ratios calculated. It was shown that increasing the quantity of tobacco leaves resulted in increasing toxic effect whilst increasing the quantities of leaves of the occimum viride, rock salt and juice of citrus medica caused progressive decrease in the toxic effect of the concoction. The reason for the latter effect is obscure.

An analysis was carried out of the mortality rate on the medical wards of the University College Hospital, Ibadan, over a 14-year period (1960-73). A total of 4,568 cases were reviewed with an annual death rate of between 300 and 400. Most of the deaths resulted from cardiovascular diseases, especially hypertension, the mortality rate from which has shown no appreciable decline over the years. Death from cerebrovascular accident is steadily increasing. Infections contribute considerably to mortality from chest and alimentary tract disease, although there has been a progressive decline in mortality rates from infectious diseases such as tetanus and typhoid fever. The standard of death certification needs to be improved upon, especially with respect to the clarification of the primary and the contributory causes of death and whether post-mortem examination was carrie dout or not. It is suggested that more effort should be made to ensure that post-mortem examination is carried out in cases where there is doubt about the ante-mortem diagnosis unless such a request is specifically refused by the relatives of the deceased after explaining to them the value of such an examination to medical knowledge.

For the purposes of medical practice, a `rural setting' implies an environment with little or no facilities for the sophisticated laboratory investigations that may be needed for the diagnosis of certain endocrine disorders. Fortunately, however, most of the commoner endocrine disorders may be diagnosed from the patient's history and a physical examination, together if necessary with the observed response to therapy. A lack of facilities, therefore, need not hinder the effective practice of endocrinology in rural areas.

A 16-year-old female presented with severe chronic periodontitis and previously unsuspected diabetes mellitus. Her diabetes was mild initially. As the periodontitis improved with antibiotics, het diabetic control worsened because she was able to eat more. In the light of their personal observations and this case report, the authors believe there to be a direct association between diabetes mellitus and periodontitis.

Over a 9 months period, 675 old and new diabetic patients were examined in the medical outpatient department of the University College Hospital, Ibadan, to ascertain the prevalence of and relationship between hypertension and obesity. For the purpose of the study, the criterion for hypertension was diastolic blood pressure of 95 mmHg and above on three or more occasions, that for obesity was a body mass index of 28 and above. Of the 675 patients, 79 (11.7%) were obese hypertensives, 102 (15.1%) were non-obese hypertensives, 116 (17.2%) were obese normotensives and 378 (56%), non-obese normotensives. The total number of hypertensives was 181 (26.8%) and of obese patients, 195 (28.9%). A significant association between obesity and hypertension was found among the diabetic patients. The association was such that we feel greater efforts are required to curtail the growing number of obese and hypertensive diabetic patients. This is to combat the present trend of cultural and dietary changes in many African communities, tending to produce more overweight, hypertensive and diabetic problems.

A review was carried out on patients with acute drug poisoning managed over a five-year period, between 1968 and 1972 at the University College Hospital, Ibadan, Nigeria. Of the 139 cases, 23 were admitted for in-patient management while the rest were managed in the Emergency Department of the hospital as out-patients. The pattern of poisoning, clinical presentation and management were discussed, as well as suggestions for a more efficient management of similar cases, in the future.

Therapy of diabetes mellitus with oral hypoglycaemic agents is reviewed in 445 patients, excluding 18 patients who failed, primarily, to respond to these drugs. The findings are discussed with particular reference to the latent period between the onset of therapy and the observed response. It is probable that the more potent, newer oral hypoglycaemic drugs may help to remove this latent period or reduce its duration.

Insulin therapy was reviewed in 172 Nigerian diabetic patients. Insulin zinc suspension (IZS--lente) was the preparation most commonly used and therapy was free of side effects. Only a small number of the patients (students) had the problem of unrestricted physical activity and possibly irregular eating habits which might adversely influence insulin therapy. Although in the majority of cases, the age of onset of diabetes mellitus was under 21 years, insulin dependence covered a broad age spectrum. It was not possible to predict the severity of the diabetes from the age of onset. There was about equal chance that therapy might be changed from insulin to oral hypoglycaemic drugs or vice-versa.

A prospective cross-sectional study of 84 foot lesions in 50 diabetic patients was done in a Nigerian teaching hospital over a three-year period (1982–1984) to assess factors that may influence the choice of treatment and treatment outcome. Age, gender, duration of diabetes, mode of treatment of diabetes and tobacco smoking did not influence whether or not a diabetic with a foot lesion will have major amputation, an unsatisfactory outcome of primary treatment, prolonged hospital stay or will die. Similarly, the presence of foot Infections alone, microangiopathy (nephropathy, retinopathy), foot ischaemla alone or neuropathy alone had no relationship to poor prognostic indices. However, when these complications appeared in concert (neuropatby, ischaemia and infection) and when, at presentation, there was associated systemic disease (as shown by anaemia and leucocytosis), severe fasting hyperglycaemia, evident bone destruction and anaerobic superinfection, the outcome of treatment was adverse. In addition, hypertension and infection of the foot were related to need for major amputation. Poor long- term control did not influence prognosis adversely. We therefore suggest that the high morbidity seen with diabetic foot lesions could be reduced by optimizing glycaemic control, using combination antibiotic chemotherapy, vigorously correcting anaemia and encouraging early presentation of even mild lesions before underlying bone disease supervenes.

Studies were carried out on diabetic patients that came to autopsy, over a 15-year period between 1959-1974 at the university college hospital, Ibadan, Nigeria. The findings have shed some light on the natural history of diabetic illness in the nigerian african and are sufficiently interesting to warrant a more long term prospective study of similar cases that come to autopsy. They have shown that contrary to an earlier study Greenwood and Taylor (1968), the classical Kimmelstiel-Wilson's lesion of diabetic nephropathy is not as rare as these earlier observers had assumed and that some cases of "insulin resistance" may be associated with adrenal cortical adenomata.

A clinico-pathological review of the "long term" complications of diabetes mellitus was carried out on patients who have had the disease for over 10 years and are currently attending the diabetic outpatients' clinic of the University College Hospital, Ibadan and those who had been autopsied in the same hospital, after having had diabetes mellitus for over 10 years. The findings were discussed with a suggestion for further prospective studies using more sophisticated investigative technique to detect these complications at their earliest stages, during life.