South African Medical Journal - Volume 26, Issue 7, February 1952

*Paper read to the Baragwanath Hospital Medical Society, Johannesburg, on 24 September 1951. Post-bulbar ulcers tend to occur at a later age than the classical duodenal ulcer. The male sex is affected to a greater degree than the female and roughly in the same proportion as that of a classical duodenal ulcer. The history in most cases is prolonged. The presenting symptoms are usually pain, periodicity of this pain is notoriously absent and a tendency to radiate through into the back is a constant and important symptom in the diagnosis. Haematemesis and melaena are frequent occurrences and may be the presenting symptoms. Any case of symptomless haematemesis should be carefully scrutinized for the possibility of a post-bulbar ulcer. Too often in the investigation of such cases great attention is directed to the duodenal cap and the stomach but the post-bulbar region of the duodenum is comparatively neglected. The radiological demonstration of these ulcers in the post-bulbar portion of the duodenum calls for a considerable modification in the ordinary technique of a barium meal. Compression studies taken in the erect position are seldom as helpful as films taken in the right lateral and slightly off the prone position to demonstrate the whole length of the pars superior of the duodenum. The treatment of the post-bulbar ulcer is essentially surgical.

(Concluded from p. 118) A descriptionption has been given of a disease of doubtful aetiology which occurred in epidemic form in Salisbury, Southern Rhodesia, during 1950-51. Clinical and pathological data are given on 65 cases that were observed during a period of nine months. The age incidence varied from 2t to 12 years with a preponderance in the pre-school age group. The disease commenced usually with recurrent sore throats. The illness was characterized by prolonged elevated temperature, general ill health, marked pallor, central abdominal pain and occasional joint pains. There was a notable absence of physical signs and laboratory tests were uninformative, apart from a raised erythrocyte sedimentation rate. The differential diagnosis has been discussed and it was concluded that the children had probably suffered from one of the sequelae of streptococcal infection-the poststreptococcal state.

(Concluded from p. 104)