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Patients with clinical brain death following head injury are important potential cadaveric organ donors. We analyzed our series of cranial gunshot wounds with particular attention to the frequency and patterns of organ donation after fatal injuries. Sixty-six patients with gunshot wounds to the head, including 59 with intracranial involvement (43 male, average age 26 years) were seen during a 4-year period. Injuries were limited to the head in 50 of 59 patients. Overall mortality was 66 per cent. Predictors of mortality included Glasgow Coma Scale (GCS) of six or less (93%), self-inflicted gunshot wounds (75%), and computed tomography (CT) findings of bihemispheric injury (87%) or ventricular injury (82%). Of the 39 patients who died, 28 met standard criteria for brain death, and nine of these went on to organ procurement. Thirteen families refused donation, and six patients were not harvested for reasons including old age, pregnancy, suspicion of AIDS, coroner refusal, and failure to pursue consent. Principles essential to maximal organ retrieval include: 1) Recognition that patients suffering cerebral gunshot wounds represent potential organ donors and that certain factors are predictive of mortality; 2) Critical care/trauma team approach with standardized management and timely declaration of brain death; 3) Early search for family members and prompt notification of organ procurement agencies; 4) Sensitivity to cultural issues influencing donation; and 5) Programs to increase public awareness of organ donation.

The accuracy and reliability of an invasive intra-arterial oxygen sensor catheter was evaluated in 20 critically ill surgical intensive care unit (SICU) patients. All patients required continuous arterial blood pressure monitoring, at least 72 hours of ventilator support, and intermittent arterial blood gas sampling for clinical management. The intra-arterial sensor provided continuous PO2 (PsO2) values on a bedside electronic monitor. PsO2 values were sampled every 60 seconds and automatically stored on a bedside personal computer. Arterial blood gas (ABG) PaO2 values were collected and matched by collection time with corresponding PsO2 values. During 1,238 hours of continuous intra-arterial monitoring, 74,280 PsO2 values and 246 ABG PaO2 values were collected. Of the 246 PaO2 results, 175 (71.3%) had a matching PsO2. Regression of matched PsO2 and PaO2 values yielded a correlation coefficient of 0.58 and standard error of the estimate (SEE) of 33.1 (P0.0005). Even though matched PsO2 and PaO2 measurements demonstrated a linear relationship, only 34 per cent of the variation in PsO2 could be attributed to changes in PaO2. Technical sensor or instrument problems affected PsO2 monitoring in 17 of 20 patients and 28 of the 33 sensors tested. The authors conclude that continuous intra-arterial monitoring of PsO2 is a novel idea, but technical issues limit its use in acutely ill, conscious SICU patients.

Subacute sclerosing panencephalitis can no longer be regarded as a rare disease in all parts of southern Africa. Information derived from a third postal survey added to that from our own experience in Cape Town has brought to light 116 cases; 61 of the patients came from the Cape Province, 40 from the Transvaal and the remaining 15 from the other regions. This unequal distribution and the high prevalence in the Coloured community are important factors in any attempt to understand the epidemiology and the pathogenesis of this serious complication of measles.

A first attempt to gather the available information on subacute sclerosing panencephalitis (SSPE) in Southern Africa has produced records of 79 cases which have occurred since 1955. An important feature of the epidemiology is the clustering of 48 cases in the 5-year period 1970-1974. Thirty of these patients were resident in the Cape Province, and most of them were from the Coloured community. An SSPE registry will be maintained at the MRC Virus Research Unit of the University of Cape Town and an appeal is made to all practitioners to contribute any relevant data on patients with this disease.

An analysis of cases of subacute sclerosing panencephalitis (SSPE) in Southern Africa to the end of 1976 is presented. In the 2 years since the last report in 1975, 15 new cases have been added to the register. Seven patients from the Cape Province were investigated in Groote Schuur and Red Cross War Memorial Children's Hospitals in Cape Town and a recent postal survey revealed 6 cases in the Transvaal and 1 each from South West Africa and Rhodesia. This analysis indicates that the high incidence and temporal clustering of cases in the Cape Province is continuing, and that the relatively constant annual number of cases in the Transvaal and the apparent absence of the disease in Natal and the Orange Free State are being maintained.