Tropical and geographical medicine最新文献

A review of 81 cases of testicular biopsies, done as part of the routine investigation for oligospermia or azoospermia amongst otherwise healthy Saudi males, was carried out at the King Khalid National Guard Hospital, Jeddah. The results showed that 42% of cases had normal seminiferous tubules with adequate spermatogenesis. When compared with similar series from the literature, the Saudi population had a higher rate, 27.2%, of Sertoli-cell-only syndrome, compared to a range of 7.9-15% from other series. Hypospermatogenesis, maturation arrest and diffuse tubular atrophy with interstitial fibrosis made up 3.7, 8.6 and 16.0% respectively. The significance of environmental factors, socio-cultural habits and consanguineous marriages as possible influencing factors are highlighted.

In this report, a case of colonic perforation caused by Taenia saginata is presented. Preoperative ultrasonographic examination showed a 'pseudokidney sign' suggestive of colonic carcinoma. Clinical and ultrasonographic appearance of this rare case and the possible perforation mechanism are discussed.

There is much confusion about the most effective malaria chemoprophylactic regimen for travellers to chloroquine-resistant areas. For residents, the problem is even more confused. A prospective, multicentre trial was performed between 1987 and 1989 to assess the efficacy of three different malaria chemoprophylactic regimens (chloroquine 300 mg weekly combined with proguanil 100 mg daily, chloroquine 300 mg weekly combined with proguanil 200 mg daily and proguanil 200 mg daily only) in Dutch expatriates, who were departing for a stay of more than one year in East, Central or Southern Africa. Prophylaxis failures (defined as Plasmodium falciparum present in the blood film) were distinguished from failures of compliance by measuring whole-blood drug levels, taken at the same time as the blood slide and sent as filterpaper blood spots. The data of 200 expatriates could be analysed; the overall response rate was 52%. Twenty-six (13%) suffered from a fever; in two of them the blood slide contained P. falciparum. One subject took chloroquine 300 mg weekly with proguanil 200 mg daily, the other 200 mg proguanil daily. Assessment of compliance was possible in 10 of the 26 subjects with a fever; five (50%) were below and five (50%) were above the limit of 0.19 mumol/l. Due to the low incidence of prophylaxis failures, calculation of risks is unreliable. There were strong indications that compliance decreased with time. The ultimate cooperation needed for confirmation of prophylaxis failures and breakthroughs failed. Several factors which could have contributed to this lack of cooperation are discussed.

A case-control study was carried out among 225 cases and 450 controls aged below 60 months between July and September 1991, with the aim of determining measles vaccine effectiveness (VE) under field conditions in Tabora region, Tanzania. VE was found to be 84% (95% confidence interval (CI) 61-93%) among children vaccinated between 9 and 59 months, and 73% (95% CI: 11-92%) in children vaccinated at the age of 6 to 8 months. Loosening the diagnostic criteria and/or establishing vaccination status from vaccine registers rather than Road to Health cards, lowered vaccine effectiveness results. The protective effectivity among children vaccinated from 6 months and above and those vaccinated from 9 months and above, was 79% (95% CI: 55-90%) and 84% (95% CI: 61-93%) respectively. A relatively higher VE was found in children vaccinated at rural health centres and hospitals, 89% (95% CI: 56-97%) compared with dispensaries, 70% (95% CI: 22-88%). It is high time for the current age at vaccination to be reviewed in the country. It should be noted, however, that the present observations and conclusions are based on a study of limited numbers of persons. Repetition at a large scale would seem indicated.

Seventy-two cases of pyomyositis are reported from the north-western highlands of Ethiopia. The majority (76.4%) came from highland areas over 1,800 meters above sea level. The clinical picture of the disease was similar to that seen in other East African countries. Staphylococcus aureus was recovered from 69 of 72 pus cultures. Spontaneous rupture of abscesses was seen in two cases. Four of the five deaths were assumed to be due to complications of the pyomyositis. Further search into non-altitudinal factors is implicated to get a better insight into the nature of the disorder.

Isolated myoclonus has rarely been reported as a complication of Plasmodium falciparum malaria. We describe the development of chaotic myoclonic jerks in an afebrile and conscious patient, the fourth day of treatment with quinine for P. falciparum infection. The myoclonus finally resulted in a generalized tonic-clonic seizure and coma, which resolved without further antimalarial treatment.

Plausible reversal of secondary amenorrhoea in three women infected with onchocerciasis after Mectizan treatment in Imo State, Nigeria, is presented. The women aged 30, 28, and 32 years with drastic reduction in mean microfilaria scores had reversed amenorrhoea 8, 13 and 10 days post Mectizan treatment, respectively. They had typical manifestation of onchocerciasis including nodules, pruritic rash, body itching and musculo-skeletal pains. The manifestations eased off 4 days post treatment. The plausible link between loss of fertility due to premature menopause in women and onchocerciasis is discussed.

Rupture of the urinary bladder which is not associated with instrumental or external trauma is uncommon. Two cases of spontaneous bladder perforation were seen in a district general hospital in the Ashanti region, Ghana. Both cases presented with the primary clinical picture of an acute abdomen suggestive of a ruptured viscus. At laparotomy pin-point perforations of the bladder were found to exist. The literature is reviewed with particular reference to the possible pathogenesis within a tropical setting.

Subjects infected with the adult worms of Oesophagostomum bifurcum, diagnosed through semiquantitative detection of characteristic third stage larvae, were treated in the middle of the dry or in the middle of the rainy season with two different dosages of albendazole. A third group was not treated. The pattern of reinfection after treatment was analysed. Transmission of Oesophagostomum infection appeared to be limited to the rainy season and the rate of reinfection was independent of the dose of albendazole received. The impact on transmission of developing stages that might survive in the nodules in the intestinal wall is discussed.

The problems encountered in the use of peritoneal dialysis (PD) in the initial management of patients with chronic renal failure in Nigeria were highlighted, studying 23 patients (13 males and 10 females) aged between 15 and 68 years (mean age 36.4 years). Peritonitis was the most common complication, occurring in 16 (70%) of patients; effluent drainage obstruction in 11 patients (48%); haemorrhagic effluent in 10 patients (44%); fluid leak from catheter site infection in 7 patients (30%); accidental disconnection of line/catheter joint in 5 patients (22%); and catheter site infection in 2 patients (9%). A positive effluent culture was found in only 4 out of 18 cultured samples, with Klebsiella and Staphylococcus aureus being the organisms isolated. Dialysis was terminated in patients for the following reasons: financial constraints (8 patients), unresolving peritonitis (7 patients), drainage problems (3 patients), and clinical improvement (5 patients). The study concludes that PD in the management of chronic uraemia in developing countries, while producing clinical benefits in the majority of patients, is still not generally acceptable as a long-term treatment modality in view of the number of problems.