Tropical Doctor

A series is reported of 115 patients submitted to laparoscopy in two poorly equipped hospitals in Chad and Tanzania, with the indications for this diagnostic procedure and the findings in every patient. Laparoscopy was judged to have been definitively diagnostic in 74 (64.3%) and useful but not diagnostic in 30 (26.0%) of the 115 patients. On the grounds of the laparoscopic picture 24 patients (20.9%) underwent surgery and the other 91 (79.0%) received medical therapy. No serious complications ensued with any of the 115 cases studied.

Laparoscopy is a safe procedure with a satisfactory diagnostic success rate. We would recommend wider use of this diagnostic tool in small hospitals in developing countries where laboratory facilities are usually inadequate.

Over a period of 5 years 102 highly selective vagotomies (HSV) were performed. The cases selected excluded gastric outlet obstruction. The results show a significant cure rate of peptic ulcer, without any deaths. It is suggested that the high rate of recurrences and complications reported from other centres might be due to incomplete denervation, most likely due to variations of the nerve or damage to the nerve of Latarjet, amounting to truncal vagotomy — Complete or incomplete, depending on the nature and level of damage to the nerve. From our experience at this centre, HSV has given very good clinical results in the 5 years of review. The procedure is safe and without mortality.

A review is given of hernias in Busoga, Uganda. Special attention is paid to strangulated hernias with a Richter-type strangulation for which, in the case of necrotic bowel, on certain criteria, an invagination procedure was performed. The technique and criteria are described and the results are discussed. In less experienced hands, the invagination procedure is preferable to the more complicated resection and anastomosis.

In 90% of 213 patients, foreign bodies impacted in the oesophagus were removed during oesophago-scopy. Surgical intervention was necessary in the remainder. The complications recorded in 18 patients (8.5%) included bleeding, retropharyngeal abscess, paraoesophageal abscess, stricture, and mediastinitis. The mortality rate was 0.94%.

A combined survey of weight for height measurement (W/H) was done by two emergency aid organizations. The same 131 children were measured independently by two survey teams. One team measured 24.4% and the other team 47.7% of the 131 children as under 80% W/H. The serious logistical consequences of these differences for the emergency aid programme are discussed.

The main cause of the difference was observer error. A reason for systematic bias could be that an observer using the Nabarro chart tends to classify children who are slightly above 80% as under 80%. This bias is understandable because “one doesn't want to miss out malnourished children”. This sytematic bias does not occur when weight and height are measured separately and the percentage read from a card. The importance of following a strict protocol when measuring is stressed.

Another (much less important) cause for the different results was that the teams used two weight for height standards. The Nabarro chart (multicoloured chart), based on an adaptation of the NCHS standard, overestimates the prevalence of wasting as compared to the NCHS/CDS/WHO standard (the plastified card). A plea is made for the use of uniform standards.

In fact there is not yet a reliable, simple tool for assessment of wasting.

Weaning is an important factor in the aetiology of protein energy malnutrition (PEM). In the present study it was shown that the psychological aspects of weaning — i.e. separation from the mother — play a more important role in the development of PEM than do physical factors. Of children suffering from PEM, 80.4% were physically separated from the mother at time of weaning, whereas only 32% of a comparable healthy control group had undergone the trauma of separation.

The findings in 125 patients with endogenous eczema attending the skin clinic of the University of Benin Teaching Hospital during a 2-year period are presented.

In males nummular eczema was the commonest seen, followed by atopic, pityriasis alba, pompholyx and seborrhoeic eczema. In females seborrhoeic eczema was the most common, followed by nummular, atopic, varicose, pityriasis alba and pompholyx. The course of endogenous eczema is similar to that described from other parts of the world including Africa.