Appendicitis revisited: a comparative study of Malawian and eng appendices

The incidence of appendicitis shows a marked variation between populations which has been attributed to dietary differences. Neural mechanisms and serotonin discharge from subepithelial neurosecretory cells have been previously implicated in pain referable to the appendix and appendicitis. Forty consecutive appendicectomy specimens from Malawi were studied by staining with haematoxylin and eosin; an alcian blue - PAS diastase sequence coupled with lead haematoxylin (PbH) and immunohistology for serotonin and NSE. The findings were compared with those in appendices removed at the Middlesex Hospital; London; to see if there were any differences between a population with a low risk of appendicitis (Malawi) and a high risk population (England). Acute transmural appendicitis was seen in fewer appendices from Malawi (27.5 per cent) than in eng appendices (58 per cent). Subepithelial neurosecretory cells identified with PbH were present in 20 per cent of appendices from Malawi and 69 per cent of eng appendices. These cells in both series showed immunohistochemical staining for serotonin. Nerve hyperplasia identified by staining for NSE in the appendix was present in 17.5 per cent and 81 per cent of non-inflamed appendices from Malawi and England respectively. Appearance of subepithelial neurosecretory cells and hyperplasia appear to be concomitants of an increased risk of appendicitis. Neural mechanisms may participate in adapting to a low residue diet and in some cases may generate appendicitis

Unusual presentation of patients with myelomatosis in Malawi

Malignant myeloma is not rare in tropical Africa. Its mode of presentation in Malawi is most often that of a tumour mass in bone. The types of immunoglobulin heavy and light chains in the tumour cells occur with a frequency similar to that observed in temperate countries

Rhinoscleroma in Malawi and Eastern Zaire

"The first ten cases of rhinoscleroma from Malawi and six from Eastern Zaire are reported. Most of the patients were aged between 20 and 40 years (age range 3-60) and presented with either a nasal ""tumour' or abnormalities of the nasal septum. Histological examination of biopsy material revealed features diagnostic of rhinoscleroma - a mixture of mature plasma cells and large foamy macrophages (Mikulicz cells) containing intra-cellular Gram negative bacilli. The organisms were best seen in sections stained by the Warthin-Starry technique. This study suggests that rhinoscleroma is perhaps more common in Malawi and Zaire than has been realised."

Tropical Splenomegaly Syndrome in a Caucasian in Africa

"In recent years there has been increased interest in the tropical splenomegaly syndrome and the subject has recently been reviewed (Pitney; 1968; Marsden and Hamilton; 1969; British medical Journal; 1969). Outside Africa tropical splenomegaly syndrome has been described in the inhabitants of sout Arabia (Fawdry; 1965); who anthropologically are caucasoid; in the Melanesians of New Guinea (Marsden et al.; 1967; Pryor; 1967); who are negroid; and in Bengalis (Chaudhuri et al.; 1956); who are caucasoid. No caucasian (or ""Europian"") cases of tropical splenomegaly syndrome appear to have been reported from the African continent; and at least one observer with long experience in Africa states that he has yet to have been in negroes (Marsden et al.;; 1965; Lowenthal et al.; 1966; Ratnesar et al.; 1966; Watson-Williams and Allan; 1968). In a series from the sudan specific mention is not made whether the patients were African or Arab (Mustafa; 1965). We report here a case of topical splenomegaly syndrome in a Caucasian resident in Africa."

Postmortem Findings in Hypertesnive Subjects in Kampala; Uganda

The incidence and causes of hypertension in clinical practice in East Africa have been discussed in other papers in this symposium. In these accounts information has been derived from population surveys; from out-patient studies or from in-patient clinical records. The present paper presents material derived from a survey of postmortem material from the Department of Pathology; Makerere University College medical School and the New Mulago Hospital; Kampala. the purpose of this study was to determine the frequency and type of renal disease in hypertension

Cancer in East and Central Africa: aspects of incidence and prevention

"Abstract: the cancer pattern in East and Central Africa differs in many ways from that seen in Europe and North america.There are also local variations in the incidence of some tumours within this region; these patterns are related to environmental influences. Carcinoma of the lung; breast; large bowel; prostate; endometrium all have lower rates than in Western populations. The low consumption of tobacco and diaetary pattern of East African may account for these findings. Carcinoma of the liver; cervix; penis; Burkitt's lymphoma; Kaposi's sarcoma; oesophageal carcinoma and choriocarcinoma are more common than in the West. The causes of these; and particularly the role of viruses; are discussed. Cancer prevention in this region should aim to stope the increase in ""Western"" cancers and to attack the known aetiological factors associated with the common malignant tumours."

Exfoliative cytology in the detection of cervical cancer in Uganda

Walshe in 1851 observed fragments of malignant tissue in sputum; and duggeon and Patrick examined scrapings of tissues for malignant cells. In 1928; Papanicolaou used a similar wet fixation technique for diagnosing cancer of the female genital tract; although his classic paper with Traut was not published until 1943. Exfoliative cytology can now be applied to the study of sputum; stomach washings; pleural; ascitic and cerebrospinal fluids; aspirates; breast secretion and rectal and colonic specimens but it is in the cervix uteri that it is still of maximum value and most frequently used. Cervical cytology may be investigated to determine the hormonal status of the patient and thus serve as a guide to therapy. A second use is as an adjunct to other conventional diagnostic aids where there is an somiasis or tuberculosis. A third and more important use is in the detection of cancer in the population at large. It is this latter application that holds the greatest possibilities; has excited the greatest interest and is the subject of this paper. A group of women who would not otherwise be suspected of having cancer may be identified at a stage before the malignant process has become invasive; when it has an excellent prognosis and when it is treatable by limited surgery which is not mutilating; leaving the patient free incertain cases to have further children