African trypanosomiasis in a British soldier.

BACKGROUND: Human African trypanosomiasis (sleeping sickness) is a parasitic infection transmitted by day-biting tsetse flies. The diagnostic gold standard is microscopy of blood, lymph node aspirates or CSF. The disease is invariably fatal, if not treated. There are over 300 000 new cases of sleeping sickness each year, and approximately 100,000 deaths. CASE PRESENTATION: We describe a British soldier who acquired trypanosomiasis in Malawi. He gave no history of a painful insect bite but presented with classical early signs of sleeping sickness (a primary chancre, regional lymphadenopathy, circinate erythema and a cyclical fever pattern). His condition worsened in the next week and trypanosomes were observed in a blood sample. He was aeromedically evacuated to Johannesburg, where Stage One Trypanosoma brucei rhodesiense infection was confirmed; he also had renal and liver failure, pancytopenia and heart block. He was treated with intravenous suramin. He recovered fully over the next 5 months. RECOMMENDATIONS: Medical officers deploying to eastern and southeastern Africa must be familiar with the common presenting signs and symptoms of T b rhodesiense sleeping sickness, and should have access to a reliable local microscopy service at all times. Confirmed sleeping sickness requires immediate transfer to a tertiary diagnostic and treatment centre, where suramin (for T b rhodesiense infection) or pentamidine (for T b gambiense) and also melarsoprol (for Stage Two disease) must be immediately available.

Complications of diabetes mellitus in Malawian Adults

One hundred Malawian adults with diabetes mellitus were examined for complications of the disease and results were compared with those obtained in age and sex matched controls. Impotence; hypertension; postural hypotension; lower limb pulse deficit; lower limb reflex loss; cataract; retinopathy and urine proteinuria were significantly more common in diabetes compared with controls. Complications were related to duration of disease. Apart from cataract (treated surgically in severe cases) and proliferative retinopathy; none of the observed complications resulted in serious disability

Malaria prophylaxis amongst British residents of Lilongwe and Kasungu districts, Malawi.

Questionnaires on various aspects of malaria prophylaxis were distributed to all British residents (adults and children) of Lilongwe and Kasungu districts, Malawi, and were completed and returned by 293 (response rate 89%). Almost all residents used some measures to reduce mosquito contact, and 96% used chemoprophylaxis. Eight different chemoprophylactic regimens were used. Proguanil, alone or with chloroquine, was the most popular agent despite being associated with mouth ulcers in 25% of residents. Residents on this regimen had in general obtained their advice from a British source, and 75% considered they were adequately informed on the subject. This regimen was the most effective in preventing malaria attacks in the previous 12 months, even though over half those on proguanil alone were taking an inadequate dose. Residents on other chemoprophylactic regimens in general obtained their advice elsewhere, considered they were inadequately informed, and had a higher incidence of malaria. Whatever the regimen, 27% of adult residents would discontinue prophylaxis prematurely on return to the United Kingdom. Results suggest that more needs to be done to provide regular, precise and up-to-date information on malaria prophylaxis to British residents in malaria endemic areas.

Malaria prophylaxis amongst British residents of Lilongwe and Kasungu districts; Malawi

Questionnaires on various aspects of malaria prophylaxis were distributed to all British residents (adults and children) of Lilongwe and Kasungu districts; Malawi; and were completed and returned by 293 (response rate 89 percent ). Almost all residents used some measures to reduce mosquito contact; and 96 percent used chemoprophylaxis. Eight different chemoprophylactic regimens were used. Proguanil; alone or with chloroquine; was the most popular agent despite being associated with mouth ulcers in 25 percent of residents. Residents on this regimen had in general obtained their advice from a British source; and 75 percent considered they were adequately informed on the subject. This regimen was the most effective in preventing malaria attacks in the previous 12 months; even though over half those on proguanil alone were taking an inadequate dose. Residents on other chemoprophylactic regimens in general obtained their advice elsewhere; considered they were inadequately informed; and had a higher incidence of malaria. Whatever the regimen; 27 percent of adult residents would discontinue prophylaxis prematurely on return to the United Kingdom. Results suggest that more needs to be done to provide regular; precise and up-to-date information on malaria prophylaxis to British residents in malaria endemic areas

Endorectal pull-through with conservation of the rectal mucosa: experimental study.

The present experimental work was designed to study an abdominoanal pull-through technique, with conservation of rectal mucosa. Continence was evaluated from clinical, radiologic, and histopathologic standpoints. The animals defecated normally. A good retention of barium was seen in the radiologic enema. On the reexploration of the animals, we found a distal dehiscence with elevation of the intussuscepted stump towards the rectum in all. A reepithelization process of serosa of the intussuscepted segment was noted.

Perception at the blind spot and tilt aftereffect.

Black and white stripes were used to induce a tilt aftereffect near the blind spot. Stripe fragments on either side of the blind spot were seen as being completed across the blind spot, but the magnitude of the tilt aftereffect they induced suggested that the perceptually "filled-in" portions of the stripes did not contribute to the aftereffect. So perceptually filled-in lines seem not to be fully potent percepts.

Androgen control of territorial marking in the Mongolian gerbil.

Gerbils mark objects with the secretion of a midventral sebaceous gland. Both the behavior and the gland integrity are under androgen control, as indicated by castration and replacement with testosterone propionate. The integrity of the gland seems less important for marking than an influence on the central nervous system, although the gland can be used as an external measure of androgen levels. It is possible that the secretion acts as a pheromone to signal territorial possession.