[Vaccinations for journeys in the tropics]. / Impfungen vor Tropenreisen.

Vaccinations are among the most important measures for maintaining the health during journeys in the tropics. Vaccination against Yellow Fever is compulsory for many African countries and for French Guyana. Vaccinations against Meningococcal Meningitis is compulsory for pilgrimage to Mecca. All travellers to tropical countries should be vaccinated against Hepatitis A, Diphtheria-Tetanus and against Measles for people below forty years of age. In addition vaccinations against Poliomyelitis, Typhoid Fever, Hepatitis B, Rabies and Japanese Encephalitis should be provided according to the duration, of the journey, the country of destination, and the risk of exposure.

[ARDS in plasmodium vivax malaria]. / ARDS bei Plasmodium-vivax-Malaria.

Acute renal failure, disseminated intravascular coagulation, ARDS, hypoglycaemia, coma or epileptic seizures are manifestations of severe Plasmodium falciparum malaria. On the other hand, vivax malaria or benign tertian malaria is usually free from complications. In the present report we describe a case of acute tertian malaria with a severe and complicated course. In this situation bacterial coinfection should always be suspected and treated empirically with broad-spectrum antibiotics, until the results of cultures are available. Mixed plasmodial infection (P. vivax and P. falciparum) must be excluded by repeated and meticulous examination of blood smears. Newer techniques such as PCR processing or ParaSight F Test are mentioned.

[Fever upon return from the tropics]. / Fieber beim Tropenrückkehrer.

Malaria is the most important dangerous febrile disease in patients returning from the tropics. Falciparum malaria can occur up to one year after leaving the tropics, tertian and quartan malaria even after many years. Laboratory diagnosis is made by thick and thin blood smear. Tertian and quartan malaria are treated by chloroquine , falciparum malaria by quinine, mefloquine or halofantrine.

Disappearance of a large mediastinal pseudocyst in a patient with chronic alcoholic pancreatitis after total parenteral nutrition.

OBJECTIVE: To report the unusual case of a mediastinal pseudocyst in a patient with chronic pancreatitis, which resolved after conservative treatment. PATIENT: A 59-year-old patient with alcohol-induced chronic pancreatitis and a large mediastinal pseudocyst. INTERVENTIONS: Bowel rest and total parenteral nutrition for 4 weeks. MAIN OUTCOME MEASURES: The pseudocyst resolved completely. CONCLUSION: Conservative treatment is a valuable option in patients with chronic pancreatitis presenting with a mediastinal pseudocyst, but close supervision is mandatory.

[Vitamin deficiency in developing countries]. / Vitaminmangel in Entwicklungsländern.

Vitamin A deficiency is frequent in the tropics. It causes xerophthalamia, which, in severe cases, can develop into corneal ulceration, keratomalacia and blindness and increases morbidity and mortality of infectious diseases in infants and children. Vitamin A deficiency can be reduced by the promotion of a nutrition rich in vitamin A, by fortification of food with vitamin A and by high-dose vitamin A supplementation. Other vitamin deficiency disorders are rare or occur only in limited areas or in disadvantaged people. In refugee camps, scurvy, beriberi, pellagra and xerophthalamia occur. Travelers from developed countries are rarely affected by vitamin deficiency disorders, if they eat regularly the large variety of fruits and vegetables usually available in tropical countries. Their vitamin stocks are anyhow sufficient for several weeks.

[Conventional or complementary medicine: what criteria for choosing do patients use?]. / Schulmedizin oder Komplementärmedizin: Nach welchen Kriterien entscheiden sich die Patientinnen und Patienten?

Only a few studies have investigated in depth the motives behind the choice of conventional or complementary medicine. While some studies document failures or general mistrust of conventional medicine as the main reasons for turning to complementary medicine, others conclude that the decision to try alternative medicine is not necessarily due to disappointment with conventional medicine but rather an endeavour to do everything possible for one's own health. Patients regard complementary medicine indeed as a complement. Longer-lasting consultation and a better doctor-patient relationship are occasionally mentioned as favourable aspects of complementary medicine. Other motives are a critical attitude to modern civilization and the growing symbolic value of health. The choice may be related to the nature of the disease. Depending on the patient population involved, complementary medicine is used for either more difficult or simpler cases. As a general rule it is the chronic problems that are dealt with by complementary medicine. Users of complementary medicine cannot be regarded as a homogeneous group. Nevertheless, one Swiss study concludes that users of complementary medicine tend to be female, with higher education, from the upper middle class and aged between 30 and 50. They have postmaterialistic value priorities, holistic interpretative models of health and disease, and want to share in decision-making on treatment questions. Approaches and contexts of individual studies differ and the study populations of individual investigations are sometimes questionable. This means that some results are to be treated with caution. The literature under review rarely refers to cultural and social aspects as possible factors, and processes are likewise rarely investigated. Only one study presents behaviour in sickness as a social process which reveals how people perceive, interpret and respond to health problems. In conclusion, the sociological theories and findings involved in the entire question area are briefly outlined.

[Malaria: the most important emergency in subjects returning from the tropics]. / Malaria: der wichtigste Notfall beim Tropenrückkehrer.

Malaria is the most important emergency in people returning from tropical countries. Falciparum malaria may lead to coma and death within a few hours. The symptoms are generally not specific. A history of travelling in tropical countries is the most important factor in diagnosis. In the case of fever after a journey in the tropics, malaria must always be considered in the first place. Laboratory diagnosis is established by finding of plasmodia in blood smears. Vivax, ovale and quartan malaria is treated by chloroquine. Falciparum malaria is usually treated by mefloquine, Fansimef, quinine or quinidine.

Epidemiological experience in the mission of the United Nations Transition Assistance Group (UNTAG) in Namibia.

Epidemiological data have rarely been generated during United Nations (UN) missions to Third World countries, even in situations where there is hardly any combat involvement. Continuous surveillance was therefore carried out during the 12-month stay of UN personnel in Namibia in 1989-90. In this population of 7114 persons, mostly young men, the mortality rate was 255 per 100,000; death was mainly due to traffic accidents. Hospitalization was chiefly because of fever of unknown origin or trauma. Repatriation to the country of origin was necessary in 46 patients, frequently for psychiatric reasons including alcoholism. Over this one-year period there were, on average, 2.7 new consultations per person for treatment (mostly for dental problems), and 0.8 per person for prophylactic measures. The extremely high mortality due to traffic accidents indicates a need for prevention. In the selection process for future missions, more emphasis should be given to the psychological and dental health of volunteers. All military contingents and civilian groups should learn about effective preventive measures prior to their arrival, and adhere to them.

PIP: Medical reports modelled after the US Peace Corps surveillance form provided mortality and morbidity data of the United Nations Transition Assistance Group in Namibia in 1989-1990. Contingents included Australians, Canadians, Danes, Finns, Kenyans, Malays, Poles, Spaniards, and Britons. Traffic accidents, mostly those on long distance journeys caused 14 of 16 deaths. The fatality ratio was 0.21/million km driven which was considerably higher than that in Switzerland 0.02/million km driven. Even though heavy traffic was not a problem in Namibia, limited experience on unpaved roads; high speeds induced by long and tedious driving; and reduced visibility caused by climactic conditions, fatigue, and alcohol contributed to high fatality. The hospitalization rate of 5.2% (369 patients) was rather high for a young and healthy population. The leading reasons for hospitalization included fever of unknown origin, trauma, and respiratory tract infections. Swiss Medical Unit physicians transferred 25 patients to the State Hospital in Windhoek, most for orthopedic surgery. Injuries, psychiatric problems, and alcoholism resulted in repatriation for 66% of 46 repatriated patients. New consultations for treatment averaged 2.7/person and those for preventive measures averaged 0.8/person. Helicopter pilots was the largest group returning for 2nd visits (56% compared to 1% for logistics staff). The major reasons for attending outpatient clinics included immunizations (18.8%), dental problems (10.5%), and respiratory infections (10.5%). In addition to respiratory infections, other frequent communicable diseases included diarrhea or dysentery, dermatological infections, sexually transmitted diseases, and confirmed or suspected malaria. Preventive measures are needed to reduce mortality due to traffic accidents and the prevalence of psychological and dental problems.

Epidemiological experience in the mission of the United Nations Transition Assistance Group (UNTAG) in Namibia

Epidemiological data have rarely been generated during United Nations (UN) missions to Third World countries, even in situations where there is hardly any combat involvement. Continuous surveillance was therefore carried out during the 12-month stay of UN personnel in Namibia in 1989-90. In this population of 7114 persons, mostly young men, the mortality rate was 255 per 100,000; death was mainly due to traffic accidents. Hospitalization was chiefly because of fever of unknown origin or trauma. Repatriation to the country of origin was necessary in 46 patients, frequently for psychiatric reasons including alcoholism. Over this one-year period there were, on average, 2.7 new consultations per person for treatment (mostly for dental problems), and 0.8 per person for prophylactic measures. The extremely high mortality due to traffic accidents indicates a need for prevention. In the selection process for future missions, more emphasis should be given to the psychological and dental health of volunteers. All military contingents and civilian groups should learn about effective preventive measures prior to their arrival, and adhere to them

Thiabendazole vs. albendazole in treatment of toxocariasis: a clinical trial.

Between 1986 and 1988, 34 patients (age range six to 83 years) with visceral or ocular larva migrans were randomly assigned to a five-day treatment with thiabendazole 2 x 25 mg kg-1 day-1 (15 patients) or albendazole 2 x 5 mg kg-1 day-1 (19 patients). On the fifth treatment day, six patients (40%) in the thiabendazole group and 11 patients (58%) in the albendazole group showed excellent or good drug tolerability. Efficacy of treatment was assessed after 30 weeks (range six to 56 weeks). In the thiabendazole group, median eosinophilia remained at 14% and four patients (27%) were clinically cured. In the albendazole group, the median eosinophilia decreased from 10 to 3.5% and six patients (32%) were clinically cured. We recommend albendazole for treatment of visceral and ocular larva migrans with a minimum dose of 10 mg kg-1 daily for five days.