Schistosomal colonic polyposis: clinical, radiological and parasitological study.

One hundred and eight male Egyptian farmers with schistosomal colonic polyposis were reviewed. All patients gave a history of bloody diarrhoea. Sixty-one patients presented with finger clubbing, and four of these patients had painful, tender and swollen wrist, knee and ankle joints. X-ray revealed new bone formation in the bones around these joints. The clinical condition improved with antischistosomal treatment, but the bony changes persisted. Twenty patients showed signs of dependent oedema or ascites. Thirty-one patients had a liver of 8 cm or more below costal margin and 19 patients had a spleen of 8 cm or more below costal margin, a situation not unlike patients with schistosomiasis without polyposis. Fifteen patients had tender abdominal masses in the left iliac fossa which were shown by barium enemas to be clusters of polyps. Anti-schistosomal therapy relieved the obstruction but narrowing persisted in 70% of patients followed up. Severity of schistosomal colonic polyposis correlated with the anatomical distribution of the polyps, with their number and with the egg excretion rates.

Oxamniquine treatment for schistosomal polyposis: a 1-2 year follow-up study.

A follow-up was carried out into the study of schistosomal colonic polyposis reported in the last article. Eighteen patients with schistosomal colonic polyposis were treated with oxamniquine and their progress was evaluated for 2-3 weeks after treatment, at 3 months and at 12-24 months. Sigmoidoscopy to examine mucosa on the polyps and barium enemata to determine the size and number of polyps showed variable success, but treatment with oxamniquine produced no untoward side effects.

Correlates of weight loss in treatment and at follow-up.

Results showed that a Navy-sponsored weight-reduction program was relatively successful in helping participants lose weight during treatment and throughout a one-year follow-up. Of the 531 women and 155 men who reported a mean weight loss of 22 lb and 28 lb, respectively, 32 per cent of the women and 29 per cent of the men responded that no weight had been gained during treatment and follow-up. Regression analyses identified predictors of weight loss to be a self-reported improvement in health status, a history of few dieting attempts, and adult onset of obesity. Correlates of weight-loss maintenance included a change in eating behavior, a self-reported improvement in health status and feelings toward dieting, adult onset of obesity, and physical exercise participation. Such results pointed up the importance of developing an intervention program that incorporates an exercise regimen and the adoption of a long-term nutritionally-sound eating program.

Ameobic liver abscess presenting as fever of unknown origin (FUO). Serology, isotope scanning and metronidazole therapy in diagnosis and treatment.

In a study of obscure fevers in Cairo, Egypt, 24 cases of hepatic amoebiasis were diagnosed during a 3-year period from 1977-1980. The counterimmunoelectrophoresis amoebic serologic test was positive in 20 of the 24 patients and was very useful in confirming the diagnosis. The four patients in whom the test was negative had been ill for between 1 and 5 months and had been treated with antibiotics and amoebicidal drugs. Technetium-99 liver scanning localized the site and extent of the abscess and was essential for planning therapy. Treatment with metronidazole and tetracycline resulted in rapid clinical improvement in all except one patient. However, improvement did not indicate cure as our results show: nine patients required needle aspiration of the liver abscess, and seven others had to be referred to surgery for abscess drainage. Large abscesses over 10 cm in diameter should be aspirated to avoid relapse or rupture.

Serum enzyme tests in hepatosplenic schistosomiasis.

The serum activities of monoamine oxidase (MAO), gamma-glutamyl transferase (GGT) and glutamic dehydrogenase (GDH) enzymes were measured in 25 patients with Schistosoma mansoni infection (Group I), 26 patients with schistosomal hepatosplenomegaly and ascites (Group II) and 21 normal controls. The activities of these enzymes were compared with those of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP). The mean levels of MAO, GGT and GDH of Group I were not significantly different from controls. The mean levels of MAO and GGT in Group II, however, were significantly different from corresponding mean levels of Group I and the controls at P less than .001. Changes in the mean level of GDH and ALT were not significant. By contrast, the levels of AST and ALP in both groups showed significant elevation over control levels at P less than .001. These results indicate that estimation of the two enzymes MAO and GGT may aid in the biochemical differentiation of the stages of schistosomiasis and their associated hepatic complications.

Treatment of schistosomiasis mansoni with oxamniquine--five years' experience.

During a 5-year period (1975-1980), 171 male patients aged eight to 58 years infected with Schistosoma mansoni have been treated with oxamniquine on an in-hospital basis. The patients comprised three clinical groups--uncomplicated S. mansoni infection, colonic polyposis due to S. mansoni, and hepatic decompensation due to S. mansoni--all with active infection. After treatment all patients were observed for 12 weeks then evaluated for cure. In the uncomplicated group 40 of 73 children (55%) and 39 of 45 adults (87%) were cured. In the polyps group 24 of 29 patients (83%) were cured and in the decompensated group all 24 patients were cured. The only side effect was a febrile reaction occurring in 65 patients (38%) 3-4 days after treatment was started. This 5 years' experience showed that oxamniquine results in a low cure rate in children but is effective in adults with uncomplicated S. mansoni. In patients with colonic polyposis oxamniquine is safe and well tolerated as initial therapy, particularly in the very ill, debilitated patient. Oxamniquine is clearly the drug of choice in patients with decompensated liver disease and active S. mansoni infection.

Correlates of obesity.

Designed to create composites of eating behavior questionnaire items and determine their relationship to an obesity index within three subsamples of participants in three Navy-sponsored weight-reduction programs (N = 1,878). After item and scale analyses were performed on questionnaire items that pertained to eating behaviors, history of weight problems, activities, and feelings about food and dieting, scores for the resultant composites were computed for individuals within the three subsamples. Results of multiple-regression analyses indicated that the strongest correlates of obesity within each subsample were the Overweight History, Food Obsession, and Activities composites; the multiple R was .49 for Marine recruits, .46 for the other male subsample, and .32 for women. The Emotional Eater composite was included in the multiple regression for the women's subsample. Personality characteristics also were found to be associated with the obesity index in the men's and women's subsamples. Future studies will examine the value of these variables as predictors of weight loss and maintenance of weight loss.

Chronic hepatitis B antigenaemia in patients with hepatosplenic schistosomiasis.

Thirty-five male patients with decompensated hepatosplenic schistosomiasis were longitudinally studied and divided into 3 Groups; with hepatitis B surface antigen (HBsAg) or antibody (anti-HBs) and a control group negative to both. Patients with HBsAg were persistently carrying the antigen as estimated by radioimmunoassay (RIA) for up to 3 years and when compared with the other 2 groups, they had significantly higher serum glutamic transaminases, their liver biopsy showed more destructive liver cell lesions in the form of chronic active hepatitis or liver cirrhosis, they were refractory to diuretic treatment and had higher mortality rate (64% in 3 years compared to 22% and 33% in the other 2 groups). The majority of patients with dual infection are at greater risk in spreading hepatitis B as they proved to carry the 'e' antigen.

Rifampicin in the treatment of tuberculous meningitis.

Seventy-one patients diagnosed to have tuberculous meningitis were treated with isoniazid, streptomycin plus either rifampicin (36 patients or ethambutol (35 patients). Results of therapy were identical in both treatment-groups (approximately 50 per cent mortality). Rifampicin appears to be as effective as ethambutol in the treatment of this infection.

Treatment of complicated schistosomiasis mansoni with oxamniquine.

Twenty male patients (mean age 23 years) with Schistosoma mansoni infections (mean egg count 429 +/- 311/g feces) were each treated with oxamniquine orally in a single daily dose of 20 mg/kg for 3 consecutive days. Seventeen patients had hepatosplenomegaly, two of these had ascites. Three patients had diffuse colonic polyposis, one of these had ascites. Except for one who developed mild hematemesis 3 days after treatment, all patients tolerated the drug very well. However, 11 patients developed a fever 24 to 48 hours after completing treatment, which lasted for 2-3 days and coincided with increased excretion of schistosomal antigens in urine. Three months after completing therapy, all except one young patient ceased to have live egge in the stools or rectal tissue. Six months after treatment, three patients with colonic polyposis showed marked clinical improvement and sigmoidoscopic and barium enema examination demonstrated almost complete disappearance of all polyps.