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The West Indies, and associated parts of the Caribbean area, are extremely diverse and afford interesting examples for the study of geographical medicine. Short accounts are given of some conditions whose aetiologies have been relatively recently clarified, including vomiting sickness of Jamaica, veno-occlusive disease of Jamaica, blackfat pulmonary fibrosis of Guyana, and epidemic acute glomerulonephritis of Trinidad. The aetiology of tropical sprue, which is common in Puerto Rico and absent from Jamaica remains to be explained although a hypothesis has been put forward. Further work is needed to establish the geographical distribution of idiopathic cardiomegaly and the spinal neuropathies and associated syndromes of retrobulbar neuritis and sensorineural deafness before their aetiologies can be understood.
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PMID:Some non-infective diseases endemic in the West Indies. 15 86

The four alternatives discussed in the previous paper (5), are applied to a number of virus infections which are common in pigs. The enzootic state of SMEDI enteroviruses, vomiting and wasting virus and parvovirus should be promoted by bringing the young gilts into close contact with the older sow population at a sufficiently early stage. There should preferably not be a change of herd for primiparous sows during pregnancy. In parvovirus infection, maternal immunity may be so prolonged that gilts will only be infected after the time of breeding. Therefore, mating should preferably be postponed until they are nine months of age, unless previous serological tests have shown that they are in a state of active immunity. Considering the present disease situation of swine fever in several continental West European countries and consequently they high number of existing virus sources, compulsory vaccination of sows and fattening piglets is recommended against this virus on an international scale for at least three years. This vaccination can be omitted only after the number of outbreaks has been reduced to a very low level. Vaccination is the only possible alternative left in the combat against Aujezky's disease. Caution is undoubtedly indicated in using live vaccines in these cases. So far, methods have not become available for the effective control of transmissible gastroenteritis and prospects are not encouraging. The possibility of eradication of transmissible gastroenteritis is discussed.
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PMID:[Possible methods of control of virus disease in swine today and in the future. II. Specific applications (author's transl)]. 65 95

Clinical data on 24 civilian patients hospitalized for malaria in The New York Hospital were analyzed. Of 16 patients infected with Plasmodium falciparum, 14 acquired the disease in West Africa. Only three of the 24 had taken recommended courses of prophylaxis. Diagnosis was invariably, and often dangerously, delayed because physicians often made diagnoses of viral syndromes or used antibiotics; only one patient had a blood smear taken by a personal physician. Although all patients had fever and chills, classic malarial fever was seen in only seven patients; nausea, vomiting and diarrhea were common. Hepatomegaly and splenomegaly occurred in about half the patients. Blood smears stained in routine fashion by Wright's stain were positive in 23 of 24 patients. A normal leukocyte count was present in 19 of the 24 patients and thrombocytopenia in 16 of 23. The most frequent complications were those of central nervous system involvement. Therapy consisted mainly of chloroquine phosphate but other drugs, including quinine, pyrimethamine, sulfonamides and primaquine, were used in special situations. Suggestions for prophylaxis, diagnosis and therapy were made.
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PMID:Malaria - the mime. Recent lessons from a group of civilian travellers. 78 38

The first recognised outbreak of Marburg virus disease in Africa, and the first since the original epidemic in West Germany and Yugoslavia in 1967, occurred in South Africa in February 1975. The primary case was in a young Australian man , who was admitted to the Johannesburg Hospital after having toured Rhodesia. Two secondary cases occurred, one being in the first patient's travelling companion, and the other in a nurse. Features of the illness included high fever, myalgia, vomiting and diarrhoea, hepatitis, a characteristic maculopapular rash, leucopenia, thrombocytopenia, and a bleeding tendency. The first patient died on the seventh day from haemorrhage resulting from a combination of disseminated intravascular coagulation and hepatic failure. The other two patients were given vigorous supportive treatment and prophylactic heparin and recovered after an acute phase lasting about seven days. During this period on developed pancreatitis, the serum amylase remaining raised until the 32nd day after the onset of the illness. The other developed unilateral uveitis after having been asymptomatic for two months. This persisted for several weeks and Marburg virus was cultured from the anterior chamber of the eye.
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PMID:Outbreake of Marburg virus disease in Johannesburg. 81 15

40 patients--5 to 50 years of age--voiding eggs of Schistosoma haematobium in their urine--underwent treatment with Metrifonate at the OPD of Bong Mine Hospital, Liberia. The patients received 10 mg/kg body weight 3 times at a fortnight's interval. The drug was swallowed under medical supervision. 27 patients no longer passed eggs after the 1. dose of Metrifonate, 37 no longer voided eggs after the 2. administration. 1 patient did not show up for control after the 3. dose. Theoretically he may not be healed. 1 other patient who came for control after 12 months had been exposed to reinfection and again voided eggs in her urine. She had been negative after the 2. treatment. Reinfection may have happened. Patients could be controlled over a period of 6-14 months. Thus, Metrifonate seems to be an effective drug in the treatment of urinary schistosomiasis. Side-effects (nausea, abdominal pains, and--very rare--vomiting) were mild and disappeared spontaneously within less than 24 hours after medication. Patients did not have to interrupt school, daily activities, and treatment. Statistically, Metrifonate did not show any influence on transaminase SGOT, SGPT, and LDH during and after the course of treatment. The same evaluation applies to eosinophilia. There is no increase or decrease of this particular type of cell during and after treatment 7 patients showed alterations of their ECG curves. There were changes of the T-wave in V1-4. In adults traces were normal again several months after completion of treatment. It seems to be difficult to interpret ECGs in West African youngsters. X-ray photos of the lungs never revealed any pathological findings which could be connected to the course of treatment. Metrifonate seems to be a valuable drug in treatment of Schistosoma haematobium-infection. The drug is well tolerated if the treatment scheme--mentioned above--is used.
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PMID:[Treatment of schistosomiasis haematobium with metritionate in OPD-patients (author's transl)]. 101 47

Despite growing controversy surrounding its use as a "morning after pill," diethylstilbestrol (DES) is prescribed liberally for rape victims. Guidelines for its use in these patients is lacking. Of 150 consecutive rape victims treated at a university medical center, 63 (42 percent) received prescriptions for DES. Of the 55 (87 percent) on whom follow-up was obtained, in 40 (73 percent) there were substantial side effects-nausea or vomiting, or both. At least six (11 percent) did not complete therapy because of these side effects. The authors offer guidelines for use of DES for rape victims and a plan for patient education and follow-up.
West J Med 1976 Oct
PMID:Diethylstilbestrol in the treatment of rape victims. 103 35

We describe a case very rare in the West African sub-region, Familial Polyposis Coli, presenting with rectal prolapse. Symptoms appeared at an unusual age of three years. Histological examination of four polyps excised at random showed all to have undergone malignant change. While the patient was being built up for surgery, she developed marked abdominal distension, hyperpyrexia, respiratory distress and vomiting. She died within 24 hours of this acute illness. This is the first reported case, to our knowledge, of Familial Polyposis Coli in the West African sub-region.
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PMID:Familial polyposis coli: an unusual case in West Africa. 132 89

In a retrospective study of 84 Ghanaian infants with hypertrophic pyloric stenosis seen over a 15-year period between 1974 and 1988, the male/female incidence ratio was 9:1. First-born infants constituted 23.8% of the patient population. The incidence of associated congenital anomalies and jaundice were 10.7% and 3.6% respectively. About 33.3% of the infants started vomiting within the first week of life. The peak-age of presentation and diagnosis was between the second and sixth weeks of life. The operative mortality was 3.6%.
West Afr J Med
PMID:Infantile hypertrophic pyloric stenosis in Ghana. 139 Mar 74

Anorexia nervosa and bulimia nervosa are prevalent illnesses affecting between 1% and 10% of adolescent and college age women. Developmental, family dynamic, and biologic factors are all important in the cause of this disorder. Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea. A diagnosis of bulimia nervosa is made when a person has recurrent episodes of binge eating, a feeling of lack of control over behavior during binges, regular use of self-induced vomiting, laxatives, diuretics, strict dieting, or vigorous exercise to prevent weight gain, a minimum of 2 binge episodes a week for at least 3 months, and persistent overconcern with body shape and weight. Patients with eating disorders are usually secretive and often come to the attention of physicians only at the insistence of others. Practitioners also should be alert for medical complications including hypothermia, edema, hypotension, bradycardia, infertility, and osteoporosis in patients with anorexia nervosa and fluid or electrolyte imbalance, hyperamylasemia, gastritis, esophagitis, gastric dilation, edema, dental erosion, swollen parotid glands, and gingivitis in patients with bulimia nervosa. Treatment involves combining individual, behavioral, group, and family therapy with, possibly, psychopharmaceuticals. Primary care professionals are frequently the first to evaluate these patients, and their encouragement and support may help patients accept treatment. The treatment proceeds most smoothly if the primary care physician and psychiatrist work collaboratively with clear and frequent communication.
West J Med 1992 Dec
PMID:Eating disorders. A review and update. 147 50

Primary aorto-oesophageal fistula is a rare cause of massive and usually fatal gastrointestinal hemorrhage. We herein present a case of a 62-year-old chronic alcohol abuser who had a small haematemesis after a week of persistent vomiting. He succumbed to an exsanguinating bleed 36 hours after admission. An aorto-oesophageal fistula was found at autopsy. We emphasize the need for a high index of suspicion and recognition of premonitory signs for accurate diagnosis and management of this condition.
West Indian Med J 1992 Mar
PMID:Aorto-oesophageal fistula. A rare cause of gastrointestinal haemorrhage. 156 94


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