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We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.

Objectives. The aim of this study was to assess the usefullness of 18-fluorodeoxyglucose positron emission tomography (PET) scanning for the evaluation of metastases (nodal and distant) in patients with carcinoma of the cervix. Methods. A retrospective review was performed of 13 patients with carcinoma of the cervix who had a 18-fluorodeoxyglucose PET scan as part of their workup (10 during initial workup, 3 at time of relapse). Ten patients also underwent a fine needle aspiration (FNA) under imaging guidance for verification. Results. All 10 patients with positive sites identified by PET scan who underwent an FNA were positive for cancer. In 3 situations PET identified sites where other imaging studies were negative. Conclusions. PET scanning is a useful imaging tool in the evaluation of patients with carcinoma of the cervix. This review supports other limited published data in this regard and suggests that further prospective studies are needed.

The King Faisal Specialist Hospital and Research Center opened in 1975 to provide specialized medical treatment to the citizens of Saudi Arabia and to promote prevention of disease through research and education. It is a national and middle eastern tertiary care hospital for oncology and a principle center for radiation therapy in Saudi Arabia. In this retrospective study, 504 patients with carcinoma of the cervix were analysed. Of the 504 patients, 410 received treatment with curative intent, which comprised radical surgery alone, radical radiation alone or combination surgery and radiation. The overall 3, 5 and 10 years survival of all 504 patients was 64%, 55% and 40%, respectively and for 410 patients treated with curative intent it was 74%, 61% and 51%, respectively. Multivariate analysis, using the Cox regression method, showed that the stage of the disease is the only significant prognostic factor influencing relapse-free survival. Stage for stage, treatment outcomes at King Faisal Specialist Hospital and Research Center match those achieved in the First world, but two-thirds of patients (rather than one-third) present with advanced disease at diagnosis. Therefore, any improvement in overall outcomes will require earlier diagnosis, achievable only through an effective screening program in the Kingdom of Saudi Arabia and similarly in the other Third world countries where patients present with advanced stage disease.

This report is a 2-year follow-up of a baseline study conducted in Tanzania in 1984. 377 and 448 twelve-year old primary school children were examined in Dar es Salaam (urban) and rural areas respectively. The same criteria and examiners were employed to replicate conditions in 1984 as closely as possible. The mean DMFT score has remained stable over the 2-year period in both the urban (1984: 0.67 (s.d. 1.20); 1986: 0.64 (s.d. 1.32) and rural (1984: 0.51 (s.d. 1.07); 1986: 0.40 (s.d 0.93) areas. However, a significant decrease in the mean DMFS score in Dar es Salaam from 1.19 (s.d. 2.71) in 1984 to 0.81 (s.d. 1.96) in 1986, and in rural areas from 0.78 (s.d. 1.98) in 1984 to 0.48 (s.d. 1.44) in 1986 was observed. In 1986 significantly fewer children with caries had more than 5 involved surfaces in both urban and rural areas than in 1984. In the two areas the difference in caries prevalence observed between 1984 and 1986 affected different surfaces types to varying extents. The results do not support the finding that caries is increasing in all developing countries.

317 children born and raised in two rural areas of Machakos District in Kenya were examined for enamel changes. All sources of drinking water were monitored for F–– over a period of 1 year.

A diagnostic modality to study parasternal lymph nodes was examined at the Cancer Control Agency of British Columbia, Vancouver. Forty-five patients with carcinoma of the breast were studied. The data correlate well with that from other centres in regard to anatomic validity, lymph node distribution, cross drainage and findings in relation to the stage of disease. The frequency of lymphoscintigraphic abnormalities was almost twice as high in relation to lesions situated in the centre and inner half of the breast as compared with outer half lesions. Twenty-eight per cent of patients demonstrated cross drainage between parasternal lymphatics. In 11% of the patients, nodes were situated at locations greater than 4 cm from the midline. Work is in progress to study the correlation of lymphoscintigraphy with disease in the nodes. The data indicate that this study can be used in other centres in the management of patients with mammary carcinoma.