Search

In a prospective study on the aetiology of liver disease and its diagnostic approach in a District hospital in rural Tanzania, 48 consecutive patients with evidence of liver disorders were investigated by physical examination, biochemical tests, laparoscopy and histology. Liver cirrhosis (posthepatic, alcoholic) was found in 31%; non cirrhotic alcoholic liver disease in 15%; viral, bacterial and protozoal liver disorders in 33%, and neoplastic liver changes in 21% of all patients. Clinical impression alone coincided with the final diagnosis in 40% of all cases. This figure was increased to 46%, when haematological and biochemical results were included, and to 71%, when laparoscopy (without histology) was used in addition. Laparoscopy was particularly decisive in the diagnosis and further management of cirrhosis, liver abscess and neoplastic liver disorders. The additional information obtained from histology led to the final diagnosis. Histology was specially useful for the diagnosis of alcoholic liver disease, tropical splenomegaly syndrome and non specific reactive hepatitis. The usefulness of laparoscopy as a diagnostic tool in a district hospital is discussed.

Administration of chloroquine after major surgery is indicated in malaria endemic areas. In emergencies it is commonly administered parenterally after the operation. The present study, undertaken at St. Francis Hospital, Ifakara (Kilombero District), Tanzania, compared plasma chloroquine levels after oral and subcutaneous administration of 300 mg of chloroquine base in 14 patients after abdominal, non-bowel-resective surgery and in 12 controls. There were no significant differences in the plasma chloroquine levels of all groups, and the chloroquine concentrations reached suppressive levels for at least 3 days (> 0·1 nmol/ml). Oral administration was well tolerated in both patients and controls. In all areas where the Plasmodium strains are still sensitive to chloroquine and where parenteral chloroquine may not be easily available, oral chloroquine represents a cheap, easy and safe alternative for postoperative prophylactic malaria suppression. It can be applied after abdominal non-bowel-resective emergency surgery.

info:eu-repo/semantics/published

Le présent manuel de conception des chaussées s'adresse aux ingénieurs et aux techniciens oeuvrant dans le domaine de la construction et de l'entretien des chaussées en Suisse. L'ouvrage fournit les outils et conseils nécessaires au dimensionnement d'une chaussée, à la sélection de la structure offrant la solution économique optimale et à la sélection des techniques d'entretien et des matériaux adéquats, compte tenu du trafic, des conditions géométriques, topographiques et environnementales de l'ouvrage concerné. Il contient le savoir-faire d'experts de la construction et de l'entretien des chaussées en Suisse et fournit les informations utiles à la conception et à l'entretien des superstructures routières, qu'elles soient souples, semi- rigides ou en béton, mais ne comprend pas les ouvrages d'art. Il traite également des techniques et des matériaux innovants. Le manuel se veut complémentaire aux normes suisses et aux publications helvétiques en matière de conception et d'entretien des chaussées. Les normes reprises dans ce recueil sont complétées par les considérations pratiques en matière de construction et de maintenance des chaussées, en particulier pour le choix des structures, des techniques d'entretien et des matériaux. Le manuel doit fournir au praticien la solution technique et économique la mieux adaptée compte tenu des conditions locales de l'ouvrage considéré.

In a prospective study 20 P. falciparum isolates imported from Africa by non-immune tourists were investigated for chloroquine sensitivity using the in vitro microtest and the results were compared with the plasma chloroquine concentration. All 6 patients taking correct chloroquine prophylaxis (chloroquine plasma levels between 0.1-0.5 nmol/ml) harboured highly resistant P. falciparum strains (schizont maturation at 3.2 and 6.4 nmol/ml blood in 3 patients each). In the 4 patients with inadequate prophylaxis (plasma levels between 0.02-0.1 nmol/ml) the degree of resistance was lower (at 1.6 and 6.4 nmol/ml blood in 2 patients each). Chloroquine-sensitive strains were found only in patients with chloroquine plasma levels below 0.02 nmol/ml and in 4 of 5 patients who did not show chloroquine in the plasma. Selection of chloroquine-resistant P. falciparum strains under short term chloroquine chemoprophylaxis appears to be highly probable.