Surgery in the tropics

The practice of surgery in the tropics provides experience in the management of a broad range of conditions without many of the aids now regarded as essential in developed countries. Clinical judgement must play a greater role but the often advanced stage of disease at presentation may lessen the need for investigations and limit the treatment options. Subspecialisation is well advanced in many countries but most of the surgery performed in the world is by people not long out of medical school, much less by general surgeons. Western trained surgeons need to take into account local cultural attitudes to disease and disease management. Busy practical surgeons in tropical areas have made notable contributions to knowledge and practice. Burkitt and Huckstep, both in Kampala, and Brand in Vellore are outstanding examples. Each of these men was heavily dependent on a great many comparatively untrained but skilled paramedical workers.     

Pigmentary problems in the tropics

Pigmentary problems are one of the most frequent causes of dermatologic consultation in the tropics. This article deals with diseases seen mostly in tropical countries (ashy dermatosis, lichen planus pigmentosus, frictional dermatitis, pityriasis versicolor, and pinta) and in which a combination of racial, ecologic, nutritional, and social factors all contribute. Other common dermatoses seen worldwide, such as vitiligo and melasma, sometimes acquire dramatic expressions in tropical countries, and their management is usually difficult even for the most experienced dermatologists.     

Imported dengue fever following a stay in the tropics

We report on a tourist returning from Thailand, who presented with classical dengue fever. While in Thailand a 36-year-old Swiss female laboratory assistant suddenly developed fever, devastating headache, retro-ocular pain, myalgia and arthralgia, photophobia, nausea and diarrhea. In addition she suffered from epistaxis, urogenital and skin bleeding, and a morbilliform exanthema. After her return to Switzerland we noted lymphadenopathy and splenomegaly, enanthema and laboratory findings of mild hepatitis, thrombocytopenia and leukopenia. The diagnosis of dengue virus infection was verified serologically. Apart from a long lasting convalescent asthenia we observed restitutio ad integrum within days under symptomatic therapy. Epidemiological clinical and diagnostic aspects of dengue virus infection are discussed.     

Pituitary tumours in the elderly

Pituitary tumours in the elderly are a neglected topic in the literature of endocrinology and gerontology. Data from autopsy studies in the elderly show that the commonest tumours are microadenomas, which are either immunocytochemically negative or stain for prolactin. Prolactin-secreting pituitary tumours, however, appear rarely in clinical series of patients in this age group and non-functioning adenomas are the commonest tumour seen, although pituitary metastasis and craniopharyngiomas also occur. Diagnosis can be difficult, but the commonest presentation is visual field loss. Hypopituitarism may be diagnosed late and incidental radiological diagnosis is not uncommon. There are few data which specifically answer the question, but there is a suggestion that the syndromes associated with hormonal hypersecretion may be milder in this age group. Conventional treatment with drugs, surgery and radiotherapy should be decided on an individual basis as these therapies appear to be well tolerated and beneficial in selected patients.     

宪法概念评析

在对重要的宪法概念的界定进行评述的基础上,认同宪法是人为了自己的生存和发展,有目的建立和组织政治共同体的规则以及由该规则所构建的社会秩序.     

Comments on the origin of syphilis

An unusual case of intremedullary cysticerosis in a 22-year-old Mexican female is presented. The patient had a marked paraparesis with a D12 sensory level, absent deep tendon reflexes and no sphincteric disturbances. Pain in the spine was a prominent feature. A complete myelographic block opposite D12 proved at laminectomy to be due to a solitary cysticercus vesicle. It was removed from the conus medullaris through a right ventro-lateral myelotomy. The patient recovered.     

Comments on the activity of carbon in liquid iron

Existing data on the activity of carbon in liquid iron have been critically assessed and interpreted by using new equations derived by the author. These equations are the standard Gibbs energy of melting of graphite, the graphite-liquid iron saturation equation, and the interrelationship in the Margules equation. The resulting equation is g₂ = 130,330 - 32.19 T - (108,330 - 15.47 7) x₁² - (344,000 - 220.4 T) x₁²x₂ + (512,500 - 380.3 7) x₁²x₂² where g₂ is the partial excess Gibbs energy of dissolved carbon in J/mol, T is the temperature in K, and x₁ and x₂ are the mole fractions of iron and carbon in the melt, respectively. g₂ refers to graphite as the standard state so that g₂ = R T In γ₂ = - R T ln x₂ (at graphite saturation), where R is the gas constant, and γ₂ is the activity coefficient. From the preceding equation, g₁ for iron has been obtained.     

Frequency of bilateral tumours and primary retroperitoneal localization in tumours of the testicles

Report on 4 patients with bilateral testicular tumours (out of a total number of 181 cases) and the problems arising with a second course of irradiation. The question of histogenesis and therapeutic course in 4 patients with a primary retroperitoneal tumour localization are discussed in the second part.     

Mycetoma of the foot; a disease from the tropics

Two patients, a Surinamese man aged 50 and a Surinamese woman aged 56 exhibited a mycetoma of the foot, 30 and 28 years, respectively, after a local injury. Pathological examination revealed an aspecific chronic granulomatous inflammation. As causative agents a Fusarium species and a Cladosporium normodendrum, respectively, were cultured. The treatment consisted of curettage of fistulous ducts and administration of itraconazole.