Endemic non-filarial elephantiasis in Iringa District, Tanzania: a study of 30 patients

Endemic non-filarial elephantiasis has not yet been described in the central tableland of Tanzania. We report the results of a clinical study in Tosamaganga Hospital, located in the middle of Tanzania (Iringa District). 30 patients with elephantiasis of the lower limbs were studied parasitologically (by blood smears) and clinically. Inguinal lymph nodes were removed from 10 patients and histologically examined. The mineral content of soil samples collected from 4 different areas of the region was assayed by X-ray fluorescence. The clinical, histological, parasitological and epidemiological data prompted us to conclude that in these patients elephantiasis was not of the filarial type, and that endemic non-filarial elephantiasis is present in the Central District of Tanzania.     

Endemic goiter: clinical picture and evolution

The goiter is the most frequent clinical manifestation of the nutritional deficiency of iodine. If present in more than 5% of the general population or more than 10% of the children in school of a defined geographic area, goiter is defined endemic. Endemic goiter is an adaptive disease produced by the persistent stimulation of the thyroid gland as consequence of the thyrotropin increased secretion due to the iodine deficiency. If iodine deficiency is severe or persistent, other manifestations can be observed in the clinical picture of the iodine deficiency disorders (IDD), such as cretinism. In general goiter is not associated to other manifestations during the initial state of the disease, but nodular and toxic evolution are frequent complication of long standing disease.     

临床表现诊断饮水型氟骨症价值评析

目的 比较饮水型地方性氟骨症临床表现诊断与X线诊断的差异,评价临床表现对该病的诊断价值,为按照临床表现对该病进行早期诊断提供理论依据.方法 调查244例高氟病区居民的临床症状和体征,统计各种症状、体征检出率,并依据临床表现进行诊断与分度;拍摄骨关节X线照片,按照WS192-1999标准进行X线诊断与分度;比较临床与X线方法诊断及分度结果的差异;计算临床诊断方法的真实性、可靠性等指标,并根据上述指标对其诊断价值进行评价.结果 饮水型地方性氟骨症最常见的临床表现为骨关节的疼痛和僵硬;临床和X线方法检出率分别为69.3%和63.1%,两种方法诊断结果的差异没有统计б庖?P>0.05);临床与X线诊断方法的符合率为69.3%;二者在分度上表现出交叉;临床诊断方法灵敏度为80.5%,特异度为50.0%,假阴性率为19.5%,假阳性率为50.0%;ROC曲线下面积为0.653.结论 临床与X线诊断方法对氟骨症的检出率相同.依据临床表现对该病进行诊断的特异度不高,可能由于临床表现为非客观性指标,不好控制;临床表现诊断法误诊率较高;临床诊断与X线诊断方法对该病的诊断结果较一致,虽不可单独诊断,却可为确诊该病提供重要线索.     

The association of endemic elephantiasis of the lower legs in East Africa with soil derived from volcanic rocks

Endemic elephantiasis of the lower legs in Ethiopia, which reaches a maximum of 86·7 per 1,000 adults in affected areas, is related to the distribution of red clay soil derived from volcanic rocks, particularly basalt. Prevalence falls rapidly on leaving these areas.This observation has been tested in regions of non-filarial elephantiasis reported in Kenya and north-western Tanzania and further investigated in volcanic areas of Rwanda where the disease had not previously been reported. The same relationship is found to occur in these areas. The limitation to the lower legs of the bare-footed section of the farming community suggests that the aetiological factor or factors enter by the feet.The occurrence at high altitude (over 1,200 metres) is noted and the predominance of basalt or basalt-like lava in each case is considered significant. The altitude governs rainfall and temperature and thus governs the type of soil produced.The soil produced from these rocks is rich in colloidal iron oxide, alumina and silica, to which a number of metallic ions are adsorbed. This soil is a reddish-brown clay which, when wet, is strongly adherent to the skin. The derived ions are known to be toxic to human tissue and absorption through intact human skin has been shown to occur experimentally. It is suggested that absorption of these irritants through the bare feet is responsible for the irreversible damage to the lymphatic channels.The present studies support the hypothesis that “high-altitude” elephantiasis of the lower legs in East Africa is a geochemical disease.     

Silica and silicates in femoral lymph nodes of barefooted people in Ethiopia with special reference to elephantiasis of the lower legs.

Electron microscopy of femoral lymph nodes of barefooted Ethiopians show the presence of numerous particles of colloid-size and electron-density in the lysosomes of the macrophages in the gland. On diffraction analysis, the particles are found to be amorphous. Elemental microanalysis of the X-ray spectrum indicate the predominance of Si, Al and Fe. In elephantiasics some particles contain silicon alone, presumably silica. The distribution of the Al/Si ratios of the particles in subjects with elephantiasis of the lower legs show a difference from that of non-elephantiasics which is statistically "highly significant" at p less than 0.001. The importance of this as a possible aetiological factor in the disease is discussed. The hypothesis that the disease is discussed. The hypothesis that the disease is a silicosis of the peripheral lymphatics of the lower limbs is supported by the present study.     

The elemental content of lymphatic tissues of barefooted people in Ethiopia,with reference to endemic elephantiasis of the lower legs

Previous field studies of endemic (non-filarial) elephantiasis of the lower legs in East Africa have indicated a distribution related to that of the red clays of volcanic areas. The present study on the lymphatic tissues of the lower limb of elephantiasic and non-elephantiasic subjects examines the numerous microparticles observed in these tissues, using the technique of electron microscope microanalysis.In both groups, minerals of colloid size are present containing the elements found in clays, notably Al, Si, Mg, Na, Ca and Fe. Si is present in 80 to 90% of particles and both Si and Al in 70 to 80%. The trace elements present are those characteristic of volcanic rocks. The microparticles are seen within the macrophages of the lymph nodes and correspond to those observed by the light microscope as birefringent.It is noted that birefringent particles are much more commonly observed in elephantiasic nodes than in non-elephantiasics, and it is suggested that this may indicate a protein coating in the latter group which could protect the tissues against the harmful effects of otherwise damaging ions; this coating would be absent in the elephantiasics.A difference is also defined in the $\text{Al}\text{Si}$ ratios of particles between the elephantiasics and non-elephantiasics which is statistically highly significant at p < 0·005. It appears that the two groups are handling the silicates in different ways. Further studies are being undertaken to examine this difference.     

大豆膳食纤维和低聚果糖临床降糖效果研究

目的 探讨大豆膳食纤维和低聚果糖临床降糖效果,为改善糖尿病人膳食结构提供依据.方法 从大豆中提取膳食纤维,选购市售低聚果糖,按照特定加工工艺制成高纤维面包,对糖尿病患者进行膳食干预实验.将60例糖尿病患者随机分为大豆纤维(A)组,低聚果糖(B)组和混合(AB)组,分别补充相应的高纤维食品进行降糖效果观察.结果 补充大豆...     

The role of the routine clinical history

Twenty-two final-year clinical medical students, twenty-two pre-registration house physicians and twenty-two post MRCP (U.K.) registrars were studied during the clinical interview by the method of videotape-stimulated recall. It was found that the course of the clinical interview was determined by three thinking processes. There was no significant difference between the students, house officers and registrars in the extent to which their interviews displayed these thinking processes. Taking all subjects together, however, there was a significant difference in overall frequency of usage of the processes. The results show that students and doctors largely conduct the clinical interview according to either the demands of their own interpretation of the clinical information as it is gathered or the requirements of the routine format but usually by a combination of both. The active role of the interviewer in following his/her own interpretative needs is the most important feature of our findings. The routine enquiry was used by all groups as a failsafe or background search mechanism. Increased knowledge of these thinking processes among students and teachers of medicine may lead to a more realistic and efficient balance in the teaching and learning of the clinical history.     

The burden of non-filarial elephantiasis in Ethiopia

Although known for many years, non-filarial elephantiasis remains a public health problem in tropical Africa, including the farming community of Ethiopia. The problem may be exacerbated in women who shoulder most of the burden of agricultural labour in the countryside. The intention of this brief review is to emphasise the burden of the disease and to alert researchers and organisations concerned with health care and prevention.     

Endemic gastrointestinal anthrax in 1960s Lebanon: clinical manifestations and surgical findings

Anthrax is an ancient disease caused by the gram-positive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare. Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal. The last type results from ingestion of poorly cooked contaminated meat. Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley. We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment.