Acute gluteal abscess following intramuscular chloroquine injection: a clinical and experimental study

This prospective study contains clinical and experimental parts. In the clinical study, 125 patients given intramuscular chloroquine for malaria were followed for 2 months in order to detect local injection site complications. Adequate local antiseptic conditions were ensured before giving the injection. Twenty-three patients (18.4%) had minimal local reaction in the form of redness, induration and/or a lump. No pyogenic abscess was noted in contrast to a previous report. In the second part of the study, an experimental animal (Green monkey) was given either chloroquine phosphate, Ampiclox or normal saline intramuscularly. The injection site was later biopsied and histologically examined. Intramuscular chloroquine was found to cause severe inflammatory reactions and muscle necrosis, whereas other injections had very minimal local effects. It is concluded that intramuscular chloroquine causes muscle necrosis which may lead to acute pyogenic abscess if minimal contamination takes place.

Blood pressure in a multiracial urban Sudanese community

A study was conducted into blood pressure in a sample of 510 urban Sudanese working in the post office in Khartoum. The mean age was 35 years and 65% of the workers came from Northern Sudan. Cigarette smoking and any consumption of alcohol was commonest amongst those from Southern Sudan. Both systolic and diastolic BPs rose with age. The prevalence of hypertension (140/90 mmHg or greater) was 7.5%. BP levels in this study were lower than those reported in Nigerians or blacks in the Caribbean or the United States. There was a significant positive correlation between SBP and DBP and age, weight, body mass index and duration of residence in the city. These data confirm that hypertension is becoming an important health problem in the Sudan.

Current palliative modalities for esophageal carcinoma. Clinical review

Esophageal carcinoma is often advanced at diagnosis, and management consequently can only be palliative, with relief of dysphagia and its consequences as the primary aim. The various methods for palliation are reviewed and their indications, advantages and drawbacks are discussed. If resection of the tumor is not feasible, YAG laser therapy seems to be the palliative method of choice in malignant dysphagia.

Haemorrhoids in Khartoum

Five hundreds and seventy two patients with haemorrhoids seen during the period 1981-1984 in the rectal clinic at Khartoum Teaching Hospital and a general surgical clinic at Soba University Hospital were studied. Pure internal piles were found in 39.86% of patients, both internal and external components were found in 33.22%, only external component was found in 5.07% and there was a miscellaneous group of 125(20%) patients. Constipation was noted in 21% of patients suffering from haemorrhoids. Patients with pure internal piles were best treated conservatively--89% responded to local ointments, injection or rubber band ligation while 11% required surgery. In the second group with both internal and external components--66% responded to conservative treatment. In patients with pure external component like those with skin tags, reassurance was all that was needed whereas those with external piles were treated by surgical excision. In the miscellaneous group the three main diagnosis were acute or subacute prolapsed piles (43 patients), perianal haematomas (25 patients) and bilharzia with piles (20 patients).

Metronidazole prophylaxis in acute mural appendicitis: failure of a single intra-operative infusion to reduce wound infection

The efficacy of a single 500 mg intravenous intra-operative dose of metronidazole in the prevention of postoperative wound infection, following appendicectomy for acute mural appendicitis, was studied in a prospective randomized placebo controlled trial. Fourteen of the 96 patients (14.6%) in the metronidazole group and 13 of the 94 in the placebo group (13.8%) developed postoperative wound infection. Late sepsis was noted in 4 out of the 96 patients in the metronidazole group and in one of the 94 patients in the placebo group. This study suggests that a single intra-operative dose of metronidazole dose not reduce the incidence of postoperative wound infection following appendicectomy for acute mural appendicitis.

Quantitative sweat test in diabetics with neuropathic foot lesions

The volume of sweat produced by axon reflex stimulation using acetylcholine was measured in one foot each of 35 control subjects and 52 feet of 37 diabetic patients (28 with neuropathic ulceration, 11 with Charcot arthropathy, nine with somatic neuropathy but no foot lesion and four with no evidence of somatic neuropathy). In controls, the volume of sweat was greater in males than females. A flare response was seen in 94% of control feet. In diabetics, the volume of sweat was within the control range in 17 feet, increased in one, reduced in seven, and absent in 27. Sweating was absent in 75% of feet with a neuropathic ulcer; a flare response was absent in 86% of them. Sweating was only absent in 36% of feet with Charcot arthropathy and was increased in one, whereas the flare response was absent in all. Autonomic cardiovascular reflexes were more frequently abnormal than the sweat test; sweating was absent in only one patient with normal cardiovascular reflexes.

The role of autonomic neuropathy in diabetic foot ulceration

Five standard, non-invasive tests of cardiovascular, autonomic function were performed in each of four groups of 30 subjects: controls, group 1, diabetics without clinical evidence of neuropathy; group 2, diabetics with neuropathy, but without foot ulceration; group 3, diabetics with neuropathic ulceration of the foot. The results showed a significant impairment of autonomic function in diabetics without clinically demonstrable somatic neuropathy compared with controls diabetics with somatic neuropathy compared with those without diabetics with neuropathic ulceration compared with those with neuropathy without ulceration. Parasympathetic function was more seriously affected than sympathetic. In patients who had only mild sensory neuropathy on clinical assessment, those with ulcers had significantly greater impairment of autonomic neuropathy compared with those with uncomplicated neuropathy.

Lack of difference between malignant and accelerated hypertension

The clinical features and survival rates of 200 consecutive patients with malignant and accelerated hypertension admitted to a district hospital were investigated. Ninety five patients had bilateral haemorrhages and exudates and papilloedema (grade IV retinopathy) and 31 had bilateral haemorrhages and exudates with no papilloedema (grade III). A further 74 patients had bilateral retinopathy but failed to meet the criteria for grade IV or III and were investigated separately. No overall differences were found in survival when comparing the various grades of retinopathy. Cigarette smoking was significantly commoner only in grade IV patients compared with those with non-malignant hypertension matched for age, sex, and race. In patients with grade III retinopathy excess smoking was not statistically significant. In conclusion, the clinical features and survival rate showed that malignant and accelerated hypertension are one and the same disease.

Acute gastric dilatation following upper gastrointestinal endoscopy

A patient who developed symptoms and signs of acute gastric dilatation following upper gastrointestinal endoscopy is described. Relations of endoscopy to the development of the condition are discussed.

A blood pressure clinic in a developing country

There are few studies of hypertension in Sudan. In this report, 124 patients attending a newly established hypertension clinic are studied, most of whom were taking irregular treatment initially. Seventy-three (59%) had a strong family history of hypertension. There was a very low incidence of cigarette smoking (13.7%), and alcohol consumption (4.8%). As with blacks in the U.K. and the U.S.A., the commonest complications were cerebrovascular accidents and congestive cardiac failure. Most of the patients had moderately elevated blood pressures on the first visit, which fell significantly after 3 and 6 months of clinic attendance. Methyldopa and thiazides were the commonest drugs used, but a small pilot survey demonstrated that beta-blockers were effective. The high cost and poor availability of drugs contribute to poor compliance in these patients.

A comparison between clinical and laboratory tests in rheumatoid arthritis

Five clinical measurements (clinical score, articular index, visual analogue pain score, visual analogue function score, grip strength) were compared with two laboratory tests (the erythrocyte sedimentation rate and serum C-reactive protein concentration) in 68 patients with rheumatoid arthritis (RA). Patients treated with nonsteroid anti-inflammatory drugs showed clinical deterioration when treatment was interrupted, followed by improvement on resumption; there was no change in the laboratory tests. Patients treated with remission-inducing drugs (RIDs) had improved clinical measurements and also reduced erythrocyte sedimentation rate and serum C-reactive protein levels. Treatment with RID's led to similar trends in both clinical and laboratory tests, but correlation coefficients between the tests at intervals rarely attained statistical significance. The different response times for each test and probably also errors inherent in clinical measurements introduced sufficient variability to account for the discrepancy. Of the clinical tests, 'clinical score' appeared the most satisfactory.