Toxoplasma gondii antibodies in pregnant women and their newborns in Dar es Salaam, Tanzania.

The sera of 849 Tanzanian pregnant women were tested at delivery for Toxoplasma gondii antibodies with the Sabin-Feldman dye test (DT) and an immunosorbent agglutination assay. A total of 296 (35%) of these women had DT titers greater than 1:4. The percentage of women with dye test titers greater than 1:4 was 34-37% regardless of the individual ages. The rate of positivity for human immunodeficiency virus 1/2 (HIV-1/2) using Western blotting was 11.5%. There was no relationship between prevalence of a positive DT result and HIV infection nor between the intensity of the DT result and HIV infection. Sixty-four parturients had a DT titer of 1:1,000 or more. From 57 newborns of these mothers, cord sera were available and were screened by the DT and the immunosorbent agglutination assay. Seven of these were found to be positive for IgM and/or IgA antibodies. It was concluded that the rate of serologic evidence for prenatal Toxoplasma infection in cord blood samples in the present study of Tanzanian pregnant women was approximately 0.8%.

Heterotopic pregnancy in a spontaneous cycle: do not forget about it!

Heterotopic pregnancies are estimated to be less frequent than 1:30000 if no assisted reproduction technologies (ART) are performed. After ART this entity is more frequent and in the range of 1:100. In the case reported here an ectopic pregnancy was detected in the right fallopian tube at 7+ 1 weeks of gestation. It was misdiagnosed as an ectopic singleton, and treated by laparoscopic salpingectomy, because of a previous ectopic in the same tube. Rising hCG after laparoscopy during the subsequent days followed by ultrasound evaluation revealed a viable intrauterine pregnancy. The pregnancy continued uneventfully and a healthy child was delivered at term. The problems, which lead to the misdiagnosis are discussed. The problem of rare cases in medicine, and the problems of a 'modern' medicine are discussed.

Evaluation of tolerance of and response to iron dextran (Imferon) administered by total dose infusion to pregnant women with iron deficiency anemia.

Six hundred twenty-three pregnant women with iron deficiency anemia received iron dextran Imferon by total dose infusion (TDI). Two dose levels were compared in respect of tolerance and hemoglobin response. The incidence of delayed reactions was significantly higher in the high dose group (P less than 0.01) but there was no significant difference in the incidence of reactions occurring during the infusion. These findings are discussed in relation to the hemoglobin response.

The forgotten child--a case of heterotopic, intra-abdominal and intrauterine pregnancy carried to term.

Heterotopic pregnancies are estimated to be less frequent than one in 30,000 if no assisted reproduction technologies are performed. Here we report a case which occurred in Tanzania. An abdominal pregnancy at term was first misdiagnosed as an ovarian tumour and diagnosed on the first post-partum day of the intrauterine fetus, which was delivered spontaneously. The abdominal pregnancy was then treated by laparotomy and removal of the placenta. The fetus was alive and healthy. The follow-up of the twins was normal.

Small diameter laparoscopy using a microlaparoscope.

In order to determine the suitability of new microlaparoscopes of < 2.0 mm diameter for diagnostic laparoscopy, 28 small diameter laparoscopies (SDL) were performed during a 4 month period. These cases were performed under general anaesthesia with immediate follow-up confirmation with conventional laparoscopic equipment (group I). An additional 13 SDL procedures were performed under analgesic sedation plus local anaesthesia and were well tolerated by the patients (group II). For group I, the visualization results were comparable in 27 out of 28 procedures. In group II, patients were highly satisfied and reported less post-procedural discomfort and minimal scar formation due to the smaller access ports. In this study, two different types of microlaparoscopes were used; while both were adequate, the newer high-resolution microlaparoscope delivered an image much more similar to conventional laparoscopy and required little or no change in technique in order to obtain images. This new endoscopic technology, with optical performance comparable to that of conventional laparoscopy, has been demonstrated to be a useful procedure for certain clinical indications.

Chlorinated hydrocarbon content of fetal and maternal body tissues and fluids in full term pregnant women: a comparison of Germany versus Tanzania.

Chlorinated hydrocarbons are distributed worldwide and due to their lipophilic properties and chemical stability they accumulate in the foodchain. The concentrations of 19 different chlorinated hydrocarbons (hexachlorohexane (HCH), DDT and various metabolites and nine different polychlorinated phenyl (PCB) congeners were detected in various body tissues and fluids (maternal and fetal serum, adipose tissue, placenta, amniotic fluid) of full term pregnant women from Germany and Tanzania. Great variation of total toxin burden and toxin distribution within the different body compartments was found. This was in part due to local differences of exposure to some of the chlorinated hydrocarbons. Comparing samples from Germany and Tanzania, typical distribution patterns reflected the specific economic situation of the two countries with a high burden of insecticides (DDT and Dieldrin) in the agricultural country and high levels of constituents of industrial products (hexachlorobenzene (HCB) and PCBs) in Germany. Different chlorinated hydrocarbons seem to show different distribution patterns in body tissues, probably due to their chemical structure, the lipid content of the compartment and the overall toxin burden of the individual. A 10 to 100 fold accumulation of chlorinated hydrocarbons was observed in maternal adipose tissue compared with the other compartments. The concentrations of certain toxins in fetal cord serum and placenta were higher than in maternal serum.