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The paper presents the results of a retrospective study and the experiences with 4000 fibreoptic oesophago-gastro-duodenoscopies (EGD), which were performed at Kilimanjaro Christian Medical Centre (KCMC) between 1985 and 1989 in an open access service. Seventy per cent of all patients examined had abnormal findings with duodenal ulcer as the most frequent diagnosis (22%). Pyloric stenosis was seen in 6%, gastric ulcer in 5% and esophageal varices in 4% of all patients. High figures were found for carcinoma of the esophagus (4%) and malignancy of the stomach (5%). Gastritis was diagnosed in 11%. We consider fibreoptic EGD a cost effective and appropriate technology. Because of its high diagnostic yield, we advocate its use in certain centres in developing countries.

One hundred and sixty-eight laparoscopies, performed for various indications between 1985 and 1989, were studied retrospectively and the findings and experiences are reported. The most frequent diagnoses were hepatocellular carcinoma (20%) and liver cirrhosis (18%). Correlation of macroscopic and histopathological diagnosis was satisfactory in hepatocellular carcinoma (74%) and poor in liver cirrhosis (38%). Laparoscopy was judged diagnostic in 45%, diagnostically helpful in 20% and non-contributory in 35% of all cases. The highest yield was obtained in hepatocellular carcinoma and liver cirrhosis, the poorest results in obstructive jaundice. It is concluded that for optimum diagnostic outcome the indication for laparoscopy should be strict and that it should be practised only in those centres where experienced clinicians and competent histopathologists are available.

Severe bronchopneumonia in a 66-year-old patient failed to respond to sensitivity-tested antibiotics, with only erythromycin providing improvement. The indirect immunofluorescence test for legionnaire's disease gave a highly significant titre rise (eightfold). Legionnaire's disease should be considered in the differential diagnosis of treatment-resistant bronchopneumonia.