CONFERENCES AND MEETINGS Tropical Splenomegaly Syndrome

A one-day symposium was held at the Royal Postgraduate Medical School in London on 17 November. The participants comprised experts in tropical medicine, parasitology, pathology, immunology, and haematology, most of whom had had personal experience with splenomegaly in the tropics. They met to review the present state of knowledge and to define those areas where further research was likely to be fruitful. Splenomegaly is common in tropical countries, and well-recognized causes include portal hypertension due to hepatic cirrhosis, haemoglobinopathy, leishmaniasis, and schistosomiasis. In some areas there exists a form of massive splenomegaly found mostly in adults in which the above causes can be excluded. This type of splenomegaly has been termed idiopathic splenomegaly, tropical splenomegaly, " big spleen " disease, cryptogenetic splenomegaly, Bengal splenomegaly, and African macroglobulinaemia. The disorder is found in regions where malaria is endemic, and it has been customary to consider malaria a causative factor, although the evidence in favour is largely circumstantial. Many interesting features have been described as a result of studies by workers in Uganda, Nigeria, New Guinea, and elsewhere using modern techniques. The majority of participants favoured a noncommittal title of tropical splenomegaly syndrome, at least for the time being. It was pointed out that a syndrome only has been described, which may not, in fact, be a homogeneous entity in all areas studied. A more definite title should wait until further work has produced a clearer understanding of the causal mechanisms.