Serum trypsin in hepatosplenic schistosomiasis in the Sudan.

Serum trypsin was measured by radioimmunoassay in 30 patients with hepatosplenic schistosomiasis and 30 healthy controls. Patients with hepatosplenic schistosomiasis had a significantly lower serum trypsin 164.3 +/- 43.3 ng/ml than controls 241.3 +/- 74.0 ng/ml (P less than 0.001). It is concluded that the exocrine pancreatic function is impaired with regard to serum trypsin in hepatosplenic schistosomiasis.

Gastric secretion and basal gastrin concentration in bilharzial hepatic fibrosis.

Gastric secretion and fasting plasma gastrin levels were investigated in 26 patients with bilharzial hepatic fibrosis and 26 controls. The groups did not differ in their basal secretion. When stimulated by intravenous infusion of histamine the maximal acid output in patients with bilharzial hepatic fibrosis was significantly less than in the control group. This was unlikely to be a result of neutralisation by reflux of alkaline duodenal contents as the volumes of reflux were not different from control subjects, but was compatible with a true reduction in gastric secretion as assessed by two-component hypothesis. Neither the lowered gastric acidity nor the liver damage in patients with bilharzial hepatic fibrosis correlated with circulating gastrin. The fasting levels of plasma gastrin in these patients were not different from controls. As in other liver diseases the cause of diminished gastric secretion remains unclear.

Volvulus of the sigmoid in Khartoum, Sudan.

Twenty-six cases of acute volvulus of the sigmoid in Khartoum Hospital are analysed. The condition accounts for 17.8 percent of all cases of acute intestinal obstruction. The majority of patients were from the Southern tribes whose diet contains a large amount of fibre. Of the different methods of surgical management simple operative detorsion and deflation gave the best results. The overall mortality rate was 23.1 percent.

Bilharzial granuloma of the gastro-intestinal tract.

Thirty-four patients with bilharzial granuloma of the gastro-intestinal tract were analysed. The commonest site was the rectosigmoid, Bilharzial "appendicitis" was also common but the exact relation between bilharzial granuloma and acute inflammation remains unclear. Preoperative diagnosis is bilharzial granuloma is occasionally difficult and histological proof is necessary. Surgical treatment with polypectomy in the case of a solitary polyp and excision of the affected segment of bowel when there are multiple polps are recommended. There is no evidence that the condition is premalignant.

Prognosis of colo-rectal carcinoma in Sudan.

Forty-two histologically confirmed cases of colo-rectal carcinoma were analysed. Thirty-three per cent were below the age of 30 years. Patients presented at an advanced stage of the disease evidenced by lympth node and/or hepatic involvement, ascites and intestinal obstruction. Nearly half of the patients had low grade tumours. Emergency and multi-staged operations were often necessary. The hospital mortality rate was 38.2 per cent. The problems of diagnosis and management under the conditions prevailing in the Sudan were discussed. It is suggested that a better health education of the people and more awareness of the medical profession are necessary to improve the present results.

Cancer of the alimentary tract in the Sudan: a study of 546 cases.

Five hundred and forty-six primary malignant alimentary tract tumors in Sudanese patients are analyzed for frequency, age, sex, site, geographic distribution, and clinicopathologic presentations and are compared with other series. The disease is much less frequent in Sudan than in Western countries; within the Sudan itself it is much less prevalent in the South than the North. Generally, it tends to occur in younger age groups than in Western countries. Esophageal cancer is relatively common, especially in the Northern Province and has a female preponderance. Possible explanations are offered. Rectal cancer is more frequent than colonic cancer per se and occurs more often in males; more cases are recorded in relatively young patients. Colonic cancer has a predilection for the caecum. Alimentary cancer does not seem to be related to intestinal bilharziasis or other granulomas though these conditions may clinically mimic malignancy. The shortcomings in the collection of data are noted.

Carcinoma of the large bowel in the Sudan.

Large bowel cancer is not common but is showing increased frequency in the northern part of the Sudan. It is relatively uncommon among southerners, which may be due to the socio-economic factors prevailing in the Sudan. The disease affected our population at a younger age than has been generally reported in the literature, and the lesions in nearly 30 per cent were of the mucoid and undifferentiated types. The incidence in young adults is difficult to explain in the absence of precancerous lesions, and there is not enough evidence to incriminate parasitic infestation.