Toombak dipping and cancer of the oral cavity in the Sudan: a case-control study.

To investigate the possible causal association between squamous-cell carcinomas of the oral cavity and use of toombak, we retrospectively compared the history of use of this substance in 375 patients with squamous-cell carcinomas of the lip, buccal cavity and floor of mouth, and 271 patients with squamous carcinomas of the tongue, palate and maxillary sinus, with 204 patients exhibiting non-squamous oral and non-oral malignant neoplasms and 2,820 individuals who had no malignancy, selected from the general population. The study revealed that the high prevalence of oral cancer in the Sudan is largely due to chronic use of toombak. The adjusted ORs associated with toombak dipping for the first case group, cancer of the lip, buccal cavity and floor of mouth in comparison with the hospital and population control groups, were 7.3 and 3.9 (95% confidence limits, 4.3-12.4 and 2.9-5.3) respectively and among long-term users the adjusted ORs were 11.0 and 4.3 (95% confidence limits, 4.8-25.1 and 2.9-6.3) respectively. The elevated risk found when investigating intra-oral cancers of sites in direct contact with toombak quid compared to those with little or no contact, confirms the hypothesis that direct contact with tissues is an important factor in tobacco carcinogenesis in the mouth. The increased risk associated with the use of toombak is of particular concern in view of its wide consumption in the Sudan.

Studies on nasopharyngeal carcinoma in the Sudan--I. Epidemiology and Aetiology.

Three hundred and seventy-four cases of nasopharyngeal carcinoma (NPC) recorded in the Sudan Cancer Registry (SCR) and 512 cases seen at the Radiation and Isotope Centre, Khartoum (RICK) were analysed. NPC formed 5.8% of all cancer cases in the SCR and 7.2% at the RICK; this is the highest frequency so far reported outside the Chinese. The male/female ratio was 3:1; NPC was the commonest tumour in males at the RICK (12.1%) and second commonest in the SCR (9.2%). It tended to occur in younger patients (youngest, 3 yr), with 14 and 12.1% of cases in children 14 yr or under in the SCR and RICK respectively; it is the commonest childhood malignancy in the Sudan. The ethnic and geographical distribution of the cases showed that racial susceptibility played a significant role in the aetiology of NPC in the Sudan whereas environmental factors could be excluded; however, Epstein-Barr virus might be an exciting factor.

Scrotal swellings in Sudanese patients: a surgical pathology study.

Scrotal swellings are frequently encountered in surgical practice in the Sudan and other tropical countries and, because of the diversity of possible etiological agents, often pose problems in differential diagnosis. In this communication, 443 histologically verified scrotal swellings in Sudanese patients are surveyed as regards their causes and salient clinico-pathological features. Common lesions such as hydroceles have been considered as well as rarer but important conditions, including tuberculosis and Schistosomiasis. Clinicians practicing in tropical environments should consider these possibilities and the limitations of clinical diagnosis indicate biopsy confirmation. Since some conditions might respond to medical therapy, some orchidectomies could be avoided.

Louse-borne relapsing fever in the Sudan. A historical review and a clinico-pathological study.

A small outbreak of louse-borne relapsing fever in Khartoum (May-June 1974) provided material for a clinico-pathological study. The history of the disease in the Sudan is reviewed and the clinical and laboratory findings in 32 patients are presented. Fever, headache, jaundice, epistaxis and hepatosplenomegaly were the commonest clinical findings; thrombocytopenia was detected in 93% of cases. Although elevated levels of fibrin degradation products were found in most patients, disseminated intravascular coagulation could not be diagnosed. Hepatocellular derangement was found in 68% of cases, while 78% had high blood urea. In five autopsied bodies there was bronchopneumonia, interstitial edema with focal myocardial fibrosis, hepatic necrosis, splenic infarcts, increase in size and cellularity of the glomeruli and brain edema and congestion. Intracranial haemorrhage was found in three of the autopsied cases.

Tumors of the eye and adnexa in the Sudan.

854 lesions involving the eye and adnexa in the Sudan were studied as regards their frequency, sex and age incidence, site, pathologic types and geographic and racial distribution. Of 279 primary malignant tumors (frequency ratio 4.3%), conjunctival squamous carcinoma was the commonest (50.4%) while retinoblastoma formed 20.8%, basal cell carcinoma 6.1% and malignant melanoma 4.6%. Conjunctival carcinoma and allied epithelial lesions occurred much more predominently in Northern than in Southern Sudan and no basal cell carcinoma of the eyelids was recorded in the latter. Retinoblastoma and melanoma showed certain tribal predilections. Most cases of Burkitt's lymphoma occurred in Southern Sudan. It is concluded that geographic and racial factors play important roles in determining the frequency and pattern of eye neoplasms in the Sudan.

Epstein-Barr virus antibodies in Sudanese patients with nasopharyngeal carcinoma: a preliminary report.

With the use of an immunofluorescence technique Epstein-Barr viral capsid antigen antibody titers were determined in the sera from 226 Sudanese: 41 with nasopharyngeal carcinoma (NPC), 77 with other head and neck cancers, 21 with malignant lymphomas, 63 with other cancers, 6 with specific granulomas, and 18 normal controls. Of the NPC patients, 87.8% had titers of 320 or greater and 43.9% had titers of 2,560 or more, whereas none had titers of less than 40. Their geometric mean titer (GMT) level was 1,855. However, compared to the NPC patients, the other patients and normal controls showed significantly higher percentages of sera with low titers and lower percentages of sera with high titers and they had a GMT that was 4--16 times lower. The high NPC titers were independent of age, sex, tribe, or locality of patients. The preliminary results indicated the importance of future immunovirologic and immunogenetic field investigations on the natural history of the Epstein-Barr virus and on the genetics of the host.

Sudden coronary deaths associated with sexual activity.

Two cases of sudden coronary deaths occurring in circumstances of unusual sexual activity are reported. Previous recorded cases are reviewed and the subject is discussed as regards the magnitude of the problem, its circumstances, the mechanisms involved, and the preventive measures to be adopted.

Burkitt's lymphoma in the Sudan.

During the period 1962-73 twenty-nine cases of Burkitt's lymphoma were seen and examined histologically in Khartoum, Sudan. Burkitt's lymphoma formed 20% of the cases of childhood lymphomas. The average age at presentation was 6.8 years and the male to female ratio was 3.8:1. The clinical features, the anatomical localization and histological appearances were similar to those reported in the literature. The geographical distribution of the tumour showed close correlation to that of holo- or hyperendemic malaria.

Tumoural lipocalcinosis: a clinicopathological study of 20 cases.

Twenty cases of tumoural lipocalcinosis are described. Active and inactive stages can be recognised, each with distinctive histological features. The aetiology and pathogenesis of the lesion remains obscure.

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.

Pattern of bladder cancer in the Sudan and its relation to schistosomiasis: a study of 255 vesical carcinomas.

Two hundred and fifty five vesical carcinomas in Sudanese patients are analysed as regards frequency, age, sex, local geographical distribution, morphological features and association with urinary schistosomiasis. The findings are compared with those from other series. It is concluded that the pattern of bladder cancer in the Sudan in general conforms to that reported from regions endemic for schistosomiasis and differs significantly from that seen in non-schistosomal regions. The limitations in the study are noted.

Superficial cancer in the Sudan. A study of 1225 primary malignant superficial tumours.

Superficial cancer in the Sudan accounted for 17·2% of all malignant tumours examined histologically during the period 1962-72 inclusive. Of the 4 pathological types studied, squamous cell carcinoma was the commonest (63·3% of all superficial cancers) followed by malignant melanoma (18·8%) and basal cell carcinoma (14·9%) whilst Kaposi's sarcoma formed only 3% of the total. Generally, twice as many cases occurred in males as in females, with the exception of Kaposi's sarcoma where all the patients were males. Although a relatively high proportion of cases occurred in the young age groups, the age-specific incidence was noted to increase with age. Similarities and differences in the anatomical site of tumours compared with European and African series were noted. Certain differences emerged in the geographical distribution of these tumours in the Northern and Southern regions of the Sudan-regions which differ both ethnologically and geographically-thus suggesting possible roles played by racial and environmental factors in this respect.