The presence of several infections was determined in tissue and serum samples from 34 cases and 23 controls seen in 1984-85 at Mulago Hospital in Kampala, Uganda. When assessing single infections, association with cervical cancer could be shown for 5 agents, namely by Southern blot assay for human papillomavirus types 16 and 18 (HPV), and by serological tests at varying levels of antibody titres, for herpes simplex virus type I and/or 2 (HSV), cytomegalovirus (CMV), Epstein-Barr virus, viral capsid antigen (EBV-VCA), and Chlamydia trachomatis (CLT). Due to interaction, HSV and CMV were associated with cervical cancer only when infection by both of these agents was demonstrable. In the assessment of the simultaneous presence of these 5 infections, moderately high antibody titres were taken as the cut-off point for infection by HSV, CMV, EBV-VCA, and CLT. This showed that 3 and 4 infections at a time were seen in the majority of the cases in contrast to the controls with essentially no more than 2 such infections. A linear trend in the rise of risk for cervical cancer was noted with increasing number of infections.

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Biopsies of malignant lymphomas collected from all districts of Uganda, filed in the Kampala Cancer Registry for the 8-year period 1966-1973, were reviewed. This review confirmed a relatively low frequency of follicle-centre-cell lymphomas with a follicular growth pattern and the geographical co-distribution between malaria and Burkitt's lymphoma (BL). It also showed a similar, though less marked, association between non-Burkitt, non-Hodgkin's lymphoma (NBNHL) and malarial endemicity, and a correlation in the regional incidence between BL and NBNHL. In both comparisons, these associations were strong for high-grade lymphomas and weak for low-grade neoplasms. BL and other NHL may therefore share, to a varying degree, some common pathogenesis. The excess in frequency of NBNHL of high-grade malignancy in malarial endemic areas appears to be in contrast to Western countries where most non-Hodgkin's lymphomas are of low-grade malignancy.

As in a prior study on malignant lymphomas, 3 and 6 areas of Uganda showing low and high malarial endemicity, respectively, were selected for analysis and the data retrieved from the Kampala Cancer Registry, which in the 1960s and 1970s collected cases of cancer through a widely used free biopsy service from the whole country. Overall incidence rates were derived from 924 cases from the 12-year period 1964 -1975. For reasons of economy, grade of tumour was determined only in cases pertaining to the 6-year period 1968 -1973. Of 457 cases, 304 could be reviewed histologically. Only the group of squamous cell carcinomas (84.9%, 258 cases) was large enough for subsequent geographic analysis. High incidence rates of CC were found in areas with high malarial endemicity, whereas low incidence rates occurred where malaria was either frequent or rare. A correlate to malarial infection was the proportion of high-grade carcinomas irrespective of the overall incidence of CC. With high prevalence of malaria and high CPRs of 35-74%, the relative share of high-grade cancer amounted to 50 -67%. Where malaria was rare with low CPRs of 8 -11%, these values were lower and varied only from 25-39% with a similar range of 14%. Geographic agreement between malarial endemicity and the PI of high-grade cancer was high in the 9 study areas and only slightly lower than for BL, for which the association with malaria is beyond doubt. Compared to areas with little malaria, the RR for the incidence of high-grade carcinomas in areas with severe malaria was increased. The value was 2.04 with a 95% confidence interval of 1.37-3.04. Attributable to secondary immunodeficiency, lifelong exposure to malaria may result in excess frequency of high-grade malignant tumours not only in the group of malignant lymphomas but also in CC. © 2002 Wiley-Liss, Inc. Key words: cervical cancer; tropical Africa; malaria; immunodeficiency; malignancy gradeGeographic pathology is a useful tool to arrive at hypotheses in aetiologic research of diseases. In Uganda, a small country with marked variation in climate, ethnic composition and disease patterns, material for study of the geographic distribution of malignant tumours is available from the KCR 1 for the 12-year period 1964 -1975. The opportunity is unique since such countrywide cancer surveys have not been conducted in any other region of tropical Africa. A notable contribution is the observation of an association between malaria and BL 2 and the other groups of aggressive or high-grade Hodgkin's and non-Hodgkin's lymphomas. 3,4 Incidence was higher in areas of high compared to areas of low malarial endemicity due to an excess frequency of cases of aggressive or high-grade malignancy.Sexually transmitted infections are common in Uganda, 5,6 as presumably in many parts of tropical Africa. Data on their geographic distribution in up-country areas are lacking. In Kampala, a prior study on the sexually transmitted disease CC had shown, in addition to HPVs, an association with multiple concurrent genital infections. 7...

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Review of histologic material seen in Uganda over the 5‐year period, 1964–1968, revealed 83 cases of nasopharyngeal carcinoma out of a total of 7,000 malignant tumors. All tumors conformed to the anaplastic type, but those with a small cell structure occurred in older men than those made up of larger cells. The histologic appearances of this tumor were seen but rarely in other sites. In Uganda, tumors occur at a remarkably young age; 25% occur in people under the age of 20 years. The different tribes vary markedly in tumor incidence; Nilotic and Para‐Nilotic peoples show a much higher incidence at an earlier age than Bantu or Sudanic groups. The extent to which these differences are due to hereditary and environmental factors is uncertain. It would seem that both will influence the incidence within a given community.

Sixty-seven patients with bleeding Grade 1 hemorrhoids were allocated alternately to receive either injection sclerotherapy or a bulk laxative. In either treatment group one third of patients was constipated with passing hard stools.At 2 weeks, 4 weeks and half a year information on the outcome was obtained from diaries kept by the patients. Injection sclerotherapy proved to be clearly superior than the use of bulk laxative. 36%, 23% and 35% compared to 59%, 58% and 72%, respectively, continued to bleed. An unexpected finding was noted among the constipated. Statistical significance could not be obtained, but the use of bulk laxative may show perhaps even better results than injection sclerotherapy. At 4 weeks and after half a year, the rates were 33% and 36% compared to 50% and 60%, respectively. Among the non-constipated patients injection sclerotherapy is the treatment of choice.At 4 weeks and half a year, only 10% and 24% were still bleeding.When a bulk laxative was taken, the effect was negligibly small. 74% and 94%, respectively, showed no response. Recurrences were fewer after injection sclerotherapy. 21% of patients free of bleeding at 4 weeks became symptomatic again in the following 5 months compared to 54% of such patients using bulk laxative. Again, bulk laxative was of little use in patients without the complaint of constipation, but was as effective as injection sclerotherapy among the constipated. These results are in line with prior histological investigations detailing the value of injection sclerotherapy. However, they are in contrast to a report showing that injection sclerotherapy plus bulk laxative is not more effective than the use of bulk laxative alone. They are also different from a meta-analyis of 18 randomized, controlled clinical trials recommending rubber band ligation as the initial treatment of Grade 1 to 3 hemorrhoids. In addition to showing the place of injection sclerotherapy and bulk laxative in the treatment of Grade 1 lesions, the results of the present investigation emphasize the need to ensure comparability between studies by using similar treatment groups and to monitor bowel habits.

Whole mount sections were made from all amputation specimen of patients treated for carcinoma of the penis in Mulago Hospital, Kampala, Uganda, during a 21-month period in 1968-1970. Among a total of 55 cases four tumors were found which were large, but histologically showed low invasiveness suggestive of absence of metastatic spread. There were two giant condylomas, and two giant condylomas showing possible microinvasion. Two further cases showed a small squamous cell carcinoma together with a giant condyloma in the remainder of tumor. The most chracteristic feature was an orderly, well-circumscribed, expansive downgrowth, leaving little stroma to be seen between the epithelial masses to tumor. Within these limits, however, the spectrum of growth pattern, differentiation, and malignant change was very wide and much more varied than in tumors recorded form Western countries. This should be remembered when a presumptive diagnosis of the condition is to be made on small routine biopsies. Additional changes showing marked similarities to condylomata acuminata were often seen in superficial portions of tumor. This transition in histological picture within one tumor favors the view that giant condyloma is an intermediate lesion in the development of cancer in condylomata acuminata.