Case Report on Primary Intratesticular Leiomyosarcoma of the Spermatic Cord

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Laryngeal involvement causing dysphonia in a 29 year old nursing mother with lepromatous leprosy

Leprosy is a granulomatous disease that mainly affects the skin and peripheral nerves. It is caused by infection with mycobacterium leprae ormycobacterium lepromatosus. In most instances, diagnosis of leprosy can easily be made based on the clinical signs and symptoms. However, when patients present with atypical features, clinical diagnosis can be a challenge. We report a case of a nursing mother with lepromatous leprosy who presented with dysphonia and skin lesions initially thought to be a deep cutaneous mycosis

HIV and male fertility at the University Teaching Hospital Lusaka

Background: There has been anecdotal evidence of a declining male fertility in Zambia over the last 10 years1. This prospective study of men seen in the fertility clinic was designed to look for an association between the increasing HIV infection in the population and male fertility.Methods: This prospective study compared the prevalence of HIV in men with a confirmed diagnosis of infertility seen at the Urology Clinic, to the national HIV prevalence among men of child bearing age. The study was done from October 2006 to October 2007.Results: A total of 34 men were diagnosed with infertility and included in the study. Among these patients 9 were seropositive. This gave an HIV prevalence of 26%. There was a statistically significant difference with the normal population of 13% (p = 0.043).Conclusion: HIV infection is higher in men seeking fertility treatment than in the general population. Further studies are required to determine the precise relationship between HIV and Male Fertility at the University Teaching Hospital Lusaka

The Pattern of Urological Cancers in Zambia

Objective: To examine the pattern of urological malignancies, particularly cancer of the bladder, seen at the University Teaching Hospital (UTH) in Lusaka and to compare the findings with previous studies on the same parameters done at UTH. Material and Methods: A retrospective study of urological cancers in Zambia was performed, based on histopathology reports of specimens reviewed at the UTH Pathology Laboratory inLusaka, Zambia, between January 1990 and December 2005. The parameters studied were the histological type of the cancer, patient age and trends over a 15-year period. Results: In total, 8829 cancers were diagnosed during the study period, of which 749 (8.5%) were urological malignancies affecting the kidney, bladder, prostate, testis or penis. The maleto- female ratio of the urological cancers was 10.7 to 1. Cancer of the prostate was the most common urological malignancy (54.6%), followed by bladder cancer (21.1%) and penile cancer (18.6%). The histological type of bladder cancer was mainly squamous cell carcinoma (46.2%), transitional cell carcinoma (23.4%) and adenocarcinoma (22.2%); other types (8.2%) included rhabdomyosarcoma, small cell carcinoma and lymphoma. The majority of patients (79%) with bladder cancer were between 56 and 65 years of age. Whereas 20 years ago prostate cancer comprised only 26% of urological malignancies, it accounted for 55% of urological cancersdiagnosed in Zambia between 1990 and 2005. In contrast, cancer of the penis, kidney and testis have shown no change in frequency distribution compared to 20 years ago. Conclusion:Over the last 15 years there has been an increasing proportion of cancer of the prostate and squamous cell carcinoma of the bladder. This is associated with high levels of schistosomiasis, cystitis (some of which is HIV-related) and bladder stones. It may also be due to the extension of urological services and the diagnostic armamentarium (PSA, cystoscopy and histologicaldiagnosis) to indigent rural populations, where the incidence of squamous cell carcinoma is likely to be higher than in affluent urban populations

Gastric adenocarcinoma in Zambia: A case-control study of HIV, lifestyle risk factors, and biomarkers of pathogenesis

Background. Gastric cancer is a leading cause of cancer deaths worldwide but there are few data from Africa. We recently observed a trendtowards diagnosis in younger patients.Objective. To test the hypothesis that HIV might have altered risk factors for acquisition of gastric cancer, in a case-control study in theUniversity Teaching Hospital, Lusaka, Zambia.Methods. Patients (n=52) with confirmed gastric adenocarcinoma and controls (n=94) undergoing endoscopy but with no macroscopicgastric pathology. Established risk factors and HIV status were compared.Results. HIV status did not differ significantly between cases and controls (odds ratio 1.03; 95% CI 0.2 - 4.3; p=1.00) and seroprevalencein cases was similar to that of the Zambian population. Smoking, regular alcohol intake, and gastric atrophy were all associated with cancerin univariate and multivariate analysis. Helicobacter pylori serology was positive in 84% of patients studied and cytotoxin-associated gene A(cagA) serology in 66%; neither serological marker was associated with cancer. Atrophy was common in cases (57%) and controls (30%) andassociated with both smoking and alcohol use. Intestinal metaplasia was present in 17% of the controls, but was not associated with atrophy.Conclusions. HIV was not associated with gastric cancer and does not explain the apparent younger age distribution. Atrophy was commonand was not essential for the development of intestinal metaplasia, suggesting that gastric carcinogenesis in Africa does not always followthe pathway from atrophy to intestinal metaplasia to gastric carcinoma (the so-called Correa pathway)

Gastric Malignancy Survival in Zambia, Southern Africa: A two year follow up study

Background: Gastric cancer poses a significant global health burden. It is the second most common cause of cancer death worldwide and the ninth leading cause of cancer mortality in Zambia, at a rate of 3.8/100,000; comparable to USA (2/100,000) and UK (3.4/100,000). Survival data on gastric malignancy in Zambia is not known.Objectives: To provide preliminary survival rates of patients with histologically proven gastric adenocarcinoma in Zambia.Study Design: Using our prospective gastric cancer research database, we conducted a retrospective audit of patients diagnosed with gastric cancer at the University Teaching Hospital, Zambia, from June 2010 until January 2012. We contacted patients or their relatives using phone numbers provided at time of enrollment.Main Outcomes: We reviewed age, sex, demographic data (income, education), body mass index, symptoms, duration of symptoms, treatment (surgery, chemotherapy, radiotherapy or combination) and survival outcome.  Analysis was performed using Kaplan-Meier models and log rank test.Results: Fifty one patients were diagnosed with gastric adenocarcinoma during the study period, but follow-up data were available for 50. Median survival was 142 days. Age, sex, income, education, BMI, tumor location, and treatment modality were not significantly associated with overall survival. In Cox regression models, covariates associated with survival were a history of regular alcohol intake (HR 0.49, 95%CI 0.26,0.92; P=0.025) and intestinal type cancer histology (HR 0.40, 95%CI 0.19,0.83; P=0.01).Conclusion: Prognosis of newly diagnosed gastric cancer in Zambia is poor with significant mortality within 1 yearof diagnosis, particularly among patients with weight loss and dysphagia

Management of cryotherapy-ineligible women in a "screen-and-treat" cervical cancer prevention program targeting HIV-infected women in Zambia: Lessons from the field

Objective: We demonstrate the feasibility of implementing a referral and management system for cryotherapy-ineligible women in a "screen-and-treat" cervical cancer prevention program targeting HIV-infected women in Zambia. Methods: We established criteria for patient referral, developed a training program for loop electrosurgical excision procedure (LEEP) providers, and adapted LEEP to a resource-constrained setting. Results: We successfully trained 15 nurses to perform visual inspection with acetic acid (VIA) followed by immediate cryotherapy. Women with positive tests but ineligible for cryotherapy were referred for further evaluation. We trained four Zambian physicians to evaluate referrals, perform punch biopsy, LEEP, and manage intra-operative and post-operative complications. From January 2006 through October 2007, a total of 8823 women (41.5% HIV seropositive) were evaluated by nurses in outlying prevention clinics; of these, 1477 (16.7%) were referred for physician evaluation based on established criteria. Of the 875 (59.2% of 1147 referred) that presented for evaluation, 748 (8.4% of total screened) underwent histologic evaluation in the form of punch biopsy or LEEP. Complications associated with LEEP included anesthesia reaction (n = 2) which spontaneously resolved, intra-operative (n = 12) and post-operative (n = 2) bleeding managed by local measures, and post-operative infection (n = 12) managed with antibiotics. Conclusion: With adaptations for a resource-constrained environment, we have demonstrated that performing LEEP is feasible and safe, with low rates of complications that can be managed locally. It is important to establish referral and management systems using LEEP-based excisional evaluation for women with cryotherapy-ineligible lesions in VIA-based "screen-and-treat" protocols nested within HIV-care programs in resource-constrained settings

Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia

Background: The diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical features of abdominal (excluding genitourinary) TB in HIV infected adults attending the University Teaching Hospital, Zambia. Methods: We screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples. Results: Of 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71%) had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size), and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts <100 cells/μL. Conclusion: The clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count. © 2009 Sinkala et al; licensee BioMed Central Ltd

Implementation of 'see-and-treat' cervical cancer prevention services linked to HIV care in Zambia

Greater than 80% of the world's new cases and deaths due to cervical cancer occur in the developing world. No more than 5% of women in these settings are screened for cervical cancer even once in their lifetimes. Earlier attempts to establish population-based cervical cancer prevention programs using cytology screening in resource-limited settings have inevitably fallen short or failed. Although many of the reasons for failure can be attributed to lack of resources and trained manpower, the multiple visit requirements of cytology-based screening programs jeopardizes success and sustainability