Histologic response after neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma: experience from Sudan.

BACKGROUND: Locally advanced rectal cancer can be down staged by neoadjuvant therapy and the resultant tumor response can be quantified histologically. This study aimed to assess pathological response of neoadjuvant chemoradiation in patients with locally advanced rectal cancers treated in Wad Medani Teaching Hospital (WMTH) and National Cancer Institute (NCI), Wad Medani, Sudan. PATIENTS AND METHODS: A total of 36 consecutive patients with locally advanced rectal cancer that were managed in WMTH and NCI during the period from 2006-2011 were reviewed. Preoperative pelvic radiotherapy was delivered. Total of 46 Gray were delivered concurrently with 5- fluorouracil (5-FU) on the first and last week of radiation. Total mesorectal excision of the rectal tumour either by anterior or abdominoperineal resections was planned at 6-8 weeks from completion of preoperative treatment. The pathological response to therapy was assessed by histopathology examination of the surgical specimen. RESULTS: Initial clinical staging of patients revealed 58.3% of them were stage T3/T4N2M0 and 41.7% were stage T3N0M0. Down-staging to stage T1/T2N0M0 was found in 36.1% and stage T3N0M0 in 30.6%. No response was seen in 8.3% of cases with stage T3/T4N2M0 while complete clinical response (no residual) was seen in 25.0%. Complete histological response was observed in 13.8%. Positive lymph-nodes metastasis was confirmed in 8.3% of cases. CONCLUSION: Neoadjuvant chemoradiation is a reasonable option for cases of rectal cancer and deserves further evaluation.

Surgery as a career choice among medical students at University of Medical Sciences and Technology.

BACKGROUND: Medical students are the source of a country's surgeons. There are concerns regarding a possible decline in the proportion of students choosing surgery as a career in some developing countries. OBJECTIVE: To identify the level of interest in surgical careers and the factors influence a student's interest in pursuing a surgical career in Sudan. METHODS: A cross-sectional descriptive study was conducted in September 2013 at the Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan. A self administered questionnaire was distributed to 887 male and female students, (from first to fifth academic years) recruited in the study. RESULTS: Response rate was 73% with 647 questionnaires were collected, out of 887 medical students. Of the returned questionnaires, 604 were valid. Most of the students have decided upon a specialty 541 (89.6%) while 63 (10.4%) did not. Two hundred (36.9%) out of the 541 respondents stated that surgery is their choice for specialty. General Surgery was the popular surgical specialty (48%), followed by Cardiothoracic Surgery (16.5%), Neurosurgery (11%) and Orthopedics (10.5%). Compared with students interested in a career in other medical specialties, those interested in surgery were younger (Pre-clerkship students). CONCLUSION: Surgery is the most popular choice of postgraduate training by medical students. Fewer than half of the medical students who choose surgery were willing to consider general surgery as a future career choice. Financial reasons and advice from of others were considered by many students as important factors to select surgery.

Multiple parenchymal leiomyomas of the breast in a Sudanese female.

Leiomyomas are benign smooth muscle neoplasm. They can occur in any organ, but the most common forms occur in the uterus, small bowel and the esophagus. Leiomyomas of breast are rare benign non epithelial tumor. Only 21 cases of solitary parenchymal leiomyoma of the breast have been reported. This is the first case of multiple breast leiomyomas being reported in the literature. Here we report a case of a 38-year-old woman who presented to us with a painless right sided breast swelling. Histopathology revealed a growth pattern of interlacing fascicles of smooth-muscle cells consistent with leiomyoma of breast. To the best of our knowledge, this is the first case of multiple intraparenchymal leiomyomas of the breast reported in the literature.

Evaluation of clinical and pathological response after two cycles of neoadjuvant chemotherapy on Sudanese patients with locally advanced breast cancer.

BACKGROUND: The use of neoadjuvant chemotherapy in treating breast cancer has shown efficacy in downstaging primary tumors, and allows breast conservative surgery to be performed instead of mastectomy. This study aims to evaluate patterns of clinical and pathological response after two cycles of neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIALS AND METHODS: This is a prospective study. Ninety-eight patients who presented from April 2009 through May 2011 with locally advanced breast cancer and treated with neoadjuvant chemotherapy were included. RESULTS: The clinical response rate was 83%; 11 patients (11.2%) had a complete clinical remission (cCR); 71 had a partial remission (72.4%); 13 had stable disease (13.3%), and 3 had progressive disease (3.1%). Seven patients had complete pathological response. CONCLUSION: Neoadjuvant chemotherapy can achieve a high objective response rate in patients with locally advanced breast cancer even after two cycles. We recommend further research to find predictors for response.

Cervical Pott's disease presenting as a Retropharyngeal Abscess: Controlled by Aspiration and Anti-tuberculous chemotherapy.

Tuberculosis of the cervical spine is very rare. An unusual case of a 6 year old child presenting with spinal tuberculosis involving cervical and thoracic vertebrae, along with retropharyngeal abscess is reported. The patient presented with progressive neck swelling, neck pain, fever with night sweats and difficulty of swallowing. The lab studies confirmed tuberculosis. The patient was successfully treated with fine-needle aspiration and antituberculous drugs. The patient improved rapidly. His neck stiffness decreased, and he was able to eat comfortably.