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The need for the postgraduate training of medical practitioners in the environment in which they will eventually work is well recognized, and in 1967 it was felt that the University of East Africa had reached sufficient maturity to undertake postgraduate instruction and certification in medicine. This paper describes the evolution and the present structure of the MMed (Surgery) degree at Makerere.

A cell line of penile cancer from a 60-year-old Ugandan black patient has been studied by the authors. Transmission and scanning electron microscopy showed a large number of blebs and microvilli at cell surface; desmosomes were evident at TEM. Cytogenetic investigation (R-, C-, Nor-banding) showed the frequent presence of some markers: del(1p),del(1q),iso(3q),der(4),del(8p),11q+, t rob(13;14), 14p+, t rob(21;21). The epidemiology, geographical distribution, and aetiological role of human papilloma virus type 16 and herpes simplex type 2 are discussed.

In a Phase II clinical trial, 14 patients with histologically proven primary hepatocellular carcinoma were treated with adriamycin administered intravenously at a dose of 75 mg/m2 every 3 weeks. All 11 evaluable patients responded with 3 exhibiting complete tumor regression after two, three, and five courses of adriamycin respectively. The remission durations for these 3 were 3, 6, and 7 months, and their survivals were 8, 9, and 13 months, respectively. The median survival of the evaluable patients is 8 months (range 1-13 months). The side effects encountered included myelosuppression, anorexia, nausea, vomiting, and alopecia. Adriamycin seems to be an effective agent in hepatocellular carcinoma. Further trials are underway to test its true efficacy both singly and in combination with other drugs in the management of this tumor.

Previous studies have established an association between cytomegalovirus (CMV) and classic and endemic Kaposi's sarcoma (KS) which can be extended to include the epidemic form of KS. The identification of nucleic acid sequences homologous to CMV but not to Epstein-Barr virus (EBV) and Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) as well as the detection of CMV gene products, particularly early antigens, in tumour biopsies and/or early cultures derived from them is an important criterion in the establishment of the type of association. Detection of CMV early antigens but not late antigens as well as the failure to demonstrate virus particles in primary tumour biopsies rule out a simple passenger role of this virus or a preferential site for virus replication in neoplastic tissue. In the setting of a profound immune dysfunction, as in the case of acquired immune deficiency syndrome (AIDS), renal transplant recipients under immunosuppressive therapy, and other iatrogenically immunosuppressed patients (the three groups in which KS has been most frequently observed), the specific involvement of CMV oncogenes, of which at least two have been so far identified in experimental systems, is strongly indicated. Moreover, in vitro transformation experiments indicate that the virus is clearly involved in the initiation of transformation, while other factors (co-carcinogens, activation of cellular oncogenes?) might be required for the maintenance of the transformed phenotype. Endothelial cells, permissive for CMV infection, might be the prime target for these events, since there is evidence that they are a main constituent of KS tissue. Data obtained during 14 years of research on KS are reviewed and possible etiopathogenetic mechanisms giving rise to this type of tumour are discussed.

In attempts to encompass multiple events responsible for the development of cancer in man, with a particular interest to the possible involvement of viruses, multidisciplinary studies have been conducted on KS during 1971-1979. There is accumulating evidence associating this malignancy with CMV. African KS patients have high antibody titers to CMV, but they are not significantly different from controls of the same regions (Ag-Ab complexes?). A specific serologic association of European and American KS with CMV was established. CMV-related antigens can be demonstrated in 22% of tumor biopsies and comparably in early passages of cell culture derived from them. Recently, CMV-DNA sequences have been detected in tumor biopsies. Furthermore, a CMV, strain K9V, has been isolated in tissue culture from a KS culture. Cells infected in vitro with K9V have shown some of the characteristics of cells transformed previously by other oncogenic CMV strains. In vivo K9V has induced a fatal disease in old world monkeys, mainly involving the lymphoid system. Moreover, a cluster type of occurrence of KS was detected in the West Nile District of Uganda, an area with as high incidence of KS as BL; and finally, there is a significantly higher incidence of a second primary tumor in KS patients, particularly of the lymphoreticular system. Whether CMV plays a role in the development of KS, a complex neoplasia which involves different cell types cannot be claimed by these results only. However, similarities between CMV and EBV, the latter being closely associated with BL and nasopharyngeal carcinoma are worthy of consideration.

The presence of circulating alpha-interferon and neopterin was investigated in sera of 47 patients affected by African Kaposi's sarcoma, both HIV-seropositive (13 patients) and HIV-seronegative (34 patients). For comparison, analyses were also performed in 20 HIV-seropositive symptomatic African subjects as well as in 20 African and 20 Italian healthy individuals. Alpha-interferon and neopterin levels appeared significantly higher in comparison with healthy control groups (P less than 0.001) but not with HIV-seropositve African individuals without Kaposi's sarcoma. Moreover, alpha-interferon and neopterin levels were significantly higher in progressive Kaposi's sarcoma (27 patients) than in regressive Kaposi's sarcoma (20 patients) (P less than 0.001). A significant correlation between alpha-interferon and neopterin was observed (r = 0.57; P less than 0.01). Furthermore, alpha-interferon levels of HIV-seropositive Kaposi's sarcoma patients resulted significantly higher in comparison with the seronegative ones (P less than 0.05). It is concluded that alpha-interferon and neopterin may be reliable prognostic markers in Kaposi's sarcoma patients.

In Uganda, Kaposi's sarcoma is predominantly a disease of the male African with a male:female ratio of 13:1. It is a multifocal disease and all parts of the body may be involved. When confined to the skin in the form of nodular tumour, it runs a slow 'benign' course. The florid, the visceral and bone lesions in adults and lymphadenopathy in children are malignant lesions. The three histological types are useful in determining prognosis and choosing drugs for treatment. A change from benign to malignant forms is associated with loss of cellular immunological status of the host.