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The incidence of abdominal cysts in infants is 1 in 500 to 1 in 1,000 live births. Among the ovarian cysts in infants, serous cystadenoma is extremely rare with only few reported cases in the literature. Here, we report a case of a giant neonatal ovarian serous cystadenoma treated with laparoscopic cystectomy and confirmed by histopathological examination.A 27-year-old delivered a female baby with uneventful caesarean section at full term. The antenatal ultrasonography (USG) in third trimester had showed an abdominal cyst in the left side of the abdomen. Postnatal USG was suggestive of omental cyst. A contrast-enhanced computed tomography scan of the neonate showed a large cyst occupying the entire abdomen. On laparoscopic evaluation, a cystic mass filled with 500 mL of clear yellow fluid was seen in the left pelvic fossa. Left ovary could not be visualized separately. The right ovary, fallopian tubes, and uterus were normal. The entire cyst was removed and sent for histopathological examination. On gross examination, a unilocular cyst measuring 10×8×6.5 cm with a wall thickness of 0.2 cm was noted. On microscopic examination, the histomorphological features were consistent with serous cystadenoma of the ovary. There is a paucity of literature regarding pathological diagnosis of such cases and hence we report one such case.

Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening campaign aiming to improve awareness of blood pressure at the individual and population level. Adults ({greater than or equal to}18 years) recruited through opportunistic sampling were screened at sites in 92 countries during May 2019. Ideally three blood pressure readings were measured for each participant, and data on lifestyle factors and co-morbidities were collected. Hypertension was defined as a systolic BP {greater than or equal to} 140 mmHg, and/or a diastolic BP {greater than or equal to} 90 mmHg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants' mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1,508,130 screenees 482,273 (32.0%) had never had a blood pressure measurement before and 513,337 (34.0%) had hypertension, of whom 58.7% were aware and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to

SummaryDiverse risk factors intercede the outcomes of COVID-19. We conducted this retrospective cohort study to identify the risk factors associated with morbidity and mortality outcomes with a cohort of 1016 COVID-19 patients diagnosed in May 2020. Data were collected by telephone-interview and reviewing records using a questionnaire and checklist. Morbidity (64.4% Vs. 6.0%) and mortality (2.3% Vs. 2.5%) outcomes varied between the 14th and 28th day. Morbidity risk factors included chronic obstructive pulmonary disease (COPD) (RR=1.19, RR=2.68) both on the 14th and 18th day while elderly (AOR=2.56) and smokeless tobacco (SLT) (AOR=2.17) on the 28th day. Mortality risk factors included elderly (AOR=10.14), COPD (RR=5.93), and SLT (AOR=2.25) on the 14th day, and elderly (AOR=24.37) and COPD (RR=2.72) on the 28th day. The morbidity risk was higher with chronic kidney disease (CKD) (RR=3.33) and chronic liver disease (CLD) (RR=3.99) on the 28th day. The mortality risk was higher with coronary heart disease (RR=4.54) and CLD (RR=9.66) on the 14th while with diabetes mellitus (RR=3.08, RR=2.08), hypertension (RR=3.14, RR=2.30), CKD (RR=8.97, RR=2.71), and malignant diseases (RR=10.29) on both 14th and 28th day. We must espouse program interventions considering the morbidity and mortality risk factors to condense the aggressive outcomes of COVID-19.

Diverse risk factors intercede the outcomes of coronavirus disease 2019 (COVID-19). We conducted this retrospective cohort study with a cohort of 1016 COVID-19 patients diagnosed in May 2020 to identify the risk factors associated with morbidity and mortality outcomes. Data were collected by telephone-interview and reviewing records using a questionnaire and checklist. The study identified morbidity and mortality risk factors on the 28th day of the disease course. The majority of the patients were male (64.1%) and belonged to the age group 25–39 years (39.4%). Urban patients were higher in proportion than rural (69.3% vs. 30.7%). Major comorbidities included 35.0% diabetes mellitus (DM), 28.4% hypertension (HTN), 16.6% chronic obstructive pulmonary disease (COPD), and 7.8% coronary heart disease (CHD). The morbidity rate (not-cured) was 6.0%, and the mortality rate (non-survivor) was 2.5%. Morbidity risk factors included elderly (AOR = 2.56, 95% CI = 1.31–4.99), having comorbidity (AOR = 1.43, 95% CI = 0.83–2.47), and smokeless tobacco use (AOR = 2.17, 95% CI = 0.84–5.61). The morbidity risk was higher with COPD (RR = 2.68), chronic kidney disease (CKD) (RR = 3.33) and chronic liver disease (CLD) (RR = 3.99). Mortality risk factors included elderly (AOR = 7.56, 95% CI = 3.19–17.92), having comorbidity (AOR = 5.27, 95% CI = 1.88–14.79) and SLT use (AOR = 1.93, 95% CI = 0.50–7.46). The mortality risk was higher with COPD (RR = 7.30), DM (RR = 2.63), CHD (RR = 4.65), HTN (RR = 3.38), CKD (RR = 9.03), CLD (RR = 10.52) and malignant diseases (RR = 9.73). We must espouse programme interventions considering the morbidity and mortality risk factors to condense the aggressive outcomes of COVID-19.

Background and Objectives Type 2 diabetes is common amongst Bangladeshis, and prevention strategies are needed. Little is known about the views of younger people concerning diabetes prevention and the risk factors. We aimed to explore the experience and views on the prevention of diabetes amongst young Bangladeshis in Tower Hamlets. Methods Semistructured interviews involving 40 young Bangladeshis. Results Participants were aware of diabetes being a major health issue and its link with poor diet. Many had a relative with diabetes, and some had negative experiences, such as suffering poor control, complications, or hypoglycemia. Knowledge of diabetes was predominantly gleaned from school. Many felt that older generations were at higher risk due to lack of exercise and reliance on traditional diets. Participants recognized that the Westernized diets also increased the risk of diabetes. Views on prevention of diabetes were strong, including increasing diabetes awareness in schools, rewards for healthier lifestyles, reducing costs of exercise, reducing advertising of poorly nutritious foods, and tackling the proliferation of fast food outlets. Conclusions Young Bangladeshi people showed good knowledge of diabetes and its causes and have cogent ideas on its prevention. The views of young people should be considered when developing diabetes prevention strategies at the local and national level.

Background There are well established gender, ethnicity and socio-economic differences in the incidence and prevalence of epilepsy, autism and allergy sensitisation. 1,2,3,4 Less is known about these differences within an ED setting. Simons et al. noted a gender disparity with more boys presenting to ED with sickness, head injury and falls than girls, 5 but this was not statistically significant. Aim To establish the role of gender, ethnicity, and social deprivation as factors associated with presentation to ED in children under 5. Methods Study design: A retrospective study was conducted on a routine operational data set of basic demographic data collected from a large district general hospital. Sample: Paediatric ED data 01/04/2015–31/03/2016 for children below 5 years. Levels of deprivation: 2015 Index of Multiple Deprivation. 6 Office for National Statistics (ONS) mid-year data used for denominator. Analysis: Descriptive analysis. Rate ratios were calculated for each age. Deciles were obtained for each postcode using 2015 Index of Multiple Deprivation data. Results Of the 19 267 under 16 year-olds paediatric attendances, 10 925 (56.7%) were less than 5 years of age. Of these, 6227 (57%) were male; M:F ratio in ED 1.33 cf. 1.05 local population. The proportion of the population attending ED decreased with age. Presentation rate was consistently higher in males than in females, but the gender gap decreased with age. Ethnicity was recorded for 89.9% of attendances. The gender difference in presentations was greatest for the black population (622 males vs 392 females, M:F ratio 1.59 cf. 1.01 population). At extremes of IMD, the rates of presentation were lowest (4.8% decile 1, 7.3% decile 10) and gender gap is least pronounced (male:female rate ratio 1.13 decile 1, 1.26 decile 10, greatest 1.39 decile 4. Conclusions and clinical implications More males attend ED than females in all ages and ethnic groups, with greatest gender disparity in the black population. In addition, it appears that the least and most deprived are least likely to present to ED. This study emphasises the utility of operational data for epidemiological research at local level and supports the need to further explore clinical and sociological reasons for differences in gender related attendances. References . Levine R, Kilbourne B, Rust G, Langston M, Husaini B, Gittner L, Sanderson M, Hennekens C. Social determinants and the classification of disease: Descriptive epiidemiology of selected socially mediated disease constellations. PLoS One 2014;9(11). . Retico AG Alessia, Tancredi R, Cosenza A, Apicella F, Narzisi A, Biagi L, Tosetti M, Muratori F, Calderoni S. The effect of gender on the neuroanatomy of children with autism spectrum disorders: A support vector machine case-control study. Mol Autism2016;7(5). . Pickrell W, Lacey A, Bodger O, Demmler J, Thomas R, Lyons R, Smith P, Rees M, Kerr M. Epilepsy and deprivation, a data linkage study. Epilepsia2015;56(4):585–91. . Joseph C, Zoratti E, Ownby D, Havstad D, Nicholas C, Nageotte C, Misiak R Enbeg, Ezell R, Johnson C. Exploring racial differences in IgE- mediated food allergy in the WHEALS birth cohort. Ann Allergy Asthma Immunol2016;116(3):219- 224. . Simons J. Young children in AE24(7). . Department for Communities and Local Government. The English indices of deprivation 2015;2015.

A case of unilateral proptosis attributed to midbrain tumour is reported. The proptosis disappeared after release of intracranial hypertension. The postulated mechanism of the unilateral proptosis on the left side is a relative increase in orbital venous stasis on that side, consequent upon intracranial hypertension.

Pulmonary vascular remodeling and increased arterial wall stiffness are two major causes for the elevated pulmonary vascular resistance and pulmonary arterial pressure in patients and animals with pulmonary hypertension. Cellular copper (Cu) plays an important role in angiogenesis and extracellular matrix remodeling; increased Cu in vascular smooth muscle cells has been demonstrated to be associated with atherosclerosis and hypertension in animal experiments. In this study, we show that the Cu-uptake transporter 1, CTR1, and the Cu-efflux pump, ATP7A, were both upregulated in the lung tissues and pulmonary arteries of mice with hypoxia-induced pulmonary hypertension. Hypoxia also significantly increased expression and activity of lysyl oxidase (LOX), a Cu-dependent enzyme that causes crosslinks of collagen and elastin in the extracellular matrix. In vitro experiments show that exposure to hypoxia or treatment with cobalt (CoCl2) also increased protein expression of CTR1, ATP7A, and LOX in pulmonary arterial smooth muscle cells (PASMC). In PASMC exposed to hypoxia or treated with CoCl2, we also confirmed that the Cu transport is increased using 64Cu uptake assays. Furthermore, hypoxia increased both cell migration and proliferation in a Cu-dependent manner. Downregulation of hypoxia-inducible factor 1α (HIF-1α) with siRNA significantly attenuated hypoxia-mediated upregulation of CTR1 mRNA. In summary, the data from this study indicate that increased Cu transportation due to upregulated CTR1 and ATP7A in pulmonary arteries and PASMC contributes to the development of hypoxia-induced pulmonary hypertension. The increased Cu uptake and elevated ATP7A also facilitate the increase in LOX activity and thus the increase in crosslink of extracellular matrix, and eventually leading to the increase in pulmonary arterial stiffness.

The results of a personal series of 44 consecutive patients undergoing burrhole evacuation and closed system suction drainage for chronic subdural haematoma are presented. 43 patients made a complete recovery and one was left with moderate disability. Contralateral weakness in one patient, recurrence of haematoma in another, and a new contralateral haematoma in a third were the only complications. The operative procedures responsible for the rather low complication rate in this series are described. It is concluded that to avoid complications following surgical treatment of chronic subdural haematoma, attention must be paid to the following factors: evacuation of the haematoma through two burrholes overlying the subdural collection; attention to ensure free communication through the subdural space between the two burrholes; identification and opening of additional loculations overlying the cortex; irrigation of the subdural space to ensure as complete an evacuation of the subdural collection as possible and the use of closed system suction drainage, nursing the patient flat, and intravenous hydration of the patient for three days. In addition, in patients with coagulopathy, correction of these disorders before surgery is most essential.

To determine the relative and absolute contributions of postprandial glucose (PPG) and fasting or preprandial plasma glucose (FPG) to daytime hyperglycaemia and HbA(1c) respectively, in persons with type 2 diabetes (T2DM).Subjects (n = 52; 37 men) had 12hr plasma glucose (PG) profiles determined in response to three serial identical test meals. PPG exposure was calculated for each meal. Excess hyperglycaemia was calculated above a PG concentration of 5.5 mmol/l. Fasting hyperglycaemia was the difference between excess hyperglycaemia and PPG exposure. Subjects were divided into three groups according to HbA(1c)-(Gp1:7.3%;Gp2:7.3%-8.0%;Gp3:8.0%) and the relative contribution of PPG exposure and fasting hyperglycaemia to excess hyperglycaemia calculated for each meal. The absolute contribution of PPG and fasting hyperglycaemia to excess HbA(1c) (mean HbA(1c)-5.1%) was also calculated.The relative contributions of PPG exposure to excess hyperglycaemia for the three groups were: 58.3%, 54.3% and 35.4% (P = 0.483-Group 1 vs. Group 2; P = 0.002-Group 2 vs. Group 3) for meal 1; 69.8%, 54.7% and 23.7% (P = 0.163-Group 1 vs. Group 2; P = 0.005-Group 2 vs. Group 3) for meal 2; 85.8%, 70.2% and 48.6% (P = 0.153-Group 1 vs. Group 2; P = 0.046-Group 2 vs. Group 3) for meal 3. Absolute contributions of PPG to excess HbA(1c) in the three groups were 1.4%, 1.6% and 1.3% (P = NS).The relative contribution of postprandial glucose to excess hyperglycaemia decreases as glycaemic control deteriorates, being dominant with HbA(1c)/= 7.3%, irrespective of the timing of the meal during the day. However, the absolute contribution of postprandial glucose to excess HbA(1c) does not differ significantly ( approximately 1.5%) with varying glycaemic control.

✓ The authors report a case of cerebral heterotopia in the right temporofacial region of a neonate. The lesion presented as a massive cystic swelling containing cerebrospinal fluid. It produced calvarial and facial bone deformities. After the mass was excised, histological examination revealed glial tissue and choroid plexus.

A severe form of Erythema multiforme (EM), diagnosed as Stevens-Johnson syndrome (SJS) was detected in a 10-year-old Indian male child who took herbal medication of plant origin prescribed by a traditional healer for remission of his fever. The child developed a severe and florid form of mucocutaneous oral ulceration, severe ocular manifestations, along with marked constitutional disturbances and dehydration. An extensive literature search revealed few previous reports of herbal drug induced EM and SJS. In India, traditional therapy with herbal preparation (Ayurvedic medicine) is not uncommon.

A 5-year-old girl presented with a 1-year history of a subcutaneous swelling in the right parietal region. There were no cerebral symptoms or signs. Plain X-ray of the skull showed a lytic bony lesion with sclerotic margin. Computed tomography showed a hypodense, osteolytic lesion with thinned and bulged inner and outer skull tables with intact continuity. There was no intracranial lesion. At operation, the mass was found to be pink and granular, and was totally enucleated. Histology revealed it to be a benign osteoblastoma.

A 3-year-old boy presented with a 3-day history of total blindness. There were no features of raised intracranial pressure or endocrine disturbance. Magnetic resonance imaging of the brain showed a giant craniopharyngioma measuring 5 x 3 cm. It was located in the suprasellar region and produced a mass effect with compression of the III and both lateral ventricles. The tumour extended downwards into the pituitary fossa. Urgent surgical decompression and subtotal excision of the tumour resulted in complete visual recovery in the right eye. The left eye remained blind. The blindness might have been caused by direct pressure on the optic nerves and chiasma by the tumour. The lack of visual recovery in the left eye may be the consequence of additional ischaemic insult to the left optic nerve. It is concluded that surgical decompression should be carried out in a patient with a giant craniopharyngioma presenting with total blindness before the condition is considered hopeless.

We present the MRI features of the lumbar spine in a patient with ochronosis.

A case is reported of bilateral patellar tendon rupture in a fit man after a fall. He had a history of repeated local steroid injections into both tendons and histology confirmed steroid-induced changes. The history of repeated local steroid administration has to be implicated as the cause of this extremely rare injury in this patient, which can also be associated with hyperparathyroidism, systemic lupus erythematosus, diabetes and rheumatoid arthritis. All doctors performing repeated local steroid injections into the patellar tendon should be aware of the possible dangers of inducing tendon rupture and should ensure that the steroids are not delivered into its substance.

Department of Oral Biology, Centre for Oral Disease Prevention and Control, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore 574 160, India Department of Paediatrics, KS Hegde Medical Academy, Deralakatte, Mangalore 574 160, India Savar Hospital, Dhaka, Bangladesh Department of Oral and Maxillofacial Surgery, Poole General Hospital, Bournemouth, Dorset BH15 2JB, UK Department of Oral Pathology, Osaka Dental University, Osaka, Japan

A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries during "Operation Desert Storm". Fifteen of these patients had received intracranial debridement through a craniectomy and five patients had received care of scalp wounds only. Following treatment and stabilisation in a frontline hospital, these patients were transferred to the Riyadh Armed Forces Hospital for further evaluation and management. On admission, all the patients received a computerised tomographic scan which revealed shrapnel fragments inside their brain. No attempt had been made to remove the metal fragments. A patient with an infected scalp wound was treated with a course of appropriate antibiotics and the wound dressed. Dexamethasone was not used. Anticonvulsants were used only in one patient who had been treated for a presumed cerebral abscess. The neurological status of the patients improved along with the reduction of oedema and the swelling of the brain as shown in the follow-up CT scans. No patient died or developed a seizure disorder. These results suggest that re-operation for removal of retained fragments is unnecessary. It is concluded that the initial treatment of shrapnel wounds of the brain should be to preserve maximal cerebral tissue and function either by limiting the wound debridement performed through a craniectomy or by care of scalp wounds only.

We report a 2.5-year-old boy with Saudi variant of multiple sulfatase deficiency (MSD or Austin's disease). He presented with the features of cervical cord compression and a severe form of hydrocephalus. The former was due to a thickened posterior arch of the atlas and the latter from a narrow foramen magnum and meningeal thickening. Decompression of the cord was achieved by removal of the posterior margin of the foramen magnum and posterior arch of the atlas, and followed by a duroplasty. At a later date, ventricular decompression was achieved by insertion of a ventricular-peritoneal shunt. NMR did not demonstrate white matter changes in the brain. In this regard the reported case differs from the earlier description of the Saudi Variant of MSD.

Objective To determine the association between smokeless tobacco (SLT) use and coronary heart disease (CHD) among non-smoking adults in Bangladesh. Methods A case-control study of non-smoking Bangladeshi adults aged 40–75 years, was conducted in 2010. Incident cases of CHD were selected from two cardiac hospitals. Hospital controls were selected from outpatient departments of the same hospitals. Community controls were selected from neighbourhoods matched to CHD cases. Four community controls and one hospital control were matched to each case on age and gender. Results The study enrolled 302 cases, 1208 community controls and 302 hospital controls. Forty percent of the study subjects were current users of or had used SLT in the past. Current use of SLT was similar among cases (33%), community controls (33%) and hospital controls (32%). Current use of SLT was not associated with increased risk of CHD when community controls were used (adjusted OR 0.87, 95% CI 0.63 to 1.19, p>0.05), or hospital controls were used (adjusted OR 1.00, 95% CI 0.63 to 1.60, p>0.05), or when both controls were combined (adjusted OR 1.00, 95% CI 0.74 to 1.34, p>0.05). Risk of CHD did not increase with use of individual type, frequency, duration and past use of SLT products. Conclusion In this study, there was no statistically significant association between SLT use and CHD among non-smoking adults in Bangladesh. If the findings can be replicated in prospective studies, it may well be that strategic focus for reducing CHD in Bangladesh should be upon smoking control rather than on SLT.

Objective To determine whether hospital controls could be used in case-control studies where resource constraints limit recruitment of community controls. Methods Hospital controls and community controls were compared in terms of socio-demographic and risk factor variables in a study of smokeless tobacco (SLT) and coronary heart disease (CHD) in Bangladesh in 2010. Incident cases of CHD were selected from two cardiac hospitals. Hospital controls were selected from outpatient departments of the same hospitals. Community controls were selected from neighbourhoods matched to CHD cases. Four community controls and one hospital control were matched to each case on age and gender. Results The study enrolled 302 cases, 1208 community controls and 302 hospital controls. There were no differences between hospital controls and community controls with respect to age, gender, marital status, occupation, economic status and risk factors for CHD. Hospital controls were more educated but less active physically than community controls. Current use of SLT was similar among community controls (33%) and hospital controls (32%), which was also not significant statistically (adjusted OR 0.81, 95% CI 0.58 to 1.12, p>0.05). Current use of SLT was not associated with increased risk of CHD when data from community controls were used (adjusted OR 0.87, 95% CI 0.63 to 1.19, p>0.05), nor when data from hospital controls were used (adjusted OR 1.00, 95% CI 0.63 to 1.60, p>0.05). Conclusion For comparable future studies in situations of resource scarcity or difficult socio-political context, it is possible to enrol hospital controls with careful planning which are similar to potential community controls minimising bias.

Objective To determine accuracy of the Rose Angina Questionnaire (RAQ) for diagnosing coronary heart disease (CHD) among Bangladeshi adults, by comparing the classification based on the questionnaire with cardiologists9 diagnosis. Methods A case-control study of non-smoking Bangladeshi adults aged 40–75 years, was conducted in 2010. Cases were incident cases of CHD from two cardiac hospitals if diagnosed as such by the cardiologists; controls were non-cardiac patients from cardiac outpatient departments. One control was matched to each case on age and gender. Full version of the original RAQ questionnaire was used for study participants. Results The sample comprised 302 CHD cases and 302 controls (mean age 53±8.5 years). RAQ detected 194 cases (32%) and 409 controls (68%) from either hospital. RAQ categorised 17.5% of sample as having CHD who were considered not to have CHD by the cardiologists; RAQ categorised 34.5% of sample as not suffering from CHD, who were diagnosed as having CHD by the cardiologists. Among 301 CHD cases, 160 (53.2%) were diagnosed as CHD by both hospital cardiologists and RAQ. Among 302 controls, 268 (88.7%) were diagnosed as not having CHD by both hospital cardiologists and RAQ. CHD patients are five times more likely to have RAQ positive result compared to controls. Conclusion The RAQ had sensitivity of 53%, specificity of 89% and likelihood ratio positive of 4.8 in diagnosing CHD among Bangladeshi adults compared with diagnosis by cardiologists. RAQ can be used as an alternate tool for diagnosing CHD at field sites where there are limited resources.

Perineal canal is an infrequently encountered female anorectal anomaly. The available surgical techniques for repair of this malformation are unsatisfactory because of their high risk of recurrence. We present a new surgical technique with posterior repositioning of the perineal canal in continuity with the anorectum. The advantages are a low risk of recurrence and excellent functional and cosmetic results.

Faiza Bary Malik (“Lipi”) took the unusual decision to train in the male dominated specialty of surgery. She arrived in Scotland in 1967, later pursuing training in paediatric surgery and working in various parts of England. Her interest gradually focused on general practice, and in 1979 she joined a long …

6125 Background: In developing countries one-third of the people suffer from mal-nutrition. It has been shown that a good nutritional status can reduce complications of treatment, strengthen the immune system and contribute to the patient’s general well being throughout treatment. A good nutritional status is therefore essential for optimal treatment of a cancer patient. The aim of our study was to see the nutritional status of cancer patients on diagnosis and effect of nutrition on outcome of therapy. Methods: In this study we prospectively analyzed the nutritional status of 500 cancer patients in Netaji Subhash Chandra Bose Cancer Research Institute, a tertiary cancer center of eastern India during period from January 2004 to December 2005. The age range of the patients was 19 years to 74 years (median age 46 years). The parameter analyzed were weight for age, total protein, serum albumin and mid arm circumference. The weight for age and mid arm circumference were taken as normal if they were between 3rd and 97th percentile curve of the growth chart recommended by the Indian Council of Medical Research. The albumin level and the total protein were considered normal if the value is equal to or more than 3gm% and 5.8gm%. Result: It was seen that total 120 patients (24%) were low weight for age and 100 patients (20%) had low mid arm circumference. Total 90 patients (18%) had low serum albumin while 130 patients (26%) were low serum protein. Low weight for age, low serum albumin and low mid arm circumference were significant factors in disease free survival and toxicity of chemotherapy (p value < .001) Conclusion: We conclude that mal-nutrition is a major finding in cancer patients in developing country like ours. The patient with mal-nutrition had less disease free survival and more toxicities during therapy as compared to well-nourished patients. No significant financial relationships to disclose.

Department of Oral Biology, Centre for Oral Disease Prevention and Control, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore 574 160, India Department of Paediatrics, KS Hegde Medical Academy, Deralakatte, Mangalore 574 160, India Savar Hospital, Dhaka, Bangladesh Department of Oral and Maxillofacial Surgery, Poole General Hospital, Bournemouth, Dorset BH15 2JB, UK Department of Oral Pathology, Osaka Dental University, Osaka, Japan

Twenty-eight patients presenting with low back pain, associated with sciatic or femoral neuropathy, were found to have lateral recess stenosis occurring as a result of hypertrophy of the facet joints, with preservation within normal limits of the sagittal AP diameter of the lumbar canal. Pathology was believed to be traumatic in origin, and the variable nature of the adhesions suggested recurrent inflammation; the hypertrophy of the facet joints may have been the result of traumatic inflammatory hyperaemia. Radiological investigations were unhelpful. The diagnosis of the condition was made at the time of surgical exploration by the findings of alteration of the facet joints, adhesions and fixity of the nerve roots, normal sagittal AP diameter of the canal, and absence of other significant lesions. Gratifying results were obtained with decompression by wide laminectomy with excision of overhanging facet joints and release of adhesions.

Paucity of electron-microscopic studies on the fate of endogenous heme iron, released as a result of planned surgery, in the central nervous system warranted the present work. During investigations of neuronal plasticity in the cat, an experimental model, in which the proximal cut end of the vagosympathetic trunk was rerouted into the diencephalon, presented an ideal substrate for studying this problem. At 3 months, the brain tissue containing the implant was processed for light and electron microscopy and histo-chemistry. Under light microscopy, Prussian-blue-positive, dense cytoplasmic aggregates were visible within the macrophages. The cells were mostly clustered around the junctional area between the central and peripheral nerve elements. Electron-microscopic findings were highly characteristic and distinguished the macrophages from the surrounding neural elements by their rich content of electron-dense granules. While the latter were mostly scattered as free cytoplasmic particles, large aggregates of the same were also observed inside the lysosomes. Besides, a few inclusions were seen within astrocytic processes, close to the plasma membranes. At higher magnifications, the particles revealed the characteristic internal subunit structure of ferritin micelles. The uptake of hemoglobin and its subsequent conversion to ferritin within the macrophages and astrocytic processes are discussed at subcellular level in the light of other available studies.

A personal series of 14 patients with tuberculomas of the brain were treated with anti-tuberculous drugs. There were eight patients with solitary and six with multiple lesions, the size of the lesions varying from 3 x 2 cm to 7.5 x 6 cm. The symptoms and signs of tuberculomas of the brain are non-specific. The initial diagnosis is therefore presumptive and based on their characteristic CT patterns on contrast enhancement. These patterns are usually solid enhancing lesions, ring enhancing lesions or mixed solid and ring forms. The final diagnosis is established by the patient's clinical improvement and the CT scan evidence of decrease in the extent of the oedema and the size of the lesion after a therapeutic test by means of triple anti-tuberculous drug therapy lasting for 12 weeks. All patients but one were treated successfully with triple anti-tuberculous drug therapy, for a continued total period of 18 months. A failure of medical treatment occurred in one patient due to non-compliance. In this patient, the residual cerebral lesion after the tuberculoma had healed required excision to control intractable epilepsy. Associated obstructive hydrocephalus in another patient needed a ventriculo-peritoneal shunt. The patients were followed for six months to five years. There were no recurrences. It is concluded that medical treatment with anti-tuberculous drugs is the treatment of choice for tuberculomas of the brain. With the use of steroids to control the brain oedema and its resultant mass effect and increased intracranial pressure, and a ventriculo-peritoneal shunt for hydrocephalus, almost all tuberculomas of the brain, irrespective of their size, can be cured by medical treatment.

Sixteen consecutive patients with brain abscess, including two with multilocular and two with infratentorial abscesses, were treated by primary total excision of the abscess. The patients were followed for six months to three years. Only one patient died and there were no recurrences. Immediate primary excision is therefore the treatment of choice in brain abscess.

A 32-year-old man had the clinical features of progressive increase in intracranial pressure due to a chronic subdural hematoma except for papilledema. Lumbar puncture, however, precipitated acute tentorial coning and severe neurologic signs. The tentorial coning resulted in an acute aggravation of intracranial hypertension and precipitated an increase in the intracranial venous pressure that was transmitted to the orbital veins, causing orbital venous stasis, symmetrical increase in the intraorbital contents, and symmetrical bilateral proptosis.

✓ Twenty-seven patients with ruptured and one with symptomatic unruptured anterior communicating aneurysms were treated by proximal clip occlusion of the dominant anterior cerebral artery. These patients have been followed for 2 to 4½ years and the results evaluated. The operation carried a very low mortality rate (3.5%) and a relatively low morbidity. There was no instance of recurrent hemorrhage during the study period. Clinical and preoperative angiographic criteria for selection of patients and the timing and technique of surgery are discussed.

A series of 42 patients with lumbar disc disease and herniation, presenting with the cauda equina syndrome, has been studied. It was observed that pure disc herniation accounted for the syndrome in five cases only. Associated structural lesions were contributory factors in the remaining 37 cases, and operative manipulation and trauma during disc removal through an interlaminar approach was the added factor in two of them. Wide laminectomy with excision of the overhanging facet joints and adequate visualization of the lumbar nerve roots has been found to be the ideal procedure for disc removal and for relief of the symptoms, including backache. No postoperative spinal instability has been observed. There was no morbidity was insignificant. All cases have been followed up, and "good to excellent" results were obtained in 95 per cent of patients, and "fair" results in the other 5 per cent.

✓ A 2- to 15-year follow-up study is presented of a series of 35 consecutive patients treated for ruptured aneurysms of the middle cerebral artery by reinforcement with gauze wrapping. Only one patient suffered early recurrent hemorrhage in the postoperative period, and none had a late hemorrhage. The procedure carried a relatively low mortality rate (8.6%). Morbidity was the direct sequel of preoperative conditions. Wrapping is an effective and safe treatment of these aneurysms, with a low mortality and morbidity, and freedom from occlusive infarcts.

Apomorphine, which is believed to stimulate central dopamine receptors, caused a consistent increase in the ovarian weight of immature female rats treated with human chorionic gonadotrophin (HCG). Thi

Es werden Zellveranderungen des Hypothalamus bei traumatischen Hautschadigungen untersucht und Vergrosserungen neurosekretorischer Zellen, Protoplasmaveranderungen sowie Veranderungen der Sekretionsprozesse festgestellt.