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Acardiac twinning is the most extreme form of twin-twin transfusion syndrome occurring in monzygotic twin pregnancies with monochorionic placentation. A case of acardiac amorphous foetus, occurring in association with spontaneously conceived triplet pregnancy, diagnosed on ultrasound in early second trimester is described and its antenatal management and brief review of literature discussed.

A 55-year-old postmenopausal lady presented with signs and symptoms of ovarian malignancy. Laparotomy revealed a 8 x 8-cm degenerated, cystic and haemorrhagic mass arising from left broad ligament which on histopathology proved to be leiomyosarcoma.

An extremely rare case of vaginal birth of preterm conjoined thoracopagus twins diagnosed after delivery is being described and brief review of literature discussed.

Recurrent vaginal discharge in children may be due to variety of causes. Intravaginal foreign body retained for long duration can be a diagnostic dilemma. This report presents the case of a girl who had an intravaginal foreign body for over four years duration. Recurrent, unremitting, foul-smelling, bloody vaginal discharge in a child should alert the clinician to the possibility of a retained vaginal foreign body.

Two cases of Cantrell syndrome occurring over a ten year period are described. One was detected following caesarean section at term and the other underwent termination of pregnancy at 20 weeks following antenatal diagnosis by ultrasound.

Neurofibromatosis in pregnancy has been associated with poor perinatal outcome. A 30-year-old multigravida developed peripheral lesions of neurofibromatosis during the third month of pregnancy. She had eclampsia complicated with fatal left-sided massive intracerebral haemorrhage detected on computed tomography at 8.5 months gestation. Investigations were suggestive of HELLP syndrome. A still-born male baby was delivered. In spite of all supportive measures the patient died on the third postpartum day. We conclude that recent onset neurofibromatosis in current pregnancy should be considered as a predictor of potentially adverse maternal and fetal outcome and such pregnancies be managed in tertiary level referral centre.

A 25-year-old gravida 2 had two right cerebral hemispheric infarcts documented on magnetic resonance imaging (MRI) and computed tomography (CT) scan at 23 and 31 weeks of pregnancy. Investigations failed to reveal any cause. She was empirically treated with heparin, aspirin and nimodipine and had a successful perinatal outcome.

A 20-year-old primigravida initially diagnosed at 28 weeks to have superfetation in a case of a bicornuate uterus was subsequently found to have uterus pseudo didelphys during a cesarean section at 35 weeks. This type of uterine anomaly with twin gestation has been previously reported in five case reports, but superfetation with such müllerian abnormality has not been previously described.

An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death. Clinical examination aroused suspicion of non-communicating uterine horn with bicornuate uterus. Examination under anaesthesia and laparotomy revealed a partial vaginal septum, complete septate uterus with septum deviated to one side and fetus lying in the non-communicating right blind hemicavity (Robert's uterus). Hysterotomy and ipsilateral tubal ligation were performed.

Fifty patients of contact vitiligo were studied. Etiological agents of contact vitiligo were identified by clinical history, distribution of lesions and patch testing with suspected material. All patients were advised to avoid the suspected agent and treated with PUVASOL and topical steroid. Out of 50 patients (Male 8%, Female 92% age 14-60 years)., etiological agent of contact vitiligo was found to be sticking bindi alone in 24 (48%), while bindi along with other etiological agents were found to be purse, foot wear, plastic watch strap, lipstick and tooth paste in 14 (28%) cases. 14 (28%) patients also had disseminated lesions of vitiligo along with contact vitiligo. Positive reaction with patch testing was observed in 18 (36%) while depigmentation was seen in 4 (8%) cases. We observed that response of treatment was better in patients with shorter duration of disease while poor response was seen in patients with longer duration of disease.

Background: Distant metastasis in carcinoma of uterine cervix is a rare manifestation and bone metastasis is uncommon., Case: A 60-year-old woman treated by radical radiotherapy for moderately differentiated cervical carcinoma FIGO stage IIIB presented 4 months later with swelling over right side of the scalp. Fine needle aspiration cytology from swelling showed poorly differentiated metastatic carcinoma. X-ray of the skull was suggestive of osteolytic metastasis of calvaria., Conclusion: Bone metastasis in cervical carcinoma is a late manifestation of advanced malignancy and heralds poor prognosis. Scalp metastasis is a very rarely reported phenomenon.

An 8-year-old male child who presented with lesions of angiokeratoma on tongue is described.

Punch grafting was performed in 15 patients using punches varying in size from 2 to 3 mm in diameter. Silicone gel sheets were used as a post-operative dressing. Removal of the dressings after 7 days revealed no lifting of grafts in 13 patients. A minimally raised surface seen in two patients flattened after 6 to 8 weeks of continuous use of the dressing. At two months of follow-up, no cobblestoning or any other untoward effect was evident. Firm pressure provided by silicone gel sheets probably prevents cobblestoning by counteracting forces which tend to lift the grafts. Additionally, the sheets act as a brace preventing graft dislocation, provide a sterile atmosphere underneath the grafts, facilitate periodic observation due to their transparency, and are easily removed at the time of follow-up.

A study of clinical profile of acrochordons was carried out in 100 patients. Their association with diabetes mellitus and other disorders was studied. Acrochordons were found to be closely associated with pseudo-acanthosis nigricans, seborrhoeic keratosis, obesity and non-insulin dependent diabetes mellitus.

Thirty five patients with acquired aplastic anaemia (AAA) were treated with anti-lymphocyte globulin (ALG). Fifteen (42.9%) had non-severe aplastic anaemia (NSAA), 14 (40%) severe aplastic anaemia (SAA) and 6 very severe aplastic anaemia (VSAA). There were 17 (48.6%) responders to the first course of ALG while 2 out of 5 (40%) responded to a second course, the overall response rate being 54.3%. Eleven out of 15 (73.3%) with NSAA responded, 8 out of 20 (40%) with SAA responded while none of VSAA responded. All the non-responders have died. Out of the responders, 1 died of non-A non-B hepatitis, and 1 with relapse of AA and sepsis. One has developed paroxysmal nocturnal haemoglobinuria (PNH) and one myelodysplasia. Another 2 needed infrequent red cell transfusion support. Remaining 13 (37.1%) are asymptomatic and without any external support since 18-78 months (35 +/- 21). We conclude that ALG is an effective modality of treatment for patients with AAA.

During January 1981 to June 1991, 20 patients from 16 unrelated families were detected to have Glanzmann's thrombasthenia (GT). Twelve families (75%) had history of consanguinity, with 6 first cousins and 3 uncle-niece marriages; of these 7 were Muslims, 6 Hindus and 3 Christians. There were 12 girls and 8 boys; the mean age at diagnosis was 7.05 +/- 6.03 yr (range 1 day-22 yr). All cases had initial bleeding prior to the age of 5 yr with the mean age at the initial episode of bleeding being 2.21 +/- 1.34 yr (range 1 day-5 yr). Common pattern of bleeding included epistaxis, gingival bleeding, post-traumatic bruises, menorrhagia, gastrointestinal (2 cases), post-operative (2 cases) and spontaneous bleeding (2 cases). No patient showed hemarthrosis, intracranial bleeding or hemoptysis. Menorrhagia was a serious problem necessitating repeated transfusions and hormonal therapy. Twelve cases (60%) required 1-120 units of blood transfusions while five received platelet concentrates.

A case of acquired haemoglobin H (HbH) disease with underlying myelodysplastic syndrome in the form of acquired idiopathic sideroblastic anaemia is reported. Family studies and subsequent drop in HbH percentage strongly supported the acquired nature of the defect.

Eight cases with lupus anticoagulants (LA) were diagnosed over the last five years (1984-88). Of these, three were established cases of systemic lupus erythematosus (SLE), where bad obstetric history (2 cases) and recurrent deep venous thrombosis (DVT--1 case) prompted execution of laboratory tests for LA. In the remaining 5 cases, there was no clinical evidence of SLE. However, one case developed laboratory findings suggestive of SLE at a later date. One of these 5 patients was referred for unexplained abnormality in partial thromboplastin time (K). Three had recurrent abortions (one with additional history of DVT) while one had DVT with raised PTT (K). The clinical findings and laboratory tests by which lupus anticoagulants can be diagnosed have been discussed.

26 Patients of leprosy presenting with hypopigmented lesions were divided on morphological grounds into 3 Sub groups, Group I (9 patients) with well-defined single patch with moderate to complete sensory loss; Group II (8 patients) with single ill-defined lesion having partial sensory loss; and Group III (9 patients) having multiple hypo-pigmented patches with mild to moderate sensory loss. Epidermal atrophy was a conspicuous histological finding in all groups. Only patients in Group I showed epitheloid cells in dermal infiltrate with erosion of epidermis in one case. This group may be labelled as maculoanesthetic leprosy. Patients in Group II and III showed mononuclear cell infiltrate in dermis, around neurovascular bundles and appendages. They were histologically consistent with indeterminate leprosy. Follow-up biopsy after six to eight months of treatment showed healing of the lesion of reduction in the infiltrate in most cases.

ATPase staining and ultrastructural study of skin biopsies from six patients of leprosy (2TT, 4LL) and three normal subjects was carried out to study Langherhans Cells (LC). ATPase staining showed normal counts of LCs in tuberculoid patients, while significant reduction was observed in lepromatous cases. Electron microscopy revealed morphological changes in LL cases in the form of dense matrix and indistinct cristae of mitochondria; decreased number of lysosomes and rough endoplasmic reticulum; and numerous vacuoles in cytoplasm. TT cases showed normal morphology. Possible role of Langerhans Cells in pathogenesis of leprosy is discussed.

Eleven cases of mild autosomal dominant ichthyosis vulgaris (ADIV) were seen who presented with asymptomatic, brownish-black hyper keratotic lesions' over the flexure surfaces of wrists, dorsum of hands, knees and ankles for 1-2 months during peak summer months. The lesions disappeared with the onset of monsoon. All these cases had typical lesions of ADIV during winter months. This paradoxical phenomenon of ichthyosis alternating with hyperkeratotic pigmented lesions in the same individual during different seasons remains unexplained. Treatment with 20% urea cream and oral vitamin A had no effect on the course of the disease.

Raman microprobe spectra from the secondary wall of earlywood tissue from Picea mariana (black spruce) reveal evidence of the orientation of lignin relative to the plane of the cell wall. In most instances, the aromatic rings of the phenyl propane structural units are parallel to the plane of the cell-wall surface.

Native-state organization and distribution of cell-wall components in the secondary wall of woody tissue from P. mariana (Black Spruce) have been investigated using polarized Raman microspectroscopy. Evidence for orientation is detected through Raman intensity variations resulting from rotations of the exciting electric vector with respect to cell-wall geometry. Spectral features associated with cellulose and lignin were studied. The changes in cellulose bands indicate that the pyranose rings of the anhydroglucose repeat units are in planes perpendicular to the cross section, while methine C-H bonds are in planes parallel to the cross section. Changes in bands associated with lignin indicate that the aromatic rings of the phenyl-propane units are most often in the plane of the cell-wall surface. However, regions where lignin orientation departs from this pattern also occur. These results represent direct evidence of molecular organization with respect to cellular morphological features in woody tissue, and indicate that cell-wall components are more highly organized than had been recognized. Studies carried out in order to establish the usefulness and sensitivity of the Raman technique to differences of composition within the cell walls provide evidence of variations in the distribution of cellulose and lignin. Such compositional differences were more prominent between the walls of different cells than within a particular cell wall.