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Kenya is a country of marked environmental and ethnic diversity. A study of osteogenic sarcoma occurring in Kenya from 1968 to 1978 revealed 251 cases, representing between 89% and 100% of the predicted number. Variations in age, sex and anatomical location were within classical limits. However, the incidence of osteogenic sarcoma amongst the Central Bantu was significantly higher than predicted (P<0.0001), whilst the incidence among the Western Bantu was significantly lower (P<0.002), despite their similar ethnic origins. Two geographically dissimilar areas likewise exhibited significant differences in incidence. The Eastern province showed a higher incidence (P<0.02), whereas the Nyanza Province (P<0.001) and the adjacent Western Province (P<0.005) showed a lower than predicted incidence. These observations suggest that in Kenya a geomedical variable affects the incidence of osteogenic sarcoma and that genetic variation has no effect on incidence.

Article abstract-Parenchymatous intracerebral hemorrhage (ICH) is a serious, infrequent complication of thrombolytic therapy for acute myocardial infarction. We studied the clinical and radiologic features, manner of presentation, associated factors, and temporal course in 23 patients with ICH associated with 150 mg or 100 mg recombinant tissue-type plasminogen activator (rt-PA) and heparin therapy for acute myocardial infarction in the Thrombolysis in Myocardial Infarction (TIMI) II Pilot and Randomized Clinical Trial. In TIMI II, 13 of the 23 ICH patients developed or maintained systolic blood pressure >=160 mm Hg or diastolic blood pressure >=90 mm Hg during the rt-PA infusion and before the onset of neurologic symptoms. Six patients (26%) had life-threatening ventricular arrhythmias, five before onset of neurologic symptoms. A decreased level of consciousness was the earliest neurologic abnormality in 15 (65%) and the most common initial physical finding (in 19, or 82%). Onset was usually gradual (70%), but time to maximal deficit was frequently (61%) within 6 hours of onset. The locations of the primary ICH sites were lobar in 16 (70%), thalamic in four (17%), and brainstem-cerebellum in three (13%), but the putamen was never the primary site. Multiple lobar hemorrhages occurred in six cases (26%). The timing and size of ICH was similar among patients treated with 150 mg rt-PA and 100 mg rt-PA. Brain CT demonstrated an arteriovenous malformation in one case. Four patients had hypofibrinogenemia, which was profound in three patients. Pathologic findings were available for five patients. Of these, three patients had cerebral amyloid angiopathy, and one had hemorrhagic transformation of an ischemic cerebral infarction found at autopsy. We conclude that ICH following rt-PA and heparin therapy for acute myocardial infarction presents as a distinctive clinical syndrome. Intracerebral bleeding after combined thrombolytic and antithrombotic therapy may be associated with cerebral amyloid angiopathy and other vascular lesions. Acute or persistent hypertension before or during rt-PA infusion, life-threatening ventricular arrhythmias, and hypofibrinogenemia, either alone or in combination, may play roles in some cases. Care should be exercised when considering thrombolytic therapy for patients with risk factors for ICH.

The role of two protein C gamma-carboxyglutamic acid domain mutations in familial thrombosis, protein CVermont (Bovill, E. G., Tomczak, J. A., Grant, B., Bhushan, F., Pillemer, E., Rainville, I.R., and Long, G. L. (1992) Blood 79, 1456-1465), was investigated. Two single mutations (Glu20–>Ala and Val34–>Met) and the naturally occurring double mutation were created by site-directed mutagenesis and were expressed in human kidney 293 cells. Purified recombinant protein C with the mutation glutamate to alanine at position 20 is defective in the assays of activated partial thromboplastin time, factor Va inactivation, and fibrinolysis. Mutation from valine to methionine at position 34 has only a minor effect. Activation of Glu20 mutants by thrombin-thrombomodulin was not enhanced by phospholipid vesicles and showed a different calcium dependence compared with the wild type, suggesting that Gla20 is important in the interaction of the protein C Gla domain with a phospholipid-mediated site on the thrombomodulin molecule. Glu20-substituted protein C is not inhibited by calcium ion in its interaction with the calcium-dependent monoclonal antibody H-11, suggesting that this mutation has lost the calcium-induced, lipid-independent conformational transition of the protein C Gla domain. These data indicate that the loss of Gla20 causes the major familial dysfunction of protein C to associate with phospholipid as well as to undergo Ca(2+)-dependent, lipid-independent conformational changes and are consistent with the importance of Gla20 in both external and internal Ca2+ binding based upon the x-ray-derived structure of the homologous Gla domain in bovine prothrombin.

J Pediatr 1998;132:575-88

This article represents the greater part of a lecture which Mr. Bovill delivered at short notice on the 12th April, deputising for Mr. A. B. Cohen, the head of the African Departments at the Colonial Office, who was ill. There is something appropriate in this in the jubilee number, since Mr. Bovill contributed much to the Society's annals in the late '20s, as a student of the Sahara. He now speaks as the head of large and important commercial interests.

Thou shall surely find the most violent of all men in enmity against the true belivers to be the Jews, and the idolaters; and thou shall surely find those among them to be the most inclinable to entertain friendship for the true believers, who say, We are Christians.—Qoran, Sura V. 82.

This article represents the greater part of a lecture which Mr. Bovill delivered at short notice on the 12th April, deputising for Mr. A. B. Cohen, the head of the African Departments at the Colonial Office, who was ill. There is something appropriate in this in the jubilee number, since Mr. Bovill contributed much to the Society's annals in the late '20s, as a student of the Sahara. He now speaks as the head of large and important commercial interests.

To the Editor.—In a letter in the March 27 issue of The Journal, Dr. Maurice W. Nicholson suggests that "dislocations and fractures of the cervical spine can be treated in a more efficacious manner than that outlined in the Fracture OF THE Month (218:1288, 1971)." Nicholson then states that "approximately 14 years ago, Cloward started fusing this type of fracture dislocation by the anterior route, and for the past six years I have done so in the same manner."The case in question was a dislocation with locked facets without relevant fracture. We would agree with Nicholson that the anterior approach is applicable to selected fracture dislocations, but not to anterior dislocation with locked facets, since in the latter case the block to reduction is posterior and cannot be visualized from the anterior approach.