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Proximal-type epithelioid sarcoma (PES) of the vulva is an exceedingly rare soft tissue tumor with an unpredictable symptom pattern and frequent recurrences. Information on management is limited. This report describes a 51-year-old woman with proximal-type epithelioid sarcoma of the vulva which was resected surgically and reviewed the current medical literature regarding the diagnosis and management of this disease.

A lead-acid storage battery manufacturing industry in India produces several thousand liters of lead con-taminated acidic wastewater on a daily basis and uses hydrated lime to render the lead-contaminated acidic wastewater alkaline (pH = 8.0). Alkaline treatment of the acidic wastewater with lime though a cost-effective method, generates copious amount of lead-contaminated gypsum sludge. Other alkali agents such as sodium hydroxide, sodium carbonate and dolomite are also used for alkali treatment of the acid wastewaters. The present paper compares the relative efficiency of hydrated lime and 0.05 M to 1 M NaOH solutions with re-spect to 1) amounts of sludge produced, 2) immobilization of the soluble lead in the acidic wastewater (AWW) and 3) increase in TDS (total dissolved solids) levels upon treatment of AWW with NaOH solutions and lime. The study also performs equilibrium speciation upon alkaline treatment of AWW with lime and NaOH (sodium hydroxide) solutions using the Visual MINTEQ program to understand the chemical reac-tions occurring during treatment process.

Lime neutralization of acidic wastewater from a lead-acid battery industry produces lead contaminated gypsum sludge. An earlier study of the authors had focused on re-using this gypsum sludge without chemical stabilization to manufacture non-load bearing gypsum blocks. Un-stabilized gypsum blocks however have poor resistance to moisture. This study examines the feasibility of improving moisture resistance, increasing the compressive strength and lowering the rate of contaminant release through chemical stabilization of the gypsum sludge with Portland cement. Experimental results demonstrate that partial replacement of river sand by gypsum sludge in cement stabilized pressed blocks (CSPB) is a feasible route to achieve these objectives.

A lead-acid storage battery industry in India produces lead contaminated acidic effluent. Lime neutralization of the acidic effluent produces lead contaminated gypsum sludge. The ability of calcined gypsum to harden and gain strength upon hydration is exploited for possible re-use of the gypsum sludge in civil engineering applications. Heating gypsum sludge (chemical formula — CaSO 4 .0.5H 2 O) at 140°C obtained the calcined gypsum sludge (chemical formula — CaSO 4 .0.5H 2 O). CGS-sand slurries containing CGS (calcined gypsum sludge) contents from 10 to 100% were air-dried and their unconfined compressive strengths were determined in the un-soaked state. Toxicity characteristics leaching procedure (TCLP) tests were conducted with CGS-sand specimens to examine if the amounts of lead released by the CGS-sand specimens were within the TCLP limit of 5mg/L. Experimental results demonstrated that the air-dried CGS-sand specimen containing 34% CGS content satisfied the...

Objective: The incidence of early gastric cancer (EGC) is increasing gradually in countries such as Japan and Korea. Knowledge of EGC in other Asian countries, however, is limited. This study aims to describe the characteristics of this disease in Singapore. Method: A retrospective analysis of the operative results of a personal series of EGC was undertaken. The clinical and pathological characteristics were examined. Results: From 1979 to 1997, 226 patients with gastric cancer were operated on and 21 patients (9.3%) were diagnosed as having EGC by histological examination. All 21 patients received radical gastrectomy and lymphadenectomy. There were 12 males and 9 females with a median age of 59 years (range: 36–65). The presenting symptom was epigastric pain (15 patients), bleeding (two patients), weight loss (two patients), vomiting and incidental (one patient each). The majority of the tumours (76%) were located at the antrum and were intestinal type. Macroscopically, most of the tumours were either depressed (type IIc) or excavated (type III) type. Four cases were combined type. The lesion was limited to the mucosa in 10 cases. Only one patient had lymph node metastasis. There was no operative mortality and the morbidity rate was 14%. Nineteen patients had complete follow up for 3 months to 13 years. No patient developed tumour recurrence in the series. Conclusion: Early gastric cancer remains uncommon in Singapore. However, for these patients, radical gastrectomy yields excellent results with minimal morbidity.

Histone deacetylases (HDACs) 1 and 2 share a high degree of homology and coexist within the same protein complexes. Despite their close association, each possesses unique functions. We show that the upregulation of HDAC2 in colorectal cancer occurred early at the polyp stage, was more robust and occurred more frequently than HDAC1. Similarly, while the expression of HDACs1 and 2 were increased in cervical dysplasia and invasive carcinoma, HDAC2 expression showed a clear demarcation of high-intensity staining at the transition region of dysplasia compared to HDAC1. Upon HDAC2 knockdown, cells displayed an increased number of cellular extensions reminiscent of cell differentiation. There was also an increase in apoptosis, associated with increased p21Cip1/WAF1 expression that was independent of p53. These results suggest that HDACs, especially HDAC2, are important enzymes involved in the early events of carcinogenesis, making them candidate markers for tumor progression and targets for cancer therapy.

Background. Cell-cycle control is important in carcinogenesis and cancer progression. p27 and cyclin E are cell-cycle regulators, which control the G1-S phase transition. Recently, these two factors were found to be affected in many human cancers. The aim of the study was to examine the expression of p27 and cyclin E in gastric cancer and to evaluate their prognostic implication. Materials and methods. Paraffin blocks of 56 samples of advanced gastric cancer, 15 samples of early gastric cancer, and 17 samples of normal gastric mucosa were studied. Expression of p27 and cyclin E was analyzed by immunohistochemistry. The relationship between the expression and clinicopathological data was examined. Results. Expression of p27 was reduced in 89% of advanced cancer samples, 44% of early cancer samples, and 12% of normal mucosa samples (P < 0.0001). Among the cancers, reduced expression of p27 was associated with a large tumor size, increased cancer invasion, nodal metastases, and the presence of residual tumor after operation. No significant difference in cyclin E expression was found. Kaplan-Meier plots of survival showed tumors with low p27 were associated with poorer survival than those with high p27 expression (RR, 5.3; CI 5 1.6 ‐17.4; P 5 0.005). Tumors with low p27 and high cyclin E expression were associated with the highest mortality expression (RR, 9.8; CI 5 1.2‐ 80; P 5 0.03). Conclusions. Gastric cancer with low expression of p27 is associated with aggressive characteristics and a poorer outcome. © 2000 Academic Press

Leiomyosarcoma of the adrenal gland is a very rare tumour. We report a case of this rare tumour and review the previous case reports. The patient, a 68-year-old woman, presented with a 1-week history of right loin pain and fever associated with loss of weight and appetite. Computerised tomography and ultrasound scans showed the presence of a right adrenal gland tumour, which was subsequently surgically removed. Histological examination of the 12.5-cm tumour revealed a leiomyosarcoma of the adrenal gland. The patient was alive and well with no evidence of recurrent disease 1 year later.

Background. p53 mutations are known to occur frequently in human cancers, including gallbladder carcinoma. However, there has been no study of p53 expression in extrahepatic bile duct/ampullary carcinoma. Furthermore, gallbladder carcinoma is associated with cholelithiasis, whereas no such association is known for extrahepatic bile duct carcinoma, suggesting that they could arise from different pathogenetic mechanisms. Methods. Twenty-four gallbladder carcinomas and 35 extrahepatic bile duct/ampullary carcinomas were stained with an anti-human p53 protein monoclonal antibody by the streptavidin-biotin immunoperoxidase method. Both the extent and intensity of p53 protein staining were noted. Results. Ninety-two percent of the gallbladder carcinomas stained for p53 protein compared with only 66% of the extrahepatic bile duct/ampullary carcinomas. The statistical significance was maintained even when the comparison was restricted to strong p53 staining in moderately to poorly differentiated adenocarcinomas (P < 0.05). Of the gallbladder carcinomas, poorly differentiated adenocarcinomas stained more strongly than well to moderately differentiated adenocarcinomas; the converse was true for extrahepatic bile duct/ampullary adenocarcinomas. Conclusion. The majority of gallbladder and extrahepatic bile duct/ampullary carcinomas stain for p53 protein. The incidence and pattern of staining is different, however, and supports the contention that these could be different tumors with differing etiologies and pathogenetic mechanisms.

AIMS--To study the expression and importance (if any) of p53 protein in gall bladder carcinoma and its precursor lesions. METHODS--Immunohistochemical staining was performed on formalin fixed, paraffin wax embedded histological sections with an anti-human p53 monoclonal antibody (DO-7; Dako Corporation M7001) (24 carcinomas, one adenocarcinoma in situ, six dysplasias, three adenomas and four cases of chronic cholecystitis). Invasive, in situ, and dysplastic areas as well as normal-looking epithelium were sought. Nuclear staining was assessed according to intensity and extent of positive cells. Both variables were graded on a scale of 1-3 and aggregate p53 scores were obtained (range: 0, 2-6). Only p53 scores of > or = 3 were regarded as significant. RESULTS--Clinically important amounts of p53 were expressed in 92% of invasive carcinomas, 86% of carcinoma in situ, and 28% of dysplastic areas. None of the adenomas contained clinically important amounts of p53. Normal epithelium, present in all the cases, did not express p53 except in one case of moderately differentiated adenocarcinoma (p53 score 3). In general, there was no difference in the prevalence of p53 protein expression between dysplasias associated with, and those unassociated with invasive disease. There was a tendency for higher grade carcinomas to express more p53 protein. CONCLUSIONS--The distribution of p53 protein in invasive carcinomas and the adjacent dysplastic and preinvasive lesions suggests that it is more commonly expressed than previously thought. The fact that p53 protein is also expressed in cases of dysplasia and carcinoma in situ unassociated with invasive malignancy lends further support to the contention that p53 gene mutations may have a role in the pathogenesis of gall bladder cancer. Expression of p53 protein may possibly be an indication of likely disease progression from dysplasia, to carcinoma in situ, to invasive disease.

Previous studies have shown that malignant transformation is sometimes associated with the aberrant expression of HLA class II antigens. The functional significance of such aberrant expression is not known. Since HLA-DR antigen is expressed in normal colonic mucosa, it would be interesting to see if malignant transformation could result in the aberrant suppression of this antigen. Sixteen colonic adenocarcinomas, 29 colonic adenomatous polyps and 23 samples of normal colonic mucosa, including 9 cases of colonic mucosa adjacent to carcinoma, were stained immunohistochemically for HLA-DR antigen. The intensity and distribution of the antigen staining in the cytoplasm and luminal surface of the epithelial elements were analysed semiquantitatively. The lymphoplasmacytic infiltrate in the lamina propria was also evaluated. Cytoplasmic HLA-DR antigen expression was found to be significantly diminished in moderately and poorly differentiated adenocarcinomas but not in adenomas or well-differentiated adenocarcinomas. This suggests that the change in HLA-DR expression is not intrinsic to the neoplastic process but may merely be due to the fact that malignant cells, as they become less differentiated, tend to show alterations in their antigenic phenotype.

AIMS: To study the expression of HLA-DR antigen in the different histological types of gastric polyps. METHODS: Ninety five cases of gastric polyps were histologically classified and examined for the presence of Helicobacter pylori, and for degree and type of inflammation. Further sections were stained immunohistochemically for HLA-DR antigen expression in the epithelium using a monoclonal antibody that was reactive to formalin-fixed paraffin wax embedded tissue. RESULTS: HLA-DR antigen was expressed in all of the inflammatory polyps studied (20/20), and in most hyperplastic (12/16) and adenomatous (4/6) polyps. Only a few fundic gland polyps (8/51) stained positively for HLA-DR antigen. Gastric polyps seem to have a greater tendency to express HLA-DR antigens than non-polypoid gastric mucosa, even after considering the factors that may affect HLA-DR antigen expression, such as inflammation and the presence of H pylori. CONCLUSIONS: Growth disturbances/polyp formation may be associated with increased HLA-DR antigen expression.

We report a 25-year-old Malay man with Subutex-related endocarditis, complicated by protein-losing enteropathy from severe tricuspid regurgitation and congestive heart failure. The intestinal protein loss was reversed with surgical valvular intervention. This case highlights the importance of recognising the rare association between protein-losing enteropathy and congestive heart failure in the setting of endocarditis.

Enterogenous cyst is a rare congenital lesion presumably of endodermal derivation. It is usually located in the medistinum, the abdominal cavity, skull or within the spinal canal. To our knowledge, it has not been reported in the subcutaneous tissue. We report the first case of ectopic (left scapular region) subcutaneous enterogenous cyst in a 46-year-old man, who presented with a lump over the left scapular region of several years' duration. Clinical diagnosis of lipoma was made. The final histological diagnosis was enterogenous cyst. Enterogenous cysts at ectopic locations should be kept in mind and studied further especially with respect to their development. A better understanding of the embryology, histopathology and genetics of ectopic enterogenous cyst is desired.

Summary p53 mutations are known to occur frequently in human cancers where they are considered to be an important event in the stepwise progression towards malignant transformation. It is therefore interesting to compare p53 expression in the uterine cervix for non-neoplastic/metaplastic squamous epithelium, cervical intraepithelial neoplasia (CIN) and invasive squamous cell carcinoma. One hundred and nineteen biopsied and resected specimens of the uterine cervix were stained with an anti-human p53 protein monoctonal antibody by the streptavidin-biotin immunoperoxidase method. Histologically these could be categorized into non-neoplastic/dysplastic conditions, including condyloma (34 cases), CIN 1-3 (66 cases) and invasive squamous cell carcinoma (19 cases). Fifty eight per cent (11/19) of the invasive squamous cell carcinomas and 11% (7/66) of the CIN stained positively for p53. Except for 3 cases of invasive squamous cell carcinoma, there was only sporadic intranuclear staining of less than 5% of the cells. No staining was observed in all non-neoplastic/metaplastic squamous epithelial cells. The pattern of p53 staining is significantly different for all 3 categories. However it is undetermined as to whether the positive immunoperoxidase staining is a direct consequence of p53 gene mutation or otherwise.

Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient.

(2004). Mushroom bezoar: a rare cause of small intestinal obstruction. Pathology: Vol. 36, No. 2, pp. 207-208.

AIMS--To study the expression and clinical significance (if any) of p53 protein in hepatocellular carcinomas (HCC) arising in a population with endemic hepatitis B virus (HBV) infection. METHODS--Immunohistochemical staining was performed on formalin fixed, paraffin was embedded histological sections of 46 HCC cases using an antihuman p53 monoclonal antibody; serial sections were also stained for hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg) and alpha fetoprotein (AFP). Nuclear p53 staining was assessed according to intensity (absent, weak or strong) and extent (< 5%, 6-25%, 26-50%, and > 50%) of positive cells. Tissue HBsAg, HBcAg and AFP were recorded as absent or present. RESULTS--The p53 protein was expressed in 35% (16 of 46) of HCCs; the positive rate in grade III/IV tumours (13 of 31; 42%) was higher than in grade I/II tumours (three of 15; 20%) but this was not statistically significant. HBsAg positive tumours showed almost the same proportion of p53 staining (11 of 29; 38%) as HBsAg negative ones (five of 17; 29%). CONCLUSIONS--The p53 protein was expressed in 35% of HCC cases. There was no statistically significant correlation between HBV infection and p53 protein expression. Similarly, there was no definite correlation between p53 positivity and tumour size, histological grade or vascular invasion.

The expression of the proliferating cell nuclear antigen (PCNA) was examined to determine the proliferative activity of the cells in nonneoplastic and neoplastic lesions of the uterine ectocervix. Formalin-fixed, paraffin-embedded tissue sections of uterine cervix including normal, metaplasia, condyloma, intraepithelial neoplasia and invasive squamous cell carcinoma were stained immunohistochemically using monoclonal antibody to PCNA. The percentage of PCNA-positive cells was significantly higher in premalignant and malignant lesions of the uterine cervix than in nonneoplastic lesions. Furthermore, the growth fraction of tumor cells as detected by PCNA was increased in accordance with the progression of neoplasia. The results of this study suggest that the cell proliferation index as detected immunohistochemically using PCNA may be a useful adjunct to histological diagnosis of various grades of dysplasia.

p53 mutations are known to occur frequently in human cancers, including gallbladder carcinoma. However, there has been no study of p53 expression in extrahepatic bile duct/ampullary carcinoma. Furthermore, gallbladder carcinoma is associated with cholelithiasis, whereas no such association is known for extrahepatic bile duct carcinoma, suggesting that they could arise from different pathogenetic mechanisms.Twenty-four gallbladder carcinomas and 35 extrahepatic bile duct/ampullary carcinomas were stained with an anti-human p53 protein monoclonal antibody by the streptavidin-biotin immunoperoxidase method. Both the extent and intensity of p53 protein staining were noted.Ninety-two percent of the gallbladder carcinomas stained for p53 protein compared with only 66% of the extrahepatic bile duct/ampullary carcinomas. The statistical significance was maintained even when the comparison was restricted to strong p53 staining in moderately to poorly differentiated adenocarcinomas (P0.05). Of the gallbladder carcinomas, poorly differentiated adenocarcinomas stained more strongly than well to moderately differentiated adenocarcinomas; the converse was true for extrahepatic bile duct/ampullary adenocarcinomas.The majority of gallbladder and extrahepatic bile duct/ampullary carcinomas stain for p53 protein. The incidence and pattern of staining is different, however, and supports the contention that these could be different tumors with differing etiologies and pathogenetic mechanisms.

Cardiac myxomas are rare and noted for their varied clinical manifestations. Consequently, the diagnosis is often unsuspected until the symptoms and signs become advanced and obvious, or when the diagnosis is made fortuitously during echocardiography. This report illustrates a case in point in which the diagnosis was made on transthoracic echocardiography and amplified using transesophageal echocardiography.

A case of adenomyoepithelioma of the breast was studied by cytology, histology, immunohistochemistry and electron microscopy. Aspiration cytology of the tumor showed sheets and tubular-type clusters of cohesive, regular polygonal cells with abundant, fairly well preserved, pale, granular to finely vacuolated, clear cytoplasma and a low nuclear/cytoplasmic ratio. The nuclei were small, round and monotonous, with dispersed chromatin and small or inconspicuous nucleoli. Acinus formation was striking: an occasional gland showed a suggestion of an inner layer of cells with denser cytoplasm surrounded by an outer mantle of paler cells. The histologic, immunohistochemical and ultrastructural findings confirmed the two cell populations, constituting an inner epithelial and outer myoepithelial component, both participating in the neoplastic process. The differential diagnoses of various breast lesions with somewhat similar cytologic features are discussed.

The purpose of this study was to evaluate the relationship between cervical neoplasia and HLA-DR antigen (class II antigen) expression. Seventy-seven formaldehyde-fixed uterine specimens comprising morphologically normal cervix (12), chronic cervicitis (10), cervical intraepithelial neoplasia (CIN) of various grades (42), and invasive squamous cell carcinoma (13) were studied for the degree and type of inflammation, and immunohistochemically for the HLA-DR antigen expression in the epithelium. The nonneoplastic ectocervical squamous epithelium was consistently negative for HLA-DR antigen, even in sections showing significant lymphoplasmacytic infiltration. We found HLA-DR antigen positivity in endocervical glandular epithelium, immature metaplastic squamous epithelium, CIN, and invasive carcinoma. In cases of CIN, the aberrant expression of the antigen generally corresponded to the level of dysplasia. Specific cells exhibiting koilocytic change were negative. All the cases of squamous cell carcinoma expressed the antigen, albeit variable in intensity and distribution. These findings suggest that aberrant HLA-DR antigen expression in the uterine ectocervix may be a consequence of dysplastic changes of the squamous epithelium that is maintained even after malignant transformation. On the other hand, HLA-DR positivity in immature metaplastic epithelium is probably a mere reflection of the fact that normal endocervical glandular epithelium can express the antigen.

A case of bilateral carcinoid tumors of the breast was studied by cytology, histology, immunohistochemistry and electron microscopy. The preoperative aspiration cytologic findings strongly suggested a carcinoid tumor of the breast. The differential diagnosis with fine needle aspiration cytology of other breast lesions, the bilaterality of the condition and terminology are discussed.

The binding of peroxidase-conjugated Dolichos biflorus (DBA), Triticum vulgaris (WGA), Canavalia ensiformis (Con A), Arachis hypogaea (PNA), Lotus tetragonolobus, and Bandeiraea simplicifolia I (BSAI) to gastrointestinal carcinoid tumours was studied. The results indicate that carcinoid tumour cells express certain carbohydrates similar to those present in the adjacent surface epithelium. The differences in the lectin-binding properties of carcinoid tumours of different sites of the gastrointestinal tract are closely related to the regional differences in the lectin binding of adjacent surface epithelium. These observations therefore form a useful basis for further studies in the application of lectin histochemistry to elucidate the histogenesis of carcinoid tumours.

Twenty-four male breast lesions including ten normal, ten gynaecomastia, and four infiltrating carcinomas were studied for the presence and distribution of lectin binding carbohydrates. For comparison, tissue sections of five normal female breast lesions, ten each of fibrocystic disease, fibroadenoma, and carcinoma, were also included in this study. Formalin-fixed, paraffin-embedded tissues were tested with Glycine maximus (SBA), Dolichos biflorus (DBA), Triticum vulgaris (WGA), Concanavalia ensiformis (Con A), Lotus tetragonolobus (LTA), Arachis hypogaea (PNA), and Bandeiraea simplicifolia (BSAI). The lectin-binding patterns were similar in normal, gynaecomastia, and carcinoma, and were not pathognomonic to any male breast lesion. These lectin reactive patterns in the male breast appear to be similar to those reported for the female breast lesions.

Summary This paper describes multiple breast fibroadenomas in three siblings. It appears that the familial disorder seen is associated with bilateral multiple fibroadenomas.

A case of sarcoid lesion in the breast of a 60-year-old Negro woman, presenting as carcinoma is reported.

An analysis of 651 diagnostic lymph node biopsies performed at the Port of Spain General Hospital, Trinidad was carried out to determine the diseases that commonly present with lymphadenopathy. Non-specific reactive hyperplasia was common and tuberculous lymphadenitis was rare. There was a high prevalence of Non Hodgkin's lymphomas. The role of human T cell leukemia/lymphoma virus in the aetiology of lymphadenopathy is discussed.

3 Martyn LJ. Pediatric neuro-ophthalmology. In: Harley RD, ed. Pediatric ophthalmology. Philadelphia: W B Saunders, 1983:775-6 4 Duke-Elder S, Dobree JH. Diseases of the retina. In: Duke-Elder S, ed. System of ophthalmology, Vol. X. London: Henry Kimpton, 1967:585-7 5 Walton JN. Brain's diseases of the nervous system. Oxford: Oxford University Press, 1977:159 6 Duke-Elder S, Jay B. Simple glaucoma. In: Duke-Elder S, ed. System of ophthalmology, Vol. XI. London: Henry Kimpton, 1967:443 7 Dreisbach RH. Handbook ofpoisoning. Los Altos: Lange Medical, 1980:401 8 Yasuna ER. Hysterical amblyopia in children. Am JDis Child 1963;106:68-73

A retrospective review of breast cancer in West Indian women in Trinidad is presented. Breast cancer constituted 17% of all cancers diagnosed and represented 26% of all cancers in females. The usual presenting symptom was a painless lump. The right breast and the upper outer quadrant were the common site of cancer. 85% of the patients were multiparous with an average of 4 children and 92% of them breast fed. Most patients presented in stage I disease, but a significant number of cases were in an advanced stage of the disease. Infiltrating duct carcinoma was the most frequent histological diagnosis and lobular carcinoma was seen in 1% of the cases.

Immunoperoxidase studies were performed on 8 granular cell tumours using various intermediate filament proteins, as well as lysozyme, S-100 protein, and lectins. All the lesions gave negative results to cytokeratin, vimentin, desmin, myoglobin, neurofilament protein, glial fibrillary acidic protein and lysozyme. One was positive for alpha-1-antitrypsin and alpha-1-antichymotrypsin. S-100 protein and lectins (Concanavalin ensiformis and Triticum vulgaris) were uniformly positive in all the lesions. S-100 protein positivity would indicate that granular cell tumours are of neural or neuroectodermal origin, although the cell type involved is not clear. There is no obvious explanation for the lectin-binding properties of granular tumour cells. It is hoped that further studies will evaluate the usefulness of lectin histochemistry in defining the nature of granular cell tumours.

Intussusception is the commonest cause of intestinal obstruction in childhood in Trinidad. A review of 94 consecutive cases seen at the General Hospital, Port-of-Spain, over a 12-year period (1974-1985) indicates that there had been a very rapid increase in incidence of intussusception in the last 4 years. The majority were under 1 year of age (87%) and there was a predominance in the Negro child (62%). Male to female ratio was 1.2:1. A high misdiagnosis rate (55%) lead to inappropriate treatment and delay in surgical intervention. This resulted in a high case fatality (6.4%) and complication rate. In order to minimize morbidity and mortality from intussusception steps must be taken to ensure earlier diagnosis and treatment.

Sections of an adult filarial worm, probably Dirofilaria tenuis or related species were found within the breast tissue. This is the first human dirofilarial infection reported from Trinidad.

Summary Our analysis of 1051 breast biopsies in West Indian women under the age of 30 y revealed that 99% of the breast lumps were benign. Fibroadenoma was the commonest (67%) lesion and there was a steady increase in the frequency of fibrocystic disease with age. Carcinoma in this group is therefore rare. Thus most patients can be reassured with certainty of their benign disease and have biopsy at a convenient time.

A case of granulomatous orchitis in a 52-year old negro male is reported. The distinction between granulomatous orchitis and cancer is important in particular in coloured people where the former is not rare while testicular cancer is uncommon.

Summary Splenic flexure volvulus is rare, only 22 cases having been reported. Though these usually present with chronic intermittent clinical features we recently encountered a case presenting as acute intestinal obstruction which, on plain abdominal X-rays, had classical features of this condition.