We report 13 cases of ectopic pregnancy following tubal ligation out of 287 ectopic pregnancies seen during a six year period (1984-1989). These findings suggest that tubal sterilization does not invariably confer infertility. Ectopic pregnancy must not be disregarded in women who have undergone tubal ligation, especially if two or more years have elapsed since the sterilization.

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It has been proved beyond doubt that the causation and perpetuation of disease in the dependent sinuses (maxillary and frontal sinuses) is secondary to disease of the ostiomeatal complex, the primary focus of which is the anterior ethmoid. Based on this concept, functional endoscopic sinus surgery (FESS) aims at correcting the underlying pathology in the ethmoids and helps to re-establish normal ventilation and mucociliary clearance of the dependent sinuses.

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Twenty eight fatal cases out of the 97 cases of methyl alcohol (MA) poisoning admitted to K. E. M. Hospital in August 1988 during a single outbreak were studied. The latent period between consumption of the drink and development of symptoms was variable (range 7 1/2 hours to 60 hours). CNS symptoms were predominant (75% of cases) and shock either at admission or as a late event was seen in 89% of the cases. Blurring of vision was seen in 42.8% and blindness in 10.7% of cases. Minimum fatal period was 7 1/2 hours and maximum was 12 days. Methanol levels in blood and viscera were variable (average 155.8 mg%, max. 420.4 mg%). In 4 cases, significant amount of MA was detected in stomach contents 5-12 days after consumption of MA, raising the question of resecretion of MA in stomach. Shrinkage and degeneration of neurons in the parietal cortex was seen in 85.7% of cases. Putamental degeneration and necrosis was seen in 7.14%. Haemorrhage (3.5%) and sponginess (7.14%) was observed in the optic chiasma. Severe renal tubular degeneration and patchy necrosis was seen in all cases. Fatty changes (67.8%) and microvesicular fat (42.5%) were seen in the hepatocytes.

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Urological injuries during obstetric and gynaecological operations carried out between Jan. '88 to Dec. '88, at a hospital involved in resident teaching programmes were analysed retrospectively. Each case was reviewed for predisposing factors, location and type of injury, time and method of recognition and management. Fifteen injuries were documented in 892 gynaecological procedures and 296 obstetric procedures. Twelve injuries occurred during gynaecological operations whereas 3 occurred during obstetric operations. Thirteen were bladder injuries and two were ureteric injuries. Infiltrating carcinoma of cervix, pelvic adhesions, adhesions because of previous operations and distorted anatomy, were the important risk factors.

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Seventy patients with palpable adnexal masses were subjected to ultrasonographic examination. Three patients with negative ultrasound and no disease were excluded from the final analysis. Correct diagnosis was obtained in 58.2% patients; contributory information in 16.4%. Ultrasonography is valuable in diagnosing functional and benign ovarian neoplasms. It is also useful in suspecting malignant ovarian neoplasms and confirming diagnosis of ectopic pregnancy, if correlated with the clinical findings.

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Seven cases of tuberculosis of breast are presented. The clinical features were multiple discharging sinuses, lump, ulcer and recurring abscess of breast. Diagnosis relied on histological appearance. Acid fast bacilli being present in only one specimen and positive culture obtained in one patient. Successful treatment combines antituberculous drug therapy with removal of infected breast tissue.

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Sixty five breast milk samples were subjected to bacteriological studies; each sample thrice (in fresh state, after heating at 1000C and freezing for 5 days at -20 degrees C). In fresh State, Staphylococci and diphtheroids were predominant organisms. After heating, none of the samples showed any micro-organisms while after freezing for 5 days, all the samples showing presence of micro-organisms earlier, showed decrease in colony counts. None of the milk samples showed inclusions of cytomegalovirus. Serum samples of mothers tested for Hepatitis B surface antigen and human immunodeficiency virus antibodies gave negative results. Such studies i.e. screening of breast milk samples are important if human milk is to be stored in banks and supplied to premature (high risk group) children.

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Seventy-eight patients of chronic sinusitis were subjected to functional endoscopic sinus surgery by the technique described in the previous paper. The clinical features, findings at surgery and the results of this technique are described here.

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Pathological conditions are known to affect pharmacokinetics of many drugs. Antipyrine half-life is used as a marker of liver microsomal enzyme function. Antipyrine pharmacokinetics, therefore, was investigated in 23 thyrotoxic and 11 euthyroid goitre patients. Of these, 11 thyrotoxic and 9 euthyroid goitre patients also participated in doxycycline bioavailability studies. In thyrotoxic patients, antipyrine half-life and AUCo infinity and doxycycline Cpmax and AUCo infinity were found to be reduced as compared to those of healthy euthyroid normal subjects. Following treatment of thyrotoxicosis, the antipyrine half-life and AUCo infinity returned to normal. Doxycycline AUCo infinity returned to near normal range but Cpmax did not.

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In a prospective controlled trial, 0.25% formalin spray was compared with 2% silver sulfadiazine cream as the local treatment of burns. Formation and separation of eschar, infection and death rates were recorded. In the group receiving formalin, rates of formation and separation of eschar were significantly more (P less than 0.001 and P less than 0.05 resp.) compared to other group. Infection rate and fatality due to infection were also reduced. Other advantages of formalin are ease of application and the low east.

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Two cases of annular pancreas in adults are being reported. In the first case, a middle aged lady presented with duodenal obstruction and gastric ulcer. Anterior H. S. V. with posterior truncal vagotomy and isoperistaltic duodeno-jejunostomy relieved her symptoms. In the second case, a young girl presented with duodenal obstruction, severe wasting and gross dehydration. She had an uneventful recovery following a duodeno-jejunostomy.

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Cervicofacial actinomycosis is today a rare disease in our country. Isolated actinomycotic neck masses are extremely rare. A case of young man with an isolated midcervical tumour like actinomycotic granuloma without sinuses or discharging granules is reported here.

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Paragangliomas are rare tumours of the head and neck and are a diagnostic challenge. Two cases of paragangliomas arising from the vagus are being reported. In the first case, an angiogram raised the possibility of intravagal tumour and exploration followed by biopsy confirmed the diagnosis. In the second case, it was a diagnostic surprise where exploration was done on a clinical suspicion of parotid swelling and on the table, the swelling was found to arise from the vagus nerve pushing the parotid gland laterally.

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Anaesthetists at times encounter difficult intubation in an apparently normal individual in spite of using the best possible positioning and most profound relaxation. This study was carried out to find out the most simple and easy measurement that may predict a difficult intubation. The study was conducted in three groups of patients of twenty each. The first group consisted of patients in whom intubation was easy. Second group consisted of anticipated difficult intubation. Cases in whom very difficult intubation was encountered were analyzed retrospectively and were included in third group. An attempt has been made to predict difficult intubation with the roentgenographic study of lateral view of mandible along with the measurement of distance from chin to thyroid cartilage. Of all the parameters, ratio of effective mandibular length to posterior mandibular depth and distance from chin to thyroid cartilage were found to be important to predict difficult intubation.

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A 35-year-old female patient was evaluated for thyroid function and was found to be hyperthyroid clinically and by laboratory tests. During the course of treatment with neomercazole, she developed a bizarre picture with consistently low T3 levels irrespective of her clinical thyroid status and other laboratory tests like serum T4 and TSH levels. The serum of the patient when analysed for the presence of autoantibodies was positive for those against T3. The presence of T3 autoantibodies was confirmed by other laboratory techniques like assessment of blank values in radioimmunoassay, binding of T3-125I to isolated gamma globulin and starch gel electrophoresis. Autoantibodies were found to be present only against T3 and not against. T4 The affinity constant of T3 antibodies was 4 x 10(9) lit. mol-1 as determined by Scatchard plot analysis while total binding capacity was 23 x 10(-11) mol/L.

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A case of tetralogy of fallot with congenital intermittent atrioventricular dissociation is reported. A review of standard postgraduate books of cardiology fails to describe this condition, thus showing its extreme rarity. The therapeutic dilemma in treating such a case is also discussed.

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Iniencephaly is a rare neural tube defect. We report a rare association of iniencephaly with cyclopia, probably the third such report in the literature.

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