Bartter's syndrome has been reported as a rare case of hydramnios. A unique case of recurrent hydramnios in pregnancy as a result of fetal Bartter's syndrome on both occasions is presented.

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Hundred and ten consecutive cases in acute and various stages of chronicity were studied. Incidence regarding age, sex, bone affected and complications was established. The optimum way to manage osteomyelitis in different stages was sought. It was found that in acute stage early decompression of bone leads to resolution of disease. Hip involvement leads to necrosis of capital epiphysis and should be treated on an emergency basis. In the sub-acute stage it is necessary to protect the weakened bone. In chronic stage, we suggest sequestrectomy only after adequate involucrum has formed properly. Antibiotics in acute stage should be instituted as early as possible and should be continued for three weeks after the fever subsides. Antibiotics in sub-acute and chronic stage are given only in cases of reactivation of infection and around the time of surgery. Surgery, when required should be performed without too much soft tissue damage especially the covering periosteum. But repeated surgery should be avoided as they lead to cicatrization of muscles and further sequestration of bone.

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The levels of serum total thyroxine (TT4), triiodothyronine (TT3), free T3, (FT3) free T4 (FT4) and thyrotropin (TSH) were measured in 127 clinically euthyroid patients with varying grades of chronic renal failure (CRF); and 97 healthy individuals. They were grouped as: Group I containing 93 patients on conservative management; Group II containing 34 patients on regular dialysis therapy; and Group III (normals). Group I patients showed significant decrease in TT3, TT4 and FT3 levels (p less than 0.001) as compared to Group III, whereas FT4 and TSH values in group I were not significantly altered. TT3, TT4 and FT3 levels reduced as the severity of renal damage increased. Variations in TT3, TT4, FT3, FT4 and TSH levels in Group II patients were similar to those in Group I, except for a decrease in TSH levels (p less than 0.05) as compared to normals. Several thyroid function tests are abnormal in CRF patients, however, finding of normal FT4 and TSH levels would indicate functional euthyroid status.

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A rare case of disproportionate short stature suggestive of spondylo-epiphyseal dysplasia tarda is reported and relevant literature reviewed. It is emphasized that its radiological features show a marked similarity to ochronotic spine, with which it is therefore commonly mistaken. An indeterminate pigment was observed in the liver biopsy in this case with connective tissue disorder.

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Neurogenic tumors of urinary bladder are rare. A ganglionure fibroma arising from the trigons of urinary bladder in two year old boy presenting with hematuria, is described here.

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A rare case of simultaneous anterior and posterior dislocation of hip joints is presented. The mode of injury and its management have been discussed.

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Four hundred and fifty cases were operated for vasectomy by pre-pubic approach. The relative fixity of vas at this place made this approach easier than conventional scrotal approach. Mean healing duration was 6.06 days. This approach leaves the scrotum free, needs no scrotal support and scrotum is not involved in hematoma and inflammatory complications. Thus the pre-pubic approach for vasectomy provides a superior and beneficial alternative to conventional scrotal approach.

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One hundred and thirty samples of cerebro spinal fluid were collected from patients admitted with suspected signs and symptoms of meningococcal meningitis (M. meningitis) during the period from January 1986 to April 1989 and were processed for gram's staining, cultivation and latex agglutination tests for detection of polysaccharide antigen in the CSF. Totally 41.5% of turbid and hazy spinal fluid were positive for N. meningitidis by smear examination. Only 24.6% were positive by culture but 61.5% of sample were positive by latex agglutination tests. All the strains were sensitive to all antibiotics except one strain which was resistant to penicillin but it was sensitive to rifampicin.

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Pulmonary complications encountered in 67 patients undergoing upper abdominal surgery in our unit in one year period are analysed. Pulmonary function tests and their post-operative reduction, as also the risk factors are discussed. Pathophysiology responsible for pulmonary complications is outlined.

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Craniopharyngiomas have been by and large excised by the transcranial route. Since 1982, 11 patients have been operated by the traus-sphensidal route in the department. The clinical features with which they were presented, diagnostic investigations, details of surgical procedures and follow-up analysis is being presented here. A retrospective study of radiological investigation was done to determine the features that help decide the choice of surgical approach to these lesions. Only lesions that were primarily intrasellar, cystic and those that expanded the sella could be treated by the trans-sphenoidal route. Associated suprasellar extensions could also be removed. Predominantly calcified or firm, fleshy tumours lent themselves poorly to removal by the trans-sphenoidal route.

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This is a retrospective analysis of 82 patients of intussusception in infancy and childhood. Males were more than females in the ratio 2.4 : 1, the ages varied from 2 months to 12 years. Majority (73%) were less than 1 year old. Commonest presentations were pain, vomiting, distension, palpable lump and blood and mucus in stools. The management of these patients varied from barium enema reduction (3 cases), reduction by surgery and manipulation (59 cases) and resection with primary anastomosis (20 cases). We analysed our patients by giving scores based on clinical criteria. We concluded that the patients in our circumstances do not show any correlation of the scoring pattern with morbidity or mortality, chances of reduction by barium enema or manually. Resection, however, did correlate with a high incidence of death (75%). Resections were required slightly more in ileo-ileal intussusceptions than in those having a colonic involvement, morbidity in the form of wound dehiscence, and sepsis was higher in those patients who had undergone resections.

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Five instances of urethro-venous intravasation during retrograde urethrography are reported. Four cases were of urethral strictures and one case was of urethral hemangioma. All patients had post procedural bleeding while one patient got allergic reactions, another showed chills and rigors. Anatomy of the drainage veins is described. Factors responsible for this complication and its clinical implications are discussed. It is suggested that urethro-venous intravasation should be considered a diagnostic sign of urethral inflammation.

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A number of plasmids carrying the Lac+ character have been reported. Lac+ character of salmonella S:41:z10:- studied for transfer of Lac+ character to standard Escherichia coli K12 Lac-F- Nalr and Escherichia coli K12 F- Lac- Rifr, failed to transfer in in vitro experiments. Similarly, identification and characterisation of plasmid DNA by agarose gel electrophoresis technique did not show specific plasmid DNA as compared to standard molecular weight plasmids. Plasmid DNA appeared to have been embedded with chromosomal DNA molecule.

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Ultrasonography (US) remains underutilized as a guidance tool for performing fine needle aspiration cytology (FNAC) mainly because of a lack of understanding and experience in this technique. We describe here our experience in performing 346 FNACs. In our opinion, US guided FNACs are highly accurate and safe procedures which can be done on an out-patient basis, with routinely available equipment.

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