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This was a retrospective study, carried out at the Department of Neurosurgery at Jai Prakash Narain Apex Trauma Centre (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi. Many patients with head injury whose identity cannot be ascertained, are admitted in our hospital. Care and management of these neglected patients from pre-hospital till discharge, rehabilitation or death is fraught with many challenges. Very few studies in world literature are available on this subgroup of patients. We analyzed data pertaining to 70 consecutive patients at our hospital. Out of 70 patients, 68 (97%) were male, most were in the age group of 21?30 years 25 (36%). The mean age was 33.7? 14.6 years (range 5?70 yrs). Mean duration of hospital stay was 27.9?52.2 days (range 2?368 days). Principal cause of head injury was road traffic accident seen in 47 patients (67%). Majority of the patients had Glasgow coma scale less than 8 on admission. Forty three patients were treated conservatively and 20 patients needed surgery. Ten patients 10 (14%) died in hospital, 7 (10%) patients had good recovery. During the course of treatment identity of 51 (73%) patients could be established and they were either discharged to home 42 (60%) or referred to their 9 (12%) district hospital. Nine patients(12%) remained unknown and on recovery were sent to destitute homes for rehabilitation.

Background: Breast cancer results from uncontrolled proliferation of malignant cells resulting appearance of a lump or a mass in the breast. Although many epidemiological risk factors have been identified, the cause of any individual breast cancer is most often unknowable. A women's reaction to any suspected disease of breast may include fear of disfigurement, loss of sexual attractiveness and death. Social and religious factors, unawareness of fatality of the disease, fear of infertility hinder early diagnosis & treatment. Early diagnosis is the key to increased survival. Objective: To find out clinical presentation for breast cancer. Study design: It is a prospective study of 50 carcinoma breast patients who palpable breast lump. It was conducted during the six months period. Data were collected pre-designed data collection sheet. Data were analysis statistical package for social science (SPSS) program. Result : Most of the malignant lesions are above the age of 40 years and peak incidence are between 41-50 years and most of patients under this study were in advanced stage-III (54%) and stage-IV (22%). Patients were presented as nipple discharge (20%), pain in the breast (26%), ulceration over the lump (14%), paeu'd orange (10%) skin fixation over the lump (18%), fixation to the chest wall (14%) nipple retraction (22%). Among the 50 patients there was only one male ca-breast patient (2%). Among the histopathological types infiltrating duct cell carcinoma (NST) were 41 (82%), ductal carcinoma in situ 6 (12%), lobular carcinoma invasive 2 (4%), lobular carcinoma in situ 1 (2%) and carcinoma involved in different quadrants were upper & outer 21 (42%), lower outer 5 (10%), upper and inner 12 (24%), lower and inner 4 (8%), central 7 (14%) and breast as a whole involvement was 1 (2%). About the involvement of carcinoma breast, left breast involvement were 52%, right breast 46% and bilateral involvement was 2%. Conclusion: This prospective study shows an alarming high incidence of carcinoma breast with palpable breast lump. The diversity of clinical presentation of breast lumps in different age group were observed is our hospital practice. This study gives an idea about the incidence of various types of lesions of breast in different age groups in our country.

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Thirty five patients were selected to evaluate the outcome & prognosis of metastatic brain tumour in the department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, (BSMMU) Dhaka from February 2002 to December 2005. A structured questionnaire was made. Data were collected after the patient admission. All patients were evaluated with detailed history and clinical examination. MRI of Brain of these patients revealed intracranial lesions highly suspicious of metastatic brain tumour. Investigations like USG of the whole abdomen and x-ray chest were done to locate any primary site. Some of the primary lesions were confirmed by FNAC and histological examinations. Solitary intracranial space occupaing lesion (ICSOL) and sizable lesion among the multiple lesions were treated by surgery, and then histopathological examination were done followed by radiotherapy and / or chemotherapy. This was a prospective study. This study showed the highest age of incidence of tumours were above 60 years. Male predominated than female (60.00%). Among the clinical features the most common sign was hemiparesis (34.28%). The commonest site of lesion was in frontal region (34.28%). Histopathological reports showed adenocarcinoma 40.00%, small cell carcinoma of lungs 28.57%, squamous cell carcinoma 22.85%, follicular carcinoma of thyroid 5.71%. Treatment options were surgery, radiotherapy and chemotherapy. Sixty percent patients were improved after treatment. Highest survival rate was 3 to 6 months with treatment (31.42%). This study revealed that commonest type of brain metastases was adenocarcinoma and primary site of lesion was lungs. Best option of treatment was surgery plus radiotherapy and longest survival rate of 1 year was in 20.00% cases. DOI: http://dx.doi.org/10.3329/bjn.v24i1.3036 Bangladesh Journal of Neuroscience 2008; Vol. 24 (1) : 17-23

Encephalocele means if meninges and brain tissue protrude out of the cranium. There are different types of encephalocele. The occipital encephaloceles are the most common type. Craniocervical junction and upper cervical spine abnormalities can rarely be associated with occipital encephalocele. We discuss this case because there is rare association between torcular encephalocele and proatlas anomalies.

Abstract

Key words: extradural haematoma; Glasgow Coma Scale; pupillary dilatation; computerized axial tomographydoi: 10.3329/jcmcta.v19i1.3843Journal of Chittagong Medical College Teachers' Association 2008: 19(1):8-10