RDW, a widely available parameter on FBC, is independently associated with an increased risk of short- and long-term mortality following hip fracture.

Three children are described in whom painful subcutaneous nodules developed 1-2 years after the injection of adsorbed diphtheria, tetanus and pertussis vaccine. The diagnosis of aluminium hydroxide granuloma was established by ultrastructural examination with X-ray microanalysis.Mild cutaneous reactions frequently occur with adsorbed diphtheria, tetanus and pertussis (DTP) vaccines (Burland et al, 1968). Persistent nodules are seen less commonly, but previous histological studies have suggested a localized response to retained aluminium hydroxide (Erdohazi & Newman, 1971;Savage, 1973)-We describe three cases of aluminium hydroxide granulomas where the diagnosis was established by ultrastructural examination with X-ray microanalysis. These findings do not appear to have been previously reported. PATIENTS Case IAn 18-month-old boy was referred to a surgeon with several small painful subcutaneous nodules (1-5 mm diameter) over the left deltoid muscle. The nodules had developed over the preceding months following the injection of adsorbed DTP vaccine 13 and 15 months previously. The nodules were excised under general anaesthesia but not submitted for histology. However, a new nodule appeared 3 months later and following removal was submitted for histology. Case 2A 2-year-old girl was referred to a surgeon with a i-month history of a 5-mm diameter painful

Prostate cancer is extremely rare in men under 35 years of age. The tumour is invariably poorly differentiated and aggressive, with rapidly growing bulky soft tissue metastases and negative tumour markers. Bone metastases develop late and are usually osteolytic. The disease responds poorly to radiation or hormonal therapy and is too advanced at presentation for radical surgery. Chemotherapy appears to be of some benefit, though in the majority of cases death occurs within a year. We describe a 31-year-old man with carcinoma of the prostate. A review of the literature is presented. This is the first patient in whom the epithelial origin of the prostate cancer was confirmed by immunoperoxidase staining with prostatic specific antigen. Plasma prostatic specific antigen was normal despite a large tumour burden and widespread metastases. He did not respond to conventional treatment. The phenotypic expression and biological behaviour of these tumours are distinct from those occurring in men beyond the fourth decade.

A series of 19 cases has been reviewed in which biopsy of an intra-nasal lesion revealed a granulomatous pathology. These have been classified on an aetiological basis. They include infections, Wegener's granuloma and neoplasms with a granulomatous stroma. One patient with sarcoidosis first presented with lesions in the nasal cavity. Cholesterol granulomata were seen in four lesions removed from the paranasal sinuses. In six cases clinical and histological examination failed to show a cause for the granulomata; in all of these patients the nasal cavity was free from disease at a subsequent examination.

No abstract