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Subependymomas of the fourth ventricle are generally considered incidental postmortem findings, and have received scant attention from neurosurgeons. The authors present a surgical series of 12 cases of this disorder diagnosed over a 13-year period. The clinical and radiological findings were reviewed and correlations made with pathological studies. The subependymoma is a histologically benign tumor that tends to be calcified. It has a predilection for the fourth ventricle and a peak incidence in the fifth decade of life. It is usually of considerable size with extensive attachment at the time of its detection, and is associated with significant surgical morbidity. The authors believe that magnetic resonance imaging may be the best method of investigation. Intraoperative disturbance of circulatory or respiratory control should suggest to the surgeon that the operation be abandoned. A laser or ultrasonic aspirator may be very helpful in removing these tumors. Postoperative care must include monitoring for apnea.

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To assess the value of computed tomography in investigating patients with dementia, 500 consecutive patients presenting with a provisional clinical diagnosis of dementia of recent onset were reviewed and the results analysed in a computer. Most patients had either cerebral atrophy or infarction, but 82 patients had a normal scan and 42 others had tumours. More than 10% of all patients, including 5% with no other symptoms or signs, had a treatable lesion. Various associated symptoms and signs were useful pointers to such a treatable lesion and clearly indicated computed tomography. Accurate diagnosis is the cornerstone of proper management, and if a few patients with treatable lesions can be identified then the benefits to all concerned may be incalculable.

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A large number of melanocytic nevi is the strongest known risk factor for melanoma in whites, but its relationship to sun exposure overseas among young white women living in temperate climates is unclear. A total of 754 white English women aged 18-46 years were recruited into a cross-sectional study in 1997-2000 to investigate the effect of ultraviolet exposures on numbers of nevi and atypical nevi, and on skin aging as measured by microtopography. Having ever holidayed in hotter countries was associated with a greater age- and phenotype-adjusted mean number of whole-body nevi (percent increase=74; 95% confidence interval: 24, 144; P=0.001), particularly for holidays taken at ages 18-29 years and for counts of the trunk and lower limbs. Having ever lived overseas was not associated with nevus counts, but was inversely associated with number of atypical nevi (P=0.02). Skin aging was not associated with residence or holidays abroad. The association of holidays overseas with an increased nevus count in young white women, which was stronger in the anatomical sites intermittently exposed to sunlight, supports the hypothesis that intermittent sun exposure is of relevance in the etiology of nevi and, hence, melanoma. The findings are of public health relevance given the growing popularity of foreign holidays.

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