A young man presented to our unit with a colloid cyst of the third ventricle. Following successful surgical treatment his parents expressed concern over the possibility of his identical twin brother having a similar cyst. After finding one other case of colloid cysts in identical twins in the world literature we arranged a magnetic resonance scan of the asymptomatic twin. We were sceptical, but much to our surprise the scan also showed a colloid cyst in the third ventricle. Familial colloid cysts of the third ventricle have been reported only rarely. This is the second account of third ventricular colloid cysts in identical twins reported in the world literature. We present case reports of the twins, discuss the world literature on familial colloid cysts and also the genetic implications.

Abstract. Eight cases of post-traumatic syringomyelia are reviewed and in each one the first symptom was excessive sweating. It is the only feature of a descending syrinx in patients with a complete cord transection. Other factors in volved in the sweating are discussed.

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A paraspinal abscess extending through a sacral foramen has not, to our knowledge, been reported previously. Paraspinal abscesses occur primarily in the midthoracic region and below the second lumbar vertebra. The organisms responsible reach the epidural space via the blood stream or by local implantation. Neurological signs appear when the abscess is small and result from cord a n d root compression o r thrombosis of spinal vessels. Large abscesses are rare, though spread along the whole length of the vertebral canal has been reported'. Early diagnosis and prompt surgical treatment of paraspinal abscesses has been stressed recently'. Waldeyer's fascia would be expected t o prevent extradural pus tracking into the pelvis, but this barrier was evidently insufficient in this case. Case reportA 35-year-old woman was admitted with a 5 month history of back pain, a 2 week history of mild weakness and paraesthesiae of the left leg, and difficulty voiding urine. Five years previously osteomyelitis of her right femur had been treated by sequestrectomy and antibiotics. Staphylococci, enterococci and Klebsiella had been cultured but no primary source of the infection had been found. Apart from a uterine myomectomy performed 2 years previously, she had undergone no surgery and had had no serious illnesses. There were no symptoms of gastrointestinal or gynaecological disease.Examination revealed pyrexia (38.5 "C), slight neck stiffness, mild tenderness over the lumbar spine and a positive Kernig's sign. Ankle jerks were absent but there was no sensory loss. Rectal examination was normal.On admission her haemoglobin was 12.0 g/dl and WCC 19.7 x 109/l. Lumbar puncture revealed turbid CSF with 103 x lo6 WCC/I (100 per cent lymphocytes) together with a raised protein and low sugar. Later Staphylococcus pyogenes was cultured from both CSF and blood. Myelography showed extradural compression of the lower part of the cauda equina which was therefore promptly explored through a laminectomy. A surprisingly large volume of pus (40 ml) was found in the extradural space and it was noted that pus reappeared in the spinal canal after it had been cleared suggesting the presence of an external reservoir. The area was drained by total laminectomy of L4 and L5 and de-roofing of the sacrum to S.4. No attempt was made to explore the spinal canal either anteriorly or laterally. Two irrigation catheters were left in the extradural space. S. pyogenes was again grown from the pus. No source of infection was found.Postoperatively her general condition improved slightly but she remained pyrexial and on the sixth postoperative day developed diarrhoea. On the tenth day the wound broke down and discharged Short notes and case reports faecal fluid from which Escherichia coli and Bacteroides fragilis were cultured. Rectal examination revealed a tender indurated area on the left side of the pelvis at 10 cm but sigmoidoscopy did not show any breach of the mucosa or intrinsic bowel disease. A plain X-ray of the pelvis showed a gas shadow extending out of the...

At the time of the Boer War in 1899 penetrating head injuries, which formed a large proportion of the battlefield casualties, resulted in almost 100% mortality. Since that time up to the present day, significant improvements in technique, equipment and organisation have reduced the mortality to about 10%.

In a series of 22 patients, cryohypophysectomy gave relief of bone pain from metastatic breast cancer for 3 months in 55% of patients and for 6 months in 32% of patients. On average they were pain free for 55% of their remaining life. Advantages of this technique are the avoidance of a major operation, the mild disturbance to the patient, a short hospital stay and the paucity of significant complications apart from a need for hormone replacement.

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