Fatema Jawad  ( 7/6, Rimpa Plaza, MA. Jinnah Road, Karachi-74400. )

BACTERIAL PNEUMONIAS IN SERIOUSLY INJURED HOSPITALIZED PATIENTS - AN AUTOPSY STUDY Latif, Z., Nagi, £H. and Awan, N.R. Rawal Med. J., 1991; 19:65-68.
An autopsy study was conducted on hospitalized medicolegal cases in the department of forensic medicine, K.E.M.C. Lahore to determine the incidence of pneumonia and its anatomical type. 23 cases whose death had occurred in unnatural circumstances were studied. Both lungs were obtained on post-mortem and fixed in 10% formalin. Sections were made after 48 hours and examined microscopically. Pneumonia was found in 11 cases with 8 being the lobar type and 3 being bronchopneumonia. All these patients had been in hospital for at least 3 days before death due to road accidents. All underwent surgery. This caused colonisation of the oropharynx followed by aspiration. Antibiotics interfired with the normal bac­terial flora and corticosteroids depressed leucocyte bactericidal function. Nasogastric intubation provided a direct access of the micro-organisms to the lungs. Septic wounds in the body predisposed to septicaemia and chest infection. Pneumonia is the leading cause of mortality in the severely injured patients and should be given due importance in managing these cases.
METASTASING ALVEOLAR SOFT PART SARCOMA OF THE MAXILLARY SINUS. Baig, £5. Pak. J Otolaryn­gob, 1991; 7:177-179.
The case of an alveolar soft part sarcoma of the left maxillary sinus with metastasis in the right parietal bone is presented. This is a rare tumour of uncertain his­togenesis and usually occurs in the extremities. The patient was a 23 year old female who came in with a swelling on the left side of the face since 3 months. This was painless and had gradually increased in size to 8 cms x 6 cms. Two weeks later a swelling had appeared on the right parietal region reaching a size of 3 cmx 2.5 cm. The patient was 32 weeks pregnant and generally well. The facial swelling occupied the anterolateral aspect of the left maxilla extending to the left eye and narrowing the left palpebral fissure. It was non translucent, freely mobile, slightly tender hard at the peripherry and soft in the centre. The Scalp swelling was attached to the underlying bone. Routine clinical and laboratory ex­aminations were normal except for an B. coli growth in the urine. Biopsies were taken from both the masses and both had a similar histopathological picture diagnosed as alveolar soft part sarcoma. This rare tumour usually found in the extremeties has only one case documented in the nose and sinuses in world literature. Usually surgery and radiation are combined for treatment. In the presented case due to the presence of metastasis, radiotherapy was resorted to and it gave good results by reducing the tumour size. The patient was lost to follow-up after 6 months.
COMPARISON OF CORE AND SURFACE CULTURES IN CHRONIC TONSILLITIS Akturk, T., Akiner, M.N., Tekeli, E., Dursun, G., Saatcl, M., Karagul, S. and Kurt, H. Pak.J. OtolaryngoL, 1991; 7:158-160.
The microflora existing on the surface and core of 50 tonsil specimens obtained by tonsillectomy were evaluated. Cultures by swabbing the tonsil surface is a routine procedure in treating patients with chronic recurrent tonsillitis. This study included 50 patients, 27 males and 23 females who underwent elective tonsillec­tomies due to recurrent tonsillitis for 3 years. Their ages ranged between 4 and 46 years. Surface swabs were obtained preoperatively. After surgery the tonsils removed were cut into halves and core swabs taken. Cultures were inoculated on blood agar plates and examined after 18 to 24 hours. Thirty seven specimens had identical floras in the surface and core cultures. 30 of these were normal flora, 3 were normal flora with staphylococcus aureus and 4 had a normal flora with group A beta hemolytic strep­tococci. Thirteen patients showed a difference between the surface and core flora 11 cases were a normal flora on the surface but pathogens as group A beta hemolytic strep­tococci in the core were detected in six and staphylococ­cus aureus in five. 4 cases from all the 50 had a pathological growth in a single tonsil. The study thus concluded that surface tonsil cultures may not be sufficient for treatment. Repeated penicillin therapy may be inadequate as the antibiotic may not achieve a required level in the tonsil tissue and also beta lactamase producing microorganisms may be present. Surgery should be considered in cases resistant to medical treatment
AETIOLOGICAL FACTORS IN BREAST CANCER IN THE PAKISTANI WOMEN. Rathore, A.H., Hussain, R. and Yasmin, B. Specialist, 1991;7:29- 34.
A preliminary report of 101 cases of breast cancer treated in 8 years at the surgical unit II of Quaid-e-Azam Medical College Hospital Bahawalpur, is presented. All the patients were thoroughly interrogated and examined. Laboratory tests and x-ray chest was done in every case. Open biopsy was performed in all patients except those with advanced disease. As a control study, 1500 normal women were questioned. The results proved that carcinoma breast was prevalent equally in rural and urban areas. Majority of the cases studied belonged to the low socio-economic class. The age group of the patients was between 35 and 54 years with the youngest being 20 years old. The average age of matrimony was 17.7 years, of first conception 20.1 years, menarche 13.4 years and menopause 45.5 years. 4 percent of the cases were unmarried. Parity was 1:4.9 and the average period of lactation was 18 months. Compared to the control group it was noted that the menopausal age of the sufferers was higher and the age of marriage and first conception was lower than the controls. Compared to western statistics the incidence of breast cancer in unmarried women in this country appears to be significantly less. But this could be a false figure as unmarried women perhaps hesitate to see the doctor at an early stage. Multiparous women with longer periods of breast feeding are more commonly involved in breast cancer compared to the western figures. In view of these findings there is a strong suggestion of genetic factors playing a role in breast cancer. Prolactin and its receptors could be an important factor too in the etiology of breast malignancies.