Histoplasmosis is a rare disease in India. We are reporting this disease in a middle-aged non-Caucasian male who has never travelled outside India. Successful treatment was achieved with the nephrotoxic anti-mycotic drug (Amphotericin B), despite a pre-existing renal impairment.

There are a number of patients with unresectable recurrent carcinoma of the head and neck who continue to lead a relatively functional life despite advanced local disease. For these patients bleeding from tumor represents a devastating complication that can abruptly terminate the course of an otherwise chronic disease, albeit a uniformly fatal one. The technique we describe renders a relatively safe and effective treatment that seems to control this problem.

We report on our experience with three patients whose tumor bleeding was controlled by permanent intra-arterial embolization with Ivalon, a polyvinyl alcohol-based foam. The technique, indications, and complications are discussed.

Submucous palatal fibrosis invariably leads to trismus due to fibrosis in the retromolar region. Medical lines of treatment are of no use in relieving the trismus once it is established. Various surgical methods, such as excision of fibrous tissue or excision of fibrous tissue with skin grafting, have been suggested, but none of them has been proved to give a lasting cure. We have made use of tongue flaps on either side in cases of trismus due to submucous palatal fibrosis in the retromolar region. Twentyfive cases have been operated upon with this technique and the results are quited encouraging. Regular follow-up for up to three years has shown good results without any complications.

Serum phosphohexose isomerase (PHI) levels were estimated in 28 patients with head and neck cancer. The mean value was significantly higher when compared to the controls. There was no difference in mean PHI value with respect to the character of the lesion or with the histopathological type of growth. The activity was increased with the advancement of the stage of cancer.

With radiotherapy, a gradual and significant decrease in serum PHI activity was observed.

An unusual case of a labyrinthine sequestrum is presented. During mastoidectomy on a patient with chronic recurrent mastoiditis, a large sequestrum in the labyrinth was found. Four years earlier he had been treated for a posterior fossa abscess, which had followed acute otitis media. An extensive ablative and drainage procedure of the pars superior and pars inferior with preservation of the facial nerve was indicated in this patient.

We describe seven typhoidal tularemia patients without ulcers or lymphadenopa-thy, who underwent diagnostic bronchoscopy. Four patients had had obvious airborne exposure to F. tularensis during farming activities, and the remaining three had respiratory symptoms also. Bronchoscopical findings were pathological in all cases, varying from local to diffuse haemorrhagic inflammation; in one case a granulomatous tumour was seen. Early histopathological changes in three biopsies consisted of haemorrhagic oedema progressing to a non-specific inflammatory reaction, which could still be found 45 days after the onset of symptoms. Granulomatous inflammation, indistinguishable from tuberculosis or sarcoidosis, was seen in four biopsies from two patients, three to seven months after the onset. Most patients had radiographic hilar enlargement. We conclude that transmission of typhoid tularemia usually occurs through inhalation leading to bronchial changes, which correspond skin ulcerations in ulcero-glandular tularemia, the hilar enlargement corresponding to the lymph node component. We emphasize that usage of the term ‘typhoidal’ tularemia should be discontinued. Instead, tularemia transmitted through inhalation should be called pulmonary or respiratory.

Besides advancing our knowledge of histogenesis, immuno-cytochemical studies of salivery gland tumors have added an important objective component to the diagnosis and classification of the tumors. Cellular localization of S-100 protein now allows identification of myoepithelial cells and tumors composed of these cells. The four tumors presented in this report illustrate the diagnostic advantages afforded by S-100 protein immunocytochemistry.

The purpose of this paper is to define the incidence of squamous cell carcinoma (SCC) of the head and neck as seen at the Free University Hospital, Amsterdam, the Netherlands, in the last six years, according to the latest revised classification system of the International Union against Cancer (UICC, 1982). In addition, male to female ratios, relative frequencies at the various sites, age distribution, incidence of second or third primary and the relationship of distant metastases to the nodal metastases and the T-stage of the primary lesion are reported. These incidences are compared with those in other countries and the major differences are discussed.

A study of skeletal lesions in the head and neck region of 20 adult patients with von Recklinghausen's disease, seen in the Surgical Out Patient clinic of Lagos University Teaching Hospital from 1979 to 1985, has been carried out. Among the 20 patients, 13 (65 per cent) had symptoms related to the head and neck while 7 (37 per cent) did not; however, on radiological screening, all of them were observed to have skeletal lesions. The commonest feature was enlarged intervertebral nerve root exit foramina from mesodermal dysplasia, which occurred in 16 (80 per cent) of our patients. Other major findings were erosion of the mandible, 8 (40 per cent); erosion of the wings of the sphenoid, 4 (20 per cent); poor mastoid bone pneu-matisation, 3 (15 per cent); erosion of the parietal bone, 3 (15 per cent) and heterotopic bone formation, 1 (5 per cent). Congenital calvarial defects were not detected. In view of the fact that all our patients showed radiologically detectable skeletal lesions of the head and neck, despite absence of symptoms in 35 per cent, it is advisable that all patients with von Recklinghausen's disease should routinely have radiological screening of this region, to detect early lesions.

Carcinoid tumours of the larynx are extremely rare, only 13 cases having previously been reported in the world literature. A case is reported here with the unusual complication of skin metastases. The true diagnosis is seldom made on the original biopsy, which is commonly reported as poorly differentiated carcinoma. A review of the literature is made with a discussion of the histological diagnosis and treatment modalities.

While it is well known that mumps is a potential cause of deafness, it is not generally appreciated that it can produce total deafness. The damage is usually unilateral but bilateral disease has been recorded. A case is presented of severe bilateral hearing loss during a mumps epidemic in which, in spite of intensive conventional as well as lesser known therapy, no improvement occurred. In the absence of a successful therapeutic regime it is clearly advisable to intensify immunization in non-developed countries.

Neurinomas originating from the ninth cranial nerve are rarely boserved. The early signs and symptoms of a glossopharyngeal neurinoma are rather discrete, and it can happen that a tunour here will often first be recognisd with the signs and symptoms of an expanding posterior fossa lesion—thus often closely resembling an aconstics neurinoma.