Three cases of hydatidosis of bone with pathological fracture were treated by wide resection, custom mega prosthesis replacement, and chemotherapy. Two patients were females and one was male, with a mean age of 47 years (range, 38-55 years). Two of them had a pathological fracture of the proximal femur, and one had a pathological fracture of the distal femur. All patients were treated postoperatively with albendazole 400 mg, twice daily, for 12 weeks. During the mean follow-up period of 4.5 years, no recurrence of Echinococcal infection was noticed. The use of the custom mega prosthesis technique has not been reported elsewhere, and hydatid disease of the bone can now be considered an extended indication for custom mega prosthesis in addition to its application in surgery for tumours and massive trauma.

Although it is possible to propose a pragmatic screening protocol for pulmonary metastases, this is not possible for bronchogenic carcinomas. Therefore, we recommend that thoracic CT is used in all cases to screen for coexistent pulmonary pathology.

Objectives.  Screening for synchronous pulmonary tumours at initial presentation of squamous cell carcinoma of the head and neck is important as detection may alter management. Currently no consensus exists regarding best practice.1 We present the largest series reported, and based on our data propose a pragmatic policy. Methods.  Retrospective review of the findings of pulmonary imaging performed on all patients presenting with HNSCC between January 1996 and January 2007. Results.  A total of 1882 patients were identified. Overall 66 (3.5%) presented with synchronous pulmonary tumours (bronchial carcinomas (1.4%), metastases (2.1%). In terms of numbers needed to scan (NNS) to detect one tumour, in the T1N0‐3 group, NNS = 70. For other stages NNS are 25.6, 26.3 and 17.5 for T2N0, T2N+ and T4N+ respectively. NNS for T0N+ lesions is 6.8. Considering site specific data, NNS is 4.6, 20.4, 42.2, 43.3 and 57.5 for oesophagus, hypopharynx, oropharynx, larynx and oral cavity respectively. No synchronous lesions were detected in our nasal cavity/paranasal sinus series (n = 51). Recurrent disease is highly significant for pulmonary lesions (P < 0.005). Conclusions.  We propose the following protocol. Thoracic CT for all T0 tumours, T2–T4 tumours regardless of N stage, loco‐regional recurrent disease, where signs/symptoms of neoplastic chest disease exist, positive signs on staging CXR. Given that CXR has a NPV of 98.5% it can suffice as an investigation in T1 disease of any site excluding oesophagus, and potentially all lip/oral cavity and nasal cavity/ sinus tumours. If our series was investigated on this basis there would have been a potential cost saving of £61218. Reference.  1 Jackel M.C., Reischl A. & Huppert P. (2007) Efficacy of radiologic screening for distant metastases and second primaries in newly diagnosed patients with head and neck cancer. Laryngoscope 117, 242–247

serum lipase levels was nearly double that of patients in whom serum lipase levels were normal (15.2% vs 8.8%,).CONCLUSION: Elevated serum lipase appears to be a novel biomarker associated with severity of SARS-CoV-2 infection in patients hospitalized with COVID-19 and may be an appropriate standard laboratory test for this patient population. This study may help determine if hyperlipasemia is predictive of mortality in hospitalized COVID19 patients.