Outcome of gamete intrafallopian transfer in women of 40 and over according to whether the number of oocytes transferred was rstricted.

A 15 years old girl of African origin was admitted with a history of headaches and a generalised tonic seizure. Her clinical examination including fundoscopy was normal. She claimed she had been assaulted. Within a few hours of her admission she was found dead in her bed during the ward round. Cardiopulmonary resuscitation was unsuccessful. At post-mortem, the major organs showed no pathological changes and neck dissection showed no abnormality. Neuropathological examination after formalin fixation revealed a cystic lesion in the fourth ventricle, ependymitis and acute hydrocephalus. Histology showed parts of the parasite Taenia solium and the diagnosis was neurocysticercosis. This case highlights the need for forensic and general pathologists as well as forensic medical examiners and paediatricians to be aware of neurocysticercosis as a possible cause of sudden death in the presence of normal clinical findings and negative autopsy, especially in patients from Asian, African or South American countries. As cysticercosis is the commonest cause of seizures in the developing world, neurocysticercosis needs to be considered as a cause of sudden and unexpected death in any patient with a history of headaches and/or seizures.

A 14-year-old boy presented with a 6-year history of intermittent right submandibular swelling. It arose with no specific trigger but was associated with pain on swallowing. It usually lasted several hours before spontaneously subsiding. There was no pyrexia, sore throat, tuberculosis contact or foreign travel.On examination the lump measured 3×3 cm, was non-tender, firm, mobile, non-fluctuant, with normal overlying skin. The patient thrived along the 25th and 50th centiles for height and weight respectively. No lymphadenopathy, pallor or petechiae was noted. All systemic examinations were normal.Laboratory findings, chest x-ray and neck ultrasound scan were normal. A presumed diagnosis of reactive submandibular lymphadenitis was made but the swelling was resistant to antibiotics. Subsequent bimanual palpation revealed a stone in the right submandibular gland. This was confirmed on neck x-ray (figure 1) and was removed surgically.Sialolithiasis in children comprises only 3% of all cases. 1 The youngest documented age in case reports is 2 years. 2 The majority occur within the submandibular gland as in our case or in the proximal Wharton's duct but they can arise anywhere along the duct or in other salivary glands. 2 Calculi account for half of major salivary gland diseases with prevalence of 0.45%. 3 Typical presentation is intermittent swelling and pain particularly on mastication because of increased salivary flow. Due to the anatomical position, submandibular swellings are often mistaken for cervical lymphadenopathy. 3 Bimanual/intraoral examination is most helpful. 4 X-ray, sialography, ultrasound, CT are useful in stone evaluation. 5 Treatment options include conservative care, lithotripsy, intervention radiology and sialoadenectomy. 1 REFERENCES 1 Kim JP, Park JJ, Son HY, et al. An unusual case of bilateral submandibular sialolithiasis. J Med cases 2012;3:106-9. 2 Ellies M, Laskawi R. Diseases of the salivary glands in infants and adolescents. Head Face Med 2010;6:1. 3 Mehana H, McQueen A, Robinson M, et al. Salivary gland swellings. BMJ 2012;345:36-41. 4 Chung MK, Jeong HS, Ko MH, et al. Pediatric sialolithiasis: what is different from adult sialolithiasis? Int J Pediatr Otorhinolaryngol 2007;71:787-91. 5 Hébert G, Ouimet-Oliva D, Nicolet V, et al. Imaging of the salivary glands. Can Assoc Radiol J 1993;44:342-9.Figure 1 X-ray showing calculus in right submandibular salivary duct. Whyte LA, et al. Arch Dis Child 2013;98:405-407.

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