Cerebellar astrocytoma of childhood has always been regarded as a benign tumour. Certain issues still attract debate, in particular the role of radiotherapy as an adjuvant to surgery, management of the cyst wall in cystic lesions and treatment of recurrent tumours. To provide some answers to these questions, the experience in Birmingham (United Kingdom) between the years 1959 and 1991 was reviewed. Ninety-seven patients aged 0-14 years had been treated and the histological material was reassessed independently. Detailed statistical and clinical analysis revealed that the main factor of negative prognostic value was the presence of brain stem involvement. In cystic tumours the surgical excision of the cyst wall did not offer significant advantage on survival. Similarly, postoperative radiotherapy did not improve survival, and there is a suggestion that it may actually predispose to malignant transformation. The implications on management are discussed.

Case reportA 25 year old primigravida was known to have an asymptomatic congenitally bicuspid aortic valve which had been diagnosed seven years previously. Retrograde cardiac catheterisation in 1986 had shown a peak systolic gradient across the aortic valve of 38 mmHg. Regular cardiology follow up had since recorded some progression of the stenosis with mild aortic regurgitation. She was referred for cardiological review after her antenatal booking consultation.She was noted to be a little tired, but otherwise well. On examination there was a systolic thrill with a left ventricular impulse, and there was an ejection click with a systolic murmur grade 3/6 at the base and early diastolic murmur grade 2/6 at the left sternal edge. Blood pressure was 100/50mmHg. The ECG was normal and echocardiography showed mild left ventricular hypertrophy. The peak systolic gradient was 50 mmHg, and aortic regurgitation was demonstrated on Doppler sonography. There was no evidence of significant progression from her previous review, and it appeared that the cardiac abnormality did not pose a significant problem in her pregnancy.She remained in good general health during her pregnancy, although at 38 weeks gestation there was evidence of mild intrauterine growth retardation. Further tests of fetal wellbeing were arranged, but the evening following her attendance at the antenatal clinic she was referred by her GP to the accident and emergency department with a 3 h history of sudden onset upper retrosternal chest pain, burning in nature. The pain was worse on inspiration, but there was no radiation or positional variation. She felt shaky, complained of headache but denied other symptoms. On examination she was flushed but apyrexial. Her pulse rate was 100/min, and her blood pressure was 138/60 mmHg. Jugular venous pressure was not elevated, and the heart sounds were normal with a grade 4/6 ejection systolic murmur and thrill and grade 2/6 early diastolic murmur. The chest was

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BackgroundCollagenous colitis (CC) is by definition a histological diagnosis. However, colonoscopy often reveals characteristic endoscopic findings. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in 4 participating centers.MethodsThis was a retrospective study; the databases of 2 university hospitals in Edinburgh (Scotland) and Malmö (Sweden), and 2 district general hospitals in Tomelloso (Spain) and Gateshead (England) were interrogated for patients diagnosed with CC between May 2008 and August 2013. Endoscopy reports and images were retrieved and reviewed; data on lesions, sedation, bowel preparation and endoscopist experience were abstracted. Categorical data are reported as mean±SD. Fischer’s exact, chi-square and t (unpaired) tests were used to compare datasets. A two-tailed P-value of <0.05 was considered statistically significant.Results607 patients (149 male, mean age 66.9±12.25 years) were diagnosed with CC. A total of 108/607 (17.8%) patients had one or more suggestive endoscopy findings: i.e., mucosal erythema/edema, 91/607 (15%); linear colonic mucosal defects, 12/607 (2%); or mucosal scarring, 5/607 (0.82%). For colonic mucosa erythema, there was no difference in the odds of finding erythema with the use of different bowel preparation methods (P=0.997). For colonic mucosal defects there was some evidence (P=0.005) that patients colonoscoped by experienced endoscopists had 87% less odds of developing such defects. Moreover, there was evidence that analgesia reduced the odds of developing mucosal defects by 84%.ConclusionA significant minority of patients with CC have endoscopic findings in colonoscopy. The description of such findings appears to be related to the endoscopist’s experience.

Purpose Paucity of reliable long-term data on the prognostic implications of the 2004 WHO bladder cancer classification system necessitates utilisation of both this and the 1973 grading systems. This study evaluated, in noninvasive (pTa) bladder tumours, the prognostic value of the 2004 system independently and in combination with the 1973 system while establishing concordance between tertiary centre uropathologists. Methods We used a cohort of non-muscle invasive bladder cancer (NMIBC) patients diagnosed between 1991 and 93 where tumour features were gathered prospectively with detailed cystoscopic follow-up data recorded over 15 years. Initial grading was by one senior expert uropathologist (UP1) using the 1973 WHO classification alone. Subsequently, two other expert uropathologists (UP2 and UP3), blinded to the previous grading, re-evaluated the pathology slides and graded the tumours using both the 1973 and 2004 systems. Association between grade and recurrence/progression was analysed and the Cohen Kappa test assessed concordance between pathologists. Results Of 370 new NMIBC, 229 were staged noninvasive (pTa). Recurrence rates were 46.2% and 50.0% for LGPUC (low-grade papillary urothelial carcinoma) and HGPUC (high-grade papillary urothelial carcinoma), respectively, while progression was seen in 3.9% and 10.0% of LGPUC and HGPUC, respectively. Concordance between uropathologists UP2 and UP3 for the 2004 and 1973 systems was good (Kappa = 0.69) and fair (Kappa = 0.25), respectively. Conclusions With good inter-observer concordance, the 2004 WHO classification system of noninvasive bladder tumours appears to accurately predict recurrence and progression risks. The combination of both grading systems to low-grade tumours allows further refinement of the natural history.