It is feasible to conduct a study on this subject in a rural area of Zambia. The results show that reduced infant weight and length were significantly associated with maternal 'depression'. Other adverse outcomes may be and need investigating in an appropriately powered study.

In male smokers, statins may reduce the odds of pancreatic cancer. Statin use should be measured in aetiological studies of pancreatic cancer but analysed in specific sub-groups. Future work should investigate statins as chemopreventative agents in this high risk sub-group.

Introduction There are plausible mechanisms that carcinogenesis may be altered by: aspirin, NSAIDs, calcium-channel blockers and statins, through both inhibition of cyclo-oxygenase enzymes and the production of mediators of the cell cycle. The current epidemiological data in this area is either limited, reports confl icting results or does not consider important confounders. The aim of this study was to investigate whether there is a negative association between these medications and the development of pancreatic cancer in a case-control study in the UK. Methods Clinical management databases were used to identify patients diagnosed with pancreatic cancer managed in Norfolk (years 2004Norfolk (years -2006 and Leicestershire (2007). The use of these medications, prior to diagnosis, was recorded from a detailed review of the medical records. The control group were 251 dermatology patients of similar ages treated for basal cell carcinoma. ORs with 95% CI, for the development of pancreatic cancer for each medication, were estimated using unconditional logistic regression and adjusted for gender, age at diagnosis, cigarette smoking and type II diabetes. Results A total of 206 cases of adenocarcinoma of the pancreas (median age=71 years, range 49-99 years, 52% women, a median survival of 3.5 months) and 251 controls were identifi ed. Aspirin use was negatively associated with the development of pancreatic cancer (OR=0.49, 95% CI 0.29 to 0.84, p=0.01). There were no associations with either NSAIDs (OR=0.98, CI 0.50 to 1.91, p=0.95), statins (OR=0.64, CI 0.38 to 1.11, p=0.11) or calcium-channel blockers (OR=0.78, 95% CI 0.43 to 1.39, p=0.40). Conclusion The data support a protective role for aspirin, but not currently for the remaining medications in the aetiology of pancreatic cancer. The work is continuing to identify more cases and controls that may confi rm our preliminary results for aspirin's negative association and also show an effect for statins. Before aspirin can be recommended as a chemo-preventive agent, further population-based studies are required to confi rm the association and provide detailed information on the dose of aspirin needed and its duration of use. Competing interests None.

A 50-year-old woman presented to the urology department with an acute history suggestive of left-sided renal colic. There were no other associated symptoms, but urine dipstick revealed non-visible haematuria. CT-KUB revealed a soft tissue mass at the left vesico-ureteric junction. Flexible cystoscopy demonstrated a mass intruding into the posterior bladder. A transurethral resection of the bladder 'tumour' was undertaken, and it was noted that the mass was not macroscopically consistent with transitional cell carcinoma. Histology demonstrated Müllerianosis, a rare lesion characterised by locally invasive growth of tissue originating from the Müllerian ( paramesonephric) duct. The patient was seen by gynaecologist who initiated hormone treatment with an lutenising hormone -releasing hormone (LH-RH) analogue. Urological follow-up 3 months later highlighted ongoing pelvic pain but no further colicky loin pain. Repeat cystoscopy showed the mass had become smaller and the left ureter was laterally displaced. Further gynaecological input is planned if symptoms are ongoing. BACKGROUND

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