Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40–50 years. This is a case of low-grade ESS presenting as rapid enlargement of a fibroid uterus. Because of her secondary infertility, she was planned for myomectomy. However, due to the high degree of suspicion of a sarcomatous change in the fibroid, in view of rapid enlargement of uterus within the last 4 months, we planned for a preoperative endometrial aspiration. It showed low-grade ESS, which was later confirmed by histopathology examination of total hysterectomy specimen. As surgery was the main treatment for ESS, because of the proper preoperative diagnosis, we could plan the treatment accordingly. Despite the rarity of the tumor, one has to consider the possibility of ESS in cases with presentation of rapid enlargement of a fibroid uterus.

Objective:To chronicle the history of medicine and neurology in India with a focus on its establishment and evolution.Background:The history of neurology in India is divided into two periods: ancient and modern. The ancient period dates back to the mid-second millennium Before Christ (B.C.) during the creation of the Ayurvedic Indian system of Medicine, which detailed descriptions of neurological disorders called Vata Vyadhi. The early 20th century witnessed the birth of modern Indian medicine with the onset of formal physician training at the nation's first allopathic medical colleges located in Madras (1835), Calcutta (1835) and Mumbai (1848). Prior to India's independence from Britain in 1947, only 25 medical schools existed in the entire country. Today, there are over 355. In 1951, physicians across the field of neurology and neurosurgery united to create the Neurological Society of India (NSI). Four decades later in 1991, neurologists branched out to establish a separate organization called the Indian Academy of Neurology (IAN).Design/Methods:Information was gathered through literature review using PubMed, MD Consult, OVID, primary texts and research at various academic institutions in India.Results:Neurological disorders were first described in ancient India under Ayurveda. The transition to modern medicine occurred more recently through formal training at medical schools beginning in the 1930's. Early pioneers and founders of the NSI (1951) include Dr. Jacob Chandy, Dr. B Ramamurthi, Dr. S. T. Narasimhan and Dr. Baldev Singh. Later, Dr. J. S. Chopra, a prominent neurologist and visionary, recognized the need for primary centers of collaboration and subsequently established the IAN (1991). The future of Neurology in India is growing rapidly. Currently, there are 1100 practicing neurologists and more than 150 post-graduate trainees who join the ranks every year. As the number of neurologists rises across India, there is an increase in the amount of basic, clinical and epidemiological research being conducted across the country every day.Conclusions:The history of neurology in India roots back to its rich culture and tradition. Over time, there has been great structural and organizational evolution and the future of neurology in India appears to be bright. However, the number of neurologists and research in neurology needs to experience a significant growth in the future to ensure the best patient care.

Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements.Context: Evidence-informed quality standards (QS), including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG) and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state.Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators) was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes.Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

THOUGH much attention has been devoted to the elucidation of the biology of the eels, the records of their eggs are very rew and , st rangely enough, even the egg of the European eel , Anguilla vulgaris, which was th e subject of intensive investigation. remains unknown to Science. The first account of eel eggs was by Raffaele (1888) who studied the early development of .five types of unidentified eggs from the Bay of Nap les . This was followed by Eigcnmann's (1901) investigation on the development of an eel egg resembling Raffaele's .• Species No.6 " collected 30 miles south of South Shoal and assigned by him to the Conger eel. Boeke (1903) described nin e types of eel cggs and larv:e from the Naples Bay which included the types studied by Raffaele. Schmidt (1913) described the eggs of the Mediterranean Conger. MUl'I1ma helena. He also collected the eggs of NellaSloma mefan-lIrUIIl from the Balearic and Tyrrhenian Seas and identified R affaele's "Species No.7" a nd Boeke's "Munena No.3" as that of Ophichthp hispal111S and Boeke's "Murrena No . 2" as that of Ophichthys serpens. Fish (1927) gave an account of the egg and la rvre of the American eel , Anguilfa roslrala, collected 10 miles south-west of Bermuda Island. Recently Delsman (1933) described a few eggs and larvre of eel s obtained [rom the Java Sea.Tile only reco rd of eel eggs from Indian I'.a ters is by Aiyar, Unny and Varkey (1944, Abstract) from the Madra, Coast.

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