A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease (CLD). There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and management of needy CLD patients as a poverty-reduction health intervention.

One hundred infants with intracranial tumors symptomatic during the 1st year of life were studied. They differed from older children in having a higher percentage of supratentorial tumors and in the fact that 90% of the tumors were of neuroectodermal origin. Vomiting, alteration of psychomotor development, and macrocrania were the most common presenting features. The "diencephalic syndrome" was seen in 5 infants, and subarachnoid hemorrhage due to tumor was diagnosed in 4. Computed tomography as the primary investigation is increasing the number of neoplasms diagnosed in this age group, although review of the skull roentgenograms in the series disclosed an abnormality in 92%. Eighty of the tumors were verified, 68 by a cranial operation and the rest at autopsy. Of the verified neoplasms, 20% were medulloblastomas, 12.5% were choroid plexus papillomas, and 10% were cerebellar astrocytomas. The cumulative average survival was 27 months but, for those who underwent a tumor operation, the average survival was 37 months. The operative mortality was 30%. Thirty-nine patients were irradiated, and this subset had a 5-year survival rate of 43%. The morbidity was high irrespective of radiotherapy; 60% of those who survived 1 year were moderately or severely disabled. Those infants receiving more than 5000 rads of whole brain radiation tended to have greater deficits in the long term. When analyzed separately, patients treated after 1970 had greatly improved mortality and morbidity rates.

Complex partial seizures associated with tumors and other mass lesions are readily diagnosed by modern imaging techniques but their optimum surgical treatment remains unresolved. Lesionectomy has been reported to produce seizure outcomes equal to outcomes after resection that ablates the epileptogenic cortex with the lesion. However, some evidence suggests that when the lesion is in the temporal lobe, simple excision of the tumor or lesion more often fails to control seizures. After retrospectively reviewing the records of 30 patients with complex partial seizures and temporal lobe tumors who underwent surgical treatment at the University of Cincinnati hospitals (1985-1992), the authors divided them into two groups: Group A (16 patients) underwent lesionectomy only and Group B (14 patients) received surgical treatment for seizures with electroencephalographic delineation of the epileptogenic zone and resection of the lesion. Seizure control was best achieved in Group B patients with 13 (92.8%) seizure free at follow up (mean 52 months). Only three (18.8%) of the Group A patients became seizure free after lesionectomy at follow up (mean 33 months). In eight Group A patients, who underwent temporal lobectomy as a second procedure after lesionectomy failed to control seizures, five (62.5%) became seizure free. Group B patients had a longer duration of seizures and were more likely to have lesions smaller than 2.5 cm compared with Group A. Analysis of covariance demonstrated that the differences in outcome between the groups remained significant even with adjustment for the variation in duration of seizures (p = 0.0006) and size of tumor (p = 0.0001). Based on this study, the authors found that the probable relief from seizures caused by a temporal lobe lesion is greater if the region of epileptogenicity, usually the amygdalohippocampal complex, is resected along with the tumor in a temporal lobectomy.

The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinomas, while a number of recent reports have demonstrated the safety of direct surgery. In order to improve treatment planning, attempts have been made to distinguish the various tumor types by computerized tomography (CT) and by the use of markers for germ-cell tumors. This paper reports a study of 35 patients with pineal tumors including two ectopic germinomas. Pretreatment CT was performed in all 35 patients, and human chorionic gonadotropin and alpha-fetoprotein levels were assayed in 11. Histological verification was available for 33 tumors; the other two were characterized by clinical and CT features plus tumor markers. Of the 27 tumor operations, 21 were for a pineal mass and six for ectopic germinoma or metastasis. There was no operative mortality. Morbidity was minimal, and surgery did not increase the incidence of subarachnoid seeding. Each histological type of tumor has a typical appearance on CT scanning, although, in the individual case, a firm diagnosis is not always possible. However, consideration of CT scans together with the clinical features, cerebrospinal fluid cytology, tumor markers, and (if there is still doubt) response to a small dose of irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumors less likely to respond may be subjected to primary surgery.

Subependymomas of the fourth ventricle are generally considered incidental postmortem findings, and have received scant attention from neurosurgeons. The authors present a surgical series of 12 cases of this disorder diagnosed over a 13-year period. The clinical and radiological findings were reviewed and correlations made with pathological studies. The subependymoma is a histologically benign tumor that tends to be calcified. It has a predilection for the fourth ventricle and a peak incidence in the fifth decade of life. It is usually of considerable size with extensive attachment at the time of its detection, and is associated with significant surgical morbidity. The authors believe that magnetic resonance imaging may be the best method of investigation. Intraoperative disturbance of circulatory or respiratory control should suggest to the surgeon that the operation be abandoned. A laser or ultrasonic aspirator may be very helpful in removing these tumors. Postoperative care must include monitoring for apnea.