A house-to-house, cross-sectional, population study of epilepsy on 24,130 individuals of all ages from southern Pakistan indicates an age-specific prevalence rate of 9.99 in 1,000 (14.8 in 1,000 in rural and 7.4 in 1,000 in urban areas) for recurrent, nonfebrile "active" epilepsy in Pakistan. Mean onset of epilepsy was 13.3 years, and 74.3% epileptic persons were aged < 19 years at onset of the disorder. The most common seizure type was tonicclonic in 77% [primary generalized tonic-clonic (GTC) in 59% and secondarily generalized in 18%], simple partial (SPS) in 5%, complex partial (CPS) in 6%, generalized absence in 1%, tonic in 3%, and myoclonic in 3% cases. Multiple seizures types in the same person were evident in 9.6% of only the generalized group. A putative cause could be suggested in 38.4% of cases: 32% had a positive family history of epilepsy, most common among siblings. Common perceived precipitants included fever in 29.2% and emotional disturbances in 16.6%. Only 3% of epileptic persons believed that their illness was due to super-natural causes. Treatment status was very poor, with only 2% rural and 27% urban epileptic persons receiving antiepileptic drugs (AEDs) at the time of the survey. We discuss the logistic and management problems of population-based epidemiologic studies in developing countries.

Although CT imaging provides an excellent means of preoperative diagnosis, suggestive signs and symptoms in a "skinny old lady" should prompt immediate operative intervention without delay.

Objective To determine age- and sex-specific incidence rates of inguinal hernia repairs (IHR) in a well defined USA population and examine trends over time. Summary Background Data IHR represent a substantial burden to the US healthcare system. An up to date appraisal will identify future healthcare needs. Methods A retrospective review of all IHR performed on adult residents of Olmsted County, MN from 1989 to 2008 was performed. Cases were ascertained through the Rochester Epidemiology Project, a record-linkage system with >97% population coverage. Incidence rates were calculated by using incident cases as the numerator and population counts from the census as the denominator. Trends over time were evaluated using Poisson regression. Results During the study period, a total of 4,026 IHR were performed on 3,599 unique adults. Incidence rates per 100,000 person-years were greater for men: 368 vs 44 for women, and increased with age: from 194 to 648 in men, and from 28 to 108 in women between 30 and 70 years of age. Initial, unilateral IHR comprised 74% of all IHR types. The life-long cumulative incidence of an initial, unilateral or bilateral IHR in adulthood was 42.5% in men and 5.8% in women. Over time (from 1989 to 2008), the incidence of initial, unilateral IHR in men decreased from 474 to 373 (relative reduction, RR=21%). Bilateral IHR increased from 42 to 71 (relative increase=70%), contralateral metachronous IHR decreased from 29 to 11 (RR=62%), and recurrent IHR decreased from 66 to 26 (RR=61%), all changes p<0.001. Conclusions IHR are common, their incidence varies greatly by age and sex, and has decreased substantially over time in Olmsted County, Minnesota.

The AJCC 7th edition did not accurately predict survival in patients with ICC. A multivariable model including tumour size and differentiation in addition to the criteria used in the AJCC 7th edition may offer a more accurate method of predicting survival in patients with ICC.

No abstract