Twin gestation, a high-risk pregnancy is responsible for 10% of all perinatal mortalities. The high perinatal mortality of twins has been repeatedly stressed over the years. Studies have also revealed difference in the perinatal mortality rates in relation to chorionicity. Thus, a prospective study of 100 twin pregnancies was carried out at our institute to assess the morbidity and mortality of twins in relation to chorionicity and to analyse the factors responsible for the greater loss. The perinatal mortality rate of monochorionic twins was 17.64% and that of dichorionic twins was 8. 88%, which is statistically significant. Birth weight was found to be the most important factor correlating with mortality rates. The higher perinatal mortality of monochorionic twins was largely due to low birth weights (29.3% of monochorionic twins weighed less than 1500 gm as compared to 12.6% of dichorionic twins). Avoidable deaths were comparable in the two twin groups but dichorionic twins showed greater percentage of fresh stillbirths (40%) whereas in monochorionic twins, 50% were macerated stillbirths. Prematurity was another common factor responsible for greater perinatal mortality in monochorionic twins. Monochorionic twins showed increased incidence of discordant growth (34.8%) as compared to that of dichorionic twins (14.08%). The type of placentation did influence the perinatal outcome of twins making its antenatal diagnosis important.

A double blind randomized placebo controlled clinical trial was carried out to assess the efficacy and safety of L-carnitine in patients suffering from acute anterior wall myocardial infarction with respect to left ventricular function. Sixty patients (34 men, 26 women, mean age 56+11 yr.) with acute anterior wall myocardial infarction were randomized to placebo and L-carnitine. All the patients were given intravenous L-carnitine / placebo in the dose of 6gm/day for the first seven days followed by oral L-carnitine / placebo 3 gm/day in three divided doses for a period of three months. Echocardiography was performed for regional wall motion abnormality, left ventricular end systolic volume (ESV), end diastolic volume (EDV) and ejection fraction (EF) on admission, after seven days and after three months of the infarction. Forty-four patients completed the study. There were three deaths, two in the placebo and one in the L-carnitine group (p>0.05). Thirteen patients were lost to follow up. Echo parameters in both groups were comparable (p>0.05). The duration of chest pain prior to initiation of the I.V. L-carnitine was 7.5 + 5.2 hrs in the L-carnitine group and 7 + 4 hrs in the placebo group (p>0.05). There was no statistical difference in the EF, ESV and EDV on admission, at discharge and after three months in the L-carnitine and the placebo groups (p>0.05). No significant adverse effects were noted. L-carnitine, though a safe drug, does not affect the left ventricular function in patients with myocardial infarction.

New approaches need to be pursued towards the assessment of sperm quality using biochemical markers. In order to help develop a good biochemical marker to assess sperm-membrane integrity, the enzyme creatine kinase (CK) was studied in semen of normal, oligospermic and azoospermic samples and correlated with sperm concentration, lipid-peroxidation (LP) and water test. Presence of isoforms of creatine kinase (CK-MB) was also seen. An inverse correlation was observed between CK activity and sperm concentration (p<0.001). Water test was seen to be inversely correlated with CK activity (p<0. 001). Lipid peroxidation showed positive correlation with CK activity (p<0.001). A significant correlation between loss of sperm function meditated by induction of peroxidative damage to sperm plasma membrane is indicated. Enzymes like CK can serve as good biochemical marker along with lipid peroxidation to confirm loss of sperm membrane integrity. The water test can be used as a preliminary screening test for sperm membrane integrity.

Rupture of intracranial dermoids tumour is rare and carries with it the risk of significant morbidity as well as fatality. Three cases that presented with varying symptoms ranging from headache to chiasmatic compression and suspected to have rupture of dermoid tumour are described. The importance of MR imaging in their diagnosis is discussed.

We describe imaging findings of a patient with multiple intracranial lipomas, hypogenetic corpus callosum and a vestibular schwannoma. We did not find association of intracranial lipomas and vestibular schwannoma in English literature.

Malignant hidradenoma is a rare sweat gland carcinoma, which can have an aggressive course with recurrence and/or metastasis. A case is reported, in an elderly male. The tumour had a histologic similarity to its benign counterpart, but exhibited additional features of infiltrative growth pattern and invasion of adjacent tissue.

Penicillin-induced immune haemolytic anaemia is very rare. A ten year-old-female with rheumatic mitral stenosis on benzathine penicillin prophylaxis presented with features of haemolytic anaemia and investigations supported the diagnosis of immune haemolytic anaemia. Patient responded to discontinuation of the drug and therapy with oral prednisolone. This is first such case reported from India.