Destroying hills in the northeastern part of Bangladesh: a qualitative assessment of extent of the problem and its probable impact

Indiscriminate cutting of hills in the Sylhet region has become a major environmental issue. The nature and life style of Sylhet intimately related with the hills are thus under the threat of a drastic imbalance in its ecosystem. Due to such hill cutting the mostly affected sectors of this region will be its weather and climate, geomorphology and hydrology, and the indigenous flora and fauna. As a result the frequency of natural calamities like earthquake, flash flooding etc may increase considerably. Deforestation and resulting increased soil erosion, decreased ground water recharge and deteriorated water quality might also be as consequences of such hill cutting. This paper investigates the cause and extent of the problem along with its probable impact and finally suggests actions for conservation of hills for ecological balance of the region

[Breast carcinoma associated to cancer of the vulva]

The synchronous association of breast infiltrating ductal carcinoma and moderately-differentiated squamous cell carcinoma of the vulva is extremely rare. The interest assigned to this association is not only resides in its rarity, but also in the therapeutic problems that it can raise. A 50 year woman, presented with a lesion of the left labia major of the vulva, its diameter measured 2cm, The tumour was mobile, painful, and bleeds at the least contact. The biopsy concluded to a moderately-differentiated squamous cell-carcinoma. Systematic genital examination revealed the presence of a nodule the right upper quadrant of breast. It was hard, painless and without axillary's nodes. The surgical intervention consisted at a radical mastectomy, with axillary's lymphonodectomy; in followed by a radical vulvectomy and bilateral inguinal lymphatic nodes dissection. The pathological examination concluded to a breast infiltrating ductal carcinoma II rank of SBR, confirmed the histological type of the vulvar tumour, and showed an inguinal involvement node. A postoperative radiotherapy and chemotherapy has been done. The patient was well with a postoperative follow up period of 18 months. The coexistence of a breast infiltrating ductal carcinoma and squamous cell carcinoma of the vulva is an extremely rare occurrence. Two cases have been previously reported in the literature. A congenital origin is possible; adenocarcinoma can be developed from ectopic, mammary gland tissue in the vulva. The acquired origin is also possible; the vulvar localization can be secondary to a metastatic breast cancer. Nevertheless, these two etiological approaches suppose that in the two localizations, the cancers are of the same histological type. The association of distinct types is uncommon. The double localization poses a problem of operative time chronology, and of the necessity of adjustment of doses of radiotherapy or chemotherapy. It must be discussed case by case; indeed the reduced number published case doesn't permit to establish a standard protocol. The logical therapeutic attitude seems to be, the surgical excision in the same time; every localization being considered as isolated. Otherwise all complementary pen-operative treatment [radiotherapy, chemotherapy] should include an adjustment of doses