The teenage coeliac.

management of spinal cord or cauda equina compression from recurrent primary or secondary malignancies was not discussed. (6) The critical role of dexamethasone in emergency treatment was not mentioned. (7) Chemotherapy now has a central role in the management of intraspinal malignancy,S yet receives no mention whatever. If a specific diagnosis can be made by biopsy (of the cord compressing lesion itself or of a separate site of tumour spread-for example, lymph node, bone marrow or, in the case of neuroblastoma, by a combination of biochemical and radiological criteria), laminectomy can be avoided. This is important because multisegment laminectomy can cause major morbidity. Besides the acute deterioration of neurological function, mentioned by Dr Cole, major cosmetic and functional consequences of laminectomy are also common. When radiotherapy and laminectomy are combined, these 'late effects' are particularly severe.4 (8) The role of 'lamina replacement' after laminectomy also deserves mention. The morbidity of the operation (especially in young children) will almost certainly be reduced by the general introduction of this technique.