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One hundred and fifty-two patients who underwent abdominoperineal resection for cancer of the rectum and rectosigmoid are reviewed. Six physicians were selected to predict which of these patients would have a local recurrence. All the information available at the end of the operation was duplicated and submitted to the observers. None of the physicians was able to predict local recurrence significantly better than random. There were 31 local recurrences, i.e. an incidence of 20·4 per cent. Low level of tumour in the rectum, local spread into perirectal fat or serosa, lymph node involvement and age below 60 years at time of operation were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.

Summary The clinical and radiological features of seven cases of naso-pharyngeal fibroma are reviewed. Particular emphasis is laid on: 1. The radiological demonstration of the mode of local spread of the tumour. 2. The possibility of the tumour behaving as a frankly malignant growth. 3. The response to radiation therapy.

1. 1. This syndrome, to our knowledge, has not been emphasized before. 2. 2. These arterial venous connections are usually misdiagnosed as varicose veins. These connections occur much more commonly than is supposed. In our practice 24 per cent of the patients we see with advanced varicosities have this syndrome. The syndrome can be diagnosed by the various features already discussed. 3. 3. Accurate diagnosis of this syndrome is required in order to perform the necessary surgical treatment. This is also important from the prognostic standpoint. 4. 4. The condition should be suspected if the veins appear rapidly on the lateral or posterior portions of the legs, if the patient is relatively young, if there is increased local heat and if the veins recur after previous competent vein surgery. 5. 5. Adequate and at times repeated surgery will control the condition. 6. 6. The tendency of these arterial varices to recur seems inherent. With the immaturity of the blood vessels and their local spread and difficulty of eradication, the condition simulates new growth.

Studies on the local spread of fluids injected into the larynx, carried out as a preliminary investigation to the use of radioisotopes, have revealed interesting anatomical data pertaining to the presence of isolated submucosal laryngeal compartments. These are herein reported. Whether the use of radioisotopes will be effective in the treatment of laryngeal cancer is not known, but before it is attempted, certain basic facts should be established. These include the direction and degree of spread of fluids injected into a particular site, and the effects of locally injected radioactive isotopes on the normal structures of the larynx. A technique needs to be developed for the injection of the isotopes to assure effective distribution throughout the involved area and to avoid contamination. Determination of the length of time that the radioisotope will remain within the larynx is of particular importance, since up to now it has not been known

A patient with leiomyosarcoma of the rectum is presented with a brief review of 7 other patients seen in the Birmingham region from 1950 to 1967. A short discussion is given concerning the difficulties of diagnosis and treatment. We would concur with Diamante and Bacon's view (1967) that abdominoperineal excision is the treatment of choice, but that for small border-line tumours local excision may be adequate if intensive follow-up is used. Radical excision is practised at the first sing of possible local recurrence. The Birmingham cases seem unusual because of the predominance of distant metastases when compared with the local spread more commonly reported by other workers.

Biologists, in the laboratory, see cancer cells as individual entities while physicians, in the clinic, see them as tumor masses. A mathematical model is described which bridges the relationship between the observations in the clinic and the underlying movements of the individual tumor cells. For this purpose the model is developed according to the protocol of an actual study of patients with cancer of the endometrium and includes the effect of preoperative radiation treatment in reducing the visible size of the tumor. In this way it is possible to obtain a quantitative estimate of the radiation effect. The model is also used to estimate the motility of tumor cells in vivo and this is compared with measurements obtained in the laboratory. A short discussion is presented of how mathematical models could become useful tools for bridging the gap between discovery in the laboratory and application in the clinic.

The pathologic findings of the excised specimens from 174 cases of high-grade rectal cancer were closely correlated with the subsequent outcome of the patients. Despite confirmation that high-grade cancers show more extensive local spread, more extensive rectal excisions have not improved results, and probably have resulted in increased short- and long-term morbidity.

A case of subcutaneous implantation and growth of mammary cancer following needle biopsy of the parietal pleura is reported. This is a rare complication which does not affect the prognosis of patients with malignant pleural effusions. Fear of such local spread of tumor should not serve as a contraindication to pleural biopsy.

BACTERIAL infection of the stomach is a rare occurrence. It may arise from local spread through the mucosa1or from hematogenous dissemination from a distant focus.2The infection may involve a discrete portion of the stomach or may affect the stomach diffusely.3Of the latter, diffuse phlegmonous gastritis, fewer than 400 cases have been documented in the literature.4 The propensity for generalized embolic infection in patients with pneumococcal endocarditis is well known.5,6The association of endocarditis and phlegmonous gastritis is unusual, however. Only one case documented by culture of pneumococcal endocarditis and associated diffuse phlegmonous gastritis has been reported.7Three other cases of suppurative gastritis with endocarditis following pneumonia, presumably pneumococcal, have been described.8-10The present report of a patient with endocarditis and diffuse phlegmonous gastritis is the second case in which the causative organism was found by culture to be the