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✓ A case is presented in which two separate concurrent astrocytomas of the brain in the same patient were successfully operated on. The patient has been followed for 3 years and remains well. The authors believe that the diagnosis of multifocal tumors can be established on clinical grounds when the tumors are remote from each other, and when there has been no recurrence of neoplasm between the lesions after a long follow-up period. It is felt that a more optimistic approach to the treatment of multifocal tumors may yield good results.

ALTHOUGH the kidneys are often involved in polyarteritis nodosa (PAN),1-4acute renal failure is uncommon in this condition and has an unfavorable course. The outcome of 27 cases of oliguric PAN described in the literature was uniformly fatal shortly after the onset of anuria.5-9 Our patient had acute anuric PAN, with renal function partially restored after dialysis and combined prednisone-cyclophosphamide therapy. Report of a Case A 17-year-old girl was admitted to the hospital because of anuria. She had been well until three weeks earlier, when she noticed that she passed dark urine and had pedal edema. Four weeks earlier, she had had a sore throat and was treated with ampicillin. On admission, the patient was pale and dyspneic. She had peripheral edema (4+ ). Blood pressure was 210/130 mm Hg. Moist rales were present bilaterally, and a grade 3 systolic ejection murmur was heard over the precordium. The liver

A clinicopathological study of 150 patients with primary malignant melanoma of the skin is presented. Information concerning the site, type, depth of invasion and thickness of the tumor is reported. The value of tumor thickness in assessing prognosis is emphasized.

Ultrastructure of the capillaries of malignant and benign thyroid tumours has been examined. The material consisted of biopsies from six cases of thyroid papillary carcinoma, one case of follicular (foetal type) adenoma and six cases of nodular adenomatous goitre. In the group of nodular adenomatous goitre and in the follicular adenoma, the capillary wall was made up of fenestrated endothelium similar to that of capillaries of normal human thyroid. The fenestrae occupied a large area of the endothelial wall. Micro- and macropinocytotic vesicles were frequent in the endothelial cytoplasm. In the thyroid carcinomas the papillary structures always contained numerous capillaries with fenestrated endothelium. The microfollicular area and the solid tumoral areas of the papillary carcinoma showed occasional capillaries with fenestrated endothelium, but many capillaries were lined with continuous endothelium. The capillaries in all the specimens were surrounded externally by a continuous basement membrane which was frequently bilaminate or multilaminate. This study indicates that capillaries with fenestrated endothelium are characteristic of thyroid tumours which arise from follicular cells.

A 5-year-old boy was admitted to the neurosurgical ward because of pain in the lumbar region of 1 year's duration. During the last few months the pain had increased considerably and became so severe that the touch of the trouser waist band was unbearable. There was no family history of neurofibromatosis or other neurological disease. Examination. On palpation, a very tender tumor mass of lobular consistency was felt in the midline lumbar region. The skin was normal except for local hirsutism in the area of the tumor. There was no neurological deficit, and the mass did not expand on coughing. X-ray examination of the spine did not show any pathological findings. Since the clinical and radiological picture excluded spinal involvement, myelography was not performed. Operation. On May 5, 1967, a large tumor located between the skin and the lumbodorsal fascia was exposed and totally removed. Grossly, no connection with underlying tissue was seen. The tumor was reddish yellow, solid, multilobular, and composed of "spaghetti"-like bundles (Fig. 1 ). Postoperative Course. The pain disappeared completely, and the child was discharged on the 7th postoperative day in good general condition. Neurological examination after 1 month was within normal limits. Pathological Examination. The specimen consisted of a fiat roundish mass of fat tissue, 0.5 cm thick and 4 cm in diameter, and

A neonate girl experienced generalized seizures on the 19th day after birth. Examination of the girl's serum showed hypocalcemia, hypomagnesemia, and hyperphosphatemia, compatible with the diagnosis of hypoparathyroidism. The seizures were controlled following administration of calcium, magnesium, and oral aluminum hydroxide. A study of urinary phosphate excretion in the child suggested that it took her approximately three months to return to euparathyroid state. As a result of the child's illness, the mother was examined, and was found to have hyperparathyroidism. The mother was cured following resection of a parathyroid adenoma.

RENAL papillary necrosis has been reported as complicating pyelonephritis and diabetes, 1 ureteral obstruction, 2 and other ischemic processes. 3-5 Although it has been associated with kidney transplant, 6,7 it has not, to the best of our knowledge, caused primary acute failure of a kidney graft. We describe such a case. Report of a Case A 14-year-old girl with terminal renal failure owing to medullary cystic disease was admitted to our hospital for long-term hemodialysis in 1967. Fasting and postprandial blood glucose levels were repeatedly within normal range. A year later, in January 1968, a cadaveric kidney transplantation was performed. The warm and cold ischemic times were 55 and 140 minutes respectively. The graft failed to function, although the donor's other kidney had been successfully transplanted to another recipient, and long-term satisfactory renal function has been achieved. Angiograms made 18 days after the transplantation showed patent arterial anastomosis of the

Introduction Pneumocystis carinii pneumonia is an infection affecting primarily premature and weak infants. It is characterized by progressive dyspnea, cyanosis, tachypnea, and tachycardia. There are no or only slight signs upon physical examination of the chest, as opposed to a radiological picture showing progressive opacities in the lungs, fever, tendency to leukocytosis, lack of response to any therapy, and a usually fatal outcome, death being the result of respiratory failure. Pathologically it is characterized by infiltration of the alveolar septa by mononuclear cells, mostly plasma cells, and the presence of numerous small round bodies, Pneumocystis carinii, within the alveolar spaces. The causal agent is Pneumocystis carinii, thought to be a protozoan parasite. Already well known as a pediatric problem, Pneumocystis carinii pneumonia in adults is rare, and has until now been recorded as a secondary finding in patients suffering from malignant diseases, mainly of the lymphoreticular system or leukemia. We

Two patients with pheochromocytoma developed symptoms and signs of peripheral vascular disease, and in both cases, all peripheral pulses were palpable. At autopsy, no anatomical changes in the peripheral blood vessels could be found. These findings support the hypothesis that the circulatory changes were caused by excessive secretion of catecholamines. Symptoms and signs of peripheral vascular disease in the presence of palpable pulses in a hypertensive patient should raise the suspicion of pheochromocytoma.