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An analysis of 36 closed malpractice claims related to the diagnosis of cancer was conducted at a time when both subjects are receiving particular attention. Awareness of cancer statistics and the medicolegal literature is necessary. Factors related to the allegation of delay as well as the psychological aspects of cancer are presented. Suggestions for claims prevention have been delineated.

Evidence in the literature suggests that von Willebrand's disease constitutes part of a mesenchymal syndrome accompanied by coagulopathy. The cases of two patients with symptomatic intestinal angiodysplasia and concurrent von Willebrand's disease are summarized along with the eight cases previously reported in the literature. All ten cases were in adults ranging in age from 34 to 80 years (average, 58 years). The vascular lesions were located in the stomach or duodenum (four cases), right colon (three cases), and terminal ileum (two cases). One patient had angiodysplasia of the stomach, jejunum, and sigmoid colon. While the prevalence is unknown, these ten cases linking gastrointestinal angiodysplasia with von Willebrand's disease appear to reflect an association greater than more coincidence. Coagulation testing, including determination of template bleeding time and partial thromboplastin time, should probably be performed in all patients bleeding from gastrointestinal angiodysplasia to screen for von Willebrand's disease.

Abdominal cramping and diarrhea developed in a 24-year-old woman with facial acne vulgaris five days after she started topical therapy with 1% clindamycin hydrochloride. A stool specimen contained a significant titer of a toxin produced by Clostridium difficile. Findings from sigmoidoscopy and a colonic biopsy specimen were consistent with pseudomembranous colitis. The patient became asymptomatic after ten days of supportive care and oral vancomycin hydrochloride therapy. This case is presented as an example of pseudomembranous colitis associated with topical application of clindamycin.

Antibiotic-associated colitis is known to occur with temporal and geographic clustering. During 1979 a marked increase in the incidence of this disease was noted at our institutions. The clinical, epidemiological, and endoscopic features are reported. Typical features included the acute onset of watery diarrhea, fever, abdominal pain, tenderness, and the presence of leukocytosis. Epidemiological data revealed a nosocomial pattern of this illness and a striking female predominance. Two-thirds of the patients had an underlying gynecological or urological disorder. Dysuria and sterile pyuria were unexpected findings. It is suggested that the organism responsible for this disease may be hospital acquired and associated with underlying genitourinary disorders.

Acute pancreatitis of biliary tract origin and that of alcoholic origin may be difficult to separate on clinical grounds alone. Such separation is important since operation prevents recurrent attacks in gallstone pancreatitis. We examined the records of 78 patients in the first attack of pancreatitis from gallstones or alcohol. The gallstone group were usually women, older, and had a shorter period of abdominal pain. Pancreatic complications occurred more frequently in the alcoholic group and led to two deaths. Amylase values were diagnostically helpful in that a level greater than 1000 units in patients of the proper age and sex, and a level greater than 2000 units by itself indicated gallstone pancreatitis.