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Mesothelioma of the peritoneum is a rare malignant neoplasm easily mistaken by both surgeon and pathologist for one of the more common neoplasms of the abdomen. Review of our records from metropolitan-area hospitals for the past 15 years identified seven patients with primary peritoneal mesotheliomas. Their diagnosis, management, and survival is analyzed. We report a case of an extended survivor (7 years) and one of a long-term survivor (15 years), as well as what we believe to be the only case in the literature presenting with a coexistent malignant neoplasm. Prevention of this commonly fatal neoplasm is linked to avoiding occupational exposure to asbestos; long-term survival for a few patients may be achieved with correct identification of the neoplasm and aggressive management. This report includes a review of the literature.

This monograph is well written and easy to read and provides a comprehensive overview of gastric carcinoma beginning with epidemiology and ending with a description of current chemotherapeutic efforts to reduce the mortality associated with this dread disease. The major portion of the book is a description of the authors' experience and the methods of diagnosis and management they employ for carcinoma of the stomach. The classification of gastric carcinoma and the descriptions of precancerous conditions and lesions are accompanied by some color plates of excellent quality and are presented in a particularly lucid manner. The authors' methods and procedures for the management of gastric cancer are, in general, consistent with those of other students of the disease. The authors have had considerable experience with gastric carcinoma; for example, they treated a total of 189 patients with adenocarcinoma of the gastroesophageal junction from July 1, 1982, to October 1, 1987. The extent

• Of 42 critically ill patients with toxic megacolon, 31 required emergency surgery, and 11 were treated without operation. Of the 11 patients treated by medical measures alone, there were two deaths (18%): one early, secondary to undiagnosed colonic perforation, and one late death from recurrent ulcerative colitis. Nine of ten survivors (90%) experienced continued morbidity, and five (50%) required subsequent elective surgery. Thirty-one patients required emergency operation for failure of medical treatment (19), colonic perforation (ten), and uncontrolled hemorrhage (two). Early and late morbidity was 74% (two-thirds occurring after subtotal colectomy and ileostomy). Surgical mortality was 19% (8% over the last ten years). (Arch Surg112:518-522, 1977)

Among the considerations in making the decision for proctocolectomy in ulcerative colitis is the hazard of ileostomy. Since our current techniques for constructing an ileostomy were developed less than 20 years ago, the long-term risks associated with a permanent ileal stoma cannot yet be assessed. Nevertheless, periodic follow-up information on ileostomy patients is of value when operation is being considered for a patient with chronic ulcerative colitis. In this report attention has been focused on the frequency and type of ileostomy complications which require a corrective operation. Material The case histories of all patients who had a permanent ileostomy established during the 20-year period ending Dec 31, 1967, were reviewed. Patients in whom the ileal stoma was constructed because of chronic ulcerative colitis were selected for study. Cases in which the ileal stoma was made because of granulomatous colitis were excluded. Using these criteria a total of 88 cases were

Infection of a saphenous vein graft with mucormycosis resulted in recurrent perforation of the graft. Although the incidence ofMucorinfection is increasing, vascular endothelium is not a common site of infection. General debility and the administration of antibiotics appear to predispose to infection with mucormycosis and these factors were present in the case described. This report suggests the importance of histologic study of available portions of vein grafts which have failed.