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Certain pulmonary stenoses differ markedly from the usual types of isolated valvular stenosis in their clinical features (maximal murmur situated lower down), their radiological signs (absence of a prominent median arc), the electrocardiograph (atypical electrical axis), the haemodynamic findings (usually a poor gradient), and especially the angiocardiography (valvular dysplasia, lack of a post-stenotic dilatation). They are encountered especially in the multiple malformations, as shown by this series of 23 cases comprising the syndrome of Noonan (9), of Gorlin or 'leopard' (7), of Watson or 'café-au-lait spots' (3), or those defying classification, but always having a disorder of facial structure and mental deficiency, sometimes with deafness (4). The frequent finding of a gradually progressive hypertrophic cardiomyopathy is a feature of these syndromes, and usually accounts for the abnormal ECG findings. It leads to a discussion of the pathogenesis, and of the place of these syndromes in a wider context, alongside the phacomatoses and the hereditary forms of neuromuscular degeneration.

Disturbances of Cardial conduction in the Leopard syndrome are described. In this syndrome disturbances of cardial conduction are better demonstrated and diagnosed in the VCG than in the ECG.

Lentigo maligna, a precancerous lesion, is a brown-black irregularly pigmented freckle, usually occurring on the face of the elderly subject. In a series of 99 patients with malignant melanomas, lentigo maligna was the pre-existing lesion in 21. The clinical and histological findings, and previous publications on the subject are reviewed. Lentigo maligna itself is not a superficial malignant melanoma. After the development of malignant melanoma from lentigo maligna, eight of 21 patients developed metastatic disease. This seems to indicate that once malignant melanoma has developed (whether de novo from the junctional portion of a pre-existing nevus, or from a lentigo maligna), the outlook is the same. During the development of malignant melanoma from lentigo maligna there is an indefinite period when it is virtually impossible to determine histologically whether malignant melanoma is present. Naturally, the inclusion of these indefinite cases will greatly influence reported results of treatment.