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The following case of carcinoma of the nasopharynx presents several features interesting not only to the otolaryngologist but also to the neurologist, the ophthalmologist, the roentgenologist and the pathologist. It is presented because of its value to both the clinician and the pathologist in that an attempt has been made to explain clinical symptoms from a complete study at autopsy. Of further interest was the intracranial extension of the tumor with marked destruction of bone, metastasis to the liver and an apparent implantation of tumor cells by contact from the growth in the nasopharynx to an ulcer on the nasal surface of the soft palate. This ulcer approximated and was irritated by the tumor in the nasopharynx on phonation and swallowing. That malignant tumors of the nasopharynx are not uncommon is evidenced by the abundance of literature on the subject, many authors reporting fairly large series of cases. It was

The larynx of old persons has frequently been examined. However, a perusal of the literature reveals that no two physicians agree in their findings as far as the muscles of this organ are concerned. Kofler 1 mentioned slight atrophy of the muscles, without giving further details, and Imhofer 2 found that the lipoid pigment usually situated around the nuclei of the sarcolemma increased in amount in old persons. Segre 3 found simple atrophy of the adductor and the abductor muscles, characterized by an increase of the nuclei of the sarcolemma and an increase in both the collagenous and the elastic fibers. This atrophy was least marked in the interarytenoid and the vocal muscles. In contrast, Imhofer 4 did not observe an increase in elastic fibers. The cricothyroid muscles showed hypertrophy in the cases of Segre, 3 which was considered compensatory, because of the atrophy of the adductor muscles. Carnevale Ricci 5 described essentially the same conditions

F ISTULAE due to peptic uIceration are not uncommon. Most of them deveIop as compbcating sequeIae to surgica1 intervention in the treatment of chronic peptic ukers. They are represented by the gastrojejunal or gastrojejunocohc fistmae. Corresponding to the increase of gastric surgery in the treatment of peptic ulcer, their number has increased manifold in the past three decades. In contrast to the above, the occurrence of spontaneous gastric fistuIae, on the basis of a peptic uIcer, seems to be rather uncommon. The Iiterature contains onIy few references to f%tuIae between the stomach and other contiguous abdomina1 organs. Thus one finds onIy isolated reports of peptic ulcer causing fistuIae into (a) the transverse colon, (b) the duodenum, (c) the iIeum, (d) the jejunum, (e) the gaIIbIadder, if) the common biIe duct, (g) the pancreatic duct, (h) the porta vein, (i) the renaI pelvis, and (j) the spIeen. A few instances of I?stuIae between the stomach and nonabdomina1 organs, as the heart (Ieft ventricIe) s pericardium, Iungs, pIeura1 space, and skin, are aIso rec0rded.l A perusal of the Iiterature reveaIs that only very few cases of true gastroduodena1 fistmae have been reported. AIthough met only infrequently, the awareness of such a condition is of obvious importance to those engaged in gastrointestina1 practice. The folIowing two cases are, therefore, reported

Whether the megacolon in this patient was due to a congenital defect in the innervation of the colon and its sphincters, or to a defect in the innervation secondary to the “brain fever” suffered at two months of age is conjectural. However, it is quite probable that the mental deficiency associated with poor personal hygiene and pica was an important contributory cause of the megacolon in this case.