A further analysis of 1152 hospital autopsies provides data on inaccuracies of specific diagnoses; there are many examples of overdiagnosis and underdiagnosis. All were encountered in a routine hospital autopsy service and their frequency confirms the importance of the hospital autopsy in medical audit. A knowledge of the misdiagnoses which recur frequently could provide guidance in the selection of cases for autopsy.

In an area of Tanzania in which Burkitt's lymphoma (BL) is endemic, five families are described in which multiple cases of BL were found or BL occurred with other neoplasms. The patients include two brothers and one half‐brother with BL, two brothers with BL, a woman with nasopharyngeal carcinoma (NPC) whose daughter had BL, a boy with BL whose sister developed chronic myelogenous leukaemia (CML), and a man with CML whose son developed BL. The two full‐sib pairs with BL is significantly more than would be expected to have arisen by chance and the association of BL with NPC and CML among close relatives is remarkable in view of the rarity of the last two neoplasms in the study area. It is suggested that genetic factors may be important in determining susceptibility to the three malignancies in this population, but the possibility that the clustering of cases within families may be due to local environmental factors cannot be excluded.

An attempt to obtain necropsies on all deaths from a selected group of clinical units resulted in a necropsy rate of 65% (compared with a normal of 30% in these units). The effect of increasing the necropsy rate was to produce a higher rate of confirmation of clinical diagnoses; nevertheless, 15% of main diagnoses and 42% of causes of death were not confirmed. A large proportion of these were deemed by clinicians in consultations with pathologists to be clinically significant. Of main diagnoses considered certain, 10% were not confirmed. The proportion of diagnostic discrepancies was virtually identical in two groups--those in which the clinicial believed he would normally have requested necropsy, and those in which he would not. Thus clinical confidence in the diagnosis is not an adequate assurance of its accuracy. Although in this survey necropsy was requested on almost all cases, permission was refused in many which may be attributed either to resistance by relatives or to an inadequate approach by the medical staff. The proportion of permissions secured by individual units varied from 50% to 92%. This indicates that the nature of the approach to relatives is the more important factor. As present practices do not adequately allow for the detection of a wide range of misdiagnoses and missed diagnoses it is proposed that a "partial audit" would provide a valuable yardstick; clinicians would be asked to obtain permission for necropsy on an agreed proportion (say, 20%) of deaths over and above those cases in which they are particularly interested and would normally request a necropsy.

Book reviews'Identification and Mixtures of Anti- bodies' withits very helpfulTable (22.2) on identification of antibodies.For any haematology and blood transfusion trainee acquisition of this book would be £12.00judiciously spent; it merits a place on any transfusion laboratory's bookshelf next to 'Mollison' and 'Race and Sanger'.I. A. D.

An enquiry into the attitudes of clinical consultants to autopsies was conducted by questionnaire. Responses indicate that most of the consultants accept that the autopsy is important in hospital practice and in teaching. There are, however, marked differences of view on the reasons for doing autopsies, and on the results of autopsies (e.g. in altering diagnoses or revealing unsuspected pathology), differences which influence the frequency with which autopsies are requested. Some clinicians believe that increasing resistance by relatives to granting permission contributes to the falling rate, but this is a minority view. Clinicians also vary in their reactions to the falling rate, some regarding it as worrying while others are not concerned.

The adult nephrotic syndrome as met with in Nairobi is predominantly encountered in young sophisticated African women, most of whom began to use skin-lightening creams containing mercury before the symptomatic onset of their illness. The particular form of mercury involved is well known to cause the nephrotic syndrome in other circumstances-for example, when applied to the skin in the treatment of psoriasis. In these circumstances the pathogenetic mechanism is thought to be of an idiosyncratic type. The use of mercury-containing skin-lightening creams in the patients studied seemed to be particularly associated with a "minimal-change" ("light-negative") renal glomerular lesion, this lesion being present in half of the patients. The prognosis in this group of patients seems remarkably good, with 50% entering remission, 77% of these doing so spontaneously on discontinuing the use of the creams.

Two hundred and forty‐nine sera derived from African donors suffering from a variety of malignant diseases were examined for EBV‐related antibody levels. When divided into three major subgroups (lymphoproliferative tumours, carcinoma and sarcoma) none of the mean titres approached the high anti‐VCA, anti‐MA or anti‐EA levels characteristic for Burkitt's lymphoma (BL) or nasopharyngeal carcinoma (NPC). On breaking down the material further into specific diagnostic or pathological subgroups, similar low mean values were found, except for small groups of plasma cell tumours and carcinomas of the palate (with high anti‐VCA and anti‐MA) and osteogenic sarcoma (with moderately high anti‐MA). The data do not support a regular association of high anti‐EBV titres with malignant disease in general and thus reaffirm the special position of BL and NPC in this respect.

The Journal of Pathology and BacteriologyVolume 68, Issue 1 p. 293-295 Short Article Adenoma of the epididymis H. MacDonald Cameron, H. MacDonald Cameron Department of Pathology, Maryfield Hospital, DundeeSearch for more papers by this author H. MacDonald Cameron, H. MacDonald Cameron Department of Pathology, Maryfield Hospital, DundeeSearch for more papers by this author First published: July 1954 https://doi.org/10.1002/path.1700680141Citations: 10AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References Blumer, C. E. M., and Edwards, J. L., 1941–42. Brit. J. Surg., xxix, 263. Charache, H., 1939. Urol. Cutan. Rev., xliii, 663. Evans, N., 1943a. J. Urol., 1, 249. Evans, N., 1943b. Amer. J. Path., xix, 461. Fajers, C. M., 1949. Acta path. et microbiol. Scand., xxvi, 1. Golden, A., and Ash, J. E., 1945. Amer. J. Path., xxi, 63. Horn, R. C., Jr., and Lewis, G. C., Jr., 1951. Amer. J. Clin. Path., xxi, 251. Lee, M. J., Jr., Dockerty, M. B., Thompson, G. J., and Waugh, J. M., 1950. Surg. Gyn. Obst., xci, 221. Longo, V. J., McDonald, J. R., and Thompson, G. J., 1951. J. Amer. Med. Assoc., cxlvii, 937. Malisoff, S., and Helpern, M., 1943. J. Urol., 1, 104. Morehead, R. P., 1946. Arch. Path., xlii, 56. Ormond, J. K., and Culp, O. S., 1951. J. Urol., lxv, 906. Sundarasivarao, D., 1953. This Journal, lxvi, 417. Willis, R. A., 1953. Pathology of tumours, London, 2nd ed., pp. 184 and 646. Citing Literature Volume68, Issue1July 1954Pages 293-295 ReferencesRelatedInformation