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A 33-year-old woman presented with sudden, severe, pain in her left iliac fossa, associated with left shoulder tip pain and a feeling of faintness. She had noticed upper lumbar backache over the previous month, and thought she was 7 weeks pregnant. Examination revealed her to be pale, normotensive with tachycardia, and with lower abdominal tenderness worse on the left side. There was left forniceal tenderness and marked cervical tenderness on vaginal examination. With a diagnosis of ruptured ectopic gestation she was transferred to the operating theatre.Through a lower transverse abdominal incision the pelvis was noted tocontain 200 ml of milky fluid with uterine enlargement consistent with 7 weeks gestation. A large firm mass was palpated behind the stomach. A left subcostal incision was made and a smooth, 10 cm diameter cystic swelling was seen in the body and tail of the pancreas. There were no signs of invasion, inflammation, fat necrosis or overt rupture of the tumour. The tumour was opened and found to contain the same fluid as that found in the pelvis. The mass was thought to be a necrotic pancreatic cyst. Biopsies were taken of the wall and a cystgastrostomy was fashioned. Biopsy histology revealed a moderately differentiated, papillary, mucin secreting adenocarcinoma.Her pregnancy was confirmed and the patient requested termination which was performed just before distal pancreatectomy, lOdays after the original surgery. Excision of the tumour included a 2 cm cuff of normal pancreas, a cuff of stomach at the cystgastrostomy site, and the spleen. Histology showed a cystadenocarcinoma of the pancreas with separate areas consistent with benign cystadenoma. Her postoperative recovery was uneventful. DiscussionCystadenocarcinoma is biologically different from ductal adenocarcinoma of the exocrine pancreas. I t occurs a t a younger age (4&50 years) with a 3:l female preponderance'. The tumours originate from the exocrine glandular elements and malignant change may occur in benign cystadenomas'.'. There is frequently coexistence of malignant and benign elements allowing histological sampling error, thus prompting recommendation for total removal for histological examinationlS2. A 5-year survival rate of 65 per cent has been reported following complete excision of the carcinoma2. I n our patient the tumour was asymptomatic until the spontaneous leak during pregnancy. Leak from this malignancy has not been reported and pregnancy may have played some role. There have been recent reports of hormonal influence on experimental ductal carcinoma of the pancreas, with androgens stimulating and antiandrogens inhibiting tumour growth3. A report from Norway supports this premise and has shown increased survival in a small group of patients, with disseminated ductal carcinoma treated with tamoxifen4. Given these d a t a and the 3:l female preponderance in tumour incidence, it could be postulated that these tumours may be hormonally dependent. The effect of the pregnancy in our patient may have increased tumour activity and p...

Abstract-The Virtual Museum of the Pacific is a digital ecosystem implemented as Web 2.0 application that experiments with information and knowledge acquisition for a digital collection of museum artifacts from the Australian Museum. The Virtual Museum of the Pacific allows several search methods: attribute search based on a control vocabulary, query refinement and query-by-example but importantly it facilitates a number of social media interfaces that enable content to be added and tagged, the control vocabulary to be extended, user perspectives to be defined and narratives added via wiki. We characterize the design of the Virtual Museum of the Pacific as: a semantic Web application with a Web services back-end, and as a digital ecosystem by identifying its purpose, function and stakeholders. In doing so, the paper illustrates the issues encountered in its design and deployment, the technical platform, the historical context of the growth of the collection and the challenges to the organization and management of a digital ecosystem metadata model.

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In a study of 66 patients intubated to relieve dysphagia, 52 (79 per cent) survived the procedure and were discharged home. Of these, 23 (44 per cent) developed further dysphagia due to tube dysfunction, and 19 patients (37 per cent) were readmitted for further procedures to restore swallowing. With early intervention, the periods of dysphagia were short and the palliation so achieved was effective. Overall, intubation proved to be an effective method of relieving dysphagia in patients unsuitable for curative treatment.

EDITORIAL SYNOPSIS A patient with intussusception occurring in the course of a Salmonella typhimurium infection is described, and a review given of the literature of intussusception as a secondary complication to inflammatory diseases of known origin.

This paper reports a novel semantic web application developed to deliver a collaborative tagging system for a digital on-line museum. The key features of our application -called the Virtual Museum of the Pacific -concern the browsing and retrieval interface based on Formal Concept Analysis, the extensible distributed data model to support collaborative tagging and its web services implementation.