Background. Carcinoid tumors of the gastrointestinal tract are most common localized in the appendix, followed by the small intestine, the rectum, and the stomach. The localization of these tumors at the ampulla of Vater is extremely seldom. Methods. In the present study the authors describe two patients with carcinoid tumors of the ampulla Vater and review 71 previously published cases. Results. Most patients presented with jaundice, but without carcinoid syndrome. Because the tumor grows submucosally, preoperative diagnosis was correct only in 15%. Most tumors were around 2 cm in size. Metastasis to lymph nodes and/or liver was present in 45%. Standard treatment is Whipple resection or local excision in small tumors. Conclusions. Carcinoid tumors of the ampulla of Vater are an extremely rare clinical entity. Generally, the prognosis is good with a 5‐year survival period of 90%.

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SUMMARY Metatarsophalangeal and metacarpophalangeal joints from 3 patients with rheumatoid arthritis were investigated electron microscopically with regard to the occurrence of polymorphonuclear granulocytes (PMNs) at the pannus-cartilage junction. In all 3 cases PMNs could be detected at the junction and within the cartilaginous matrix. PMN cytoplasmic processes surrounded collagenous islands in the cartilage. From the morphological findings it is deduced that PMNs are cells capable of destroying cartilage in inflammatory joint diseases, in particular in rheumatoid arthritis.Using enzyme histochemical and immune histological investigations we recently demonstrated the appearance of polymorphonuclear granulocytes (PMNs) at the pannus-cartilage junction in rheumatoid joints.1-4 As some doubt remains about the specificity of the naphthol-AS-D-chloroacetate esterase reaction5 for the demonstration of PMNs with regard to the content of this enzyme in monocytes,fi we tried to characterise PMNs at the pannuscartilage junction by electron microscopy. MAterial and methodsSurgically removed metatarsophalangeal and metacarpophalangeal joints were fixed in buffered formalin. After decalcification in Versen (Titriplex III) the specimens were bisected. One half of the tissue was processed by the routine paraffin method, stained with haematoxylin-eosin and the naphthol-AS-D-chloroacetate esterase reaction.5 The second half was stored in formalin. Joints from 3 patients ( Table 1) with accumulations of PMNs at the pannuscartilage junction, proved by light microscopy, were chosen for electron microscopy. From areas corresponding to the histological PMN-rich foci small pieces of the articular cartilage with adherent pannus tissue were dissected and rinsed in water. Thereafter

We conclude from the increased release of toxic, allergic, and potentially carcinogenic ions adjacent to stainless steel that commercially pure Ti should be treated as the preferred material for osteosyntheses if a removal of the implant is not intended. However, neither material provoked a foreign-body reaction in the local tissues, thus cpTi cannot be recommend as the 'golden standard' for osteosynthesis material in general.

Utilizing monoclonal reagents directed towards antigens of the monocyte-macrophage lineage and Ia antigens, the tissue architecture of synovial membranes obtained from patients with non-inflammatory joint diseases and patients with rheumatoid arthritis was studied. Emphasis was placed on the localization of the type I, type II and type III synoviocytes that previously had been defined by their cell surface phenotype with regard to the expression of monocyte-macrophage lineage (M theta) and Ia antigens as well as by their phagocytic capacity or the ability to produce glycosaminoglycans. In patients with non-inflammatory joint diseases, cells with the M theta + Ia+ (type I) phenotype constituted the majority of synoviocytes immediately adjacent to the joint cavity; cells with this phenotype were also scattered in the subsynovial tissue and in the perivascular regions. The fibroblastoid type III cells defined by the absence of both M theta and Ia antigens formed the major cell population in the subsynovial tissue in this patient group. In patients with rheumatoid arthritis, the Ia+ M theta + cells were present in a characteristic double configuration forming an intensely positive layer adjacent to the intra-articular space followed by an Ia- M theta - layer that again was succeeded by an intensely Ia+ M theta + layer. Large numbers of synoviocytes bearing M theta + Ia+ antigens were also demonstrated in the diffusely inflamed subsynovial tissue, in the perivascular regions as well as around and within lymphoid infiltrates.(ABSTRACT TRUNCATED AT 250 WORDS)

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A BFigure 1, A and B. Polymorphonuclear granulocytes (arrows) accumulating at the pannuscartilage junction (K=cartilage). (Naphthol-AS-D-chloroacetate staining; nuclear staining with hematoxylin. Magnification X 328.)

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