We have undertaken esophagoscopy 1/2 to 17 1/2 years after surgery in 20 patients with a total gastrectomy and an esophago-jejunal anastomosis. In 5 cases we found a complete columnar lining of the distal esophagus (Barrett-esophagus). 2 other cases showed a multilocular columnar epithelium. One case with a Barrett-esophagus had endoscopy before surgery, and it could be proved that the columnar lining developed after surgery. We suspect that it was the same in the remaining cases. All examined patients, except one, showed an erosive esophagitis of varying severity. These observations support the current view that the columnar lined esophagus is usually an acquired one. The pathogenesis is not completely clear, but reflux of digestive juices destroying the squamous epithelium and impairing healing is the condition for columnar lining. The observations on patients with total gastrectomy prove that it must not necessarily be gastric juice. The very urgent question of the origin of columnar lining cannot be answered at present.

These features show an association of p21 over-expression with certain clinico-pathological parameters of gastric cancer. In this context, our data suggest that p21 immunoreactivity in more than 5% of the tumour cells has a predictive value for the course of adenocarcinoma of the stomach.

The management of pulmonary aspergilloma is still a topic of discussion. Demonstrating several cases of pulmonary aspergilloma, their clinical course and their follow-up, we try to contribute some arguments for the preference of an early operation. Between 1992 and 1998, 18 patients underwent thoracotomy for treatment of pulmonary aspergilloma. The most common indication for operation were hemoptysis [6] and indeterminate mass [6]. Lobectomy was the most frequent operation [11]. Underlying diseases were bronchiectasis [10], tuberculosis [3], carcinoma [2], blebs [2], and epitheloid granuloma. Two patients had postoperative complications, another three died later in the clinical course because of liver failure, septicemia, and persisting air leakage and sepsis. We recommend early resection of symptomatic, cavitating aspergilloma in the simple form and even with an inflammatory reaction of the surrounding tissue. Especially low-risk patients profit highly from an early operation. High-risk patients should be operated on only in cases of life-threatening complications.

Carcinoma of the nasopharynx is reported in young dizygotic male twins. Presenting symptoms were similar, and time of onset was almost simultaneous. They were both treated by telecobalt irradiation and are in full remission for over 2 years. Aspects of the peculiar racial distribution of this tumor are discussed. This appears to be the first report of a familial occurrence of this well‐known but rare tumor.

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