The use of clinical autopsy has been in decline for many years throughout healthcare systems of developed countries despite studies showing substantial discrepancies between autopsy results and pre-mortal clinical diagnoses. We conducted a study to evaluate over time the use and results of clinical autopsies in Sweden. We reviewed the autopsy reports and autopsy referrals of 2410 adult (age > 17) deceased patients referred to two University hospitals in Sweden during two plus two years, a decade apart. There was a decline in the number of autopsies performed over time, however, mainly in one of the two hospitals. The proportion of autopsy referrals from the emergency department increased from 9 to 16%, while the proportion of referrals from regular hospital wards was almost halved. The autopsies revealed a high prevalence of cardiovascular disease, with myocardial infarction and cerebrovascular lesion found in 40% and 19% of all cases, respectively. In a large proportion of cases (> 30%), significant findings of disease were not anticipated before autopsy, as judged from the referral document and additional data obtained in some but not all cases. In accordance with previous research, our study confirms a declining rate of autopsy even at tertiary, academic hospitals and points out factors possibly involved in the decline.

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Malignant struma ovarii' with peritoneal disseminationSir: Struma ovarii with metastases is extremely rare. Of the 27 cases reported in world literature, 13 manifested initial dissemination to the peritoneal cavity [1][2][3][4][5] . Owing to the rarity of the disease, little is known about its true nature and adequate treatment. Some authors have even questioned the malignant nature of the peritoneal spread, suggesting that, in the majority of cases, it might merely represent a sequestration of nodules from a benign struma ovarii 6 . Clinically, it is important to be aware of the condition as it can easily be confused with a disseminated ovarian carcinoma. The present report describes two additional cases.A 50 year-old-woman, para 1, was referred because of a right lower mass and post-menopausal haemorrhage. Explorative laparotomy disclosed a cystic tumour in the right ovary, approximately 150 mm in diameter. Multiple peritoneal lesions, mimicking endometriosis, and varying between 2 and 15 mm in size, were found in the omentum, on the bladder, and in the pouch of Douglas. The operation performed comprised a right salpingo-oophorectomy, subtotal hysterectomy, and resection of the omentum and some of the major peritoneal lesions. On the clinical suspicion of disseminated ovarian carcinoma the patient was referred for

Clinical and experimental observations suggest that oestrogens may influence immune reactivity. The oestrogen-binding properties of the human thymus were studied by the use of an aqueous two-phase separation technique. A specific, high-affinity and low-capacity binding was found in 9 out of 10 thymic tissue samples obtained from children and adults of both sexes, their ages ranging from 1 to 42 years. The association constant ( ± SD) for the oestradiol binding in human thymus was 3.7 ± 1.4 × 10⁹M^-1 and was in the same range as the receptor binding in the human uterus. The steroid specificity was found to differ from the classical oestrogen receptor. The concentration of oestrogen-binding sites ( ± SD) was 182 ± 181 fmol/mg protein and was higher than the receptor concentration of the uterus. According to histochemical analyses the binding is located in the reticulo-epithelial stroma rather than the thymocytes. Data suggest that the human thymus is a target organ for oestrogens which may influence lymphocyte function during therapy.

The ACTH cells of human foetal pituitary displayed intense formaldehyde-ozone-induced fluorescence characteristic of peptides or proteins with NH2-terminal tryptophan. Fourteen pituitary tumours were examined histochemically. Of these, two displayed formaldehyde-ozone-induced fluorescence. These two tumours were the only ones to exhibit ACTH immunoreactivity.