bluuebunny/crossref_metadata_2025 huggingface dataset:
NEPHRECTOMY FOR HYPERTENSION1
Authors: Maitland By A. I. L.
Published: December 2008

The position may be summarised thus. Nephrectomy for the hypertensive patient should be performed only after exhaustive tests of divided renal function have shown that one kidney is definitely of poor secretory quality and that the other one has an adequate reserve of function. The benefit which accrues will occur at any age but comes more freely to the younger patients. The hypertension should be labile and not of known long duration, and if the pressures return to normal and remain there for over a year this effect may well be permanent.

Lest it be thought that in this matter I am an advocate and not a judge, I should like to conclude by bringing before you the up‐to‐date clinical notes of a case first described during a discussion on hypertension at the Royal Society of Medicine in 1952.

Female, aged 16 years, seen August 1950. Increased pressure (170/120 mm. Hg) was discovered at a routine examination. Intravenous pyelography showed poor function of the left kidney, the right being normal. Retrograde pyelography of the left kidney showed a small normal outline. The differential renal analysis demonstrated very poor renal function on the left and not very good on the right (standard urea clearances: left, 1 06; right, 10–25). The pressure remained high after a week's rest in bed but was labile on sedation.

One year later conditions were essentially the same. She has been treated conservatively in view of a history of retention in infancy and in childhood and the doubtful function in the right kidney.

During a pregnancy in 1952 her blood‐pressure was found to be normal (140/90 mm. Hg). After parturition early in 1953 she was reinvestigated; the renal results were the same but her pressure was still normal (140/90 mm. Hg). She was seen on 3rd June 1957 when she was symptom‐free and her blood‐pressure 118/86 mm. Hg).
MYOBLASTOMA OF THE BLADDER NECK: REPORT OF A CASE
Authors: ANDERSEN RAGNAR , HÖEG KARI
Published: December 2008

We have observed a case of myoblastoma in the bladder neck in a 66‐year‐old man who was referred for urological examination for pyuria and hæmaturia. Cystoscopy revealed an ulcer of unusual appearance in the bladder neck. The ulcer and surrounding tissue were removed by transurethral resection with McCarthy's apparatus. The histological examination revealed myoblastoma. No signs of metastases were found on X‐ray examination of the lumbar spine, pelvis, and lungs. The patient is symptom‐free and there are no signs of recurrence.

As far as can be seen, this is the first published report of a benign myoblastoma in this region. It is important to have this diagnosis in mind in cases of unusual alterations in the bladder neck, and also for the histological diagnosis so that the case is not interpreted as cancer and incorrectly treated with radiotherapy which has no effect on myoblastomas. Horn and Stout (1943) report a case from the tongue which was treated with radium. They write: “This case provides evidence of the marked radio‐resistance of this type of neoplasm, since the tumour survived a sufficient dosage of radium to produce necrosis of the tongue.”
CYCLOSERINE IN THE TREATMENT OF INFECTION OF THE URINARY TRACT
Authors: SYME J. , SLEIGH J. D. , RICHARDSON J. E. , MURDOCH J. McC.
Published: December 2008

Forty patients with urinary tract infections were treated with cycloserine in doses of 250 mg. eight‐hourly for fourteen days. Whenever possible, bacteriological, biochemical, and radiological investigations were carried out before treatment. Thirty‐six patients (90 per cent.) had sterile urine seventy‐two hours after treatment; the results of follow‐up studies are presented. Serious toxic effects were encountered in two patients (5 per cent.).

Cycloserine is a valuable drug in the treatment of urinary tract infections which have failed to respond to the more commonly used drugs. It is especially likely to succeed where the causative organism is E. coli; less so in the case of B. proteus. Serious toxic effects are unlikely to arise with a dose of 250 mg. eight‐hourly: such treatment should be continued for at least fourteen days, fluid intake being restricted during this time. The risks of toxic effects will be minimised by biochemical assessment of renal function before, and estimation of plasma levels of the antibiotic during treatment. As with any other antibacterial agent, drainage defects of the urinary tract should be sought and, if possible, corrected before treatment. Clinical and bacteriological follow‐up should be prolonged.

We wish to thank Messrs Eli Lilly and Company Limited for a generous grant to defray laboratory expenses and for supplies of cycloserine. Dr S. C. Frazer kindly carried out the chemical estimations of cycloserine. We are indebted to Mr W. S. Tulloch for carrying out the surgical urology, and to Professor R. J. Kellar for referring many of the patients from his department.
SPONTANEOUS RUPTURE OF THE BLADDER
Authors: HAMMAR B.
Published: December 2008

Two cases of spontaneous rupture of the bladder are described, occurring secondarily to lesions of the bladder wall, viz., carcinoma and bilharziasis. The aetiology, clinical picture, and treatment are described and the literature is briefly reviewed.
CONGENITAL ANOMALIES OF THE URINARY TRACT AND THEIR ASSOCIATION WITH SPINA BIFIDA
Authors: ROBERTS J. B. M.
Published: December 2008

Spina bifida is commonly associated with congenital anomalies of the urinary tract. These anomalies are discussed and their incidence in 179 cases of spina bifida is described. It is suggested that this relationship is of significance to urologists, who are increasingly likely to have to face urinary problems in patients with spina bifida.
THE PERINEAL PROSTATECTOMY: A MODIFIED YOUNG TECHNIQUE FOR CONSERVATIVE ENUCLEATIONS
Authors: ARNOLD JASPER H.
Published: December 2008

Because of its minimal morbidity the perineal prostatectomy merits wider use for conservative enucleations in men who are not sexually active, or who are severely debilitated. The relationships of the levator prostata? muscle to the urogenital diaphragm and the relationship of the rectum to the levator prostatas with the patient in the perineal position are not adequately described in the literature and the correct concepts which are important to the successful execution of this operation are discussed and illustrated. Hemostatic sutures which coincidentaliy close the capsular incision are described.
DIVERTICULA AND FISTULÆ OF THE URETHRA IN PARAPLEGICS1
Authors: GRIFFITHS I. H. , WALSH J. J.
Published: December 2008

Thirty‐one cases of fistula of the urethra were encountered at the National Spinal Injuries Centre amongst 2,060 male paraplegics. Only two cases developed during treatment at the centre itself. Ten fistulae were due to avoidable external causes, and twenty fistulas were due to mismanagement of a urethral catheter. Treatment is discussed and a new application of Turner Warwick's principle is described for the more extensive and recurrent urethral diverticula.
QUANTITY AND QUALITY IN THE DIAGNOSIS OF URINARY TRACT INFECTIONS1
Authors: Gould J. C.
Published: December 2008

Each patient under investigation for urinary tract infection should have a full series of specimens examined, diagnostic or pre‐treatment, during treatment, and for clearance and follow‐up.

Quantitative examination should be carried out in combination with a careful interpretation of the quality of the microflora present, its relative proportions, the presence or absence of antibiotic substance, the time interval between sampling and examination, the method of collection, and the results interpreted in the light of knowledge of the previous history of the case.
THE USE OF P32 IN THE TREATMENT OF SEVERE PAIN FROM BONE METASTASES OF CARCINOMA OF THE PROSTATE1
Authors: Smart J. Gordon
Published: December 2008

Nine cases of carcinoma of the prostate with severe pain from bone metastases are reported together with the results of their treatment with a combination of testosterone and P32. Two patients were terminal at the time of treatment (Cases 3 and 5), the former dying just after completion of the treatment and the latter a month after treatment. Both, however, had considerable relief of pain. Three patients (Cases 1, 2 and 6) had total relief of pain, subsequently dying of their disease between four and six months later. One case (Case 8) showed no response to P32 therapy and died at three months. Of the remaining three cases, two had 90 per cent. relief (Case 4 for five months with the aid of two courses of treatment and Case 9 for seven months). Case 7 had 50 per cent, relief for two months.

The literature is reviewed and the results compared with other therapeutic measures.

It is concluded that P32 therapy may result in the total or marked relief of the pain from bone metastases from carcinoma of the prostate for a period of months and more extensive trials are indicated.

Attention is drawn to the necessity for close observation of the blood picture in the early weeks following P32 therapy.

My thanks are due to Mr T. W. Mimpriss for permission to treat eight of his cases and for his encouragement and advice. I also thank Mr Murray Pheils for his permission to treat Case 4.
COMPENSATORY STRUCTURAL AND FUNCTIONAL CHANGES IN THE KIDNEY1
Authors: Lodge By Thomas , Williams J. L.
Published: December 2008

1. The radiographic assessment of the renal size and the factors influencing renal hypertrophy are discussed.

2. The importance of compensatory hypertrophy and its prognostic significance is emphasised. These changes are correlated with renal function as measured by the glomerular filtration rate and renal plasma flow.

3. Renal hypertrophy is considered in its relationship to the recovery of function following relief of ureteric obstruction.

We wish to thank Mr J. C. Anderson, O.B.E., under whose care several of the patients were admitted, and Dr R. G. Grainger for the aortogram of Figure 6.
CELL PROLIFERATION IN COMPENSATORY RENAL GROWTH1
Authors: Bury H. P. R. , Crane W. A. J. , Dutta L. P.
Published: December 2008

Rats with one kidney removed showed a progressive increase in weight of the remaining kidney over a six‐week period.

Autoradiographic and radiochemical studies with 3H‐thymidine indicated that the increase in new kidney cell formation was maximal forty‐eight to seventy‐two hours after unilateral nephrectomy. This early response was chiefly due to the production of new cells by the renal cortical tubules. Normal rates of tubule cell turnover were achieved two weeks after operation. The glomerular tufts contained fewer new cells and their peak production was delayed to the one‐week period with a slow decline thereafter.

Rats forty‐eight hours after unilateral nephrectomy were chosen as a model to study the effect of various substances on the magnitude of new cell formation. The number of DN A‐synthesising cells in the stimulated kidney was reduced by treatment with hydrocortisone, ACTH, 9,10‐dimethyl‐1,2‐benzanthracene, and 1,2‐benzanthracene; the numbers were increased by the administration of deoxycorticosterone and aldosterone.
PATHOLOGICAL CHANGES IN SIX TREATED BABOON‐TO‐MAN RENAL HETEROTRANSPLANTS
Authors: Porter K. A. , Marchioro T. L. , Starzl T. E.
Published: December 2008

Six baboon‐to‐man renal heterotransplants, each consisting of a pair of kidneys, were examined. Two had been removed from their recipients at forty‐nine and sixty days after transplantation because of the ever‐increasing doses of immunosuppressive drugs needed to control rejection; the other four pairs of kidneys were examined after death of the recipients at nineteen, twenty‐three, thirty‐five, and forty‐nine days.

All the kidneys were enlarged. On the subcapsular surfaces of one pair there were petechias; four were mottled with irregular haemorrhages and infarcts; one pair had undergone almost complete hemorrhagic infarction.

The transplants were heavily infiltrated with plasma cells, lymphocytes, large pyroninophilic lymphoid cells and eosinophils. Mitoses, “LE” cells and erythrophagocytosis were seen. Associated with this infiltration there was rupture of peritubular capillaries, interstitial cedema and widespread tubular damage.

Fibrinoid necrosis of the walls of arterioles and interlobular arteries, with narrowing and obstruction of some vessels by fibrin and platelet deposits on the intima were common in all except one pair of kidneys. Associated with these vascular lesions there were focal infarcts and extensive interstitial haemorrhages.

All the histological changes were more severe than those seen either in treated human renal homotransplants or in a comparable series of chimpanzee‐to‐man renal heterotransplants where cellular infiltration was slight and vascular lesions only present at the height of rejection.

This work was aided by grants A‐6283, A‐6344, HE‐07735, AM‐07772, A1‐01452, and OG‐27 from the U.S. Public Health Service, and by a grant from the Medical Research Council.

We would like to thank Drs D. Baitlon, J. Gordon, R. B. Hill, D. Lang, and D. E. Smith who performed the autopsies on these cases. We are particularly grateful to Dr D. T. Rowlands, who supervised most of the autopsies, for his helpful co‐operation throughout this study.

Expert assistance in preparing the sections and photomicrographs was given by Miss Jane Rendall.
TECHNICAL ASPECTS OF CADAVERIC RENAL TRANSPLANTATION
Authors: Calne R. Y.
Published: December 2008

A brief account is given of the present surgical techniques used in cadaveric renal transplantation at Westminster Hospital. It has been possible to obtain excellent initial function in cadaveric renal transplants in man by removing the kidney as soon as possible after death, cooling it by perfusion with chilled Ringer's solution containing human albumin and keeping the kidney in a vacuum flask surrounded by ice until the vessels of the recipient are mobilised and ready for anastomosis to the renal vessels.

I wish to express my gratitude to the medical and nursing staff of Westminster Hospital for their continuous help and support in this work; to the Blood Transfusion Service for providing the human albumin; to Dr J. B. MacGillivray for taking the photomicrographs, and to Mrs Ann Helm and the Department of Medical Illustration, Westminster Hospital, for the drawings and photographs.
STILBCESTROL DIPHOSPHATE (HONVAN) IN THE TREATMENT OF ACUTE URINARY RETENTION DUE TO PROSTATIC CARCINOMA1
Authors: Parton Ian
Published: December 2008

In a series of fifty cases (two with extreme difficulty, four with retention and overflow, forty‐four with acute retention) intravenous Honvan was given in daily doses of 500 to 1,000 mg. for five to ten days, the commonest dose being 1,000 mg. daily for five days. In thirty‐three (66 per cent.) cases no surgery was required, the other seventeen (34 per cent.) being treated by transurethral resection. Unless the patient is very old or feeble, prostatic biopsy is essential if any doubt exists about the diagnosis. Once the patient is ambulant and voiding, an oral oestrogen is usually more convenient, as well as being cheaper than an intravenous one. A trial of Honvan is specially recommended for the bad‐risk case of prostatic carcinoma with acute urinary retention.
EARLY ATTEMPTS AT REHABILITATION OF TERMINAL UREMIC PATIENTS BY PERIODIC HEMODIALYSIS
Authors: Rae A. I. , Pomeroy J. , Rosen S. M. , Silva H. , Shaldon Stanley
Published: December 2008

Early experiences with periodic hemodialysis in four patients with terminal renal failure are reported. Initial improvement was followed by mental deterioration, wasting and peripheral neuropathy. These poor results were attributed to inadequate hæmodialysis. Hypertension could not be controlled by hypotensive drugs alone. Prolonged rehabilitation can be achieved only by twice‐weekly hæmodialyses with rigid sodium and water restriction and a reduced protein intake.
URETHROPLASTY
Authors: Shun‐Shin M.
Published: December 2008

A one‐stage operation for the repair of impassable strictures of the urethra, using split‐skin graft, is described.

Ten cases have been done during the past five years and in only one case has a stricture recurred. This failure is ascribed to the fact that excessive hæmorrhage necessitated packing of the wound and the application of the graft during a second operation.

My thanks are due to H.E. Sir John Shaw Rennie, Governor of Mauritius, for permission to publish the above article and to Dr Y. Cantin, my former chief, for his kind assistance and advice during the first operation.
CLINICAL EXPERIENCE WITH RENAL TRANSPLANTATION1
Authors: Straffon Ralph A. , Nakamoto Satoru , Kolff Willem J.
Published: December 2008

The results of our first thirty‐five cases of renal homotransplantation performed on thirty‐two patients are reported. Of the twenty patients living, seven received kidneys from live donors and all of these patients have functioning kidneys. In addition, these patients are all out of the hospital and are living normal or relatively normal lives. In general, the renal function has been maintained somewhat better than in the majority of the cadaver transplants. There are thirteen patients living who had cadaveric renal homografts. Of this group, eleven have functioning kidneys and two required nephrectomy of the homograft and are being maintained on chronic dialysis. Four of these patients are still in the hospital at this time, but the remainder are leading normal or relatively normal lives.

Experience obtained to date would seem to indicate that clinical experiments with renal transplantation are of such success as to encourage further work in this field. We are particularly hopeful that the utilisation of cadaver donors will continue to be a rewarding one. There remain many questions to be answered, but careful work in this field should provide many of the answers.
CAVOGRAPHY IN THE ASSESSMENT OF RENAL TUMOURS
Authors: Wright F. W.
Published: December 2008

Cavography may be helpful in showing extension of tumour into the inferior vena cava in cases of renal carcinoma especially on the left side where radical cure is impossible, except by an anterior approach. The examination may also show para‐aortic glands resulting from renal tumours.
THE EFFECT OF ORAL PHOSPHATE IN PATIENTS WITH RECURRENT RENAL CALCULUS
Authors: Edwards N. A. , Russell R. G. G. , Hodgkinson A.
Published: December 2008

The administration of disodium hydrogen phosphate dihydrate (12 g. daily) to male patients with recurrent calcium‐containing renal stones resulted in an increased urinary excretion of orthophosphate, pyrophosphate, and citrate and a decreased excretion of calcium and magnesium.

The decrease in urine calcium and magnesium was accompanied by an increase in fascal calcium and magnesium but the change in the fasces was less marked than in the urine and the net effect was a more positive calcium and magnesium balance.

Favourable results were observed in eighteen patients with frequently recurring calculi who received orthophosphate for periods varying up to two years. In two other cases, however, there was radiological evidence of new stone formation.

The changes in urine composition resulting from phosphate supplementation and deprivation are discussed in relation to their effect on the “crystallising propensity” of urine.
THE RÔLE OF THE VESICAL MUCOSA IN REFLEX MICTURITION
Authors: Sabetian M.
Published: December 2008

Evidence has been cited that the mucosal‐submucosal lining of the bladder incorporates a rich plexus of nerve endings and end organs.

 It is shown that a pharmacological exclusion of this complex by the application of large doses of local anaesthetic agents does not suppress or impede the development of involuntary micturition in the lightly anaesthetised animal. It is concluded that normally the mucosal‐submucosal complex has no appreciable role in the genesis of the micturition reflex.

 The application of a surface irritant to the mucous lining of the bladder is shown to have a powerful disturbing effect, causing premature reflex emptying. It is suggested that this is akin to nociceptive reflexes in some spinal states and may explain the symptoms of frequency and urgency in inflammatory disease of bladder in the human patient.
VESICOUTERINE FISTULA
Authors: Willson‐Pepper J. K.
Published: December 2008

A case of vesicouterine fistula following on Caesarean section is described. The case is briefly discussed and the literature reviewed.
VENO‐VENOUS CANNULA FOR HÆMODIALYSIS
Authors: Bisson P. G. , Parker A. S.
Published: December 2008

An indwelling veno‐venous cannula is described by which numerous hemodialyses can be performed with one cannulation. The risk of infection and of thrombo‐embolic phenomena has been minimal possibly because of the continuous infusion of a small amount of heparin. The cannula makes easy the taking of blood for biochemical investigation. The use of a heparin perfuser could be beneficial, as this would enable the patient to become ambulant more quickly.
THE PHYSICAL BASIS OF THE USE OF RUBIDIUM‐86 TO MEASURE RENAL BLOOD FLOW BY EXTERNAL SCINTILLATION COUNTING
Authors: Sear R. , Blandy J. P. , Ritchie H. D.
Published: December 2008

It has been shown by measurements on a phantom with a scintillation counter, using a If by 2 in. crystal, that the count rate expected externally to the body over a normal human kidney after an intravenous injection of Rb‐86 would be about two and a half times that obtained when the counter is moved off the kidney.

 To achieve this result, the collimation must be such that when the counter is correctly positioned over the centre of the kidney the latter almost entirely fills the field of view, and the shielding must nowhere be less than the equivalent of 1 ½cm. of lead plus 2 ½ cm. of steel.
NEW SURGICAL TREATMENT OF BLADDER TUMOURS: MUCOSAL DENUDATION OF THE BLADDER
Authors: Harada Naohiko , Yano Hisao , Ohkawa Tadashi , Misse Toru , Kurita Takashi , Nagahara Atsushi
Published: December 2008

Mucosal denudation of the bladder is a simple and reasonable form of treatment for multiple papillary tumours of the bladder. The method is more radical than simple resection of the tumour. A combination of this method with segmental resection of the bladder might be a valuable operative technique in the treatment of certain bladder tumours.
BACTEREMIA, SEPTICæMIA AND INTRAVASCULAR HEMOLYSIS DURING TRANSURETHRAL RESECTION OF THE PROSTATE GLAND
Authors: Kidd Elizabeth E. , Burnside Kennedy
Published: December 2008

Blood, urine and prostate cultures and estimations of intravascular hæmolysis were performed on forty‐seven patients during transurethral resection of the prostate gland.

No relationship was established between the presence of a positive blood culture and intravascular hæmolysis.

The source of the five observed blood‐stream infections appeared to be the urine or prostate.

The occurrence and extent of hæmolysis was shown to be related to the length of operation.

The importance of bacteræmia and intravascular hæmolysis is discussed in relation to renal failure and post‐operative complications.
RETROPUBIC PROSTATECTOMY AND SIMULTANEOUS INTRAPELVIC HERNIAL REPAIR1
Authors: Riba Leander W. , Apfelbach G. Leonard , Uehling David , Logan Donald
Published: December 2008

One hundred and sixty‐five cases of retropubic prostatectomy are presented. A simple technique is outlined and its short and long term results evaluated. Spinal anæsthesia augments wound relaxation during surgery and frequently avoids chest complications in the older age group. Simultaneous elective hernioplasty at the time of prostatectomy is strongly advocated. Routine vasectomies prevent epididymitis. Sexual function is preserved at the pre‐operative level. The high incidence of late vesical neck obstruction following retropubic prostatectomy is noted. The development of muscular hypertrophy is most interesting and its development is unexplained.
SURGICAL THERAPY FOR ABNORMALITIES OF THE URINARY SPHINCTER IN THE FEMALE1
Authors: Lapides Jack
Published: December 2008

In the female the urinary sphincter is synonymous with the proximal three‐fourths of urethra and is a tubular structure with a wall composed of smooth muscle and elastic tissue. The efficiency of the tube as a sphincter varies directly with the length of intact urethra.

Most cases of non‐neurogenic urinary incontinence are due to a decrease in length of intact urinary sphincter. The shortened sphincter may be caused by a drooping of the urethra in the erect position, a defect in the wall of the urethra or by a defective urethra which droops.

Treatment incorporates restoration of normal length to the involved urethra by anterior urethropexy, excision of the urethral defect or by a combination of the two procedures. Posterior buttressing of the urethra and urethrocystopexies which do not lengthen the urethra are inadequate, unphysiological procedures for restoring urinary continence.
URINARY INCONTINENCE IN DISORDERS OF THE NERVOUS SYSTEM1
Authors: Gibbon N. O. K.
Published: December 2008

The physiology of the bladder is reviewed briefly with special reference to continence.

 The effects of disorders of the nervous system upon bladder function are considered.

 The mechanism and significance of incontinence in nervous system disorders are discussed. The point is made that the loss of bladder control is often associated with retention of urine and complications in the upper urinary tracts. Treatment of the incontinence takes its place, therefore, as part of the general urological management.

 The management of incontinence of neurological origin is outlined.

 Enuresis.–The special problem of the adult enuretic with diurnal frequency and urgency‐incontinence is raised. The effect of entero‐cystoplasty in five such cases is reported. Reference is made to the possibility of treating such cases by partial division of the sacral parasympathetic outflow.

 The Future.–Brief reference is made to the new prospect opened up for the paraplegic by the development of electrical stimulators which can be applied to the bladder and the external sphincter.
THE PRINCIPLES GOVERNING THE TREATMENT OF STRESS INCONTINENCE OF URINE IN THE FEMALE1
Authors: Jeffcoate T. N. A.
Published: December 2008

The female urethra is normally empty at all times except during voiding, and this means that continence is maintained by the internal sphincter at the urethro‐vesical junction.

 The urethral resistance made up by muscle tone and elasticity of the urethra itself, and the external urethral sphincter, each offer secondary defence mechanisms which can sometimes prevent the escape of urine which leaks past an incompetent urethro‐vesical junction.

 Continence does not ordinarily depend on the length of the urethra nor on its position in the pelvis. The incidence of stress incontinence is the same in women without as in those with prolapse.

 Radiological studies of the urethra and the bladder base must include lateral views and care is needed over the technique to avoid the many possible artefacts and misinterpretations. The radiological sign of loss of the posterior urethro‐vesical angle, which indicates an incompetent internal sphincter, is seen in 90 per cent. of cases of stress incontinence. I n the remainder the radiographs usually show another cause and give a clear lead to treatment.

 Stress incontinence is only rarely the result of trauma to the sphincter mechanism. Its leading cause is pregnancy and not labour, the conditions of pregnancy serving to reveal an intrinsic weakness in the tissues.

 It is probably the high level of steroid hormones during pregnancy which lowers the tone of the internal sphincter. This explains why stress incontinence in the non‐pregnant woman is most troublesome during the premenstrual phase, and why this complaint can be induced by administering continuously large doses of estrogen and progestogens to previously continent women.

 Operations such as bladder‐neck plication posteriorly or anteriorly, urethropexy, urethrocystopexy and urethral sling operations all cure by the same mechanism. They tighten the internal sphincter and restore the radiological anatomy of the urethro‐vesical junction to normal.
THE VALUE OF SIGMOID‐MYOTOMY IN REDUCING BOWEL PRESSURE AND THUS AVERTING RENAL DAMAGE FOLLOWING URETEROCOLIC ANASTOMOSIS1
Authors: Daniel Owen , Ram R. S.
Published: December 2008

Reference is made to a simple method of measuring intracolonic pressure. This pressure shows marked individual variation, in one‐third of subjects exceeding 30 cm. of water and predisposing to renal failure following ureterocolic anastomosis. Sigmoid‐myotomy is a safe and effective method of reducing pressure to levels compatible with successful transplantation of the ureters. Potentially high bowel pressure may escape detection, even after repeated study, unless drugs are used to stimulate maximal contraction.
MANAGEMENT OF URETERIC STONE: A REVIEW OF 292 CASES1
Authors: Fox Miles , Pyrah L. N. , Raper F. P.
Published: December 2008

The management of 292 patients with stone in the ureter treated in the Department of Urology in Leeds between 1957 and 1962 is described. Indications for conservative and operative procedures are discussed in the light of follow‐up results.
RESULTS OF THE TREATMENT OF STRESS INCONTINENCE IN WOMEN1
Authors: Wesolowski Stefan
Published: December 2008

Sixty patients were operated on for stress incontinence: forty‐four with the Ingelman‐Sundberg operation (fourteen failures); twelve with the Marion operation (five failures); four cases with the Marshall‐Marchetti operation (no failures). Out of the sixty patients forty‐one were cured.
PHÆOCHROMOCYTOMA: Advances in Accuracy of Diagnosis and Safety of Treatment in the Past Decade: a Report of Three Cases
Authors: Siegel Jerald , Stackpole Robert H. , Lattimer John K.
Published: December 2008

Three patients with phæochromocytoma operated upon at the Kingsbridge Veterans Administration Hospital are reported, as a comparison of methods available in 1949, 1951, and 1962. The first patient was operated upon in 1949 for a single adrenal phæochromocytoma. The second patient had bilateral lumbocostal incisions, in the prone position, for a right adrenal phæochromo‐cytoma in 1951. The third patient had a bilateral adrenal phæochromocytoma excised in 1962. During the thirteen‐year period, advances and refinements in technique have taken place. These changes have been described and include:–

 More accurate diagnostic tests, namely:

 Twenty‐four‐hour urinary catecholamine determination.

 Urinary and serum VMA.

 Better and safer techniques for the localisation of tumours by using carbon dioxide via the presacral route for retroperitoneal pneumography and nephrotomography.

 Safer anaesthetic management.

 Successful blood‐pressure regulation during and after operation with the use of:

 Regitine for controlling hypertension.

 Norepinephrine for controlling hypotension.

As a result of our study, supported by the experience at the Presbyterian Hospital, it is our opinion that a transverse, transperitoneal incision be utilised. The prone position should be avoided because of poor exposure of the great vessels and Regitine should not be given in the immediate pre‐operative period. We feel that careful regulation of blood‐pressure is essential for a favourable prognosis. Anaesthetic agents which cause cardiac complications such as cyclopropane and chloroform are to be avoided.
COMPARISON OF NITROFURANTOIN AND NITROFURAN 246 IN THE TREATMENT OF INFECTIONS OF THE URINARY TRACT
Authors: KAFETSIOULIS A. , SELKON J. B. , SWINNEY J. , YEATES W. K.
Published: December 2008

Forty–six patients were admitted to the study, 26 treated with a new nitrofuran (NF246) and 20 with nitrofurantoin. The response to treatment was evaluated bacteriologically. The results obtained show that there is no significant difference between NF246 and nitrofurantoin in treating urinary tract infections.

No clinical side–effects were observed in the group of patients treated with NF246, whereas two of the patients treated with nitrofurantoin reacted adversely. Three patients allergic to nitrofurantoin tolerated the NF246 uneventfully.

We would like to thank the Smith Kline and French Laboratories Limited for the supply of NF246 anp nitrofurantoin (Furadantin) tablets.
TESTOSTERONE–INDUCED ACTIVATION OF FIBRINOLYSIS IN CARCINOMA OF THE PROSTATE
Authors: ROSSWICK R. P.
Published: December 2008

A case is recorded in whom the administration of testosterone, as a preliminary to P32 treatment for the pain of bony metastases, induced a fibrinolytic state which was corrected by giving EACA. No further fibrinolysis occurred even though the testosterone treatment continued. The same events occurred after a second course of treatment. This is the first report of a possible dangerous complication of this valuable treatment of so distressing a condition.

My thanks are due to Mr H. F. Anderson, under whose care the patient was admitted, and to Dr J. W. Hamer for the hematological investigations and advice on therapy.
PERFORATION AS A COMPLICATION OF CARCINOMA OF THE BLADDER
Authors: GLASHAN ROBIN W.
Published: December 2008

Spontaneous rupture of the bladder is defined. Carcinoma as a cause is rare. Reports of two cases are recorded where carcinoma was the underlying pathology. The condition would appear to be very rare in the female.

My thanks are due to Mr W. Barr Stirling and Mr W. Reid for allowing me to publish details of cases under their care.
PROLIFERATIVE CHANGES IN BLADDER MUCOSA AND CARCINOMAIN SITU
Authors: BLAKE J.
Published: December 2008

A case of proliferative mucosal changes in the bladder, associated with generalised carcinoma in situ is presented, and the pre–malignant nature of the proliferative lesions is discussed.

I am grateful to Mr R. Cox, under whose care the patient was admitted, for permission to publish this account. My thanks are also due to Dr I. M. Dawson, who reported the histology, and together with Dr R. C. B. Pugh gave much helpful advice and criticism, and to the Photographic Department of Westminster Hospital.
ADENOCARCINOMA OF THE URETER SECONDARY TO URETERITIS CYSTICA
Authors: RICHMOND H. G. , Path M.C. , ROBB W. A. T.
Published: December 2008

The clinical and pathological features of an unusual case of primary adenocarcinoma of the ureter are described. Metastatic growth was confined to the regional lymph nodes. Evidence is presented to show that this tumour developed secondary to ureteritis cystica.
LIPOGRANULOMATA OF MALE GENITALIA
Authors: O'ROURKE M. G. E.
Published: December 2008

SUMMARY AND CONCLUSIONS

Two cases of lipogranulomata of the male genitalia are presented.

They may present as an acute disease or as a more chronic lesion with symptoms and signs coming on months or years after injection.

Often there is no history of injection and the patient is apt to be psychiatrically abnormal.

There is a febrile reaction but no leucocyte response. In one case there was splenomegaly.

The treatment is surgical removal of the affected skin and indurated subcutaneous tissue. The macroscopic and microscopic features are described.

I wish to thank Mr E. J. Radley–Smith and Mr A. Emlyn Williams for permission to publish these cases which were admitted under their care. I would also like to express my thanks to Mr John Hopewell and Mr H. Daintree Johnson for their most helpful criticism and suggestions.
LEUKOPLAKIA OF THE BLADDER:A Report on 20 Cases, including 2 Cases Progressing to Squamous Cell Carcinoma
Authors: O'FLYNN J. DERMOT , MULLANEY JOAN
Published: December 2008

A series of 20 cases of leukoplakia of the bladder is reported.

Details of clinical and pathological findings and of treatment are given.

Two further cases of leukoplakia progressing to squamous cell carcinoma are reported.

The problem of the treatment of this condition is discussed.

We wish to thank our colleague, Mr Victor Lane, for his co–operation in the study of these cases.
EXPERIMENTAL STUDIES OF HUMAN BLADDER CANCER: HETEROTRANSPLANTATION TO THE HAMSTER CHEEK POUCH
Authors: KAUFMAN JOSEPH J. , LICHTENAUER PETER
Published: December 2008

An experimental testing method was devised to study in vivo the chemo–responsiveness of human bladder tumours growing as xenografts in the hamster cheek pouch. These tumours maintained their human specificity. Some parallels were observed between the response of these tumours to 5–Fluorouracil and Mitomycin–C and clinical observations of the effectiveness of these drugs in treating patients with bladder cancer.
RENAL NEOPLASM IN THE NEWBORN INFANT
Authors: FRASER G. C.
Published: December 2008

A case of renal neoplasm in a newborn infant is presented. The literature is reviewed with regard to the pathology of such tumours and their management.

I wish to thank Mr Innes Williams for permission to report this case and also Drs Claireaux and Berry of the Morbid Anatomy Department for reporting the histology and providing the photomicrographs.
CHANGES IN WHOLE BODY POTASSIUM ASSOCIATED WITH URETERO–INTESTINAL ANASTOMOSES1
Authors: WILLIAMS R. E. , DAVENPORT T. J. , BURKINSHAW L. , HUGHES D.
Published: December 2008

Our experience has been that the measurement of whole–body potassium has revealed a deficiency in the majority of patients with uretero–colic anastomoses. This deficiency is not reflected by the plasma concentration of potassium. No similar effect was observed among a group of patients with ileal conduits.
SURVEY OF LONG–TERM RESULTS OF TOTAL URINARY DIVERSION 1
Authors: MURPHY JOHN J. , SCHOENBERG HARRY W.
Published: December 2008

Fifty–four patients subjected to total urinary diversion by the use of isolated bowel conduits were completely re–evaluated 4 to 14 years after surgery. Review of the problems encountered and their management emphasises the need for frequent careful post–operative re–evaluation of these patients.
OBSERVATIONS ON THE EFFECT OF LOWER URINARY TRACT OBSTRUCTION
Authors: BULCKE C. VAN DEN , HENNEBERT P. N.
Published: December 2008

Observations are made on the effect of lower urinary tract obstruction in Africans. These observations are remarkably different from those made up till now. This difference may lie in an anatomical difference of the uretero–vesical junction in the African and in a different reaction of the lower urinary tract on lower urinary obstruction.
BLOOD CELL EXCRETION RATES
Authors: ELLIOTT Surgeon Lieut.–Commander D. H. , PEAD P. J.
Published: December 2008

1. Two methods for the quantitative estimation of formed elements in the urine have been compared. Using a stable suspension of red cells prepared by serial dilution it has been found that the counting chamber gives results within 10 per cent. of the predicted value whereas less than 50 per cent. of the cells are found by filtration of the urine.

2. Using the counting chamber technique, the range of values in 104 apparently healthy young men was determined. The upper limit of normal rates for red cell excretion may be given by the 95 percentile as 56,000 cells per hour, 1,120 cells per ml., and for white cell excretion as 216,000 cells per hour, 3,900 cells per ml.

3. A timed collection of urine is not essential as there is a high correlation between cells excreted per hour and cells excreted per millilitre of urine.
THE RECTILINEAR SCANNER
Authors: WALKER R. H. SECKER
Published: December 2008

Kidney scanning is a simple and safe way of estimating relative functioning renal mass and assessing areas of regional dysfunction. It is usefully combined with measurements of the rate of uptake of 197 Hg chlormerodrin. Processing the data by digital computer is likely to add considerably to the information obtained from scans.

By combining conventional kidney scanning with vascular scanning it is possible to distinguish cysts from tumours.
The Single Ectopic Ureter
Authors: MOGG RICHARD A.
Published: December 2008

The embryology of the single ectopic ureter is discussed. 3 cases of single ectopic ureter, 1 bilateral and 2 unilateral, are described together with the methods of investigation and treatment.
Experimental Ureteric Obstruction
Authors: OSBORN DAVID , LEE JULIUS , WILLIAMS GRANT
Published: December 2008

Renal function during and after release of a short period (less than 2 hours) and following release of a long period (6 hours) of total ureteric obstruction in the rat was studied in 2 series of experiments.

Ureteric end pressures were found to be significantly higher in diuretic compared to dehydrated rats in the short period series of experiments. In both series of experiments nephron recovery following release of ureteric obstruction was greater in dehydrated compared to hydrated rats.

The reasons for the difference of results in hydrated compared to dehydrated rats and sites of nephron damage are discussed.

Possible relevance to clinical work is also propounded.
Anatomical Factors in Prostatitis
Authors: BLACKLOCK NORMAN J.
Published: December 2008

The intrinsic anatomy of the prostate and the sphincter mechanism of the urethra allows more objective consideration of the aetiology of prostatitis and its pathology.

The pathological anatomy provides a further reason for the anomalies in the characteristics of the EPS and the difficulty of cure in some cases.

It furthermore provides support for a transurethral approach to surgical cure in the cases which advance to this stage.
The Post‐natal Development of the Muscle and Connective Tissue of the Normal Ureter‐A Quantitative Study
Authors: GILL GORDON W. , EMERY JOHN L.
Published: December 2008

A quantitative study of the muscle and connective tissue using a Point‐Counting technique and measurements of the extravesical and intravesical ureters was carried out on normal ureters from infants and children (age range 0 to 6 years).

Ureter growth‐both intra– and extravesical‐was found to be directly proportional to the height of the child. There is progressive development of muscle and connective tissue. During the period from 0 to 6 years the growth of muscle appears to be due to a progressive increase in the number of muscle cells. Normal values are presented for intravesical and extravesical ureter length and musculature.
Autonomic Innervation of the Renal Calyx
Authors: LONGRIGG NEIL
Published: December 2008

Isolated strips of pig renal calyx undergo spontaneous rhythmical changes in tension.

Noradrenaline, adrenaline and phenylephrine mediate their stimulatory effects by interaction with α‐adrenoceptors, and isoprenaline its inhibitory effect via β‐adrenoceptors.

Acetylcholine exerts a similar excitatory action via muscarinic receptors.

Evidence is presented for innervation of the a‐adrenoceptors, although this innervation appears to be relatively sparse.
Hydatid Cysts of the Kidney: Simulating Similar Kidney Lesions
Authors: SHAWKET TALAL N. , AL‐WAIDH MACKI
Published: December 2008

Five cases of atypical hydatid cyst of the kidney are present.

Four cases simulated kidney tumours and 1 an infectious lesion, but were misdiagnosed on account of the absence of the typical signs and finding of hydatid disease.

With the increase in world travel hydatid disease should be included in the differential diagnosis of all other kidney masses, especially when they are atypical.
Calcium‐47 Absorption in Urolithiasis
Authors: BLACKLOCK N. J. , MACLEOD M. A.
Published: December 2008

The intestinal calcium absorption was measured in a group of stone formers using an external isotope counting technique.

Hyperabsorption was found in 82% and was even more prevalent in the recurrent cases.

Comparison of absorption with urinary calcium excretion showed greater correlation in a group of recurrent stone formers than in cases of apparently solitary stone formation.

The finding of intestinal hyperabsorption of calcium in a high proportion of stone formers may be aetiologically significant in the parenchymal calcium deposition found in these cases.
Ureteral and Vesical Metastases in Nephroblastoma
Authors: PAGANO FRANCESCO , PENNELLI NATALE
Published: December 2008

A case of multilocular renal cyst associated with an intrapelvic small nodule of malignant Wilms' tumour presenting subsequent urothelial metastasis is described. To avoid the possibility of urothelial neoplastic cell implantation the authors suggest more detailed histological examination and removal of the ureter in appropriate cases.
Methotrexate Treatment for Advanced Bladder Cancer
Authors: HALL R. R. , BLOOM H. J. G. , FREEMAN J. E. , NAWROCKI A. , WALLACE D. M.
Published: December 2008

Intermittent intravenous methotrexate has been used to treat patients with locally advanced or metastatic transitional cell carcinoma of the bladder (40 cases) and of the renal pelvis (2 cases).

Objective evidence of tumour regression, attributable to the methotrexate therapy, was observed in 11 patients (26 %) for 2 to 20 months. Several other patients gained relief of symptoms but in these there was no clear evidence of tumour regression.

Toxic side‐effects from methotrexate interrupted treatment for a time in 29 patients but were seldom serious and were never fatal.

It is concluded that intravenous methotrexate therapy is of value in the management of advanced bladder cancer.

The possibility of improving tumour response and decreasing drug toxicity is discussed.
Abnormalities of Detrusor and Sphincter Function in Multiple Sclerosis
Authors: ANDERSEN JENS T. , BRADLEY WILLIAM E.
Published: December 2008

Bladder and urethral function was studied in 52 patients with multiple sclerosis using gascystometry combined with sphincter electromyography.

96% of the patients showed abnormalities of either detrusor or sphincter function.

The abnormal patterns discovered indicated demyelinating lesions in the corticospinal as well as in the reticulospinal tract.

Urgency and urge‐incontinence were the predominant symptoms, whereas no signs of involvement of the upper urinary tract was found.

The use of gas‐cystometry provides a fast and differentiated method for assessment of the detrusor function.
Latent Carcinoma of the Prostate: the Probability of Identifying Small Lesions in Routine Histology
Authors: DELIDES G. S. , BALTOPOULOS G. , PAPAHARALAMPOUS N. X.
Published: December 2008

In 3,072 open prostatectomy specimens covering a 25–year period 117 (4%) showed frank carcinoma.

A further 74 cases showed areas of occult carcinoma or atypical hyperplasia. These focal lesions had an average diameter of 1 mm and 96 % were situated in the peripheral regions of the specimen. In view of the situation of these lesions and their small size, an improved method of taking blocks for histological sections from prostatectomy specimens is proposed, resulting in an increased probability of demonstrating the areas of occult malignancy.
The Use of Bromocriptine in the Treatment of the Unstable Bladder
Authors: FARRAR D. J. , OSBORNE J. L.
Published: December 2008

Initial experience with the use of bromocriptine in 24 patients with troublesome micturition symptoms associated with an unstable bladder is described.

14 patients responded symptomatieally to treatment with bromocriptine and these results were confirmed by a double blind trial in this group.

11 of these patients had previously failed to benefit from treatment either with drugs or vesical distension.

It is concluded that bromocriptine has a part to play in the treatment of some cases of primary detrusor instability.
Vasoplasty: a New Technique
Authors: NAIR V. R.
Published: December 2008

A technique by which plain catgut is used as an internal splint in vasoplasty is described. 28 cases have been carried out, of which only 4 have failed.
Comparison of Sterile Bag, Clean Catch and Suprapubic Aspiration in the Diagnosis of Urinary Infection in Early Childhood
Authors: HARDY J. D. , FURNELL P. M. , BRUMFITT W.
Published: December 2008

Bag, clean catch and suprapubic specimens of urine were taken on the same day in a group of 30 unwell infants and young children.

On microbiological grounds suprapubic aspiration was far superior to clean catch collection and clean catch collection superior to bag collection in the diagnosis of urinary tract infection.