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This paper presents the results of a random clinical trial designed to contrast megavoltage (4 MV linear accelerator) with conventional therapy (300–500 KV) in the radical treatment of bladder cancer. Two hundred and thirty-four patients were included in the trial and allocation to treatment was on a true random selection basis in accordance with the principles set out in Part 1 of this series of papers (Paterson 1958). It is concluded that subject to qualitative differences there is no strong evidence to suggest that the MV treatment is superior to the KV treatment.

DURING the past ten years the danger of giving patients (particularly those with impaired cardiac function) too much sodium has frequently been stressed. However, the opposite danger of hyponatremia, or a low sodium level, has received very little emphasis and for this reason has often not been recognized. Time does not allow a general discussion of electrolyte balance, which has been more than adequately covered by numerous books and papers on the subject. Actually, this great volume of work has made the subject seem unduly complex. In this purely clinical paper I wish to emphasize the facts that low sodium . . .

ADIATION R effects on normal tissue are inherent in the radiation treatment of patients with cancer. The aim of the radiation therapist is to achieve the highest possible cure rate with the lowest possible complication rate; to avoid these complications entirely would mean lowering the cure rate. Radiation effects may be acute, occurring during the course of treatment, or subacute or chronic, arising months or years after treatment has been completed. One of the basic problems the clinician and radiologist face is to differentiate radiation effect from recurrence of cancer. The anatomic areas covered in this paper include the kidneys, ureters, bladder, male and female genital tracts, and the embryo and fetus. The clinical conditions include lymphoma and neuroblastoma; cancer of the cervix, uterus, ovary, kidney, bladder, prostrate, and rectosigmoid; and vertebral body and spinal cord tumors. The ovary, testis, embryo, and fetus may also be irradiated inadvertently during diagnositc radiologic examination or radioisotope study.

The use of intravenous urography in patients with suspected renal colic is now widely established. In the majority of cases with ureteric stone the findings are predictable and well known. There is delay in excretion of the contrast with an accentuated nephogram; later films show distension of the calyces, pelvis and ureter down to the point of obstruction. It is less well recognised that the bladder may sometimes show changes due to the presence of a calculus in the lowermost portion of the ureter. This paper describes two cases in whom lower ureteric stone caused bladder oedema sufficient to produce a striking filling defect. A 26-year-old man was admitted on 7.8.67 with a history of 24 hours of right lower abdominal pain radiating into the right lumbar region. There had been slight dysuria, but there was no history of previous urinary tract disease. Physical examination revealed slight right-sided abdominal tenderness, but was otherwise negative. Radiographs of the chest and abdomen were normal. There ...

Two general types of constipation have been described which are based on etiology (1, 3, 5, 6, 9, 10, 20). In organic constipation, of course, there is an underlying organic cause such as aganglionic megacolon, anal fissure, ectopic anus, or intrapelvic mass. The type to be discussed in this paper is nonorganic constipation in which there is no detectable organic cause. For this reason it is also referred to as “functional” and “psychogenic” constipation. Attention has been directed to urinary tract problems associated with aganglionic megacolon (19). Attention has been focused on the colon of patients with nonorganic constipation, however, and little thought has been given to the association of urinary tract pathology. Culp (4) was aware of the relationship when he showed a patient with severe bilateral hydronephrosis due solely to “the fact that the colon was chock-full of feces.” Kottmeier and Clatworthy (8) found “obstructive uropathy” in 30 per cent of 13 patients with functional megacolon. Burke (2)...

The purpose of this paper is to draw attention to an unusual cystographic appearance of the bladder in a newborn infant and to relate this to the pathological findings. A female infant, birth weight 9 lb. 6 oz., was admitted under the care of Mr. J. E. Scott with possible intestinal obstruction, when one day old. There was an abdominal mass arising from the pelvis which proved to be an enormously enlarged and distended urinary bladder. A radiograph of the abdomen at that time (Fig. 1) showed the grossly distended bladder extending up into the epigastrium and displacing the stomach, small bowel and transverse colon upwards and to the left. Catheterisation yielded 400 ml. of urine. Intravenous pyelography showed a marked degree of bilateral hydronephrosis with tortuous dilated ureters.

SUMMARY A classification of proliferative and neoplastic lesions of mouse bladder is proposed and illustrated. It differs only slightly from the descriptive account of such lesions given by Bonser and Jull in 1956. I am greatly indebted to my colleagues, Dr J. K. Ball, Dr W. E. H. Field and Mrs M. Walters, who helped to provide the material on which this paper is based, to the staff of the Photographic Department of the Chester Beatty Research Institute for producing the many illustrations, and to Dr C. E. Dukes because of his experience in the “staging” and “grading” of tumours. This investigation has been supported by grants to the Chester Beatty Research Institute (Institute of Cancer Research: Royal Cancer Hospital) from the Medical Research Council, the British Empire Cancer Campaign, the Anna Fuller Fund, and the National Cancer Institute of the National Institutes of Health, U.S. Public Health Service.

This paper describes the nature of bladder calcification in urinary schistosomiasis. Ten patients who showed calcification on X-ray during life were examined at autopsy and the calcium was shown to be confined to the ova. Bladder calcification indicates a heavy bilharzial infection.

This paper summarizes the findings in a series of 52 children suffering from vesical calculus. Urological investigation in most cases was complete, and was always as complete as circumstances permitted. Complete investigation is recommended as a routine, in order to differentiate the calculi which form de novo from those which have a background of urinary tract obstruction. Secondary changes due to the vesical calculus were found to be more marked in the presence of reflux.

Iintravenous infusion of a large volume of dilute contrast material, as devised by Winchell and Arata (13), has proved a useful and versatile technic in urologic roentgen diagnosis. Excellent, anatomically complete pyelograms are consistently obtained (Fig. 1). The nephrogram is dense; the calyces, pelves, and ureters are completely filled. The resulting cystogram rivals the average retrograde bladder study in quality and allows for good voiding urethrograms. Early “minute sequence” and late “wash-out” films are easily obtained in the study of hypertensive patients. In addition, the technic has been diagnostic in chronic renal failure, where ordinary intravenous methods commonly fail. Drip infusion also provides a simple method for modified nephrotomography. The technic of drip infusion, its indications and adaptations, and our experience in more than 200 cases are the subject of this paper. Technic Understanding the principle of drip infusion is basic to proper technic. The drip infusion pyelogram achiev...

This paper deals with our experience in the management of four patients who have come to our notice during the past 15 years, each presenting with a clinical picture strongly suggestive of bladder malignancy. Each of them had, however, some months or years prior to the development of urinary symptoms, undergone an inguinal herniorrhaphy in which silk had been used for the repair. The pseudo-neoplasm of the bladder was believed in each instance to be due to a paravesical granuloma following the use of non-absorbable sutures. Awareness of this complication helped to prevent unnecessary major surgery in two of the four patients.