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Ninety-eight children have been treated with clean intermittent catheterization (CIC) over a five-year period. Follow-up in 73 of these is presented herin. The complication rate encountered with the technique is low (7 per cent major complications). Only 21 per cent of the patients were able to maintain persistently sterile urine, although no new bouts of pyelonephritis were encountered in the group since our report of three years ago. Six of 44 (14 per cent) refluxing renal units stopped refluxing on CIC, but in two units reflux de novo developed while on treatment. Most patients (79 per cent) demonstrated stable upper tracts on CIC, while 14 per cent showed increased calicectasis with 7 per cent showing improvement. Thirty-one of the patients were less than three years of age when begun on clean intermittent catheterization. We recommend CIC as the treatment of choice in neurogenic vesical dysfunction where total bladder emptying is a problem and advise that it be started as early as possible.

The results of the application of clean intermittent catheterization to children are discussed. Of 34 patients only 7 maintained persistently sterile urine and 52 per cent had more than 1 positive culture in the followup period. Complications of the application of this technique are discussed. The major complication rate was 15 per cent and 6 per cent were considered failures of therapy. Only 1 of the 34 patients demonstrated progression of upper tract disease by excretory urography during the followup period. Intermittent catheterization was found to be effective in preserving renal function as well as helping to improve patient social acceptability.

Human lymphotoxins (LT) are a multicomponent family of related and distinct cell-lytic and growth inhibitory glycoproteins (Toth and Granger, 1979). They are inducible and can be released specifically when immune lymphoid cells are cocul-tured with the immunizing antigen or nonspecifically when nonimmune lymphoid cells are cocultured with lectins (Daynes and Granger, 1974; Granger and Williams, 1968; Granger et al., 1969). An exception to the inducible mode of release of these effector molecules is that certain continuous human lymphoblastoid cell lines con-stitutively release low levels of LT in vitro (Fair et al., 1979; Granger et al., 1970; Khan et al., 1982). There is now evidence that certain LT forms may have a role as lytic effectors in different classes of cell destructive reactions mediated by human lymphocytes in vitro (Weitzen et al., 1983a,b; Yamamoto et al., 1979, 1984b). However, the situation is complex for it is clear that different classes of effector lymphocytes (T cells, NK cells) can release different LT forms (Harris et al., 1981; Weitzen et al., 1983a,b; Wright and Bonavida, 1982; Yamamoto et al., 1984a). Moreover, in these reactions the different LT forms may assemble together to induce cell lysis as molecular complexes or alternatively may act as individual components on a target cell in a synergistic fashion.

A case is presented of a renal allograft recipient with 2 episodes of cryptococcal septicemia temporally related to genitourinary manipulation, which preceded the usual signs of meningeal or cutaneous infection. A review of the literature suggests that cryptococcal disease may, occasionally, manifest itself initially in the genitourinary tract. Therefore, we suggest that cryptococcal infection be suspected in the compromised host who has symptoms of cystitis or bladder outlet obstruction during a short period.