NOTES ON INTERESTING CASES 169

The differentiation from perinephric abscess may be difficult, and this difficulty is increased by the fact that the latter condition may be a sequel of renal carbuncle.

The chief interest of this case lies in the fact that it illustrates the value of intravenous pyelography in differentiating between the two lesions. When a perinephric abscess produces pressure on the upper end of the ureter, the radiological appearances may be somewhat similar, but there is no deformity of the intrarenal portion of the pelvis unless there is some renal focus.

HYDRONEPHROSIS WITH MULTIPLE CALCULI AND A CARCINOMA OF THE PELVIS

By KENNETH WALKER, F.R.C.S.

THIS case is of interest not only on account of the existence of three separate lesions in the kidney but abo because of the somewhat remark-

Fra. 1.

160 THE BRITISH JOURNAL OF UROLOGY

able appearance of the skiagram. The patient was a man, aged fifty, who had suffered from periodic attacks of painless haematuria for twenty-nine years. Three months previous to consulting me he had noticed a per-

FIG. 2.

NOTES ON INTERESTING CASES 161

sistent dull ache in the left side and some frequency of micturition. He had also lost weight and felt out of sorts. He had never suffered from an attack of renal colic. X-rays showed the presence of multiple calculi, a large number of small faceted calculi arranged in groups in the periphery of the kidney and a large triangular one situated in the pelvis. Excretion urography showed what appeared to be a normal kidney on the right side but no shadow appeared on the left. The renal function tests being satisfactory, a nephrectomy was carried out and was followed by a normal convalescence. The description of the specimen removed is as follows :-

Large hydronephrotic kidney, with large cavities containing clear fluid. A small amount of apparently normal cortex at the upper pole. Seventy-five small and one large calculus present. A growth, pale in colour and necrotic in places, extends inwards from the pelvis, invading the parenchyma, reaching the surface at several points.

Microscopic examination : Typical squamous carcinoma. Many cell nests.

Stones : The small ones are smooth and shiny, nearly black, poly- gonal and with rounded edges. In size, they are rather larger than a pea. The large stone was moulded to the outer part of the pelvis, black in colour, and had a dull surface.

When chemically examined the centres were found to consist of a mixture of uric acid and calcium oxalate, and the periphery ofcalcium oxalate and a little phosphate.

It is probable that the sequence of events in the kidney was first of all the development of a hydronephrosis followed by a deposit of calculi in the cavities and finally, through the chronic irritation these produced, the development of carcinoma.

BILATERAL CALCIFICATION OF HYDROCELE SACS

By N. M. MATHESON, F.R.C.S.

THE accompanying figures show excessive calcification of the tunica vaginalis of both the right and the left testis.

The specimens were obtained from a man of 72 years who died of cerebral haemorrhage. The hydroceles were noticed on routine examina- tion as painless, heavy, and very hard swellings which had caused little inconvenience during life.