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Thirty patients injected intravenously with a nonionic contrast medium, iohexol, for urography were compared with 30 patients similarly injected with sodium iothalamate. Comparable radiographic results were obtained in these patients with normal renal function. Few minor responses were observed with the iohexol, suggesting that it may prove to be an attractive contrast medium for this purpose.

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We have seen 13 patients with sclerosing cholangitis diagnosed mainly by ERCP. An elevated alkaline phosphatase is frequently the first manifestation. ERCP is adequate for diagnosis, and an operation is usually not necessary. Radiologic findings include diffuse and irregular areas of stenosis, dilation, beading, and extensive involvement of both the extrahepatic and intrahepatic biliary radicles. There was an association with long-standing ulcerative colitis, but no relationship with activity of this disease or its complications. Liver biopsy in 10 of 11 patients demonstrated very little progression of disease, and evidence of secondary biliary cirrhosis was found in only one case. Corticosteroid therapy was used in 10 patients without clinical evidence that this altered their course. Prognosis appears to be reasonably good and unrelated to the course of ulcerative colitis.

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Twenty-four patients with surgically treated unilateral renovascular hypertension were investigated by minute sequence urography, angiography, surgical repair and pathologic examination. In only 10 patients did the urogram demonstrate evidence of the lesion. It is recommended that the hypertensive urogram not be used as a general screening device, that only selected hypertensive patients be investigated, and that the first radiologic examination in those selected patients may be renal angiography.

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Sodium iothalamate was injected intravenously into mice to test the hypothesis that reactions to contrast media are controlled by the central nervous system. Particular emphasis was placed on (a) the effect of the limbic portion of the brain on the hypothalamus and (b) the outflow through the autonomic nervous system. Diazepam and hexamethonium significantly affected the LD50; in addition, in comparison trials with control mice, they markedly decreased the death rate (p < 0.0005). High doses of methylprednisolone sodium succinate, given every 6 hours before the contrast medium, had no effect.

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Two hundred and twenty-eight deaths due to the use of contrast media are reported, including 15 from intravenous cholangiography, 69 from angiography, 140 from urography and four other. The causes are analyzed and the various explanations for reactions to contrast media are considered. Data concerning the high incidence of cardiac death, the large number of deaths due to pulmonary edema, and the known transgression of the blood-brain barrier by contrast media are used to construct a theory that bases all reactions on the effect of contrast media on the central nervous system.

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1223 patients underwent aspiration biopsy with a diagnostic yield of 86.4%; 24.2% of the patients had a small pneumothorax, but only 4.4% required treatment; one patient developed a moderate hemothorax. The method, problems, and complications including morbidity and mortality are discussed. The relative success of aspiration biopsy with different lesions of the lung and mediastinum is identified.

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Emphasis is placed on the minor degree of caliectasis often observed in the presence of severe renal failure in patients with retroperitoneal fibrosis. This finding should suggest the diagnosis in individuals presenting with obscure causes of renal failure. A possible explanation for this is based upon an interference with ureteral dynamics and subsequent interference with normal ureteral peristatic activity rather than mechanical obstruction of the ureter per se. Twenty-one patients with retroperitoneal fibrosis are reported with the usual sex and age distribution (mostly male, aged 40-55 years). Two of the patients are interesting because of associated cardiac disease and 31 had been on prolonged methysergide therapy for migraine headaches. Eighteen patients appeared to be improved or cured and 3 died.

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This report presents a comparison of the complications of surgical exploration with unroofing and renal cyst puncture. Two hundred fifty-five patients were operated on, with a mortality rate of 1 per cent and a morbidity rate of 28 per cent. The complications in 63 patients examined by mass aspiration included a morbidity rate of 6.4 per cent and no mortality. The possibilities of over-looking carcinomas through cyst aspiration are weighed against the demonstrated morbidity of surgical exploration and found to be much less significant. The authors recommend that an asymptomatic renal mass that radiographically appears to be a cyst and is unaccompanied by urine changes or clinical stigmata of renal neoplasia be treated by cyst aspiration and not subjected to surgical exploration.

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The male urethra can be demonstrated following intravenous urography by having the patient void against the partial obstruction produced by a penile clamp. The clamp is useful for both the normal or stenosed male urethra.

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