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T lymphocyte control of Epstein-Barr virus (EBV) infection of autologous B lymphocytes was examined in parallel to the enumeration of subpopulations of mononuclear cells in 22 multiple sclerosis (MS) patients and in 22 healthy individuals. All were seropositive for EBV. The incidence of lack of T cell control was significantly higher in patients than in controls, confirming previous published work. In the present study, we have shown in addition a significantly reduced proportion of OKT8+ cells and a significantly increased ratio of OKT4/OKT8 cells in the group of patients with lack of control. The findings point to abnormal immunoregulation in MS.

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Cytologic features indicative of malignancy were related to the subsequent rate of tumor recurrence in 50 patients with T1 and T2 transitional cell carcinoma (TCC) of the bladder. All patients with T1 disease in whom frequent recurrences developed had more than 15 per cent malignant-looking (ML) cells in their original biopsy. In patients with less than 15 per cent ML cells recurrences developed infrequently. All patients with T2 disease who had more than 15.5 per cent ML cells subsequently had a poor prognosis, whereas those with less than 15.5 per cent ML cells had a good prognosis.

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A patient with primary squamous carcinoma of the proximal colon, who also had a previous adenocarcinoma of the large bowel, is described along with a review of the literature. Clinical features, etiologic factors, and possible pathogenesis are discussed.

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Wide excision of the rectum in inflammatory bowel disease is both unnecessary and undesirable as the healthy pelvic floor is damaged and the pelvic nerves put at risk. An operative technique is described which includes dissection of the anal canal and rectum in the intersphincteric plane, i.e. the plane of fusion between the visceral rectum and anal canal and the somatic pelvic musculature, which minimizes these undesirable elements. Fifty-three cases are presented. Perineal wound healing rates are comparable with those of other methods of resection and only 1 of 14 men reported partial sexual dysfunction following this operation.

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The clinical, virological and pathological findings in 5 patients with neurological complications associated with rubella virus infection are described. The neurological illnesses began four to ten days after the rubella illnesses. The patients were all males aged between 6 and 17 years and were diagnosed during one non-epidemic year in a population of 1-5 million people. All the patients had rubella specific IgM in their sera. Two patients had no rash. In one of the patients who died, left internal carotid artery thrombosis and cerebral infarction were found at post-mortem. Rubella virus antigen and particles resembling rubella virus were found in the brain together with IgG and IgM in the same areas. This patient also had extensive liver necrosis. The other patient had a severe meningomyelitis and radiculitis and he recovered completely after two years. His serum rubella antibody rose significantly and was shown to leak into CSF during the acute stage of his illness. Three patients had a rash. Two of these patients had encephalitis: one recovered completely and the other had residual disability. The third patient had bilateral optic neuritis from which he recovered completely. Rubella specific IgM was, however, present in his serum for the abnormally long time of twenty-eight weeks indicating possible persistence of rubella virus.

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A case of a woman aged 88 years with a volvulus and strangulated small bowel in a hernia, following removal of iliac crest for bone grafting, is described. Emphasis is laid on prevention of an incisional hernia when obtaining the bone graft.

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The effect of Dicynene on blood loss during and after transurethral resection for benign enlargement of the prostate was studied in 76 patients. Median loss of blood at operation was 17 ml in those given Dicynene compared with 72 ml in the placebo group (p equals less than 0.001). Median postoperative blood loss was 38 ml in the Dicynene group, and 103 ml in the placebo group (p equals 0.05). Clinical evidence of deep vein thrombosis was found in neither group. Dicynene helps to reduce blood loss in transurethral resection.

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