Milk-of-calcium urine associated with hydronephrosis is rare, with only 8 unilateral cases reported previously. We report the first case of bilateral occurrence. Upright films are necessary for making the diagnosis. Although previous reports indicate that the involved kidney has little or no function our patient had only slight impairment of renal function. Nephrectomy should not be done without evaluation of renal function, since some function may be preserved by removing the obstruction that is associated with milk-of-calcium urine and hydronephrosis.

The role of ultrasonography, computed tomography (a), and radioisotopic scanning in the staging of bilharzial bladder cancer has not been reported previously. Forty patients with invasive bladder cancer seen at the King Faisal Specialist Hospital and Research Centre between January 1978 and June 1981 underwent complete preoperative workup for staging of their tumors prior to radical cystectomy. The preoperative radiologic investigations included excretory urography (IVP), ultrasonography (US), CT of the pelvis, and liver and bone scans. The results of these investigations were compared with the operative and pathologic staging. Ninety‐three percent of the patients with bilharzial cancer had evidence of ureteric obstruction on IVP compared with 22% of the nonbilharzial cancer patients. The presence of ureteric obstruction in these patients did not correlate with the stage of the disease with 83% of the patients with superficial tumors (TI and T2) having hydroureteronephrosis. Ultrasonography and CT had an 83% accuracy in the staging of superficial tumors. Stage T3 tumors were understaged in 14% of the cases. Ultrasonography did not differentiate Stages T3 and T4 tumors while CT scan differentiated these two stages in 57% of the cases. Bone scan failed to reveal evidence of metastatic disease in any of the bilharzial cancer patients. Liver scan was suspicious for liver metastases in two patients with bilharzial cancers in whom open liver biopsy revealed only hepatic bilharziasis. Of all the radiographic studies, US or preferably CT scan seem to be of some value in the staging of bilharzial tumors localized to the bladder. Bone and liver scans are probably of no cost effective benefit.

A 60-year-old man was admitted to King Faisal Specialist Hospital and Research Centre because of fever and back pain.He had a three-year history of pain in the right leg radiating to the back with associated poor appetite and weight loss. Four months before being admitted to this Hospital, he was seen at another hospital. Examination there revealed a palpable right lower quadrant mass that was firm, round, and fixed. He had a mildly enlarged liver and chest x-ray was normal. Results from a barium enema indicated a possible lesion of the cecum and ascending colon.One month after admission to the first hospital, an exploratory laparotomy was done, and the patient was thought to have a locally advanced, inoperable carcinoma of the cecum. The doctors performed a side-to-side ileotransverse colostomy, without biopsy, and he was transferred to King Faisal Specialist Hospital.Upon admission the patient was thin, somewhat dehydrated, and febrile. His temperature was 38 °C, weight 41kg, and vital signs were normal. There was an ill-defined mass in the right iliac fossa. The rest of the examination was normal. White blood count 5500; hemoglobin 11.2g/dl; sedimentation rate 54mmHg/h; albumin 3.0g/dl (normal-5.0g/dl); and total protein 7.8g/dl (normal-8.0g/dl). Liver function studies were all within normal limits. Serum sodium was slightly decreased at 134meq/l (normal-145meq/l); electrolytes were otherwise within normal limits. Electrocardiogram was normal. A chest x-ray, done prior to admission, showed a slightly irregular radio-opaque density in the apex of the left lung that seemed to be an old, calcific nodule. A barium enema series was done and the results showed an undistended cecum with an irregular mucosal pattern and marked narrowing in the cecal region. There was no reflux of barium into the ileum. Test findings strongly indicated carcinoma of the cecum and ascending colon. The oncologist at King Faisal Specialist Hospital was not able to determine the type and extent of the tumor. Another laparotomy was deemed necessary in order to assess the extent and histology of the tumor.One week after admission to the Hospital a diagnostic laparotomy was performed. The surgeon reported extensive seeding of small deposits on the surface of the peritoneum throughout the pelvis and over the liver. Two masses were found, one in the cecum and the other in the right portion of the transverse colon. The peritoneum was studded with innumerable two to four millimeter white nodules such as those in tuberculous implants or adenocarcinoma. Biopsies revealed confluent granulomatous inflammation consistent with tuberculosis; a number of biopsy specimens were examined.One day following surgery, the patient was started on isoniazid, 150mg IMq 12h and streptomycin, 300mg IMq 12h. Three days later the medication was changed to isoniazid, 300mg PO/day, ethambutol, 600mg PO/day, and rifampicin, 600 mg PO/day, with pyridoxine cover. He was discharged on these medications and followed as an outpatient.The patient's initial clinical response was...