A controlled, prospective study comparing streptokinase and heparin treatment has been completed in 51 patients presenting with acute proximal venous thrombosis of less than 8 days' clinical duration. Patients were studied by means of pre-treatment, post-treatment, 3- and 12-monthly phlebography and pulmonary perfusion scanning and were followed up at 3-monthly intervals. Of the 26 patients randomized to receive streptokinase, therapy was stopped in 3 because of complications. Phlebography 5 days after starting treatment showed 80--100 per cent lysis in 17 of the 23 patients who completed the course of streptokinase. Two patients later developed partial rethrombosis. One patient developed an asymptomatic pulmonary embolus during treatment. During follow-up (mean 19 months) only 1 of the 17 patients with 80--100 per cent lysis developed postphlebitic symptoms, 3 patients died of unrelated causes and 1 patient was lost to follow-up. In patients randomized to heparin therapy no significant lysis was achieved in any of the 25 patients and only 2 of these patients were found to have asymptomatic legs on follow-up. Two patients in this group died and autopsy confirmed massive pulmonary embolus during treatment. These data suggest that streptokinase is superior to heparin in the treatment of acute proximal venous thrombosis of less than 1 week's clinical duration especially if the thrombus is largely non-occlusive. It must be stressed that in order to avoid the bleeding complications of thrombolytic therapy, streptokinase must not be used within 10 days of major surgery, or even longer after vascular, neurosurgical or eye operations.

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A case of giant condyloma of Buschke and Loewenstein is presented. The clinical course and pathology of these tumors are reviewed. This case illustrates the delay in establishing the diagnosis in spite of numerous biopsies. It is emphasized that the only effective treatment is wide local excision.

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15 had no recurrence in 2-15 years. Niceberg and others (1956) report that 7 of 26 cases treated only by appendicectomy died of proven metastatic carcinoma within 5 years.It would appear that, provided there is no pseudomyxoma peritonei, the prognosis for mucocele is excellent, and for cystadenoma it is good, but with the latter there may be local recurrence. In adenocarcinoma the prognosis is very variable. In this series, of 6 patients with adenocarcinoma, 3 have died ( I was an incidental finding at necropsy) and the others were alive 14 years, 10 years, and 2 months after the operation. It would also appear that when the diagnosis of adenocarcinoma is made unexpectedly on microscopy in an appendix removed incidentally at another operation, the prognosis is good. SUlMlMARYAn account is given of 7 columnar-cell tumours of the appendix (6 adenocarcinomas and I cystadenoma) and 2 mucoceles. The terminology, treatment, incidence, pathogenesis, and prognosis are discussed.The only constant feature in the histological differentiation between an adenocarcinoma and a cystadenoma is that there is invasion of the wall in the former. A mucocele of the appendix is lined by flattened, cuboidal epithelium or by no epithelium. The presence of papillary projections suggests a cystadenoma rather than a mucocele.Acknowledgements.-We

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The aim of this study was to assess the long-term clinical and physiological sequelae of lower limb venous trauma in a civilian practice. Twenty-six patients who had undergone surgery for lower limb venous trauma (median elapsed time 19.5 months) underwent assessment. Injuries had been sustained to the external iliac, common femoral superficial femoral and popliteal veins in two, four, nine and eleven limbs respectively. Using clinical assessment, photoplethysmography recovery time, the presence of popliteal reflux and venographic evidence of thrombosis, the final outcome was graded as good, fair or poor. Fourteen patients had pedal oedema, including two with a postphlebitic limb. The overall photoplethysmography recovery time (mean and s.d.) was 20.6 (8.7) s in the injured and 32.1 (6.7) s in the non-injured limbs (P = 0.002). Patients with a venographically occluded vein had a shorter photoplethysmography recovery time than those in whom the vein was patent (13.4 (5.6) versus 21.6 (8.7) s; P = 0.07). Popliteal reflux was present in 12 injured limbs. Seven of 12 venograms performed on limbs with a vein repair had evidence of previous thrombosis. Vein ligation carried considerable morbidity and all end-to-end anastomoses initially failed. In retrospect, saphenous vein grafts were too narrow for the recipient veins and panel grafts might have been more appropriate. Overall 11 of 26 patients (42 per cent) had a poor result. The repair of choice is a saphenous vein patch for lesser injuries and a saphenous panel graft for major injuries. Vein ligation should be avoided unless another life-threatening injury demands priority.