Contributorship and guarantor: MJ conceptualised this article, undertook the literature search and is guarantor. JC used her knowledge of chest radiology to inform the content of the article and sourced the images. JP used his knowledge of assessment and management of covid-19 patients to inform the article. MJ, JC, and JP drafted and checked the final article. Patient consent:We considered seeking individual consent to use radiological images. However, as patients with covid-19 are ill and an infectious risk, obtaining consent was not possible. We approached the hospital ethics committee chair, Trust R&D, and Data Protection lead for permission to use anonymised radiological images without specific consent. They agreed this was acceptable.

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A case of uretero-uterine fistula following lower segment Caesarean section is described. Its features and method of management are compared with previously reported cases whose number is only 30. CASE REPORTThe patient was a 25-year-old Nigerian whose first pregnancy, two years previously, was complicated by pre-eclampsia at term for which

SOLITARY giant diverticulum of the sigmoid colon is a rare disease of which there are only 8 other published cases, none of which presented initially as an abdominal emergency.This report concerns a further case with an acute presentation requiring emergency treatment. CASE REPORTA 72-year-old female patient presented in May, 1967, with a z-day history of intermittent, colicky, central abdominal pain of sudden onset, which had become more severe on the day of admission, and was associated with the the erect position (Fig. 2) revealed that this shadow contained a definite fluid level. There was no radiological evidence of intestinal obstruction.Leucocyte count was I 1,900 per c . m . ; haemoglobin 11.8 g. per IOO ml.; blood-urea and electrolytes were within normal limits. Urine contained a few red cells and epithelial cells and was sterile.A laparotomy was performed 6 hours after admission through a right paramedian incision. The only abnormal finding was a thick-walled cystic swelling 20 cm. in diameter arising from the antimesenteric border of the apex of the sigmoid colon (Figs. 3, 4), which contained a small amount of faecal fluid. There was a communication between the lumen of the swelling and that of the sigmoid onset of fever. There was no history of vomiting, no change in bowel habit, no recent weight-loss, but she had had long-standing frequency of micturition and nocturia. There was no relevant past medical history. On examination she was flushed and moderately dehydrated but otherwise looked well. Temperature was 1 0 2~ F., pulse-rate IOO per minute, and blood-pressure 130/9o mm. Hg. Her tongue was dry and coated.On abdominal examination there was central distension. On palpation there was a central, regular, spherical, tender, immobile mass approximately 20 cm. in diameter. This was associated with generalized tenderness, guarding and rebound tenderness, and an absence of bowel-sounds. Percussion note over the mass was tympanitic. Rectal examination was normal. Plain radiography of the abdomen in the supine position revealed a large, round, gas-filled shadow 20 cm. in diameter (Fig. I)

Six (19 ",) of the 32 men carrying yeasts were circumcised compared with 35 (24,,) of the 143 not habouring yeasts. Of the total 175 patients about 70 .O were from the UK or Eire and 20 from the West Indies. There was no significant difference in carriage rate in the racial groups or in the three main diagnostic groups. Thus nine (22 00) of the 41 men with gonorrhoea, 13 (21 00) of the 61 men with non-specific urethritis, and eight (17%0) of the 47 men with no abnormality carried yeasts. Relatively few women contacts attended, but eight out of 11 contacts of the 32 yeast-positive men harboured yeasts in the vagina compared with six out of 25 contacts of the 143 yeast-negative men (P < 0 02). CommentThe high carriage rate of yeasts in these patients suggests that sexual transmission could account for many instances of yeast infection in women. This is supported by the findings in the female contacts and the increasing incidence of genital yeast infection in both sexes reported by VD clinics.1 Women might, however, acquire the organism in other ways and the male partner then be infected by sexual contact. The risk of the man infecting others will depend on how long the yeasts persist. Serial cultures were not taken in this study, but of the 20 men with proved candida or torulopsis infection 10 had not had sexual intercourse for two weeks or more, and four of these 10 not for one to three months. We report what we believe is the first case of this nature treated by abdominoperineal excision of the rectum. Case reportA 24-year-old housewife was admitted to hospital with a perianal abscess. She was very pale but there were no other abnormal physical findings. Blood examination showed Hb 5-5 g/dl; WBC 3 x 109/1 (3000/mm3), of which 99 9 were blast cells; platelets 50 x 109/1 (50 000/mm3). Sternal marrow biopsy confirmed the diagnosis of acute myeloblastic leukaemia. She was transfused with packed red cells, white cells, and platelet concentrate. The gastrointestinal tract was sterilised by giving nystatin and then adding framycetin and colistin. Under broad spectrum antibiotic cover the abscess was incised. It contained necrotic tissue-but no pus-from which coliform organisms sensitive to ampicillin were cultured. The leukaemia was treated by a regimen of cytotoxic drugs including daunorubicin and cytosine arabinoside.Despite these measures the abscess extended to erode the left lateral rectal wall and adjacent ischiorectal fossa, establishing a faecal fistula, and continued outwards to the ischial tuberosity and up to but not through the pelvic peritoneum. Recurrent massive local haemorrhages required repeated blood transfusion. Three weeks after the incision septicaemia developed (Pseudomonas pyocyanea), which was complicated by acute tubular necrosis. Renal function recovered without dialysis. A defunctioning sigmoid colostomy was performed, which slowed the progress of the lesion, but by this time there was a large cavity with a skin defect of 8 cm 10 cm (see fig) and spontaneous healing seemed impossible.Finally...

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From the Third Department of the Kommunehospitel (chief: Poul Iversen M. D.) and the Pathological Ineiitute (prosector-in-chief: Sveod Petri, M. DJ. Copenhagen.

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