Background Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency. MethodsIn this pragmatic, parallel-arm, multicentre randomised controlled trial, we initially recruited participants at 27 neurology or epilepsy services in England, Scotland, and Wales. Adults (≥18 years) who had dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous 12 months were subsequently randomly assigned (1:1) from 17 liaison or neuropsychiatry services following psychiatric assessment, to receive standardised medical care or CBT plus standardised medical care, using a web-based system. Randomisation was stratified by neuropsychiatry or liaison psychiatry recruitment site. The trial manager, chief investigator, all treating clinicians, and patients were aware of treatment allocation, but outcome data collectors and trial statisticians were unaware of treatment allocation. Patients were followed up 6 months and 12 months after randomisation. The primary outcome was monthly dissociative seizure frequency (ie, frequency in the previous 4 weeks) assessed at 12 months. Secondary outcomes assessed at 12 months were: seizure severity (intensity) and bothersomeness; longest period of seizure freedom in the previous 6 months; complete seizure freedom in the previous 3 months; a greater than 50% reduction in seizure frequency relative to baseline; changes in dissociative seizures (rated by others); health-related quality of life; psychosocial functioning; psychiatric symptoms, psychological distress, and somatic symptom burden; and clinical impression of improvement and satisfaction. p values and statistical significance for outcomes were reported without correction for multiple comparisons as per our protocol. Primary and secondary outcomes were assessed in the intention-to-treat population with multiple imputation for missing observations. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN05681227, and ClinicalTrials.gov, NCT02325544.

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SUMMARY AND CONCLUSIONS A case is reported of hamangioma of bladder occurring in a boy aged 4 years. The nature and treatment of this lesion as it affects young people is reviewed with an analysis of 31 cases previously reported in the first two decades of life. The following points emerge: Hzmangioma of bladder usually presents with recurrent episodes of hzmaturia which may be associated with anamia. Hamangiomatous lesions elsewhere on the body have been described in 31 per cent. of the cases reported to date. Some abnormality of the bladder outline in the intravenous pjelogram was noted in only 50 per cent. of cases in which this investigation was done. Although there is some disagreement. it is generally considered that biopsy should be avoided for fear of provoking troublesome bleeding. In two‐thirds of the reported cases the lesion has been solitary and well defined, usually involving the upper half of the bladder. It is exceptional for these lesions to involve the ureteric orifices or bladder neck. Hamangiomata may achieve great size, and 64 per cent. involved the muscular layers of the bladder wall, many of which extended into the perivesical tissue. Cavernous haemangioma is the most common histological type. Partial cystectomy appears to be the most safe and effective method of treatment.

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Nephro-ureterectomy is the standard treatment for transitional carcinoma of the renal pelvis and caliceal system. In recent years a modification of the conventional two-incision technique has been described in which the intramural ureter is resected endoscopically and the remaining ureter is removed in continuity with the kidney through a single loin incision. Twenty-one patients had their renal pelvic tumours treated by this modified technique between 1970 and 1983. Of 16 patients available for analysis, 37.5% subsequently developed bladder tumours. It was concluded that this modified technique has no greater incidence of subsequent bladder tumour development than the conventional technique of nephro-ureterectomy, whilst giving considerable benefit to the patient.