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Malignant mesothelioma can be a confusing disease, resembling either carcinoma or sarcoma. Although it usually causes death rapidly by local and regional spread, distant metastases may be seen more frequently as more effective therapy controls local disease and prolongs life. Our patient's local and then regional mesothelioma was controlled by aggressive treatment, which allowed him nearly two years of productive life before a metastasis to the right infraorbital region occurred. He died shortly thereafter with widesspread metastases. This is the first reported case of mesothelioma metastatic to the face. This case also emphasizes the association of malignant mesothelioma with asbestos exposure, and points out advances in pathologic techniques that aid in the diagnosis of the disease.

The dilemma created for and presented to the urologist by the combination of a patient with increasing uremia from advanced pelvic malignancy and a referring physician frustrated by the situation is solved best by individual decisions appropriate for each case. Urinary diversion should be reserved for the occasional circumstance when reasonable life expectancy approaches 6 months or more. Drainage by circle tube nephrostomy provides minimal trouble for patient and physician, while providing excellent relief from the obstructive uropathy. In this series of 20 patients the average survival was 5.3 months. An attempt to assess the quality of life after diversion by circle tube nephrostomy is made.

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The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependent from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls.