The Doppler technique has been used to evaluate venous reflux in the spermatic cord. Valsalva-induced reflux occurred on the left side in 83% and on the right side in 59% of 118 patients without clinical varicoceles and there was no difference in incidence between fertile and infertile men. The significance of Valsalva-induced reflux should be questioned. Greater importance should be attributed to the spontaneous venous reflux that occurred during quiet respiration in the majority of patients with varicoceles. Seven velocity waveform patterns are described and these are thought to represent increasing degrees of internal spermatic vein reflux and provide a basis on which it is possible to grade varicoceles. The Doppler grades correlated with the size of the varicocele, and with the internal spermatic vein diameter and testosterone concentrations.

A retrospective analysis of 70 cases of adenomatous metaplasia seen in the St Peter's Hospitals over a 15-year period has been carried out. The lesions occurred at all ages (7-81 years) and in both sexes (51 males, 19 females) and were found throughout the urinary tract from pelvis to urethra. In the pelvis and ureter the finding was usually an incidental one in association with stones or chronic inflammation; ulceration was a frequent accompaniment. Most vesical and urethral lesions followed a surgical procedure months or years previously, the patients re-presenting with haematuria or irritative bladder symptoms. The endoscopic appearances varied but there was often a striking correlation between the location of the lesions and the site of previous surgery. The association of adenomatous metaplasia with ulceration and previous surgery leads us to suggest that it is merely an unusual response to wound healing and attempts to treat it by diathermy resection are, therefore, likely to meet with limited success. Cystoscopic follow-up of persistent lesions gives no reason to suppose they are pre-malignant.

This study concerns 2043 male partners of infertile marriages who underwent testicular biopsy in the 28 years from 1955 to 1982. In a review of the pathological material carcinoma in situ (CIS) was diagnosed in 8 men (0.39%). Six of these men were later found to have invasive germ cell tumours; one has remained tumour-free and one is lost to follow-up. The implication of these findings in relation to the selection of patients for biopsy and the treatment of CIS when diagnosed is discussed.

A study of 35 cases of inverted papilloma of urothelium confirms that it is a distinctive entity and typically benign. These lesions occur mainly in males, may be multiple, and are sometimes situated elsewhere than in or near the trigone, which is their characteristic site. Their precise histogenesis remains uncertain. It must be stressed that not all transitional cell tumours of inverted pattern are of this type; some will have the appearance of and behave as malignant tumours. The same diagnostic criteria of malignancy established for the more common exophytic papillary neoplasms must be applied also to the inverted papillary tumours herein described.

Two hundred and three patients with upper tract urothelial tumours were reviewed. Eighty had pelvicaliceal tumours, 90 ureteric tumours, and 33 multifocal tumours of both pelvis and ureter. Two hundred patients had transitional cell carcinomas and 3 had squamous cell carcinomas. The overall corrected 5-year and 10-year survival rates were 59.7% and 41.1% respectively. Widespread multifocal occurrence poor differentiation, penetration of the muscle coat and conservative resection of tumours predisposed to a poorer prognosis.

SUMMARY 1. Eight cases of malignant lymphoma of the bladder are presented, and their clinical and pathological features discussed with reference to twenty‐three cases from the literature up to 31st December 1959. 2. Malignant lymphoma of the bladder occurs more frequently in females than in males. The majority of the patients are over the age of 40 years. 3. The commonest presenting symptom is periodic hematuria. It is very often associated with dysuria and frequency of micturition. 4. Back‐pressure changes in renal pelves and ureters are characteristically absent or minimal. 5. Cystoscopic appearances are very typical. It forms a smooth or nodular (occasionally convoluted), rounded, pink, and solid tumour that is essentially submucous. The mucosa over it is usually intact but occasionally central ulceration may be seen. It infiltrates relatively little compared to its size. 6. Histologically, in the less extensive cases, the tumour is confined to the deeper part of the lamina propria. Later on, the superficial part of the lamina propria and the muscle are infiltrated. Muscle is infiltrated in most cases but perivesical invasion is unusual. The cells consist mainly of lymphocytes, lymphoblasts, and reticulum cells. Histological subdivision of the tumour is often difficult and at times impossible. Hence it is best to consider them under a single non‐specific title of malignant lymphoma. 7. Radiotherapy appears to be the treatment of choice, though it is also possible to get good results with surgery. 8. Prognosis is favourable because the tumours tend to remain localised for a considerable time. So far, none of these eight cases has shown any sign of dissemination. Their survivals (at the time of the last examination) have ranged from four months to ten years.

The first step in the investigation of infertile men is to obtain 2 seminal analyses 3 days after the previous ejaculation. Clinical assessment of testicular size is an unreliable means of assessing spermatogenesis and is best done by performing bilateral testicular biopsies. Azoospermic men with grossly elevated FSH levels should be advised to consider AID or adoption. Those with normal or mildly elevated FSH levels should undergo testicular exploration in an attempt to correct an obstructive lesion. Azoospermic men with subnormal FSH levels may have an isolated hormone defect which will respond to treatment with Pergonal. Different treatment programmes for oligozoospermic men depending on the results of the FSH and LH assays may lead to a more rational approach to therapy. Infertility associated with varicocele may possibly be associated with a local disturbance of "inhibin" and FSH concentrations.

IN an accompanying paper the induction of sarcomata at the site of repeated subcutaneous injection into rats of cadmium sulphate, or of cadmium-precipitated rat-ferritin, is described, and the failure to induce such tumours in mice by similar treatment reported (Haddow et al., 1964). In the present paper the occurrence of testicular lesions and of pituitary changes in cadmium-treated rats and mice is described and discussed.For some time it has been known that cadmium is highly toxic to the testes of a number of animals. Parizek and Zahor (1956) reported complete necrosis of the testes of rats given one subcutaneous injection of cadmium chloride in a dose as small as 0.02 millimole per kilogram of body weight. They obtained similar results in mice, rabbits, guinea pigs and golden hamsters. This work has since been confirmed by a number of other workers, including Meek (1959), using mice.Kar and Das (1960) studied the sequence of events after a cadmium chloride injection in rats and noticed intense va'scular congestion of the testis within six hours. After two days the seminiferous epithehum was completely destroyed and transformed into a mass of debris. The changes in the interstitium, which they described as being of " similar magnitude ", resulted within two to seven days in total loss of anatomical structure and functional activity. The present authors obtained similar results in male rats using a single subcutaneous injection of cadmium, sulphate (Cd S04-4H20) in doses varying from 0.5 to 2-0 mg. per 100 g. body weight (equivalent to 0.2 to 0-8 mg. per 100 g. cadmium).A number of reports have commented upon the return of androgenic activity to testes rendered necrotic by cadmium and have described proliferation beneath the tunica albuginea of fibroblast-like cells which later show the typical structure of Leydig ceRs.The