In a study of kidneys obtained from adult human subjects at necropsy, the specificity and sensitivity of the alizarin red S method for detecting calcification is confirmed. A survey of the relevant literature indicates that, while calcification is frequently found in the human renal papilla at necropsy, conflicting opinions have been expressed regarding its anatomical site. In the present study of 62 adult human kidneys, in which specific renal disease had been excluded, papillary calcification was present in 43 (69 per cent). A detailed histological study of the papilla, using thin and thick sections, demonstrates the predominant site of calcification to be in the walls of the long loops of Henle, where it is closely related to the basement membrane. The nature of papillary calcification and its possible relationship to the physiology of the renal medulla are briefly discussed. The question is raised as to the possible part played by the loops of Henle in the genesis of renal calculi.

Details are given of 37 consecutive patients with radiation damage to the rectum. Twenty-eight presented with rectovaginal fistulas, 3 with haemorrhage from ulcerative proctitis, 3 with low rectal strictures, 2 with a painful rectal ulcer and 1 with a rectal carcinoma. Thirty-five of the 37 had been treated for carcinoma of the cervix, and of these, 30 were Black South African women in whom this disease forms approximately 70 per cent of all malignancies. Associated pathology in these patients included urinary fistulas, small bowel fistulas or stenoses and a variable degree of fibrosis of the pelvic cellular tissue. Treatment involved subtotal rectal resection with restoration of continuity by means of a peranal sleeve anastomosis between healthy colon and the rectal stump denuded of its mucosa. Technical success was achieved in 35 of the 37 patients, with no mortality. The functional results were assessed both subjectively and objectively in 31 patients followed up for more than 6 months. Full continence was achieved in 54 per cent initially, improving to 75 per cent (21 of 28) at 1 year postoperatively. At 1 year, variable degrees of incontinence for a liquid stool persisted in 7 of 9 patients who had low fistulas with a low anastomosis at dentate line level. Where anastomosis was possible at a higher level, all 19 patients cured of fistula, ulcer, stenosis or haemorrhagic proctitis were fully continent at 1 year.

The presence or absence of starch granulomas on the peritoneal surface or within peritoneal adhesions is reported in 20 patients subjected to a second laparotomy. Evidence is presented to show that starch granuloma formation is common in the early months following operation and that adhesions associated with starch granulomas cause intestinal obstruction. It is suggested that although starch is usually absorbed within 2 years, associated band adhesions may persist. Glove powder contamination of the peritoneal cavity may thus be a common cause of band adhesion obstruction.