No abstract

No abstract

i T~~~~~~~ of the ureter is so rare that it is worth adding a further case to the eleven collected and recorded by Smith (i946), especially as the case to be described falls into the " double ureter with one bifid " group, of which only two cases have been previously recorded.Mrs M. S., aged 40, Para I V , was referred to me at Stirling Royal Infirmary for investigation of left upper abdominal pain. Excretion pyelography showed good function of both kidneys with normal structure of the right Cystoscopy showed a normal bladder, a l but some anomaly of structure of the left.Outline o f triplicate ureter normal right ureteric orifice, and two left ureteric orifices of which the lower and more medial was small and the other dilated. Ureteric catheters were passed through the two left ureteric orifices, and retropyelography showed apparent triplication of the left ureter.At a subsequent cystoscopy one catheter was passed through the smaller more medial orifice and two catheters were passed through the larger orifice. It was found that by good fortune each catheter had passed to its own segment of the left kidney. By injecting opaque medium through each catheter in turn it was possible, therefore, to delineate accurately the exact anatomy which is shown on the diagram. The ureter from the medial orifice obeyed the Weigert-Meyer law and passed to the uppermost renal segment. The ureter from the lateral orifice split at 5 cm. from the orifice; the two daughter ureters ascended in close company to near the left kidney. where they separated to go each to its respective renal segment. The three segments of the total renal pelvis were quite separate and no filling of any one from the catheter in any other was possible. The ureter from the uppermost renal segment crossed the other two ureters twice, from within out and from without in as it descended from the kidney, a feature commonly seen in ureteric duplication. No calyceal abnormality was noted in any segment of the pelvis and the abnormal formation apparently caused no symptoms (see illustration).This case throws no further light on the embryological explanation of multiplication of the ureters. The older theory of Chievitz, Hauch, and Felix that instead of one uretero-pelvic bud from the Wolffian duct there may be two or three is supported by the presence of two ureteric orifices in the left side of the bladder. The later theory of Heidenhain is supported by the splitting into two distinct ureters of the common ureter arising from the lateral ureteric orifice. REFERENCE SWITH, I. ( 1946). Brit. J . Sw,?., 34, 182.124

MEDICAL MEMORANDA 2. Insertion of a Davis gag and opening it to the maximum extent produced a dislocation of the jaw, which served to fix it in place and also to bring the inferior dental foramen into the most forward possible position. Most of the operation was -then carried out without a gag, but with medial and lateral retraction of the tongue and cheek. No packing was placed in the pharynx; continuous suction was used, and the blood remained a nice bright colour throughout.

No abstract