THOUGH usually attributed to von Mikulicz (Tasker, 1953), the operation of ileocystoplasty was first performed by Tizzoni and Foggi in 1888. Since then it has become an accepted part of urological surgical practice. Maged (1968), reviewing 32 cases where this operation had been performed for contraction of the bladder following bilharzia, commented that " Ileocystoplasty has been proven to be of real value in cases of contracted bladder or extensive resection of the bladder wall ".

We have described the MRI features of a juxta-articular myxoma. The imaging features are similar to those of intramuscular myxoma. The lesions are differentiated by their location.

Chondromyxoid fibroma is a rare benign cartilaginous tumour seen most frequently around the knee in children and young adults. Up to 17% occur in the foot, where more aggressive appearances have been reported. Four cases of chondromyxoid fibroma in the forefoot are presented, demonstrating the wide range of radiological appearances of this primary tumour. Three of the four tumours recurred, one at 19 years after the surgery. These cases illustrate the need for thorough preoperative assessment to ensure complete surgical resection in an attempt to reduce the incidence of local recurrence.

Previous reports have suggested that secondary hyperparathyroidism is extremely uncommon in hepatic osteomalacia. This, together with other findings, has led to suggestions that in chronic liver disease there may be selective resistance of bone to vitamin D or a specific bone mineralization defect unrelated to Vitamin D. To examine these possibilities, twenty-five patients with chronic liver disease have been studied by bone biopsy, serum calcium and inorganic phosphate, plasma 25-hydroxyvitamin D, plasma immunoreactive parathormone (iPTH), fasting urine cAMP, fasting renal tubular maximal reabsorptive capacity for phosphate (TmP/GFR) and fine grain hand x-rays. Nine of the patients had osteomalacia on bone biopsy, eight of these had subnormal levels of plasma 25-hydroxyvitamin D and the other had a borderline result. Based on the consensus of all the tests, five of these had evidence of secondary hyperparathyroidism. Plasma iPTH was higher in patients with osteomalacia than in patients without osteomalacia (P less than 0.01) or controls (P less than 0.01). Urine cAMP was higher in patients with osteomalacia than in patients without osteomalacia (P less than 0.001) or controls (P less than 0.01). TmP/GFR was significantly lower in patients with osteomalacia than in controls (P less than 0.05) but not significantly different from patients without osteomalacia. The findings of this study indicate that hyperparathyroidism occurs in a substantial proportion of patients with the osteomalacia of chronic liver disease. Moreover, osteomalacia in chronic liver disease is clearly related to reduced levels of plasma 25-hydroxyvitamin D. We conclude that hepatic osteomalacia is a vitamin D deficiency state and there is no need to suggest an unusual aetiology.

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