Eight patients with the middle aortic syn-

SUMMARY In two groups of gallstone patients ideally suited for medical treatment, the effect of six to 18 months' therapy was compared retrospectively in 52 given chenodeoxycholic acid (CDCA) and 46 given ursodeoxycholic acid (UDCA). The minimum dose (mg kg-1day-1) 18 months' treatment with CDCA and UDCA in diminishing the saturation of bile with cholesterol and in dissolving gallstones. We also compared the frequency and severity of symptons (such as biliary colic and non-specific dyspepsia) and the incidence of side-effects, before and during treatment. This paper reports our findings. Methods PATIENTSFifty-two patients treated with CDCA and 46 treated with UDCA fulfilled the criteria listed above and were selected for the comparative study. Details of their ages, sex ratios, and body weights are summarised in Table 1. There were no significant differences between the groups for any of these

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Four hundred and two videourodynamic studies were performed on 207 children with neuropathic vesicourethral dysfunction due to myelomeningocele. The children were divided into three groups (contractile, intermediate and acontractile) according to the urodynamic behaviour of their bladders, and the behaviour of the bladder neck and distal sphincter mechanism was assessed in each group. The bladder neck may be competent or incompetent in children with contractile bladders but is never obstructive, and is always incompetent in children with either intermediate or acontractile bladders at their usual bladder volumes. The distal sphincter mechanism is nearly always dynamically obstructive (detrusor-sphincter dyssynergia) in children with contractile bladders but is rarely if ever incompetent, whereas in children with intermediate or acontractile bladders, both (static) distal sphincter obstruction and sphincter weakness incontinence exist to some degree, although the predominance of one of these may mask the existence of the other unless it is specifically looked for or some therapeutic manoeuvre unmasks it. The main conclusion from this study is that, with the possible exception of those few children with more minor partial cord lesions, dysfunction of one or both sphincter mechanisms is the rule in congenital cord lesions.

The left arm and leg are longer than the right and there is a flexion deformity of the left hip and knee. The pigmented area can be seen above the left hip.