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A case is presented of thrombosis of an anomalous left-sided duplication of the inferior vena cava misinterpreted on CT as lymphadenopathy or other retroperitoneal mass. Recognition of this anomaly is important in reaching the correct diagnosis in such cases. The diagnosis by imaging methods is described as well as their pitfalls.

The prevalence of hepatitis C infection and possible predisposing factors was assessed in a renal unit. Of 343 patients at our renal dialysis centre, 37 (10.8%) were anti-HCV positive by a 1st-generation assay (ELISA, Ortho/Chiron) and confirmed positive in 35 (10.2%) with a 2nd-generation test (UBI, New York). Anti-HCV positivity was significantly associated with: duration of renal replacement therapy (P < 0.0001); quantity of blood transfused (P < 0.002); duration of hospital haemodialysis (P = 0.0001); duration with a functional renal transplant (P = 0.039); and aspartate aminotransferase (P < 0.0001). Logistic regression determined the following variables to be independent risk factors: duration of renal replacement therapy with a relative risk of 34.3 for 5-9 years and 87.4 when the duration was in excess of 10 years; renal transplant for less than 1 year (relative risk of 5.0); transfusion in excess of 50 units of blood (relative risk of 11.6). Clinical assessment of anti-HCV-positive patients revealed peripheral signs of chronic liver disease in 40%, hepatomegaly in 34%, and splenomegaly in 9%. This prevalence of hepatitis C infection is similar to other European and North American centres, but contrasts with low prevalence rates reported from dialysis populations in the UK. It adds further support for routine screening of blood and possibly organ donors and implementation of further infection control measures in dialysis centres.

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Cancer and patients with end-stage renal failure Recipients of renal transplants may acquire cancer by the accidental transplantation of cancer cells with a kidney taken from donors with cancer, by the growth of residual or metastatic tumour in patients with pre-existing malignancy, or by the de-novo formation of neoplasms some time after transplantation. ' An increased incidence of de-novo neoplasms has been reported1 2 in patients after renal transplantation, and the main factor responsible is thought to be the prolonged use of immunosuppressive drugs given to prevent rejection. Penn and Starzll reported 75 long-term survivors of organ transplantation who had developed de-novo neoplasms, including 16 of their own patients. The data on the increased incidence of malignancy in uraemic patients have been criticised as inconclusive. The reports from the National7 and European Dialysis Registries8 have been said to be inadequate because non-fatal cases were not reported and the length of exposure to uraemia and size of the population at risk were unknown.9 Lindner et al9 therefore studied 153 patients who had had long-term dialysis for an average of 66 months to determine the incidence and type of neoplasms and to compare these findings with cancer rates for the population in the same geographical area. Nine cancers were found among 148 men (six lung, one kidney, one pancreas, one carcinoid). Eight of the nine men were smokers. This result was higher than expected (that is, 3-6 cases; p <0 0137) for exposure-specific and age-specific controls of the same sex.The increase in the incidence of common tumours supports the findings of Matas et al3 and contrasts with the increase in the incidence of epithelial and lymphoproliferative tumours after renal transplantation.