SUMMARY A case is described of a female who, after her only pregnancy at the age of 23 years, developed some of the typical symptoms and signs of an ectopic ureter which persisted until surgical treatment for that condition was carried out fourteen years later. Reference is made to other somewhat similar cases recorded. The investigations and possible causative factors are briefly discussed.

HAEXOSTATIC MANAGEMENT.-PreOperatiVely, screening tests for the presence of AGH inhibitors were carried out as described by Bxr, Forbes, MflicoL and Douglas A haemophilic boy, aged 14 years, presented with rupture of the upper end of the ureter as a result of a successfully carried out under cover of cryoglobulin precipitate therapy. Renal function tests carried out at z months were normal, although the isotope renogram showed slight diminution of function on the injured side and an intravenous pyelogram showed some narrowing of the ureter at the site of the anastomosis. crushing injury. Primary ureteranastomosis was (1 969). CqoPreciPitate dosage Was calculated by the RUPTURE of the upper ureter as a result of blunt trauma is rare, presumably because of its protected position in the abdomen and its natural elasticity. T h e following is an account of a boy with severe haemophilia who sustained a rupture of the upper end of a ureter as a result of a crushing injury. CASE REPORTThe patient, aged 14 years, was a severely affected haemophiliac with an antihaemophilic globulin (AHG) level of o U. per 100 ml. He had a history of multiple admissions to the Regional Haemophilia Centre with spontaneous haemarthroses, haematuria, and haematomata. His general health had been good except for mild bronchial asthma as a child.On this occasion he was admitted to the centre after having been crushed by the crowd at Ibrox Football Park, Glasgow, a disaster in which 66 people died. He had the features of traumatic asphyxia: cyanosis of the face, bilateral subconjunctival haemorrhages, extensive abrasions of the back from the upper thorax to the buttocks, and large haematomata of the head, arms, and legs. His only complaint, however, was of slight pain in the left loin. His blood-pressure was normal and his pulse-rate was IZO per minute.In the next IZ hours his condition deteriorated and he developed severe pain in the left loin with the appearance of a large, tender mass and gross haematuria. His bloodpressure fell, the pulse-rate rose, and the haematocrit, which had been 46 per cent on admission, dropped to 29 per cent. An intravenous pyelogram (Fig. I) showed lateral displacement of the left kidney at its lower pole with leakage of the contrast medium into the retroperitoneal space ; the bladder was elevated symmetrically, suggesting that blood and urine had tracked into the pelvis. A radiograph of the chest showed fractures of the sixth to ninth ribs on the right side near their anterior ends. FIG. I.-Intravenous pyelogram showing extravasation of the contrast medium into the retroperitoneal space and symmetrical elevation of the bladder by a haematoma in the pelvis.method described by Prentice, Breckenridge, Forman, and Ramoff (1967), and was administeredtwice dailyfor the first 4 days. On average, 1000 U. of AHG were given at each infusion, I U. being the amount of AHG present in I ml. of normal plasma. Plasma levels of AHG were determined before and after each infusion (Fig. 2). Aminocaproic acid was also given in a dose o...

diverticulum and the resulting oedema somehow provoked the onset of mechanical kinking.In the second patient obstructive symptoms were presumably due to kinking of the bowel wall at the site of the ulcer on the mesenteric border of the ileum, whilst the bleeding came from the ulcer itself.Such a minor degree of failure of rotation would be unlikely to have caused symptoms without the presence of the additional lesions. Mintz (1924) and Oelschlagel (1924) reported patients in whom a similar degree of malrotation was present, the anomalies being brought to light because of operation for coexisting appendicular disease. SUMlClARYI . Two patients are presented with anomalies of the final phase of the second stage of intestinal rotation. 2.In both patients the terminal ileum lay in the position of the normal right colon. In one there was an associated Meckel's diverticulum with peptic ulceration, whilst the other had a distended subhepatic loop of terminal ileum containing a nonspecific ulcer of the ileum.3. A brief summary of the features of normal intestinal rotation is given with an explanation of the more common anomalies.Acknowledgements.-We wish to thank Mr.N. C. Tanner and Mr. J. Burke for permission to publish these cases.

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