RECURRENT stone-formation is probably the most important problem in the after-care of patients who have undergone operations for renal and ureteric calculi. Surgical treatment usually provides immediate relief from symptoms and some improvement in kidney function, but it confers little permanent benefit unless steps can be taken to prevent the formation of other stones. The thoughtful stone patient is anxious to know the frequency of this complication, and asks advice about preventive measures. In spite of the considerable volume of research that has been carried out on these subjects in the last few decades it is still difficult to answer his first question accurately or his second adequately.An attempt is made in this paper to assess the incidence of recurrence in a series of patients who have undergone operative treatment for upper urinary tract stone. The practical application of this information to the prevention of recurrence is briefly discussed.Results of Other Investigations.-At the Annual Meeting of the British Association of Urological Surgeons in 1948, Professor John Hellstrom remarked that there had been surprisingly few investigations in recent years to determine the frequency of recurrence after operations for renal lithiasis. Table I indicates that the most modern studies of all aspects of recurrence were conducted by Twinem (1937), Oppenheimer (1937), and Spence and Baird (1939), who must have been given considerable food for thought by the fact that some fifteen to twenty years had elapsed since the well-known investigations of Cabot and Crabtree (191 5), Barney (1922 a), Braasch and Foulds (1923), and Brongersma ( 1 924), without any significant reduction in recurrence rate. Swift Joly (1929) considered that Brongersma's report to the International Society of Urology in 1924 was the most complete and convincing review of the late results of the various operations for renal stone, and in many respects this is still true. His figures are worth recalling. Following thirty-eight cases of pyelolithotomy, recurrence was present in 23.6 per cent., compared with 35.5 per cent. recurrence after sixty-two cases of nephrolithotomy : but perhaps the most significant feature was Brongersma's discovery that only 16.1 to 16.4 per cent. of sterile cases recurred, compared with 50 to 54-8 per cent. of those infected. Hunner (1928), an enthusiastic advocate of urostasis and ureteral stricture as causes of stone-formation, followed seventy-eight of 302 cases and found 9.5 per cent. recurrence after kidney operations. Higgins (1 936) reported that his recurrence rate had been reduced from 16.4 to 4.7 per cent. by a strict dietary and follow-up regime. In a recent Hunterian Lecture Hamilton Stewart (1952) described the progress of 101 partial nephrectomies performed in the thirteen years prior to the early part o f 1950 : he re-examined eighty-seven of these and found recurrent calculi in only six (6.8 per cent.). Reasons for Wide Variations in Reported RecurrenceRates.-There are several possible explanations for t...

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Of 175 patients operated on from 1925 to 1955 for upper urinary tract stones, in whom immediate postoperative x-rays were available for study, there were 38 instances of false recurrence (22 percent). Subsequent review of the x-rays in a further 130 patients showed no residual stones and no stone had passed during the intervening period. This finding adjusted the rate of 12.5 per cent (38 instances in a series of 305 patients). The incidence of residual stones afer nephrolithotomy was 30 per cent. Factors responsible for a continuing high incidence of residual stones are discussed, along with important radiographic and surgical adjuvant techniques in their prevention. Proper use of these techniques should reduce the incidence of false recurrence to less than 10 per cent. Accurate intraoperative localization of the stones is of paramount importance.

A census of African American cross-cultural overseas missionaries was completed between 2020 and mid-2021, encompassing data gathered since 1998. Over 600 mission agencies listed in the North American Mission Handbook were canvassed for US-born Black missionaries, and comparisons made between data from the 21st and 22nd editions. A slight majority of the 179 African American foreign missionaries located were single, and 57% of marrieds were in inter-ethnic marriages. Almost half of these cross-cultural workers served in Africa. Not more than 10% were found in any one mission agency, and 21% of missionaries were salaried.

IN spite of increased interest recently shown in the subject and great efforts directed towards it by the various drug houses, there is at the moment no perfect agent for the treatment of urinary infections. Since these are the commonest urological disorders encountered, research is not only important but promises to be endless. No sooner has one antibiotic or chemotherapeutic agent been introduced than some measure of resistance develops towards it and impairs its efficacy. New agents appear with such regularity that it seems almost impossible at times to keep abreast of the literature on the subject. Only a few years ago we had reached the point where chloramphenicol was regarded as the most potent broad-spectrum agent available, but since then other agents such as colomycin, kanamycin, cycloserine and nalidixic acid have been added to our armamentarium.In the excitement engendered by the arrival of each of these, it seems almost ingenuous to remind ourselves that the sulphonamides are probably still the best agents for the treatment of the commonly encountered, uncomplicated coliform urinary infections. A great deal has been heard lately of the new penicillin compounds, but the new composite long-acting sulphonamides have not enjoyed the same measure of publicity.The present investigation has been undertaken to observe the effect of treatment of sulphonamide-sensitive urinary infections with the long-acting composite sulphonamide known as Dosulfin (Geigy). Other aspects of urinary infection were given more general consideration at the same time.To date there have been several clinical trials with Dosulfin (Aufdermaur and Pulver, 1955;Cramer, 1956;MacFarlane, 1959). None of these trials has been concerned solely with urinary infections and all of them leave much to be desired in respect of the numbers involved, the thoroughness of follow-up, and the details of investigations carried out at the time. Dosulfin, in its pharmacological and early clinical aspects, has been well studied by Quattrin et al. (1955). It contains equal quantities of sulphaproxyline which is rapidly absorbed and reaches its maximum blood level within two hours, and of sulphamerazine which is slowly absorbed, taking much longer both to reach its maximum blood level and to be excreted. The individual components dissolve independently of one another according to the reaction to any given pH of the urine. The risk of crystallisation is low, even if fluids are not forced or if there is no concomitant alkali therapy. The antibacterial effects of the two components appear to be cumulative yet this does not apply to the toxic side-effects. Excretion appears to be almost entirely through the kidney so that low dosage and economy in use can go hand in hand with a therapeutically effective drug level.In this investigation adult patients of average body weight were given a loading dose of two tablets (1-5 g.) followed by one tablet eight-hourly for three days, then one tablet twice daily for eleven days. The total course, therefore, was over fourteen ...