Multipolar recording technics have been employed to record the spread of excitation through the wall of the ventricle. The construction of isochronous planes in a block of tissue aids in visualizing the direction of spread. The results give direct support to the idea of fast endocardial spread followed by syncytial spread through the wall at a slower rate. No evidence is found that the impulse spreads through the individual cardiac muscle bundles. 539

The effects of the new diuretic metolazone were studied in ten patients with chronic renal insufficiency and ten with nephrotic syndrome. Patients were maintained on metolazone for up to 44 months. Beneficial effects of treatment included loss of edema and improved control of blood pressure. The natriuretic effect of metolazone facilitated the use of sodium bicarbonate to treat acidosis in several patients. Concurrent administration of metolazone and furosemide produced a dramatic diuresis in one patient resistant to either diuretic alone. Adverse effects of metolazone therapy were those characteristic of other effective diuretics, Including serum electrolyte losses and hyperuricemia. Initial treatment produced small increases in serum creatinine among patients with renal insufficiency, suggesting that GFR was decreased secondary to diuresis-induced volume depletion. The study demonstrates that metolazone is both safe and effective over long periods of time.

A new technique for inferior vena caval tumor thrombectomy is described. Vascular isolation of the cava from the right atrium to the pelvis is achieved by temporary circulatory arrest of the lower torso. Removal of the neoplastic thrombus under direct vision with minimal blood loss was accomplished in a patient with renal carcinoma, whose tumor extended into the intrapericardial vena cava.

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It is not uncommon for urologists to be involved in the care of patients with either adult polycystic kidney disease or horseshoe kidney. Personal clinical experience indicates that it is most unusual to have these 2 congenital disorders simultaneously in the same patient. The first known report of such a situation describing removal of a kidney so involved in preparation of renal transplantation is presented.