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Milk-of-calcium urine associated with hydronephrosis is rare, with only 8 unilateral cases reported previously. We report the first case of bilateral occurrence. Upright films are necessary for making the diagnosis. Although previous reports indicate that the involved kidney has little or no function our patient had only slight impairment of renal function. Nephrectomy should not be done without evaluation of renal function, since some function may be preserved by removing the obstruction that is associated with milk-of-calcium urine and hydronephrosis.

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Obstruction of the biliary system due to intraductal echinococcal cysts is a rare but serious presentation of hepatic echinococcal disease. Four cases are described. There was a 50% mortality rate and morbidity was high. The clinical presentation is difficult to differentiate from other disease processes. Careful preoperative sonograms should be taken to detect echogenic cyst material in the biliary system in all patients with hepatic echinococcal cysts. If biliary pigments are seen in the cyst during surgical removal, or if the patient has a recent history of jaundice or cholangitis, intraoperative cholangiography should be done to rule out intraductal cysts, which may cause obstruction.