Two cases of cancer of the colon have occurred recently in our series of 38 patients with exstrophy of the bladder treated by ureterosigmoidostomy. Twenty-six and 14 years elapsed between the original operation and the diagnosis of malignancy. Since 1929 the literature contains reports of 55 patients who have developed bowel neoplasms as a late complication of this form of diversion. The operation was performed for exstrophy in 35 of these, in whom the resulting tumour at the anastomotic site was malignant in 28 and benign in 7 patients. The shortest interval between ureterosigmoidostomy and recognition of the growth was 10 years with a mean latent period of 25 years. The aetiology remains uncertain but it is clear that long-term survivors after ureterosigmoidostomy should have diagnostic large bowel studies included in the follow-up.

Of the 37 patients with exstrophy of the bladder in whom ureterosigmoidostomy was selected as the mainstay of treatment 4 died of causes related to the procedure. Faulty judgment and poor followup accounted for these deaths, which might well be preventable today. In 18 survivors, or approximately half of the entire series, the operation has held up well for many years, with no further surgical procedure being required for complications. In 12 patients, or approximately a third of the group, remedial operations for complications attributable to the ureterosigmoidostomy have been required but it was elected to retain this form of diversion. The long-term end result in these patients also remains acceptable. Combining these 2 groups 30 of 37 patients with ureterosigmoidostomy may be considered to have been eventually successful. However, in 7 of 37 patients the method was a frank failure, in that 4 patients died and 3 required substitution of another form of diversion. While all forms of treatment of exstrophy of the bladder leave much to be desired, results obtainable in today's setting lead us to recommend ureterosigmoidostomy as first choice in the management of this disorder. This recommendation is accompanied by the admonition that systematic followup is imperative so that if things do go badly from the clinical, laboratory or urographic viewpoint corrective measures can be done before renal deterioration occurs. The measures required may range from simple correction of electrolytes to conversion to an ileal loop.

CP-20,961, N,N -dioctadecyl- N′, N′ -bis(2-hydroxyethyl)propanediamine, is an antiviral drug with low acute toxicity in mice. Parenteral injection of this compound protected mice against lethal infections with encephalomyocarditis and Semliki Forest viruses and effectively suppressed pox formation by vaccinia infection. Maximal antiviral effects were observed when CP-20,961 was administered 6 to 12 h before infection. An interferon detected in plasma 12 to 20 h after the drug was given appeared to mediate these effects. Comparison of the minimal effective and lethal doses in mice established a therapeutic index of 300.

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