The Function of the Ureterovesical Valve

showed the bladder normal.Injection of right renal pelvis showed it to have a capacity of .'¡.") CO. without leakage."V-ray was again negative for stone.OpVation.In February, 1!H2. the kidney was exposed by lumbar im-ision and found very movable without abnormal adhesions but with a moderately dilated renal pelvis.The Capsule was stripped and the kidney fixed ill normal position.in May.1912, patient had returned to her work; was free from symptoms.CASE 5. History.-M.W. M., aged -III.carpenter, for six months bad had a somew bal indefinite pain in the back which troubled him chiefly when he was up and about and was relieved after a short time by the recumbent position.This pain WHS sufficiently severe entirely to prevent llilll from working.Three weeks before examination he was wakened in the night by a sharp pain in the left loin which did not radiate, which lasted for twelve hours and was relieved only by morphin, ami which accompanied and was followed by con¬ siderable vomiting.Two days later, he passed a pea-sized stone from the bladder.This attack produced no effect on Ihe pain above described.The urine had always been normal.Cystoscopy was entirely negative.A radiogram laken with studied catheter in place strongly suggested kinking of the left, ureter.Two days later, a radiogram of Ihe injected renal pelvis showed distinct dilatât ion, with kinking of the ureter (rig. 4).Operation.May 2'A : The left kidney, delivered through a Somewhat oblique lumbar incision, was found very freely mov¬ able and markedly lobulated with portions of the cortex some what thinned, The upper portion of the ureter was found markedly bound to the lower pole of the kidney by abnormal bands of libroiis tissue.After the ureter was freed from these adhesions, the kidney was fixed in its normal position.The wound was closed.Case ti.History.-A.D., aged 31, Italian shoemaker, live years before coming under examination began to have attacks of pain in Ihe right Hank, made worse by bending over.Ill these attacks (he pain came on rather slowly, Increased for a few days and then diminished and disappeared.It was not rapid or sudden.There was no change in urine, so far as the patient was aware; no gravel, He had hi.s appendix removed without relief of symptoms.Examination was negative, except that ou deep pressure under the right costal margin there was some tenderness and this started a pain which the patient described as running down into the pelvis.Cystoscopy showed Ihe bladder normal; the ureters were catheterized easily and free from obstruction.The urine obtained from both kidneys was apparently normal.Sediment from right side was inoculated into a guinea-pig; the subsequent report showed no tuberculosis.Dee. 15, 1911, there was recurrence of pain; the urine was clear and clean, with rare shreds.The right ureter was catheterized with No. 0 which passed to kidney.The urine was examined for culture and sediment, and showed no bacterial growth.Mctliylene-bluc and boric acid (8 ce.) injected caused pain, and fluid then came back around catheter.Pain was in same place but not so sharp as usual..V-ray plates were made with the patient prone and standing with 7 C.C. collargol in pelvis.About 15 c.c. of Oollargol and urine were obtained when ineteral llovv was again released (Fig, 5).December 2G, 31-ray showed movable kidney.December .'in.admitted to house.Operation.-dan.3, 1912, oephropexy for (right) nephroptosis was performed.January 16, patient was discharged to out-patienl department, .May 28, lie had had only two or three slight attacks of pain since operation; had been at work.Urine was clear with shreds.There was no albumin.The sear was firm. GROUT illCasi: 7.This ease, which was reported earlier in the paper (1!.B.) should be regarded as belonging to this group.Case 8.-History.-L.L., aged -21, factory girl, six months before coining under observation began to have pain in the left side, which came and went in irregular fashion; it might last for a week and be absent for u week or more.Pain was never sharp but dull and.again, sufficient to disturb sleep.It did not radiate, 'rítete was some frequency of urina li»"' particularly a! night.Physical examination was negativ except for slight tenderness to the left of umbilicus and o» one occasion the left kidney was felt.Cystoscopy show," considerable inject ion of the bladder, most marked about tl'c loll ureteral orifice.Three days later both ureters were call"" terized.Showed a very free flow of an apparently non11" urine from botli sides.Guinea-pig inoculation made ironi urifl obtained at this lime subsequently reported negative.Colla'' gol injection showed the rather curious appearance of the renj pelvis reproduced in Figure 6.Urine nt this time showed con' siderable pus and blood but repeated cultures are negativ1'' This case seems to me clearly to belong to Group 11'' although the proof by operation has not been fortheoiir ing up to the present time.The patient was allowed t°l eave the hospital because my colleagues and I were s?¡ much in doubt of the diagnosis and so inclined to regar'' the kidney as probably tuberculous.Subsequent devel' opments have altered our conclusion.87 Marlboro Street.