Case 62-1961

Presentation of CaseA sixty-seven-year-old man entered this hospital for the first time because of difficulty in breathing.Twenty-one and again sixteen years before admission the patient had attacks of nephrolithiasis that were characterized by dysuria and "gravel" in the urine; on each occasion a ureterolithotomy was performed, one on each side. After the second operation there were no chills, fever or dysuria, but intermittent, aching mid-line low-back pain and slowing and hesitancy of the urinary stream developed several years before entry. Eleven years before admission a portion of the small intestine was resected because of regional enteritis, and a . . .