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The authors describe their experience with a routine Medicaid audit and discuss the damage such a procedure can do to the trust between psychiatrists and patients, confidentiality, doctors’ reputat...

SummaryThe tears of 14 patients receiving sulfathiazole were quantitatively analyzed. Sulfathiazole was found in all the cases. The concentrations varied from 0.1 mg % to 0.98 mg %.Four patients suffering from sulfathiazole conjunctivitis showed a tear concentration of 0.6 mg %, or more. On the other hand, 6 of 10 patients without conjunctivitis had a tear concentration of 0.56 mg %.A single case of conjunctivitis was observed in which the eye inflammation disappeared without sequelae despite the uninterrupted administration of sulfathiazole.Among 31 consecutive patients receiving sulfathiazole, 5 developed conjunctivitis. In 4 of these the conjunctivitis appeared during a second or a subsequent course of therapy.Conclusions. 1. The amount of sulfathiazole secreted in the tears is not proportional to the blood sulfathiazole concentration.2. The concentration of sulfathiazole in the tears does not of itself appear to be the cause of the conjunctivitis.

These instruments are the result of an effort to devise a simple shock-proof anterior urethroscope for fulguration with unipolar or bipolar current. Since the bakelite sheath itself acts as an insulator, it is safe to use a thin bare wire electrode which does not appreciably obstruct the urethroscopic view. This fact, in addition to the improvement in the light system, will, I trust, afford better visualization of the anterior urethra, as well as safety for fulguration. In closing, I wish to thank Mr. Frederick C. Wappler for his willing cooperation and for his assistance in the making of these instruments.

To the Editor:— The physician should suspect the presence of an ectopic ureter when a patient presents the complaint of continual dribbling of urine superimposed on micturition at normal intervals. This dribbling usually has its onset in infancy; it occurs primarily when the patient is in a vertical position and hence is usually diurnal in nature. The ureter is sufficiently flaccid to pool urine when the patient is recumbent, and the incontinence is effected by gravity when sitting or standing. Ectopic ureters oftenest arise from the upper pelvis of a double kidney, which embryologically is the result of formation of an accessory ureteral bud on the Wolffian duct. The distal end may open, in females, in the vestibule, the external meatus, the urethra, the vagina, and the uterus; in males, in the urethra, the ejaculatory ducts, and the seminal vesicles (Higgins, T. T., and others: The Urology of Childhood, London

A remarkable sudden increase in the incidence and pathogenicity of Aerobacter aerogenes (Bacillus lactis aerogenes) in the genitourinary tract was reported from the Beth Israel Hospital by Wilhelm and Orkin 1 in 1948 (published in 1949). At that time this organism was found, either in pure form or in association with other organisms, in the urine of 49.2 per cent of 257 consecutive patients admitted to the urologic service. Studies made subsequently by us in 100 consecutive admissions revealed that A. aerogenes was present in the initial urine cultures of 50 per cent of these patients and that the organism was recovered in later cultures in 75 per cent of the patients at some time during their hospital stay. Bacteremia caused by A. aerogenes was proved in 24 patients, 7 of whom died. In one of the fatal cases, suprapubic prostatectomy was complicated by an acute bacterial endocarditis. 2 At

The first recorded surgical attempt to reestablish the seminiferous channels was that of Bardenheuer, 1 who in 1886, following excision of the epididymis for tuberculosis, implanted the cut distal end of the vas deferens in the testis. Since then many operations have been devised for the relief of male sterility due to obstructive lesions in the epididymides. These fall into three main categories: 1. Vaso-epididymostomy 2 2. Vaso-orchidostomy 3 3. Miscellaneous operations ( a ) Vaso-orchidocystostomy 4 ( b ) Sac epididymostomy 5 ( c ) Transplantation of the saphenous vein as a substitute for the vas deferens 6 ( d ) Vaso-urethrostomy 7 There are valid objections to most of these operations on anatomic and physiologic grounds. 8 It appears from a review of the literature that Martin's vaso-epididymostomy with technical modifications is the most popular and the most successful operation for the reestablishment of the seminiferous channels following bilateral obstructive epididymitis. The largest series of cases

Recent studies with corticotropin (ACTH) and cortisone indicate that Cushing's syndrome is basically caused by hypersecretion of certain adrenal cortical steroid hormones.1Such adrenal hyperfunction, or perhaps dysfunction, may be caused by an intrinsic lesion of one or both of the adrenal glands, or may be activated by hormonal hypersecretion of the pituitary and possibly also of other endocrine glands. This newly acquired evidence supports the assumption that Cushing's syndrome may occur on a purely functional basis in the absence of demonstrable pathological changes in the adrenal glands. While some lesion of an adrenal gland, such as hyperplasia or neoplasm, has been demonstrated in most cases of Cushing's syndrome,2there are a few authentic cases in which the adrenal glands were found histologically normal.3Such was the case reported here of classical Cushing's syndrome in a woman aged 45, whose progressive downhill course was suddenly interrupted by