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This technique is a safe simple way to administer sub-Tenon's anesthesia that provides akinesia comparable to that of retrobulbar and peribulbar anesthesia and frequently results in excellent lid block. The potentially serious complications associated with retrobulbar and peribulbar methods appear to be absent.

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A unilateral multicystic mass in the connective tissue adjacent to the vas deferens in a 46-year-old man is reported. Anatomically, it was distinct from the epididymis and vas and contained no sperm. The epithelial lining was simple, ciliated, and cuboidal to columnar. The cysts were surrounded by connective tissue collars containing smooth muscle. The authors postulate that this lesion represents a cystic hyperplasia of vestigial Wolffian duct remnants, based on its unique histologic features and the exclusion of other plausible explanations. The supraepididymal, paravasal location suggests origin in the paradidymis.

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This study examines resource data for a variety of services in North Carolina's continuum of care for older adults. It qualifies the widespread contention that older adults in urban areas receive a greater number and more varied services than their rural counterparts. It also demonstrates that one of the most important differences between these communities is the greater variability of services among rural compared to urban counties. The comparative findings on urban and rural variations in the continuum of care for older adults have implications for further research and future policy development.

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Poor patient positioning with subsequent patient and physician strain commonly occurs during slitlamp examination. Contributing factors include slitlamp stands that lack handles and patient uncertainty regarding hand placement. This problem can be resolved by using wooden dowels inserted into standard bicycle handles. The handles are attached to the slitlamp stand by placing a hanger bolt screw into the wooden dowel, inserting the exposed end of the screw through a hole drilled in the slitlamp table, and fastening the handle with a wing nut.

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At the request of the Society of University Urologists a survey of urological teaching at 113 United States medical schools was done. The most distressing finding was that more than two-thirds (68 per cent) of the schools do not require any clinical exposure to urology before graduation. In view of the fact that urology is rarely, if ever, taught in any of the primary care disciplines after graduation, it is suggested that patient care may well suffer for this shortcoming in our medical education curriculum.

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In summary, hematuria, either gross or microscopic and with or without any accompanying symptoms, should always alert the clinician to the possibility of serious urologic disease and should virtually always trigger a thorough urologic investigation. This can be done by immediate referral to the urologist, or it can be done by the primary care physician initiating the diagnostic work-up in children by obtaining studies for acute poststreptococcal glomerulonephritis and in adults by obtaining excretory urograms with physiologic voiding films and also by urine cytologic studies and urine cultures. Appropriate referral to a urologist can then be made for additional studies that might be indicated, such as cystoscopy and cystourethroscopy and for meticulous follow-up of any abnormal findings. The physician who delays or defers a careful investigation into the cause of a given patient's hematuria (gross or microscopic) does the patient a disservice at best and, at worst, may inadvertently permit a significant disease process to become more extensive.

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Thirty-five percent of patients over 70 years old who received an unsolicited visit by a health visitor were found to have previously unidentified needs. In all, 71% of the 110 patients surveyed were found to have problems involving mobility, communication or caring for themselves. Most of their needs were social ones. It was concluded that unsolicited visiting by health visitors was efficient use of time by members of the primary health care team. Changes in practice administration are suggested to improve access to medical care for elderly patients.

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Rat liver cytoplasmic acetyl-CoA synthetase was partially purified (purification factor = 23, yield = 30%). The apparent Kms for acetate, coenzyme A, ATP and MgCl2 were determined and found to be 52.5 microM, 50.5 microM, 570 microM and 1.5 mM, respectively. The partially-purified enzyme showed a low affinity for short-chain carbon substrates other than acetate. The properties of the partially-purified enzyme were compared with those of enzymes from other sources.

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Priapism, a complication of male patients with sickle hemoglobinopathies, has been managed by a variety of surgical and nonsurgical forms of therapy that often are unsuccessful. The application of automated erythrocytopheresis (red blood cell exchange) by continuous-flow and semicontinuous-flow procedures appears to offer distinct advantages in the treatment of complications resulting from sickle hemoglobinopathies. The successful application of erythrocytopheresis for the relief of priapism in a patient with hemoglobin SC disease is presented and probably represents the first case reported on the use of automated red blood cell exchange procedures in the treatment of this condition. Data and results of automated erythrocytopheresis in 4 additional patients are presented. The advantages and disadvantages of erythrocytopheresis in the treatment of priapism (and other complications of sickle hemoglobinopathies) are discussed and the method is compared to other modes of therapy.

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The existence of a microsomal acetyl-CoA carboxylase in the rat epididymal adipose tissue was demonstrated in vitro in the present study. Its specific activity was of the same order of magnitude as that of the cytoplasmic acetyl-CoA carboxylase. The effect of several experimental conditions on the enzymatic activities of both enzymes were tested; fasting for 24 hr strongly increased (2.5-4 times) the activity of the microsomal enzyme while the cytoplasmic enzyme remained unchanged. Palmitoyl-CoA (1 and 5 microM), an inhibitor of acetyl-CoA carboxylase, had a greater effect on the cytoplasmic (33 and 88% inhibition) than on the microsomal enzyme (0 and 37% inhibition).

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During a 3-year interval 171 patients with urinary tract calculi were seen and studied: 98 had kidney, 52 had ureteral and 21 had bladder calculi. In 54 of the 98 patients with kidney stones (55 per cent) abnormal elevations of the blood and/or urine calcium, uric acid or creatinine were noted. Of these 98 patients 54 (55 per cent) were treated with observation only, 42 (43 per cent) were treated surgically (with an operative mortality of 2.4 per cent) and in 2 the renal stones passed spontaneously. Sixty-two per cent of the patients with renal calculi had a history of stones. It is believed that asymptomatic renal stones located in a calix or calices and not associated with infection are best managed nonoperatively. The average age of the 52 patients presenting with ureteral calculi was 12 years younger than that of patients presenting with renal calculi (36 versus 48 years). In 46 per cent of these cases the ureteral calculi ultimately passed spontaneously. Conservative therapy of ureteral calculi with long-term expectant observation (weeks and even months) often is indicated in the obstructed and uninfected patient. Twenty-nine per cent of the patients with ureteral calculi had a history of stones.

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Acute lower urinary tract infections were treated in 57 women according to a randomized protocol, using either cefaclor, a cephalosporin whose chemical structure is similar to that of cephalexin, or trimethoprim-sulfamethoxazole combination. Urine cultures were made before treatment was started, midway through the 10-day course of therapy, 1 week after therapy and 4 to 6 weeks after therapy, if possible. Urine cultures in 100 per cent of the patients became sterile during therapy and remained so 1 week after therapy. Of those patients undergoing followup cultures 4 to 6 weeks after therapy 98 per cent had sterile urine. Twenty-nine patients were randomized to cefaclor therapy and 28 received a trimethoprim-sulfamethoxazole combination. There was no difference between the 2 drugs studied in terms of efficacy. No side effects were noted with cefaclor and 2 minor side effects were noted with the trimethoprim-sulfamethoxazole combination. Cefaclor in a twice daily dosage schedule appears to be a safe and useful drug in the treatment of urinary tract infections caused by the common gram-negative organisms and it appears to be as efficacious as the trimethoprim-sulfamethoxazole combination.

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