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arcus senilis. Hemoglobin seventy per cent. (Dare) ; leucocytes, 74,000. Rectal e.xamination revealed a large, moderately firm, and tender prostate with no gross evi- dence of malignancy. By catheterization, which was very painful, 500 c.c. of urine were removed. The urine Buy Cialis Online Safely was greenish from the taking of methylene blue tablets and contained much pus from which the colon bacillus was isolated in pure culture. It was strongly alkaline. Be- catise of the desirability of giving the patient immediate relief from his tenesmus, a suprapubic incision was made Buy Cialis Online Safely with novocaine anesthesia and tubular drainage estab- lished. There was a slight amount of shock following the operation but Buy Cialis Online Safely after about an hour he went to sleep and slept continuously for four hours, the longest continuous sleep which he said Buy Cialis Online Safely he had had for two weeks. After three weeks of drainage his blood pressure had come down from 205 to 160, the urine was practically free from pus, and a phthalein test showed sixty per cent, elimination in ^wo hours. The temperature had been normal for two weeks. The patient was now regarded as a safe risk for the prostatectomy, and accordingly it was quickly per- formed with light ether anesthesia in six minutes. There was no appreciable shock following the operation. Re- covery was uneventful and the patient was discharged three weeks after tlie operation with the wound healed and continence sufficiently well established to enable him to Buy Cialis Online Safely retain liis urine for four hours at a time. Microscopical examination revealed a simple adenoma of the prostate. Six months later he reported that he had gained thirty pounds in weight, felt twenty years younger and was able to hold his urine all night and then void it normally. _ Case III. — A patient aged sixty-two years, with prostatic obstruction complicated with a carcinoma of the fundus of the bladder entered the hospital complaining of passing very bloody urine almost continuously for the last three months and of frequent attacks of severe tenesmus and difficulty in urination. At intervals he was compelled to urinate as often as every hour. He had been treating him- self during this time with various kinds of Buy Cialis Online Safely proprietary medicines. There I'.ad been symptoms of moderate urin- ary obstruction present for about eight years, char- acterized chiefly by difficulty in starting the flow of urine. He had been catheterized only once about ten days ago. There had been no marked loss of weight. Exam- ination revealed rather marked signs of senility, such as a well marked arcus senilis, marked arteriosclerosis, etc. A specimen of urine obtained by voluntary micturition was bright red in color from the presence of a large amount of blood, and there were numerous small clots in it. The urine was alkaline in reaction. Catheterization immediately afterward resulted Buy Cialis Online Safely in the withdrawal of about twenty c. c. of foul smelling, bloody urine. The systolic blood pressure was 165. Hemoglobin, 70 (Dare) ; leucocytes, 10,200; temperature, 99° F. Rectal e.xamina- tion revealed a soft moderately enlarged prostate which was also somewhat tender. A cystoscopic examination was attempted by Dr. M. J. Fitzpatrick, but was aban- doned because the presence of the blood rendered a good vision of the bladder impossible. Buy Cialis Online Safely A tentative diagnosis was made of hypertrophy of the prostate and a papilloma of the bladder. An exploratory operation on the bladder was advised and consented to. A suprapubic incision was made under ether anesthesia and an elevated plateaulike, soft carcinoma was found on the right lateral wall of the fundus of the bladder. This tumor was about two centi- metres in its longest diameter and was elevated from the bladder wall to a distance of about one centimetre. The prostate was found to have a large middle lobe which projected over the urethral opening. The carcinoma was removed by resecting a portion of the bladder widely around the base of the tumor, cauterizing the edges with the actual cautery and closing the defect with No. 3 cat- gut. A tube was inserted into the bladder and closure made in the usual way in cases of suprapubic cystostomy. Microscopic examination of the tumor confirmed the diag- nosis of carcinoma. Convalescence from the operation was uneventful and tliere was no blood in the urine after the second day. Two weeks later the phthalein test showed an elimination of sixty per cent, in two hours, and the enucleation of the prostate was performed quickly through the suprapubic opening with the aid of nitrous oxide and ether anesthesia. The prostate microscopically was found to be an adenoma. Three weeks later the pa- tient was discharged from the hospital with the wound completely healed and with continence sufficiently estab- lished to allow him to go from four to six hours without urinating. At the time of this writing, seven months after the operation, there has been no return of any of Buy Cialis Online Safely the for-' mer symptoms, and the patient feels well. Case IV. — A retired farmer, aged sixty-six years, Buy Cialis Online Safely had marked myocarditis with arrhythymia and a history of having had several attacks of decompensation and pros- Buy Cialis Online Safely tate symptoms for five years. Acute retention of urine was relieved by catheterization four times during the past year by his physician. There was a moderate colon bacil- lus cystitis. Phthalein test showed thirty-eight per cent. eliminated in Buy Cialis Online Safely two hours. Suprapubic cystostomy was done with local anesthesia. One week later there was marked edema of lower extremities and of penis and scrotum, followed on the tenth day by acute cardiac col- lapse. Compensation was recovered. Four weeks after the establishment of cystostomy the phthalein test showed sixty-two per cent, elimination and absence of edema. The prostate was then removed throu,gh the suprapubic opening by intraurethral enucleation method of Squier. It proved microscopically to be an adenoma. Convalescence was rapid and the patient was discharged on the nineteenth day with the wound healed and continence nearly entirely established. Case V. — A man, aged fifty-four years, had had slight prostatic symptoms for one year : acute retention four 450 EDELMAN: ECZEMA DUE TU HYPERTHYROIDISM. (New Yo«k MbDICAL JOUKMAI.. ilays previous to admission was relieved by catheter. There was no cystitis. Phthalein test showed sixty-five |ier cent, elimination in two hours. This was Buy Cialis Online Safely a simple, uncomplicated case of prostatic hypertrophy and the two stage operation was unnecessary. Suprapubic operation was performed in one stage with light ether anesthesia. Recovery was uneventful and the patient was discharged on the sixteenth day.