TP-US is a useful complementary technique to assess fistula-in-ano and has special advantage when there is anal canal distortion, complex fistula type or suspicion of a recto-vaginal fistula.

Twenty-four recent cases of digitalis toxicity were characterized by 4 salient points:(1) Nine cases, or 37%, were identified electrocardiographically by atrioventricular dissociation with an AV nodal rate above 70.(2) The average age in this group was 69.7 years.(3) Twenty cases, or 83%, were induced by digoxin.(4) Nineteen patients, or 79%, were on chlorothiazide or mercurial diuretics.All hospitalized cases of digitalis excess were recorded during a 12-month period.Since the average age was in the seventh decade, it must be assumed that the aging patient is the most likely candidate for such toxicity. It is a particularly tragic parodox that those who must require the unique action of digitalis are the most intolerant to slight variations in dosage.1 Indeed, in repeated cases, as the ratio between therapeutic and toxic dosage narrowed, it was impossible for the aged heart to tolerate any therapeutic amount of digitalis. It must be stressed that an aged heart is used in this paper to signify a heart with profound and long-standing pathology. Though com¬ parable cardiac enlargement can occur in young patients with rheumatic and con¬ genital heart lesions, in actual fact, with but one exception, toxicity appeared in our pa¬ tients in the presence of cardiomegaly and congestive failure which had become promi¬ nent after the age of sixty. Thus by pro¬ longing the life-span in this country, the face of digitalis intoxication has altered, for patients with advanced cardiomegaly survive for many years and reach the point where the physician is presented the baffling challenge of digitalis intolerance. Criteria for Diagnosis of Digitalis IntoxicationThis series consisted of 14 women and 10 men. For the diagnosis of toxicity, it was necessary that these criteria be met.(1) An arrhythmia attributable to the action of digitalis in excess must be present. Sporadic ventricular premature contractions are not considered diagnostic unless asso¬ ciated with gastrointestinal, neurological, or other clinical evidence of toxicity; but bigeminy, repetitive, and bi-directional ven¬ tricular beats are felt to be highly suspicious.(2) The arrhythmia must occur concomitantly with increase in digitalis dosage or with the appearance of factors which decrease myocardial tolerance to digitalis.(3) The arrhythmia must disappear with decrease of dosage or cessation of digitalis therapy. DataArrhythmias.-The Table lists the variety and frequency of the arrhythmias en-

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A method of recording electrocardiograms during the performance of a double two-step exercise test is described. Data