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tery is very loose it can coming off 10mg cipralex be straightened out to its full length, but if it is short, the appendix will cipralex⬠10/- 20 mg filmtabletten curl up. We can thus see that a long appendix with a loose mesentery may swing to almost any part of the peri- toneal cavity, whereas a small appendix with a short mesentery can swing only in a small area. When an appendix is inflamed at the end, it becomes heavy and tends to gravitate down, becoming adherent to any tissue with which it comes in contact. It will thus be easy to see how in certain cases pus may be pres- ent and yet no tumor exist in the iliac fossa and there be no tenderness at McBurney's point. It also shows how remote abscesses may occur, in the pel- vis, for example, due to an appendix when their origin is not suspected. In cases in which there is a , large abscess extending into the pelvis it is a question I whether it might not be better to cipralex 20 mg tabletten open through the rectum in case the tumor is immediately in front of the gut, and I have concluded to resort to this pro- cedure in the next such case that I find. The question of counter-openings is an interest- ing one. I think it may be said that the smaller the incision, getting off cipralex 10mg and the fewer the number, the better it is for our patient. In almost every case one incision is enough. In some cases, however, where the abscess is cipralex price india under the crecum or ascending colon, and we have to drain around a curve, a counter-incision in the loin may be of assistance. As the fascia is .often dense, a cross incision may be made in order to drain with ease. It can easily be seen how much more directly the drain can be inserted from below into the bottom of the abscess cavity, in cipralex 15 mg hinta the class of cases mentioned, than from above. When the abscess cavity has filled to the outer side of the gut it is no longer necessary to use double drainage, and we can drain from above or below, as we prefer. One of the most important questions in the appen- dicular surgery of to-day is whether we should re- move the appendix in abscess cases or not. It may 10 20 mg cipralex be said definitely, I think, that in all large abscesses no effort should be made to remove it, but in the case of small, recent abscesses, or multiple abscesses of short duration, it might be well to do so, provided the condition of the patient is good. In all operations on the appendix care should be taken not to handle the tissues roughly, as cipralex 20 mg tablet by using cipralex farmaco generico force we may tear the gut, iliac vein, omentum, or some other important tissue. The complications that may occur are hjemorrhage from the circumflex iliac artery at cipralex 10 mg insomnia the cipralex 10mg weight loss T^me of the operation, intestinal fistula, 15 mg cipralex intestinal obstruction from bands of adhesions that have formed or from adherent omentum, phlebitis of the external iliac and femoral veins, suppurative nephritis, septic pneumonia, and any other suppura- tive conditions. In regard to cipralex 15 mg biverkningar the after-treatment, the drain should be allowed to remain in place for the first thirty-six or forty-eight generika f𴱘r cipralex hours. The drains are either glass tubes, gauze, rubber tubes, or wicks, the last being preferable. In some cases in which the sinus going to the bottom of the abscess cavity is a curved one, and a counter-opening is not made, one or more large elbowed catheters can be pushed down to the bottom and pinned or sutured to the skin. The diet cipralex 20 mg fiyat should be fluid for the first week, or. can take 30 mg cipralex at any rate, as long as the patient has an elevated tem- perature. The bowels should be moved daily by salines, to be assisted by enemata if necessary. Regarding the prognosis, the surgeon should never say that a patient will recover after an opera- tion, as in some of the simplest cases they occasion- July 6, igoi.] GRIFFITH: HEAT PROSTRATIONS. ALDEN: PUERTO RICO. 17 ally die, while in some of the worst cipralex 20 mg 56 tablet they at times recover. 75 West Fifty-fifth precio de cipralex 15 mg Street. AN IMPROVED FORM OF AMBULANCE WOULD INCREASE cual generico cipralex THE VALUE OF THE TREATMENT OF HEAT PROSTRATIONS. BY FREDERICK GRIFFITH, M. D., NEW YORK.

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