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Related post: Placing herself upon the table and removing Ramipril Price her dress, she
remaining clothed alone in her chemise, a pair of blanket draw-
ers made for the occasion, shoes and stockings, and the admin-
istration of the angesthetic (Squibb's sulphuric ether) was begun
at 1.55 P.M. precisely. It was given in the manner usually
employed in Bellevue Hospital, viz., from a cone Buy Ramipril formed of
heavy paper, covered and lined with Ramipril Cough a towel, and enclosing a
sponge kept constantly saturated with the fluid. She yielded
easily, rapidly, and without struggling, to its influence, though
her breathing, after she was wholly under its effect, was some-
what irregular and labored. This duty was intrusted to Dr.
H. Lyle Smith, (senior assistant in charge of the case.)
Before complete anaesthesia had been produced, her urine
was drawn with a catheter, in quantity amounting to nearly
4 oz. Shortly after, she vomited the breakfast she had taken
at about 10 a.m., and from which she had abstained till that
hour, on account of religious motives, she not having had until
then an interview with the priest. The matter ejected con-
tained, moreover, large pieces of unmasticated meat, (beef,)
which must have remained in the stomach Ramipril 25 Mg since the day pre-
vious, Ramipril Tablet as none was allowed her on the day of the operation.
This was the only time vomiting occurred. The whole amount
of ether used was a trifle less than 2 lbs. Dr. Elliot was
assisted immediately by Drs. Mott, Gouley, Peaslee, and Ev-
erett, (house physician in charge of the case,) and surrounded
by the following gentlemen : Drs. Isaac Wood, Isaac E. Tay-
lor, Lewis A. Sayre, John J. Crane, T. G. Thomas, Wm. H.
Church, T. A. Emmet, P. H. Hapiilton, Jr., Dr. Perry, J. B.
Done; and of the house staff. Drs. Russ, B. Brownell, H. G.
Piffard, J. W. Southack, Jr., E. G. Jaueway, W. A. Lockwood,
H. Eno, F. D. Edgerton, E. Farrell, A. L. Luaces, W. H.
Birkhead, George Gamble, and R. Ramipril 10mg Pell.
414 EEMOVAL OF AN OVAEIAN TUMOE. [Sept.,
The first incision ^as made at 2.16 p.m., with a broad
scalpel, in the median line, about midway between the umbil-
icus and symphisis pubis, oyer a hard projecting portion of the
tumor. The room had been previously heated to between 90
and 100 degrees Ramipril 5mg Fahrenheit, and was maintained at this tem-
perature during the whole operation. The incision being
made down to and through the peritoneum, of a size just suffi-,
cient to admit a number fourteen steel bougie, this instrument
was introduced and moved freely about over the surface of
the cyst, showing it to be Ramipril Tablets entirely free from adhesions to the
abdominal or pelvic walls, anteriorly or laterally. These par-
ticulars being fully ascertained and understood, the incision
was carried downward in the same direction to the extent of
three and a half inches. As the opening was 'enlarged, Cheap Ramipril the
fluid contained in the cavity of the peritoneum began to escape.
As much as possible, however, was retained, by approximating
the edges of the wound as the incision was enlarged.
Drs. Elliot and Peaslee then, alternately, introduced their
hands into the abdomen, again verifying the diagnosis, that no
adhesions existed, and at the same time recognized the situa-
tion, perfect mobility and freedom of the uterus. Dr. Elliot
also discovered that a large portion of the tumor rested in the
right iliac fossa?. The tumor, on the withdrawal of the hands,
each time presented itself at the opening as a multilocular
cyst. Still hoping to reduce its diameter, and enable the oper-
ator to remove it through the incision already made, two
cysts, of moderate size, were deeply tapped, one of which con-
tained a clear, colorless serum, running freely Tablet Ramipril from the canula;
while the other was found to contain a thick creamy sub-
stance, What Is Ramipril resembling the white of egg mixed with water. All
this did not reduce the bulk of the growth, and it was deemed
necessary to enlarge the incision, which was done upwards
to the distance of one-half an inch. This not being found
sufficient to admit of the removal of the tumor, it was again
enlarged about one inch downward. Pressure was then ap-
plied to the tumor in such a way as to raise it upward, and by
lifting, and rolling*it from side to side, it passed, after distend-
ing the incision to its utmost Buy Ramipril Online capacity. At Buy Cheap Ramipril the time it was
emerging from the abdomen, endeavors were made to clo.-e tlie
\
\
1865.] REMOVAL OF AN OVARIAN TUMOR. 415
opening, so as not to allow the admission of air or any foreign
body, which Ramipril 10 Mg was successfully accomplished by Drs. Mott and
Gouley. At 2.40 p.m. the tumor was entirely lifted out, and
now the diagnosis of an " exogenous multilocular, ovarian
cyst, with a short pedicle, not connected Ramipril 25 with the uterus, and
entirely free from adhesion," was clearly proved. Its pedicle
was found to be thin and flat, and not to exceed two
inches in its long diameter. Its Ramipril 2 Mg length was amply sufficient.
A three strand white silk double ligature, well waxed, Order Ramipril was
passed through its base with an awl-shaped needle, Ramipril Mg and
tied in both directions ; and the peduncle was cut. No Ramipril Online
hemorrhage followed. As the tumor and fluid were removed,
the respiration did not become as much embarrassed as was
feared ; in fact, the relief of the distension enabled the anses-
thesia to be urged. The patient was then rolled upon her right
side, and the remaining fluid, together with some flakes of
lymph, allowed, as far as possible, to flow out. On replacing
her, the air was heard to enter the abdomen, although the
edges of the cut were held. At this time she Order Ramipril Online seemed much
weakened, though her pulse was good and regular, and respi-
ration somewhat labored. Upon placing her again in the su-
pine position, additional serum and flakes of lymph were pressed

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