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Related post: fomid the hearmg normal. Taste and smell unimpaired. Dr. Dercum reported no Babinski reflex, no ankle clonus, no paradoxical reflex, no OppcMiheim reflex, superficial re- flexes preserved. The knee jerk and Achilles tendon re- flex increased on both sides. No observed sensory abnor- mality. Stereognosis preserved. Bladder and rectum nor- mal. There were complaints of horrible headache, which was general but worst in the occipital region, and \vl)en patient stood erect ; greatly aggravated by tapping the head anywhere or by making any movement ; but relieved some- what by lying down and keeping quiet ; the pain kept him awake. The urine normal except for rather low specific gravity, 1.008; passed about fifty ounces a day. Blood report : 9,400 leucocytes ; 4,300,000 erythrocytes ; eighty-one per cent, hasmoglobin. Dr. Manges made the x ray examination. He determined by stereoscopic skiagraphs that the bullet lay in or almost in the median line of the skull and at a depth of over two inches from where the sagittal suture joins the lambdoidal suture. Fig. 3. — This picture shows siniiily tlie shadows of the transverse view. As the bullet was located practically in the median line the shadows of the anteroposterior view would not show in this sec- tion. The small dark spot is a fragment of the bullet probably lodged in the petrous jiart of the temporal bone. The irregular dark spot above the middle of the zygoma shows point of entrance of bullet. Because of the depth at which this bullet lay the local- izing apparatus was taken into the operating room, ster- ilised, and used ns a guide just before opening the skull. On February 6 the patient was anrcsthetized. It was determined to seek for this bullet by way of the longitudi- nal fissure and not by incising the brain along the track of the ball. An osteoplastic flap was made by the method of Gushing. The base of the flap was over the occiput. The dura was opened, and the brain appeared Purchase Neggram Online normal. The right hemisphere was retracted outward. I passed my fin- ger along the falx cerebri in the median fissure and at a depth of over two inches felt the missile. The bullet was lodged in (he falx and against the superior surface of the straight sinus. The whirr of the blood in that sinus was very distinct as the finger pushed against the bullet. The falx was Buy Neggram Online incised, the bullet was exposed and removed with bullet forceps. On its removal there was a great gush of blood, presumably from the sinus. The' bleeding was ar- rested by gauze packing which made much pressure on the falx and tentorium. Because of the large amoimt of gauze employed, the fear of further haemorrhage, and the appre- hension as to the results of compression, the bone flap was removed and the scalp sutured about the protruding gauze. He reacted quickly from the ether and a few hours after the operation was perfectly conscious and free from pain. The packing was not removed for nine days. On its re- moval there was x\o bleeding. Order Neggram The patient was sent home February 25 feeling well and cheerful, entirely free from pam, and with the wound near- ly healed. At present he is in excellent health' and is working as a stevedore. In this case the melancholia was improving when I op- erated and was completely recovered from soon after the Order Neggram Online operation. Entering the longitudinal fissure to reach the bullet saved injury to Purchase Neggram the brain which would have proved most disastrous had any attempt been made to follow the track of the ball through the right hemisphere to the falx. The lodgment in the falx explains the violent headache. An interesting postoperative phenomenon was an enor- mous increase in the amount of urine. The Buy Neggram day after the operation 7300 c. c. were passed. The eighth day after the operation 4600 c. c. were passed. It was judged that the pressure of the gauze was responsible for this. On re- moval of the gauze the amount dropped during the subse- quent twenty-four hours to 2750 c. c, and gradually the daily output became normal. The daily urine was care- fully estimated by Dr. Rumbaugh, to whom I am greatly indebted for the skillful and unremitting care he gave this patient. Irritation of the medulla may cause polyuria and per- haps this is the explanation of its occurrence in this case. At times the urine showed a trace of albumin but never sugar, acteone, a diacetic acid. DEMONSTRATION OF A SIMPLIFIED TECHNIQUE FOR Buy Cheap Neggram X RAY LOCALIZATION OF BULLETS IN THE THICKER PORTIONS OF THE BODY.* By Sinclair Tousey, A. M., M. D., New York. Related links: purchase clomid cheap, Amoxil Tablets, Coupon For Flonase, 25 mg zoloft enough anxiety, Buy Trental, Gen Clozapine, Pentoxifylline Trental, Erythromycin Price Uk, Buy Cheap Alli, Generic Ramipril
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