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 |   Related post: ir.,n.l,„l,,l /,.„„,..,;,. lur,.) The Treatment pf Posterior Uterine Displacements by Utero-vaginal Ligature.— Dr. II. J. Boldt, of New York, apoke on the oinpliivmeiit of this method for conditions when the displacement rendered operative interference necessary and the uterus was perfectly mobile, or when the uterus would re- main anteposfcd only while a pessary was worn and the patient desired something done by which she could subsequently dis- pense with the supporter. The objections raised as to possible injury of the bladder or intestines could, in the speaker's opinion, be overcome by ob- servance of proper techoicpie, the uterus being jiulled down as far as possible toward the left side and the body being pushcil to the right, the bladder to the left, by a sound in the hands (jf an assistant ; this would avert injury of the bladder. Thesliglit- ly bloody tingeing of the urine observed occasionally he consid- ered due to injury Nimodipine Cost by the si>und used in the bladder and not to the needle. Injury of intestines could only occur if these were adherent to the anterior surface of the uterus, and this could be deter- mined by bimanual examination. Non-adherent intestines would gravitate toward the diaphragm as soon a.s the [jatient was placed in Trendelenburg's posture; then, the uterus being thoroughly anteflexed, there was not the slightest diinger. The speaker recognized the fact that a simple posterior dis- placement produced only mechanical symptoms, but, owing to the malposition, other pathological conditions were caused. The operation was of course contra-indicated in coexisting dis- Nimodipine Price ease of the appendages or if the uterus was fixed, unless the ad- hesions Nimodipine Iv could first be readily broken up by either Schultze's or Brandt's method. To insure success, the ligature must be left in about two months; and also a pessary, which should be in- serted immediately after operation, should be worn for a few months. Of one hundred and forty-one cases known to the speaker to have been operated upon, not one serious accident had oc- curred. Of his own nine cases he had recorded two failures, owing, he thought, to the omission of a pessary after the opera- tion. Another objection — that of the probability of a woman not conceiving or of aborting, owing Buy Nimodipine to the anteflexed position of the uterus — had also been overthrown by two cases in Dr. Schiicking's practice, and one in Thieme's practice. All three women had gone to term and had a normal delivery, and their uteri had subsequently remained anterior. The adhesion hold- ing the uterus anteposed would take place in the lower part of the vesico-uterine space. The operation was especially indi- cated in those cases of retroflexion where the body of the uterus would invariably tip over the upper bar of the supporter. A strict observance of asepsis was of course necessary. Dr. A. F. CuHRiKR thought that Schiicking's ojieration was not likely to obtain in general practice. It was opposed to good surgical principles in that it substituted one anatomical abnormity for another. Then the operation was done under conditions which left grave doubt as to what the result might be. He thought that plain open surgery, freed as it now was from much risk, was to be preferred. There certainly did exist in this operation, as detailed by Dr. Boldf, elements of danger from sepsis, from injury of the intestines or blad- der, and from the sutures, which had to remain in position so long as to render their cutting through the tissues extremely probable. Dr. W. Gill Wtlie said he did not believe that this opera" tion would ever be of much practical use. He regarded it as dangerous and its successful performance rather as an exempli- fication of what risks might be run in these days of clever sur- gery with strict cleanliness. He thought that where everything was loose and free from adhesion, and the displacement was such as to call for something to ho attempted for its relief, there was nothing bettor than the Alexander operation. Where the cases were selected as being without perimetric inflammations, the operation was practically free from danger. Dr. Boi.iJT said that he had expected just such criticism, bat thought that one hundred and forty-one cases without mishap, and a resulting cure in a majority of them, constituted a pow- erful nrguiiient in favor o the method. The Treatment of Injuries to the Floor of the Vagina.— This was the title of a paper by Dr. H.T. Hanks, of New York. He stated that no deep laceration could occur without destroy- ing the integrity of those fibers of the levator ani which passed and met above the rectum, and that when they gave way the transversns perinioi encouraged a still further gai)ing of these lateral fibers. The obstetrician should try to avert the accident, but when it did occur he ought to proceed to repair the injury 254 PROCEEDINGS OF SOCIETIES. [N. Y. Mud. Jouh., Related links: Cyclopentolate Hydrochloride, Meloxicam 15mg, retin-a micro gel buy online, Colchicine .6 Mg, Norpace Cr, Phexin 500, terbinafine hydrochloride, Buy Cheap Shatavari, Parafon Forte 500 Mg, buy cheap clomid online no prescription
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