upejakedoub

Related post: sion was made along the lower floor of the urethra, the superabundant mucous membrane drawn out, and removed. But shortly after this she had such severe pain that it led to an examination under ether for stone. No calculus, however, was found in the bladder, but it was observed for the first time that there was a tumor in the right upper part of the ab- domen. Thinking this was possibly due to the pres- ence of a calculus in the ureter, a sound was intro- duced into the right ureter through the vesical fistula, which had been Order V-Gel further enlarged, but with negative results. I believe that an operation for removal of the kidney was then suggested, but the patient went out of the hospital, and afterward came under the care of Dr. Peters, at St. Luke's Hospital, where an exploration with the hand in the rectum was made, and also an endeavor to catheterize the ureters. No positive evidence was obtained by these examinations. When the patient entered my ward there was felt on the right side of the abdomen a smooth, but some- what painful, tumor, which stretched from the edge of the ribs nearly to the crest of the ilium, and which measured some four inches in its transverse diameter. * Read before the New York Surgical Society, December 9, 1884. This was believed, from its situation and history, to be a kidney in a condition of pyonephrosis. Aspiration having failed in extracting any pus, and in consequence of the report furnished that the previous rectal exam- ination had Buy V-Gel gone against the renal nature of the tumor, the patient was Buy V-Gel Online again etherized, and, by the small and skilful hand of Dr. Sabine, the regions of the kidneys carefully examined, and the tumor proved to be, as thought, a diseased kidney. Order V-Gel Online At the same time, by strongly holding aside the large fistula in the bladder, the mouths of the ureters could be seen and explored their whole distance by flexible metallic sounds. There was no calculus to be discovered, and while the urine from the affected kidney was flocculent from the admixture of pus, that from the left or sound side was clear and normal. On each side it was voided in intermittent jets. The patient's general condition was fair, though her annoyance from the continued urinary leakage was great. During the time she was kept under ob- servation before the operation, the urine was repeat- edly examined, had a satisfactory specific gravity and absence of casts. This increased the confidence that the left kidney was in a good condition, in spite of the statement that she had had several convulsions during the past three years. During the two weeks prior to the operation, her condition began to fail, less perhaps from inflammatory than from mental causes. She was urgent for surgical interference, though aware of the danger of the procedure. An operation possessed no terrors for her, as she had already been anaesthetized twenty-three times since her cystitis began. Nephrectomy was performed November 3d, under antiseptic precautions, by a lumbar vertical incision, starting just below the twelfth rib, three inches from the spine, and running to the crest of the ilium. A second transverse cut was made from near the top of the vertical one, out- wards along the edge of the ribs nearly five inches long. This gave large access to the kidney without opening the peritoneum, which was seen at the outer part of the transverse incision, but sunk out of the way by the semi-prone position of the patient. Oir exposing the dense fatty capsule, it was scratched through and the kidney partly brought into view. An aspirator showed the situation of an abscess, which was opened to determine whether simple nephrotomy with drainage would suffice. Explora- tion showed that it was a small cavity, and apparently others existed which did not open into the first one, and extirpation was therefore proceeded with. It was at once experienced that the fat capsule was inti- mately adherent to the kidney. The true fibrous envelope of the organ was therefore split open, and enucleation accomplished with rapidity everywhere except over the anterior surface of the kidney, where the peritoneum was felt to be very thin. The pedicle was finally reached, and a loop of strong ligature silk 7o8 EXTIRPATION OF THE KIDNEY. [Medical News, cast Purchase V-Gel Online around the kidney, and carried to its base and tied, after which the kidney was removed. A gush of venous blood ensued, which was only partly ar- rested after repeated seizures of long forcipressure forceps, and was finally controlled by stopping the wound full of sponges and turning the patient on her back. The shock was profound, and all the measures to produce reaction were resorted to, such as heat, stimulants, the application of Esmarch's bandages to the limbs, and saline transfusion. The latter, re- peated twice to a total amount of twenty-two ounces, gave Purchase V-Gel rise at first to great improvement in conscious- ness, pulse, and warmth of body, and up to lo o'clock P.M., she appeared to rally, but then failed steadily, and died at 2 a.m., ten hours after the operation. The autopsy showed that the hemorrhage came from a vein of considerable size, one and a half centi- metres above those secured by the ligature and for- ceps. The fibrous capsule of the kidney was so closly adherent to the condensed fat without that it could only be removed by a close dissection. The peri- toneal cavity was not invaded. The left kidney was larger than normal, and, microscopically, the convo- luted tubes contained a good deal of fat in* their epi- thelial cells. This change was quite general. The removed kidney, slightly larger than natural, Related links: Thorazine Tablets, Cymbalta 60 Mg Cost, Caverta Uk, Lexapro 40 Mg, Albenza Tablets, Buy Amoxicillin Antibiotic Online, Clindamycin Phosphate 1, can you buy clomid online, Claritin Cheap, Betnovate Ointment