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Nonsurgical Treatment of Cirrhosis of the Liver, by Dr. Purchase Avandia N. S. Davis, Jr. — See Avandia 4 Mg this Journal for July 5, p. 50. AuKUSt 9. 1913] /'//// or PkocREssjyE literature. 295 MEDICAL RECORD. .'i,;.v .'0. ;y;.,-. Is Appendicitis Ever Catarrhal? — [•'. A. Palmer sa^s lliat the caption catarrlial ap]jendicitis is une found in all classifications of disease of the appen- dix, and is used to designate clinically those patients who show only slight but long continued or per- sistently recurring symptoms. Clinically the mean- ing of this term is clear and may suffice, but when the cases come to be classified upon the basis of the pathological condition present we hnd the widest tlivergences of opinion and description. In view of the predominance of lymphoid elements in the apjK-ndix, and the types of intlaninialion usually found upon microscopical examination of appen- Avandia Cost dices, it is the author's opinion that the primary inflammation of the appendix is lymphoid, rather than catarrhal. From Iiis studies on the subject the following conclusions seem warranted: i. The gross appearance of the appendix is never a sufficient criterion of the Generic Avandia severity of the pathological condi- tion present. 2. Absolutely no idea of the nature or severity of the inflammation can be formed from the clinical symptoms. 3. Appendicitis may run its course through perforation and subsequent healing without symptoms which will admit of its recogni- tion, or, indeed, severe symptoms of any kind. 4. The clinical condition designated as catarrhal appendicitis does Avandia Mg not have a catarrhal inflammation of the appendicular mucosa as a pathological basis, and is, therefore, a misnomer which is dangerously misleading to the general profession. 5. No catar- rhal inflammation, truly speaking, has ever been described as a pathological finding in appendicitis. For all these reasons the term should be definitely abandoned. Lastly, appendicitis is much more fre- quent than is usually assumed or than is indicated by our present means of diagnosis. The mortality of this disease is still large, and the only measure which oflfers any prospect of immediate reduction ot this mortality is early operation upon all recogniz- able cases. The Beneficial Effect of Duodenal Alimenta- tion in Cirrhosis of the Liver. — Max Einhorn fays that if we consider the intimate connection of the liver with the Purchase Avandia Online digestive apparatus, we have reason to expect that the rest given to the stomach by means of duodena! alimentation may have some bearing Avandia Tablets upon its neighboring organ, the liver. If the liver is diseased, its function of working Avanafil Buy up the portal blood and making it fit for the vena cava is slackened. What now happens is either the en- trance of faulty metabolic products into the circu- lation or. if the supervision of the liver is still effi- cient but slow, an accumulation of blood in Cheap Avandia the liver, i. e., this organ becomes unable to work up all the blood flowing in during the process of digestion. Thus it becomes temporarily swollen. In some in- stances both factors coexist. In cirrhosis this diffi- culty in functionating is always present. In duo- denal alimentation the upper part of the digestive system is not working, and is kept at rest. The venous circulation there is not Buy Avandia very active : the portal vein is thus freed of part of its blood supply, and the entire work of the liver is made easier. Duodenal alimentation was applied in six cases of beginning cirrhosis. During this in all the six patients (,five of whom Buy Avandia Online had ga>lric ulcer j the liver l)ecame Avandia 8 Mg markedly smaller. In four the result was lasting ; in one, the liver began to grow larger a few days after the termination of the feeding; and in one patient, with pure cirrhosis and dilated heart, ihe liver quickly resumetl its original proportions. In this last case the influence of the procedure was \ ery marked, but not lasting. The author concludes that the cirrhosis of the liver and allied conditions accompanied principally by swelling of the hepatic tissues form a field in which duodenal alimentation may be applied apparently to great advantage. The Diagnosis and Prognosis of Duodenal Ulcer. — In the observation of some two hundred cases, by J. T. Pilcher, the history of an uncompli- cated duodenal ulcer has in the great majority of them elicited four preeiriinent factors: i. The chronicity of the complaint ; 2, the periodicity of the exacerbations of epigastric distress : 3, the occurrence of pain of a peculiar character (burning Buy Cheap Avandia or gnawing) with precise time of onset (between tw-o and one half and four hours after eating) ; 4, the control of this discomfort by the ingestion of food or alkalies. In his experience, cases properly chosen for medical or surgical treatment appear Buy Avanafil to have remained fairly comfortable, and he feels justified in saying Avandia Canada that the prognosis in the great majority of cases is Avandia Price good. Treatment of Progressive Cases of Pulmonary Tuberculosis. — Mary E. Lapham believes that the recognition of Order Avandia the progressive Avandia Online nature of a case, far from releasing the physician from responsi- bility, adds another burden, that of deciding what nnist be done, and when. He must first of all be able to recognize when a patient is unable to make his ow-n fight, and then come to his relief : first, by attempting an artificial Order Avandia Online pneumothorax, and, if this faiU, then by resecting the ribs. The reported re- sults from these procedures have been most encour- aging. AMERICAN JOURNAL OF OBSTETRICS AND DISEASES

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