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some experiments showing that, in cases etoricoxib arcoxia in which the ankle clonus and exaggerated patellar reflex coexisted, the former could be made to disappear while the foot and knee tendon reflexes persisted. This was done by buy arcoxia making the artected member anwmic by means of an Esmarch's bandage. He concludes, therefore, that those who main- tain an identity of causation of these two arcoxia 90mg phenomena are in error, and that the ankle clonus is to be explained in some other way. The Treatment of Snake-Bites. — Mr. J. Mildred Creed, in a (japer read before the New South Wales Branch of the British Medical Association {Australasian Medical Gazette, .\o. lo, 1884), states as his belief that many of the alarming symptoms following a snake-bite are due rather to fright, pure and simple, than to the poison recei\ed from the fangs of the snake. He relates a number of cases in support of this assertion. The bite had been promptly excised in every case, and only two arcoxia price of the patients i)resented any alarming symptoms. In one of these cases the patient recovered speedily on be- ing assured that there was no cause for fear, although she had a short time before been apparently at death's door. The other case was simply one of profound intoxi- cation resulting from the large amount of brandy which had been given as an antidote. The author also relates several other cases of people who had died of fright after being bitten by non-venomous reptiles. He does not believe that there is any physiological antidote to snake poison, and thinks that the only effectual means of averting serious consequences is by the prevention of the absorption of the poison. Tliis is best done by the early stoppage of the circulation in the wounded limb by the application of a strong ligature, and the excision of the bite. The reckless administration of alcohol the author condemns as not only useless but harmful. He recommends the administration of ether by inhalation as answering a double indication, that of slight stimula- tion and of removing the feeling of dread by inducing unconsciousness. The ether should be administered for one or two hours, when the patient may be allowed to recover sensibility to such an extent, as to enable the surgeon to judge of his condition. After this, should it be necessary, he might be again brought under the influ- ence of the anaisthetic and kept there as long as desired. Any other symptoms which may arise are to be treated according to general principles. The Micrococci of Dvsentery. — At a recent meet- ing of the Medical Society of the Caucasus, Dr. Gaudelin, ot Tiflis, exhibited micro-organisms found by him in the intestine and liver of patients dead of dysentery. The micrococci were found in great numbers in the arcoxia cost digestive tube, covering the surface and penetrating all the tunics of the intestine. They were especially numerous within and about the veins of the sub-mucous layer and in the muscular coat. In the liver they filled the capillaries and the branches of the portal vein. The author also found bacilli in the mucous and submucous layers of the large intestine, but not elsewhere. — Journal de Medecine de Paris, August 30, 1884. Mild Forms of Typhoid Fever. — Laffoni thus classi- fies the milder forms of typhoid fever : Forms slight by their duration, forms slight by their intensity, and a third class slight by duration and intensity. Of forms slight as to their duration, constant symptoms are : splenic tumefac- tion, bronchial catarrh, and fever. The course of this last characterizes the different varieties. The temperature either, as in ordinary attacks of typhoid fever, has three well-marked stages — period of ascending oscillations, sta- tionary period, and period of decline — or is limited to one or two of these stages only. In some rare cases the fever assumes the course of a quotidian intermittent, with- out repeated rigors or sweats. Of the forms slight by intensity, the duration may be long. These either ap- proach the classical type, or are irregular when the fever is subcontinuous or intermittent, or is partly continued, partly intermittent. Splenic tumor is a constant symp- tom. These slight forms must be considered due either to a small dose of the poison or to its exhausted activity, or possibly to the mode by which it gained access to the organism, as well as to the conditions of receptivity or organic resistance of the patient. The anatomical altera- tions are identical with those of ordinary typhoid fever. There is no constant relation between their extension and the intensity or gravity of the clinical form. The diagnosis is very important, esi^ecially as regards prophy- laxis. It is often very diflicult. The splenic tumor, rash, pain in the ileocnecal fossa, evening headache, apathy of the patient, bronchial catarrh, often good appetite, notwithstanding the fever, pulse small, and very often dicrotic, are the chief elements of a sure diagnosis. The prognosis in children is good ; in adults it is sub- ordinated to the docility of the patients and to the possibil- ity of complication ; in old people, it is always more doubt- ful. As to treatment, the author recommends calomel for the first three or four days, then mineral acids or benzoic acid. Except the general or partial cold bath, antipy- retics, especially in cases of long duration, are harmful or useless. Abscess of the Cerebellum Consecutive to Otitis Media. — In a communication addressed to the Society of Anatomy and Physiology of Bordeaux (Journal de Medicine de Bordeaux, August 24, 1SS4), Dr. E. Cap- deville relates the case of a woman, twenty-tour years of age, admitted to hospital suffering from obscure cerebral symptoms. She lay, always on the left side, in a state of semi-stupor, vomiting occasionally, and complaining of an intense general cephalalgia. She had a discharge from the right ear dating back seven months, and recently an abscess had formed and opened spontaneously over the tip of the right mastoid process. At the autopsy the le- sions of otitis media with condensing osteitis of the mas- toid process were found. The meninges, cerebrum, and sinuses of the brain were all normal, but in the right lobe of the cerebellum was an abscess containing over three ounces of pus. The mode of propagation of the inflammation from the ear to the cerebellum could not be discovered, and possibly the latter may have been merely coincidental and independent of the otitis. Iodine Injections in Hydrarthrosis of the Knee- JoiNT. — Dr. Douglas Morton, in The American Prac- titioner, July, 1884, speaks very highly of iodine injec- tions into the knee-joint for the cure of hydrarthrosis. He bases his favorable opinion on the excellent results obtained in four recent cases of this kind. The views of most surgical authorities are against all such procedures, as purchase arcoxia online may be seen from the following extracts : " I have not been so bold as to use injections for the permanent cure of this affection, convinced that the practice must be fraught with danger '' (Gross). " Tapping, arcoxia mg iodine injections, etc., notwithstanding considerable testimony in their favor, are remedies of doubtful propriety " (Hamilton). " This mode of treatment has been used with great success by several European surgeons ; as, however, the plan is necessarily attended by some risk, it should not be employed except in very chronic cases which have resisted other modes of treatment. Even the simple use of the aspirator in these cases is at- tended with some danger, as shown by fatal results which have occurred in the hands of Dubreuil, and of McDonnell, of Dublin'' (.\shhurst). " In very chronic and obstinate cases generic arcoxia paracentesis of the joint by means of the aspirator has been employed with marvellous success. Sir J. Fayrer was one of the strongest advocates'' (Bry- ant). " But when these (the usual remedies) liave failed the joint must be injected with iodine. Care must be taken to exclude air. buy cheap arcoxia . . . The case may be converted into one of etoricoxib msd acute abscess. But generally October ii, 1884.] THE MEDICAL RECORD. 405 it does well, and the patient recovers with more or less stiffening'' (Holmes). "The results of this operation (injecting iodine) may be divided into four classes : (i) Complete cure with preservation of mobility ; (2) cure with certain amount of stiffness ; (3) comiilete failure ; (4) suppuration and injury to joint. The first and fourth classes are uncommon. The operation should not be done except after trial and failure of other remedies " (Panas, quoted in Holmes' " Surgery "). " Dangerous etoricoxib 60 mg both to life and limb, and can very rarely be justifiable " (Keetley). " If these means fail, and the absence of false bodies and osteophytes has been verified, purchase arcoxia the joint may be injected with iodine " (Barwell). " If these means fail, we have a very jiowerful method of cure at our com- mand in the injection of the joint with tincture of iodine. This plan, a sufficiently bold one, has been much em- ployed by Jobert, \'elpeau, and Bonnet. . . . Ac- cording to the statement of the French surgeons, it has in no case been followed by any serious consequences, but in several instances by a complete cure without an- kylosis. ... In one case of hydrarthrosis of the knee in an old man, in which I employed it, about six ounces of thin synovia were buy etoricoxib drawn off and a drachm of strong tincture of iodine was injected. Slight inflamma- tion ensued, and the disease, which etoricoxib tablets was of two years' standing, was completely cured. The chief points that appear to require attention are buy arcoxia online that no inflammation be going on at the time, there being no tenderness or pain in moving the joint, the effusion being quite passive and of a very chronic character, and above all that no air be allowed to enter with the injected fluid" (Erichsen). " Iodine injections in hydrarthrus are made by few sur- geons. I have seen them made three times and have made two, always with good results. . . . Cases have also occurred where severe inflammations of the joint have resulted after these iodine injections, which have been most used in France because they are a French invention (of Bonnet and Velpeau) ; as so often happens in traumatic articular inflammations, the acute serous synovitis often becomes purulent. . . . It is always dangerous to joint and to life, and hence should be done as rarely as possible" (Billroth). Dr. Morton believes that the prejudice against the operation prevailing in the minds of most surgeons con- sists of the too lingering remains of a belief long domi- nant in the professional mind, that the joints, and ijarticu- larly the knee-joint, order arcoxia could not be surgically interfered with except at great risk. Now that we have learned. especially from McEwen and Ogston, how very tolerant are the joints of the knife and the saw ; and since we hold it to be so light a matter to throw iodine into the tunica vaginalis, it does appear anomalous that any one, on any supposed general principles, should consider it highly dangerous to inject iodine into the synovial sac of the knee-joint. Stress has been put upon the danger of admitting air. The author can understand how importance should have been attached to such an accident before the days of antiseptic surgery. But now he cannot, and in his own operations air was admitted freely — so much so, that when the injected iodine was forced out by pressure a multitude of air-bubbles would come with it. He took pains to bring the iodine in contact with as much of the membrane as had been touched by air, and by this, he believes its admission was rendered perfectly harmless, and therefore made no special effort to prevent it. With out the use of iodine or some other jtowerful disinfect- ant, he should regard admission of air into the joint dangerous, and believe it arcoxia tablets very probable that the fatality occurring in the practice of McDonnell and Dubreuil, mentioned by Ashhurst, was due to this cause. It was said by Volkmann, in his address on antiseptic surgery before the International Congress in London, that results in surgery were no longer involved in the uncertainty of former times. Then the work of the surgeon was like that of the agriculturist, dependent in its issue upon con- ditions which he could neither anticipate nor control ; but now, it is rather like that of the skilled mechanic, the conditions of whose work are largely subject to his control and from whom we may confidently expect re- sults. Dr. Morton does not know that this is true to the full extent of the analogy, but this is certain, that the striking statement places surgery downrightly upon the basis of the inductive method, upon which alone substantial progress is possible. In making a practical application of this method of reasoning to the question before us, he thinks we mav safely conclude that two points are definitely and finally settled : first, air may be freely admitted into a synovial sac and no harm result ; and, order arcoxia online second, undiluted officinal compound tincture of iodine may be safely injected. Any doubt as to these particular points may be arcoxia online regarded as forever eliminated from the question, which is now narrowed

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