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was discharged from the hospital in 1914, with an artificial pneumothorax on one side and an inactive tuberculosis in the other lung. He returned to this hospital a month ago Buy Nortriptyline Online with a hydropneumothorax containing about two thousand c.c. of fluid. Under the fluoroscope, the first examination was made and the waves of the fluid were clearly demonstrated on slightly shaking the patient. During his stay away Nortriptyline 10mg from the hospital he had been working con- stantly and without any other bad result than the collection of fluid in the chest. The fluid is gradu- ally being removed and air injected to replace it. DISCUSSION. ■ Since Nortriptyline Mg it is in the hemorrhage cases that the most satisfactory results are obtained, it should never- theless be borne in mind that it is in this class of cases that the greatest risk is also taken ; for, while it is usually possible to presume that the hemor- rhage is from the side showing the Order Nortriptyline Online greatest involve- ment, still it is possible to collapse a lung showing considerable involvement when the hemorrhage might occasionally be from the lung showing the minor lesion. In these cases, the x ray plates have been showing small cavities in the region of the hilum of the lung that Nortriptyline 25mg appears Cheap Nortriptyline to be least involved. A few patients have come to the autopsy table and on sectioning the lung, the apex of the lower lobes and the middle lobe on the right side revealed very small cavities. The condition of the chests of the tuberculous patients, found at the autopsy table, brings out the statements made in the paragraph on adhesions and pleurisy. The pathologist found great difficulty in trying to remove the lungs in such cases without tearing part of the lung tissue. If these conditions are present, it would then be useless to try to force air into Nortriptyline 25 Mg such a chest. In a few cases, fibrous bands of adhesions can be released by persistent frequent injections of air. If these bands are not too strong, the chances for collapsing the lungs are very good. The gradual tearing Nortriptyline 10 Mg loose of these bandlike adhe- sions can be beautifully studied I)y the radiographic 6. — Final examina examinations, as the treatments are continued. In the beginning, one sees air pockets formed about the adhesions with gradual thinning out ; finally the desired result, the complete separation and the col- Octobi-r 30. ll-'O.] VAN PAING: SURGERY OP THE THORAX. 673 lapse of the lung. Generic Nortriptyline We always find these bands attached to the upper lobes, where the greater per- centage of cavities occur, and which may communi- cate with the periphery of the lung. CONCLUSION. In compressing the affected lung, the walls of the cavities are put in opposition and become fixed Fig. 7. — Hydropneumothorax as a complication. together and the desired results are obtained, namely, giving the patient the feeling of wellbeing and com- fort. Since the symptoms are lessened and comfort increased, there is no doubt in my mind that an artificial pneumothorax is an excellent adjunct to the other treatments of pulmonary tuberculosis in the advanced cases, in association with the rontgen- ologist, who gives the clinician the guide to the suc- cessive steps taken for collapsing the lungs. We must not forgret the possibility of acceleration of the tuberculous process of the opposite lung, when one lung is collapsed and a burden put Nortriptyline 25 upon that lung to functionate Buy Nortriptyline and take care of the toxemia from the affected lung. 485 Stone Avenue. THE KNIFi^ CAUTERY IN SURGERY OF THE THOR.^X * By John F. Van P.mng, M. D.,

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