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cludes that : 1. There is still uncertainty as to which tissue Generic Vibramycin in the ovary produces the internal secretion. 2. Although the follicles continue to develop Order Vibramycin in the conserved ovary after hysterectomy, it is uncer- tain that the function of the internal secretion con- tinues uninfluenced by the great changes in the blood supply and by the traumatisin to the Vibramycin Mg pelvic svmpathetic nerves incident to the operation. 3. The relative influence upon the climacteric syndrome of oophorectomy and injury to the pelvic nerves during operation is undetermined. 4. Clinically, there is slight symptomatic ditTer- FlG 1. — Posterolateral view showing the relatively small posterior lip, the long glass rod protruding from the external os Vibramycin For Acne and above, Buy Cheap Vibramycin anterior lip with an angle of the laceration. ence between hysterectomy with and hysterectomy without Vibramycin Cost oophorectomy. 5. Vibramycin Antibiotics Logically, the ovaries should be retained at all Purchase Vibramycin Online ages and not limited to these under forty-five years, as is done by most of Vibramycin Acne the advocates of conservation, since it has been shown that of the women who suffered most severely from the artificial meno- pause twenty-three per cent, were over Vibramycin Hyclate forty-five years of age. 6. Subsequent disease of the conserved Vibramycin Tablets ovary oc- curs in some cases. 7. The clinical Vibramycin 50mg advantages accruing from retain- ing the ovaries Vibramycin Indications in hysterectomy are doubtful and the Vibramycin Antibiotic likelihood of subsequent disease Vibramycin Suspension and adhesions of such ovaries is great. The ovaries should not be retained in hysterectomy unless enough of the lower uterine segment with its endometrium could be left to insure menstruation. Vineberg cites a case in which supravaginal hysterectomy had been performed elsewhere. At reoperation sixteen months later Vineberg found the ovaries to be free from adhesions. One ovary was removed and proved to be normal microscopically. Vineberg notes that conditions were favorable for conservation of the ovaries since the uterus had been about normal in size and there was no dislo- cation of the site of the ovaries as occurs frequently with fibroid growths of the uterus. Richardson concludes, on the other hand, that our knowledge of the complex ovarian function is incomplete ; that the uterus is not essential to a continuation of ovarian function except as regards menstruation and reproduction ; that the disturb- ances of ovarian function attributed to hysterec- tomy are partly those associated with Buy Vibramycin Online normal men- struation (the clinical syndromes of menstruation and of the physiological and artificial menopause differ chiefly in degree and rate of development), and partly those arising from damage to the ovary through unnecessary operative trauma or disease ; that the weight of evidence furnished by anatom- ical, experimental and clinical investigations is overwheliningly in favor of retention of sound ovaries both before and after the menopause age. In response to a questionnaire the following replies were received : Dr. J. Wesley Bovee (23) : Normal ovaries should not be removed with the uterus in women under forty years of age. Since interference with the ovarian blood supply is so great in hysterectomy by the ordinary technic that rapid atrophy of the ovaries ensues we can only expect a slower and nearer normal type of menopause from thus leaving in the ovaries. Dr. John G. Clark (24) Order Vibramycin Online : I have always posi- tively taken the ground that whenever it is possible to conserve the ovaries, particularly in young women, it is the wise plan to pursue. ... I have worked on this basis for fifteen years and personally have seen no reason to deviate from that rule. Dr. Edward P. Davis (25) : Up to the age of thirty-five Vibramycin Doxycycline Hyclate the ovaries, if healthy, should remain. The tubes should be removed in hysterectomy. In older women the Vibramycin Syrup ovaries should be removed with the body of the uterus, since, at this time, the ovary is most prone to degenerative changes. Ovaries retained after hysterectomy probably undergo rapid atrophy. It is practically impossible to remove the body of the uterus and the fallopian tubes without so interfering with the ovarian blood supply that atrophy or degeneration soon occur. This is the only reason why inost operators invariably remove

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