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TORSION OF THE SPERMATIC CORD. Among the clinical lesions of the testicle resulting fruni morbid changes in its vasculonervous pedicle torsidn of the avapro recall cord is paramount. In order avapro avalide that avapro discount card the testicle can twist on the cord the gland must plunge in the vaginalis as the heart does in the pericardium, that is to say, an embrj-onal defect exists having as a consequence the absence of the mesorchium, the tes- ticle being suspended like a cherry on its stem. In these avapro vs diovan circumstances a strain or violent movement will cause torsion of the pedicle with the resulting clinical phenomena. Vanverts was able to collect only forty- four reported cases to which he added one of his own and after clinical and experimental researches on the subject he came to two conclusions different from those of his predecessors which relate to the evolution and surgical treatment of the lesions. Ac- cording to avapro classification the opinion of most observers, torsion of the avapro tablet cord almost invariabl}' results in suppuration and septic gangrene of the structures involved. Now \'anverts maintains that these phenomena only occur when there is a superadded infection and the aseptic focus that the testicle represents after its own cir- culation has been cut off should not be any more ex- posed to infection than would be a subcutaneous avapro cost hematoma. For this reason Vanverts believed that recovery with simple atrophy of the testicle without suppuration is the rule both in man and animals. The experiments undertaken to demonstrate this special viewpoint were positive and conclusive in this respect, so that Vanverts has been led to regard the testicle as being much less compromised in its vitality after torsion of the cord than is generally admitted unless an infection becomes superadded. avapro 10 mg Too much importance must not be attributed to the vascular lesibns. Some observers — \'olkrnann, Miflet, Neu- mann, and English — have recorded curious instances of hemorrhagic gangrene of the testicle without tor- sion of the cord including them either among cases of torsion of the testicle or among those of primary phlebitis or arteritis of the vessels of the cord. In fact torsion and phlebitis often coexist as in Bevan's ca-;e of gangrene of the testicle in which the avapro price phlebitis of avapro 75 mg the spermatic veins of an ectopic testicle was most manifest. The venous coagulum being filled with bacteria, while torsion of the cord was distinctly made out. In Nicoladom's case the veins were com- pletely occluded and the artery partially so. This avapro coupons was likewise the condition found by Keers and Lang- let in their cases. Unquestionably, the effects of torsion vary ac- cording to the presence or absence of blood infection and comparatively with Chauveau's researches, it may be admitted that in many if avapro generic alternative blood infection does not preexist or follow, torsion ends in simple atrophy of the testicle. Although not denying the frequency of phlebitis and venous and arterial thromboses fol- lowing torsion there is reason to ask whether or not among these avapro generic name cases some were not in reality simple primary phlebitis and venous and arterial thromboses with a torsion more apparent than real and Scheeds has remarked that torsion of the testicle may merely be a secondary symptom and not the cause of necro- biosis of the testicle which often takes place spon- taneously. But if we consider only simple cases it appears evident that when no infection exists the morbid changes arising in order avapro the testicle can only be attributed to some mechanical factor. If buy cheap avapro torsion causes a complete occlusion of the elements of the cord the surgeon in some cases provokes the same condition of affairs with no untoward results to the testicle. Lucas-Championniere excised the cord in eight cases of operation for large inguinal hernia and eight cases of operation avapro coupon for large inguinal hernia and the operation in no way aft'ected the testicle although the gland was deprived of its excretory duct and ar- terial supply. The gland at first swelled and was painful but the tumefaction soon retrogressed and never completely atrophied. Carlier is also of the opinion that an aseptic total excision of the cord does not necesSfirily result in necrosis of the testicle and i absence of atrophy may, in some cases, be attributed to anastomoses of the arteries of tlie cord avapro alternatives with the arterial circulation of the bursae. These results conflict with the findings in atrophy of losartan vs avapro the testicle sometimes occurring rapidly after op- erations for varicocele in young adults or in cases of hernia where the sperinatic artery has been di- vided unintentionally. This may be due to absence or insufficiency of the collateral circulation in "youth — as in the case of dogs — hence the necessity of maintaining a more complete arterial irrigation of the testicle in young people than those of advanced years. The age of the patient, the individual differ- order avapro online ences in the blood supply and the length of time the patient is followed after operation must all be taken into consideration. When this is done sufficiently numerous and careful histological examinations will then have some real value.

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