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dressing constituting the only treatment necessary in the majority of cases. Pressure may be relieved by aspiration and hemorrhage controlled by strapping. Any attempt to recover the ball would be fraught with danger and is rarely justifiable, as the bullet will continue to be harmless unless it buy cheap cytotec has carried in septic material." But Koenig in the same year stated that the treat- ment of these cases depends upon individual circum- stances. In general, he says, it may be stated that only rarely is one justified in operating within a short time after the accident for the purpose of arresting hemorrhage. If two or three days after the injury the phenomena cytotec cheap (respiratory distress, fre- quency of pulse, and elevation of temperature) increase, one should not hesitate to perform a thorac- otomy. A rise of temperature and cytotec 400 mg difficult breath- where to buy cytotec ing appearing at a later stage suggest infection, and constitute another indication for operation. Notice that Koenig refers to the elevation of temperature accompanying the hemothorax per sc. This has often led to the mistaken diagnosis of infection and precipitated a thoracotomy plus drainage, thus almost inevitably producing infection. In order to avoid the possibility of infection in a hemothorax, operation should be performed only under the strictest aseptic precautions ; otherwise a hemothorax may be con- verted into an empyema. When the resorption is slow, one may remove the blood by puncture, and only w-hen this proves unavailing is a thoracotomy justifiable. This advice relative to the cytotec 200 mg treatment of hemothorax is practically that of Elliot (1919) one of the best of the English authorities on the sub- ject. Elliot says "early aspiration must be the routine and if this is found to fail by reason of clot, then the chest must be evacuated at the earliest possible date by thoracotomy, without drainage." In the following year Grunert advocated a more radical plan of treatment, and advised delayed thoracotomy for the removal of the blood clot cytotec order in slowl}- developing hemorrhage and immediate operation in severe cases with an attempt to arrest the hemorrhage by ligature, suture or tampon. In 1905 the epoch making paper of Garre appeared in which he presented a statistical study of 700 wounds of the lung treated conservatively, dwelt upon the high mortality imder such methods cytotec cost of treat- ment, and exposed some of the fallacies which had long influenced the treatment of these lesions. He pointed out that the general mor- tality was forty cytotec price per cent. ; in ruptures of the lung, uncomplicated by other injury it exceeded fifty per cent. ; w-hile stab wounds and gunshot wounds in the antiseptic era exhibited a death rate of thirty-eight per cent., and thirty per cent, respec- tively. He also clearly demonstrated that antisepsis as ordinarily applied could not favorably influence the internal wound which opened the lung itself; that the small calilire jacketed bullet was as danger- ous as the old fashioned projectile; he also asserted that the often repeated view that bleeding spon- taneously ceased in the collapsed lung had neither clinical nor experimental confirmation. The prime indications for operation, according to Garre, were hemorrhage, (abundant, persisting, or recurring.) and pressure pneumothorax not yielding to aspira- tion. While these were buying cytotec only cytotec 200mcg present in five or six per cent, of cases of lung injury, they demanded prompt interference. He collected nine cases of suture of the lung, including one case of ruptured lung (his own) with six recoveries. The online pharmacy cytotec principles of treat- ment, as he laid them down, are not very different from those found useful by his followers cytotec buy online ; nor has his technic been greatly modified buy cytotec except as in- fluenced by the facilities afforded by the develop- ment of differential pressure and a better under- standing of the influences of pneumothorax and its relationship to cytotec on line drainage. This paper of Carre's, and the invention of the negative pressure chamber of cytotec mg Sauerbruch and the positive pressure helmet of Brauer gave an impetus to thoracic surgery which has continued to this day. A number of valuable contributions appeared in the German literature particularly those of Kiittner, Lawrow, Stockey, Moller, Wolf, and Grassman, 616 MVLLER: purchase cytotec GUNSHOT INJURIES OF CHEST. and tlie (|uestion was discussed in detail in the Paris Surgical Society in 1907 and 1909. In 1911 a lively discussion between the abstentionists and the inter- ventionists cytotec 200 mcg took place at the International Surgical Congress. Lenormant drew up the report for this congress and, according to his order cytotec online statistics, out of 1056 online cytotec cases the rate of mortality was only ten per cent. In order to appreciate these figures correctly, it must be mentioned that they deal only with patients in civil practice, and that cases complicated by injury

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