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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