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of the vessels of the hilum were excluded. The Cytoxan And rate of mortality would be considerably higher if all cases of injuries to the lungs were included. A third of the mortality in Lenormant's cases was the result of infection and two thirds Adriamycin And Cytoxan from hemorrhage. He favored expectant treatment. At that time the abstentionists seemed to have the better of the argument because, while the reasoning of the inter- ventionists was perfectly sound and their operative indications the result of logical deduction, the statistical evidence was not always as convincing. Thus Cytoxan Generic Lavrofif quotes the results of a series of 257 cases occurring in Zeidler's clinic during a period of five years. Of these, 155 cases operated upon gave a mortality of thirty-six and seven-tenths per cent., while in 102 cases treated conservatively the mortality was only fourteen and seven tenths per cent. The author explains the figures by stating that the nonoperative cases were far less severe in character. Holmberg reported a series of 324 cases, of which 266 were stabwounds, thirty-nine gunshot wounds, and nineteen closed or subparietal injuries. All but four of these patients were treated conserva- tively, that is, the stab wounds were carefully dis- infected and sutured ; the gunshot wounds were cleaned and an aseptic dressing applied, and the closed injuries were treated expectantly. The total mortality in this series in injuries involving the lung or pleura was Cytoxan And Adriamycin fifteen and eight tenths per cent., of which the largest series, that is, the stab wounds, showed eight and one tenth per cent., the gunshot injuries thirty-seven per cent., and the closed rup- tures, forty-seven per cent. In spite, however, of the statistics of Lenormant, Holmberg and others, Cytoxan Cyclophosphamide the tendency of the times was towards active inter- ference, especially in those cases when hemorrhage and pneumothorax threatened life. Thus, in an article by Brewer (2), written in 1907, he advised the following : Treatment of exist- ing shock ; control of cough and restlessness by morphine : disinfection of the wound area, rest, strapping of the chest; aspiration of air in pneu- mothorax. Taxotere Cytoxan Cyclophosphamide Cytoxan If Buy Cytoxan there is a progressively increasing hemothorax threatening life, the surgeon should freely open the pleural sac by resection of one or more ribs and attempt to arrest the hemorrhage Taxotere And Cytoxan by suture, ligature, or by packing. But, five years later Brewer wrote that he would advise immediate exploratory thoracotomy in all cases of penetrating wounds of the chest which pre- sented signs of hemorrhage threatening Cytoxan Taxotere the life of the individual or seriously embarrassing respiration ; in all cases where there was reason to suspect in- jury of the diaphragm, heart, or other important structures ; and in all cases of large pleural wounds where there is evident septic Order Cytoxan contamination and an open pneumothorax. He advised careful disin- fection and aseptic dressings in penetrating gunshot wounds without symptoms or signs of a more grave injury, and in simple stab wounds without evidence of grave hemorrhage, pneumothorax, or injury to diaphragm or heart. In all cases of doubt, in wounds of the heart zone, or in the region of possible diaphragmatic injury, he favored Cytoxan Tablets explora- tory operation as the safest method of treatment. In 1911 Jopson read Oral Cytoxan an illuminating paper before the Philadelphia Academy of Surgery. He pointed out that the binding indications for operation in penetrating wounds were as follows: 1. A wound which from its situation and direc- tion would render likely a penetration of the heart, pericardium, or diaphragm. Buy Cytoxan Online 2. Severe primary or recurring hemorrhage, as shown by the physical signs of hemothorax or ex- ternal bleeding, or by severe hemoptysis with threatened aspiration of blood into the other lung. 3. Secondary hemorrhage, especially to be looked for in gunshot woiuids. 4. Severe pneumothorax, especially when accom- panied by symptoms of mediastinal and cardiac dis- Cytoxan And Taxotere placement, Adriamycin Cytoxan dyspnea, cyanosis, and threatened suiTo- cation, and which is not relieved by aspiration ; also when extensive and increasing external emphysema is present. 5. Secondary pneumothorax, which is always due, according to V. Moller, to suppuration or sloughing of lung tissue. 6. Empyema. At about the Cytoxan Adriamycin same time Dorrance, also of Phila- delphia, reported the results of some experimental work on animals and advised the following: "If hemothorax develops the chest wall should be opened as soon as the diagnosis is made ; all clots and serum removed ; the Cytoxan Oral wounds in the lung sutured ; the pleural cavity inspected and its toilet completed ; and the chest wall Iv Cytoxan immediately closed, the lung being expanded by either negative or positive pres-

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