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Chicago. In a recent article (1) I called attention to the importance of the knife cautery procedure as an operative technic in decreasing postoperative shock, hemorrhage, and the morbidity incidental to con- valescence. It can be used in incising the visceral pleura and the lung proper, in removing foreign bodies, such as bullets, fragments of high explosive shells, and particles of bone or bits of clothing, carried into the lung tissue by the missile, and in operating for hemorrhage, lung abscess, or tumor. Before the advent of the knife cautery, pulmonary operations were the least developed and the least Generic Norvasc Price understood from the viewpoint of technic and post- operative complications of all forms of surgery. The mortality rate Norvasc Other Names was exceedingly high, shock and hemorrhage being the chief contributors, and the postoperative morbidity continued over a period of weeks or months. Hemorrhage. — Heretofore hemorrhage has been Buy Norvasc 5mg very Norvasc 50 Mg difficult to control and postoperative Norvasc Canada oozing has caused a large number of deaths, owing to the facts that suture of lung tissue is unsatisfactory in the control of bleeding and the needle punctures themselves continue to bleed after the wound is closed. Lung tissue in particular must be free from oozing when the wound is closed, or the bleed- ing- may continue for an indefinite period, exsan- guinating the patient and being almost impossible to control without a large firm packing. The re- moval of this packing produces a return of bleeding, and, Norvasc Coupon while it is in position, it causes incessant Norvasc Cmi cough- ing, which so greatly weakens Generic Norvasc 10mg an already over- burdened heart that cardiac dilatation is likely to occur. Furthermore, iodoform or cyanide gauze Norvasc Coupons will in almost every case cause some symptoms of toxemia, the absorption being so rapid that often within twenty-four hours toxic symptoms manifest themselves by rigor, vomiting, high temperature, and delirium. Shock. — Profound shock followed by delirium accompanies a large percentage of pulmonary operations by the older Norvasc 100 Mg methods, induced, I believe, by the combined factors of hemorrhage, anesthesia, and packing. Then, too, the class of patients in whom these operations are indicated suffer from low vitality, secondary anemia, and usually present profound toxic phenomena. Blood transfusion is, in my opinion, the ideal treatment in this condition. Lung abscess, tumors and foreign bodies are in- dications for surgical intervention, and with all of these dyspnea and cardiac weakness or irregularity are prominently associated. Obviously, therefore, any procedure which decreases the danger of post- operative shock Norvasc 5mg Generic or cardiac dilatation is to be pre- ferred. Dyspnea. — All cases of pulmonary disease re- quiring surgical operation are accompanied by dysp- nea, its severity depending upon the location of the diseased area, the toxic element, and cardiac com- pensation. Pleural effusions and hemothorax greatly embarrass respiration, and I believe it is good prac- tice to aspirate or drain these accumulations forty- eight hours before pneumotomy is to be performed. Atropin and digitalis in full doses sometimes Norvasc 7.5 Mg will temporarily control dyspnea to a Norvasc Pi great extent. When it is dependent upon increased intrathoracic pres- sure it is impossible to control until this pressure is relieved. Postoperatively, strychnine, administered in large doses hypodermically, diminishes respira- tion and may sustain the circulation through the shock period. Morphine of course is preeminent in Cheap Norvasc Online decreasing respiration and quieting delirium, as well as controlling cough. TECHNIC Location of incision — external marking.- — The location of the primary incision on the chest wall should conform to the pulmonary area to be incised as nearly as possible. Preliminary outlining with •Read before the Chicago Academy of Medicine, May 27, 1920. 674 I'AX PAING: SURGERY OF THE THORAX. iodine or silver nitrate .stick is useful in that it remains as a guide after sterilization of the chest wall is complete. The incision may be U shaped or longitudinal, Norvasc Logo conforming to the contour of the ribs, the primary flap consisting of skin, superficial and deep fascia down to the muscle. The muscles may be separated or incised. The number of ribs chosen is important, three being Norvasc 7 Mg the usual number. Norvasc 5mg Price All of them may be fractured, and reflected; or Norvasc 2 Mg Norvasc Patent one may be fractured and removed and the one above

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