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vical mucosa has returned to its normal state, the discliarge has decreased in amount, and resumed its clear, mucoid character. Furthermore, the size of the cervix -will have perceptibly diminished through the removal of Order Trileptal Online the underlying cause of the November 6, 19-'0.] HEINEBERG: DISEASES OF THE CERVIX. 709 hypertrophy, except in those cases of a very tough, fibrous cervix. In many cases I have observed a shrinkage of fifty per cent, in the size of the cervix. The time required to produce the desired results by this treatment varies between three and six months. Its distinct advantage is that it lessens the necessity for extensive amputation. The cases of bad erosion and ectropion which were formerly subjected to high amputation in Order Trileptal or^er to get rid of the diseased tissue require after the treatment only trachelorrhaphy or a moderate amputation, if any at all. In Leonard's most instructive and impor- tant essay, to which reference has been Trileptal 60 Mg made, he has brought out the advantages of trachelorrhaphy over amputation. He showed that after tra- chelorrhaphy, as . com- pared with amputation, there was an increase in fertility, a decrease in the frequency of abortion and premature labor, and a more favorable influence upon Trileptal 135 Mg the character of the ^rst labor after the operation. He reports fertility Trileptal Vs Tegretol in thirty-eight per cent, of the cases after trachelorrhaphy as against nineteen Cheap Trileptal and four tenths per cent, after the . amputation. Abortion and premature delivery oc- curred Trileptal 450 Mg in twenty-eight per cent, of the trachelor- rhaphy cases and in fifty-five per cent, of the ampu- tation cases. The character of the first labor after each operation is interesting. "Following amputa- tion of Trileptal Cost the cervix, Tegretol Vs Trileptal the first labor was difficult in seven of the eleven cases. In striking contrast to this result is the fact that in eight of the ten cases of full term pregnancy following trachelorrhaphy labor had been easy." In addition to these figures of Leonard, other authors have shown that dystocia after amputation of the cervix (due to cicatricial stenosis) is not only of frequent occurrence but it may reach any extreme, even causing rupture of the uterus. "After trachelorrhaphy, dystocia has evi- dently seldom been met Purchase Trileptal Online with, for references to its occurrence are very scarce." If Trileptal Acne after the treatment of the cervix described herein an amjnitation of moderate extent is still re- quired to reduce the hypertrophy and relieve the Trileptal Coupon ectropion, it should be undertaken. In order to re- duce the stenosis following the amputation and to eliminate the uneven surface produced by the older plan of tying the sutures over the edges of the flaps, I resorted to the Bonney suture Trileptal 150 to invert the long, external flap of the amputated cervix. Unfortu- nately, the traction of the suture not infrequently caused sloughing of the central area of the inverted flap, and left an ulceration which occasionally per- Cost Of Trileptal sisted for a long time and in cicatrization caused a Trileptal 150 Mg depression resembling a laceration, which detracted from an otherwise satisfactory result. This defect of the Bonne}' suture has been overcome in my later cases by introducing both ends of the suture about one quarter of an inch back of the edge of the external flap and then carrying them through the cervical wall at the edge of the internal flap Buy Trileptal Online before they are tied to each other. (Figs. 1, 2 and 3.) This modified method eliminates the pressure caused by tying the suture over the edge of the flap, distributes the tension over a wider Trileptal Generic Name area, prevents sloughing, and gives a better cosmetic result. During the last two years I have further improved the cosmetic eiTect Buy Cheap Trileptal of amputation by exercising greater precision in fashioning the flaps and more exact coaptation of their edges. Trileptal Tablets These results have been rendered easier by securing a bloodless field of operation.

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