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FiG. 1. — Cleveland's needle holder; Emmet's tenaculum; Tuttle's cervix scissors (right and left) ; double volsella forceps; Dudley's cervix needle. fully preserving the proper distance from the os and surrounding the cervix with Valtrex Order a circular incision, which usually corresponds to the line surrounding the cervix at its greatest periphery. The mucous membrane of the vagina is then v^fiped back with gauze to Valtrex To Buy the desired height, that is, to a point above the diseased tissue. The cervix is then amputated with scissors by clean cuts at right angles to the long axis of the uterus. Two sutures are placed in the centre, in front, and two behind to bind the mucous Valtrex On Line membrane of the vagina Valtrex Online to that of the cervix to insure a new canal which will not con- tract. These are passed first, then the sutures passing from before backward, picking up the mu- cous membrane of the vagina, then entering the solid tissue of the cervix beside the canal, emerg- ing and Valtrex 500mg picking up the vaginal mucous membrane of the posterior wall. From three to five sutures are used on either side at intervals of about one quarter of an inch, picking up the solid tissue of the cervix as well as the mucous membrane in front and behind. After all sutures have been passed, they are tied, beginning with the central ones, which pass into the cervical canal, then tying those on the side. For better understanding of the technic, see Figs. 1 and 2. The instruments used are also shown in Fig. 1. HEIGHT OF .IMPUTATION. In Buy Valtrex cases of severe dysmenorrhea accompanying anteflexion and where sterility also exists, care must be used not to amputate the cervix too How To Order Valtrex high. If the Cheap Valtrex amputation extends as far as the internal OS, the patient will be unable to carry a fetus to term and abortion will occur almost invariably be- tween the third and fourth month, the circular fibres in the cervi.x which keep it closed having been cut away. As soon as its tissues become softened as a result of pregnancy and the fetus begins to attain weight, it sags down into the lower segment which starts dilatation with the invariable result of being expelled. If the amputation Valtrex Mg is made to extend to a point within one third of an inch of the internal os, it will easily accomplish the' purpose attempted and at the same time preserve Order Valtrex for the patient the ability to carry a fetus to term. A modification of this operation which has a distinct field of usefulness constitutes a combina- tion amputation trachelorraphy. This is suitable for cases in which the laceration has extended to or almost to the internal os. The amputation if carried beyond the point of the Buying Valtrex laceration would remove so much of the cervix that childbearing would not be possible. By amputation of the an- terior and posterior lips, and then by cutting out a wedge shaped piece from the site of the laceration on the sides, the operation may be completed, yet leaving a sufficient Online Valtrex amount of the cervix to make childbearing possible. In labors following ampu- tation of the Valtrex Purchase cervix, it is not especially prone to tearing, but if this should occur it should be re- paired again. Since amputation of the cervix is frequently one 500 Mg Valtrex of several operations done at the same time, the postoperative care is embraced in that which is observed for the sum total of the operations done. But where it is Valtrex Buy Online the primary and ciiief operation, the care resolves itself to that of amputation of the cervix alone. A patient should remain in bed for at least ten days. Douches are unnecessary, ex- cept at about the Purchase Valtrex tenth day, when a bichloride douche of one to six thousand may be given and repeated every Valtrex Buy other day for eight days. Other 712 FOWLER: CERVICAL LACERATION. [New York EDiCAL Journal. aftertreaiiiieiit consists in the usual attention to the Get Valtrex bowels, the diet and the general comfort of the patient. It is unnecessary and bad technic to place gauze in or against the cervix after operation. References. Valacyclovir Valtrex

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