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ney. The golf-hole opening indicates atonic di- latation of the ureter. A calculus arrested near the mouth of the ureter produces edema of the orifice. Much can be observed by a study of the shoots or the urinary afflux from the ureteral orifices. These shoots may be accentuated by giving methylene blue b)^ the mouth or indigo carmine by hypodermic. Valtrex Mg When the urine shoots in dis- tinct jets, but more frequently on one side than the other, greater functional activity is indicated when the shoots are large and uniform in size. If they are small in size, frequent or irregular irritation may be inferred. Stricture, stonCj or in- flammatory troubles are to be suspected when the shoots are irregular or distorted in form. The action of certain drugs, the drinking of fluids, ex- citement, etc., may cause a very rapid flow of urine. Dilatation of the ureter without paralysis of the sphincter is denoted when the urine drib- bles into the bladder at intervals. When the sphincter has lost its efficiency the urine flows into the bladder almost continuously. When no urine is being secreted no shoots will be seen even after several examinations. The orifice of the ureter may be undiscoverable. The urinary shoots consist of blood-stained urine in acute in- flammation of the parenchyma of the kidney, in breaking down carcinoma and sarcoma of the pelvis, in injuries of the kidney, in ulceration of the pelvis, in malignant disease, and in syphilis; occasionally slight bleeding is seen in stone, Valtrex Order in early tuberculous disease, and in chronic intersti- tial nephritis. The flow of urine from the ureter is pus stained ; in septic pyelitis and pyonephrosis, when the kidney is still active, the urine will be ejected at regular intervals. In tuberculous pyelitis the pus is not intimately mixed with the urine and many of the shoots will be clear ; most of the pus passed will be in the shape of flakes. In old- standing pyonephrosis, in advanced tuberculous, syphilitic, or malignant disease, the secretion of urine will have practically stopped and pus, blood, or 500 Mg Valtrex bands of puttylike material may come from the ureters; About the most easily discovered morbid ob- ject in the bladder is a stone lying on its floor; this stone may be covered with mucus or be in such a position that it cannot be reached with a sound. At times a calculus will float in the urine content of the bladder. The stone may be lying behind the prostate and may be brought into view by placing the patient Valtrex 500mg in the knee-elbow position. Ureteral catheters can best be sterilized by sus- pension in a rack in a container Valtrex To Buy over formalde- hyde solution. Just prior to its introduction into the Purchase Valtrex bladder by way of the cystoscope the catheter should be lubricated with glycerin or oil. As a precaution against a possible introduction of in- fection into the ureter and renal pelvis, some irri- gate through the catheter with a small amount of dilute silver-nitrate solution. In introducing the catheter one should be careful not to touch the bladder wall with its tip. The ureteral catheter is of especial value in de- termining in a given case which of two kidneys is involved. Strictures of the ureter may be located, Order Valtrex dilated, and treated, and some mild cases of hy- dronephrosis may be cvired by this means. Stone in the pelvis of the kidney has been detected Cheap Valtrex a number of times by the use of the wax-tipped Nov. 24, 1906] MEDICAL RECORD. 825 bougie. Inasmuch a.-^ the introduction of the ure- teral catheter often causes some bleeding, it is well, especially in uncertain cases, to lea%'e it in situ for some time. In addition to its value as a diagnostic instrument, the catheter is useful for the purpose of lavage of the renal pelvis and as a guide and protection to the ureters in certain cases of pelvic surgery. The cystoscope and ureteral catheter should be, as a rule, used in cases in which a positive diag- nosis cannot be made by other means. In the introduction of the instrument into the bladder, with the possible traumatisms incident thereto, a certain risk of infection is incurred. In the same way there are chances of ascending infection of the ureter and possible kidney involvement from the use of the ureteral catheter. A few cases of contracted bladder and certain cases in which the hematuria or pyuria is excessive cannot be satis- factorily cystoscoped. In cases of stricture so large an instrument cannot be passed. At times it is impossible to catheteri/^e the ureters. Time, patience, expensive apparatus, excellent eyesight, extensive e.xperience, and skill are prerequisites to the accomplishment of results from this sort of work. Some patients cannot tolerate this pro- cedure even by aid of a local anesthetic. In a considerable number of otherwise obscure cases I believe the cystoscope and ureteral ca- theter to be of much value, and that they till a want in our armamentarium of diagnosis that nothing else will. My conclusions are that the cystoscope as an accurate scientific instrument is of comparatively recent incejition and perfection ; that the other mechanical aids to the collection of the separate urines are not by any means absolutely depend- able ; that the cystoscope and ureteral catheter have their limitations, shortcomings, and defects, and are not Valtrex Buy Online ideal ; that these appliances are of especial value in diagnosing the causes of hema- turia, in the discovery of calculi and foreign bodies in the bladder : that a careful study of the ureteral orifices gives more than an inkling of the conditions present in ureter and kidney. Definite information concerning the origin of a pyuria can be elicited by the use of the cystoscope and ure- teral catheter which could not have been obtained in anv other wav. The Origin and Structure of Moles. — Dr. Wilfred S. Fox has made a study of moles, and in a subsequent paper will discuss their relation to malignancy. He considers that the tendency of research into the origin of cancer has been toward abandoning the infective hy- pothesis. Moles are of two general classes: smooth or abnormal pigmentations, and verrucose with hyper- trophy. He makes the following groups: Vascular nevi, dermoid cysts, hard nevi, soft nevi, (or moles »s generally understood), giant nevi, linear Buying Valtrex nevi, and mullusciform nevi. His paper deals chiefly with the commoner forms of hard and soft nevi. He finds that though congenital in their origin, moles are seldom actually present at birth, but develop during the first year or may be delayed till puberty. Von Reck- linghausen's and Unna's views as to origin are dis- cussed. The conclusions drawn from a series of cases examined and from the evidence given by histological workers are that the cells of soft moles which show the typical columnar formation Valacyclovir Valtrex in the corium are epidermal in origin, but that there does appear to exist a more rare variety of soft mole, which resembles clinically the above, but whose cells are in all probability derived from the mesoblast. — British Journal of DermatolKgy. Recurrent Luxations of the Patella. — .According to Dupic, in cases in which the first Valtrex Purchase by trauma this accident may be brought about afterward by Valtrex Buy merely an energetic con- traction of the quadriceps extensor femoris. This dis- location, which occurs more commonly than is gen- erally thought, is found most often in young subjects from twelve to twenty years old. Two-thirds of the cases are girls and women. Valtrex On Line The dislocation occurs nearly always on the external side, and is of two prin- cipal varieties, being complete or incomplete, according lo the degree of the displacement. As a predisposing cause there generally exists an affection which dis- tends the ligaments, such as hydrarthrosis, a bony de- formity, or a slight degree of genu valgum. In such conditions a violent muscular contraction, when the leg is half flexed, is sufficient to bring about the displace- ment. The prognosis of these dislocations is alwavs serious and depends upon the number and location of the recurrences. The number of recurrences is ex- tremely variable. In some Get Valtrex cases they take place several times a day and even oftcncr. The degree of the dislo- cation is equally important. Sometimes it is so slight that the function of the part is hardly disturbed. In other cases the dislocation is complete, with absolute functional impotence. Reduction is generally easy. Im- mobilization should be enforced for about eight days, after which massage and electricity are indicated. How- ever, when recurrent dislocation becomes chronic sur- gical intervention is indicated. — Gazette Medicate de Stras- bourg. Acute Intoxication by Mercury. — Barthe and Ch. Mongour record certain observations which they have made. There are three distinct phases in cases of this kind, the initial period being How To Order Valtrex separated from the ter- minal by an absolute cessation «of symptoms in cer- tain instances. The first period begins soon after the ingestion of the poison. It is characterized by bilious vomiting, followed by hemorrhagic fluid. A painful sensation of burning in the retrosternal and epigastric regions is very troublesome. In the hours which fol- low, salivation develops, with lesions of mercurial stomatitis. There is also fetid diarrhea, the dejecta being bloody and stringy. This period lasts from two to live days. As to the condition of the blood, the leucocytes, accordine to their oower of resistance, tolerate a mercurial infiltration for a period more or less long. When the lesions of the digestive tract begin to Valtrex Online heal, this tolerance still exists and the patient appears to be entering unon con- valescence. But the mercury later disorganizes the white cell, which then allows the poison to diffuse itself through- out the entire organism. The general symptoms of the third period then develop. Although the white cells do not play an exclusive role in the defense of the organism, they are the most important factor. This whole subject is of medicolegal interest. — Journjl de Medccine de Bordeaux. A Benign Tumor Developed on the Interior Surface of the Labium Minor. — Gaigncrot reports this case. The size of the tumor corresponded to that of a mandarin. It was elastic, of unequal consistence, and had on its surface a series of nodosities of woody hardness and of the size of small peas. At the time of its extirpation its color was a pinkish yellow. On section this tumor was seen to consist entirely of small granules like those that covered its surface, hard and yellow. These granules were connected by a gristly tissue, slightly translucent. Online Valtrex Microscopically this growth was found to be a fibroma, with lipomatous patches here and there. The tumor was interesting on account of its location. The patient was fifty-four years old and en- tered the hospital for Buy Valtrex the treatment of an umbilical hernia. It was by chance only that the tumor was mentioned. She had noticed a small swelling at the age of seventeen years. This growth had increased in size up to the present time. — Journal de Medecine de Bordeaux. -826 MEDICAL RECORD. [Nov. 24, 1906

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