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for the reason that with Purchase Avandia rapidly revolving drills perforations can be made with so slight a pressure that there is little danger of injuring the deeper parts of the ear or walls of the meatus by the slipping so likely to occur with hand drills or with hammer and chisel. The instrument is also held between the thumb and fingers in such a way as to in- terfere to a less degree with illumination and inspection of the meatus. During the operation the drills and burrs can also be used, not only to perforate with their points, but also to enlarge openings already made to any extent or di- rection by lateral pressure with their sides." All of the above-enumerated advantages which Matthewson alleges for the dental engine seem to be applicable to the electro-osteo- tome. The control of the instrument, while it may be more difficult to acquire, seems to be more certain Buy Avandia Online than that of the dental engine Avandia Price ; for, if we only give the matter a moment's thought, it must be apparent that, there being no weight sustained Avandia Cost by the hand of the operator and no muscular power required to keep the cutting tool in contact with the bone, the tactile sense of the operator is unimpaired by muscular exertion, which is not the case wlion using bono- cutting instruments deppiidcnt for their j)owor upon manual labor. 'I'lic use of the trephine by setting tho instrument close to the Avandia Canada Avandia 8 Mg baso of the tumor, thus cutting it off close to its attachinont, would seem to be j>referal)lo to the method recomincndod by MatthcwBon, and less likely Avandia Mg to leave a ragged and uneven Hurface. In conclusion, I wish to dis- Order Avandia Online sent from what seems to be the generally adoptcnl plan of treating the contraction of tho canal froiri swelling of the soft tissues by dilatation and the inserting of tubes. So far as one case goes to prove anything, the one ju«t reported proves that such a plan is not only of no use, but Avanafil Buy even per- nicious. The thrcatiMHul entire closure of the canal was, I believe, only averted by llic abandonment of all such meas- ures, which only aggravated the irritation Cheap Avandia and inflammation. Whether the inflaiiimation of the iniddle ear was the clirect result of injury to the membrana tympani during the opera- tion it is difficult to say. I am, however, of the opinion that it was not, but that it was caused by the extension of the inflammation by contiguity. Note. — Since this paper was read I have seen the patient again. The canal through its entire length has almost its normal Hize. The membrana tympani is almost of normal appearance, the perforation having entirely closed. Hearing for the voice is normal, and the watch can be heard at two inches. There only remains a slight tinnitus, which is daily diminishing. Normal Parturition after Extra-uterine Pregfnancy. — Dr. Tiippert, of Wunsiedel, reports the case of a healthy woman, aged thirty-four, who had borne two children, the youngest ten years previously. She became pregnant in March, 1885. In July, severe pains occurred in the left side of the abdomen, with dysuria. On examination, a round- ish body was felt just above the left pubic bone, and smaller parts on the opposite side of the abdomen. The enlarged breasts secreted milk. The cervix (which was not deviated laterally) was thick, short, and soft ; the orifices " as in the non-pregnant condition." No mass could be felt through the uterine walls ; the uterus was not enlarged and was freely movable. The placental bruit was heard Avandia Tablets just above the sym- physis. The diagnosis made was abdominal pregnancy with transverse position of the foetus. Fcetal movements were perceived at the end of July. In the middle of September severe pains for one day were felt, with a rigor, and after this the movement ceased. The abdomen re- mained " not very much smaller," though free from pain, and for two Buy Avanafil years the Purchase Avandia Online woman was apparently healthy. In November, 1887, she again became pregnant, and foetal movements were perceived in April, 1888. The remains of the previous pregnancy were still to be felt as a hard mass, "as thick as an arm," just behind the symphysis; Avandia 4 Mg but bi- manual examination showed that the pelvis was not Order Avandia obstructed. An easy labor took place in August. On December 12, Buy Cheap Avandia 1888, Dr. Tiippert made another examination, and the remains of the previous foetus were found to have shifted their position ; the head, which previously lay on the left pubic bone, now rested against the symphysis ; the trunk and the feet were about four fingerbreadths from the right pubic bone. The latter were somewhat movable, the head less so. Since the last labor the fcetal remains had undergone no diminution in size, and were of stony hardness. — British Medical Journal. The Influence of Position on Fractures of the Lower Extremities.— Colles ("Dub. Jour, of Med. Sci.," September, 1888) explains the fact that a Generic Avandia change Buy Avandia from the horizontal to the sitting posture is injurious to patients with fractures of any of the bones of the lower extremities by showing that, as the patient rises into a sitting posture, the extremity of the ischium is used as a fulcrum, and, as the head of the femur is at least three inches above that point when the patient is in the horizontal position, it must be pushed downward two or three inches. This must influence the point of weakest resistance, the seat of fracture. March 9, 1889.] LEADING ARTICLES.— MINOR PARAGRAPHS. 271 NEW YORK MEDICAL JOURNAL, A Weekly Avandia Online Review of Medicine.

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