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opening the patient had been fed, first with milk and subse- quently with solid food, and had survived the o|)eration about five weeks, dying of the progress of his disease. About Bupropion Online three weeks after the operation the oesophagus had again become per- vious to liquids. The specimen showed the stomach firmly fixed in the abdominal wound and the opening healed all around. In a second operation the stomach had been opened three days after its fixation in the abdominal wall, and, although the patient had died three days afterward from rupture of the oesophageal cancer Cheap Bupropion into the trachea, the opening into the peri- toneal cavity had been found to be solidly closed by adhesion between the opposing surfaces. He thouglit it was important to seek for early union of the cutaneous incision about the gas- tric fistula, Buy Cheap Bupropion and to drain the parietal wound only by its upper and lower ends, in order to avoid interference with primary union by leakage of the contents of the stomach. Gunshot Wound of the Brachial Artery.— The President also showed a portion of the brachial artery of a man who had been shot in the arm with a pistol. Half of the portion of artery which lay in the course of the ball had been carried away. The accident was a rare one. In 80,000 cases of wounds by missiles recorded during the late war, only 45 had been Bupron Sr Tablets put down as having shown ])!irtial wound of an artery. Ligation of the Uterine Arteries in their Continuity as an Early Step in Total or Partial Abdominal Hysterec- tomy. — The President then Buy Bupropion Online presented two specimens removed by laparotomy — a large carcinoma of the body of the uterus and a uterus containing large fibroids. The circumstances in each case had compelled the choice of the abdominal method in pref- erence to vaginal hysterectomy, but he was inclined to believe that the preference should be given to this method in many cases in which vaginal hysterectomy was possible, because in both instances he had found that the Hgation of the uterine arteries beforehand greatly simplified and expedited the removal. In both cases also he had made a total removal, and he asked the opinion of those present concerning the relative Order Bupropion advantages of removing and t)f leaving the cervix. In the first case (one of carcinoma of the body) the growth had Buy Bupron Sr spread anteriorly so as to involve a portion of the peritonseura covering the bladder, a circumstance which be thought would probably have made the removal necessarily incomplete if it had been attempted by the vaginal method. The operation had been begun in the usual manner, by multiple ligation of the broad ligaments and of the uterus below the tumor, with a view to possibly leaving the cer- vix as a pedicle. However, in the course of the operation he had sought for and tied the uterine arteries near the uterus, and had then found that he could remove the whole organ easily and rapidly with the knife and scissors, and with but slight hjemorrhage. The operation had thus been facilitated Order Bupropion Online so much that in the second case he had proceeded at once to tie the uter- ine arteries. In this case two large fibroids had developed in the anterior wall of the uterus, the lower one extending so far down that the cervix could not be i^M per vaginam. The uterus had been drawn out through the abdominal wound and the uterine arteries found by palpation of the posterior surface of the broad ligaments close to the cervix ; the overlying perito- nseum had been divided and catgut ligatures placed about the arteries. A silk ligature had next been passed around the outer border of each broad ligament well below the ovary, to secure the ovarian arteries. Both ligaments had then been cut straight across, and the incision prolonged across the peritonfeum cover- ing the back of the uterus, and across the lower fibroid ante- riorly. Through this incision the fibroid, together with the ad- Buy Bupropion joining part of the uterus, had been readily pushed out and the organ severed just above the cervix, thus facilitating the subse- quent removal of the latter. This had been eff"ected by lifting it with a volsella while a hole was made with a blant instru- ment forced through into the vagina anteriorly, and by cutting round it with scissors. The bleeding had been insignificant. A comparatively slight reflux of venous blood from tlie divided edges of the broad ligaments had been easily controlled by the temporary use of a long-bladed clamp. In both cases the ab- dominal incision had been entirely closed, and drainage made through the vagina for the first three days. The first patient had now entirely recovered ; the second (then in the fifth day) was doing well. In all previous hysterectomies the speaker had left the cer- Generic Bupropion 278 PJtOCEEDINQS OF SOOIETIBS, [N. Y. Med. Jouk, vix, and troiitod it oxtraiioritoiioally. In H()in«* of tlioin ricatri- /atioti had I)i>(MI Ioii); dclavcd liy tho Purchase Bupropion iiicvitalilt' Hii|i|>iirMtii>n of tlio |>iMli('l(> and tlio hIow tilling' Purchase Bupropion Online up ot tlio fiuin(ti(l>'il I III' liv|MMl('i'iiiiilir iiijcclinti ot from .'j^ to ij^^ of a trraiii of atropiiu« provions to t^ivitiff other lor an operation. In the second of tiio t\vi> foroffoinj; cases the woman had hoon

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