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5. The Care of the Patient During Serious Abdominal Operations, By H. B. Gardner. 6. Sterility Among X Ray Workers, By A. C. Jordan. 7. Spontaneous Aneurysm of the Dorsalis cipro price Pedis Artery. By A. Cuff. 8. Upon the Bacteriology of the Summer Diarrhoea of In- fants. (Report CII of the Science Committee of the British Medical .Association), By H de R. Morg.\n. 1. Sudden Cerebral Lesions. — Gowers states that sudden cerebral lesions are among the most buy cipro online perplexing probelms met with by the practitioner. The nature of the lesion nuist he discerned price of cipro at once in order that treat- ment may be wise and prompt. After a few hours the chief part of the opportunity is over. The most com- mon evidence of a sudden lesion cost of cipro of the brain is hemi- plegia, very rarely diplegia alTocting both sides. An organic lesion of the brain of sudden onset, coming on in a few minutes or in a few hours is a vascular lesion. Moreover, in a vast majority of, it is an arterial lesion; it is due to the rupture of cipro 500mg an artery causing h.Tinorrhage, or to the closure of an artery causing necrotic softening. The first question in a case of sud- den hemiplegia is the age of the patient. Has he reached the degenerative period of life? This usually begins at fifty years in normal individuals, but may be- gin earlier if there is an inherited tendency to early arterial degeneration, or Rright's disease. In the ab- sence r)f those last two inlluences. one of two lesions is probable — hajniorrhage from the rupture of a minute artery which has dilated to a " miliary aneurysm," or necrotic softening from thrombosis in a larger artery the seat of atheroma. High tension of the pulse and a strongly acting hypertrophied heart are the conditions which point to haemorrhage and a soft feeble pulse with a weak dilated heart are the indications of thrombosis. Distinct degeneration of the brachial arteries is in favor of atheroma, but tortuosity of the temporal ar- teries means little, as it is often due to the mechanical influence of hard hats. If the heart presents a val- vular murmur, the diagnosis from embolism arises. Albuminuria, as indicating organic renal disease, is in favor of haemorrhage ; the cipro order same is true of a high degree of albuminuric retinitis, especiallv if acute in course and hemorrhagic. Preceding cerebral attacks, if slight, and especially if repeated, are strongly in favor of thrombosis and softening. Warning symptoms during the few days before the attack are an important indi- cation of thrombosis. They consist of tingling in the parts afterwards paralyzed, transient weakness, brief loss of speech, and giddiness. Thev are probably due to impaired circulation in the narrowed vessel. In haemorrhage they are absent. In thrombosis a condi- tion of fatigue, exhaustion or depression is often to be traced just before the attack. The onset of the symp- toms in thrombosis is much more frequently buying cipro online during sleep than in the case of haemorrhage. buy cipro Loss of con- sciousness occurs in either lesion, but in haemorrhage more readily than in softening, especially if the sever- ity of the cipro cheap paralysis is considered. It js probably first due to irritative inhibition of the cortex, which is main- tained by increased intracranial pressure. In throm- botic softening loss of consciousness depends chiefly on the size and importance of the artery, and the sud- denness of the closure. Convulsions at the outset are more buy cheap cipro frequent in thrombosis ; the same is true of true aphasia, especiallj' if enduring. Hemianopia suggests softening. Early signs of considerable irritation are purchase cipro online in favor of haemorrhage. " Ingravescence." the steady increase of coma, signifies haemorrhage ; the same is true of a rapid rise of temperature. As regards treat- ment, an active purge should not be given in throm- bosis where a clot has formed, but it should in hjenior- rhage, so as to lower the blood pressure. In throm- bosis citric acid may be given in the hope of lowering the coagulability of the blood. In ha;niorrhage calcium salts should be given to produce the opposite effect — /. cipro 250 e., increased coagulation of the blood. Physical tran- quillity is, of course, imperative in every case of either kind. In the first part of adult life, most sudden cere- bral lesions are cipro 250 mg due to arterial closure, caused by em- bolism or by thrombosis, the result of syphilitic disease of the wall of a cerebral artery. In embolism there are no related cipro 250mg preceding symptoms. With rare exceptions, the source of an embolus is a diseased valve on the left side of the heart. The presence of an organic mitral nuirmur justifies the diagno.sis. X'alvular disease is one of the chief causes cipro hc of intracranial aneurysm, by embolic transplantation of inflammation. The treat- ment is that of the heart and the general state. In making a diagnosis of thrombosis due to syphilitic ar- terial disease, the absence of positive evidence has lit- tle cipro cost negative weight. Headache a week or more before the onset is a valuable premonitory symptom. No fea- tures of the onset are characteristic enough to be of nnich weight in the diagnosis. Needless to say purchase cipro the iodides should cipro online be promptly given — twelve or fifteen grains, every three cipro online pharmacy hours, for the first two days, after which the dose may be reduced. Larger doses are un- wise, as they may reduce the coagulability of the blood. The hemiplegia that occurs after acute disease is gen- erally thrombosis from exhaustion, but sometimes em- bolism. A sudden lesion, sometimes severe, leavinor

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