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dilatation in diseases of the pyloric end of the stom- ach, which can be done in several ways. There are two classes of cases in which gastroenterostomy can be done : first, those in which the patients are weak- ened and cannot withstand pyloroplasty, and secondly, those in which it is expected to cure palliatively. In addition to this, dilatation may also be done as a pre- liminary step to the complete removal of the pylorus. He believes in buy viagra colombia encouraging pylorectomy, although he fully realizes the gravity of the operation and is aware of its mortality. The medical treatment of can- cer of the pylorus has a mortality of one hundred per cent., while within certain limits buy viagra colombia pylorectomy permits of a cure. In fifty per cent, of the cases in which it was performed recovery followed, and one patient, who went on for three years, is now working on a farm. In nineteen per cent, of over nine hundred cases re- corded cancer did not reach the peritoneum. Dr. Donald Maclean, of Detroit, said that he agreed with Dr. Mayo, but was not able to speak very positively on the subject, not having had much to do with surgery of the stomach. Exploration of the Brain with a Needle buy viagra colombia and Syringe through Capillary Holes Drilled through the Skull. Dr. Edward Souchon, of New Orleans, read a paper with this title. The method, he said, is designed to take the place of trephining, i.e., re- moving a ring of bone before exploring the subdural spaces and the brain. The simplicity of the proce- dure and its safety recommend it as an easy means within the reach of a greater number than the other comparatively more serious and complicated operation of the trepan. By its ready employment it is expected that many lesions, especially abscesses, cysts, and hard tumors, can be earlier diagnosed and located with cer- tainty after exploring by buy viagra colombia this means the region sus- pected from the distant symptoms. It is only in cases of tumors of the same buy viagra colombia consistency as the brain, that is, soft but not fluid, that the explorations would be of no avail, but this would also be the case if the trepan had been used instead of the drill. Even then, in some cases, the microscopical examination of the par- ticles expelled from the needle might give reliable information. The modus operandi is most simple. Spots of the scalp are disinfected; a puncture is made with a sharp bistoury clown to the bone. The drill employed is an ordinary stem-watch drill, to which is added an adjustable guard to prevent unlim- ited penetration of the drill into the brain substance after penetration of the bone. When the inner table is reached the drill is worked more cautiously. The perforation of the skull is easily completed with the point of a No. 1 aspirator needle attached to a syringe. All must be done under thorough asepsis and accord- ing to the rules followed in exploring after ordinary trephining. Several holes can be drilled at a distance from one another at the same time. Referring to ap- prehensions which have been expressed as to the dan- ger of hemorrhage, the writer cited experiments made by himself on dogs whose brains were several times explored at several places at each sitting and which never exhibited any symptoms of hemorrhage. One of the dogs was killed and no trace of hemorrhage worth mentioning was found, lie reported also post- mortem examinations by Spitzka, Meinchard, and Schmidt of cases in which the subjects had succumbed from the natural course of the original buy viagra colombia disease and in whom no traces of hemorrhage were found. Dr. Thomas H. Manlev, of New York, said that he could not agree with many of the points mentioned in this paper. If there is an effusion of blood into the brain, there is no reason why that blood should not undergo rapid resorption the same as it would else- where, especially on account of the high vascularity in this region. If it is necessary to explore the skull, we should be ready at the viagra cost patents same time to go on and operate, and the anaesthetizing of the patient should be just as complete as for any other operation. Dr. Nicholas Senn, of Chicago, said that the paper was a very valuable one, but he was compelled to dis- agree with a number of the ideas which it contained, as the operation described had never given viagra cost patents any diag- nostic information that he felt he viagra cost patents could rely upon. A small perforation is attended viagra cost patents with more danger than is opening the skull, just as small wounds often give more trouble than large ones. Temporary resection of the skull combined with a puncture with the needle often buy viagra colombia yields valuable diagnostic information, and when doubtful these may be followed by palpation. The sensation imparted to the finger is viagra cost patents also of great value in determining between a solid tumor and a cyst, and increased resistance to the needle will often be of ser- vice. In the case of such pathological productions as blood, serum, cysts, or abscesses, the needle may give positive results and may also be utilized as a guide to reach the abscess. The difficulty of sterilizing buy viagra colombia and properly cleansing the apparatus is an objection to the use of the needle. Dr. Alex. Hugh Ferguson, of Chicago, considered Dr. Souchon's paper a valuable one, but in his own experience he had not found the use of the needle a reliable method. In cases of hemorrhage he would prefer to use some other method, as, for instance, gauze packing. Dr. Souchon, in closing the discussion, said the use of the needle has frequently proved of viagra cost patents great service to him, and if the size of the needle and its thorough cleanliness be attended to, much good may result from its use. Surgical Shock. Dr. Fenton B. Turck, of Chi- ago, read a paper on the treatment of shock. He said that he had performed twenty-three experiments and obtained practically the same result in all of them. The following was the method employed in his exper- iments viagra cost patents upon animals : The abdominal wall was opened for about four inches and the stomach was brought out of the opening and exposed to the viagra cost patents air from an open window. The chloroform was pushed to viagra cost patents narcosis and in a short time the vessels became markedly congestive, while the buy viagra colombia gastric vein and the buy viagra colombia gastro-epiploica were distended and of a bluish color. An empty bag with tube attachment was then introduced into the stomach and hot water at 125 F. was rapidly introduced, with the result that the animal began to breathe and the