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I have operated in at least twenty in which one side has been ligated in connection with curettements or the vaginal enucleation of submucous fibroids. The results of this simple and safe operative treat- ment have been almost uniformly gratifying in my experience. Its effect on exhaustive haemorrhage has buy cheap prednisone been uniformly prompt in relief of the flow. In at least three cases, however, it has not been perma- nent. In these exceptional cases the flow has grad- ually returned after a few months. In the mean- time, however, in prednisone 20mg every case, the patient has had a substantial respite and, as the majority of these cases were those in which the haemorrhage had been desperate and the patients reduced to the last order prednisone ex- treme, the value of this respite can be appreciated. If this rational operative procedure had been de- scribed before hysterectomy became safe, it would have been one of the popular operative treatments, ranking buy prednisone online with hysterotrachelorrhaphy as a conven- tional operation, and rivalling because of its greater safeness, the Battey-Tait castration as a treatment for fibroids. Now, however, while it will become finally established as one of several efficient means of deal- ing with fibroids and their many vagaries, it is destined to fill one of the small but, I trust, definite positions in the armamentarium of the surgeon in- purchase prednisone stead of the ambitious place fondly hoped for it by its parent. Myomectomies, the Battey-Tait Operation, and Hysterectomies. — My experience has led me to pre- fer abdominal hysterectomy with supravaginal am- putation to myomectomy except when one or, at best, two centres of development, superficially lo- cated and so situated that they do not materially increase the area of the endometrium, are presented. Such tumors can be eneucleated safely and when one can be positive that no other centres exist, a cure may be accomplished. I do not favor removing several centres, especially when one or more of them are deeply seated ; because, when there are several such centres of development, small ones which -will later develop are sure to be overlooked and, besides, the operation is a more dangerous prednisone online and mutilating purchase prednisone online one and one in which sepsis may be introduced from the uterine canal and in which hsemostasis may be defective. The Battey-Tait operation of castration need only be mentioned in order to acknowledge our obliga- tions to it in the days when we prednisone cost were learning, be- fore we had discovered that hysterectomy was easier to do and more satisfactory in its results. Hysterectomy, abdominal and vaginal, are the two operations which may be said to offer positive cures for fibroids of the uterus. Either will remove completely the tumor or tumors from the body and, at the same time, the tissue in which such tumors prednisone price grow. Therefore, no matter how favorably we may look upon other forms of treatment, hysterectomy is the only sure remedy. In the choice of a cheap prednisone route for hysterectomy for fibroids of prednisone 10mg the uterus, I prefer the abdominal route, with supravaginal amputation of the cervix. The cervix is seldom the seat of fibroid development and when it is involved it is only by invasion from above. Hence the cervix should be. spared unless it is the seat of a carcinoma, in order to preserve the proper contour and integrity of the vaginal vault. This is often of great importance in order to retain inviolate the most important function of the sexual organs. A vaginal hysterectomy or a panhysterectomy of necessity shortens the vaginal canal and leaves at its vault a painful cicatrix. While hysterectomy is the only absolutely sure cure for fibroids of the uterus, we must remember that it has a legitimate mortality even in the hands of the most experienced surgeon. This mortality which will constantly grow prednisone mg smaller, I believe may be now stated as varying from a minimum of five per cent, in the hands of well trained surgeons con- stantly buy prednisone doing abdominal surgery, to 15 per cent, or higher in the hands of one onl}- occasionally opening the abdomen. There is no operation in surgery in which the right kind of experience counts for more than in hysterectomies. In the 200 consecutive cases recorded in this paper representing the last cases done by me, many of which were desperate, there were nine deaths, or aYnortality of four and one half per cent. In the future, this mortality will be greatly re- duced because cases prednisone tablets will be operated in early, before vascular and cardiac changes have taken place, be- fore kidneys have been impaired by pressure, before tumors become large and unwieldy, before women generic prednisone have been reduced by exhaustive haemorrhages, before tumors have become necrosed and order prednisone online infected, June 17. 1905.]

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