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of micturition but also lessens the actual momentary discomfort. Severe headache is not uncommon in appendicitis and is best relieved lisinopril 20mg by the use of the ice bag. The feeding of the patient is of online lisinopril the greatest importance. A feeding cup should be used in every instance, as on no account must the patient be al- lowed to move from the recumbent posture. The author gives a teaspoonful of beef jelly every two hours, with milk and barley water in addition. In fact the less food given the better. A surgeon should only be called in when, in spite of careful treatment, the patient grows steadily worse. Many cases of appendicitis are operated on which would have made a good recovery under medical treatment. The au- thor cites three cases of appendicitis, all of which made satisfactory recoveries under medical treat- ment. lisinopril 10mg From them and other cases he draws the fol- lowing conclusions : (i) Although, when first seen, lisinopril hctz 12.5 mg a case of appendicitis mav not seem very serious, the patient may with 20 mg lisinopril remarkable rapidity develop ver^ grave symptoms. (2) The temperature is not nearly so important as the pulse and is likely to vary to a greater extent during the progress of the illness than does the pulse-rate. (3) A pulse-rate of 120, though necessarily giving rise to anxiety, need not indicate lisinopril 10 mg operative intervention. (4) lisinopril 40 mg We are not entitled to give up any case as hopeless, even though the patient seems in immediate danger and operation is refused. Some, at least, of such cases, do eventually recover. SURGERY purchase lisinopril AND ANATOMY. Obstruction of the Bowels from Meckel's lisinopril hctz 20 Di- verticulum. — Dr. James E. Moore {Journal of the American Medical Association, October 4th) savs that the symptoms of obstruction from lisinopril buy a diverti- culum are those of obstruction from any cause, but occasionally they are of such a character as to make an accurate hctz 12.5 lisinopril diagnosis possible. The suggestion that the possession of a harelip, clubfoot, or other congenital deformity, by a patient suffering from obstruction of the bowels, would point to a diverti- culum as the probable cause of the obstruction is not, in the author's opinion, a practical one and might even be misleading. Localized meteorism in the right inguinal region in a young male patient is strong presumptive evidence of obstruction from a diverticulum. The treatment of intestinal obstruc- tion from Meckel's diverticulum does not differ from that of obstruction from any cause, for only rational treatment in all cases is early operation, but a posi- tive diagnosis would aid the surgeon in securing an early operation and would help him to locate his in- cision properly. Fitz concludes that in operation for acute intestinal obstruction not due to intussusception and without local symptoms the incision should be made in the right lower quadrant. The main points in the operation are to remove the obstruction as early lisinopril 5 and as quickly as possible, and when the condi- lisinopril 12.5 mg tion of the patient will lisinopril 10 permit, to remove the diverti- culum. Under these conditions the prognosis is remarkably good, but when operation is delayed it is necessarily bad. Experiences with the Roth-Drager Oxygen An- aesthesia Apparatus. — Dr. Fritz Engelmann {Cen- tralblatt fiir Chirurgie, September 13th) sums lisinopril 20 up the advantages of the apparatus as follows : i. The diminished danger, owing to the constant quantity of exactly estimated chloroform administered, and the impossibilitv of giving too much chloroform, as well as the simultaneous administration of oxygen and atmospheric air with the chloroform vapor; 2. the solid construction of the apparatus and the simplicity of the technics of its use. The anaesthetist has oni hand free, which is not the case when the drop method is used. The mask can be sterilized, and the apparatus is so constructed that the depth and fre- quency of the respirations can be easily detected. Notes of Three Cases of Inoperable Cancer of the Breast Treated by Removal of the Ovaries. By D'Arcy Power, F. R. C. S. {Lancet, October 4th). — The author reports three cases of inoperable cancer of the breast, in which the ovaries were re- moved in the hope of benefiting the patients. Case I. cheap lisinopril — A single woman, aged fifty-two years, suffering from ascites and a large fungating cancer of the right breast. The fungating breast was re- moved (without the glands), together with both ovaries. The patient made a good recovery and lived for six lisinopril 5 mg months. The removal of the ovaries had no effect on the cancer, but she was made more comfortable by the removal of her ascites. Case 2. — A widow, aged fortv-two years, suffer- ing from a large cancer of the right breast with nu- merous secondary growths. The ovaries were re- moved ; one month later the patient had gained seven pounds in weight and felt much better. The growth in the breast and the axillary glands were decidedly smaller. Two months later the condition of the pa- tient was even better. Case J.- — A very fat woman, aged fifty-five years, suffering from cancer of the left breast. This was inoperable on account of its size and extent. Both ovaries were removed, but without the slightest ef- fect upon the disease of the breast. Results of Operations on the Kidney for Tuber- culosis. — Dr. Edgar Garceau {Annals of Surgery, October) records the statistics of two hundred and ninety-three cases from which he draws the follow- ing conclusions : ( i ) Tuberculosis is rarely, if ever, primary in the kidney, and the original focus is in some other organ in more direct contact with the external air in the majofity of cases. (2) The pres- ence of a primary focus of disease in the body, even if the lisinopril 12.5 disease has been thoroughly eradicated from the urinary tract, makes the ultimate prognosis in these cases, doubtful at least. (3) Such foci may remain permanently quiescent, but they may also be PITH OF CURRENT order lisinopril LITERATURE. [N. Y. Med. Joub.,

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