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GUNSHOT INJURIES OF THE SPINE WITH REPORT OF A CASE. A case illustrating this form of injury and resulting in recovery was described at great length by the author, who then referred to the writings of a number of prominent surgeons on the treatment of these conditions. The author etoricoxib 60 mg divided these injuries into three classes: (i) Those that simply fracture the arches, (2) those that in- vade the canal crushing the cord and damaging the verte- bra, and (3) those complicated by serious injury to the abdominal or thoracic viscera. Details of cases with the result of treatment occurring in the practice were then given and arcoxia tablets the author stated that of forty-nine cases treated since the aseptic era twenty- four had been subjected to operation, resulting in eleven recoveries and thirteen deaths. The author concluded his paper by stating that: (1) It is the duty of the surgeon to advise immediate opera- tion in all cases of gunshot wound of the spine, provided the wound has involved the arcoxia cost posterior or lateral buy arcoxia parts of the'spine at an accessible part, unless the condition of the patient is such as to indicate clearly that he is hope- lessly crippled. (2) To wait 10 see whether Nature is competent to restore the damage is to wait until irrepara- blejdamage has been done in many cases and rapid de- generative changes, meningitis and myelitis, have re- Suited. The delay permits of the continuance of conditions the removal of which is the purpose of the operation. These considerations apply with greater force if possible in gunshot injuries than in others. (3) The presence of complications due to penetration of the great cavities and injury of the viscera will influence the question of opera- tion but not necessarily forbid it. Dr. Keen spoke in favor of operating for gun- shot injuries of the spine in the absence of evidence of a total transverse lesion, the principal index of which would be the entire loss of the patellar reflexes. In looking up the question etoricoxib tablets of the surgery of the spine some years ago he noted that although there were very few cases of suturing the spinal cord on record yet in no case did the result seem to be good. Dr. arcoxia online Richardson expressed great hesitancy in opera- ting on these cases on account of the difficulty of diag- nosing the conditions present. Dr. Burrell believed that the only way to arrive at a proper recognition of these cases was to first understand the pathologic condition existing in the cord and to do this all buy arcoxia online cases should be opened up and examined unless contraindicated by the presence of shock. He cited the case of a woman who died thirty-six hours after having jumped from a window, doubling the spine on itself and causing complete paralysis. At the autopsy it was noted that red softening had already begun although no com- pression of the cord was apparent. In his opinion this was evidence in favor of prompt etoricoxib arcoxia operative interference for the removal of a clot, bullet, or fragment of bone. He had presented a report to the British Medical As- sociation in 1894 containing statistics on this subject which he divided into those extending from 1864 to 1886, and those from 1887 to 1894. The cases referred to in the first group were treated purchase arcoxia by immediate rectification of the arcoxia mg de- formity by force, and out of one hundred cases thus treated eighteen per cent, recovered. The second group contained those cases treated by immediate suspension and the use of a plaster-of-Paris jacket and as a result twenty-eight per cent, or an increase of ten per cent, re- covered. Dr. Carson was also of arcoxia price the opinion that there would be a considerable number of recoveries after operation. He referred briefly to an accident which happened to a man who, while trying to enter a low doorway riding on a load order arcoxia of hay, was caught by the neck and pulled forward, causing a complete dislocation of the spine followed by loss of sensation and paralysis of the bladder. He was immediately suspended with a Sayre's suspension-appa- ratus and by extension and counter- extension the disloca- tion was readily reduced. No sooner was this done than the patient immediately collapsed and lost consciousness, so that he had to be lowered at once and after being well padded was left alone. The further treatment consisted in the application of a plaster-of-Paris jacket. The patient made an excellent recovery. Dr. Conner felt that it was well always to ascertain the exact character of the injury and remove any sub- stance that might be pressing upon the cord, purchase arcoxia online to do which he believed an operation both necessary and justifiable. The symptoms present in his opinion did not ordinarily act as an index to the generic arcoxia real character of the lesion present In spite of the fact that the mortality from operation would be considerable he believed it the preferable method of treatment. Dr. F. S. Dennis of New York stated that he had published some time since a number of cases treated with the plaster-of-Paris jacket in which he obtained excellent results. A method which had found great favor with him was the administration of large doses of potassium iodid during the time the patient was wearing the plaster- of-Paris jacket as in his opinion this drug was of great benefit in absorbing the clot. Dr. Carson continued his previous discussion by stating that buy etoricoxib he had been order arcoxia online very well pleased with the etoricoxib msd results following the employment of the plaster-of-Paris jacket. Dr. Carmalt thought that in order to prevent infec- buy cheap arcoxia tion in cases of gunshot wound arcoxia 90mg one should operate with- out hesitation. He recalled, however, one case where operation was refused and the application of the plaster- Digitized by Google

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