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May 14, 1898] TUBERCULOSIS OF THE UPPER AIR-PASSAGES. 615 each other. X-ray examinations, in suitable cases, give earlier evidence of disease than the older methods. I daily cipralex farmaco generico find them indispensable in ma- king a complete examination of patients who may have a disease of the chest, and can by them de- termine in some cases the presence of an abnormal condition, or more fortunately its absence, or some- times completely change the diagnosis which had been previously made. The X-ray is still too recent a discovery to have reached the limit of its usefulness, and its application cipralex 20 mg tabletten in medicine deserves and will repay careful study. TUBERCULOSIS OF THE UPPER AIR-PAS- SMGES. 1 By EMIL MAYER, M.D., OP DEW YORK; ATTENDING STIR O EON TO THE MEW YORK BYE AND BAR INFIRM- ARY (THROAT DEPARTMENT); INSTRUCTOR IN LARYNGOL- OGY IN THB NBW YORK POLYCLINIC. The short time at my disposal for the presenta- tion of so exhaustive a subject must be my excuse for brevity on many points which would ordinarily require detailed and elaborate description. Tuberculosis of the upper air-passages may can take 30 mg cipralex be either primary or secondary. In the primary forms the disease is presented either as an ulcerative or a hyperplastic process. These may be cipralex price india cipralex 10mg weight loss differentiated from lupus and syphilis by the presence of numer- ous bacilli, and, clinically, by the history. Although many maintain that cipralex 20 mg 56 tablet the presence of tu- berculous disease of the air-passages is coincident with acute miliary tuberculosis, 10 20 mg cipralex yet cases of primary lesion have been reported in which pulmonary tu- berculosis supervened two years after the precio de cipralex 15 mg local mani- festations. The early diagnosis of the primary dis-' ease in the nose, as also in the pharynx and larynx, is of inestimable value when we consider that thus we may prepare for the coming storm, and with eternal vigilance as to habits of life, great care in the selection of nutritious food, and salubrious cli- matic influences, postpone the evil day when the system will be overwhelmed, or, still more happily, avert it altogether. Nasal Tuberculosis. — Tuberculosis of the nasal passages is very rare indeed. It getting off cipralex 10mg may be primary or secondary. In the former variety, persistent ulcers, bleeding upon the slightest touch, may be present, or there may be hyperplasia. The latter form oc- cipralex 20 mg tablet curs usually from the septum, the floor of the nose, or upon the turbinates. They may have irregular surfaces and vary from four to ten millimeters in diameter. Their nature is readily determined by microscopic examination. 1 Read at a meeting of the Harlem Medical Association, March 14, 1898. By far the most frequent condition of the two is the secondary variety. In this, the diagnosis of pul- cual generico cipralex monary tuberculosis having been made, nasal ulcer- ations and hyperplasia are 15 mg cipralex promptly recognized as existing from the conditions that are present. In both forms the symptoms are the same: Excessive secre- tion, the formation of tenacious crusts, the removal of which is followed by some hemorrhage, or a de- gree of nasal stenosis may be present. Pain is usually absent. The treatment consists in the thorough removal of all crusts by means of alkalin sprays, or by a solution of eucalyptol or menthol in albolene, cipralex 15 mg hinta and wiping with pledgets of absorbent cot- ton, after which an application, under cocain, of a fifty -per-cent. lactic-acid solution may be made. An insufflation of powdered iodoform or ot nosophen is of value. New growths are best removed with a cold wire-snare, and their bases should be thoroughly cauterized with the galvanocautery under cocain an- esthesia. If treatment of this cipralex⬠10/- 20 mg filmtabletten cipralex 15 mg biverkningar kind be instituted early in the primary forms of the disease the prog- nosis is apt to be better than in any cipralex 20 mg fiyat other tubercu- lous manifestation in the upper air-passages. In the secondary forms of the disease only such treatment can be instituted as will add to the pa- tient's comfort. Pharyngeal Tuberculosis. — It is worthy of note that microscopic examinations of the lymphoid tissue, commonly generika f𴱘r cipralex called adenoids, removed from the vault of the pharynx have demonstrated the presence of the tubercle bacillus in quite a few instances. Such a microscopic finding is, of course, an indication for careful observation and attention. In coming off 10mg cipralex about one per cent, of all cases of tuberculous laryngitis there are pharyngeal symptoms. This form of tuberculosis also occurs primarily. Thus, cases are cited in which a single tuberculous ulcer was found on the tonsil; still, the disease is very rare in this location. The velum and soft palate are cipralex 10 mg insomnia most apt to be affected, and under such circumstances a number of minute gray nodules, which eventually break down and ul- cerate, are found in these parts. The chief symptom of pharyngeal tuberculosis, secondary to the disease in the larynx, is pain, usually extending to the ear. No pain is so con- stant or so distressing as this. The suffering becomes very acute, the agony is pitiful, the patient refuses food, there is constant rasping to avoid swallowing

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