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to eoiifoiiiul ondometi'itis ehn>niea with epithelioma. In eonelusion, it would .set'in. thert'fore, that it would usually he easy to ostahlish n histolo;;ieal diagnosis if one posses.sed the entire uterus. If, on the other hand, a diapiosis is to he made from the oliaraeteristies of fnif^- ment.s ohtaineil by serapiufi, whieh may or Generic Tadalis may not present the eondi- titms of glandular hypertrophy, it can not be done satisfactorily un- less one has specimens which show the entire depth and area of Tadalis Uk the gliiiuis. Oophoritis and Cysts of the Ovary (IVtit, \h\<{., Aug., '25, 1888). — The conclusions of the Tadalis Tablets autiior's clinical and anutomo-pathological investiga- tions are the following : 1. With the two jirincipal forms of ovaritis, the sup])urative and the sclerotic, the principal cystic formations are related — namely, the encysted abscesses, the follicular cysts, whether serous, caseous, or san- guineous — and it is important to distinguish these from the other tumors of the ovary. 2. It is Tadalis 20 Mg generally admitted that the abscesses are not intimately re- lated to the puerperal state. It is possible that they are first localized in the follicles of Purchase Tadalafil the ovary. They may continue a long time in a chronic state, Buy Tadalafil acting as a focus of infection. With reference to cysts of Buy Tadalis Online the follicles it is probable that the primary cause is, in many cases, a morbid and repeated congestion of the ovary, interstitial inflammation following slowly. The successive phenomena in the history of these cysts of the follicles are hypergenesis of the epithelial elements, sclero- sis of the follicular walls, degeneration of the epithelium, liquefaction of the exuded and retained exudate, and haemorrhage. 3. In the presence of a small ovarian tumor, with no general or local symptoms of malignancy, one should first treat the case by means of hot injections, curetting, etc., and watch the progress of the growth for two or three months before resorting to castration. A Clinical Concept of the Cellular Inflammations of the Pelvis (Gutierrez, ib'ul., September 10, 1888). — Circumuterine inflammations are so frequent and their consequences are of such importance that every one should be able to make a diagnosis of them and establish suitable treatment. The anatomical disposition of the connective tissue which constitutes the pelvio-subperitoneal space, with its numerous veins and lymphatics, enables one to understand why it so readily re- sponds and reacts to morbid causes, both directly and secondarily. Cheap Tadalis The traumatisms which this tissue experiences during pregnancy, and the infectious elements which are communicated to it Buy Cheap Tadalis from the uterine cavity by the open mouths of the lymphatic vessels, are the conditions which cause these inflammations, which are apt to be suppurative and often place the lives of the puerpene in danger. In other cases trauma- tism alone produces a local Order Tadalafil inflammation in the form of Buy Tadalafil Online a circumscribed parametritis, which tends to resolution, but at the same time causes a hard, fibrous retraction of the tissues, drawing the uterus into a vicious position, and thus leading to important changes. Other causes which Tadalis Online may give rise to the same conditions of inflammation consist of trac- tion, which may be exerted upon the lower part of the uterus Tadalafil Mg for diag- nostic or therapeutic purposes, mechanical dilatation of the cervical canal, the introduction of the uterine sound, inappropriate intra-uterine medication, perhaps on the eve of menstruation, the impioper use of a pessary, the abuse of coitus, and improperly administered vaginal douches or injections. A septic or gonorrhoea! endometritis may also serve as an eSicient cause. Individual disposition or tendency to this disease is much more pronounced in some persons than in others, the same being also true with respect to intensity. The effects of the dis- ease are more or less limited to those portions of the genital apparatus which nro prt)vidcTadalis 20 timate contact with the cellular tissue, will lie involved, and the symptoms of pelvic cellulitis and jiclvic jx^ritonitis will be mingled, though clinical observation has shown the relativ<' independence of both inflammations, especially in true i)arametritis. Thes(! inflammatory processes frctpiently terminate by resolution, but frerpiently also, in the [luerperal state, by suppuration. In the former case there is a condensation of the con- nective tissue with contraction and retraction; there is also cicatiiza- tion, and deviation of the uterus from its normal position. The final result of parametritis proper is not the same as that of phlegmon of the broad ligament, when both terminate by resolution. In the former the adhesions and immobility appear, for the most part, above the cer- vix uteri; in the latter they are above the cervix, and also above the tube and ovary, often causing deviations of the uterus, various nervous phenomena, and sterility. The termination by suppuration follows a distinct course, according as it is treated by one or another method. If the parametritis is circumscribed, the pus finds exit by the vagina, the rectum, and sometimes by the bladder. If the inflammation is dif- fuse, the pus may make its exit from the abdominal wall, or it may col- lect in the peritonicum. The experiments of Koenig confirm the state- ments which have resulted from clinical observation, that phlegmonous inflammations of the Tadalis Sx broad ligaments open, if they suppurate, in Cheap Tadalafil the in- guinal region and the iliac fossa ; parametritic inflammations in the rec- tum and vagina, and pelvic cellulitis in the inguinal region. Pelvic Peritonitis : its Treatment by Forced Dilatation and Curett- ing (Walton, ibid.). — The lesions Purchase Tadalafil Online of the endometrium constitute an im- portant factor in the letiology of diseases of the Falloppian tubes, peri- tonaeum, ovaries, and parametrium, though it does not follow that this

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