Generic Levitra (vardenafil) 20mg | OVERNIGHT Delivery!

veins occupied the broad ligaments. Then from both sides in a horizontal direction Generic Levitra (vardenafil) 20mg the broad ligaments were tied in several portions between two ligatures until close to the lateral edges of the uterus, and cut across. I then passed an elastic ligature under the peritoneal covering of the cervi.'c uteri, and tied it by means of a coarse silk thread. About three centimetres above the ligature tlie uterus was amputated, and thus tlie whole mass removed. Tlie tissue of the stump was then excised in the shape of a funnel, so that the mucous membrane was re- moved as low down as the elastic ligature permitted. At the deepest point the actual cautery was applied, and a small quan- tity of iodoform dusted over the eschar; tlie funnel was then closed by a number of deep catgut sutures, between which the peritoneal covering was adjusted by superficial ones. The ends of all the ligated tissues were then cauterized and sprinkled witli iodoform, and the abdomen closed by peritoneal and other sutures in the usual manner. The patient had a very rapid re- covery almost without any feverish reaction, and is so far en- tirely well. In a case like this the operation does not present any very great Generic Levitra (vardenafil) 20mg difliculty, nor does it involve any particular danger if only the proper care is taken not to expose the patient to an unneces- sary loss of blood. I think the patient, apart from the blood that was contained within the parts removed, lost hardly more than an ounce of blood. The way of passing the elastic ligature beneath the peritonfeum was intended to secure a certain amount of nutrition for the stump ; the latter, in fact, did not become entirely bloodless, but jiresented, during the act of being tightly closed up with stitches, some slight oozing, wliich, however, was safely checked by the sutures. The weight of the tumor now before you, after five months' preservation in alcohol, is nine pounds and a half. It is throughout Generic Levitra (vardenafil) 20mg all its sub.stance a fibro- myoma. The second specimen, which I present now, was obtained by an operation of much more seriousness and difficulty. In fact, the operation was only undertaken at the urgent request of the patient. At the time of the operation she was thirty-three years of age, and from her twenty-sixth year she had suffered from profuse menstrual hsemorrhage due to a tumor. She had been treated with hypodermic injections of ergot, some of which she states were injected into the mass of the tumor itself, and gave rise to an intense peritonitis which lasted for six weeks. No relief followed ; the tumor gradually increased in size. Within the last month her suffering had been most intense, she had constant pain, she was hardly able to walk, her digestion became impaired, and she lost rapidly in strength and iiesh. The exter- nal examination revealed the presence of hard, lumpy, irregu- lar-shaped masses in the lower part of the abdomen, which on the left side extended close to the border of the ribs. A large portion of the tumor could be felt from the vagina reaching far down into the true pelvis, displacing the os uteri toward the symphysis pubis, Generic Levitra (vardenafil) 20mg and pushing it in an upward direction, every- thing seeming fixed and immovable. On January 11th the tumor was removed. Gradually the numerous adhesions to the anterior abdominal wall, the omentum, and intestines, were overcome. There existed venous vessels in such quantity and enormous size as I had never seen before, and requiring careful ligation. A great difficulty was experienced in shelling out that part of the tumor Generic Levitra (vardenafil) 20mg which on both sides had grown under the peritonffium between the layers of the broad ligaments. At last the cervix uteri was reached, an elastic ligature applied, and the mass re- moved ; the rather free haemorrhage from the extensive raw- surface, which corresponded to the numerous attachments of the tumor, was at last checked by ligatures, sutures, and the actual cautery. Generic Levitra (vardenafil) 20mg A careful toilet of the peritonasum followed, 22 PROCEhhlNOS OF SOCIETIES. [N. Y. Mel). Jodk., and the abdomen was closed. Daring the operation the patient had repeated alarming attacks of heart-weakness, which obliged me to intermit the operation and at one time apply artificial respiration. It seemed to me that these attacks depended on forced tractions, which could not very well be avoided during the attempts to get under the immovable and fixed mass. In this case the cervix uteri was entirely void of peritoneal cover- ing, which had been lifted from it by the adjacent tumor masses. The mucous membrane of the cervix was excised as in the case before, but the indication to finish the operation was so urgent that I was compelled to desist from any further details in treat- ing the stump of the uterus ; the operation altogether lasted three hours and a half. The patient had a very protracted con- valescence, disturbed by peritonitis and the formatiou of an abscess which discharged itself opportunely tlii-ough the cervi- cal channel ; another abscess formed near the anterior ab- dominal wall and was opened in Generic Levitra (vardenafil) 20mg the line of the original inci- sion, leaving a fistula. On April 21st I dilated the cervix on account of Generic Levitra (vardenafil) 20mg persistent offensive suppuration, and extracted quite a number of coarse silk ligatures, hut was unable to find the elastic ligature, which apparently was safely encysted. Several ■other ligatures were removed through an incision in the abdomi- nal wall, a few centimetres to the left from the original cut, and since then the discharge has almost entirely disappeared ; the patient does not suffer any more, and can be regarded, I think, as definitely convalescent. The weight of the tumor presented is ten pounds. I may be permitted to add that a Generic Levitra (vardenafil) 20mg i)atient from whom I re- moved the uterus for myosarcoma about four or five years ago, and whose specimen and history were presented before this society, is so Generic Levitra (vardenafil) 20mg far enjoying good health. I saw her about a year Generic Levitra (vardenafil) 20mg ago, and there was no evidence Generic Levitra (vardenafil) 20mg of any recurrence of the disease; she promised to let me know if in any way she should 'be troubled. I should also like to mention a case of multiple fibro-myomata •of the uterus in which my operative etforts were not followed by such good fortune. A recently married woman, about thirty years of age, a nullipara, had been suflTering like the above-mentioned patients during her menstrual periods. Lately a great deal of pain and tenderness in the hypogastric region had supervened, and the patient, asking for a radical curative effort, was subjected to laparo-myomotomy. Two pedunculated fibromata, of about the size of a small fist, were found arising from the fundus uteri ; the one, impacted in Douglas's space, was easily removed after ligating the pedicle. The other, to the right side of the Generic Levitra (vardenafil) 20mg uterus and in Generic Levitra (vardenafil) 20mg front of the broad ligament, had become necrotic in con- sequence of torsion of its pedicle, and was imbedded in a sac of adherent peritonwum, which, however, could be detached with- out great difficulty. There was no exudation of pus or fluid ; the tumor looked gray with a greenish tint, and contained no fluid blood. I tried to tie the pedicle within its living part, but Generic Levitra (vardenafil) 20mg a small necrotic portion remained beyond the ligature. A third, smaller myoma, of the size of a small hen's egg, was broadly in- serted on the anterior wall of the uterus, right above the cervix, and for its removal and shelling out a thin layer of uterine tis- sue had to be severed. Generic Levitra (vardenafil) 20mg There was considerable capillary oozing