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soreness. This change in the tumor was ascribed by the patient to carrying a- grandchild in her arms. At the time of the operation the tumor in the breast was of about the size generic atarax of a small lemon, very hard atarax cost and somewhat nodular, and was at the upper and outer border of the gland. It was perfectly movable over the pectoral muscle, and presented a distinct elevation above atarax mg the general skin surface. The skin was not entirely movable over the mass, but was not hard- ened or otherwise altered in character. There was no nodular involvement of the integument. The superficial veins were not enlarged. The nipple was not retracted, but seemed entirely normal, and no buy atarax online fluid could be pressed out of it. There were three enlarged axillary glands, the largest very hard and a little larger than a partridge's egg. There was no enlargement of the glands above the clavicle. Owing to the long duration of the masses, their entire mobility, the freedom of the skin from nodular infiltration, the absence of retraction of the nipple and of oozing from it, and also owing to the evident atrophy of the mammary gland, I concluded not to remove the entire breast, but only the tumor, including those of the axilla, and to remove also the integument overlying the mammary tumor. This I effected by atarax tablets an elliptical incision, and then, extending the incision to the axilla, removed three enlarged lymphatic glands. It was not necessary to ligate any vessel ; the oozing, which was not great, was stopped entirely by the use of hot water. The incision was buy atarax about seven inches long. The edges were approximated by deep silk sutures. A few strips of rubber adhesive plaster were applied, and all was covered with a layer atarax 25 mg of salicylated absorbent cotton, and the chest surrounded with a flannel binder. This entire dressing was allowed to remain until the fourth day, when, on removal of the cotton, it was seen that primary union had been secured throughout the entire incision. There was neither hardness nor swelling to indicate inflammation. On the sixth day the sutures were removed, and on the tenth day purchase atarax online the patient sat up. No Tiiedicine of any kind, not even an anodyne, was given during the entire treatment. Tiie long duration and small size, the normal appearance of the nipple, the freedom of the skin from pitting and nodular infiltration, and the 296 PROCEEDINGS OF atarax 50 mg SOCIETIES. mobility of the mammary tumor botli over the pectoral muscle and on the mam- mary gland, have led me to hope that the growths are fibromata ; but the en- largement of the axillary glands and their induration make me fear carcinoma. Microscopical Examination, by Dr. Henry Beates, Jr. — The specimen atarax price pre- sented by Dr. Parish is of unusual pathological interest. "When it is remem- bered that the growth was present for nearly thirty years without undergoing a noticeable change, and only during the last year occasioned suffering and was accompanied with axillary involvement, the question of malignancy suggests itself, especially as the clinical history almost forces the diagnosis of adenoma. As many representative pathologists incline to the belief that typical mammary adenomata do not undergo carcinomatous degeneration, and many assume a con- servative or non-committal position, this instance is of unusual interest, and demands close study. Sections were made through the mass, and including the cutaneous surface. The skin, so far as the stratum corneum where to buy atarax and rete mucosum are concerned, is normal, but in the coriiun there are areas of inflammatory changes. The radicles of several of the vascular papillaa are choked and sur- rounded by numerous embryonic cells and inflammatory corpuscles. The larger vessels are in a like manner involved, and the tissue in their immediate proximity is infiltrated. The pars order atarax reticularis, where it becomes continuous with the sub- cutaneous connective tissue, is cheap atarax in many places the seat of proliferated connective- tissue corpuscles. The glandular structure shows beautifully its purely adenoid character. The acini, although filled with cells and almost hidden from view, are with care easily distinguished. The interacinous connective tissue is hyper- plastic. The hyaline meuibrana propria is partially destroyed, and the acini 1 epidcrmia (stratum corneum); 2, rete mucosum; 3, corium (pars papillaris); 4, pars reticularis; ' 5 inflammatory area in pars reticularis ; 6, proliferated fpindlc-stiaped connective-tissue corpuscles and tivperplaeia of fibroid element ; 7, infiltrating cells occupying interacinous lymph spaces; 8," acinus with partially destroyed mcmbrana propria and atarax tablets 25mg free cells; 9, lym- phoid cells and proliferated epithelium. are filled with degenerated epithelial cells and order atarax online cellular elements of increased size, possessing many nuclei. Some of the acini have the membrana propria entirely destroyed. The lymph spaces are occluded by cells, multi-nucleated, and of increased size and irregular contour. The interacinous fibroid tissue presents incipient formation of buy cheap atarax stroma and aggregations of cells. JVjEW yore society of GERMAN PHYSICIANS. 297 The axillary gland is completely altered in its structure, and, instead of the mass of lymphoid cells occupying large spaces bounded by the characteristic fibrous stroma with its triangular basal form, we have typical carcinomatous structure. Fibroid stromata, joining at acute angles, forming numerous inter- spaces filled with irregular multi-nucleated cells, characterize the degenerated gland as carcinomatous. This fact, in conjunction with the changes seen in the mammary gland, proves conclusively that the breast tumor was originally a typical adenoma, which after thirty years began to undergo malignant degenera- tion and became a center from which the axillary glands were infected. Dr. Robert P. IIaeris remarked that a point of great interest in the history atarax 10mg of this tumor was the long period during which it remained dormant. He had had under observation a case in which a mammary tumor had remained perfectly dormant for seventeen years, during which two pregnancies occurred. After the second labor the tumor commenced to enlarge and become painful purchase atarax ; an oper- ation for its removal was performed some months later, when it had attained the size of a duck's egg. A chain of nine enlarged glands was removed with the tumor. The tumor recurred in the same breast, and was followed by one in the other breast, and numerous hard nodular growths over the entire body. The patient's death was due to this cause. Two of her aunts had died of cancer. A sister atarax online had a tumor in the abdominal wall, which was allowed to attain the size of a door-knob without interference. At that time Dr. Agnew and other sur- geons were opposed to an operation. After a year the tumor commenced spon- taneously to discharge a purulent matter. It was then successfully removed by Dr. Agnew, who pronounced it an encephaloid growth. It had made no attach-

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