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which the author proposes consists in exposing the round ligaments where they are covered only by the skin, fat, and areolar tissue of the pubes, drawing upon them cipralex price india so as to raise the uterus, and securing their ends so as to cause them to form new attachments to the pubes. The operation was first performed by the author upon the living subject last February, and was unsuccessful. The author acknowledges that be has been anticipated in the publication of his views by Dr. Alexander, the operation having been worked out by each precio de cipralex 15 mg inde- pendently of the other. [For an ab- OBSTETRICS AND GYNECOLOGY. 319 stract of Dr. Alexander's paper, see the July number of this journal, p. 83.] For the past two years coming off 10mg cipralex the author has frequently demonstrated the operation upon the dead subject. A full descrip- tion of the organs and cipralex 10mg weight loss tissues forming the floor of the pelvis is given. The round ligaments are described with minuteness. [A full description of these ligaments appears in the August cipralex⬠10/- 20 mg filmtabletten num- ber of this journal, under the " Report on Obsteti'ics and Gynecology."] As to the operation, he directs that an oblique incision, about two inches long, be made over the external inguiual ring, cual generico cipralex and that the fibers be dissected from the areolar tissue as they emerge from that ring. Care should be 15 mg cipralex taken, in the dissection, to avoid the inguinal nerve. The fibers having been isolated, the ligament is to be pulled through the ring, as far as necessary. [He lays down cipralex 20 mg tablet no rule as to the extent.] The peri- tonaeum is easily separated from the 10 20 mg cipralex ligament; hence inguinal hernia is not likely to follow. Five or six catgut sutures should then be passed over and under the ligament, cipralex 10 mg insomnia securing cipralex 20 mg fiyat it to the surrounding tissue. The wound is then closed with additional sutures, except at the most dependent part. There is nothing peculiar about the after-treat- ment. The great difliculty is in isolat- ing the extremities of the ligaments, in which statement Alexander concurs. The operation is cipralex 15 mg hinta unsuitable when large tumors are connected with the uterus, or when that organ has contracted in- flammatory adhesions to neighboring parts. Previous careful examiiuition generika f𴱘r cipralex is therefore necessary, and neglect in cipralex 20 mg tabletten this respect resulted in want of success to the author in tlie o)»eration which he performed upon the living subject. In that case the body of the uterus was firmly bound down by adhesions. He hopes to share with Dr. Alexander the merit of introducing a valuable operation to the notice of the profes- sion. 10. I)r. Atthill presented to the Dub- cipralex farmaco generico lin Obstetrical Society, at a recent ses- sion, a specimen illustrating hypcr- trojihy of the uterus. This condition, together with dilatation of the uterine cavity, was brought about by a stenosis of the cervical canal. The patient was a servant, forty years of age, a virgin, and had always suffered from dysmen- orrhf«a from the time that menstrua- tion was established. As she grow older the periods became more painful, and the loss cipralex 20 mg 56 tablet of blood more abundant. From the latter cause she had become quite anaamic. When she presented herself at the Rotunda Hospital, a cipralex 15 mg biverkningar few weeks before death, the body of the uterus appeared to be about as large as a cocoa-nut ; the os was hardly distin- guishable, being pin-hole in size, and with ditBculty admitted a small silver probe. This was passed to a depth of five inches. From the symptoms given, a diagnosis of fibroid of the uterus was made. The os was incised to a moder- ate degree, preparatory to future oper- ations. A few days getting off cipralex 10mg later the incision was extended to the os internum, and was followed by an abundant flow of muco-purulent fluid. Jaundice and con- stant vomiting can take 30 mg cipralex followed in five days,

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