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pleural cavitv was emptv. The heart was very large, its muscle thick and firm, and there was hypertrophy and dilatation, especially of the left ventricle. The mitral orifice admitted two fingers. The valves were stretched, but not thickened. There was moderate atheroma of the ascending aorta. The left kidney was large, finn, and contained several small cysts. The capsule was somewhat adherent, and the surface be- neath granular. The right kidney presented a similar condition. The kidney showed under the microscope the changes of chronic diftuse nephritis. The spleen and liver were normal; the stomach was small; the large intestine and vermiform appendix were Suhagra Tablet normal. The upper and posterior wall of the aorta exhibited an opening one-fourth of an inch in diameter and nearly round. It was supposed at first to communi- cate with the descending aorta, which had ruptured into the pleural cavity. The aneurismal dissection in Suhagra In India the thoracic aorta appeared to the left and in front, extending behind beyond the middle line to the right. Between the tenth and eleventh intercostal arteries it was far over to the right and behind. At the level of the renal arteries it had travelled still farther around, and a little below this point it entirely encircled the pair of aortic trunks to be subsequently described. It reached to the bifucration of the aorta, and on the right common iliac to its bifurcation into the external and internal iliacs. The Suhagra 100 opening below the left sub- clavian arter}^ did not communicate directly with the aneurism, but with a vessel which was continuous with the left common iliac. What had been supposed to be the only aorta was continuous with the right common iliac. The dissecting aneurism surrounded both vessels more or less completely. The aneurism had its origin in a rupture, not Cipla Suhagra of the main artery but in a channel to the left Suhagra 100mg of it. It had stripped off the pleura on the left side and had broken August I, 1896] MEDICAL RECORD. 171 through this, causing the fatal hemorrhage into that cavity. A careful examination .showed that there was a du- plication of the aorta from the left subclavian down, the two portions being separated b)- a complete septum. The right was the larger and was in line with the de- scending limb of the arch. The left branch did not exhibit arterio-sclerosis. The principal vessels arose from the right branch, except the anterior mesenteric, which was given off from the left and behind. The coeliac axis, superior mesenteric, and both renal ar- teries arose from the right or principal branch. There were ten pairs of intercostal arteries arranged along the right aorta, most of them patulous. Many of the intercostals opened from the right aorta into the left, and went no farther. Dr. Williams said that this condition was very rare. Krause cited five examples of double aorta. In view of the fact that in the development of the human embryo the right and left systems of arterial arches fuse together at a Generic Suhagra very early period, it was astonishing that the man should ha\e lived to a good age in health and comfort. Rupture Suhagra Cipla of the Aorta. — Dr. J.\mes Ewing pre- sented a specimen of rupture of the aorta removed from a woman twenty-six years of age. She presented no personal or family history of importance. The ill- ness had begun three years before death with the ordi- nary symptoms of acute nephritis developing after ex- posure to cold. It was characterized at the onset by oedema and dyspnoea. These symptoms continued ir- regularly for about one year, after which ura;mic symp- toms were added. She entered the hospital on Jan- uary 27th and was then pale and cyanosed. There was a paralysis of the right side of the face which had appeared three months before. The pulse was 100, somewhat irregular, and showed remarkably high ten- sion. There was severe and constant headache, and a constant feeling of sinking and choking about the heart. She was given the usual remedies for reducing arterial tension without much effect, and they were finally stopped. Within two hours after discontinu- ing the use of arterial dilators, she complained of se- vere pain in the chest and became greatly prostrated. The house physician then found in addition to the loud systolic murmur, heard all over the precordiuni, a remarkably harsh double murmur, heard loudest over the aortic valve. The patient went into collapse, and died within an hour. At the autopsy the kidneys were found to be of about the normal size, the surface was coarsely granular, the capsules non-adherent, the cor- tex irregular in thickness, the markings obliterated, and the kidney tissue in part replaced Suhagra 50 Mg by Buy Suhagra uric-acid in- farcts. There was very little congestion of the kidney. The heart was moderately enlarged. The wall of the left ventricle was very considerably hypertrophied without dilatation. There was no roughening of any of the valves, and there was only very slight athe- roma. On opening the pericardium a large amount of fresh bloody serum was evacuated. The heart was surrounded by Suhagra 50 a thick dark clot. Some difficulty was experienced in finding the origin of the blood, so the abdominal viscera were removed and the aorta stripped up. On reaching the aortic valve the finger was passed into a peculiar pouch. About one inch above the aortic cusps was a clean linear rupture of the whole aortic wall, and through this rupture the blood had infiltrated the tissues around the aorta, and, rupturing into the pericardium, had infiltrated the tis- sues of the aorta to the middle of the transverse arch. At the origin of the left subclavian artery could be seen a healed partial rupture of the subclavian vein, about three-quarters of an inch in length, which ap- fieared as if the intima and media had been slightly displaced on the adventitia. The remainder of the aorta showed very little atheroma. The Suhagra Tablets speaker remarked that at least two such cases had been reported to the society within tlie past few- years. Dr. Geori;e P. Biocs said that about a year and a half ago Dr. Ferguson had presented to the society a specimen showing a vertical linear rupture in the aorta, situated just a short distance above the aortic valve. In this case the blood, after having dissected along the aorta nearly its entire length, had finally broken through into the pericardium, causing sudden death. Dr. Van Horne Norrie recalled a case of rupture of the aorta, seen about two years ago Suhagra For Women in a male pa- tient in St. Luke's Hospital. This man was suffering from phtiiisis and nothing unusual had been noticed until about half an hour before his death, when, after a sudden attack of pain around the heart he went into collapse and died. The autopsy showed complete transverse rupture of the aorta about one inch above the aortic orifice, and a large amount of blood in the pericardial sac. The gross appearance of the aorta was normal. Dr. Ewing said that Dr. Delafield thought that the primary cause of the rupture in the case he had just reported had been the high tension of the arteries. From the gross and microscopical appearances of the specimen presented, it was evident that the rupture had not been due to the giving way of a cicatrix of syphilitic origin. The society then adjourned. (CUiiical department A CASE OF FATAL TRAUMATIC MYO- CARDITIS (?). Bv R. V.VX SAXTVOORl), M.D., .NEW YORK. The following case presented from the standpoint of pathology so many points of interest upon which little light is shed by recent literature, in addition to its medico-legal importance, that it seems worth Order Suhagra reporting, although, in the absence of an autopsy, it is unfortu- nately incomplete. L. Z , aged twenty-four, an engineer by occupa- tion, had consulted his physician, Dr. G. W. Oakes, of Williamsbridge, a few days before the accident about to be narrated, for a trifling derangement of di- gestion. He was otherwise well and able to attend to his work. On June i, 1894, a wagon in which he was riding was struck by a trolley car and he was thrown violently to the pavement. Just how he fell I was not able to ascertain. He was taken to a hospital and ten days later to his home, where he was attended by his own physician. On July 2d I saw him in consultation and found the following: He was seated with his elbows resting on a table in front of him, suffering from great dyspncta. There were old ecchymoses about the right side of the head and face. The pulse was feeble, regular, beating 136 per minute. The heart was not appreciably enlarged or dilated. Its sounds were weak but normal. There were a few moist rales over the lower lobes of both lungs. The legs and feet were very cedematous. There were no fractures of ribs or evidences of intracranial injury. I was informed by his physician that the symptoms had been Suhagra Online the Suhagra Price same, thougli at not so intense, dur- ing the period of his attendance since the accident and the patient was saitl to have sutTered similarly in the hospital, though of this part of the history I could get no satisfactory account. On July 5th death occurred from cardiac exhaustion. 172 MEDICAL Cipla Suhagra 100 RECORD. [August I, 1896 We have here a case of fatal cardiac lesions, the exact nature of which was not self-evident, resulting from traumatism, but without any penetrating wound. An erroneous statement that a diagnosis of fracture of the base of the skull had been made at the hospi- tal led me to consider first the possibilit}- of some nerve lesion. Rapid heart action has been observed in cases of lesions of the medulla, presumably from paralysis of the pneumogastric or by pressure upon the latter by tumors in the thorax. Neither in the one case ' nor in the other" Suhagra 100 Cipla does the rapid heart action im- peril life. In Bouveret's article on paroxysmal tachy- cardia' several fatal cases of this disease are recorded and the theory is advanced that the disease is due to the exhaustion of the cells of the bulbar centres of the vagus. In the only case among those which Bouveret regards as typical of this malady, that of Bristow,' death did not occur during a paroxysm and no lesion of the nervous system was found, but the heart was much dilated. In view of the facts that in cases of demon- strated lesions of the medulla and of the pneumogas- trics, the heart's action has not been so rapid as to imperil life, and that the only case in which an au- topsy has been recorded in a case of paroxysmal tachycardia a Cheap Suhagra lesion of the myocardium was found, the statement that there may be a lesion of the vagus centre or of any other ner\-e centre which betrays itself by dangerously rapid cardiac action seems at least unproved. In such cases a lesion of the myocar- dium seems much more probable, in the light of our present knowledge. These considerations led me to think of the probability of the existence of a lesion of the myocardium in my case. A considerable number of cases of injury to the heart due to non-penetrating injuries have been col- lected by Fischer' and Schuster." More or less ex- tensive Buy Suhagra Online lacerations and ecchymoses of the heart mus-

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