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aged twenty-two years. This condition is rare, and but few cases are on record. In almost all instances the abscess is secondary. The splenic arteries, be- ing, as is well known, terminal, there is a liability to infarcts and necrosis of circumscribed areas of the organ. The case here reported is of special in- terest because it shows that splenic abscess may sometimes be of tuberculous origin, for tuberculosis was produced in animals by the injection of pus from the spleen of the patient. The Bacillus colt was, however, found on examination in this pus. The most important general symptom of splenic abscess is fever. This may be continuous or re- mittent, but in most cases it cheap elavil is typical of pyjemia. A pyaemic fever which develops during convales- cence from an infectious disease, and which is ac- elavil 25 mg companied by other symptoms of local character points to suppurative process somewhere elavil for in the body. The other general symptoms are allied to the fever, and consist in the typhoid state, weak and rapid pulse, etc. The local signs consist of tumor in the splenic region and pain. The tumor is only diagnostic when it is of considerable size, and when fluctuation is to be detected in it, otherwise it can- not be distinguished from an enlarged spleen. The pain varies in intensity and may not annear until late, when the abscess is large. The characteristic I)osition of the patient is upon the back, with the trunk flexed laterally. 3. Chlorides elavil 25mg in Pneumonia. — Santini draws the following conclusions, as the result of his in- vestigations on the subject of the chlorides of the urine in pneumonia and the elavil 10 organic chlorine of the tissues. The quotient of the alkaline mineral chlor- ides remains invariably or almost constant in the tissues of a patient with pneumonia, as well elavil 50mg as in a healthy elavil uses individual, or it is slightly diminished. Dur- ing the infectious process the amount of chlorides not eliminated by the organism elavil 10mg enters into combina- tion with the organic substances which are abnor- mally produced during the disease, and which are impermeable to the kidneys. During physiological conditions there is also a constant and definite por- tion of the chlorides which remains in the tissues as alkaline mineral combinations, while another portion of the chlorine is in combination with or- ganic substances. 4. Gunshot Wound of Abdomen. — LSardellini concludes from a study of a case of gunshot wound of the abdomen that, even when there are no signs of perforation or other visceral lesions of grave character, the patient's life may be in immediate danger, and that in cases of gunshot wounds of the abdomen it is not wise to wait till elavil mg such signs de- velop, but it is imperative to operate elavil 50 mg at once, and to seek elavil 10 mg to ascertain all the damage done by the bullet. In the case elavil amitriptyline cited, the patient was in good condition and did not show any signs of perforation when admitted, but owing to the nature and localization of the wound (in the mesogastrium, to the left of the umbilicus) there was no doubt as to the fact that the wound had penetrated through the intes- tines. On laparotomy, six perforations were found and closed. A portion of the intestine had to be re- sected and a Murphy button was used to unite the ends. The patient made a good recovery. REVISTA MEDICA CUBANA. June I, 1903. 1. A Case of Amyotrophic Lateral Sclerosis of Long Dura- tion. By J. A. Valdes .\xciaxo. 2. .\ Case of Double Gastric Ulcer. By G. CoccHi and L. Cuervo. 1. Amyotrophic Lateral Sclerosis. — A'aldes Anciano reports a case presenting som.e unusual features: elavil 25 For example, entire absence of bulbar symptoms, notwithstanding the ten years' duration of the disease ; the commencement of the symp- toms of sclerosis in the lower limbs rather than in the upper, as is the general rule ; and, finally, the long duration and slow evolution of the disease as compared with its usual, rapid (two to five years') elavil buy course. June 27, 1903.] PITH OP CURRENT LITERATURE. 1 197 2. Double Gastric Ulcer. — Cocchi and Cuervo describe elavil used for tiie case of a man, giving a history of pre- vious malarial attacks, who came under hospital treatment elavil 50 for gastric ulcer. But little could be done for his relief, and death from perforation elavil for anxiety of the ulcer and consequent peritonitis followed shortly after his admission. Autopsy revealed a second, healed ulcer in the stomach, from the existence of which and the development of the ulcer which caused the patient's death, the authors believe a practical lesson is to be drawn. In view of the fact that buy elavil online gastric ulcer occurs most frequently in the ansemic, and that malaria is a fruitful source of impoverishment of the blood, they hold that the pa- tient should not be considered cured when quinine has done its work in breaking up the malarial seiz- ures ; but that a vigorous tonic treatment should follow, in order that the patient may be guarded against its after efifects. In the case reported, gas- tric ulcer is believed to be a late manifestation <;f the former paludal state, which might have been obviat- ed by appropriate postmalarial treatment. JOURNAL AKOUSCHERSTVA online elavil I CIENSKIKH BOLIESNEY January, 1903.

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