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artificial anus. buy betnovate cream Death followed on the sixth day, from general peritonitis. The causes of the irreducibility are numerous. In the case of rupture the betnovate scalp solution difficulties are greater tlian in a simple incision through the betnovate scalp lotion abdominal wall, because the effort must be in betnovate ointment 0.1 a direc- 552 QUARTERLY REPORT ON tion not perpendicular, but more or less oblique, to the opening, in the axis of the rectum ; and every eliort tends to push the mass up the large intestine rather than into the rent from which it has escaped, which betnovate buy online is never gaping, sometimes irregular, and often partly obliterated by the mesentery, thickened and infiltrated with blood. On the other hand, it is necessary to restore an enormous mass which is distended by gas and ffecal matter, and, in propor- tion as the reduction is accomplished, the intra-abdominal betnovate n cream pressure increases and becomes a new source of diliiculty. Another and important reason of the difficulty, according to the author, is found in the neglect to appreciate the order in which the intestinal loops have appeared, and therefore in the neglect to handle tliem in their proper order. The reduction may best be accom- plished by placing the patient on the side with one leg slightly extended betnovate face and the other flexed at a right angle. An assistant separates the buttocks, and, while betnovate skin cream the patient is advised to make no effort, the surgeon, after having at- tempted to discover the seat of the rupture, gently empties the intestine, commencing with the loops which are the least changed from normal. From time to time gas and liquids may be made to circulate by pressing gently with the fingers from below upward the betnovate gm skin cream portion of the tube which he is trying to reduce. The reduction being accomplished, something else remains necessary, for the loops constantly tend to pass the rupture and again fill up the rectum. Should the surgeon be content to place a tampon on the anus and perinasum, and postpone active interference till another time; or should he, as in the case of Adelmann, close the rent with sutures? In the author's own case he was led, by the exhaustion of the pa- tient, and the difficulty of reaching the rent, to postpone the operation ; but it is certain that, if the betnovate online operation is possi- ble, the sutures should at betnovate gm once be ap- plied as a betnovate c ointment preventive of the penetra- tion of the fajcal contents into the peri- tonajum. When reduction is impossi- ble, a laparotomy must be performed. Adelmann, even after opening the abdo- men, was obliged to puncture the in- testine. After reduction the rectal wound betnovate for acne should first be closed, and then the abdominal. But the author goes still furtlier and asks whether, the re- duction being accomplished, and the closure of the rent still being impossi- ble, the surgeon is not authorized in making an abdominal wound for the sake of closing that in the rectum. He answers the question by the state of the I)atient. If the patient is prostrated, and liable to die during the operation, the laparotomy must be postponed ; under opposite circumstances it may be undertaken at once. Surgical betnovate scalp application interfer- ence has not been productive of very encouraging results. Eupture of the rectum has always been fatal except in the case betnovate c cream of Needham, and the recovery in this last was rather a fortunate acci- buy betnovate cream online dent. The pathogeny of these rare acci- dents betnovate cream 0.1 still remains to be considered. Detailed anatomical reports are very necessary in this connection, and, un- fortunately, the authors who have re- ported these cases betnovate c have neglected post- mortem examinations. The writer, however, gives a short resume of the principal betnovate n facts attainable. Brodie :

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