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The following officers were elected for the ensuing year : President — Dr. Gilman Kimball, of Lowell, Mass. Vice-Presidents — Dr. Albert H. Smith, of Philadelphia, and Dr. Theophilus Parvin, of Indianapolis. Council — Dr. John Byrne, of Brooklyn; Dr. W. T. Howard, of Baltimore; Dr. A. Reeves Jaok- GON, of Chicago ; and Dr. buy glucophage online H. F. Campbell, of Augusta, Ga. Secretary — Dr. Frank P. Foster, of New York. Treasurer — Dr. Paxtl F. MundI;, of New York. Dr. Matthew D. Mann, of Buffalo, N. Y., and Dr. W. H. Baker, of Boston, ■were elected members; and Mr. J. Knowsley Thornton and Mr. Lawson Tait, of England, honorary members. PATHOLOGICAL SOCIETY OF PHILADELPHIA. g25 PATHOLOGICAL SOCIETY OF PHILADELPHIA. A REGULAR meeting was held glucophage cost September 7, 1882, Di*. J. Solis Cohen, Vice- President, in the chair. Carcinoma Mammae.— Dr. C. B. Nanckede related glucophage buy the case for Dr. Charles Wirgraan. Mrs. Josephine M., aged forty-eight years, married at twenty-three, the mother of three children, tlie last born sixteen years ago, had nursed all her children, but the last died from marasmus, order glucophage owing to the small amount of milk the mother had, although lactation was free after the first two confinements. She never had had any abscess of the breast, or any traumatism or eczema of the nipples, although she had always experienced pain and uneasiness in the right breast when nursing. There was no trace of carcinoma in the family history. A sister had had glucophage diabetes an enchondroma of one of the metacarpal bones. When young, the patient had suffered from dyspepsia, and on one occasion had had an attack of haemoptysis. glucophage tablets Of late years Mrs. M. had grown very stout, although never robust or strong. About the middle of June, 1882, she first noticed a lump in her right breast at its upper inner quadrant, of about the size of a hen's egg. A few nights previously she had been awakened by a severe lancinating pain in the right breast; but, experiencing no farther inconvenience, she paid no attention to it. The mass did not seem to grow till handled and an exploring needle had been inserted, when the growth became softer, much larger, and painful, and the skin and superjacent veins rapidly showed marked changes. I saw her August 6, 1882, with Drs. Wirgman and Hearn, when the only additional points to be noted were, generic for glucophage that the growth was freely movable with the breast upon the chest walls and that a mass of the size of a pigeon's egg could be felt in the axilla under the outer margin or the glucophage mg pectoralis major muscle. Dr. Wirgman removed the whole breast glucophage 500mg by two semicircular incisions, opened glucophage xr up the axilla, and removed all the glands up to the clavicle. This operation again emphasizes what Dr. S. W. Gross has specially insisted upon — viz., that, although the axillary glands may appear before operation uninvolved, yet glucophage generic when the axilla is opened numbers are often found enlarged. This accords with my own repeated experience. Although slow in healing, the case has done well since operation. This case presents special points of interest which I shall now dilate upon. In the first place, its history and appearance were eminently suggestive of a rapidly forming sarcoma, which was either cystic, or, what at once suggested itself to me before etherization, one into whose substance ha;morrhage had oc- curred. Upon careful examination under ether, the discovery of the enlarged gland at once suggested the strong improbability of sarcoma, which view I abandoned. After the removal, the macroscopic appearances once more threw doubt on the diagnosis, a,s there was, for at least one half, if not more, of the circumference of the growth, a distinct appearance of a cheap glucophage cajjside, and, as I had surmised, the tumor had been broken down by a ha>morrhage glucophage price into its substance. Subjected to glucophage sr micro- scopic examination, the specimen was again puzzling, since sections of the first pieces imbedded showed in every portion of their extent — with a few very slight exceptions — small spindle cells of a connective-tissue type. Dissatisfied, I im- bedded a second piece, sections of which revealed a typical carcinoma of the soft variety. This again illustrates what I have many times insisted upon in this society — viz., that either very large sections of growths should bo made, as Dr. Seller advocates, or sections from several and varied portions of the morbid mass should always bo carefally examined. 40 g25 PROCEEDINGS OF SOCIETIES. Dr. Ttson said tliat the presence of a capsule seemed to be clearly demon- strated. Eectjreing CARCfiNOMA OF THE Mamma AND AxiLLAET Glands. — This case also was presented by Dr, Nanceede. The patient, Mrs. F., aged thirty-seven years, from whom the specimens were removed before the discovery of the pri- mary cost of glucophage tumor, about eighteen months back, was in perfect health, although from pecuniary losses she had undergone much mental anxiety since the Chicago fire. Hearing a vivid account from a friend of another case of carcinoma raamm^, her mind became deeply impressed, and shortly after she discovered a growth in the upper inner quadrant of the left breast, which continued to grow until it had attained at the time of the first operation to the bulk of a small orange price of glucophage — viz., one year after her first discovering it. She lost much flesh from tlie time of the dis- covery of the growth ; she had never suffered from any form of traumatism ; had had no eczema of the nipple ; and, although she had borne one child a number of years back, and had suckled it, had never had sore nipples. There was nothing which could be fairly construed as an hereditai-y history of carcinoma. The primary operation had consisted in a removal of part of the breast. In less than two months after this a small nodule appeared in the cicatrix, while the axillary glands began to enlarge rapidly. On July 8, 1882, I saw her in consultation with Drs, K. R, Taylor and Harlow, when I found that there was a small nodule in the middle of the original cicatrix, while the axilla was occupied by the mass of in- durated glands which I here present. The growth partially embraced the axillary artery, since, when the former was compressed, the radial pnlse was decidedly affected. Not being allowed to remove the glucophage online whole breast, I freely excised the whole growth, next the recurrent growth, and, after a tedious dissection, removed the axillary tumor, laying bare the artery and vein for a space of over an inch, clearing everything out to the clavicle, and distinctly recognizing the coracoid process of tablet glucophage the scapula. Although this is not the place for a clinical discussion, I can not refrain from empl)asizing the importance of the thoroughness with which this axillary dissection should be performed. Not a single gland should be left, enlarged or not. Properly conducted, there is hardly any hseraorrhage, a vessel rarely requiring ligature. This case was treated on Listerian principles, but with a spray of acetate of aluminium, and the wound was dressed with the same. There was no inflammation, heat, pain, or subsequent induration, and, if I remem- ber rightly, the case required but five dressings, until the wound became super- ficial, and fewer would have been necessary had perfect coaptation been secured. glucophage xr 500mg

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