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Dr. Vineberg, in closing the discussion, said that according to Dr. Sturmdorf's theories no good results ought to be expected from this procedure which he had described, buyviagrachicago but that good results did occur never- theless. With regard to keeping the patients in bed buyviagrachicago for a how long is viagra good for while before they were operated upon, in the wards of hospitals this could be done better than with private patients. It might be pointed out, however, that the involution spoken of did not take buyviagrachicago place in cases of fibroids or fibi'osis. In all cases buyviagrachicago the method of treatment was a matter of selection. One should how long is viagra good for not leave an organ that gave rise to nervous symp- toms and there was no pelvic condition more fruitful of manifold nervous disturbances how long is viagra good for than a uterus in a state of chronic metritis or fibrosis. With the opera- tion he had described he had secured perfect anatomical results and relief from symptoms. Intraperitoneal Hemorrhage of Unknown Origin. — Dr. Robert T. Frank presented this report. He stated that how long is viagra good for this was the buyviagrachicago third buyviagrachicago case which he how long is viagra good for had encountered in which, on opening the abdomen, a large intraperi- toneal hemorrhage buyviagrachicago was found, the source of which was never determined. The patient was 23 years of age and single. Her menstrual history had been normal until about a year ago when dysmenorrhea buyviagrachicago and menorrhagia developed. Three days before admission to the hospital there was an acute attack of abdominal pain and faintness. The bowels were constipated how long is viagra good for and urination painful and frequent. At the time of admis- sion the patient looked very ill. The temperature buyviagrachicago was 105° F. and pulse 120. A large hard tumor was felt in the right hypochondrium, reaching to the umbilicus. The uterus how long is viagra good for could not be outlined. A diagnosis of ovarian cyst with twisted buyviagrachicago pedicle was made. A laparotomy was performed immediately and a large amount of fluid and clotted blood evacuated. The tumor proved to be a firm fibroid of the uterus. The adnexa were normal. A thorough inspection of all the viscera revealed nothing abnormal except some jelly-like deposits on the intestines. Rapid supra- vaginal hysterectomy was performed together with the removal of the right adnexa. The specimen removed buyviagrachicago showed a hard fibroid with tuberculosis of the en- how long is viagra good for dometrium and buyviagrachicago ovary. A pin point opening on one of the veins of the fibroid which was supposed to be the source of the hemorrhage was found to be trau- matic, that was made at buyviagrachicago the time of operation. Dermoid Cyst of the Ovary with Carcinomatous Change. — how long is viagra good for Dr. Robert T. Frank reported this case. He stated that only about 40 cases of this nature had been buyviagrachicago reported in the literature. The patient, 50 years of age, had been told nineteen years before that she had a tumor. The menopause had occurred six years be- fore. She had had no children, but two abortions. The abdomen was prominent, buyviagrachicago lax, and contained a tumor in the median line, extending to half way be- tween the xiphoid and the umbilicus. A diagnosis of ovarian cyst was made. At laparotomy a right ovarian cyst the size of an adult head w'as removed. This cyst contained hair and sebaceous matter. At one pole was a thickened area, gelatinous in consistency, with putty-like inclusions. Microscopical examination by Dr. F. S. Mandiebaum showed carcinomatous areas in the dermoid. Some buyviagrachicago months later the buyviagrachicago patient was readmitted to the hospital with symptoms pointing to lung and vertebral involvement (confirmed by .r-ray). No response to buyviagrachicago recent inquiries could be obtained. Cesarean Section Necessitated by Large Gartner Cysts. — Dr. buyviagrachicago Robert T. Frank reported this case. This patient presented herself in August, 1913, when she was seven and one-half months pregnant, because of a large protrusion from the right buttock and a feeling of fullness in the vagina. Examination showed a large cystic mass how long is viagra good for how long is viagra good for which caused the right buttock to protrude three inches beyond the left and encroach greatly on the pelvic cavity. Above the how long is viagra good for large how long is viagra good for cyst was another the size of an orange, extending to the promontory. As labor through the natural passages was not buyviagrachicago pos- sible the child was delivered by cesarean buyviagrachicago section at term, and five months later the mother presented her- self for the removal of the cysts. A large cystic buyviagrachicago mass the size of a small grape fruit was found how long is viagra good for buyviagrachicago in the but- tock, pushing the right and posterior vaginal walls inward. Above this was a cyst the size of a walnut. The tumors were smaller than during how long is viagra good for pregnancy and veins in the vagina which were distended and varicoso 628 MEDICAL RECORD. how long is viagra good for [Oct. 9, 1915 had disappeared. The patient was later readmitted because of complete prolapse, and on e.Kamination a cystic mass the size of a lemon was discovered behind and to the right how long is viagra good for of the vagina. Either a small cyst had been overlooked or this had grown in the interval. The cyst intimately adherent to the right lateral and posterior rectal walls was removed after how long is viagra good for the fibers of the right buyviagrachicago levator ani were cut across. The dissection had to be carried up to the peritoneal reflection, and the lower four inches of the rectum had to be mobilized as for a resection of the rectum. The operation was completed by a large Hegar denudation and a typical colpoperineorrhaphy. The patient how long is viagra good for had since remained cured. Dr. F. S. Mandlebaum had reported that the cysts were composed of how long is viagra good for fibromuscular wall, lacked how long is viagra good for definite epithelial lining, and probably originated from Gartner's ducts. Cysts how long is viagra good for of this nature did not ordi- narily attain sufficient size to obstruct labor or to cause technical difficulties in their removal. Dr. George W. Kosmak asked if there was any pos- sibility that the hemorrhage had come from a corpus luteum. A case had been reported at a recent meeting in which, after a prolonged search, a corpus luteum was found to be the buyviagrachicago source of hemorrhage. Dr. buyviagrachicago Frank replied that the bleeding had not come from a corpus luteum ; they how long is viagra good for had buyviagrachicago searched every viscus,