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the screen. The gastric outline is smooth and regular, though a slight indenture may be no- ticed below the cardia due to the spleen and should not be mistaken for a deformity. A deeper depres- sion is also observed at the pyloric antrum. A peristaltic wave usually begins at the pars media and becomes deeper as it advances toward the pylorus ; the wave is always more pronounced on the lesser curvature than on the greater ; golden viagra at the pyloric antrum it disappears and the food advances into the first portion of the duodenum, usually outlining the bulbus duodeni. This is called a stomach cycle. This functional process begins over again in a normal stomach in about 15 or 20 seconds. During an examination of this process any abnormal con- dition in its activity, such as exaggeration, prolonga- tion, interruption, or spasm, can be observed and put down as part of the pathological findings. The advances in radiology of recent years have added an entirely new conception of the anatomy and physiology in relation to the form, position, and action of the gastrointestinal canal. The radiological signs of cancer may be classi- fied as follows : Filling defects ; altered pyloric function; gaping or obstruction of the pylorus; viagra soft tabs information hypermotility or advanced position of the six-hour meal (being placed in the left half of the trans- verse colon or the descending colon) ; absence of peristalsis over an involved area of the wall of viagra soft tabs information the stomach; six-hour residue as result of stenosis and obstruction; hypertonic stomach, oblique, and placed high up under the diaphragm, due to in- volvement and stiffening of the walls ; finger- shaped projections in the surrounding tissues; hourglass contraction with central canalization ; diminished or absent peristalsis; diminished mo- bility of the stomach ; the forming of a diverticulum viagra soft tabs information in the surrounding tissue as a result of the impair- ment of the walls due to the medullary growth. The filling defect is a positive and practically indispensable sign of cancer of the stomach. It is formulated by the tumor mass projecting into the stomach, and when the organ is viagra soft tabs information filled with bismuth the gastric lumen shows a corresponding ■; '•'Sccreridns" , ■: in luhich - mcaura tr Ulcer on r^y >• Fig. 4 — Schematic drawing after Carman illustrating ulcers of the pjiorus and lesser curvature. .-V large zone of residual secretions is present. Observed under fluorescent viagra soft tabs information screen. irregularity. These defects vary according to the size and the amount of involvement. There may be various types of defects as a result of golden viagra the differ- ent kinds of tumors; for example medullary car- cinoma produces a number of indentations along 642 MEDICAL RECORD. [Oct. 16, 1915 the stomach walls, while a scirrhus is apt to be of a small, concentric, narrow, or funnel shape, especially of the pylorus. When the pars media is involved the hourglass type of stomach is formed. Central canalization may result and is diagnostic Fig. 5 — Cliror^ie perforating ulcer (with diverticulum or pouch). Adhesions of the hepatic flexure to the duodenal region. viagra soft tabs information Discovered with the fluorescent screen and verified by the radiographic plate. of malignancy, while lateral canalization is pathog- nomonic of a contracture due to an old callus or perforating ulcer. Filling defects must be care- fully differentiated from indentations into the wall of the stomach by gas in the colon, adjacent ex- trinsic tumors, enlarged spleen or liver, mesenteric growths, and organic spasm of the gastric walls. With palpation of the stomach walls while the patient is i-ecumbent, the stomach can be pushed away and indentures filled out, thus showing its true contour. Stomach tumors in contact with the gastric walls are much more difficult to eluci- date; under such circumstances the patient may be turned from one golden viagra position to another and ex- amined at difl'erent angles, and the growth's inti- mate relationship to the stomach may in that way be determined. The deformity due to an organic hourglass contraction is sharply delineated; it is very often irregular in outline and will not relax on palpation or the administration of an anti- spasmodic such as belladonna or papaverine. In the cardia a filling defect may deform the normal gas bubble or magenblase of the Germans. Exami-