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August 28, 191.''). 1. The Bone Graft Wedge. F. H. Albee. 2. Pituitary ou acheter du viagra sans ordonnance Tumor with Improvement After Puncture of the ou acheter du viagra sans ordonnance Corpus Callosum. W. M. Leszynsky. 3. Greek Physicians at the Persian Court. W. B. Konkle. 4. The Initial Strain in Weak Foot. P. W. Roberts. 5. Uterine Fibroids. synthetic viagra G. E. Shoemaker. 6. Gonorrhea in the Male. H. Schoenrich. 7. synthetic viagra Fractures. J. F. X. Jones. S. Midwives and Physicians Factors in Puerperal Fever. N. Kavinoky. 9. Vaccine Therapy in Permatolosy. A. Stickler. 10. Acetonuria and Carbohydrate Starvation. S. H. Blodgett. 11. Laryngeal Tuberculosis. A. S. Kaufman. 12. John Bunyan, Hypochondriac. H. D. King. 1. The Bone Graft Wedge.— F. H. Albee states that in many cases of hip dislocation the acetabulum is found to be too shallow and with a ou acheter du viagra sans ordonnance superior rim insufficient to retain the femoral head. synthetic viagra To obviate this defect HofFa in 1800 did his first successful operation, which consisted chiefly in deepening the acetabulum by scooping out the contained fat, articular cartilage, and bone to synthetic viagra furnish an adequate concavity to receive and hold the head of the femur. By this method he was enabled to produce a 452 MEDICAL RECORD. [September 11, 1915 stable joint, but in many instances with little or no mo- tion associated with pain, and in many others producing a stiff hip with a varying amount of shortening of the leg, depending upon the amount of excavation made in ou acheter du viagra sans ordonnance the superior portion of the acetabulum to ou acheter du viagra sans ordonnance receive the head of the femur. In cases in which motion seemed free shortly after the operation a later examination showed it to be slight, and at a still later period a prolif- erative arthritis which completely locked the ou acheter du viagra sans ordonnance joint fre- quently occurred. The author's method which has been performed successfully in a number of instances is ou acheter du viagra sans ordonnance said to obviate the above-mentioned disadvantages and pro- duces a stable joint, with full and free motion and with- out pain or shortening. The most important feature is that ou acheter du viagra sans ordonnance it preserves the entire acetabulum and joint carti- lage, thus guarding against any later joint change. It may be described as a bone wedge graft remodeling op- eration for paralytic and congenital dislocation of the hip. The important points of advantage which it is said to possess over the Hoffa open operation are: (1) it is an operation of less synthetic viagra magnitude, producing less shock and mutilation of the anatomical joint structures; (2) there is a preservation of the synovial membrane and hyaline cartilage of the joint as well synthetic viagra as of synthetic viagra the ligamentum teres. The operation is performed without the disarticulation or extensive trauma of the head of the femur, a most important factor synthetic viagra in avoiding shock and subsequent trau- matic degenerative change in the joint. There is no shortening of the limb by the operation, as no portion of the existing articular structures is removed or scooped out as in the Hoffa operation. There is a restoration of joint stability and a reinforcing of the joint structures, and an actual addition synthetic viagra to the joint anatomy by the in- sertion of these bone grafts to be described. The au- thor's method minimizes any synthetic viagra possibility of limited mo- tion of the remodeled joint, or subsequent production of osteoarthritis to limit motion or produce painful motion. 2. Pituitary Tumor.— By W. M. Leszynsky. ou acheter du viagra sans ordonnance (See Medical Record, July 24, 1915, page 172.) 10. Acetonuria and Carbohydrate Starvation.— S. H. Blodgett concludes that acetone in the urine may be caused experimentally by carbohydrate starvation, but not clinically, except to a very slight extent. Acetone ou acheter du viagra sans ordonnance alone or in conjunction with dietetic acid may, and in this unnamed condition frequently does, appear in the urine, often in enormous amounts, when there has been no carbohydrate starvation. Therefore the theory that a carbohydrate diet should be pushed in this condition appears to the author ou acheter du viagra sans ordonnance to be unfounded. 11. Laryngeal Tuberculosis.- A. S. Kaufman treats this condition as follows: In the early or catarrhal stage the patient is taught to spray the larynx with a mild al- kaline solution in connection with the local application of mild astringents, followed by an oil spray. In regard to applications they should be made with the aid of a laryngeal mirror to guide the proper performance of this operation. Nodules and ulcerations call for surgical in- terference. The ou acheter du viagra sans ordonnance use of the punch in the former and the curette in the latter permits the medicaments which may be applied later to gain better results. Lactic acid, 25 to 50 per cent., and formaldehyde solution, 2 to 10 per cent., are efficient remedies when applied directly to the affected area, and not to the surrounding tissues. A drug recently used in this condition, and which has given very gratifying results, is scarlet red. Application of a 10 per cent, solution in oil causes a marked lessening of pain, and the ulcerations show a tendency to heal. Fur- thermore, it is nonirritating, and may be applied to the larynx without causing the patient discomfort by the use of the laryngeal mirror. For dysphagia, local anes- thetics are indicated. The author has found that a 20- per-cent. mixture of orthoform and boric acid insufflated into the larynx gives relief for some time after its use. Journal of the American Medical Association.