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The complications in the pelvis outside
the tumor are largely infections of the
tubes. In my cases these have played a
large part, because four-fifths of the cases
have been in colored women. So in under-
taking a hysterectomy for fibroids we
must take Metronidazole 500 into consideration pelvic infec-
tion, and, 500mg Metronidazole of course, clear out everything
in that region, allowing no possible chance Metronidazole 500mg
for secondary infections to arise.
I have here a summary with names and
dates of 586 hysterectomies for fibroids
done since March 1, 1909. In these cases
there are sixteen deaths, giving a mortal-
ity percentage of 2.7. The cause of deaths
are : infection, 3 ; thrombosis and embol-
lus, 4; injury to the ureter, 2; shock, 3;
hemorrhage, 1 ; intestinal obstruction, 2 ;
and in one case the cause Buy Cheap Metronidazole of death was not
discovered.
I Metronidazole Buy present these Metronidazole Where To Buy statistics not for the
purpose of exhibiting a low mortality rate,
but simply to show the number of cases
operated upon largely in a Negro clinic ;
and to emphasize the fact that the surgical
treatment of uterine fibroids compares fa-
vorably with — ai)d indeed surpasses — any
other form of treatment so far devised.
In conclusion I wish to call attention to
the fact that the indications for operating
upon fibroids are very Where To Buy Metronidazole plain in most cases;
that the methods are immaterial so long
as we u.se the right principles; and that
the results will follow if we adhere to those
principles.
DISCUSSION
Dr. L. E. Burch, Nashville, Tenn. — Fibroid
tumors are innocent in the respect that they do
not invade contig^uous structures and do not
metastasize. At the same time we .should look
upon the fibroid tumor as a dangerous growth,
for the reason that it is likely to undergo one
or Metronidazole Online more serious complications, not only local but
general.
Dr. Royster has emphasized the possibility of
a "fibroid heart," as he calls it. In addition to
this, patients with fibroid tumors are likely to
have embolus and thrombus. It is not unusual
for them to present renal changes from pressure.
They are also likely to have high blood pressure
if the case is one of long standing.
There are many local complications that may
occur that are quite dangerous. Malignant de-
generation is not at all unusual. Inflammation;
suppuration and cystic degeneration frequently
occur. It is obvious that the woman who has a
fibroid tumor and does not present symptoms
should be kept under careful observation. We
occasionally find in Metronidazole 500 Mg young women a small Purchase Metronidazole Online fibroid
that is not 500 Mg Metronidazole producing symptoms. I think it ad-
visable, in these rare instances, especially if the
woman Metronidazole To Buy is ' anxious to have children, not to op-
erate, but to observe the course of the condition
very carefully. In those cases where the hemo-
globin is low I think it is advisable to transfuse
before operating. This procedure not only brings
up the hemoglobin, but in addition it puts them
in a position to withstand shock.
Dr. Royster mentioned in his paper that fibroids
produce menorrhagia but not metrorhagia. This
differentiation was brought out by the late Dr.
Murphy in his clinic. It is a diagnostic point,
however, that I do not consider of any great
value. The fibroids that we see in Tennessee
frequently have both menorrhagia and metrorrha-
gia.
In regard to treatment, it is impossible to lay
down a fixed law, for the reason that every case
is different. The ideal operation for fibroid is
myomectomy, but there are very few cases where
this operation is applicable.
I am sorry Dr. Royster did not mention the
X-ray and radium treatment. I consider Order Metronidazole Online both of
these methods as in the Buy Metronidazole experimental stage. Some
few, however, have reported good results. Per-
sonally, I do not think that these two methods
of treatment will ever be universally adopted,
but at the same time I think we should study
carefully the results obtained both by X-ray and
radium.
I do want to emphasize again the point that
Dr. Royster laid a great deal of stress upon in
his paper, and that is that fibroid tumors are Where Can I Buy Metronidazole
innocent growths, yet at the same time they post-
pone the menopause and bring on many serious
complications, and the majority of them will
demand surgical relief.
Dr. H. R. Shands, Jackson, Miss. — I do not Cheap Metronidazole
think that all cases of uterine fibroids should be
Vol. X Purchase Metronidazole No. 5
ROYSTER: HYSTERECTOMY FOR FIBROIDS
415
treated with operation. Wliere one's experience
is largely with colored patients hysterectomy will
nearly always be indicated for the reason that
most colored patients have a complicating Neis-
serian infection. In the past five years I have
had a number of patients with fibroids who were
young women. The main indication for treat-
ment was to relieve the severe bleeding which
had reduced them to an extreme degree of Order Metronidazole ane-
mia. The tumor in these cases being small and
the women being young, I felt it to be my duty
to have them treated with radium rather than
to remove their uteri. The results Generic Metronidazole in these cases
were excellent, and on the whole I think better
than would have been gotten with operation. The
bleeding was entirely checked and the tumor
seemed to have stopped growing. I feel that in
the Buy Metronidazole Online future radium will be used much more exten-
sively in the treatment of uncomplicated uterine
fibroids.
Dr. E. B. Claybrook, Cumberland, Md. — As to
speed and safety, these two words are synony-
mous as used, if we draw the fine distinction be-

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