Cialis 5 Mg Once Daily | OVERNIGHT Delivery!

Thus, if we are to avoid the destructive changes that so often follow septic endometritis, our efforts i68 IVEIL: SEPTIC ENDOMETRITIS. must be (i) to prevent the infection from spreading to the peritonaum if possible, and (2) in case of peritoneal Cialis 5 Mg Once Daily infection, to establish good and efficient drainage. In the first case the adhesions being of no further use will undergo absorption just as the congestion and cell infiltration from a slight burn on the skin rapidly disappears ; in the second case if our drainage is thorough and complete we dispose of the pus, etc., and the adhesions having nn further function undergo absorption just as the inflamma- tory reaction surrounding a boil disappears with the disposal of the infecting agent. It has been found convenient to classify septic endometritis into two groups dependent upon their secondary characteristics ; thus, this infection k-ads either to a salpingitis or a lymphangeitis and this is dependent upon the nature of the infecting bacteria. Exhausive investigation by numerous writers tends to show that the gonococci is almost invariably re- sponsible for primary pyosalpinx, that is pyosalpinx not secondary to pelvic pbscess. atul that lymphaii' geitis and its consequent pelvic abscess to be the re- sult of any of the ordinary pus germs, but not the gonococcus. The physical characteristics of the gonococcus, such as their peculiar affinity for epi- thelial tissue, their impotencv when injected Cialis 5 Mg Once Daily into the deeper tissues, their lack of mobility, and their low vitality are ample to Cialis 5 Mg Once Daily explain this fact, particularly when considered in connection with the characteris- tics of the pus germs in general ; for taking the streptococci as the commonest of these later we note their impotency when implanted upon healthv epi- thelial tissue, their activity Cialis 5 Mg Once Daily when injected intn deep tissues, their mobility, and their remarkable vitality. These statements if true have consideralile bearing upon the treatment of these cases. Streptococci and pus germs generally have no ef- fect upon normal epithelial tissue. It follows that any septic infection (non specific) of the endome- trium must be the result of a breach of continuitv of the endometrium such as would occur as result of intrauterine instrumentation or as a result of abortion or labor at term. Taking up first the non- puerperal cases, it is but a few years ago that cur- rettage was considered almost a specific, but more experience and mature consideration together with a clearer appreciation of the various factors involved in these cases ([uestions the value of this operation, for it seems that if normal epithelial tissue is im- mune to this type of infection it would be folly to remove it and thus expose tissue that is not inmiune. thus converting a small infected area into a large one ; particularly since by no amount of curretting can we hope to dispose of the infecting germs. Nature's one effort in the jjresence of infection is to provide drainage, and one might well take its cue from this particularly Cialis 5 Mg Once Daily since the normal uterus, not being a secretory organ provides but scant drainage. It is probable that this latter factor is important letiologically. The uterus in a well con- tracted state exhibits remarkable resistance to germ invasion, otherwise we should see a much greater percentage of infection following labor. Bumm found streptococci present in the lochia of from thirty per cent, to sixty per cent, of cases at various periods following labor, and yet infection following labor is at present comparatively rare. If the pner- £New YoiiK Medical .Ioi'skai..' peral uterus with its enormous raw surface is able to resist bacteria to this extent one would expect the' small involuted organ with its protecting layer 01 epithelial cells to be more resistant so that it is diffi- cult to conceive an infection of this type niakini; any headway except in the absence of drainage, and inversely the treatment would thus be to Cialis 5 Mg Once Daily establish early and persistent drainage by thoroughly dilatins the cervix and maintaining it so. Cases of this typi are at present rare but should not be confounded with sepsis occurring during early pregnancy. Taking up next the sepsis following abortion or labor at term we have here an entirely different state of affairs, since the possible presence of retained fcetal products is a factor and because of the exten- sive alteration of the intrauterine surface at the placental site. The contraindication for curettage does not hold good in these puerperal cases. Tht very possibility of retained tissues within the'uterine cavity makes some sort of intrauterine exploration imperative for even the most conservative must con- cede that an empty uterus is imperatively indicated. Whether this procedure is done with finger or cur- ette Cialis 5 Mg Once Daily is immaterial, the chief aim being to carry it out with as little traumatism as possible. In this connection the relative virtues of the finger and cnr- ette are still a matter of dispute. Again, the altered mtrauterine surface in these puerperal cases is in nu sense inhibitory to the usual pus germs, quite the contrary, so that the danger of converting a resistant surface to a nonresistant one, such as exists in tht nonpuerperal cases, is in these cases absent. Once the uterus is emptied the subsequent treat- ment will depend upon the further character of the disease. If the infection takes on the inflanimatorv or lymphangetic type as it usually will foUowini,' early abortion, little can be done locally except to maintain Cialis 5 Mg Once Daily drainage by dilatation, irrigation and pos- ture until such a time as the infection localizes itself in pelvic abscess, when this should be carefully and thoroughly drained through the vaginal Cialis 5 Mg Once Daily vault. If on the other hand the disease assumes a toxasmic or septichcemic type, and it will usually do this after late abortion or labor at term, then steps must be taken to prevent toxine absorption from the uterine cavity, for I have pointed out {New York Medical Journal, January 9 and Cialis 5 Mg Once Daily June 12, 1909) (i) the tox- ine laden and toxic nature of the lochia, (2) the ab- sorptive power of the puerperal uterus, (3) the in-