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Related post: Diaphragmatic hernias are not common, but
they occur with sufficient frequency to make it
necessary to bear the condition in mind Cost Of Zyban when
making a diagnosis in an obscure case. At
the time of the publication of Giffin's paper
in the Annals of Surgery for March, 1912,
six hundred and fifty cases had been reported,
but most of these were either congenital her-
nias occurring in babies or symptomless her-
nias discovered at autopsy. According to Gif-
fin, only fifteen cases of diaphragmatic hernia
had been correctly diagnosed during life.
The recognition of the condition is based on
a careful inquiry into the patient's previous
historv', especially with reference to injuries,
on a thorough physical examination of the
chest, and on radiographic and fluoroscopic
examinations after the ingestion of Zyban Order a bismuth
meal. The conditions most difficult to Price Of Zyban exclude
in making a differential diagnosis are pneu-
mothorax and eventration of the diaphragm.
The treatment of diaphragmatic hernia is
essentially surgical. While patients with the
trouble have been known to live for years,
sooner or later they all develop obstructive
symptoms, inflammatory complications or
strangulation with gangrene.
Two exploratory routes have been recom-
mended to reduce the hernia and repair the Purchase Zyban
tear in the diaphragm — the thoracic and the
abdominal. Those who favor the thoracic
SOUTHERN MEDICAL JOURNAL Zyban Buy
route claim that the adhesions can be more
safely separated, that the diaphragmatic open-
ing can be more easily sutured and that Buying Zyban by the
entrance of air into the pleural cavity the nega-
tive or suction power of the thorax is abol-
ished so that replacement of the viscera is less
difficult.
Those who favor the abdominal route claim Zyban Price
that a considerable number of hernias can be
reduced without opening the thorax, and that
on the subject of treatment. We can not hope
to close the aperture in Zyban Cheap the diaphragm by any
measures which science or mechanical Buy Zyban surgery
would justify; could we accurately detect the
existence of a protrustion it were in vain to
attempt its reduction with any benefit to the
patient or credit to ourselves."
Von Bergmann's Surgery, published in
1904, states: "Up to this lime no radical
operation has ever been Zyban Cost performed for non-
Fig. 1. Radiogram before oin ratimi, .showing stom-
ach in left pleural cavity.
Fig. 2. Radiogram before operation, showing pas-
sage of stomach through tear in diaphragm.
it is not wise to collapse the lung if it. can be
avoided. Also Zyban 150 that the viscera injured from
strangulation are the abdominal organs and
that they can be better repaired through Buy Zyban Online an
abdominal incision.
The following brief quotations from various
authors will show the evolution of surgical
opinion on the subject of diaphragmatic hernia
during the last twenty-five years.
Holmes' System of Surgery, published in
1881, contains the following: "We are silent
^trangulated Zyban On Line hernia in this region, although an Buy Online Zyban
operation is indicated provided the diagnosis
is certain."
Fergusson in his book, ^lodern Operations
for Hernia, published in 1907, says: "The
presence of diaphragmatic hernia is seldom
discovered during life. In but seven of the
two hundred and sixty-six cases reviewed by
r.achner was the diagnosis made ante-mortem.
If the hernia is incarcerated I believe the
Ihoi'ncic route the ])referable one. but in :i
McGUIRB: DIAPHRAGMATIC HERNIA.
case where the hernia is inflamed, ulcerated,
strangulated or gangrenous when a resection
of Cheap Zyban the bowel must be done the thoracic insures
less tendency to infect the peritoneal cavity."
Ochsner in his Clinical Surgery, published
in 1911, says: "Diaphragmatic hernias are
very rare, and when they do exist are seldom
discovered before the abdomen is opened. The
majority of cases that have been reported have
been found at post-mortem. Diaphragmatic
hernia may be congenital or acquired. The
congenital variety is rarely amenable to sur-
gical treatment because so great a portion of
Fig.
3. Cut showing incision in operation by
Thoracic Get Zyban Route (copied from Binnie).
the diaphragm is absent that it is Order Zyban impossible
to close the large opening. The acquired va-
riety may frequently be benefited by opera-
tion."
Mumford in his book Zyban Online on Practice of Sur-
gery, published in 191 1, says : "The treatment
of strangulated diaphragmatic hernia is ob-
viously to open the abdomen and treat the vis-
cera as the conditions indicate. Hitherto no
operation is reported as performed upon a
non-strangulated diaphragmatic Zyban Purchase hernia."
Binnie in his Operative Surgery, Online Zyban published
in 1914, says : "Of the cases of strangulated

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