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serous sacs have always been regarded with anxiet}', because of the inflammation liable to follow their incision— an inflam- mation which, bactrim and uti unfortunately, does not always confine itself to the serous membrane, but, spreading to the suiTounding areolar interspaces, produces some of our most formidable cases of far-spreading suppurative cellulitis. 4:68 MARKOE: SARCOMA OF SYNOVIAL SUEATHS. [N. Y. bactrim 800 mg Med. Jocb., The following cases present some features in which they differ from those which I have thus sketched, and serve, it seems to me, to suggest a modification in diagnosis, and a caution in prognosis which may possihly save a serious dis- appointment : Cask II. — Frank McNair, aged forty-three, a man of good habits and apparently in excellent health, came into the New York Hospital, December 5, 1879, with a swelling on the plantar surface of the great toe of one foot. It had commenced about bactrim generic two years before, bactrim 400 mg without any known cause, and hud slowly and steadily increased in size. It was from the first somewhat pain- ful on walking, but of late had become so serious an iniperiiment to him bactrim 800mg tliat be was very desirous that something should be done for his relief. There bad never been any evidence of inflamma- tory action about it, though it was more painful at some times than at others, particularly when he had been obliged to stand or walk on it more than usual. On admission, a softisb, doughy feelin" swelling occupied the under surface of the great toe, ex- tending back into the bactrim tablets ball of bactrim and the toe, so that its posterior mar- gin was well behind the metatarso-pbalangeal articulation. It had an elastic feel, and, when pressed upon, the whole swelling became bard bactrim for mrsa and tense. A feehng of fluctuation was distinct enough, but left a doubt in the mind whether it was produced by a fluid or a semi-solid material within the cyst. The cyst- wall seemed to be quite thick. The diagnosis was clear as to the disteniiion of the synovial sheath, but the nature and consistence of the contents were not so manifest. My notes do not say that aspiration was performed, but, if it was, no information was elicited by it. The case was regarded as one of the usual forms of distension of the synovial sheath from a low grade of inflam- mation with eflfusion of a fluid which had become partially solidified by the admixture with it of some form of a plastic fibrin. I was at the time experimenting bactrim bactrim with " through drain- age," and on the 6tb of January I employed that method in the treatment. An opening was made into the sac as far back as possible, and the contents were with some difficulty squeezed out. The substance thus evacuated was of a yellowish-white color looking not antibiotic bactrim unlike the sebaceous contents of some of the cysts of the scalp, but it was evidently not a perfect fluid, for certain portions of what was squeezed out showed some such coherence as would bo found in a soft growth which hail been forced bactrim cost from the cavity in which it had lain, and which, though in the main broken up into a diflBuent pulp, showed clear indi- cations of its having been mrsa bactrim originally a continuous tissue, though of the softest bactrim price possible consistence. Not much attention was given to this peculiarity at first, as its cohesion antibiotics bactrim was supposed to be explained by the idea of the fibrinous masses of which the substance sulfa bactrim was partly composed adhering more or less intimately together. It was afterward recognized that this feature was of most important significance. After emptying the cai-ity of all that could bo forced out, the walls, as far as could be -seen through the opening, presented the ordinary smooth, shining, white surface of healthy synovial membrane. An opening was now made at the anterior extremity of tlio cavity, and a perfo- rated drainage-tube passed from one opening to the other. The wound was dressed antiseptically, and the ends of tlie tube were allowed to project through the dressing, thus allowing tlie cav- ity to be easily washed out with a weak solution of carbolic acid. No infiammatory reaction occurred. The tube was re- moved in about a week, and the wounds soon healed. The pa- tient thought hiujself cured, and could walk pretty well before ho left the hospital. t>ix mqntbs afterward 1 saw liim with the swelling about as bad as before, and the impairment of motion steadily increasing. From tliat time I have not seen him. The report of the pathologist on the material expressed from the cavity was as follows: " Specimen consists only purchase bactrim of irregular fragments scraped and torn out of what seemed to be a cyst, though the cyst-wall was not demonstrated. Microscopic ex- amination : 1st. When examined in fresh state, there was found to be much amorphous fibrin, and tumor was thought to be a benign cyst. 2d. The fragments, when hardened, show, upon section, in some cases only amorphous fibrin, but in other cases the typical structure of spindle-celled sarcoma." Case III. — Delia Daltim, aged twenty-tive, entered the New York Hospital, January 21, 1880, with a swelling of the sole of the foot. The history was similar to that of the other cases. She said that about two years previous she began to cost of bactrim bactrim prices experience pain and soreness on walking, which she attributed to the pressure of her shoe. About eighteen months before her ad- mission she sprained the same ankle, since which a lump ap- peared below the inner malleolus which has slowly increased. It has given her much pain, especially on walking. The swell- ing had been punctured several times. The first time a little serum fiowed out, but in subsequent punctures nothing was obtained. She generic for bactrim appeared to be in good general health, and

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