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tion of air into the stomach through the surgical sinus shows gross dilatation with complete stricture of the esophagus, and shows the stomach to be some- what increased in size. The liver is somewhat en- larged and the inner border is adherent to the right diaphragm. The spleen is normal and the left dia- phragm is in normal position. From an x ray view- point it is suggested that stricture in esophagxis is due to encroachment of liver upon esophagus with the probability of adhesions in this area" (Fig. 2). Three weeks after the pneumoperitoneum, daily irrigations of the flovent mg esophageal pouch was begun, and this proved beneficial to the patient. A second eso- phagoscopy two months after the pneumoperitoneum showed the esophagus still markedly dilated. fluticasone nasal The mucous membrane, however, was pink and appar- ently fluticasone spray in good condition. Two bougies were passed into the stomach. After returning to the ward the patient vomited a large amount of food which he had put into the stomach. Vomiting of part of food put into stomach continued for four days, after which he began swallowing purchase flovent online without regurgitation. The gastrostomy opening was kept patent merely for urgency. The patient felt well and continued gaining. Three weeks after the esophagoscopy, the gastric fistula having closed, the patient was in good condition, while fluoroscopic examination showed a patent cardia. order flovent online From the evidence offered by pneumoperitoneun-i it seemed likely that the symptoms of cardiospasm fluticasone nose spray in this case were due to the adhesions between the diaphragm and the liver encroaching upon the sub- diaphragmatic esophagus. Several factors probably led to the marked improvement in this patient. First, the gastrostomy which kept him alive and which placed the esophagus at fluticasone propionate nasal rest over a prolonged period. Second, the daily alkaline irrigations of the esopha- gus were beneficial to the inflamed and ulcerated mucosa. Third, after the second esophagostomy and passing the bougies into the stomach, improvement was rapid. It will be recalled that the patient upon moving experienced a flopping sensation in his abdomen after the introduction of the oxygen. In this con- nection it is just cheap flovent possible that the pneumoperitoneum may have loosened some of the liver adhesions and this in turn may have freed the esophagus and led to the marked improvement of the patient soon after the abdomen had been inflated. The use of pneumo- peritoneum has been limited chiefly to the diagnosis of abdominal and pelvic conditions. fluticasone salmeterol So far as I am aware it has not hitherto been employed in the diag- nosis of cardiospasm, the symptoms of which are chiefly supradiaphragmatic. In a similar case, should the pneumorontgenograms reveal an adherent liver, it might be feasible, under anesthesia, to free the adhesions by manipulation through the abdominal wall. The use of oxygen as an inflatant tends to prevent the reforming of adhesions since this gas is not absorbed in less than seven or eight days. Judging from the buy flovent experience gained in this case, pneumoperitoneum should be of considerable value in the buy cheap flovent study of similar obscure cases flovent cost of cardiospasm. The procedure is practically free from danger (3) and according to Stewart and Alvarez, by inflating flovent price with carbon dioxide instead of oxygen or air, the discomfort of the patient is greatly diminished, since the carbon dioxide is absorbed within thirty minutes. REFERENCES. 1. Jackson, C. : Peroral Endoscopy and Laryngeal Sur- gery, Laryngoscope, St. Louis, 1915, p. 510. 2. MosHER, H. P. : Transactions Amer. Laryng., Rhino., and Otological Society, 1920, p. 5. 3. Ruben, I. C. : American Journal of Rontgenology. Hodgkin's Disease in Which Endoscopy Led to Diagnosis* By purchase flovent LEE M. HURD, M. D., F.A. C. S., New York. Case. — F. G., female, twenty years of age, first consulted me on January 20, 1920, because a throat specialist wished to operate on the septum and nasal spray fluticasone some part of the throat to relieve cough. She had had a dry cough for a year and a half which had grown much worse during the past four months, and pain over the left eye and left side of face for the past three months, which usually occurred in the after- noon or evening. There was a moderate nasal dis- charge, but no impairment of breathing. Adenoids were removed sixteen years ago. There was no sore throat, the teeth and ears were normal, and there was occasional hoarseness. She had lost ten pounds in the past four months. There were no night sweats or fever. Her appetite was poor and she was con- order flovent stipated. She slept well. •Read at the fourth annual meeting of the American flovent online Bronchoscopic Society, June 1, 1921. Examination of the nose showed a pale mucous membrane, a slight deviation of the septum, and hypertrophied generic flovent middle turbinate. Larynx and trachea, by laryngoscopic examination, were found normal. The Wassermann buy flovent online reaction was negative ; von Pir- quet was positive; small gland behind left. clavicle. Blood count was 5,200,000 red corpuscles ; white blood corpuscles, 16,000 ; polymorphonuclears, eighty-nine per cent. ; small lymphocytes, five per

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