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maining, which has a great tendency to con- Order Geodon tract. The appendix itself may act precisely as a band, becoming adherent by its tip to the parietal peritonieum, to the mesentery, to the in- testine, to the uterine annexae, etc. In these 33 reported cases, the appendix was the obstruct- ing band in eleven cases. In anj' case the band predisposes to a dangerous condition, for it may lead to anj' one of several occurrences. A band, attached to an intestinal loop, by its contraction may draw the intestine out into a spur, whose free peristaltic movements are lessened by the adhe- sion, both causes consequently placing an ob- stacle in the way of the circulation of faeces. As the stasis increases, the kink increases, until final- ly the obstruction is Purchase Ziprasidone Online complete. Or, again, a band may become attached by its two extremities to a loop of intestine parallel to its long axis. Con- traction of this Buy Geodon Online band ma}' produce either a kink or a torsion of the intermediate portion of bowel. Or a band may be formed in front of a piece of in- testine which it compresses. An attack of acute in- digestion may distend the intestine above the loop, and the increased distention and peristalsis may cause it to kink so as to obstruct its lumen, and cut oflf the circulation at this point ; or a com- plete kink may be caused by some sudden blow 368 McWILUAMS: INTESTINAL OBSTRUCTION. Buy Ziprasidone Online N. Y. MBD. .lotlR. AND I'llILA. MBD. JOCBNAI^ or exertion. A loop of intestine may force itself beneath this band, and, by the same causes act- ing as above, a twisting, or volvulus, be produced beyond the band, cutting off the circulation of blood and faeces. Again, a band may form the partial boundary of an opening through which a loop of intestine may force itself and become strangulated, and we then have an internal, stran- gulated hernia. A loop of ileum may become at- tached Order Ziprasidone Online to the small intestine in immediate prox- imity to the inflamed appendix. These two loops may suddenly become twisted about their points of attachment, so as to produce complete obstruc- tion. There may also be formed true knots of the intestine. Unless each of these conditions is speedily relieved, gangrene of varying lengths of the intestine, from cutting Purchase Ziprasidone oflf of the vascular cir- culation, may supervene, resulting in perforation and fatal general Order Ziprasidone peritonitis. A localized abscess is rarely formed, because perforation is so rapid as to occur before protecting Buy Geodon adhesions have a chance to form, which would wall Buy Ziprasidone in the abscess and thus prevent infection of the general peritoneal cav- ity. Obstruction is not so apt to occur during the first attack of appendicitis as some time after- wards, since, during the first attack, the adhe- sions are soft and yielding, not yet having had time to organize. Kocher (Mittheil. aus Purchase Geodon den Grenzgeb. de Med. und Chir., 1898, page 227, Vol. IV) lays down in part the following propositions: i. The chief danger in each case of ileus rests upon the disturbances in circulation in the bowel wall, and its conse- quences, namely, venous hyperaemia leading to haemorrhages, and infarcts, oedematous infiltra- tion, and the collection of decomposing fluids in the intestine, injury and exfoliation of the epi- thelium, and the consequent permeability of the bowel wall for the passage of ferments, toxic sub- stances, and bacteria. 2. This permeability leads, on the one hand, to general intoxication and in- fection, and, on the other hand, to local inflam- mations of the bowel Cheap Geodon walls, necrosis of the same with ulcerations, perforations, and peritonitis. 3. The circulatory disturbances in the intestinal walls are caused by pressure, first, from without upon circumscribed portions of the wall, and also by pressure upon the mesenteric vessels, due to strangulation by bands, internal herniae, volvuli, invaginations, etc. Secondly, the disturbances in the circulation in the intestinal walls are caused by pressure from within by the stagnation of the Buy Cheap Ziprasidone intestinal contents, increased transudation, and secretion above the obstruction, and the conse- ■ xjuent overstretching of the bowel walls. As a result of the previous inflammations, we may find that the appendix itself is simply a band of connective tissue, its lumen having become obliterated by the antecedent inflammations. 2. The chronic types of intestinal obstruction, resulting from inflammations in and about Generic Ziprasidone the

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