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There is no doubt of the advantages which may lie gained by a radical removal of a gastric neoplasm when compared to late " gastroenterostomy " as a last resort. The best result that we may expect from a gastroenterostomy is a prolongation of life for six to 1 8 months, and even under the most favor- able circumstances this short reprieve for the (loomed unfortunate is not entirely free from very annoying symptoms. The proportion of mortality from these two operations is almost the Buy Nortriptyline same, but the remote results following complete resection are M> much better that the hope of a possible cure in the near future may be entertained. There are his- tories on record in which life has been prolonged from four to eight years following pylorectomy. an advantage not to be underestimated if one consid- ers the age of the patient when this operation is usually performed. In view of these facts, it is the dut\- of the in- ternist to turn the sufferer from gastric carcinoma over to the surgeon as early as possible after a diagnosis can be made. It must not be forgotten that the highest mortality from resection Nortriptyline 25mg of gastric neoplasm is obtained when adhesions to neighbor- ing organs have already formed, and that operation is entirely out of the question when neighboring glands have become infected. It is therefore of the utmost importance to diagnose these cases at a very early stage of the disease, and the physician must not neglect to employ all the known methods by which such a diagnosis may be consummated. What is meant by an early diagnosis? Some authors claim that as long as there is no palpable tumor a Nortriptyline 10 Mg radical operation should be performed, for so soon as the Buy Nortriptyline Online tumor is large enough to be pal- pated a considerable part of the stomach wall has already been attacked and possibly the neighbor- 298 OUR Cheap Nortriptyline READERS' DISCUSSIONS. [New York Meuical Journal. ing and remote glands have been involved. This assertion, however, is only partly correct, for it is a matter of record that palpable tumors and even large parts of the stomach wall have been siicces- fully resected. It is desirable, however, that the patient should be placed in the hands of the sur- geon before the appearance of a tumor, and what is still more important, before the sufferer has be- come so emaciated and weakened that the result of the operation may be influenced by these very fac- tors. Order Nortriptyline Online What symptoms should lead us to diagnosticate a carcinoma in the early stage? Unfortunately we do not possess a single characteristic symptom in the early stages of the disease, and even if we were in possession of such symptoms, patients in the vast majority of cases do not seek the phy- sician until later in the disease, for the manifesta- tions of this ailment are frequently very mild in the beginning, and home remedies are used until more serious symptoms develop. Even then the import of the case may not be recognized by the physician, and more valuable time is lost by treat- ment for nervous Nortriptyline 25 Mg dyspepsia, gastritis, and the like. In spite of the fact that there are no characteristic symptoms Nortriptyline 25 peculiar to the disease in its early stages, there are certain facts which, if rightly interpreted, and if the entire picture Nortriptyline 10mg of the disease is analyzed in a painstaking manner, will lead us in the right direction. While the symptoms per se may mean very little, when taken in connection with the gen- eral appearance of the patient, the fact that the anjemia, emaciation and loss of strength are out of proportion to the mildness of Generic Nortriptyline the symptoms, will point toward a serious state of afl:'airs. It is well to make it a rule to regard all those cases with suspicion wherein persons above forty, with pre- viously healthy digestive organs, dyspeptic symp- toms and persistent loss of appetite, especially for animal food, begin to be complained of. All such cases, when coupled with rapid loss of strength, require the most careful analysis, and the physician must not consider his duty performed until he has either proved or disproved the exist- ence of malignant disease. In this connection the family history of the patient with regard to carci- noma must be carefully inquired into. A history of more or less recent traumatism in the region of the stomach must be taken into consideration, as a trauma may give an impetus to the develop- ment of a neoplasm in predisposed individuals. The motor and secretory functions of the stomach must Nortriptyline Mg be carefully examined. One should test for an absence of hydrochloric acid and the ferments

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