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We must then endeavor bring the cut end into the bladder.

It fixed in the edges the wound, slit for a certain distance towards the bladder, and then a broad, flat surface freshened for unite The openings the ureters in the bladder according Simon correspond a point in the vagina about an inch outside the outer edge the uteri, and about an inch in front Simon has operated upon quite a series cases where the fistula was at this place or extended but never observed a symptom which could with certainty refer closure the ureter. In all these cases the ureter was either not included, or if was the thread cut through the ureter quickly that no marked interference with the flow urine ensued. If the ureter seen project into the fistula, can be pushed away into the bladder. Pawlik in every fistula operation introduces an elastic catheter through the urethra into each ureter, only removing them after the operation finished. If this precaution, however, has not been taken, and if after the operation there occur symptoms of interference with the flow urine, colicky pains originating in the kidneys and radiating along the course the ureters, with vomiting, etc. the sutures must at once removed.

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Finally, before putting in the Figs. Needles and Needleholder.

After Neugebauer. stitches must best freelance content writing websites certain that the bleeding surface everywhere smooth and clean all projections, etc.

may snipped off with the scissors. The edges the fistula being now fully prepared, must decide upon the material used for the sutures. Each surgeon naturally advocates the kind uses himself Simon likes Chinese silk, whilst Sims, with Bozeman and Hegar, prefers silver wire.

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I have used silk, silver wire, and iron wire, and in one case where there was but very little tension upon the elongated fistula, even catgut, and have had successful results. Simon objects wire because says very liable become the nucleus a calcareous deposit.

But this happens just as often with silk, see Simon's case, and silk cannot remain as long in situ as can the wire.

When there much tension, when the loss tissue is great, when the stitches have remain or more days, silver wire or iron wire decidedly preferable. Only recently I removed some iron wire from the vesico-vaginal septum which had lain there for weeks without causing a trace local irritation. Silkworm gut or Fil paraphrasing strategies de Method Operating when there Atresia the Urethra between two i need help writing a reflective essay Florence a very excellent material, and I have used almost exclusively in fistula operations for the last years. The hest plan use the materials most suitable for each case, and sometimes use more than one kind at an operation. Pippingskjeld uses alternate iron and copper or iron and silver threads at distances of an inch, and claims this galvanic suture have obtained union when could not have The needles, are either curved ones various sizes used with a Simon or Rose needleholder, or they are long and hollow like those Simpson or Salter or Neugebauer writing services Hagedorn's needleholder may also used. It was formerly the custom put the stitches at different distances from the margins the wound and Simon and Kuchler used the so-called double suture, the more distant 8 inch threads being designated tension, and the nearer ones uniting sutures. Latterly Simon himself gave up these tension-sutures compare and passes all his sutures one or two lines from the edge the wound. 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