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Related post: GROSSMAN: SPASTIC PARALYSIS IN CHILDREN. 495 an enormous growth of the buttock. He first noticed a swelling on Buy Cheap Medroxyprogesterone the left hip, in 1905, but it did not grow much until a year ago, when it began to enlarge rapidly. There were small masses also on the right shoulder and thigh and on the right leg. The growths were all semitluctuating. There was no history of tuberculosis or of syphilis. The man complained of no pain, but was greatly emaciated and anemic. On account of the size of the tumor (Fig. 2) he was unable to walk, and when he stood without support he fell toward the left from the tumor's weight. It was an inoperable case, but the patient constantly implored us to remove at least a portion of the mass, being perfectly sen- sible of the risk. Accordingly an excision of the tumor was attempted. After making a very long incision, I found that a part of the growth was too deeply imbedded to re- move. From this part about a pint of yellowish fluid was evacuated. The basal attachment was the intermuscular septum of the gluteal region. The patient's condition be- came critical on the table and the operation was not com- pleted. He died an hour afterward. The tumor was a typical myxosarcoma. Not a few sarcomata of the buttocks have been observed and some of them attained to large sire. A huge one is pictured in the American Textbook of Surgery (8). The enormous tumors are usually seen in patients of the lowest class, who through ig- norance and neglect allow them to grow to these proportions. Almost invariably such tumors in Buy Medroxyprogesterone the beginning were small, of slow growth, and non- malignant, but Purchase Medroxyprogesterone Online assumed sarcomatous change after a long period of quiescence. Injury or irritation may play an important role, either before the orig- inal growth develops or after it becomes large enough to be vulnerable. In a concluding paragraph it may not be out of place to mention some other rare cases of sarco- mata collected from the bibliography. Primary sar- coma of the tongue, of which there are very few cases on record, is referred to in Guy's Hospital Gazette (9), in which one case is reported and else- where by Downie (10), who presents two cases. The same number of the Gazette contains notes on a sarcoma of the esophagus, Order Medroxyprogesterone growing from the an- terior wall and dilating the lumen instead of con- tracting it, and also a large sarcoma of the neck, involving the larynx — both with interesting autopsy findings. MacDonald (11) and LeConte (12) each report a sarcoma of an undescended testicle, the former case appearing in the groin and weighing over six pounds ; the latter situated retroperitoneally and mistaken for a peritonitis of appendicular origin. Healy (13) relates a case of primary sar- coma of the pancreas Order Medroxyprogesterone Online with extension to the liver, while Jores (14) contributes an angiosarcoma of the spleen and liver. Malherbe's (5) remarkable list contains a sarcoma of the plantar aponeurosis, and one of the dura mater. Boldt (15) extirpated a primary melanotic sarcoma from the posterior vaginal wall, which proved to be malignant, evi- dences of recurrence being present in two weeks. BIBLIOGRAPHY. ^ I. SCHEPELM.\NN: Med. Klin., xi, 741. 19 13. 2. SPICER and COLLIER: Lancet. August s, 1899. 3. GEIST and WILENSKY: Annals of Surgery, Ixii, 11, 1915. 4. DUCHAMP: Loire med., Nov. 15. 1898. Purchase Medroxyprogesterone 5. MALHERBE: Recherches sur le sarcime. 6. MOSHER: Brooklyn Med. Jour., .vviii, 226, 1904. 7. BOUFFLEUR: Ann. of Surg. Nov., 1899. 8. American Textbook of Surgery, 1892, p. .198. 9. Guy's Hasp. Gazette, iii, 186, 1889. 10. DOWNIE: Bnt. Med. Jour., Oct. 21, 1899. 11. MacDONALD: Albany Med. Jour., xiv. 65, 1893. 12. LE CONTE: Internal. Clin., 17, iv, 125, 1907. ■'3;„HEALY: Jour. Roy. Army Med. Corps, iv, 362, 1905. 14. JORES: Centralbl. f. allg. Path. u. path. Anat., xix, 662, 1908. ■ 5. BOLDT: Trans. N. Y. Obstet. Soc, 153, 1906-7. 423 Fayetteville Street. SPASTIC PARALYSIS IN CHILDREN. With a Report of Seven Cases, By Jacob Gro.ssman, M. D., New York, Orthopedist, Lebanon Hospital, Out Patient Department. The etiological significance of traumatism in the production of nervous diseases in childhood is fre- cjuently overestimated by laymen and probably also by physicians. In the popular mind traumatism plays the same part in the etiology of nervous dis- eases as catching cold in that of the internal diseases. Nevertheless we cannot deny that traumatism is an important causative factor in many diseases of the brain and spinal cord, and that birth injuries may be responsible for the most severe lesions of the central nervous system. Intracranial hemorrhage is one of the common results of a birth injury or of a traumatism occur- ring at some later period. Among the causes of cerebral hemorrhage after childbirth, injuries, whooping cough, purpura, severe atrophy, and sinus thrombosis play important roles. The symptoms in this condition resemble those of brain einbolisiri and do not differ materially from the symptoms observed in the cerebral hemorrhages in adults. Intra partum hemorrhage into the lueninges pos- sesses a clinical importance which even yet is not properly Buy Medroxyprogesterone Online appreciated. Where many infants have been examined post mortem, hemorrhages within the cranial cavity were often encountered. There is no doubt that in the majority of cases of otherwise healthy newborn infants the blood is absorbed with- out producing symptoms ; but in some cases the hemorrhage is of such extent that it renders life impossible. Between these extremes there must be a long series of intermediate degrees, the recognition of which is probably impossible and which no doubt are of great importance in the production of cere- bral syinptoms that manifest themselves later. In most cases the occurrence of congestion and lacera- tion of the bloodvessels within the skull, is readily explained by a severe protracted labor with marked displacement of the cranial bones (Kundrat). Easy spontaneous delivery may also lead to submeningeal hemorrhage (Finkelstein). This is particularly likely to be the case in premature labors, or where there is a pathological condition of the blood or a congenital arterial predisposition. In most of the cases the heinorrhage takes place at the vertex, somewhere in the region of the two paracutral lobules, where heavy deposits of coagu- lated blood are found. The hemorrhage may in- volve one or both convexities of the cerebral hemi- spheres (Sarah MacNutt), more rarely the base of the skull and the cerebellum. The subjacent por- tions of the cortex are compressed and infiltrated with blood. In children who have survived a hemor-
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