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The following Buy Prilosec case illustrates the conditions Purchase Prilosec that prevail when the ethmoid area is involved: Case VI. — C. E., male, 12 years. Had a severe rhin- itis which resisted treatment for six weeks, when I first Prilosec 20 Mg saw him. He complained of dull headache all over the head; a purulent discharge from both nares and inability to breathe through the nose. Both middle turbinals Cheap Prilosec were swollen and occluded. The meatus, and considerable pus came from the ethmoid region. Un- der shrinking with adrenalin, followed by warm saline irrigations, the purulent discharge completely Prilosec Cheap ceased Prilosec Buy on the right side, but it was necessary to open the an- terior group of ethmoid cells on the left side before the pain in the Otc Prilosec head disappeared, and the purulent dis- charge entirely ceased. In some fulminating forms of sinusitis in the child and in the persistent suppurative cases resist- ing endonasal treatment, with impairment of the general health, or violently acute symptoms, exter- Feb. 21, 1914] MEDICAL RECORD. 333 nal operation will be indicated, bearing in mind, however, that previous to any radical external oper- ation in the child a careful examination should be made for any morbid changes in adjacent areas which may be keeping up 20 Mg Prilosec the sinusitis by interfer- ing with drainage, as it has been my experience that in not a few instances treatment for a consid- erable time may be of no benefit until an hyper- trophy of the middle turbinate body has been re- moved, or possibly an adenoid mass in the naso- pharynx which has acted as a constant source of reinfection. It should be emphasized that the en- largement Prilosec 20 of the middle turbinate body is a serious obstacle to the cure of inflammatory tnanges in any sinus, and until this has been relieved the sinusitis may prove most obstinate to treatment. The at- tempted Prilosec Otc removal of purulent material in Coupon Prilosec the child, by suction or negative pressure, has not in my hands been of much value, and I am not certain but that it has exercised a harmful effect. Free drainage must be secured before cure can be obtained and if intranasal treatment fails to obtain such a result, then whatever radical operation may be selected should be performed. It should be also emphasized in this connection that free drainage means free nasal respiration, and this is another prominent factor which must be taken into consid- eration in the surgical treatment of these condi- tions. In Order Prilosec addition, it is essential that whenever pus is found jn any c " the sinuses it must be evacuated as a surgical princij. 8. On this basis rests the sur- gical treatment of all chronic sinus affections, with the various modifications of technique in the care of individual sinuses, dependent upon the peculiar ana- tomical structural characteristic of each. When the external radical operation on the frontal sinus is under consideration it is essential therefore as a preliminary step to remove the an- terior portion of the middle turbinate body in order to secure thorough drainage. The external opera- tion on the frontal sinus in the young should be performed with the greatest reluctance in the ab- sence of external or intracranial symptoms. When it is necessary to operate on this Online Prilosec sinus it is well to attempt an osteoplastic procedure and to form an anterior bony flap. In those cases where the frontal sinusitis has been unrecognized, a fistula may have resulted and the condition has possibly been treated as a dacro- cystitis. The only method by which relief may be obtained is by thoroughly opening the sinus ex- ternally, cleaning out the ethmoid cells which are always concurrently involved, and obtaining free drainage through the nasal chambers. Before per- forming a radical external operation for frontal empyema Prilosec Purchase on the child it is well to remove the entire Omeprazole Prilosec group of ethmoid cells. In children the antrum rarely requires external operation, as opening through the lateral nasomaxil- lary wall the irritation is usually sufficient to cure the suppuration. In the absence of the diseased osseous tissue or new growths, external operation is never indicated; a large opening through the pars membranacea giving better results Prilosec Online in every way than a Caldwell-Luc operation. In young children operative work upon the maxillary antrum must be performed with great caution on account of the re- lation of the teeth at this age, as such procedures during the formative period of the teeth are apt to result most disastrously. In conclusion, as a result of my experience, I be- lieve that in young children radical external opera- tive procedures for the relief of purulent sinusitis are infrequently indicated, and are not as produc- tive of satisfactory results as intranasal procedures, and while the same may be said of older children, yet in such, when the sinuses approach the adult type, the same What Is Prilosec indications Prilosec Omeprazole for treatment and oper- ative procedures apply as in the adult. 4 5 East Prilosec Mg Sixtieth Street. CARDITIS Bv GEORGE MONTAGUE SWIFT, M.D..

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