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plasm. Dr. Conner said he would like to ask about the na- ture of the case; he did not know just what was to be understood by the Buy Geodon Online term metaplasm. Dr. Gibney. replying to Dr. Conner, said it meant re- placement by tissue of the Order Geodon same embryological nature. This tissue replaced normal bone tissues by meta- morphosis; these changes made the normal bone look very much like bone cysts. Subperiosteal cy.sts were often benign. He had seen many called sarcoma and treated as such. This case had gone on eight or nine years; Dr. Whitbeck's had gone for four or five. The cases were painless and shortening of the leg Buy Ziprasidone was the only symptom. Sometimes the head and neck of the trochanter major and minor were involved or part of the shaft. One of Freiburg's cases occurred in the Feb. 7, 1914 J MEDICAL RECORD. 267 tibia; one in the shaft of the femur. These were re- ported a year ago before the Chicago Medical So- ciety. In Murphy's last volume of clinics he described one that looked like hip disease without the pain. The patient was not lame at all until the adductor became shortened. Dr. Gibney did a cuneiform osteotomy over the deformity as was done by Freiburg with g-ood re- sult. The patient would be shown at the next meeting, with the a--ray pictures before and after. Dr. Jefferies, the pathologist to the hospital, had iust reported as follows: "The tissue sent by Dr. Gibney shows bone and cartilage both of which exhibit inflammatory changes, the Purchase Ziprasidone Online etiology of which does not appear. No neoplasm was observed on section cut. One bit is a portion of perichondrium showing acute inflammation." Dr. Whitbeck said that the x-ray of this case showed a remarkable resemblance to the case presented by Dr. Purchase Ziprasidone Gibney. The patient, a girl of 14 years, came to the orthopoedic clinic at Bellevue last summer. Her history was that 5 years ago she fell Order Ziprasidone and struck her hip on the left side; there was some pain for about a week but no more trouble until about 20 months ago when she began to limp, the leg becoming shorter; there was no fresh injury at the beginning of the limp and no pain Purchase Geodon or discomfort. She went to a large ortho- poedic hospital a year ago and a spica was applied which she wore for a week. This was taken off at Generic Ziprasidone home and she had worn no appliance since. Six months ago the patient fell again, striking the same hip ; there was some pain and soreness about the hip; she was admitted to one of the large hospitals and put. in bed with extension ; she was then transferred to Buy Cheap Ziprasidone the Island for four months whence she went home, the symptoms having disappeared. There was no pain or discomfort but the shortening and limp continued. She was brought to Dr. Whitbeck last summer because of the limp which was very noticeable when she walked. At the time when patient was first seen by Dr. Gibney, two months previously, there was slight flexion and adduction. Buy Ziprasidone Online Over the left trochanter was a large mass which fitted into the fist, not tender, not movable, and very hard. The motions in the joint were moderately limited, especially abduction and full extension. Dr. Gibney supposed that she had either an old fracture or an old tuberculous healed lesion. The patient had a very great enlargement of the neck of the femur, pos- sibly an old fracture; below that a nodular mass; but it was hard to say whether the deformity was a frac- ture of 5 years ago or 6 or 8 months ago. Dr. Whit- beck had supposed the case to be sarcoma, but it re- sembled so closely Dr. Gibney's case that, on examina- tion of that case under exploratory operation, he was inclined to think this case also was an osteitis fibrosa. The girl had gone to Bellevue Hospital for exploratory operation, but it was refused. At present the patient had no symptoms and walked to school; she had not lost weight ; was in perfectly good health ; the leg showed an inch and a half shortening; the limitation of motion was only moderate. Sarcoma of the Clavicle. — Dr. Gibney showed this case. The patient came into the hospital on Dec. 16, 1912, with a tumor involving the inner half of the right clavicle, of three weeks' duration. It had grown very rapidly and was regarded as a sarcoma. The operation by Dr. Coley, who operated at once without waiting for a microscopical confirmation of the diagnosis, con- sisted of total excision of the clavicle Order Ziprasidone Online and removal of the tumor. The specimen was a periosteal sarcoma of the class called small, round-celled sarcoma. The boy remained in hospital one week after the removal. It began again to Buy Geodon enlarge. Dr. Coley gave toxins and it responded promptly and was apparently cured. The patient was shown before the New York Surgical So- ciety in April. He returned in June with the tumor growing again in the pectoral region and neck, hav- ing attained the present proportions, but it did not re- spond to the toxins or the x-ray, except that the gro^vth was held in check, but showed little decrease in size, and he suggested bringing the patient to let Dr. Abbe see if the case was a suitable one for radium. Both Dr. Coley and Dr. Darling thought that the toxins and i-ray should be continued, but gave little hope that a cure could be effected. Dr. Coley considered the case inonerable. Dr. Darling said that when the patient came to him about a month ago the tumor was the present size. He was given the usual x-ray treatment .3 times a week for 4 weeks; during that time it got no larger. By examination it seemed that the sulci were a little deeper and that there was Cheap Geodon a little more room under the jaw. The cough and the breathing embarrassment be- came better. Since the use of the toxins the x-ray treatment had not been kept up. The tumor had not grown for two months. The x-ray treatment was given 3 times a week over a period of 6 weeks, filtered through 3 mm. of aluminum. The erythema dosage was not measured.

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