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Obstruction, from any cause, to the free outflow of the product of any one of the secreting or ex- creting organs elavil amitriptyline of the animal body will result in retention and stasis, favoring bacterial development, followed by absorption of foxines, precipitation of solids, overdistention. ulceration, perforation, peri- tonitis, surgical puncture, and occasionally death. The urologist is most frequently confronted bv this sort of thing elavil used for as the result of ureteral kinks and inflammatory bands, due to kidney dislocation, involving the urinary tract in ways with which we are all thoroughly familiar. Can the same be said of the online elavil relation between the urinary and biliarv tracts and elavil 25 mg the part played by elavil 50 mg the kidney in the inception of jaundice, gallstones, etc.? The liver has oft- times been accused of dislodging the kidney, what may be said of the kidney in di.>;tending the liver? Case I. — My attention was first directed to the coin- cidence of movable kidney and the gallbladder by a patient referred by Dr. \\illiam Neer. of Paterson, N. J.. Mrs. K. T., aged thirty-three, multipara. Patient stated on January 24, iSqv that two weeks ago she had sulTered from pain in tlie back below the right shoulder blade, and in the region of the gallbladder. I'"xamination showed the right kidney palpable three centimetres below the chondral Itorder, enlarged and tender, but replaceable. The gallbladder was not pal- jiable: nor was any jaundice present. She was fitted with a corset, and bad no further attacks up to Xovem- • Heml n» llio oiinunl mrelliiK of the American rroloirli-nl .ViHoi'liilinn, .riiiii' I. imi7. Atlnnllc Cll.v, N. J. 494 GALLANT: MOVABLE KIDNEY AND BILE DUCT DISEASE. ber 7, 1S98, when she was found to be pregnant, and was " lost to sight," though, as the first to direct my attention to this phase of the subject, she is still to " memory dear." elavil uses During the following year several cases were seen in which jaundice was associated with prolapsed kidney, and relieved by wearing a corset ; but it was not until November, 1900, that the writer was brought to realize how serious a jaundice could be induced bv traction or pressure of a movable kid- ney on the bile ducts, as recorded in the American Journal of Ob\Stetrics, ii, p. 86, 1901, a case of re- current jaundice, diagnosticated by Dr. Delafield and Dr. Bull as gallstones ; jaundice was too severe to warrant operation at that time; but pqtient was later cured by posture and the wearing of a cor- set, with but one slight attack during the past seven years. Several cases of the same type have elavil for anxiety been cured by the same means, and this paper is for the purpose of directing your attention to dislocated kidney as the primary cause of biliary obstruction and the inception of cholecystectasia, cholecystitis, cholangeitis. and their unwelcome sequelae. It does not require buy elavil online a long stretch of imagination to under- stand how adhesions may constrict the biliary pas- sages ; how a neoplasm by pressure or growth with- in the ducts may interfere with the bile current; or a calculus within the cystic or common ducts or the ampulla of Vater obstruct the outflow of bile; but, in the language of Moynahan, " much has been written and but little known as to the first cause of the first stage in the development of duct disease of the biliary tract. In the absence of a more reasonable explanation of the inception of cholecystitis, etc., and in view of the experience of the past seven years in the treat- ment of these elavil buy cases, we have been led to attribute the genesis of this disease to traction by a more or less movable kidney on the cystic or common ducts, and in substantiation thereof would elavil 10 mg offer for your consideration the following data elavil 50mg : The Class of Cases. — Cholecystitis, with or with- out jaundice, is cheap elavil most commonly met with elavil 10 among the same types of women as those in whom elavil mg we most frequently find dislocated kidney. The Attacks.— The onset of the trouble is usually in the form of a so called " bilious " attack, charac- terized by sick headache, indigestion, epigastric pain, bloating, nausea, vomiting, making the patient feel wretchedly enough to be glad to lie down and in a short time go to sleep. The horizontal posture elavil 25 allows the kidney to recede enough to elavil for relieve the -tension elavil 50 on the ducts, puts an end to the biliary ob- struction, and for the time being to the attack. The Course of the D(.r^a.y^.— Subsequently these attacks recur, but with increasing severity, longer duration, greater fre(|uency — elavil 25mg usually designated Dietl's crises. With all these features, and in addi- tion, there is added severe pain extending from the epigastrium or hvpochondrium through to the elavil 10mg tip

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