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or even a suspicion of ectopic gestation, we believe that all cases should be operated in as soon as a fliagnosis is made and the general condition of the patient warrants it. With inflammatory diseases of the tubes and ovaries the conditions are different. If an operation is performed too early, there is fluticasone propionate nasal an increased risk to the patient and important organs may have to be sacrificed. It is therefore best to delay operation, if the condition of the patient will permit, until the acute exacerbation has subsided. In the doubtful cases, therefore, that is, the cases in which a certain diagnosis between ectopic gestation and inflamma- tory disease buy flovent of the appendages cannot be made, it is best to delay the operation. It will be noticed, in the table, that the average delay or period of observation was 4.5 days for the ruptured and 3.9 days for the unruptured cases ; also that the longest delay for the ruptured cases was nineteen days and for fluticasone salmeterol the imruptured sixteen days. Average minil)er of days purchase flovent online silent in tlie hospital: Ruptured 21.7 days Unruptured 2\ days Period of ol)servation (admission to operation ) : Kuptiired. L'nniptiireJ. Longest 19 days Longest 16 days Shortest immediately Shortest i buy flovent online day Average 4.5 days Average 3.0 dayi Duration of time from rupture to operation : Longest 35 days Sliortest 3 liours Sterility. The relation between ectopic gestation and ])revious pregnancies is shown in the following table : Number of cases where there were previous pregnancies : Children only 20 Miscarriages only 9 Both 13 None 4 It is usually accepted that an ectopic gestation frequently follows a period of sterility. This point was confirmed by the cases in this series. In eleven cases, or twenty-five per cent, of those who were married, there had nasal spray fluticasone been a period of buy cheap flovent at least five years just previous to the ectopic gestation, during which the patient had not been pregnant. The long- est period was twenty years. Inflammatory condition. The same is flovent price true fluticasone spray of in- flammation of the appendages. It is generally be- fluticasone nose spray lieved that inflammation of the Fallopian tubes by narrowing the lumen and in this way preventing the ])assage of the impregnated ovum to the uterus is an important etiological factor in ectopic gestation. Of the forty-four cases in this series, seventy-six purchase flovent per cent, gave a history of inflammation of tlie ap- iio8 TAYLOR: ECTOPIC GESTATION [New York Medical Journal. pendages, or it was discovered at the time of the operation. AlenstruaPion. In eighty-one per cent, of the cases there was a history of irregularity in the men- strual bleeding. In 8.7 per cent, there was a his- tory of amenorrhea lasting to the time of operation. Pain. In 69.6 per cent, of the cases of ruptured ectopic sac, the classical symptoms of acute local- ized sharp pain, with nausea, vomiting, flovent cost and fainting were present. Of the unruptured cases 92.3 per cent, suffered from pain on the order flovent side of the diseased tube. Breasts. The breasts were enlarged and tender in forty-four per cent, of the cases and in fifty-five per cent, they showed no change. Blood examinations. In an unruptured ectopic sac there fluticasone nasal is no reason to expect any change in either the red or white blood cell count, excepting from excessive menorrhagia. As there is no bleeding in such cases, there should be no change in the red blood cell count due directly to the ectopic condi- tion. The white blood count may be moderately in- creased from peritoneal irritation, but the increase should be slight. In the unruptured cases in the series, the average number of white blood cells was 8,670 with cheap flovent seventy- three per cent, polynuclear cells and twenty-five per cent, lymphocytes. In cases of ruptured flovent online ectopic generic flovent sac, there are several factors which influence both the red and the white cell counts. These factors are the amount and sud- denness of the hemorrhage, the time that has elapsed between the order flovent online hemorrhage and the blood ex- amination, and finally the presence or absence of in- fection. If the bleeding is flovent mg slow, such as may occur from the uterus over a long period, or from a number of moderate hemorrhages from the ruptured tube, or from the slow continuous bleeding that sometimes occurs from the end of the tube, then there is a

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