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Lungs, bronchi 19 4 21. os Urinary bladder 17 2 11. 7 Liver 15 3 20.0 Pharynx 10 2 20.0 Kidney 14 i 7.1 104 In the clinical material of mammary cancer, a total of 858 cases with 144 bone metastases (16.5 per cent.), buy prozac online no prescription needed the vertebras were afifected twenty-one times (2.4 per cent.), the extremities eleven times (1.2 per cent.), among the bone metastases of the 144 cases of metastases alone, we have vertebral metastases in 14.5 per cent., of the extremities 7.6 per prozac purchase uk cent., and skull metastases in two per cent. The author studied his material and established the following order : 1. Vertebral column 49 or discount prozac 28.9 per cent. 2. Sternum 30 or 17.7 per cent. 3. Femur 27 or 15.9 per cent. 4. Ribs 25 or 14.7 per cent. 5. Humerus 13 or 7.6 per cent. 6. Skull \2 or 7.1 per cent. 7. Pelvic bones 9 or 5.3 per cent. 8. Tibia 2 or i . i per cent. 9. Clavicle 2 or i . i per cent. In the study of his material he found that on the vertebral column is found either isolated cancer or the entire vertebra is purchase generic prozac afifected ; there will be entire destruction of the vertebra at one place and again only .small afifected areas. The site of the cancer varies also : the anterior, posterior, and lateral sur- face being mostly afifected. In addition, buy generic prozac no prescription the ver- tebral column is characterized by extensive disease of several vertebrae, while the more removed ver- tebrae are but slightly afifected or not at all. This is hard to explain. Whether here lymphatic stream conditions play a part he is unable prozac discount coupons to say. On the femur the generic prozac price cancer masses are encountered most fre- quently at the proximal buy prozac online no prescription ends and most commonly in the upper part of the marrow cavity of the diaphysis, as well as the neck, and frequently also in the buy prozac online no prescription canada head, less often in the trochanter. Occasion- ally the lower portion of the diaphysis as well as the epiphysis is involved. On the pelvic ring the metastases are usually situated in the iliac fossa and on the outer Darm- heinschaufel, although it may occur at the promon- tory, linea innominata, sacrum, margins of the fora- mina sacralia. On the ribs, the angle and the an- terior section seem to have the preference, whereas in the sternum the distribution is diffuse. On the skull, the parietals and frontals are most commonly affected, more rarely the buy prozac canada temporals. Of the humerus the same is true as of the femur. The same is also true of the tibia and fibula. Bone metastasis begins as a rule at the marrow or periosteum where osteoclasts are found. Cancer emboli do not gain an entrance into the firm bone substance or they get no oportunity to develop. The periosteal cancers usually form circumscribed, pro- jecting tumors, while in the myelogenous forms a diffuse infiltration of the entire bone is much more common. This diffuse infiltration is peculiar to bone ; although very rarely met with in other organs, it is quite cornmon in bone. Carcinoma produces various purchase prozac changes in the bones. There where the carcinoma excites new formation of prozac cost uk bone substance, it is generic prozac no prescription designated by von Reckling- hausen as osteoplastic, ossifying; there where rare- faction is caused, Kolisko designates it as osteo- clastic. Transitional generic prozac stages also are met with, and both conditions may be seen side by side. In mam- mary carcinoma, as well as in thyroid and prostatic carcinoma, construction and destruction occur simul- taneously. Only the prostatic carcinoma is charac- terized by diffuse expansions, bony metastases over the entire bony system, combined with osteoplasia, or in other prozac cost per pill words, osteoplastic carcinosis. The theory of Kolisko, that the prozac price without insurance slow growing of certain organs leads to osteoplastic bone carcinosis, the more rapidly growing, medullary cancers to osteoclastic forms, cannot be accepted in this sense, according to Kaufmann, because in prostatic carcinoma one may observe both processes side by side. SYMPTOMS. When bone metastases occur early, while the pri- mary area is still prozac price per pill small and insignificant, the patient seeks the physician on account of the secondary suf- fering. Examination by the physician then reveals that prostatic, breast, gastric carcinoma, etc., is the primary focus of the bone tumor or there is a his- tory of operation for cancer at some previous time. The symptoms of bone metastasis depend on the location and rapidity of growth of the cancer. Bone pain occurs in the buy prozac uk later stage and is often unbearable, as was the case in my patient. The afifected skeletal areas show various prozac price ireland deformities after localization. In vertebral metastases growths, angular or curved iis6 MATTHEWS: CARCINOMA OF BONE.

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