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admission, the testicle measured about 3 by 2 cm. There was no pain or tenderness on pressure. Palpa- tion of the cord was normal; the inguinal rings were Keflex 500mg normal. There was nothing in the past history of the child that would have 500 Keflex Mg accounted for its present condition, in the way of injury, or other accident. The family history, as far as the mother knew, was negative. The general appearance of the child was Order Keflex Online good, and he looked well nourished and developed. No glandular enlargement could be felt in any part of the body. The lungs were perfectly normal; there were no heart murmurs; the pulse rate and rhythm were regular and of good quality. The abdomen was normal; no masses could be felt. The reflexes were normal. Von Pirquet reaction proved negative. The child was operated upon a few days after ad- mission to the hospital. One inch incision on the left side, parallel to Poupart's ligament; fascia divided, and the testicle expressed out of scrotum; gubernacu- lum cut away, the tunica vaginalis opened and re- Keflex 250 Mg moved from testicle; vessels of testicle ligated; epididymis ligated, and testicle cut away; skin sutures of light silk-worm gut. The wound healed by primary intention. The pathological report is as follows: "Anatomical Diagnosis: Tuberculous epididymitis. Gross appear- ance: — Specimen consists of a Keflex 500mg Price testicle removed from a child of three years. It measures 3 by 2 by Keflex 1000 Mg 1.5 cm. It Keflex Oral Suspension has been cut in several directions. The outer sur- face is still covered by a portion of tunica, and attached to Keflex 400 Mg it is about 2.5 cm. of the vas deferens. On section, the normal architecture of the organ is almost complete- ly obliterated. The parenchymal tissue is separated in small nodules and islands by wide, glistening, white bands of fibrous tissue. The distinction between the epi- didymis and the testicle proper is Keflex For Mrsa difficult to make out. The greater portion of the mass, however, appears to be composed of enlarged epididymis, the body of the testicle apparently being represented by a small nodule about 1 cm. in diameter. In some regions are found yellowish cheesy necrotic areas, resembling tubercles. The vas deferens is exceedingly small, but does not appear beaded. No distinct tumor can be made out. "Microscopical examination. A section through en- larged epididymis shows the normal structure to be almost completely replaced by abundant typically Keflex 750 Mg Jan. 24, 1914] MEDICAL RECORD. 147 formed tuberculous granulation tissue. The tubules of the epididymis are represented by scattered ducts lined by columnar epithelium embedded in this granu- lation tissue. The tubercles are both discrete and conglomerate. In some regions, extensive areas of caseation are found, but these are comparatively slight. Langerhans' giant cells are very numerous and large. The vas deferens appears normal as does also the accompanying tissue of the spermatic cord. The small portion of glandular Dose Keflex tissue in body of the Antibiotics Keflex testicle appearing in the section, also appears normal." Under the heading of "Three Cases of Tubercu- .losis of the Testicle in Infants," reported by Vi- gnard and Thevenot,' the authors state that: "Tu- berculosis of the testicle is relatively rare in chil- dren. The frequency of the disease being four times less in children, as compared to adults. The ad- mitted proportion of testicular tuberculosis is one case in two hundred cases of infantile tuberculosis. Many latent cases in general tuberculosis are apt to be overlooked unless the little patients are subjected to a routine examination. Purchase Keflex The Keflex Order reported cases show the predominance of this disease in very young children. Of these three patients one was 11 months old, another was 14 months old, and the third Keflex Online was 6 Keflex Purchase months of age. Cholmeley's patient was 6 months of age, Hochsinger's patient 13 months, and two cases of Swoboda concerned nursing infants. The four patients of Lannois were between Keflex Dosage 6 and 13 months of age. Among seventeen patients of Julien twelve were under 2 years of age; Dreschs- fell emphasized that the tuberculosis may be noted at the time of birth. Vignard found no analogous cases in his review of the literature. Testicular tuberculosis may appear either as a primary isolated manifestation or as a secondary complication in the course of a visceral tuberculosis. Primary tuberculosis is, at the same time, very re- stricted ; unilateral, and not extending above the in- guinal ring, it spares Buy Keflex the better portion of the vas deferens, the seminal vesicles and the urinary or- gans. Hence, it is essentially curable. It does not especially involve the epididymis, as in adults, nor is it essentiallj' testicular, but involves both the testicle and the epididymis, blending the organs into a pathological mass in which the primary in- fected organ can no longer be distinguished. Mac- roscopical examination shows that the mass, which is at first diffuse and indistinctly outlined, has a certain tendency to become encysted ; the connective tissue which proliferates in the vicinity may even infiltrate the gland in its entire extent, and atrophy through testicular sclerosis is often the outcome of the infection. In other cases, the tuberculous nodule suppurates, as in adult cases, it is adherent to the skin, then a fistula opens at the exterior, at the level of the tail of the epididymis, as is the rule in tuberculous fistula. More rarely, other forms of tuberculosis are observed, such as tubercular granulations or nodules scattered in the thickness of the gland; granulations or nodules in the head or tail of the epididymis. The vas deferens is often involved, but although it becomes indurated, as in adults, it is attacked only in the lower segment which is still enclosed in the scrotum. The tunica vaginalis is often the seat of a more or less profuse exudation, in other cases, the two layers have be- come adherent through a plastic process, Keflex Dose forming a shell, as it were, around the genital gland.

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