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[Medical Nbwi whose painstaking investigations are well known, has generously furnished me with methotrexate rxlist the following ac- count of the result of his recent microscopic work on this subject: "Sections of the piece of lingual tonsil submitted to me for examination were made in such methotrexate canada a way that they fell through the lacunae containing the mycelial tufts. Staining with hematoxylon-eosin shows methotrexate 12.5 mg the mycelial threads or straws lying in methotrexate for ms close apposition with the topical methotrexate thickened epithelial lining of the crypts. Desquamated epithelial cells are seen among the straws. With this stain the spores are not differ- entiated. I cannot discover in this specimen or in others which I have hitherto examined any evidence of the mycelial threads penetrating the subjacent tis- sues, or even of being fairly within the epithelial layer. With the eosin stain, however, may be seen, close to methotrexate 2.5 mg tablet the crypt, fibrous tissue with long straight fibers which resemble somewhat the mycelial threads, but when the gentian violet stain with the Gram- iodin decoloration is used, it is seen that the epithe- lial straws are sharply defined from the tissues, and there is no appearance of their having penetrated into them. Kelly claims, however, that in some cases this is noted. It is possible, though I will not venture a positive assertion on this point, that his stains have deceived him as intimated above. ' 'Both Kelly and Siebenmann assert their belief that the thickening of the epithelial lining of the crypts is the initial lesion and methotrexate pharmacology the mycelial growth a sec- ondary phenomenon. This assertion I am also methotrexate usp not at present in a position to positively controvert, but I am strongly of the opinion that this so-called 'keratosis' is merely the result of the irritation of the presence of the mycelium. As for the assertion that no evidence of inflammation is found in the lymphoid tissue, this I am 6 mp methotrexate still more disinclined to accept. Not only is this not in accord with the usual clinical appearance and history, but hyper- trophied lymphoid tissue is methotrexate b12 itself evidence of, and the product of inflammation, while the existence near the crypts of the extra amount of fibrous tissue spoken of above is a still further evidence of the chronic inflammatory process. Such a ' keratosis ' we get upon the mucous membranes wherever friction or other irritative influences are at work. Nasal polypi at the point where they rub the septum, atrophic rhinitis with crusts, the nasal mucous membrane when it is bathed in the ichorous pus which flows from the suppurating accessory sinuses, the pachy- dermia verrucosa of the posterior wall of the larynx in drinkers and in phthisical patients, the tips of the lingual lymphoid hypertrophies in adult patients — all these show quite as much 'keratosis ' as does the epithelial lining of the crypts filled by the threads of the leptothrix buccalis. ' ' The specimen stained with gentian- violet and Gram's iodin shows among the leptothrix threads the presence of another fungus, the so-called ' bacillus maximus buccalis.' The gentian-violet stain also brings out methotrexate 7.5 mg enormous numbers of spores, grouped in irregular masses outside of the mycelial straws, but also here and there they are seen enclosed within the lumina at irregular intervals. They are methotrexate injection cost very minute, some of them much smaller than the small- est micrococcus. Now, between these two forms, the minute spores and the full-grown mycelial threads or straws, are all degrees of involutionary forms, includ- ing those indistinguishable in size and appearance pharmacology of methotrexate from methotrexate india various bacilli — all deeply stained with the gentian-violet. The same may be noted of the 'ba- cillus maximus ' methotrexate generic name and its spores stained with the iodin." Treatment. — Mycosis may disappear spontane- ously, though its usual course is very persistent. As is usually the case when no treatment is satisfactory, many methods are advocated. I will enumerate a few: Attention to the general health; local use of chlorate of potash, borax, absolute alcohol, methotrexate and ms lactic acid, chlorid of zinc, perchlorid of iron, iodin and its com- pounds, bromid of iodin, chromic acid, nitrate of sil- ver, solution of bichlorid of mercury; curetting or forcibly pulling out the filaments, followed by the use of some astringent, as nitrate of silver; excision; a course of sulphur waters; application of pyoctanin, and last, the galvanocautery. Each has had its ad- vocates; none is satisfactory, but the last is probably the most useful. At present I rely upon the galvano- cautery and pyoctanin. With these two means, and perseverance, patients will recover, but perhaps as my friend Dr. Wright says, "not because of them." I must confess, however, I am not now willing to accept his conclusion. A few words about the application of these rem- edies. The treatment must be radical — all the de- posit must be destroyed and the surface from which the leptothrix develops changed. If the points of disease are few and favorably located, as on a tonsil, they may be excised and the trouble at once eradi- cated. The galvanocautery is also applicable in such cases; even when a considerable number of growths, are present it is effective, the objection to it arising, when too freely used, from the degree and extent of inflammation it may cause. The following extract from a paper on "The Uses of Pyoctanin," read by me before the American Laryngological methotrexate 17.5 mg Association in 1891, still expresses my opinion of its advantages: "Pyoctanin is apow- methotrexate sodium 2.5 mg erful germicide. It methotrexate cream ibiA^'Q^O? 5161655 ' April 30, 1898]

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