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Related post: tion curve declines, showing a subsequent
rise as the patient passes through this pe-
riod.
Blood Chemistry. — For all practical pur-
poses the determination of the non-pro ;ein
nitrogen and the preformed creatinin are
of most value. If the former is well Buy Mentat Online within
the limits of normal (25 to 40 mg. per 100
c. c. by the use of the Folin and Wu tech-
nic) the latter need not be determined,
although as a routine we always make this
estimation. An acute nitrogenous reten-
tion will be indicated by a rise in the total
retained nitrogen long before there is an
increase in the creatinin. Creatinin reten-
tion denotes chronicity and is of consider-
able prognostic value. With the presence
of the residual urine with back pressure
652
SOUTHERN MEDICAL JOURNAL
August 1922
on the kidneys there is always nitrogenous
retention. As the residual is reduced in
amount and the patient passes through the
drainage stage, the retained nitrogen of
the blood decreases, and if there has been
no permanent kidney damage it reaches
and remains at a normal level. It is usu-
ally at this stage that the 'phthalein ex-
cretion (after intravenous injection) be-
comes stabilized at its best figure.
Blood Pressure. — High blood pressureor
Hypertension is not necessarily a contrain-
dication to prostatectomy. It is, however,
a i-ery important guide regarding the time
ior operation. In a majority of cases the
blood pressure drops decidedly immediately
following the institution of drainage and
continues to decrease until the patient has
recovered from the reaction which follows
drainage and infection. Prostatectomy
should be deferred until the blood pressure
rises and reaches a point of stability.
In this connection it would not be amiss
to quote verbatim O'Conor's study of blood
pressure in a group of 56 cases of urinary
retention due to prostatic obstruction, 55
of whom were operated upon.
"It was early noted that patients operated upon
at a time when the blood pressure was accom-
panied by satisfactory renal function Buy Mentat showed a Buy Cheap Mentat
post-operative fall in blood pressure greater than
seemed normally commensurate with the degree
of operative disturbance. This suggested the pos-
sibility that we were operating upon these pa-
tients without a sufficiently prolonged pre-opera-
tive management, despite the fact that their gen-
eral condition seemed satisfactory and their renal
function entirely adequate. After this observa-
tion and in order that we might draw conclusions,
no patient was operated upon until his blood
pressure had maintained a definite level for at
least four days."
Li fiction. — Infection is one of the most
important prognostic points. Cases with a
large amount of residual urine usually
have considerable hydronephrosis and hy-
dro-ureter. When a catheter is introduced,
infection immediately follows and fre-
quently spreads to the upper urinary tract.
It is very important to prevent infection
during the first few days of treatment, as
the congestion from withdrawal of the re-
sidual urine causes considerable shock, and
if infection occurs at this time, the patient
may presenl symptoms of uremia, which
are due t an acute pyelonephritis. It is
true that infection will certainly follow the
institution of drainage which is fortunate
for the patients, as they will always de-
velop an immunity before operation. Pros-
tatectomy should always be deferred until
it has been demonstrated that infection of
the kidneys will not develop.
The time of operation depends upon com-
plete preparation of the patient. The
length of time varies greatly. In some
cases it is only a few days ; in others, many
months. Geraghty says if the patient does
not improve by Purchase Mentat Online drainage he will not be
benefited by operation, as removing the
prostate gland will do nothing more than
give drainage.
POST-OPERATIVE TREATMENT
The post-operative treatment begins im-
mediately on returning the patient to bed.
The post-operative cardinal points to be
considered are:
Shock, hemorrhage, drainage, fluid intake and
fever.
The term post-operative shock is a con-
dition following any major operation
which has been frequently described in the'
literature. Surgeons occasionally have pa-
tients who die shortly after or during an
operation, the cause of which is indefinite,
and we call it shock.
Just a few years ago hemorrhage was
considered almost Order Mentat Online a necessity in prostatic
surgery, but by the more recent means of
controlling this dreaded complication very
few surgeons are troubled with it. The
treatment, of course, is to prevent hemor-
rhage rather than to combat it. This is
accomplished by proper ligation and pack-
ing.
Proper drainage of the bladder is abso-
lutely necessary to prevent retention of
urine and absorption from an infected
bladder and surrounding tissues. Septi-
cemia from this focus of infection is easily
prevented by thorough drainage. A post-
operative rise in temperature is usually
due to improper drainage or pulmonary
complications.
The administration of fluids following
prostatectomy has been recognized for sev-
eral years as a very important factor.

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