By Q. Armon. Ripon College.

High-resolution computed tomography shows numerous centrilobular nodules (arrows) best persantine 100 mg. The radiologic and clinical findings resolved 5 days after starting corticosteroid therapy buy persantine 25 mg free shipping. Chronic hypersensitivity pneumonitis occurs after long-standing exposure to an offending antigen and can result in chronic pulmonary fibrosis ( Fig discount persantine 100 mg. In chronic hypersensitivity pneumonitis the chest radiograph most commonly reveals mild middle to upper lobe fibrosis ( 10,21). Chronic hypersensitivity pneumonitis in a 52-year-old man with progressive dyspnea. Computed tomography shows nodules, linear opacities, centrilobular nodules (arrowheads), and bronchiectasis (arrows). Acute Eosinophilic Pneumonia Acute eosinophilic pneumonia is idiopathic disease in which acute upper respiratory failure is accompanied by markedly elevated levels of eosinophilia in fluid recovered from bronchoalveolar lavage ( 13,21). Patients with acute eosinophilic pneumonia present with fever and acute respiratory failure, and have radiographic signs consistent with pulmonary edema ( 22). These findings are in contrast to those of chronic eosinophilic pneumonia in which pulmonary infiltrates are peripheral in distribution. Chronic Eosinophilic Pneumonia Chronic eosinophilic pneumonia is an idiopathic condition characterized histologically by filling of the air spaces with eosinophils and macrophages and associated mild interstitial pneumonia. The classic radiographic findings of chronic eosinophilic pneumonia consist of peripheral, nonsegmental areas of consolidation involving mainly the upper lobes. The remaining cases show radiographic findings that are nonspecific and consist of unilateral or patchy bilateral consolidation. The combination of peripheral consolidation and peripheral blood eosinophilia is virtually diagnostic of chronic eosinophilic pneumonia ( 23). Transverse thin-section computed tomography demonstrates extensive areas of air space consolidation (arrows) and ground-glass attenuation ( arrowhead) involving mainly the peripheral lung region. Drug-induced Lung Disease Pulmonary drug hypersensitivity is increasingly being diagnosed as a cause of acute and chronic lung disease ( 24). Numerous agents including cytotoxic and noncytotoxic drugs have the potential to cause pulmonary disturbances. The clinical and radiologic manifestation of these drugs generally reflect the underlying histopathologic processes. The prevalence of drug-induced pulmonary hypersensitivity or toxicity is increasing, and more than 100 drugs are now known to cause injury. The diagnosis of pulmonary drug toxicity should be considered in any patient with drug therapy who presents with new progressive respiratory complaints.

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Laparoscopic cholecystectomy requires three or four cannulae inserted through the anterior abdominal wall order 100mg persantine otc, Caudate and for visualisation and access with operative instruments 100 mg persantine fast delivery. Open cholecystecomy often requires quite a long stay Gallbladder Hepatic artery and in hospital trusted 25 mg persantine, possibly a week or more, whereas laparo- portal vein scopic cholecystectomy may be conducted as a day case. Laparoscopic tech- This means that right hepatectomy, left hepatectomy nique reduces the incidence of respiratory problems and and extended right hepatectomy (right lobe plus cau- surgical site infection. The appropriate vessels for the segment(s) Disorders of the liver are ligated and divided before the segment(s) are dis- sectedawayfromtheremainderoftheliver. Carefuliden- Introduction to the liver and tication and ligation of biliary ducts and smaller vessels liver disease is required to reduce blood loss and therefore morbidity and mortality. Drainage is required postoperatively, to Introduction to the liver prevent bile from pooling intra-abdominally. It has two blood supplies: 25% of Cholecystectomy its blood originates from the hepatic artery (oxygenated) Surgical removal of the gallbladder and associated stones and 75% originates from the portal vein that drains the in the biliary tract may be by open surgery or laparo- gastrointestinal tract and spleen. Cholecystectomy is also considered in The functions of the liver are carried out by the hepa- younger patients with asymptomatic gallstones in or- tocytes, which have a special architectural arrangement. Blood enters the liver through the portal tracts, which Carcinoma of the gallbladder is treated by wider resec- contain the triad of hepatic artery, portal vein and bile tion, including neighbouring segments of the liver and duct. The lobule is classically used to Open cholecystectomy is usually performed through describe the histology of the liver (see Fig. Cholangiography may be used to The hepatocytes in zone 1 of the acinus receive well- visualise the duct system. The gallbladder is removed oxygenated blood from the portal triads, whereas the with ligation and division of the cystic duct and artery. The liver has multiple functions, which may be im- Aetiology paired or disrupted by liver disease: The causes of acute hepatitis: r Carbohydrate metabolism: The liver is one of the ma- r Acute viral hepatitis may be caused by the hepa- jor organs in glucose homeostasis under the control totrophic viruses (A, B and E) or other viruses such as of pancreatic insulin. Excess glucose following a meal Epstein Barr virus, cytomegalovirus and yellow fever is converted to glycogen and stored within the liver. The liver is also involved in the breakdown of amino acids producing ammonia, which is converted Pathophysiology to urea and excreted by the kidneys. Cellular damage results in impairment of normal liver r Fat: The liver is involved in synthesis of lipoproteins function: bilirubin is not excreted properly resulting in (lipid protein complexes), triglycerides and choles- jaundice and conjugated bilirubin in the urine, which terol. Swelling of the liver results in stretching of the liver capsule which may result in pain. However,itissometimesdiagnosed may be an enlarged, tender liver, pale stools and dark earlier than this. Stigmata of chronic liver disease should be looked for to exclude acute on chronic liver disease. Aetiology The main causes of chronic hepatitis: Microscopy r Viral hepatitis: Hepatitis B virus (+/ hepatitis D), Acute viral hepatitis has a histological appearance which hepatitis C virus. Complications Clinical features Fulminant liver failure, chronic hepatitis, and cirrhosis. Patients may present with non-specic symptoms (malaise, anorexia and weight loss) or with the compli- Investigations r cations of cirrhosis such as portal hypertension (bleed- Serum bilirubin and transaminases (aspartate ing oesophageal varices, ascites, encephalopathy).

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Stool samples were collected from the diarrhea and dysentery patients who attended the Infectious Diseases Hospital as well as from the outpatient clinics during August cheap 25 mg persantine with mastercard, 1990 to June generic 25 mg persantine mastercard, 1991 discount persantine 100mg with mastercard. Isolation and identification of the pathogens was processed by standard biochemical test described by Cowen (1974) and according to the criteria outlined by von Graevenitz (1985). So, it is anticipated to study on these bacteria to expand the knowledge and to provide information on the epidemiological control of the disease caused by these bacteria. Stool samples were collected from the diarrhoea and dysentry patients attended to the Infectious Diseases Hospital as well as from the outpatient clinics during August, 1990 to June, 1991. Isolation and identification of the pathogens was processed by standard biochemical tests described by Cowen (1974) and according to the criteria outlined by Von Graevenitz (1985). So it is anticipated to study on these bacteria to expand the knowledge and to provide an information on the epidemiological control of the diseases caused by these bacteria. After oral ingestion of an isotonic solution containing monosaccharide and disaccharide, their urinary excretion were measured both in acute stage and recovery stage. The rnucosa damaged during acute stage and regeneration of rnucosa at recovery stage that is 4-6 weeks after acute stage were compared. Intestinal permeability in diarrhoea diseases was assessed in 38 children with various types of diarrhoea including acute diarrhoea, persistent and dysentery (bloody diarrhoea) diarrhoea. But times taken to estimate the intestinal permeability in recovery phase were ranged from 6 weeks to 24 weeks. In case of bloody diarrhoea like dysentery, there are more of bacteria dysentery and amoebic dysentery was found in only one case. In this study, nutritional statuses of estimated children were done according to the percentage of median value of growth curve of National Centre for Health Statistics as weight for age. Height for age, weight for height in both acute and recovery stage of various types of diarrhoea. But because of the patency of lactulose (disaccharides) in 5 hours urine collection of recovery sample indicated that mucosa leakiness still occurred at in recovery phase of all 3 types of diarrhoea. Therefore mucosa epithelial regeneration may not completely occurred at recovery phase and subclinical enteropathy was still play a role in intestinal permeability changes. The respondents were interviewed by pretested questionnaires, in depth interviews by same interviewr and their records were reviewed with record review check lists. The study design was hospital based cross sectional descriptive study (both quantitative and qualitative) through face to face interviews using a structured questionnaires and house hold based interviews and observations were done on the selected houses in the satellite areas of Yangon. The response rate was 100% (4) cases died during the study period of April to end of September of year 2000. For qualitative study, twelve cases were selected as ten extreme cases with extreme case sampling method and two typical cases were indepth interview with guide line for indepth interviews questionnaires. Study result indicated that 94% were under one year children and only 6% were one year and above children. It is also indicated that clinical types of (1) acute watery diarrhoea (81 cases 54%) (2) Acute bloody diarrhoea (51 cases 34%) (3) Persistent watery diarrhoea (9 cases 6%) (4) Persistent bloody diarrhoea (9 cases 6%).

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Contrast can help to distinguish lymph nodes from pulmonary vessels order persantine 25 mg line, characterize pleural disease buy discount persantine 100mg line, demonstrate vascular components of an arterial venous malformation purchase persantine 100mg without prescription, and detect pulmonary emboli. Intravenous contrast should be avoided in patients with a creatinine level above 2. Low osmotic contrast is now preferred because it has fewer side effects and should be used in patients with previous anaphylactoid reactions to radiocontrast media. Corticosteroid pretreatment supplemented with antihistamine, diminishes the risk of adverse reactions. Each level contains an airway and a pulmonary artery that act as a supporting structure, the peribronchovascular interstitium. The secondary pulmonary lobule is the smallest unit of lung structure marginated by connective tissue septa ( 8). In idiopathic pulmonary fibrosis and fibrosing alveolitis associated with collagen vascular disease, this pattern is most often observed peripherally at the lung bases (3,5). In chronic hypersensitivity pneumonitis the fibrosis is usually most severe in the mid-lung zones ( 9,10). Cysts or rounded air-containing nodules are present in a number of acute and chronic infiltrative diseases. High-resolution computed tomography demonstrates disruption of the underlying lung architecture, with a honeycomb pattern of thick irregular basilar septal lines ( arrowhead) surrounding small cystic air spaces. Ground-glass attenuation is characterized by the presence of hazy increased attenuation of lung without obscuration of the underlying bronchial or vascular anatomy. Ground-glass attenuation can result from interstitial thickening, air space filling, or both. Although ground-glass attenuation is nonspecific, it usually indicates the presence of an active, potentially treatable disease. Areas of ground-glass attenuation in patients with chronic infiltrative lung disease are commonly caused by hypersensitivity pneumonitis, collagen vascular diseases, and idiopathic pulmonary fibrosis ( 3,5). The syndrome is most commonly seen in patients 30 to 50 years of age and has no gender predilection. Patients are typically asthmatic and present with eosinophilia, fever, and allergic rhinitis. Findings of chest radiography are usually abnormal and most often consist of patchy nonsegmental areas of consolidation with no zonal predominance. The areas of consolidation may have peripheral distribution and are often transient ( Fig.

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