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Jeffrey A Brinker, M.D.

Jeffrey A Brinker, M.D.

  • Professor of Medicine
  • Joint Appointment in Radiology and Radiological Science


In both discount bupropion 150 mg with amex anxiety 4th hereford cattle, mesangial interposition gives the appearance of split basement membranes when viewed in the light microscope generic 150 mg bupropion with amex depression comic. Note that C3NeF purchase 150mg bupropion overnight delivery depression vs bipolar, present in the serum of patients with membranoproliferative glomerulonephritis, acts at the same step as properdin, serving to stabilize the alternative pathway C3 convertase, thus enhancing C3 breakdown and causing hypocomplementemia. B, Characteristic deposition of IgA, principally in mesangial regions, detected by immunofluorescence. Electron micrograph of glomerulus with irregular thickening of the basement membrane, lamination of the lamina densa, and foci of rarefaction. Such changes may be present in other diseases but are most pronounced and widespread in hereditary nephritis. The thickness of the arrows reflects the approximate proportion of patients in each group who progress to chronic glomerulonephritis: poststreptococcal (1% to 2%); rapidly progressive (crescentic) (90%), membranous (30% to 50%), focal glomerulosclerosis (50% to 80%), membranoproliferative glomerulonephritis (50%), IgA nephropathy (30% to 50%). A Masson trichrome preparation shows complete replacement of virtually all glomeruli by blue-staining collagen. Ischemia causes numerous structural and functional alterations in epithelial cells, as discussed in Chapter 1. The structural changes include those of reversible injury (such as cellular swelling, loss of brush border, blebbing, loss of polarity, and cell detachment) and those associated with lethal injury (necrosis and apoptosis). Biochemically, there is depletion of adenosine triphosphate; accumulation of intracellular calcium; activation of proteases. One early reversible result of ischemia is loss of 994 cell polarity due to redistribution of membrane proteins. The latter incites vasoconstriction via tubuloglomerular feedback, which will be discussed below. In addition, fluid from the damaged tubules can leak into the interstitium, resulting in interstitial edema, increased interstitial pressure, and further damage to the tubule. The major one is intrarenal vasoconstriction, which results in both reduced glomerular plasma flow and reduced oxygen delivery to the functionally important tubules in the outer medulla (thick ascending limb and straight segment of the proximal tubule). Finally, there is also some evidence of a direct effect of ischemia or toxins on the glomerulus, causing a reduced glomerular ultrafiltration coefficient, possibly due to mesangial contraction. The patchiness of tubular necrosis and maintenance of the integrity of the basement membrane along many segments allow ready repair of the necrotic foci and recovery of function if the precipitating cause is removed. This repair is dependent on the capacity of reversibly injured epithelial cells to proliferate and differentiate. Re-epithelialization is mediated by a variety of [84] growth factors and cytokines produced locally by the tubular cells themselves (autocrine stimulation) or by inflammatory cells in the vicinity of necrotic foci (paracrine stimulation). Figure 20-32 Possible pathogenetic mechanisms in ischemic acute renal failure (see text). Figure 20-33 Patterns of tubular damage in ischemic and toxic acute tubular necrosis. Some of the tubular epithelial cells in the tubules are necrotic, and many have become detached (from their basement membranes) and been sloughed into the tubular lumina, whereas others are swollen, vacuolated, and regenerating. Glomerular and vascular abnormalities may also be present but either are mild or occur only in advanced stages of these diseases. Acute tubulointerstitial nephritis has a rapid clinical onset and is characterized histologically by interstitial edema, often accompanied by leukocytic infiltration of the interstitium and tubules, and focal tubular necrosis. In chronic interstitial nephritis, there is infiltration with predominantly mononuclear leukocytes, prominent interstitial fibrosis, and widespread tubular atrophy. Morphologic features that are helpful in separating acute from chronic tubulointerstitial nephritis include edema and, when present, eosinophils and neutrophils in the acute form, contrasted with fibrosis and tubular atrophy in the chronic form. These conditions are distinguished clinically from the glomerular diseases by the absence, in early stages, of such hallmarks of glomerular injury as nephritic or nephrotic syndromes and by the presence of defects in tubular function. The latter may be subtle and include impaired ability to concentrate urine, evidenced clinically by polyuria or nocturia; salt wasting; diminished ability to excrete acids (metabolic acidosis); and isolated defects in tubular reabsorption or secretion. The advanced forms, however, may be difficult to distinguish clinically from other causes of renal insufficiency. Some of the specific conditions listed in Table 20-9 are discussed elsewhere in this book. In this section, we deal principally with pyelonephritis and interstitial diseases induced by drugs. Pyelonephritis and Urinary Tract Infection Pyelonephritis is a renal disorder affecting the tubules, interstitium, and renal pelvis and is one of the most common diseases of the kidney. Acute pyelonephritis is caused by bacterial infection and is the renal lesion associated with urinary tract infection. Chronic pyelonephritis is a more complex disorder: bacterial infection plays a dominant role, but other factors (vesicoureteral reflux, obstruction) are involved in its pathogenesis. Pyelonephritis is a serious complication of an extremely common clinical spectrum of urinary tract infections that affect the urinary bladder (cystitis), the kidneys and their collecting systems (pyelonephritis), or both. Bacterial infection of the lower urinary tract may be completely asymptomatic (asymptomatic bacteriuria) and most often remains localized to the bladder without the development of renal infection. However, lower urinary tract infection always carries the potential of spread to the kidney. By far the most common is Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter. Streptococcus faecalis, also of enteric origin, staphylococci, and virtually every other bacterial and fungal agent can also cause lower urinary tract and renal infection. In immunocompromised patients, particularly those with transplanted organs, viruses such as polyoma virus, cytomegalovirus, and adenovirus can also be a cause of renal infection. There are two routes by which bacteria can reach the kidneys: (1) through the blood-stream (hematogenous infection) and (2) from the lower urinary tract (ascending infection) (Fig. Although the hematogenous route is the less common of the two, acute pyelonephritis does result from seeding of the kidneys by bacteria from distant foci in the course of septicemia or infective endocarditis. Hematogenous infection is more likely to occur in the presence of ureteral obstruction, in debilitated patients, in patients receiving immunosuppressive therapy, and with nonenteric organisms, such as staphylococci and certain fungi and viruses.


  • Cystic fibrosis (CF)
  • You are having open-heart surgery for another reason and your doctor may want to replace or repair your mitral valve at the same time.
  • Lupus
  • Poor oral hygiene
  • Reduced or absent reflexes due to nerve damage
  • Geriatrics
  • Severe abdominal pain
  • Brain injury

The inferior mesenteric vein may also contribute to discount bupropion 150 mg online mood disorder management chart this junction order bupropion on line amex mood disorder nos in dsm 5, although it classically joins the splenic vein and occasionally joins the superior mesenteric vein directly order bupropion uk unspecified mood disorder dsm 5. Ligation of the inferior mesenteric vein is often a necessary step in mobilization of the body and tail of the pancreas. It is important to recognize the common sites at which these vessels join the portal vein when performing a resection of the pancreatic head. The posterior superior vein commonly drains directly into the portal vein near the superior border of the pancreas after crossing anterior to the bile duct. This latter vessel is both a common landmark and a source of trouble if Surgical management of hepatobiliary and pancreatic disorders 36 not dealt with carefully. It is formed by the confluence of the right gastroepiploic vein and an unnamed middle colic vein. Ligation of the gastroepiploic vein near this junction facilitates exposure of the superior mesenteric vein and pancreatic portal vein. Some studies seem to indicate that an anterior superior vein may not be present in all cases and that venous drainage in the corresponding region is directly into the gastrocolic trunk. The gastroduodenal in turn is a branch of the common hepatic artery and arises within the porta hepatis, where it marks the transition to the hepatic artery proper. It runs in the same general direction as the latter vessel, but when viewed from behind the mobilized and anteriorly retracted pylorus appears to run transversely. Ligation of the gastroduodenal artery is a necessary step for pancreaticoduodenectomy and can be helpful in controlling bleeding from difficult duodenal ulcers. According to some authors, preservation of the right gastric artery is crucial during a pylorus preserving pancreatico-duodenectomy. The anterior and posterior inferior pancreaticoduodenal arteries form the inferior blood supply to the head of the pancreas and duodenum. They arise either as a single trunk or separately directly from the superior mesenteric artery. The anterior arcade follows the course of the duodenal wall, passing posterior to the inferior pancreatic head as it overhangs the duodenum. The posterior arcade passes anterior to the common bile duct before it enters the pancreas and follows the margin of the head of pancreas posteriorly. The most frequent arterial anatomical variant related to the head of the pancreas is a replaced or accessory right hepatic artery arising from the superior mesenteric artery (25% of the population) (Fig. The pulse of an accessory or replaced right hepatic can normally be palpated in the porta hepatis posterior to the bile duct. Failure to identify such a vessel can result in ligation of part of the hepatic blood supply during pancreaticoduodenectomy. Surgical anatomy of the pancreas 37 With respect to the identification of vascular variants, some surgeons have advocated preoperative angiography. Trede reports examples of its failure to demonstrate an accessory right hepatic artery and points out that when such an artery is identified its position anterior to, posterior to or within the head of the pancreas cannot be ascertained. Very rarely this condition can be associated with collateral blood flow to the liver provided by the superior mesenteric artery through the pancreaticoduodenal Figure 2. However, this rare situation can be identified intraoperatively when blood flow to the liver ceases upon temporary occlusion of the gastroduodenal artery. The origin of this artery is variable, arising from the splenic artery in 38%, directly from the coeliac trunk in 22%, the common hepatic in 22%, the superior mesenteric artery in 12. Nerve supply to the pancreas the pancreas receives both sympathetic and parasympathetic input. The parasympathetic input to the pancreas is by way of vagal fibres passing through the right and left coeliac ganglia which are situated adjacent to the coeliac axis. The sympathetic input is from the greater and lesser splanchnic nerves which are formed by branches from the T4 through T10 and T9 through L2 sympathetic ganglia, respectively. The supply to the body and tail is from the left coeliac ganglion via the plexus associated with the splenic artery and directly from the left ganglion and coeliac plexus to the posterior body. The parasympathetic nerves along the arteries enter the pancreatic parenchyma along with the arteries and end on intrinsic ganglia which lie near the parenchyma, in keeping with their role in stimulating secretion of pancreatic juice. The head of the pancreas is defined as that portion to the right of the left border of the superior mesenteric and portal vein. The uncinate process is the extension of the head posterior to the portal vein and superior mesenteric artery and normally lies caudal to the pancreatic head. The pancreatic neck is that portion lying directly over the portal vein and superior mesenteric artery. The body and tail extend obliquely in a cranial direction toward the hilum of the spleen. The area anterior to the body and tail is termed the lesser sac and is bordered by the body of the stomach and gastrocolic ligament anteriorly and the transverse mesocolon and the transverse colon inferiorly. The pancreas is contained within the retroperitoneal space, which is bordered anteriorly by the visceral peritoneum and posteriorly by the transversalis fascia. The fusion of visceral peritoneum to the posterior parietal peritoneum fixes the pancreas in the retroperitoneum. This ‘fusion fascia’ is termed the fascia of Treitz in the region of the head and neck and the fascia of Toldt in the region of the body and tail. Surgical access to the pancreatic head and duodenum Mobilization or Kocherization of the duodenum and head of pancreas is a familiar manoeuvre used in many upper gastrointestinal procedures. The plane of dissection and the extent of mobilization will vary with the procedure. When mobility only is needed, the peritoneal fusion fascia can be separated from the duodenum using sharp dissection, leaving the fascial sheath overlying the inferior vena cava and aorta.

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Several constituents show anti-inflammatory activity cheap bupropion 150 mg without a prescription depression symptoms blog, such as apigenin discount bupropion 150mg otc depression psychology, eugenol buy genuine bupropion online anxiety fatigue, ferulic acid, luteolin and bergapton (Duke 2003). Studies in rats suggest that some celery seed extracts are highly effective in suppressing experimental arthritis without exhibiting any gastrotoxicity (Whitehouse et al 1999). Celery consumption has been linked to a reduced risk of developing colon cancer (Slattery et al 2000) and stomach cancer (Haenszel et al 1976). Celery extracts have also been found to have significant activity as a mosquito repellent (Tuetun et al 2004, 2005). A small uncontrolled trial of 15 patients with chronic arthritis found that treatment with celery seed extract significantly reduced pain symptoms after 3 weeks (Bone 2003). Although it is not certain that the herb has antibacterial activity against microorganisms implicated in urinary tract infection, it is used for its diuretic effect. The British Herbal Pharmacopoeia gives the specific indication of celery for rheumatoid arthritis and depression (Fisher & Painter 1996). Oriental medicine uses the seeds to treat headaches and as a digestive aid and emmenagogue. Topical exposure to celery may cause contact dermatitis angiooedema and urticaria (Kauppinen et al 1980). Photodermatitis has been recorded with occupational exposure (Seligman et al 1987) and celery has been suggested to cause ocular phototoxicity (Fraunfelder 2004). It is used to treat osteoarthritis and demonstrates anti-inflammatory activity in experimental models. Celery is likely to be safe when used in quantities commonly used in foods; however, there is the possibility for allergy and contact sensitivity. The effect of celery and parsley juices on pharmacodynamic activity of drugs involving cytochrome P450 in their metabolism. Celery allergens in patients with positive double-blind placebo-controlled food challenge. Chemoprevention of benzo[a]pyrene-induced forestomach cancer in mice by natural phthalides from celery seed oil. Celery 202 © 2007 Elsevier Australia Chamomile Historical note Chamomiles have been used as medicines since antiquity and traditionally grouped in botanical texts under the same general heading. The Anglo-Saxons used chamomile, presumably the Roman chamomile, as one of their nine sacred herbs. Culpeper lists numerous ailments for which chamomile was used, such as jaundice, fevers, kidney stones, colic, retention of urine and inflammation of the bowel (Culpeper 1995). It was also widely used to treat common conditions in children including colic in infants, teething pains and fever (Grieve 1976). It is used in the treatment of gout and to reduce the severity of sciatic pain, either taken internally or applied as a poultice externally (Culpeper 1995). Today, chamomile tea is one of the most popular herbal teas in Australia and New Zealand, and extracts are also used in cosmetics, as bath preparations, in hair dye for blonde hair, shampoos, mouthwashes and preparations to prevent sunburn (Foster & Leung 1996). Chamomile 203 © 2007 Elsevier Australia Clinical note — the difference between German and Roman chamomile. Chamomilla recutita is widely distributed in waste lands and in the neglected fields of Europe, particularly in Croatia and Hungary. Many plants are referred to as chamomile or have the word ‘chamomile’ as part of their common name. Of the large number of species of chamomile growing in Europe, North Africa and the temperate region of Asia, five grow wild in the United Kingdom and Europe. It has similar uses to the German chamomile, such as an aromatic bitter for digestive conditions, antispasmodic agent, mild sedative, and topically for its anti-inflammatory and mild analgesic properties. This is derived from matricin, also known as proazulene or prochamazulene, a precursor of chamazulene. Chamazulene (1–15%), farnesene, alpha-bisabolol and bisabolol oxides A and B (up to 50% of the essential oil; proportions vary depending on the chemotype), bisabolone oxide, chamazulene (from matricin on distillation), matricin, chamaviolin, spathulenol and cisand trans-enyne dicyclo ethers (spiroether, polyacetylenes). Chamomile 204 © 2007 Elsevier Australia German chamomile has four chemotypes (variations of the plant product according to chemical composition). These relate to slight variations in the bisabolol oxide content of the essential oil (Gasic et al 1986). Chemotypes, which contain highest levels of alpha-bisabolol (known as C and D chemotypes), should be sourced when an essential oil is required for antiphlogistic or spasmolytic properties. Chamomile extract showed anti-inflammatory effects when applied topically in animal models of inflammation (Al-Hindawi et al 1989, Plevova 1999, Shipochliev et al 1981). In a comparative trial, hydro-alcoholic extracts of chamomile produced antiinflammatory actions when applied topically in the croton ear test in the mouse. The hydro-alcoholic extract reduced oedema in a dose-dependent manner and was equivalent in effectiveness to benzydamine at twice the usual clinical dose, but hydrocortisone was found to be the most effective treatment (Tubaro et al 1984). Another comparative study investigated the anti-inflammatory effects of an extract prepared from dried flowers, an extract based on fresh flowers, and the volatile oil, in croton oil-induced dermatitis of mouse ear. The activity of fresh chamomile equalled the activity of the reference drug (benzydamine). The anti-inflammatory activity of the herb appears to be due to several different constituents, chiefly apigenin, matricin, chamazulene and alpha-bisabolol, although others may also exist. The previous study determined that apigenin exerts the strongest anti-inflammatory action, which is ten times greater than matricin, which is ten times greater than chamazulene (Della Loggia et al 1990).

The second line goes from the inferior point of the iliac bone tangential to best 150mg bupropion anxiety 6 months after quitting smoking the bony acetabulum generic bupropion 150 mg with visa depression zen habits. A shallow acetabulum in a baby less than 3/12 old may be physiological immaturity but if found after 3/12 of age it signifies dysplasia buy bupropion once a day depression symptoms cure. The angle is formed between the vertical cortex of the ilium and the triangular labral fibrocartilage. There is considerable variability in the measurement of this angle and it is, therefore, not always used. If the hip is still unstable then referral is necessary for a harness to be fitted. Refer to textbooks/published articles for diagrams of the angles referred to above. References 1) Newborn and infant physical examination: ultrasound scan for hip dysplasia (2014). Colour Doppler should not be utilised except for clearly defined clinical reasons which provide additional diagnostic or prognostic information. The ultrasound practitioner should be aware of common and less commonly used acoustic windows to the neonatal brain. While the anterior fontanelle is used as standard, the posterior fontanelle can be useful to examine the occipital horn of the lateral ventricles and the mastoid suture may be helpful in examining the posterior fossa, cerebellum, aqueduct of Sylvius and 4th ventricle. A suggested approach for examining the neonatal brain is as follows: Presence of normal anatomy the ultrasound practitioner should be aware of normal brain anatomy in the neonate, to include changes with age, presence of midline structures, ventricular appearances, appearances of basal ganglia, periventricular white matter, cerebellum and extra-axial space. Presence of intracranial haemorrhage the ultrasound practitioner should be aware of common locations of intra-cranial haemorrhage, how this may vary according to gestational age, and how these may present on ultrasound. Ventricular size the size of the lateral, 3rd and 4th ventricles should be assessed according to local protocol. This can be useful to assess change in size over time and guide timing of intervention. Periventricular white matter the ultrasound practitioner should be aware of normal and abnormal appearances of the periventricular white matter and the limitations of ultrasound in examining this region. Follow-up should be considered in cases of periventricular flaring or suspected white matter damage. Common indications Common indications for the performance of a shoulder ultrasound scan are: • Contraindications and limitations Contraindications for diagnostic shoulder scans are unlikely; however, some limitations exist and may include the following: • obesity • inability to see structures that lie deep to bone or intra articular structures of the glenohumeral and acromioclavicular joints • casts, dressings, open wounds/ulcers etc can limit visualisation • severe oedema/swelling • patients who are unable to co-operate or provide a clinical history due to reduced cognitive functions eg Alzheimer’s or dementia and through involuntary movements. As age-related changes are common in the musculoskeletal system1,2 and may not be the cause of the patients symptoms, ultrasound appearances must always be taken in clinical context and the referrer should be made aware of its limitations in the report. For example: • ultrasound cannot exclude impingement • ultrasound cannot exclude intra articular pathology. For example effusion in the long head of biceps tendon sheath does not always reflect current tenosynovitis but may be an extension of a glenohumeral joint effusion. Subacromial/subdeltoid bursal thickening may be present on the asymptomatic shoulder and does not always reflect current ‘bursitis’ so a comparison image and addition of current symptoms may help. Comparison with the contra-lateral side (assuming it is asymptomatic) will help when determining the clinical significance of age/activity-related changes and should be imaged and documented in the report. Dynamic ultrasound assessment Dynamic assessment around the shoulder may be controversial in some centres as some indications such as ‘impingement’ have multiple potential causes (some of which will not be seen using ultrasound) and may be considered to be a purely clinical diagnosis. Dynamic assessment using ultrasound may be requested for the following: • long head of biceps tendon: to assess its stability within the bicipital groove during external rotation; • subscapularis tendon: to identify the myotendinous area which normally sits behind the coracoid process of the scapula, • supraspinatus tendon: to assess for bunching of the tendon and/or overlying subacromial bursa against the acromion or coraco-acromial ligament during abduction which may be a cause of ‘impingement’; • posterior joint recess: during internal/external rotation, to assess for a gleno-humeral joint effusion. Imaging protocol A standard shoulder series should include the following minimum images for a normal scan: • long head of biceps tendon longitudinal and transverse; • rotator interval showing anterior portion of supraspinatus tendon, long head of biceps and lateral edge of subscapularis tendon; • subscapularis tendon – longitudinal and transverse; • supraspinatus tendon – longitudinal and transverse; • infraspinatus tendon – longitudinal only; • posterior glenohumeral joint recess; 73 • acromioclavicular joint. Report (see also recommendations for the production of an ultrasound report, section 2. It should be written by the person undertaking the scan and viewed in clinical context. The standard shoulder report should include: • documentation of the normal anatomy; • documentation of any pathology including measurements/ any increase in vascularity if appropriate; • document any limitation to range of movement and site and degree that pain or symptoms begin; • document any difficulties with interpretation of the ultrasound appearances. Focal tendinopathic changes are noted at the anterior/middle/posterior portion of the supraspinatus tendon, no tears seen. There is a 6mm densely shadowing calcific deposit within the supraspinatus tendon. There is a 6mm non shadowing deposit within the supraspinatus tendon likely to be soft calcific tendonopathy’. The largest area of calcification in the supraspinatus tendon measures 15mm in diameter and the patient is tender on scanning. The long head of biceps tendon has subluxed onto the medial lip of the bicipital groove. The tendon sheath is hyperaemic and contains an effusion and the patient is tender to scan here. Ultrasound appearances suggest an intact subluxed long head of biceps tendon with evidence of tenosynovitis. It is sometimes difficult for the ultrasound practitioner to appreciate the significance of a tear on the patient’s current clinical symptoms and while it is important to evaluate and accurately describe tears, care should be taken if discussing scan findings with the patient. When reporting, it is important to describe the type of tear – partial, full or complete – and the dimensions and site of the tear. These details are important for subsequent treatment and surgical planning as tendons with severe tendonopathy are less likely to have a successful repair should surgery become appropriate. Measurements Type, size and location of tears is important and measurements of full thickness tears should be made in two planes – anterior to posterior (transverse) and medial to lateral (longitudinal). Site of supraspinatus tendon tears the supraspinatus tendon can be divided into anterior, mid and posterior portions. The anterior free or leading edge, the mid-substance or footprint and the area that abuts the infraspinatus tendon the distinction between the two tendons can be difficult to define.

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Necator larvas usually invade activly through cutis order discount bupropion on line depression questionnaire pdf, penetrate into the bloody capillaries cheap bupropion 150mg overnight delivery depression definition yahoo, migrate along large and small circle of blood circulation bupropion 150 mg overnight delivery mood disorder free test. When they reach the lungs, they get into intestine through pneumanic tract, larynx and throat, where in 4-5 weeks develop up to grown – up helminth. Fixation of helminth to mucous tunic of intestine is accompanied with local damage of tissues and origin of microhemorrhages. Helminths feed with blood and excrete special anticoagulantes, which cause long – term hemorrhages. If the larvas penetrate through skin, the early manifestations are connected with their migration along organism. In the early phase of ancylostomidoses eosinophillia infiltrates in lungs and vascular pneumonia with fever and high (up to 30-60% eosonophilles in blood is discribed) Tracheitis and laryngitis with voice hoarsness and even aphonia are observed. The intestine phase id manifested in 30-60 days after contamination – pains in the stomach, vomiting, diarrhea and fatigue appear. The characteristic sign of ancylostomides is hypochromic anemia developing in a great number of patient, wich sometimes has serious form. The patients complain of fatigue, dyspnea, noise in ears, increased mental and physical defatigation, dizziness, darkness in the eyes, loss of weight, appetite lowering or increase (rarely). The blood smear analyses show anisopoikilocytosis, microcytosis, hypchromia of erytrocytes. The signs of the first stage of ancylostomidosis are – skin infection in the region of entry hilus accompaning with local inflammatory reactions. In the migration phase – allergic manifestations even Quinque edema, laryngospasm, in the intestine phase – hypochromic anemia. At long parasiting the 13 severe exhaustion may appear, children may have delay of mental and physical development. Feces or duodenal content are examined with method of native smear on a large glass with the aim of discovery ancylostomid eggs. Levamisole (120 -150 mg before sleep, one time), mebendazole (100 mg 2 times a day during 3 days), albendazole (400 mg one time), pyrantel pamoate (11 mg / kg body weight one time a day during 3 days). Ferrum medicines for treatment of ferric-deficiency anemia prescribed per os or 14 parenteral. Pubertal female are localized in the thick part of mucose tunic of duodenum, at intensive penetraits into stomach, mucose tunic of intestinum tenue, pancreatic and biliary ducts. The larvas get to the external environment with exrements, where they transformed into filarideus larvas (homogonia) or into free-living pubertal males and females (heterogony). Filarideus larvas may repeatedly invase the sick man, penetrate into mucose tunic of intestine or skin perianal region (autosuperinvasion). Contaminated soil is the source of infection (percutaneus way) penetrating through skin. There are alimentary way (if the patient eats fruits and vegetables), water way and intraintestinal autoinfection. Strongyloidosis is widely spread in the countries of east and south Africa, south-east Asia, South America. At infection through the skin larvas penertait into the tissue through the sweaty glands and hairy follicles into bloody and lymphatic vessels. The larvas penetrait into the heart and then into lungs with the current of blood and lymph. Through alveolas, bronchus, trachea larvas penetrait in the mouth cavity and then are swallowed and penetrate into intestine. There are such stages in clinical course early (acute, migratory) and late (chronic, intestinal). Incubation period is short, in 1-2 days appear dermal sings, dermal itching, nettle rash (urticaria) or papula, local edemas, appear eosinophilic infiltrates. Nausea, dull pains in epigastrium, constipations or alternation of constipation with diarrhea may be noticed. At obvious manifestations may appear nausea with vomiting, acute pain in epigastrium or in stomach, periodic diarrheas up to 5-7 times a day. In peripheral blood eosinophillia is revealed up to 70-80 %, at long invasion secondary anemia appears. Symptoms of duodenitis, enterocolitis, rarely angiocholitis and hepatitis are observed. The patient complains of loss of appetite, belching, heart-burn, nausea, vomiting, pain in different parts of the stomach, stool disorder at intestinal and duodeno-gastro-vesical forms. Stool may be up to 15-20 times a day, watery, sometimes with admixture of mucus and blood. Allergotoxic form is characterized by urticaria, dermal itching, myalgia, arthralgia. Some patients have allergic myocarditis, bronchitis, asthenovegetative syndrome, polyarthralgia as manifestation of allergia. Affection of digestive tract at this form of the disease is manifested by moderetely expressed dyspeptic disorders and abdominal pain. Ulcerous affection of intestine, perforating peritonitis, necrotic pancreatitis, intestinal bleeding, miocarditis, meningoencephalitis, asthenic syndrome, cachexia. It is possible to find larvas and pubertal parasites in sputum and urine in the migrate stage. The treatment is effective if at the secondary examination of excrements and bile, which are made in 1-2-3 months after treatment, the parasite larvas are not found. Dispansory observation are recomended for 6 months with monthly control examination. Finding and treatment sick man, organisation of sanitory measures, observance the personal hygiene.


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