Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
As fluid accumulates and the cav ity expands order fluconazole paypal antifungal antibacterial dog shampoo, patients will complain of pelvic or lower abdom inal pain relevant to 200mg fluconazole fast delivery definition de fungus the side of the trapped ovary order 150 mg fluconazole otc antifungal paint b&q. Operative findings are a cyst containing clear or tan fluid, sur rounded by adhesions and with the ovary attached. Treatment consists of unroofing and evacuation of the cyst, pelvic adhe siolysis, and suspension of the ovary to the pelvic brim or iliac fossa with sutures. Trapped ovary syndrome may be pre vented by suspending the ovaries at the time of restorative proctocolectomy and by placement of an adhesion barrier film in the pelvis. Damage to the pelvic plexus during the lateral dissection or to the nervi eri Perhaps the most critical components in the management of gentes or cavernous nerves while dissecting the anterior plane may patients with bowel obstruction are the recognition and pre result in erectile dysfunction. In closed loop obstructions or signs of progressing ischemia one recently published series of more than 1000 patients such as bowel wall thickening, pneumatosis, or portal vein undergoing surgery for small bowel obstruction, nonviable gas. Contrast studies using water-soluble agents are frequently used in patients with acute small bowel obstruction. In Presentation and Diagnosis patients with distal small bowel obstruction, a contrast enema is an efficient means by which colonic obstruction can be Nausea and vomiting, colicky pain, abdominal bloating, and excluded. Antegrade studies of the small bowel can help to obstipation are the hallmark signs of small bowel obstruction. In fact, picture will depend on the location, degree, and duration of some authors have used small bowel contrast studies as a the obstruction. Failure of contrast material to reach the colon by 24 are fever, tachycardia, leukocytosis, sepsis, peritoneal signs, hours is used as an indication for prompt surgical exploration. If any of these are found, the suspicion of ischemia tration of contrast agents may speed the resolution of partial should be high. These signs may also be found in patients small bowel obstruction, presumably through an osmotic without strangulation and are, therefore, nonpathognomonic. However, conflicting data also exist and the therapeu In many cases, however, this determination is not made until tic effects of the small bowel contrast study remain to be laparotomy, and timely surgical intervention in symptomatic defined. This fact is underscored by a report from Sarr and colleagues30 who found that the traditional clinical Initial Therapy and Nonoperative Management parameters frequently used to predict strangulation were nei ther sensitive nor specific. Nearly one-third of patients with Once the diagnosis of small bowel obstruction is made, the strangulation were not diagnosed until the time of surgery. Those with peritonitis, per foration, or signs of ischemic bowel are immediately prepared for laparotomy with expeditious correction of fluid and elec Radiographic Studies trolyte deficits. A urinary catheter is inserted to guide resus citation with the end points being resolution of tachycardia Plain Radiographs and hypotension and/or achieving a urine output of at least 0. A formed in most patients suspected of having small bowel nasogastric tube is inserted preoperatively to decompress the obstruction and consists of both upright and supine abdomi stomach, because these patients are at risk for aspiration on nal films and an upright chest X-ray. Patients with par absent, however, when the obstruction is proximal or the tial small bowel obstructions secondary to adhesions will dilated bowel loops are mostly fluid filled. The findings of pneumatosis intestinalis plete obstruction is significantly lower. This is in part attributable to the fact that mary imaging modality in patients suspected of having small long tubes with mercury-weighted tips (Miller-Abbott) are no bowel obstruction. Postoperative Complications 149 expertise, serial radiographic studies, or endoscopy to guide vomiting and distension is pathognomonic for partial small insertion. The onset of flatus, however, usually sig the use of nasoenteric tubes, mostly among radiologists. Narcotic analgesics may be administered to comfort the After the adequacy of resuscitation is confirmed and broad patient, but not to the point of diminishing mental status. The spectrum antibiotics active against enteric pathogens are practice of withholding pain medication to avoid masking the administered, the peritoneal cavity is entered through a mid signs of perforation or ischemia is probably unnecessary. This is a point in the operation where the risk of Serial abdominal examinations (ideally just before the next inadvertent enterotomy is very high because bowel loops are dose of analgesics) should be performed to assess for increas distended and often adherent to the undersurface of the ing tenderness or the presence of peritoneal signs. In general, rather than a cutting stroke, is used to breach the peritoneal a nonoperative course may be followed for 24?48 hours. Using this technique, it is usually possible to recognize obstruction has not resolved within that time period, it is an adherent bowel loop before enterotomy occurs. In the most favorable scenario, a single constricting band will be encountered that can be sharply divided to relieve the obstruction. In the worst cases, the peritoneal cavity will be Decision to Operate totally obliterated by scar tissue. An orderly and systematic Several studies have attempted to define certain criteria that approach to adhesiolysis is advised in these instances. First, would reliably predict the presence or absence of strangulated the underside of the midline scar is cleared so that the entire bowel. Unfortunately, none have been shown to be particu length of the incision can be opened if necessary. Next, adhe larly accurate and the best tool remains sound clinical sions to the abdominal wall are dissected laterally until both judgment. Certainly, patients with fever, peritonitis, pneumo paracolic gutters are reached. This will allow the placement of peritoneum, or overt sepsis should undergo emergent laparo a self-retaining retractor to facilitate exposure. In cases in tomy because these are hard signs of transmural bowel which bowel distension is severe, needle decompression may necrosis. The presence of early ischemia, however, is much be used to gain additional working space. It is not uncommon for patients with adhesions that defy identification of the bowel and peritoneal small bowel obstruction to present with tachycardia, relative surfaces (?frozen abdomen) may be injected with saline hypotension, mild acidosis, and leukocytosis, all of which through a fine-gauge needle to separate the surfaces and thus may be secondary to dehydration.
It must include measurable and expected outcomes and estimated timetables to proven 200mg fluconazole fungus gnats soap spray achieve these outcomes cheap 150mg fluconazole definition of fungus medical. The setting must have the necessary cardio-pulmonary buy fluconazole once a day fungus gnats uk420, emergency, diagnostic, and therapeutic life-saving equipment accepted by the medical community as medically necessary (for example, oxygen, cardiopulmonary resuscitation equipment, and a defibrillator) to treat chronic respiratory disease. This physical activity includes aerobic exercise combined with other types of exercise. This includes education, counseling, and behavioral intervention, tailored to the patients individual needs. The individualized treatment plan must be established, reviewed, and signed by a physician every 30 days. All settings must have a physician immediately available and accessible for medical consultations and emergencies at all times when items/services are being furnished under the program. The medical director, in consultation with staff, is involved in directing the progress of individuals in the program. Direct physician supervision may be provided by a supervising physician or the medical director. Effective for claims with dates of services on or after January 1, 2000, an x-ray is not required to demonstrate the subluxation. Implementation of the chiropractic benefit requires an appreciation of the differences between chiropractic theory and experience and traditional medicine due to fundamental differences regarding etiology and theories of the pathogenesis of disease. Judgments about the reasonableness of chiropractic treatment must be based on the application of chiropractic principles. So that Medicare beneficiaries receive equitable adjudication of claims based on such principles and are not deprived of the benefits intended by the law, carriers may use chiropractic consultation in carrier review of Medicare chiropractic claims. Payment is based on the physician fee schedule and made to the beneficiary or, on assignment, to the chiropractor. However, no additional payment is available for use of the device, nor does Medicare recognize an extra charge for the device itself. This means that if a chiropractor orders, takes, or interprets an x-ray, or any other diagnostic test, the x-ray or other diagnostic test, can be used for claims processing purposes, but Medicare coverage and payment are not available for those services. This prohibition does not affect the coverage of x-rays or other diagnostic tests furnished by other practitioners under the program. For example, an x-ray or any diagnostic test taken for the purpose of determining or demonstrating the existence of a subluxation of the spine is a diagnostic x-ray test covered under 1861(s)(3) of the Act if ordered, taken, and interpreted by a physician who is a doctor of medicine or osteopathy. However, no additional payment is available for use of the device, nor does Medicare recognize an extra charge for the device itself. Effective for claims with dates of service on or after January 1, 2000, an x-ray is not required to demonstrate the subluxation. In any case in which the term(s) used to describe the service performed suggests that it may not have been treatment by means of manual manipulation, the carrier analyst refers the claim for professional review and interpretation. A subluxation may be demonstrated by an x-ray or by physical examination, as described below. The x-ray must have been taken at a time reasonably proximate to the initiation of a course of treatment. Unless more specific x-ray evidence is warranted, an x-ray is considered reasonably proximate if it was taken no more than 12 months prior to or 3 months following the initiation of a course of chiropractic treatment. Demonstrated by Physical Examination Evaluation of musculoskeletal/nervous system to identify: Pain/tenderness evaluated in terms of location, quality, and intensity; Asymmetry/misalignment identified on a sectional or segmental level; Range of motion abnormality (changes in active, passive, and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility); and Tissue, tone changes in the characteristics of contiguous, or associated soft tissues, including skin, fascia, muscle, and ligament. To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under physical examination are required, one of which must be asymmetry/misalignment or range of motion abnormality. The history recorded in the patient record should include the following: Symptoms causing patient to seek treatment; Family history if relevant; Past health history (general health, prior illness, injuries, or hospitalizations; medications; surgical history); Mechanism of trauma; Quality and character of symptoms/problem; Onset, duration, intensity, frequency, location and radiation of symptoms; Aggravating or relieving factors; and Prior interventions, treatments, medications, secondary complaints. Documentation Requirements: Initial Visit the following documentation requirements apply whether the subluxation is demonstrated by x-ray or by physical examination: 1. Description of the present illness including: Mechanism of trauma; Quality and character of symptoms/problem; Onset, duration, intensity, frequency, location, and radiation of symptoms; Aggravating or relieving factors; Prior interventions, treatments, medications, secondary complaints; and Symptoms causing patient to seek treatment. The symptoms should refer to the spine (spondyle or vertebral), muscle (myo), bone (osseo or osteo), rib (costo or costal) and joint (arthro) and be reported as pain (algia), inflammation (itis), or as signs such as swelling, spasticity, etc. Vertebral pinching of spinal nerves may cause headaches, arm, shoulder, and hand problems as well as leg and foot pains and numbness. Rib and rib/chest pains are also recognized symptoms, but in general other symptoms must relate to the spine as such. The location of pain must be described and whether the particular vertebra listed is capable of producing pain in the area determined. Diagnosis: the primary diagnosis must be subluxation, including the level of subluxation, either so stated or identified by a term descriptive of subluxation. Such terms may refer either to the condition of the spinal joint involved or to the direction of position assumed by the particular bone named. Treatment Plan: the treatment plan should include the following: Recommended level of care (duration and frequency of visits); Specific treatment goals; and Objective measures to evaluate treatment effectiveness. Documentation Requirements: Subsequent Visits the following documentation requirements apply whether the subluxation is demonstrated by x-ray or by physical examination: 1. History Review of chief complaint; Changes since last visit; System review if relevant. Physical exam Exam of area of spine involved in diagnosis; Assessment of change in patient condition since last visit; Evaluation of treatment effectiveness. The patient must have a subluxation of the spine as demonstrated by x-ray or physical exam, as described above. Once the clinical status has remained stable for a given condition, without expectation of additional objective clinical improvements, further manipulative treatment is considered maintenance therapy and is not covered. Maintenance Therapy Maintenance therapy includes services that seek to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
Factors affecting test results (false positives and negatives) (Protein S Antigen): C4b binding protein has a very high affinity for free protein S order fluconazole 200 mg fast delivery fungus covered chest nagrand. This test is not influenced by acute phase reactants order fluconazole on line amex fungus gnats mint, rheumatoid factor order fluconazole 200mg with mastercard fungus like definition, protein C, hemoglobin, bilirubin, fibrinogen, unfractionated heparin, or low molecular weight heparin. Protein C Activity this Test is Used to Measure the Activity of Protein C in A Patient Sample Protein C is a vitamin K-dependent plasma protein that regulates hemostasis with both anticoagulant and profibrinolytic effects. Protein C is a serine protease that circulates in plasma in an inactive form until activated by 45 the endothelial bound thrombin-thrombomodulin complex. Congenital heterozygous protein C deficiency leads to a 10 fold increased risk of venous thrombosis. Nevertheless, protein C deficiency has a low prevalence in thrombosis clinics where it accounts for only 4% of patients. Homozygous deficiency in neonates is associated with very severe thrombotic disorder known as purpura fulminans. In vitamin k deficiency, other vitamin k dependent coagulation factors are also diminished in activity and therefore the risk of thrombosis under these conditions is small. Due to the short half-life of Protein C, the induction of oral anticoagulant therapy (particularly with large loading doses) without concomitant heparin therapy in patients with protein C deficiency may lead to very low levels of Protein C activity and precipitate a prothrombotic disorder known as coumarin skin necrosis which is caused by thrombosis of dermal blood vessels. Indications (Protein C Activity): the determination of the Protein C activity is indicated in the following cases: 1. In conjunction with other methods (antigenic determination, Protein C coagulometric method) for the differential diagnosis of different Protein C deficiency states. For monitoring replacement therapy with Protein C concentrates in congenital Protein C. Thus, in conditions of vitamin K deficiency, a higher Protein C activity is found with Berichrom Protein C than when using the coagulometric method. To obtain a complete picture of the cause of a Protein C deficiency, it is therefore advisable also to use the coagulometric method and antigenic determination technique. In the Berichrom Protein C method, a specific Protein C enzyme isolated from the venom of the Southern copperhead (Agkistrodon contortrix contortrix) is used to activate the protein C in the patient sample. The resulting Protein C activity is determined by its enzymatic activity on a chromagenic substrate that can be measured spectrophotometically by an increase in absorbance at 405 nm. The assay is based on the following reactions: Arrow diagram for Protein C Activator Possible results and interpretation (Protein C Activity): Protein C levels of 55% to 70% are consistent with either a deficiency state or the lower end of the normal distribution. Although vitamin K deficiency and warfarin therapy can cause reductions in protein C activity when measured using coagulometric assays, our current assay is not affected by these conditions. Hereditary Protein C deficiency is a heterozygous disorder that results in half-normal plasma levels of protein C. It is associated with an increased risk of venous thrombosis and may occur in as many as 0. Homozygous deficiency in neonates is associated with very severe thrombotic manifestations (?purpura fulminans). Factors affecting test results (false positives and negatives) (Protein C Activity): the assay is not affected by heparin when present in a concentration of less than 1U/mL of plasma. Abnormal proteins produced during therapy with vitamin K antagonists result in Protein C activity levels of <5-30% in normal individuals. Protein C Antigen this Test Measures the Concentration of Protein C in A Patient Sample Indications (Protein C Antigen): 1. To confirm a low Protein C activity or, in conjunction with the Protein C activity, to identify a dysfunctional Protein C molecule. Test Principle (Protein C Antigen): A plastic support coated with specific rabbit anti-human Protein C antibodies captures the Protein C to be measured. Next, rabbit anti-Protein C antibody coupled with peroxidase binds to the remaining free antigenic determinants of Protein C, forming a sandwich. After stopping the reaction with a sulfuric acid, then intensity of the color produced bears a direct relationship with the Protein C concentration initially present in the plasma sample. Hereditary Protein C deficiency has been described in some patients with recurrent venous thrombosis; family studies may be diagnostically useful. Patients with heterozygous deficiencies of Protein C here approximately half normal levels. Factors affecting test results (false positives and negatives) (Protein C Antigen): In extremely rare instances, anti-rabbit antibodies in certain subjects can lead to aberrant results. First, the test plasma is incubated with a known excess of thrombin in the presence of heparin. The residual thrombin is quantified by its amidolytic action on a synthetic chromagenic substrate. Levels of 60% to 80% are consistent with either a 47 deficiency state or the lower end of the normal distribution. Some patients have mutations which result in a quantitative defect that is characterized by equivalently decreased functional and antigenc levels. Others produce a defective molecule with reduced function but normal antigen levels. It is therefore suitable for testing plasmas collected from patients receiving heparin therapy. When a beam of monochromatic light is allowed to traverse a suspension of microlatex particles to which specific antibodies have been attached by covalent bonding and the wavelength of the light is much greater than the diameter of the latex particles, it can pass through the latex suspension unabsorbed. However, in the presence of the antigen being tested, the antibody-coated latex particles agglutinate to form aggregates of diameters greater than the wavelength of the light and the later is absorbed. There is a direct relationship between the observed absorbance value and the concentration of the antigen being measured.
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You could also avoid hospitalizations and the complications of inflammation that can lead to discount fluconazole online amex antifungal tablets that you swallow surgery purchase 200 mg fluconazole fungus cure. Up to fluconazole 150mg line nematodes for fungus gnats 46% of patients will be in complete remission (back to normal, with complete control of inflammation, and a completely healed colon) at 1 year. Many patients with active disease will need to stay on the higher dose of 10 mg twice daily. Patients who respond to 10 mg twice daily and taper down to 5 mg twice daily may still intermittently need to increase to 10 mg twice daily to head off a flare. Small molecules are organic compounds, and in the case of tofacitinib, it is about the same molecular size as sucrose (table sugar). In contrast, antibodies like Remicade or Humira, that are about 500 times larger, cannot be readily absorbed by the oral route, and therefore require injection into the body to be effective. This means that they partially block a particular action of the immune system, but do not completely turn it off. This class of medicines has been proven effective for rheumatoid arthritis, ulcerative colitis, psoriasis, and allergic and atopic dermatitis. While there are some specific side effects, most people do not generally get more infections when they start taking these medicines. All of these proteins amplify and transmit signals from cytokines to change the activity of cells. Small molecules often bind to the active site of enzymes, and physically block their normal activity. Small molecules are so small that they are generally ignored by the immune system. This is different from biologic therapies, which are large proteins that can lead to an immune reaction, and can be recognized as foreign proteins, leading to antibodies that can block the activity of a biologic therapy. As a general rule, most drug companies avoid combining their drug with other drugs in clinical trials, to avoid any risk of drug interactions. Tofacitinib has been tested in combination with methotrexate in rheumatoid arthritis, and did not appear to increase problems or side effects. Many patients in the tofacitinib studies for ulcerative colitis entered the study while on prednisone to control a flare, so we have experience combining tofacitinib with steroids. We also know that immunosuppressive drugs like Imuran and methotrexate help protect biologic therapies from formation of blocking antibodies, and that combinations of these drugs with biologics can increase the drug level of biologics, which can be helpful in patients who rapidly clear biologic therapies out of their bloodstream. It is possible that doses of allergy shots that you have successfully used to induce tolerance in the past could induce an allergic reaction. Chicken Pox: Tofacitinib (Xeljanz) reduces your immunity to the virus that causes chicken pox. Particularly if you have never had chicken pox, or never developed an immunity to chicken pox, you should avoid anyone with active chicken pox while on Xeljanz. Be sure to tell your doctor about all the prescription and over-the-counter medicines you are taking. This includes vitamins, minerals, and herbal products, as well as medicines prescribed by other doctors. These include blood counts to watch for low lymphocytes, neutrophils, or red blood cells, and liver tests to make sure there is no irritation to the liver. These are Original: September 30, 2009 Page 65 Revised: June 19, 2019 Inflammatory Bowel Disease Program Patient Information Guide typically tested every 3 months. Your doctor may ask you to take a cholesterol-lowering medication (statin) if your cholesterol becomes very high. This risk is particularly increased if you are also taking methotrexate or steroids at the same time. Other infections can include invasive fungal infections like Cryptococcus and pneumocystis. You need to have a working thermometer at home to check for a fever whenever you are sick. If you have a fever, cough, malaise (general sick feeling), trouble breathing, or if you notice new or increasing fatigue, you need to be seen by your doctor right away. To reduce infections, it could be helpful to avoid unpasteurized dairy products and juices, and to drink water that has been treated in a city water system or bottled water. This starts to occur about 40 years after the original chicken pox infection, so vaccination for shingles is recommended for everyone at age 50. Tofacitinib is associated with an increased rate of shingles, which can start as early as age 30 in people on immunosuppressive drugs. Non-melanoma skin cancers: increased rates of non-melanoma skin cancers were seen in patients taking tofacitinib. Other cancers: While cancers are rare, cancers have been reported in patients taking tofacitinib (Xeljanz). The most common types of malignancy reported were lung and breast cancer, followed by gastric, colorectal, renal cell, prostate cancer, lymphoma, and malignant melanoma. Pregnancy, Childbearing, and Breastfeeding Pregnancy or Breastfeeding: Tell your doctor if you are pregnant or plan to become pregnant. This information is not meant to cover all uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the medicines you are taking, please talk to your doctor, nurse, or pharmacist. Tysabri is an antibody that binds to and blocks the alpha 4 integrin protein found on white blood cells. It is an immunosuppressive medicine, which means it partially blocks the action of the immune system but does not turn it off completely. While there are some side effects, most people do not get more infections when taking this medicine.
Biol Blood Marrow Transplant 2005;11:571 mic syndrome responsive to order fluconazole american express fungus yellow toenail steroids and intravenous immune 575 buy 50mg fluconazole visa fungus gnats kill plants. Philadelphia: syndrome caused by factor H mutation: is single kidney trans Mosby Elsevier 200mg fluconazole for sale fungus gnats harmful. Besbas N, Karpman D, Landau D, Loirat C, Proesmans W, diarrhea-negative hemolytic uremic syndrome. Leukapheresis reduces early mortality in patients with hemolytic uremic syndrome associated with a factor H muta acute myeloid leukemia with high white cell counts but does tion. Differential impact of complement mutations on with acute myelogenous leukemia and hyperleukocytosis clinical characteristics in atypical hemolytic uremic syndrome. Early complications in children with acute lympho pneumococcal infection and T activation treated successfully blastic leukemia presenting with hyperleukocytosis. Ther Apher pre-transplant management of a patient with anti-factor H auto 2002;6:15?23. Blood Ferrell G, Del-Favero J, Plaisance S, Claes B, Lambrechts D, 2001;97:2121?2129. Shiga toxin-associated hemolytic uremic syndrome and and promyelocytes in the development of leukostasis syn thrombotic thrombocytopenic purpura: distinct mechanisms of drome. Management of familial hypertriglyceridemia during leukocytic adult acute myeloid leukaemia: a single-center pregnancy with plasma exchange. Leukapheresis and cranial irradiation in patients with with immunoglobulin abnormalities. Semin Hematol 1973;10: hyperleukocytic acute myeloid leukemia: no impact on early 113?124. Plasmapheresis therapy in macroglobu hyperleukocytic leukaemias?the experience of a tertiary insti linemia. Impact of pre-induction therapy leukapheresis on treatment removing abnormal protein rapidly from patients with malig outcome in adult acute myelogenous leukemia presenting with nant paraproteinaemias. Mod A, Fust G, Harsanyi V, Natonek K, Poros A, Szabo J, leukemia with hyperleukocytosis. Ef tions and outcome of children with acute lymphoblastic leuke ficacy of discontinuous flow centrifugation compared with cas mia. Intensive, Waldenstrom and multiple myeloma: influence on blood rheology long-term plasma exchange therapy for severe hypertriglyceri and the microcirculation. Adv Intern of plasma exchange by plasma separation and cascade filtra Med 1992;37:249?273. Pan ultrasound investigation of the therapeutic effect of plasma creas 1996;13:96?99. Swoboda K, Derfler K, Koppensteiner R, Langer M, Pam toma): a case of central retinal artery occlusion. Gastroenterology 1993;104:1527 globlinaemia: modified plasmapheresis as treatment option in a 1531. Therapeutic plasma mapheresis on hyperviscosity-related retinopathy and retinal exchange in patients with hyperlipidemic pancreatitis. Still a role for plasma exchange in rapidly locyte and monocyte/macrophage adsorptive apheresis and progressive glomerulonephritis? Gastroen monocyte apheresis versus prednisolone in patients with corti terology 2008;135:400?409. Hanai H, Iida T, Takeuchi K, Watanabe F, Maruyama Y, treatment of inflammatory bowel disease. Inflamm Bowel Dis Kageoka M, Ikeya K, Yamada M, Kikuyama M, Iwaoka Y, 2006;12(Suppl 1):S10?S14. Preliminary data on the use of apheresis in cyte and monocyte adsorption versus intravenous prednisolone inflammatory bowel disease. Inflamm Bowel Dis 2006;12 in patients with severe ulcerative colitis: an unblinded rando (Suppl 1):S15?S21. Kumagai M, Yamato Y, Maeda K, Nakashima E, Ushijima K, adsorptive carrier based granulocyte and monocyte apheresis de Kimura A. Extracorporeal leukocyte removal therapy for vice for the treatment of inflammatory and refractory diseases patients with ulcerative colitis. Sawada K, Muto T, Shimoyama T, Satomi M, Sawada T, gel R, Mausfeld-Lafdhiya P, Liebe S, Ramlow W. Dig apheresis in patients with active ulcerative colitis: a multicen Dis Sci 2006;51:1525?1531. Effects of intravenous im Takahashi D, Mukumoto M, Nishimura N, Yasue K, Matsu munoglobulin on muscle weakness and calcium-channel auto moto K. Granulocyte and monocyte adsorptive apheresis in the antibodies in the Lambert-Eaton myasthenic syndrome. Neurol treatment of active distal ulcerative colitis: a prospective, pilot ogy 1996;47:678?683. Am J Physiol ficacy of granulocyte and monocyte adsorptive apheresis ther 1956;187:612?613. Tsujikawa T, Andoh A, Ogawa A, Sonoda A, Yagi Y, Hata K, Calcium-channel antibodies in the Lambert-Eaton syndrome Sasaki M, Saito Y, Fujiyama Y. N Engl J Med 1995;332: consecutive leukocytapheresis for the treatment of ulcerative 1467?1474.