By B. Copper. Scripps College. 2019.

Epididymalcystsareuidlledswellingsconnectedwith Psychogenic causes can be divided into following: the epididymis that occur in males generic toradol 10mg amex flourtown pain evaluation treatment center. If the uid contains r Depression toradol 10 mg discount pain medication for dogs over the counter, causing loss of libido and erectile dys- sperm order generic toradol on-line unifour pain treatment center denver nc, it is called a spermatocele. Barbiturates, corticosteroids, phenothiazines 5phosphodiesterase), so increasing the ability to gen- and spironolactone may reduce libido. Recreational drugs such as co- 1 hour before sex, and its effects last for 4 hours. Its caine and hallucinogenic drugs can cause impotence vasodilation effects can cause headache, dizziness, a with long-term use. Auto- r Penile self-injection with vasoactive drugs such as pa- nomic neuropathy is also an important factor. There r Vacuum devices can be used to suck blood into the isalsoareexarcatS2 S4whichmeansthatgenitalstim- penis and then a ring is applied at its base to main- ulation increases vascular ow. Ejaculation is not possible with these any level can therefore interfere with sexual function. Clinical features r Psychological counselling is useful for those with a Some features in the sexual history, medical history or psychological cause. Completelossof erections, including nocturnal erections, suggests a neu- rological or vascular cause. Sudden loss of sexual func- Genitourinary oncology tion without any previous history of problems, or major genital surgery, suggests performance anxiety, stress or Kidney tumours loss of interest in the sexual partner. Ability to generate an erection, but then inability to sustain it may be due Benign tumours are commonly found incidentally at to anxiety or to a problem with vascular supply, or nitric post-mortems or on imaging. It is important to r Renal adenomas are derived from renal tubular ep- take a drug history and enquire about possible features ithelium. Tumours less than 3 cm in diameter are ar- of depression, smoking, alcohol or drug abuse. Microscopically they giomyolipomas, but there is also an increased risk of contain only large well-differentiated cells with papillary renal cell carcinoma. Malignant tumours r Clinical features The most common is renal cell carcinoma (85 90% Presenting symptoms may include haematuria, fever, in adults). These share the same pathology as in dromes are relatively common: bladder cancer. Adenocarcinoma of the kidney, which arises from the r Polymyalgia-like symptoms with aching proximal renal tubular epithelium. Many patients remain asymptomatic until advanced lo- Prevalence cal disease or metastases develop, so may present with 2% of all visceral tumours; 85 90% of primary renal the symptoms of complications and increasingly lesions malignancies in adults. On examination, occasionally a palpable loin mass Age may be found and lymphadenopathy, hepatospleno- Increases with age, most over age 50 years. Predisposing factors include smoking, carcinogens such as asbestos and petrochemical products, obesity and ge- netic factors. Complications Prognosis Local spread especially into the renal vein, and may grow If conned to renal capsule 10-year survival is 70%. Tumour poor if metastases present, 25% of patients present with may also spread into neighbouring tissues, such as the metastases and they have a 45% 5-year survival. Bladder cancer Denition Investigations Bladder cancer is the most common urological malig- Urinalysis shows haematuria in 40%. A solid tumour >3cmisdiagnostic, but sometimes a cyst is seen which needs to be differentiated Incidence/prevalence between a simple benign cyst, a complex cyst or solid Common malignancy; 1 in 5000 in United Kinddom. Management Surgical removal is the treatment of choice for those Aetiology without metastases (if there is a single metastasis this There are several risk factors for the development of can be resected along with the primary tumour). In the past, radical nephrectomy with removal of r Exposure to certain carcinogens and industries cause the kidney, perinephric fact, together with the ipsilateral as many as 20% of cases. Aromatic amines, or deriva- adrenal gland and hilar and para-aortic lymph nodes tives, which are strongly carcinogenic are commonly was routinely performed. Some now perform either total found in the printing, rubber, textile and petrochemi- nephrectomy (without removal of the adrenal or lymph cal industries. Genetic: Macroscopy r Through polymorphisms of various cytochrome P450 Low-grade tumours have a papillary structure and look enzymes, some individuals appear to oxidise ary- like seaweed. Higher grade tumours lamines more rapidly, which makes them more prone appear more solid, ulcerating lesions. T3 Deep muscle involved, through bladder wall Radiotherapy, for example for pelvic tumours, pre- (mobile mass). It is thought that in most cases, the bladder and ureters G2 Moderately well differentiated. Adenocarcinoma arises from the urachal rem- Investigations nants in the dome of the bladder. Whilst all these symptoms are most commonly be performed from the bladder upwards. Pain may be felt in the loin when there is ob- Depends on stage: struction, or suprapubically if there is invasion through i TisorTa, and T1 are initially treated by cysto- the bladder wall. Follow-up 3 months later has a 50% re- Prostate cancer currence rate and regular follow-up is needed, usu- Denition ally for 5 10 years. In Geography males it is possible to use a piece of ileum to form Varies by population (90x). Most common in Afro abladder substitute substitution urethroplasty be- Caribbeans, common in Europe, rare in Orientals. Morbidity results from radiation cystitis and proctitis leading to a small Pathophysiology brosed rectum. In females radiation vaginitis and/or The cancer is commonly androgen-dependent, but anasensatevagina,andinmalesimpotenceoccursdue there is no evidence that its growth is driven by a to nerve damage. However, popu- r Chemotherapy is increasingly used with surgery, or lation studies have shown that men with higher testos- may be used alone as a palliative measure. Neoad- terone levels appear to be at greater risk of prostate juvant chemotherapy (i. Depends on stage and grade at presentation and the age r In most cases it is diagnosed either on rectal exam- of the patient. Recurrence is common and may be of ination as the nding of an asymmetric prostate, a a higher grade (25%). T1 has an 80% 5-year survival and diagnosed because of the nding of a raised prostate T4 has 10% 5-year survival (but very age dependent). Macroscopy Management The tumours usually are in the peripheral zone of the This depends on the tumour staging, grade and also on prostate and appear as hard yellow-white gritty tissue the patient s age and co-morbidity, as many of the treat- (see Table 6. Organ-conned, low-grade disease: r These tumours tend to grow slowly, in older patients Microscopy (>70 years) and those likely to die of co-morbidity be- Most are well differentiated and consist of small acini fore the cancer causes signicant symptoms or metas- in a glandular pattern.

The study tested the effect of crude 50% ethanolic extract of Euphobia hirta on the caecum amoebiasis induced in mice by E discount toradol 10 mg with visa allied pain treatment center columbus ohio. On the fourth day best purchase toradol pain management during shingles, the mice were sacrificed and the reduction in caecal wall ulceration was compared with a negative control group of non-infected mice and a positive control group of infected mice receiving metronidazole (78mg/day) order toradol no prescription myofascial pain treatment guidelines. Marked antiamoebic activity of Euphobia hirta was seen as reduction of caecal wall ulceration in mice treated by the extract and metronidazole when compared to the control animals. The 50% ethanolic extract, at doses of 9g/kg, affect cure in 40% of the mice treated, as compared to 80% with metronidazole. The remaining 2 doses of 3 and 6g/kg extract still showed 20-25% effectiveness in treated mice. Out of 328 registered primary school children, 141 children (41%) were included in the study. A course of metronidazole 12mg per kg per day for 5 days was given to these children with Blastocystis hominis infection, detected by microscopy and 72 hour culture. Although reinfection could not be excluded, it was quite evident that metronidazole treatment alone is not sufficient to treat Blastocytis hominis infected cases. Routine examination of stool was done by applying direct smear and acid-fast stained methods. Forty four percent of athletes was found to be infected with intestinal parasites. The highest rate of mixed intestinal parasitic infection was also identified in rowers (50%). No special relationship was noted between the nature of sports discipline (either aquatic, racket, atheletic or contact sports) and type of parasitic infections. Decisions about new vaccine introduction will require reliable data on disease impact. The Asian Rotavirus Surveillance Network, begun in 2000 to facilitate collection of these data, is a regional collaboration of 36 hospitals in nine countries or areas that conduct surveillance for rotavirus hospitalizations using a uniform World Health Organization protocol. During this period, 45% of acute diarrheal hospitalizations among children 0-5 years were attributable to rotavirus, higher than previous estimates. Rotavirus was detected in all sites 175 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar year-round. This network is a novel, regional approach to surveillance for vaccine- preventable diseases. Such a network should provide increased visibility and advocacy, enable more efficient data collection, facilitate training, and serve as the paradigm for rotavirus surveillance activities in other regions. Although the therapeutic endoscopy is the definitive treatment for bleeding oesophageal varices, many patients respond poorly and rebleed after therapeutic endoscopy. For these patients, portal systemic shunt and transection devascularization (Sugiura and modified Sugiura) procedures are the two famous options currently available. The author modified the Sugiura procedure with a transabdominal approach and subcardial gastric transection instead of tloraco-abdominal approach and oesophageal transection. A total of 19 patients were included in the study during the study period of 4 years and 2 months. Out of 19 patients, 7 patients had hepatitis B positive, 5 patients had hepatitis C positive, one patient had both B and C positive and the remaining 6 patients were free of viral antigens. Among the study patients, there were 11 cases of post hepatitic cirrhosis, 6 cases of alcoholic cirrhosis and the remaining 2 cases were extrahepatic portal vein thrombosis without cirrhosis. The mean estimated intraoperative blood loss was 2120mls and the average blood transfusion during operation was 4. Since 7 of the 19 patients died within 30 days, the early operative mortality was 36. The major causes of death were early rebleeding, septicemia probably due to the effect of splenectomy and multiorgan failure especially liver failure. Twelve survivors were discharged from the hospital with the average hospital of 21. The duration of follow up ranged from 8 months to 51 months with the mean follow up of 27. On recheck endoscopy at follow up, residual varices were noted in 4 patients (33%) and varices were eradicated in 8 patients (67%). During the follow up period, 3 patients died following recurrent bleeding and eventually 9 patients survived. The mortality and morbidity of the study is high so that the procedure is routinely not recommended as an acceptable procedure for the patients with rebleeding after therapeutic endoscopy. Blunt injuries should be treated by resection and anastomosis and in many instances with a covering colostomy. Iatrogenic injuries recognized early may be suitable for primary repair, but those presenting late often require a colostomy. Highly destructive blunt trauma forms a relatively large proportion of colonic injuries and colostomy remains an important option. From the samples collected from January to December 2005, rotavirus was detected in 536 of 1180 stool samples tested (45. Of the 133 samples identified for G typing, 88% (117) were genotype G3, followed by 10 positive samples of G1 (7%), 4 of G4 (3%) and 2 of G2 (2%). In addition to the 2005 samples, preliminary screening of the P and G genotype combinations of 30 stool samples collected in 2006 December and 2007 January were also tested. Three unusual G and P combinations, that is G2/P[9], G3/P[9] and G3/P[10] were identified in the samples collected from 2007. The distribution of G and P genotype provides valuable information for the development of effective rotavirus vaccines. Intestinal parasitosis is a main contributor in causing diarrhea in immunocompromised patients. Collected stool samples were examined as wet-mount preparation and also cultivated. Modified acid fast staining and trichome staining were applied to detect coccidia. Number of parasite positive patients varied directly with the number of diarrhea patients. Ninety-five stool samples collected from children admitted to Yangon Children s Hospital with diarrhoea cases from Yangon proper (31 cases) and outskirts of Yangon proper (64 cases 0 were examined. The sex ratio amongst the diarrhoea cases admitted to Yangon Children s Hospital during this study period was 54. The lowest pathogenic isolation rate (50%) was recorded in the children 61-108 months and the highest (76. In addition, the parents of children admitted to the Children s Hospital from Yangon Proper were street sellers and labourers while the parents of those admitted to the hospital from outskirts were mainly service members who are more knowledgeable than the street sellers. This study was done in 2004, from stool samples collected from under five year-old children admitted to the Yangon Children s Hospital for diarrhoea.

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Regardless of the age or educational status most have good knowledge on diarrhoea and its home care procedure (89%) purchase toradol sciatica pain treatment guidelines. However order 10 mg toradol with visa treatment pain genital herpes, maturity best 10mg toradol pain medication for dogs, educational status and experience are attributes for the ability to translate knowledge into good practice as 83. This study illustrates the value of primary education in acquiring knowledge of health educational messages. Its also reveals the importance of technical skill of health educators in structuring messages for the public in order to materialize change in the attitude of community and ensure its commitment nd mobilization. Research findings since 1980 on Escherichia coli as an etiologic agent responsible for diarrhoeal diseases in Myanmar are reviewed and presented. The incidence and seasonality of Escherichia coli diarrhea in community and hospital based settings, in adults and children were reported. The review also consisted of studies on pathogenesis of Escherichia coli and on plasmid profiles. They are all sensitive to nalidixic acid but 97 percent to gentamycin, 96 percent to sisomycin and 95 percent to tobramycin respectively. It was observed that one case from diarrhoea cases showed alpha haemolytic activity; none of the control cases showed any haemolytic activity; and 3 cases of urinary tract infection showed beta haemolytic activity. Simultaneously, a set of questions was filled to ascertain the diarrhoea and motion of diarrhoea of children. Random samples of 238 males and 158 females children of age ranging from one month to ten years old were included in this study. From the cases detected, the age range was from ten months to five years and the duration of illness was from 3 to 30 days. It was then serotyped using O antisera by test tube serial dilution technique and found that 33 cases showed agglutination. Most of them were resistant to ampicillin, chloramphenicol, streptomycin, tetracycline and trimethoprim/sulfamethoxazole. Fecal leukocytes were identified under a high power microscope by wet mounting of methylene blue staining method. Those cells clearly identified with either round nucleus or as polymorphonuclear were noted and degenerated cells that could not be clearly identified were ignored. The bacterial pathogens and protozoal pathogens were identified by standard methods. Fecal leukocytes were present 114 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar in 31. The association between the presence of fecal leukocytes and isolated pathogens from the stools was analyzed. It was found that fecal leukocytes were seen in stools which are associated with shigella (25%), Shigella and Entamoeba histolytica 971. A total of 1805 isolates 115 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar of E. It was serotyped by using O antisera using test tube terial dilution technique and observed that 93 isolates showed agglutination. The ingredients (24 plants) present in it were selected singly and tested for their antibacterial activities. A total of 35 strains of bacteria (Escherichia coli=11; Staphylococcus aureus=3; Salmonella species=7; Shigella species=4; Vibrio cholerae=7 and one species each of Bacillus subtilis, Pseudomonas aeruginosa and Proteus morganil) were chosen for testing. Among the 23 plants tested, they were found to be active on one, two or more of the bacteria tested with different patterns 328 Mar Mar Nyein; T. It was also noted that Salmonella and Plesiomonas isolation rates were higher in the control group. Antibiotic susceptibility test revealed that these shigellae were resistant to ampicillin (84 per cent), chloramphenicol (76 per cent). From the above cases, 272 cases were also performed for the isolation of other aetiologic agents and observed that Shigella isolated from 3 cases; Vibrio species were isolated from 2 cases; and Plesiomonas shigelloides was isolated from 3 cases respectively. Adherence cell assay was done by using Lab Tek chamber slides seeded with Hep- 2 cells. Thus a study was conducted on 2522 Escherichia coil isolates from 501 diarrhoeal cases and 374 control cases from the Intakaw survey. Enterotoxigenic stains were isolated from 91 cases of diarrhoea ad from 29 control cases. A total of 923 cases of diarrhoea and 932 cases of control were included in this study. They were Vibrio cholerae O1 (21 cases) and Vibrio cholerae O139 (136 cases) from diarrhoea case attending the Infectious disease Hospital during 29-9-98 to 29-10-98. Salmonella typhi (38cases) and Escheriachia coli (15 cases) from cases with high fever for more than five days admitted to Yangon Children s Hospital during 27-8-98 to 17-8-2000. Biopsy findings of gastric ulcers and, operative findings st of some of the cases were recorded. It was a prospective study of 6 months-period from 1 th April 1994 to 30 September 1994. There were 35 patients with radiologically diagnosed ulcer, 11 cases have gastric and 24 cases have duodenal ulcers. Gastric ulcers are more commonly found at the distal 119 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar part the stomach. The diagnostic radiographic features of duodenal, and both benign and malignant gastric ulcers are studied and discussed in detail. Ten patients treated with sclerotherapy alone and 20 patients treated with propranolol alone. Elective sclerotherapy was performed by using absolute alcohol injection 2 weekly, after that 3 weekly till up to 3 months. Patients treated with propranolol bled significantly less, experienced less bleeding episode per patients (7 vs 28; p<0. Propranolol is cheap, easily available and thus, may prove beneficial and superior to injection sclerotherapy in preventing of upper gastrointestinal bleeding in cirrhotic patients. This study was also carried out to observe the effectiveness of metronidazole on them. The stool samples were collected from diarrhoeal unit of Yangon Children Hospital. If they were present in the stool, the patient was treated with metronidazole and the stool was rechecked again. Intragastric injection of both the argete and unlabelled toxin produced a significant increase of fluid targeted n i ratio over the controls indicating that the biological activity was not lost during radioiodination. In vivo uptake studies of the argete toxin by different parts of the intestine namely duodenum, jejunum and ileum indicated that the uptake by duodenum was highest and the uptake was found to decrease gradually in other parts of the intestine, jejunum and ileum, respectively. The uptake of the argete toxin by subcellular particles of intestinal cells indicated that the toxin uptake was maximum in mitochondrial-lysosomal fraction probably confirming our previous report on lysosomal involvement in the digestion of toxin. The results also seem to be consistent with the short-lived physiologic hypersecretory action of the toxin.

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However cheap toradol 10mg otc pain medication for dogs with hip problems, venous ulcers are usually found around the medial malleolus and are often associated with skin changes of chronic venous insufficiency generic 10 mg toradol free shipping pain management for dying dog. This has the fea- tures of an ulcer caused by arterial rather than venous ulceration or a mixed aetiology discount toradol uk pain tailbone treatment. The left dorsalis pedis pulse is not palpable and the capil- lary return time is greater than the normal value of 2 s. The story of pain in the legs on walking requires a little more detail but it is suggestive of intermittent claudication related to insufficient blood supply to the exercising calf muscles. In diabetes the arterial involvement may be in small vessels with greater preservation of the pulses. The periph- eral sensory neuropathy may also be associated with diabetes and lead to unrecognized trauma to the skin which then heals poorly. Other risk factors for arterial disease are the family history and the history of smoking. Further investigations would include measurement of the ankle:brachial blood pressure ratio. Ultrasonic angiology would help to identify the anatomy of the arterial circulation in the lower limbs and would show if there are correctable narrowings of major vessels. Good control of diabetes can slow progression of complications such as neuropathy and microvascular disease. Care of the feet is a very important part of the treatment of dia- betes and should be a regular element of follow-up. History A 50-year-old man has a health screen as part of an application for life insurance. Although only a single reading is given, the hypertrophy makes it likely that the blood pressure represents sustained hypertension rather than a white coat effect. It should be repeated several times over the next few weeks for confirmation, but treatment is likely to be indicated. Tables such as the Sheffield table can be used to obtain a calculation of the risks of cardiovascular disease. The other question is whether a search for the cause of the hypertension is indicated. Most of the secondary cases are related to renal disease, and the renal function is normal here. A number of endocrine causes (Cushing s syndrome, Conn s syndrome) are associated with hypokalaemia. If the blood pressure is dif- ficult to control, secondary causes such as renal artery stenosis should be considered and investigated by renal ultrasound or a technique to visualize the renal arteries such as mag- netic resonance angiography or digital subtraction angiography. The cholesterol is at a level which would warrant treatment if there was evidence of vascu- lar disease. She thinks that he might have lost a few kilograms in weight over this time, but he does not weigh himself regularly. He says that he has felt limited on exer- tion by tiredness for a year or so, and on a few occasions when he tried to do more he had a feeling of tightness across his chest. He smokes 20 cigarettes a day and drinks a pint or two of Guinness each Saturday and Sunday. His sleep has been disturbed by occa- sional nocturia, and on two or three occasions in the last few weeks he has been disturbed by sweating at night. There is no clubbing, but tar staining is present on the fingers and nails of the right hand. On auscultation of the heart there is a grade 3/6 ejection systolic murmur radiating to the carotids and a soft early diastolic murmur audible at the lower left sternal edge. The urine looked clear but routine stick test- ing showed a trace of blood and on urine microscopy there were some red cells. The findings of mixed aortic valve disease, microscopic haematuria, malaise and fever (probable with the night sweats) make infective endocarditis a likely diagnosis. In the elderly, infective endocarditis may be an insidious illness and should be considered in any patient who has murmurs and fever or any other change in the cardiac signs or symptoms. Precipitating events such as dental treatment or other sources of bacteraemia may not be evident in the history. When there is a fever or other evidence of infection in the presence of valve disease, infective endocarditis must always be considered although in practice other unre- lated infections are more common. Other infections such as tuberculosis or abscess are possible or an underlying lymphoma or other malignancy. The most important investigations would be: blood cultures performed before any antibiotics are given. In this case three blood cul- tures grew Streptococcus viridans echocardiogram which showed a thickened bicuspid aortic valve, a common congeni- tal abnormality predisposing to significant functional valve disturbance in middle and old age. Vegetations can be detected on a transthoracic echocardiogram if they are prominent, but transoesophageal echocardiogram is more sensitive in detecting vege- tations on the valves. Treatment with intravenous benzylpenicillin and gentamicin for 2 weeks, followed by oral amoxicillin resulted in resolution of the fever with no haemodynamic deterioration or change in the murmurs of mixed aortic valve disease. A microbiologist should be con- sulted about appropriate antibiotics and duration. After treatment of the endocarditis, the symptoms of pain and tiredness on exertion would need to be considered to see if valve surgery was indicated. Prior to this it would be rou- tine to look at the coronary arteries by angiography to see if simultaneous coronary artery surgery was needed. The abdominal pain started quite suddenly 24 h before admission and has continued since then. She has a glyceryl trinitrate spray but she has not needed this in the last 3 months. A year ago she was found to be in atrial fibrillation at 120/min, and she was started on digoxin, which she still takes. The only other medical history of note is that she had a hysterectomy for menorrhagia 30 years ago and she has hypertension controlled on a small dose of a thiazide diuretic for the last 3 years. Examination She was in atrial fibrillation at a rate of 92/min with a blood pressure of 114/76 mmHg. No masses were palpable in the abdomen and there were just occasional bowel sounds to hear on auscultation. The abdominal X-ray showed no gas under the diaphragm and no dilated loops of bowel or fluid levels. The patient is likely to become very ill without markedly abnormal physical signs. She has been on aspirin which will reduce slightly the risk of embolic events, but not on anticoagulants which would have decreased the risk further. In the presence of pre-existing cardiovascular problems, shown by the hypertension and angina, anticoagulation would normally be started if there are no contraindications. The risk of cerebrovascular accidents caused by emboli from the heart has been shown to be reduced. In lone atrial fibrillation with no underlying cardiac disease the risks of emboli and the benefits of anticoagulation are less.

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