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Had two recurrences of ague after the treatment was commenced purchase midamor 45 mg line heart attack chords, but made an excellent recovery purchase midamor 45 mg mastercard blood pressure reducers. No means employed had done any good, except to break it on the father for one week. It is of the tertian type, but fortunately the sick day of one is the well day of the other. Examination shows - skin pallid and relaxed; pulse soft, open and easily compressed; temperature 99°; bowels tumid, irregular; hands and feet cold; eyes dull, pupils dilated; wants to sleep; tongue full, broad, with coating somewhat resembling that after eating milk. Father reported in ten days that neither he nor the child had had a paroxysm of ague since, (the child did not take the Sulphite. Returned from Vincennes feeling very much depressed, had a slight chill, pain in head and back, intense muscular pain in right side extending from shoulder to foot. Eyesight impaired, and partial paralysis followed the subsidence of the pain; ague quotidian. It had no more effect on the ague than so much water, but produced unpleasant head symptoms and deafness, which were persistent. There was a steady amendment, and the fourth day gave a single dose of Quinine, grs. Though the chills were stopped, the deafness continued, as did the slight paralysis. Characteristic symptoms - a broad, pallid tongue, coated with a white, pasty fur; breath fetid. This is a typical case, and some physicians have found all the cases of a season to take this character. Thus we had 127 cases reported by one physician in 1868, cured with Sulphite of Soda alone; Quinine failed almost uniformly. Instead of depending wholly upon Sulphite of Soda, however, I would advise its use until this peculiar condition was rectified, and then give Quinine. Common Salt has been successfully employed in the same class of cases in doses of grs. A large number of cases, by different practitioners, were reported in one of our Southern exchanges, some twenty years ago. The cases would not yield to ordinary treatment; and in some, typhoid symptoms gradually developed, and patients died of what was at first an ordinary ague. My first treatment was a complete failure, and it was only after I had seen a prescription of our old Quaker physician, Dr. Characteristic symptoms - deep redness of mucous tissues, and dark coatings upon tongue; and to-day, with the same symptoms, I should use the same treatment. Now Quinine has no influence, only to produce cerebral symptoms and increase the severity of the disease. His skin is sallow; yellowish discoloration about the mouth; complains of dull pain in right side under false ribs extending to shoulder, and occasional umbilical pains; enlargement of spleen, bowels irregular, stools clay colored; has frequent attacks of nausea; urine highly colored with bile; pulse in intermission 90, temperature 100°; has little appetite, and is very much debilitated. The disease gives way slowly - patient had two chills after the medicine was commenced. The remedy was continued without change for two weeks, and the cure was permanent. There is nothing remarkable about the case, except the loss of energy and desire to do anything, and the fact that ordinary means do not reach it. Pulse soft and open, 70 per minute; temperature 99°; skin relaxed and moist; tongue broad and sodden; bowels irregular, stools semi-fluid with scybala: urine in large quantity, colorless. I think I have pointed out the Strychnine case, so that any of our readers may know it - but I would be very glad to have it confirmed by other observers. Shultz, of Logansport, employs Strychnine, quite frequently, by hypodermic injection, and expresses himself pleased with its action. They had contracted the disease on the Lower Mississippi, Yazoo and Red River, and it was remarkably stubborn, some cases being continued from June to Mid-Winter, with temporary arrests from Quinine. Three-fourths of them presented the following symptoms - tongue broad, heavily coated at base in the morning, bad taste in the mouth, weight and fullness in epigastrium, fetid breath, and unpleasant eructation after eating. I treated every case with thorough emesis, (Compound Powder of Lobelia), repeated in some cases, and the use of a solution of Acetate of Potash, ʒiij. The treatment was a decided success, but I obtained a reputation for giving nasty medicine that I never will get rid of.
The rec- ommendation for surgical resection results from the following criteria: the lung is the only site of metastatic spread purchase midamor 45 mg line blood pressure monitor reviews, the primary tumor is controlled purchase midamor 45 mg on-line high blood pressure medication new zealand, there is no effective medical treatment available, and the metastatic tumor can be resected completely. Survival appears to be dependent on the tumor type, number of metastasis, and the latency between the diagnosis of the primary tumor and the development of metastatic spread to the lung. The best survival has been in patients with solitary tumors and a latency over 1 year. However, 5-year survivals up to 20% are reported with multiple pulmonary metastasis presenting as synchronous disease. Tumors of the Mediastinum Tumors presenting in the chest cavity that are not originating from the lung or pleural surface are classified according to their location within the mediastinum (Table 13. The mediastinum anatomic alley is divided into the anterior, middle, and posterior compartments. The anterior compartment extends from the undersurface of the sternum to the anterior borders of the heart and great vessels. The posterior com- partment extends from the anterior border of the vertebral bodies to the ribs posteriorly. The middle mediastinum includes all structures between the anterior and posterior mediastinum. These anatomic boundaries serve as an excellent means to develop an accurate differ- 13. Anterior Thymus Thymoma Thymic carcinoma Carcinoid Lymphoma Germ cell tumor Thyroid Most commonly a benign goiter Parathyroid adenoma Posterior mediastinum Neurogenic tumors Benign Schwannoma (neurilemmoma) Neurofibroma Ganglioneuroma Pheochromocytoma Paraganglioma Malignant Malignant schwannoma Neuroblastoma Malignant paraganglioma ential diagnosis. The anterior mediastinum consists mainly of tumors of the thymus (predominantly thymomas), lymphomas, and germ cell tumors. The majority of posterior mediastinal tumors are neuroen- docrine in origin and usually are benign in adults. Clinical Presentations Primary Tumor Patients with lung cancer typically present with symptoms (Table 13. Symptoms at presentation are from the primary tumor in 27% of patients and are dependent on the location of the tumor. Peripheral tumors are more likely to present with chest pain, dyspnea, or pleural effusion. The primary tumor may cause symptoms by direct extension into mediastinal structures. Patients may present with pain from direct rib involvement, or a tumor in the superior sulcus (Pancoast) can cause radicular arm pain and weakness from invasion of the brachial plexus. Invasion of the superior vena cava (superior vena cava syndrome) may cause facial and upper torso venous engorgement. Metastatic Tumor Metastatic disease from mediastinal tumors is the presenting symptom in 32% of the cases. The most common sites of distant lung metasta- sis are the adrenal gland, lung, bone, liver, and brain. Paraneoplastic Syndromes Paraneoplastic syndromes occur most commonly with small-cell carci- nomas and squamous cell carcinomas (Table 13. Hypercalcemia from the production of either a parathyroid hormone or a parathyroid- like substance is associated most commonly with squamous cell carcinomas. Superior Sulcus Tumor Superior sulcus tumors arise from the apex of the lung and can invade the upper ribs or brachial plexus. Patients frequently complain of arm or shoulder pain and may have T1 nerve root weakness or present with Horner’s syndrome. All patients presenting with a superior sulcus tumors should have their mediastinal lymph nodes evaluated by medi- astinoscopy. The survival is extremely poor when this group of patients presents with mediastinal lymph metastasis. Patients are treated with radiotherapy (30 to 45Gy), followed by en bloc resection in 4 weeks. Recent studies suggest a benefit to neoadjuvant chemotherapy, in addi- tion to radiotherapy.
Saprophytes : Mode of life of free-living organisms which obtain their nourishment from soil and water order 45mg midamor mastercard blood pressure 8550. Commensalism: The ability to live on the external or internal surface of the body with out causing disease generic midamor 45mg overnight delivery blood pressure zantac. Invasiveness of micro-organism A high degree of bacterial invasiveness is usually associated with severe infection. Mode of release from bacteria Excreted by released on bacterial death 295 living cell (Integral part of cell wall) 4. Collagenase: Degrade collagen, which is major protein of fibrous connective tissue. Hyaluronidase: (Early spreading factor) hydrolyzes hyaluronidic acid, which is the ground substance of connective tissue. Lecithinase: Splits lecithin of cell membrane into phosphorylcholine and glycerides. Many layered impermeable barrier to invasion of the tissues by microorganisms from the environment. Lysozyme: An enzyme which lyses the mucopeptide (peptidoglycan) of the Gram-positive bacteria. Respiratory secretion: Traps bacteria and constantly moves them upward propelled by cilia on the cells of the epithelium. Phagocytosis: The process by which microorganisms are ingested and destrrroyed by phagocytic cells. Act as an early defense against infection and are the “pus cells” seen in the exudate from acute infection. Produced in the bone marrow and found in blood stream as monocyte and in tissue as fixed macrophage. Phagolysosome: Fusion ofphagosome and lysozyme (bag of hydrolytic and proteolytic enzymes found in phagocytic cells). Specific defense mechanisms There are two main mechanisms by which the host mounts a specific immune response against bacterial infection. The cell mediated response The humoral response Antibodies are proteins produced by B-lymphocytes in response to antigens (foreign substance which induces and binds with antibody). Bacterial Lysis The cell mediated response It is important in killing of intracellular pathogenic bacteria. T-lymphocytes are population of lymphocytes conferring cell mediated immunity due to release of hormone-like mediators (lymphokines). Inhibition of macrophage migration: Localizes macrophage to the site of infection. Chemotactic attraction of lymphocytes, macrophages and polymorphs to the site of infection. Transient normal flora Resident normal floras are relatively fixed microorganisms regularly inhabiting the skin and mucus membrane of the normal host. Prevent colonization by pathogenic micro-organisms and possible disease through “bacterial interference”. Normal flora of the skin 4 The skin is rich in resident bacterial flora, estimated at 10 microbes per square inch. Alpha-hemolytic streptococci and non-hemolytic streptococci 301 Normal flora of the mouth and nasopharynx and upper respiratory tract The upper respiratory tract is heavily colonized by normal flora but the lower respiratory tract is sterile. Normal flora of the gastrointestinal tract The normal flora of the stomach, duodenum, jejunum and upper ileum is scanty but the large intestine is very heavily colonized with bacteria. Anaerobes like bacteroides, bifidobacteria, anaerobic lactobacilli, clostridia and peptostreptococci Feces contain enormous number of bacteria, which constitute upto one third of the fecal weight. Normal flora of the genitourinary tract For anatomical reasons the female genital tract is much more heavily colonized than that of the male. Non-hemolytic streptococci Normal flora of the external auditary meatus It is an extension of skin normal flora and often profusely colonized. Extensive tissue destruction with necrosis of muscle, foul smelling discharge and gas under the skin. Dirty wound Laboratory diagnosis: Specimen: Swab from lesion, ulcer and discharge.
Its specific use is in cases of furunculus or boils generic midamor 45mg visa pulse pressure less than 10, and other inflammations of cellular tissue cheap midamor 45 mg visa blood pressure chart high systolic low diastolic, terminating in suppuration. Why it has this specific influence I do not propose to say, but the fact I have proven in scores of cases. Given, a case in which boils are being continually developed, the use of lime-water will effect a radical cure. In small doses it is stimulant to the cerebro-spinal centers; in large doses it produces intoxication, and finally arrest of function. It exerts an influence upon the urinary and reproductive apparatus that may be rendered available in practice, and also to some extent upon the skin. I have employed the Cannabis specially to relieve irritation of the kidneys, bladder, and urethra. It will be found beneficial in vesical and urethral irritation, and is an excellent remedy in the treatment of gonorrhœa. Camphor in small doses is a stimulant, in large doses a sedative, to the nervous system. I do not regard it as having a very extended use in medicine, though for the purpose named, it may sometimes be employed with advantage. In low forms of disease, with insomnia and restlessness, I have used it alone, and in combination with stimulant doses of opium or morphia, and quinine. As a topical stimulant, it may be employed with advantage, when the integrity of the part is threatened from enfeebled circulation. As an internal remedy, Cantharis will have but one use - as a stimulant to the urinary apparatus, especially the bladder. As Capsicum, it never gains admission to the circulation, and, in the process of digestion, it almost wholly loses its properties as a remedy. Capsicum is used as a topical stimulant to the skin, and with advantage where the circulation is feeble, and there is need of such stimulation. In torpid states of the gastric mucous membrane, such action may be very desirable, may even be essential to life, as in congestive intermittent. It is the topical action upon the gastric mucous membrane that is beneficial in some cases of delirium tremens. The solar plexus, the most important of the vegetative nerve centers, may be thus influenced from the stomach. The stimulant influence of Capsicum may, therefore, be extended through this, and be of marked advantage in states of great and sudden prostration with tendency to congestion. Given in water-brash, or where there is decomposition of the food, it is sometimes beneficial. So in topical disease - with free secretion and tendency to sepsis - its local application absorbs the one and checks the other. Why this checks it I can not tell; that it does it, I have the evidence of my own eyes. For several years I have employed the second decimal trituration as a remedy in passive hemorrhage, with most marked benefit. I employ it in threatened hemorrhage during typhoid fever, in menorrhagia, especially when chronic, in prolonged menstruation, the watery discharge that sometimes follows menstruation, hemorrhage from the kidneys, hemorrhage from the lungs, and in some cases of leucocythemia. A good indication for this remedy is a small pallid tongue, with lenticular spots, and with this it may be given in any form of disease. The dose of the first or second trituration will be one grain, repeated as often as necessary. In this form it is easily carried, and dispensed by adding the proper portion to water, so that the dose may be one teaspoonful. Carbolic Acid exerts a specific influence in those cases in which, with a broad moist tongue, there is a cadaverous odor of the breath. It makes little difference what the name of the disease is - whether bilious or typhoid fever, cynanche, pneumonia, diarrhœa, dysentery, disease of the urinary apparatus, or whether the disease is acute or chronic. In these cases it is used in small doses as - ℞ Solution of carbolic acid in glycerine, gtt. We employ it with marked advantage in cases of irritable stomach, and to check nausea and vomiting, when the symptoms above named present. As far as my experience goes, it cannot be used with advantage where the mouth is dry, or if the tongue is contracted, or enlongated and pointed. As a topical application, we employ carbolic acid when we need an antiseptic and a stimulant.
