MedicinNews

Nov 23, 2008 at 06:42 o\clock

Rickettsial pneumonia

Rickettsial pneumonia. The lesion of lungs can develop at a number of rickettsioses, but practical value has only specific lesion of lungs at fever . In the beginning at this disease the pneumonia became perceptible so often, that fever named even a pneumorickettsiosis. Now it is established, that the lesion of lungs is observed far not in all cases of fever . Possibly, the pneumonia is characteristic for the cases of fever buy cipro 5mg resulting aerogenic infection, and at other ways of transfer (alimentary, transmissible, contact) illness proceeds without pneumonia development. The lesion of lungs at fever is specific (rickettsial). Besides the pneumonic centres, at patients tracheobronchitis signs, as a rule, become perceptible, but never there are no symptoms of a lesion of the top respiratory tracts (a rhinitis, a pharyngitis, a laryngitis). The pneumonia is not unique implication of fever . However for this disease polymorphism of clinical semiology and its diagnostics (and consequently is characteristic, and definition of rickettsial character of a pneumonia) to other clinical signs also represents the big difficulties. To think of possibility of a rickettsial pneumonia follows on the basis of set of the received clinical data. Physical implications of a rickettsial pneumonia same, as well as other pneumonia, it is possible to note only their radical character and involving in process of radical lymph nodes. The pneumonia remains is long, the involution of its semiology begins only after body temperature normalisation (the fever lasts usually to 2 ). Radiological changes remain usually during 6 . From the general implications of fever it is possible to note the acute beginning, a fast fervescence (to 39 … 40 °), a headache, pains in eyeballs, retrobulbar pains, , a sleeplessness, the raised sweating. There can be a hyperemia of the person and a neck («a hood symptom»), a vasodilatation of scleras. The liver and a lien are early enlarged. The temperature curve with the big daily allowances and unlike a curve at others varies at a prescription of antibiotics, including

Tetracyclinums a little. At a blood analysis become perceptible a leukopenia (less often ), the neutropenia, an ESR is moderately raised. Differential diagnostics is based on following data. Epidemiological preconditions (stay in districts, contact to animals, the use of crude milk), the acute beginning, a high fever, early augmentation of a liver and a lien (3 are considered... 4th day of illness), unlike a canicola fever there is no icterus and a lesion of kidneys. The long current of a pneumonia, its combination to bronchitis signs are considered also. For diagnosis acknowledgement it is more often used with a specific rickettsial antigen. Melioidosis. Pulmonary forms of a melioidosis can be observed in our country only as brought in cases at a becoming infected of the diseased in some districts of Southeast Asia (Vietnam, Laos, Kampuchea, etc.) . The lesion of lungs can acutely develop, right after infections (an incubation interval from 2 till 14 days), however more often the specific pneumonia develops after some months and even years after a becoming infected as a result of transition of the latent form of a melioidosis in the demonstrative. In these cases the lesion of lungs develops gradually. There is a general delicacy, a malaise, tussis with purulent, and sometimes and with a sputum. Delicacy accrues, the patient grows thin (loss of mass of a body reaches sometimes 10 … 15 kg). A fever more often wrong type with the big daily buy rimonabant 5mg allowances . There are pleural stethalgias. Tussis amplifies, the considerable quantity of a purulent sputum is quite often allocated. Radiological changes remind sometimes changes at a pulmonary tuberculosis. Process is more often localised in the top shares. In the beginning there are infiltrates. Then there can come their disintegration with formation of thin-walled cavities in diameter from 1 to 4 sm, is usually formed 2 … such 3 cavities, but can be and more. For differential diagnostics a pneumonia great value has the epidemiological anamnesis (stay for last years in districts), subacute disease, a lesion of mainly top shares of lungs, tussis with a considerable quantity purulent or sputums, a weight loss, a fever of wrong type, formation of thin-walled cavities in lungs, negative results of research of a sputum on a tuberculosis micobacterium.

Nov 23, 2008 at 06:41 o\clock

At chronic metastatic

At chronic metastatic forms a pneumonia usually it is not observed. For diagnostics of a brucellous pneumonia by the cores symptomatologies and original implication of the general intoxication are presence . The body temperature reaches usually 40... 41 , however overall health of the patient remains rather satisfactory. At such fever patients can go, read books, play chess, etc. There are no expressed implications of the general intoxication (a headache, , weakness, etc.) . The order ultram 5mg temperature curve is characterised by the big daily allowances and waviness. Unlike a pulmonary tuberculosis at which the fever also is transferred well, the patient does not have euphoria, excitation. At inspection of the patient, besides physical signs of a pneumonia, the augmentation of all groups of lymph nodes becomes perceptible, to the extremity of 1st week from the disease beginning the sizes of a liver and a lien are enlarged. At transition in the septiko-metastatic form the locomotorium lesion (arthritises, periarthritises, bursitises and so forth), as a rule, becomes perceptible And peripheric nervous system (neuritises, polyneurites, radiculites). For acknowledgement of the diagnosis of a brucellous pneumonia by the most simple and in any hospital the intracutaneous test with a brucellin (assay ) which from the extremity of 1st week becomes positive and even sharply positive is accessible. It is necessary to consider only, that at persons, before inoculated against , assay also positive though its expression is less, than at patients . From methods the greatest diffusion was received by Right's reactions and with a brucellous antigen. the pneumonia is one of canicola fever implications, meets seldom. The lesion of lungs is caused as a result of their hematogenic dissimination. The pulmonary syndrome is most expressed on 3 … 5th day of illness and shown in semiology of an acute focal pneumonia and a bronchitis. At development of a hemorrhagic syndrome the sputum with blood can be allocated, and the pulmonary bleeding sometimes develops. Duration of changes in lungs to 10 … 14 days. During the second wave of a fever (last years it becomes

perceptible seldom) the pneumonia caused by stratification of a secondary bacteriemic infection can develop. In this case the pneumonia is surveyed as complication. Diagnostics character of a pneumonia, especially in an illness initial stage (to 3 … 5th day), causes sometimes difficulties. Acute, sometimes the sudden beginning, even at easy forms of illness the body temperature raises to 39 "With and above, the expressed symptoms of the general intoxication and on this background - pneumonia signs become perceptible. character of a pneumonia can be established not on features of a lesion of lungs, and on other implications of a canicola fever. Attracts attention disharmony of sharply expressed toxicosis and concerning small sites (centres) of a pneumonia. Early there are very strong pains unusual to another illnesses in muscles, especially in , sometimes complicating movement of patients. Appearance of the patient is characteristic: the person and a neck (« a hood symptom »), vessels of scleras , with 3 … at some patients can appear 4th day an icterus. From first days of illness the liver and lien augmentation becomes perceptible. At a serious current, and a pneumonia develop at serious forms is more often, the hemorrhagic syndrome can be observed. At a part sick (20 … 30 %) appear signs of a serous meningitis. Almost obligatory component of clinical semiology of a canicola fever is the lesion of kidneys. vpxl 5mg The quantity of urine decreases (sometimes to ), accrues the maintenance in filtrate nitrogen blood, at urine research erythrocytes, leucocytes, fiber, cylinders are taped. In blood - lejkotsitoz - (12 … 15) 109/l, ESR substantial increase. Detection at microscopy in a dark field can be acknowledgement of the diagnosis of a canicola fever. In an initial stage of illness they are found out in blood, and in the reconvalescence period - in an urocheras. Serological tests (microagglutinations, etc.) are used also. antiserum capacity increase is diagnostic 1:100 and above or better at research of didymous Serums.

Nov 22, 2008 at 06:41 o\clock

When differential

When differential diagnostics of this group is spent is painful, lesions of lungs, and others infectious disease implications are considered as clinical features actually. The actinomycosis of lungs is one of clinical forms of an actinomycosis. Illness begins gradually. The intoxication at first is expressed weakly, a body temperature subfebrile. Tussis in the beginning dry, then starts to separate buy cipro 4mg a mucopurulent sputum, sometimes with a blood impurity. Prominent feature considers that the sputum has a smell of the earth and taste of copper. The infiltrate in a lung is enlarged from the centre to periphery, grasping gradually a pleura, a thoracal wall and a skin. On a corresponding half of breast there is a painful bagrovo-cyanotic tumescence, fistulas are formed, in pus separating from fistulas it is possible to find out druses . In this stage the diagnosis of an actinomycosis of lungs does not cause difficulties. It is much more difficult to diagnose during earlier period of illness, and it is very important for timely treatment (not treated patients at this form of an actinomycosis perish). For diagnostics characteristic properties of a sputum matter the gradual beginning of illness, it, infiltrate augmentation in a lung. For diagnosis acknowledgement spend sputum research. In it it is possible to find out druses or only a mushroom. At sputum crops it is possible to allocate for a bloody agar or medium . Use also an intradermal allergy test with . Only positive and sharply positive reaction has diagnostic value. Weakly positive reactions can be observed and at other illnesses. Aspergillosis. the aspergillosis form can proceed in the form of acute and chronic disease.

Acute forms of an aspergillosis should be differentiated from a pneumonia. They are characterised by a high fever with the big daily allowances , repeated cold fits and sweats. Early there is a tussis with unit viscous mucopurulent or sputums. At some patients in a sputum it is possible to notice small greenish lumps at which microscopy clumps and mushroom dispute are visible. At patients the expressed dyspnea, accruing delicacy, a weight loss are observed, night sweats become perceptible. In lungs finely-bubbly wet rhonchuses, and at some patients a pleural rub are auscultated. the oval or roundish infiltrates inclined to disintegration are taped. Round cavities it is visible wide a shaft. In blood a leukocytosis, a moderate eosinophilia, an ESR it is raised. For diagnostics gravity of illness, its steady advance, characteristic radiological changes matter. For acknowledgement of the diagnosis crucial importance has detection of a mushroom of sort Aspergillus in a sputum. Are used also an intracutaneous test with specific allergen and with an antigen. A lethality at an aspergillosis over 20 %. Brucellous pneumonia. The specific lesion buy rimonabant 4mg of lungs is observed at acute , is more rare - at the septiko-metastatic form. Stratification of a secondary infection at patients practically does not meet, therefore occurrence of a pneumonia in the patient acute testifies to development of a specific brucellous pneumonia. Is more often it develops at an aerogenic becoming infected (air-dust). Clinically brucellous pneumonia is characterised by duration of a current when 2 … 3 it is not taped special dynamics of physical and radiological data, fast effect does not give. In blood remain a leukopenia (characteristic for ), a neutropenia, a relative lymphocytosis. An ESR it is not changed. Gradually pneumonia signs disappear without any residual phenomena. Abscessing for a brucellous pneumonia uncharacteristically.

Nov 22, 2008 at 06:40 o\clock

a pneumonia. The pneumonia

a pneumonia. The pneumonia caused Pneumocystis carrinii, meets seldom and basically at the persons weakened by any diseases (a leukaemia, a lymphogranulomatosis, neoplasms, etc.) or spent therapy (radial therapy, immunodepressants and so forth). Last years the case rate was considerably enlarged by a pneumonia in connection with AIDS diffusion. the pneumonia begins gradually, there is a general delicacy, a dyspnea (at 91 % of patients), the fervescence is observed not at all patients (at 66 %), tussis more often dry, but can be productive, and at separate patients the blood impurity order ultram 4mg in a sputum becomes perceptible even. The cyanosis quite often develops, the liver and lien augmentation becomes perceptible (at 20 … 40 %), signs of the general intoxication are expressed moderately. The tachycardia, arterial pressure without essential changes is characteristic. Physical data at inspection of lungs are taped far not at all patients. Dry and wet rhonchuses can be auscultated. The cores for diagnostics are radiological changes which also develop gradually. Process almost always the bilateral. In the beginning moderate infiltration of a pulmonary tissue in the field of lung roots becomes perceptible, then the focal shades merging in large sites of inspissation which alternate with inflation sites develop, at rupture of the last (located ) the crescent pheumothorax can develop. At a blood analysis the moderate leukocytosis - (10 … 15) - is characteristic. At sputum research the various microorganisms which have accumulated on an infection (bacteria, viruses, mushrooms) can be found out quite often. For diagnosis acknowledgement detection in washouts of bronchuses and more often in a tissue lungs and bronchuses is used. Some diagnostic value has improvement of a condition of the patient under the influence of antiparasitic therapy

(Pyrimethaminum, Sulfadimezinum, Bactrimum). At sick of AIDS the answer to therapy comes more Slowly, through 6 … 13 days after the beginning of therapy by Bactrimum and other preparations [En^elberg L. et al., 1984]. From other parasitogenic pneumonia it is necessary to note the respiratory [MA et al., 1984]. . This recently described disease proceeds usually in the form of a coloenteritis [Gerstoft J. et al., 1984], but at some weakened patients, mainly at AIDS, the original parasitogenic pneumonia similar on implications with can develop. Gradual development and a long current, process bilateral are characteristic, the body temperature raises to 38 … 39 ° and above. The diagnosis is based on originator detection in tissues of a lung with use of special colouring. The clinic a pneumonia is studied more not enough. a pneumonia. Usually a pneumonia at virus illnesses (a flu, a measles, etc.) Happen virusno-bacteriemic. Purely virus pneumonia can be caused a cytomegalovirus. It develops at the persons weakened by various illnesses and spent therapy (a cancer, patients after transplantation of an osteal brain, transplantation of kidneys, AIDS). Proceeds in the form of the progressing pneumonia which is not giving in to vpxl 4mg therapy by antibiotics and . For differential diagnostics laboratory methods are used. The most simple is the cytologic research of deposits of a saliva, a sputum, urine, a spinal liquid. As the proof detection of cytomegalic cells («») serves. They represent large cells of the oval or roundish form. In a kernel the including surrounded light («an owl's eye») becomes perceptible. Diameter of these cells reaches 25 … 40 microns. the pneumonia makes from 4 to 26 % of a pneumonia at persons with the weakened immune system [Masur et 1 „1985]. Initially-Aseptichesky pneumonia. Differential diagnostics of a chemical pneumonia is facilitated by anamnestic data (communication with gasoline, oxides of nitrogen and other toxic liquids), presence local (a combustion of a mucosa of respiratory tracts) and the general signs of a poisoning. The secondary bacteriemic infection (pneumococcal, staphylococcal, etc.) further can accumulate and there will be signs of infectious process. At an allergic pneumonia it is defined expressed in peripheric blood, it is possible to tap communication with any allergen. An aspiration pneumonia can sometimes develop and at the infectious diseases accompanied by paralyses (a botulism, etc.), but in such cases it will be complication.

Nov 21, 2008 at 06:40 o\clock

The acute pneumonia

The acute pneumonia which arises on 4 … 6th day , is bacteriemic at the expense of the accumulated secondary microflora, mainly at the expense of a pneumococcus. This variant needs to be surveyed as complication , it is similar to complications at others . Primary a pneumonia develops in the first 3 days of illness. At these forms, as well as at , also become perceptible inflammatory changes buy cipro 3mg of a mucosa of the top departments of a respiratory tract (a nasopharyngitis, a laryngitis, a tracheobronchitis), but process simultaneously grasps also a pulmonary tissue. On a pneumonia the secondary bacteriemic infection further can accumulate, i.e. The pneumonia becomes mikoplazmenno-bacteriemic, but unlike the first variant plasmas play more essential role both in the illness beginning, and in its further current that should be considered at therapy carrying out for sensitivity of mycoplasmas and bacteria to antibiotics essentially differs. Thus, a pneumonia at a mycoplasmosis as complication and as primary disease have much in common. Physical and radiological data do not allow to differentiate them among themselves and from other pneumonia. At laboratory acknowledgement of a mycoplasmosis it is possible to consider an early pneumonia mainly , and the pneumonia which has appeared on 5 … 7th day from the beginning of illness and later, - bacteriemic. The clinical semiology does not give possibility to carry out differential diagnostics of this pneumonia. a pneumonia it is necessary to think of possibility during epidemic flash in again generated collective. From laboratory methods the most effective is detection of mycoplasmas in a sputum with the help a method. This method allows to establish an aetiology from first days of illness. Serologichesky research ( with an antigen) is suitable only for retrospective diagnostics. Considering the big frequency (to 80 %) about antibodies at healthy faces, diagnostic it is necessary to consider only antiserum capacities in 4 times and more at research of didymous Serums. Histoplasmosis.

The most frequent implication of a histoplasmosis is the lesion of lungs. Acute forms of a pulmonary histoplasmosis can proceed in the form of various on gravity of clinical forms. At easy forms the state of health of patients remains good, the fever proceeds during 3 … 4 days, radiological changes are shown in a kind infiltrations mainly in the bottom departments of lungs. Serious forms of an acute pulmonary histoplasmosis are characterised by the sudden beginning, a high fever (40 … 41 °) with the big daily allowances . Tremendous cold fits Are replaced by a profuse diaphoresis. Patients the strong headache, delicacy, pains in muscles and bones disturb, stethalgias, tussis. At a part from them the nausea, vomiting, abdominal pains, diarrhoeia become perceptible. Duration of a fever 4 … 6 . In the reconvalescence period it is long the sweating, working capacity depression become perceptible a subfebrile condition, . These phenomena remain till 1 year. at an acute histoplasmosis in lungs tap largly - and shades in a kind of "wadded flakes» which can merge. Further infiltrates completely disappear or on their place there are centres of a fibrosis and . Sometimes illness passes in the chronic form which flows long time in the form of periodic an exacerbation and remission. In such cases in lungs tap caverns, a fibrosis and plural the buy rimonabant 3mg centres. Differential diagnostics of a pulmonary histoplasmosis from others represents to a pneumonia the big difficulties, especially in districts, not for the given disease. The histoplasmosis in the regions located from 45 to the north to 30 to the south from equator is most extended. Besides epidemiological data, diagnostic value long disease, plurality of the centres in lungs have, their possibility and disintegration. For diagnosis acknowledgement use allocation of the originator from a sputum, from a mucosa of a pharynx and from blood. Are applied also researches ( with an antigen, etc.). The intradermal allergy test with a histoplasmin is very simple. Enter 0,1 ml of the allergen dissolved 1:1000; results consider through 24 and 48 . Reaction becomes positive only with 3 … 4th weeks from the disease beginning.

Nov 21, 2008 at 06:39 o\clock

the pulmonary

the pulmonary tuberculosis is taped approximately at 30 sick of a tuberculosis and characterised by development of a perifocal inflammation round old tuberculous focuses. Their development is frequent provokes a flu or others , in such cases think of possibility of complication by a pneumonia is more often. There is a fever, there can be a pneumorrhagia, in a sputum tuberculosis micobacteria are sometimes found out. In diagnostics results of X-ray inspections have great value. Consultation of the order ultram 3mg phthisiatrician is necessary also. Inflammatory changes in the lungs concern not bacteriemic pneumonia, caused by chlamydias, viruses, mycoplasmas, mushrooms, and in clinical semiology lesions of lungs prevail. Ornithosis. The most frequent forms lesions of lungs are pneumonic (typical) forms of an ornithosis. At a clamidiosis caused Chlamydia trachomatis, a pneumonia (serious enough) is observed only at newborn children as a result of their pre-natal becoming infected. In differential diagnostics a pneumonia the great value has revealing of

epidemiological preconditions (professional or household contact to birds) taking into account enough long incubation interval (more often 8 … 12 days). Pneumonic forms of an ornithosis begin acutely with a fever and symptoms of the general intoxication, and signs of a lesion of organs of breath only later join. At the majority of patients the body temperature with a fever raises above 39 °, there are a strong headache, pains in muscles, the adynamia, delicacy accrue, appetite disappears, there can be a vomiting. On 2 … 4th day of illness there are signs of a lesion of lungs. They are expressed not so sharply and intoxication degrees mismatch. Patients have the dry tussis, sometimes pricking stethalgias, the dyspnea does not happen; further the small amount of a mucous or mucopurulent sputum, sometimes with a blood impurity is allocated. and it is taped the lesion of the bottom shares of lungs (VIII, IX, segments), becomes perceptible vpxl 3mg right-hand process is more often. At half of patients to 5 … to 7 day the liver and lien augmentation becomes perceptible. At more serious forms of illness there can be changes of nervous system (block, dream disturbances, delirium, a meningeal syndrome). In peripheric blood a leukopenia or normal quantity of leucocytes, ESR rising. The fever, clinical and radiological implications of a lesion of lungs last 4 … 6 and more, is long (2 … 3 ) remains . For differential diagnostics following data have the greatest value: the acute beginning with the phenomena of the general intoxication and the subsequent joining of signs of a pneumonia, absence of lesions of the top respiratory tracts, possibility of palindromias and late myocardites (on 3 … to 5th week of illness), a leukopenia in a combination to ESR rising, absence of effect from usually used preparations (Penicillinum, streptomycin, Sulfanilamidums), longer disease. The basic method of acknowledgement of the diagnosis is with an antigen. It is used also . Diagnostic for 1:16 … 1:32, for - 1:512 and above or antiserum capacity increase in 4 times and more at research of didymous Serums. a pneumonia. The acute pneumonia caused Mycoplas ma pneumoniae, makes from 5 to 15 % of all acute pneumonia. In experiences on volunteers it is established, that infection with a mycoplasma leads to development (asymptomatic) infection is more often or to a syndrome of an acute inflammation of respiratory tracts, primary the pneumonia less often develops.

Nov 20, 2008 at 06:39 o\clock

he specified pneumonia

The specified pneumonia can be as independent diseases, and to complicate other infectious diseases. . Among the illnesses caused , an original pneumonia (illness of legionaries, a legionella-pneumonia) more often is observed. In the USA on it is necessary from 0,5 to 1,5 % of all acute pneumonia. Cases a pneumonia are buy cipro 2mg registered in many countries, including in the USSR. Disease can proceed in the form of sporadic cases and in the form of flashes (epidemic diseases can be carried to illness of legionaries, sporadic - to or legionella-pnev ). The Incubation interval lasts usually 5 … 7 days. Illness begins acutely with occurrence of a high fever (39 … 40 °), the expressed symptoms of the general intoxication. The maximum expression of a toxicosis comes during the first 2 , is more rare - during 3 … than 4 days. The fever becomes perceptible, the general delicacy, weakness, muscular pains accrue. From first days of patients disturb the excruciating tussis, the pricking stethalgias amplifying at tussis and breath. Tussis in the beginning dry, then starts to separate a purulent sputum. The dyspnea develops, frequency of breath reaches 30 … 40 in

1 mines and more. Some patients are disturbed by abdominal pains, there is a vomiting and a liquid chair. At illness height signs of lesion (giddiness, delirium, consciousness disorders) become perceptible. Can develop hemo a syndrome. In these cases pulmonary bleedings are possible. The syndrome of an inflammation of respiratory tracts is not present, arterial pressure is lowered. Physical signs of a pneumonia are taped. At serious disease respiratory insufficiency quickly accrues, can develop but-toxic a shock. The mors comes to the extremity of 1st week of illness. The lethality in the absence of adequate treatment about 20 %, at treatment decreases to 5 … 10 % About it is necessary to think at development of a serious pneumonia during an unusual season (the extremity of summer) at men of an average or advanced age in the presence of contributing factors (smoking, application , an alcoholism, a diabetes, etc.). From clinical implications diagnostic value the high fever, absence of a previous lesion of the top respiratory tracts (a rhinitis, a pharyngitis, a laryngitis), a diarrhoeia, disturbance of functions of the central nervous system, a liver, have, negative results of usual bacteriological researches of a sputum, and also absence of appreciable therapeutic effect from antibiotics (Penicillinum, streptomycin, Tetracyclinum) which are prescribed for buy rimonabant 2mg treatment sick of an acute pneumonia. For diagnosis acknowledgement use methods (microagglutination reaction, a method of an indirect immunofluorescence) more often. Investigate the didymous Serums taken with an interval in 10 … of 15 days. Pulmonary tuberculosis. , focal and the pulmonary tuberculosis has clinical implications similar to a pneumonia, and quite often sick of a tuberculosis arrive in infectious hospitals. Necessity of differential diagnostics is dictated by importance of the timely beginning of antituberculous treatment. the pulmonary tuberculosis (both , and ) can begin from the high fever expressed to the general intoxication, a dyspnea, the liver and lien augmentation sometimes becomes perceptible. Such patient Quite often the erroneous diagnosis of a typhoid, an acute pneumonia make, etc. at a tuberculosis in lungs are defined plural fine . At subacute a tuberculosis the centres larger, further they can cause occurrence of individual or plural thin-walled caverns. In a sputum tuberculosis micobacteria are found out. The focal pulmonary tuberculosis meets often (about half of all initially taped sick of a tuberculosis). Proceeds at rather satisfactory state of health of patients, the subfebrile condition, small tussis, more often the dry become perceptible. Micobacteria in a sputum are taped seldom. Differential diagnostics is based mainly on data of radiological inspection. Small the roundish form the centres are more often found out in subclavial area and on apexes of lungs.

Nov 20, 2008 at 06:38 o\clock

Now even more often

Now even more often there is a fixing current of a pneumonia. At 35 … 45 % of patients, especially at the persons of advanced age weakened and with various secondary immunodeficiencies, the inflammatory infiltrations of lungs which are found out , do not resolve more than 4 . The clinical picture in this order ultram 2mg case is characterised by the poor physical Semiology, flaccid reaction of blood, prevalence of symptoms of the general the patient. When we deal with a fixing pneumonia at elderly persons, it is necessary to remember always that under "mask" of a focal pneumonia can proceed a pneumonia. The proof fixing current, absence of effect from various antibiotics, a pneumorrhagia, a repeated pneumonia of the same localisation, ESR substantial growth, an anaemia - all it is the indication for carrying out of a tomography, a bronchoscopy for the purpose of an exception of tumoral process. The focal pneumonia needs to be differentiated also from a tuberculosis (the infiltrativno-pneumonic form), and a lung fever localisations from a caseous pneumonia. It is necessary to notice, that the prescription of antibiotics of penicillinic group at a pneumococcal

pneumonia allows quickly (during 3 … 5 days) to improve general condition, to achieve fever disappearance, to reduce quantity of a separated sputum. Absence of effect from preparations of group of Penicillinum should suggest about other bacteriemic nature of a pneumonia. Streptococcal pneumonia. Now meets seldom, probably because the hemolitic streptococcus keeps high sensitivity to antibiotics of a penicillinic number. The streptococcal pneumonia can be primary and as complication of other disease (a measles, a flu, etc.) . Begins acutely, proceeds rather hardly. In the beginning one segment is amazed, more often in the bottom share of a lung, then process quickly extends. It is characterised by a high fever with the big daily allowances , repeated cold fits and sweats. There are pricking pains in a side on the lesion party, in a sputum there can be blood streaks. Complication by an exudative pleuritis which develops at 50 … 70 % of patients is typical. Its signs are taped already on 2 … 3rd day of illness. The high leukocytosis - (to 20 … 30) lO9 / "- with the expressed deviation to the left is typical also. A basis for differential diagnostics of a streptococcal pneumonia are: rather serious current, early complication by an exudative pleuritis, a high leukocytosis, presence a streptococcus in a sputum in a considerable quantity. Sometimes it is possible to allocate a hemolitic streptococcus from blood (at 10 … 15 % of patients). Staphylococcal pneumonia. The staphilococcus can cause a primary pneumonia (seldom), bronchogenic secondary (as complication) a vpxl 2mg pneumonia and a hematogenic pneumonia at a staphylococcal sepsis. Frequency of a staphylococcal pneumonia makes to 10 … 20 % of all acute pneumonia. Clinically staphylococcal pneumonia differs more serious current, predilection to purulent complications (abscesses, an empyema), presence at patients of the expressed dyspnea, a cyanosis. The staphylococcal pneumonia at children, elderly and at the persons weakened by other illnesses especially hardly proceeds. it is characterised by extensive polysegmentary infiltration of a pulmonary tissue, the accompanying pleuritis is quite often taped. In the subsequent bullas and necrotic cavities with horizontal level of a liquid are taped. The configuration and quantity of cavities in a lung quickly vary. At a hematogenic pneumonia the set of the small centres of pneumonic infiltration is characteristic. Signs of the general (septic) disease prevail. The pneumonia of the staphylococcal nature badly gives in to therapy not only antibiotics of a penicillinic number, but also other antibiotics. The pneumonia caused by a rod, pyocyanic rod, , , etc., become perceptible mainly at the weakened persons, proceed hardly, often formation of abscesses, purulent becomes perceptible . They badly give in to an antibioticotherapia. Their clinical implications are very similar and do not give the sufficient bases for carrying out of differential diagnostics. Diagnostics is based on bacteriological researches - allocation of the originator from a sputum (in a considerable quantity), from blood, from a pleural exsudate. Serologichesky researches and in practice are not used.

Nov 19, 2008 at 06:38 o\clock

In occurrence of

In occurrence of the complications caused by is conditional-pathogenic microorganisms, the big role is played by a two-dimensional infection, i.e. The is conditional-pathogenic microorganism received from other person (the sick or healthy carrier). In this connection careful individual isolation of this patient is necessary for the prevention of complications at the weakened patients (especially with an immunodeficiency) from buy cipro 1mg other patients, and the medical personnel should enter into a premise where the patient is hospitalised, only in respirators. Let's survey possibilities of differential diagnostics of a pneumonia in separate groups of patients. Originator finding-out has great value both for a purposeful causal treatment, and for preventive maintenance. Pneumococcal pneumonia. As it was already specified, on modern representations, the overwhelming majority of an acute primary bacteriemic pneumonia is caused Streptococcus pneumoniae (pneumococcus). In general clinical implications of the given pneumonia have been given in the characteristic of syndromes of a pneumonia. We will remind, that the pneumococcal pneumonia happens two clinico-morphological variants: croupous and focal. The lung fever diagnosis, as a rule, does not cause difficulties. However the lightning beginning of disease, a pneumorrhagia, a dyspnea, sharp pains in a thorax cause necessity of differentiation of a lung fever with a lung infarct (an infarct-pneumonia,

a thromboembolism of branches of a pulmonary artery). It is necessary to remember, that at an infarct-pneumonia usually there is no fever and intoxication signs in the disease beginning, and also there is a basic disease, becoming complicated a clottage of pulmonary vessels (a thrombophlebitis of the bottom extremities, a bacteriemic endocarditis, heart diseases, a sapropyra and illness , etc.). The X-ray pattern at a lung infarct has rather characteristic appearance essentially differing from those at a lung fever. At the same time the clottage of fine branches of the pulmonary artery, not accompanied by an inflammatory infiltrate, does not cause radiological changes. The essential help is rendered by a perfused scintigraphy of lungs. Quite often at a lung fever localised in the bottom departments of a lung, in process the diaphragmal pleura is involved, thus patients feel the pains irradiating in an abdominal cavity which can feign an acute abdomen picture. At intoxication height at a lung fever quite often there are consciousness disturbances, a delirious condition, especially at alcoholics. Early appointment of an effective antibioticotherapia (Penicillinum or other preparations) leads to appreciable improvement of the general condition through 3 … 5 days, but at the weakened, elderly persons, alcoholics the expressed buy rimonabant 1mg clinical picture of a lung fever remains more longly. At the same persons complications (abscessing, a purulent pleuritis, a pericarditis) are more often observed. Lethal outcomes at a lung fever (3 %) take place at the above-stated contingent of patients. The focal pneumococcal pneumonia should be differentiated from an acute tracheobronchitis, and also from an exacerbation of a chronic bronchitis, illness and a chronic pneumonia. At an exception of an exacerbation of the named chronic diseases diagnosis specification is promoted essentially by anamnestic data. Much more difficultly at times to distinguish a focal pneumonia from . To transition of the last in a pneumonia testify: The fixing disease proceeding more of 7 days, reduction of signs of a lesion of the top respiratory tracts and simultaneous occurrence zisto-gnojnoi sputums, moderate pains in a thorax, plentiful night sweats, sharp the patient. Besides physical data inherent to a focal pneumonia which be frequent can rather poor, verifying signs the radiological changes consisting available of the centres of pneumonic infiltration, observed serve a thicket in , midlobar and lingular segments of a lung.

Nov 19, 2008 at 06:36 o\clock

Allocation of 2nd group

Allocation of 2nd group is caused by that at some infectious nosological forms the lesion of lungs can be one of clinical variants of infectious process. However unlike a pneumonia of 1st group these lesions of lungs (a specific pneumonia) proceed along with other implications of an infectious disease (, a rose, plagues, etc.). Feature of this group of a pneumonia is that they are caused by the same etiological agent, as a basic disease. It also distinguishes them from complications. At some infectious diseases order ultram 1mg the joined signs of an acute pneumonia can be both basic disease implication, and complication. For example, the typroid pneumonia causes a salmonella of a typhoid and to treat it it is necessary accordingly. But at sick a typhoid can be and the pneumonia caused by a secondary accumulated infection (staphylococcal, anaerobic, etc.) . Such pneumonia should be surveyed as complication, and to treat them it is necessary taking into account the accumulated microorganism and its properties (). At other infectious diseases of a pneumonia almost always cause basic disease originators (pulmonary forms of a malignant anthrax, a tularemia, a plague, etc.). In 3rd group a pneumonia proceeding as complication is allocated.

They Always arise with the assistance of other originator (a secondary infection) except for a sepsis at which the lesion of lungs is an original metastasis (the secondary centre), the caused originator of a sepsis, instead of stratification of other microbe. Complications by a pneumonia are observed at many infectious diseases. The etiological agent of a basic disease can accept partnership in this process immediately (breeding in a pulmonary tissue), or it only prepares conditions for stratification of a secondary infection. Frequency of complications at different infectious diseases essentially differs with a pneumonia. For example more often, the pneumonia develops at the diseases caused respiratorno-sintsitialnym by a virus (in 25 % of cases), is more rare at a flu (to 10 %), is rather rare at adenoviral illnesses and a parainfluenza (2... 5 %), and at illnesses a pneumonia do not meet at all. The pneumonia which is complications unlike a pneumonia of 2nd group, is often caused by the same originators at the most various basic diseases. Among them the first place occupies a pneumococcus, then the hemophilic rod follows, and further there can be various so-called is conditional-pathogenic microorganisms vpxl 1mg which are usual inhabitants of mucosas of the top departments of a respiratory tract, and at complications as though "go down" and reach a pulmonary tissue, causing an inflammation. It in any measure clinical uniformity of the pneumonia complicating a current of different infectious diseases also speaks. Basic disease influence affects or in a lesion of a respiratory tract an infecting agent (many kinds , a measles, a mycoplasmosis, etc.), or in immunity oppression. Especially sharply it is expressed at AIDS, but it becomes perceptible and at a number of infectious diseases, is final not in such degree. It can be combined and damage of a respiratory tract with immunity oppression (a measles, a flu). At differential diagnostics of a pneumonia (as complications) it is necessary to establish first of all character of a basic disease on which the pneumonia has accumulated. It is very important for appointment of adequate therapy. Revealing of the etiological agent by which complication by a pneumonia is caused will be a following stage. On the basis of clinical semiology to establish a complication aetiology usually it is not possible. The Most exact data gives bacteriological research, and it is expedient to define not only an originator kind, but also it . Most often, as well as in 1st group of a pneumonia, complication happens is caused by a pneumococcus. Therefore the etiological role of other microorganism will not be authentically proved yet, complication therapy is spent usually as pneumococcal pneumonia.

Nov 18, 2008 at 05:21 o\clock

From reflexes

From reflexes on the top extremities it is necessary to investigate three pairs: карпорадиальный, from tendons two-headed and the three-head of muscles. Experience shows, that sometimes loss any draws of one of them attention investigating, involves more careful survey, for example sensitivity research (which at rough surveys usually it is not investigated) and finds out sometimes the initial form of a myelosyringosis, etc. The fastest method of research of buy cipro reflexes is made in such a way: the patient continues to face to the doctor; last grasps the left arm both brushes investigated for the extremities of fingers so that arms have appeared incurvated in ulnar and radiocarpal joints. Further it is offered to relax a musculation of arms; thus they should be absolutely passive and be kept in this position not a strain of muscles, and an arm of the doctor. Молоточком on the right and at the left blows of identical force are struck to a head of a beam for reception of a karpo-radial reflex. Further, in the same position blow on a tendon m is made. bicipitis in an ulnar fold, and on the right arm it is more convenient to strike, bringing armed молоточком an arm under the left arm of the investigated. Blow should be not only identical on force, but also exact (on a tendon of a two-headed muscle, instead of on the parties from it). It is possible to be guided preliminary, having groped a finger a tendon in an ulnar fold. If this way reflexes do not cause, it is possible to plant investigated, having offered it is absolutely passive, without any strain, to put arms on hips with the incurvated ulnar, radiocarpal and interphalanx joints, slightly супинированными forearms, and it is necessary to track full symmetry of position of arms. In this position blow молоточком on a beam head is made

again. The reflex from a two-headed muscle can be investigated and in such a way: the big finger of the left arm palpates in an ulnar fold a tendon of a two-headed muscle; it press pulp of a trailer phalanx to which blow молоточка is struck a little. The reflex from a tendon is investigated by the three-head of a muscle usually so: the left arm the doctor a beret investigated for a shoulder about an ulnar joint, demanding a full relaxation of a musculation; the forearm and a brush should hang down freely; a flexion in an ulnar joint - almost under a right angle. Blow молоточком is put on a tendon by the three-head of a muscle, on 2 - 3 sm above olecranon. Absence of reflexes on the top extremities buy rimonabant can be congenital anomaly; therefore loss of this or that reflex on one party or their non-uniformity has much bigger value. Many organic diseases of nervous system are accompanied by those or other changes reflexes owing to what their research is represented essentially important. For fast orientation in the relation атактических disorders on the top extremities it is possible to use a finger-nose test or to check up accuracy of hit by an index finger with open eyes in молоточек or a finger investigating, established consistently in several points. For the further research the denudation of the bottom half of body of the patient is necessary. For research of abdominal reflexes the investigated lays down on a back. In vertical position to investigate abdominal reflexes does not follow. In quiet position of a body and at a relaxed abdominal musculation on a stomach skin put shaped borings of identical force and the speed, absolutely symmetric. For reception of the top abdominal reflexes - more low and in parallel a bottom edge of costal arches, for averages abdominal - strokes are put on a direct horizontal line at level of a belly-button and for bottom abdominal - above and in parallel пупартовой to ligament. It is not recommended to investigate at first all three reflexes on one party, then on another; it is more convenient to compare in pairs: the top, average, bottom abdominal reflexes. Abdominal reflexes cause at a direction of a stroke from periphery to an average line is better. It is not necessary to put borings a stupid subject. Is better to use for this purpose the pointed goose feather, the match extremity, even a pin. The boring should have character long, superficial (to avoid to scratch), easy, but a fast stroke. It is clear, that the boring from both parties should be peer force and symmetric not to receive a false difference. Larger value, than their loss has non-uniformity of abdominal reflexes.

Nov 18, 2008 at 05:21 o\clock

Any case even

Any case even an easy nystagmus demands special attention. At vagueness of a nystagmus it should is checked up in position of the patient laying - at first on one, then on other to a side. In the presence of a nystagmus it is necessary to investigate carefully first of all abdominal reflexes, remembering, that the nystagmus and fading of abdominal reflexes are order ultram usually the earliest symptoms of a multiple sclerosis. Complaints to so-called acroparesthesias, incidental doubling in eyes, emiction disorders, fatigability of feet get essential value in these cases. Cases when, except a nystagmus and changes of abdominal reflexes, it becomes perceptible still at least easy интенционное a tremor, rising and non-uniformity сухожильных and occurrence of pathological reflexes »already give enough bases for the presumable diagnosis of a multiple sclerosis. Research черепномозговых nerves is usually limited to survey of a facial musculation, and tongue. Non-uniformity in an innervation of the person if it is expressed clearly enough, appreciable already at external examination: the expansion of a palpebral fissure insufficient смыкание a century at a nictitation, a smoothness носогубной cords, a ptosis of an angle of a mouth - are characteristic for a flaccid paralysis of facial muscles. One external examination of a mimic musculation insufficiently; it is necessary to check up uniformity of an innervation of the person by the "set" movements: наморщивания a forehead, strong смыкания a century, наморщивания a nose (many healthy people cannot do last movement "by request"), wide opening of a mouth or, better, оскаливания teeth. At a flaccid paralysis disappearance or weakening on the amazed party надбровного a reflex is

characteristic still. If the phenomena of a paralysis of a facial nerve are complicated by a contracture the paralysis picture changes, being characterised by "pulling" of the person in the amazed party at maximum смыкании a century, тикообразными twitchings of the amazed facial muscles, usually synchronous with blinking, narrowing of a palpebral fissure instead of its expansion, rising of mechanical excitability of muscles. Weakening of an innervation of the person at the expense of the central paresis concerns only the bottom department of a facial musculation, mainly stomatic muscles, is not accompanied by weakening надбровного a reflex and usually combined with others, at least easy symptoms of the central paresis: weakening on the same party of abdominal reflexes, rising, vpxl a symptom Babinsky and other signs пирамидного lesions. Value of non-uniformity of a facial innervation should not be overestimated. Cases of congenital asymmetry are so frequent, that very seldom we see the person with faultless symmetry. If easy non-uniformity of an innervation of the person is a single symptom it is regarded as "physiological" asymmetry. The same it is necessary to tell and concerning a tongue deviation aside at высовывании it if it is a single symptom. The tongue deviation in combinations with a paresis of the bottom facial musculation and presence пирамидных symptoms enters into an overall picture of the central hemiparesis. At a flaccid paralysis of a lingual musculation fibrillar twitchings with a tongue atrophy become perceptible, that happens a symptom of a syringobulbia or an amyotrophic lateral sclerosis more often. Presence usual, jerky (not fibrillar) a tongue tremor as single symptom has no value; its value as one of symptoms in an overall picture of functional disease of nervous system rather rather as the tongue tremor is very often observed at absolutely healthy people. The bilaterial paresis of tongue causes an alalia of type of a dysarthtia. Defects of an articulation, a scanning speech, афатические disorders, a stammering and others are taped in the course of conversation and interrogation of the patient. By research of pupils, their reactions, movements of eyeballs, facial musculation and tongue check of functions черепномозговых nerves can be limited at fast rough survey. Further the attention of the doctor should be referred on the top extremities. Before to investigate on them сухожильные reflexes, it is necessary to suggest to the patient to extend forward arms, to move apart thus fingers. Noted fine tremor of fingers of arms at the neurotic deserves known attention as an objective symptom of a neurosis, the truth, having only relative value. But this reception gives the chance to note variety of the phenomena having not only neurologic value: besides atrophies of fine muscles of brushes, contractures, trophic disorders, a Crocq's disease, etc. will not be seen (for example, in practice военноврачебных the commissions, at appeals and employments) various cases not neurogenic contractures, defects of fingers, teratisms of fingers and brushes.

Nov 17, 2008 at 05:20 o\clock

It is necessary

It is necessary to note inability of some persons to converge eye axes "by request", that can frame in such cases false representation about a convergence paresis. It is useful for check in the mentioned cases after «a view afar» to suggest to read inscription close brought to eyes on a matchbox or the digit finely written on a scrap of a paper. The way of research by slow approach and excision of a finger fixed by eyes is less favourable as owing to course in this case narrowings and mydriasises reaction is more difficultly caught by the investigating. Changes of pupillary tests are buy cipro a symptom of a syphilitic lesion of nervous system more often, is more rare - an epidemic encephalitis and is absolutely rare - some other organic diseases (a crack of the basis of a skull, a lesion стволового department), an alcoholism, etc. Matter not only rasping disturbances of pupillary tests (a full reflex immovability or symptom Argajl-Robertsona), but also more thin disorders, for example a difference in vivacity of reaction of one pupil in comparison with another, slackness of a pupillary test on light at rather live reaction to accommodation. Practically more often changes of reactions of pupils signal about spinal сухотке, a general paralysis, a syphilis of a brain or an epidemic encephalitis (parkinsonism). In the first case, after detection of symptom Argajl-Robertsona, the attention should is referred on other implications, as that: dropping superficial (more often painful) sensitivities at level of papillas (DV), loss or slackness (sometimes only non-uniformity) ахилловых and knee reflexes, "rheumatic disease" (shooting pains) in feet, etc. In case of consequences of an epidemic encephalitis when there can be any combinations of changes of pupillary tests, but the paresis of convergence and slackness of narrowing of pupils more often is observed at accommodation, sometimes at live reaction to light (contrary to symptom Argajl-Robertsona), it is necessary to estimate a motility of the

investigated attentively. A Parkinson's face, гипомимия, the deaf, monotonous voice, poverty of the impellent initiative, a fine tremor in distal departments of this or that extremity, sometimes not reaching sharp degrees, frame, in general, a typical picture of the easy form of a parkinsonism. Complaints of such patients on periodic «закатывания an eye» and a hypersalivation, features of behaviour (bent to sticking) are the extremely essential. After research of pupils the attention to position of eyeballs and their movement is paid. The squint (converging or dispersing) yet always specifies in a lesion of third cranial nerves (III, IV, VI) and often it appears congenital defect or is caused by anomalies of sight. In the latter case it does not become perceptible doublings in eyes whereas at a paralysis of one of third cranial nerves of the patient complains of a diplopia at a view towards the amazed muscle. At interrogation investigated concerning doubling in eyes it is necessary to be rather cautious. Leading questions are undesirable. In particular, it is necessary to mean, that on directly brought attention to the question: Whether forks in eyes, buy rimonabant we often receive the affirmative answer when no data for a diplopia are available. The independent statement of the patient for doubling available for it in eyes is valuable. At a view in the certain party. Sometimes detailed inquiry about character of a diplopia finds out, that there are visual, instead of oculomotor disorders. We remind of the reception applied on purpose отличения of a true diplopia from the hysterical. After the statement for diplopia presence in a certain direction of the view, one eye is closed by a palm then the true diplopia, naturally, disappears. Exact research of a diplopia is made by the expert-ophthalmologist by means of colour glasses. For research of movements of eyeballs the doctor takes away the finger to the right, to the left, upwards and downwards, and the patient all time follows a view a finger. The lesion of this or that eye muscle or a view paresis can be thus revealed. The same reception finds out also a nystagmus which happens horizontal more often and is taped, thus, at a view in the parties. Abduction of eyeballs thus should be maximum. Some separate "nystagmiform" twitchings are often observed at absolutely healthy people and no value has. Even the proof nystagmus if it is a single symptom, is not regarded as a sign of organic disease of nervous system. Such nystagmus can be at smokers (a chronic poisoning with nicotine), miners, at working in caissons the so-called congenital nystagmus (defect of development) etc. is quite often observed. Usually in these cases we see rasping twitchings of eyeballs, is frequent, observed even at their quiet position. Our researches show, that when at the horizontal nystagmus caused by organic disease of the central nervous system, sick translates a view up, the nystagmus either disappears at all, or weakens, becoming the vertical; at a congenital nystagmus it remains usually intensive, keeping the same horizontal or ротаторный character. We will mention a nystagmus which is growing out of diseases of an internal ear.

Nov 17, 2008 at 05:20 o\clock

often appears

Head ХIII. The TECHNIQUE of SHORT RESEARCH of NERVOUS SYSTEM ON POLYCLINIC RECEPTION And AT MASS SURVEYS The technique of research of nervous system in all its complexity and sequence often appears impracticable in the conditions of practical medical work. A situation, possibilities and research problems sometimes also do not allow and do not demand clinically full research of nervous system. Working conditions often cause of fast rough survey of a number of persons during limited time. It is natural, that in the latter case research of nervous system should be order ultram constructed under absolutely special plan, excellent, for example, from on what there will be a research for the purpose of exact diagnostics or examination. However, this research (we name its rough) permissibly only till that time as the slightest suspicions on this or that disease of nervous system will be found out at least. Since this moment research becomes already detailed. Outpatient reception hours, work in an out-patient department, in the invocatory commission, inspection for the purpose of prophylactic medical examination, sanatorium selection etc. cause of survey during limited time enough considerable quantity of persons. The research problem of nervous system should be resolved by the development of the program-minimum of research which are giving the chance quickly to be guided in each case at an economical expenditure of time for interrogation, survey and the

conclusion. At initial survey of the patient undresses to a girdle. It is not necessary to forget, that one attentive external examination can already give to the observant doctor very many. A Parkinson's face and constraint of movements of the patient at a parkinsonism, an ataxic gate at a cerebellum lesion, a spastic gate at a hemiplegia, the facial expression and behaviour of the neurotic attract at once attention. A number of the pathological phenomena, for example contractures, the atrophies of muscles some видь! Cramps also are appreciable already at external examination. Interrogation, conversation, ingenuity, speed and accuracy of performance of tasks demanded in the course of survey can give some representation about mentality of the investigated. At special neurologic objective research the attention first of all addresses on pupils. The patient put against light; simple survey define the form and size of pupils. Unequal size of pupils though is worthy but as the single symptom is not a sign of organic disease of nervous system: it can be result of "eye" disease, congenital anomaly, non-uniformity of a sympathetic innervation of eyes. Deformation of pupils deserves larger attention in sense of suspicion on organic changes of nervous system; however at normal pupillary tests value of deformation as organic symptom appreciably depreciate. But changes of pupillary tests are exclusively important: reactions to light and to accommodation with convergence. At research of reaction of pupils on light the doctor densely closes the palms of an eye investigated, which all time remain widely opened; fast vpxl movement takes away from the person only one arm to catch narrowing of one pupil on light. The eye investigated already is again closed and the second arm with a research objective of reaction of the second pupil is quickly taken away. As changes of pupillary tests are a sign of organic disease of nervous system their research, naturally, should be spent with all carefulness in overwhelming majority of cases. The erroneous conclusion about loss or slackness of reaction of pupils on light involves an unnecessary direction on test in a hospital, additional researches it is etc. practically important to have therefore on hand intensive enough light source at research. Insufficient illumination of a pupil or does not give at all narrowing, or causes flaccid reaction. At. Bad day illumination by the best way ignition and deenergizing of the electric lamp brought to an eye of the patient (other eye is densely closed by a palm of the most investigated) is. The pocket electric small lamp which can be applied in any situation is very convenient for this purpose. Reaction to accommodation with convergence is investigated is better in such a way: the patient at first looks afar then it is offered to translate quickly a view for fixation close brought to eyes молоточка or a finger. It is necessary to track narrowing of one and the second a pupil.

Nov 16, 2008 at 05:19 o\clock

The nerve admixed

The nerve admixed, is one of two basic branches of a sciatic nerve and arises basically from fibers LIV, LV and SI roots. Impellent fibers иннервируют, mainly, foot extensors (m. tibialis anterior), extensors of fingers (mm. extensores digitorum) and the muscles turning to stop кнаружи (mm. peronei). Sensitive fibers of a nerve иннервируют a skin of an external surface of an anticnemion (n. cutaneus surae lateralis) and a dorsum of foot and fingers (dermal branches from n. peroneus superficialis and n. peroneus profundus) as it is shown on fig. 96. At a lesion малооерцового a nerve the extension (a back flexion) stops and fingers, and also foot turn кнаружи is impossible. Ахиллов a reflex (n. tibialis) remains. Sensitive disorders arise on an external surface of an anticnemion and a foot dorsum (fig. 96 see). The sustavno-muscular feeling in fingers of feet is not broken (because of safety of sensitivity from n. tibialis). Pains are usually insignificant or are absent; the same concerns and trophic disorders. Foot at a lesion of a fibular nerve hangs down, is slightly turned кнутри, fingers are a little incurvated (pes equino-varus - fig. 97). Considerably buy cipro muscles on a frontexternal surface of an anticnemion. A gait of the patient becomes rather typical ("peroneal", "cock", stoppage): the patient not to touch a floor with a sock of hanging down foot, highly lifts a foot and at first goes a sock, then external edge of foot and, at last, a sole. The admixed nerve, is other basic branch n. ischiadici also arises from fibers from LIV to SIII roots. In the functional relation it appreciably is the antagonist of a fibular nerve. Its impellent fibers иннервируют сгибатели stops (m. triceps surae, i.e. m. soleus and two heads т. gastrocnemii), сгибатели fingers (mm. flexores digitorum) and the muscles turning to stop кнутри (mainly m. tibialis posterior). Sensitive fibers of a nerve  a back

surface of an anticnemion (n. cutaneus surae medialis), a sole and a plantar surface of fingers with call on a dorsum of trailer phalanxes (rr. cutanei from nn. plantares lateralis and medialis) and external edge of foot (n. suralis, made from anastomoses of fibers of fibular and tibial nerves) as it is represented on fig. 96. The lesion of a tibial nerve causes a paralysis of the muscles incurvating to foot and fingers (a plantar flexion) and turning foot кнутри. the reflex is lost. Sensitive disorders arise in the buy rimonabant zones specified in fig. 96, i.e. On a back surface of an anticnemion, a sole and plantar surfaces of fingers, on back of their trailer phalanxes. Sustavno-muscular feeling in foot fingers at safety of function n. peronei does not suffer (it is broken only at a joint lesion of both nerves, i.e. A fibular and tibial or basic trunk of a sciatic nerve). Atrophies of muscles are usually appreciable and concern back group of muscles of an anticnemion (m. triceps surae) and soles (a profound crest of foot, a retraction of intermetatarsal intervals). Foot is in position экстензии; the acting heel, a profound crest and "sharp-clawed" position of fingers define the name pes calcaneus (fig. 98). Gait is complicated, but it is less, than at "hanging down" peroneal foot: in this case the patient becomes on a heel owing to available экстензии stops. Tests for definition of impellent disorders at a lesion n. tibialis are: 1) impossibility of a flexion (a plantar flexion) stops and fingers and foot turn кнутри and 2) impossibility of walking on tiptoe. Pains at a lesion n. tibialis (and its fibers in стволеn. ischiadici) arise, as a rule, and often happen the extremely intensive. Wounds of a tibial nerve and its fascicles in a sciatic nerve trunk can cause каузалгический a syndrome. Vazomotorno-sekretorno-trophic disorders also are usually appreciable. In this respect there is a certain similarity of a tibial nerve with median why rather каузалгии and trophic disorders at its lesion it is possible to refer on told above century section of the general symptomatology of the given chapter and in the description of a lesion of a median nerve.

Nov 16, 2008 at 05:18 o\clock

Impellent fiber

Impellent fibers of a nerve m. ilio-psoas, m. quadriceps, etc.; sensitive - a skin of bottom two thirds of forward surface of a hip (n. cutaneus femoris anterior) and a frontinternal surface of an anticnemion (n. saphenus). At a lesion of a femoral nerve more low пупартовой ligaments the anticnemion extension is impossible, the atrophy m is appreciable. quadricipitis, the knee reflex is lost, sensitivity in a zone corresponding to an innervation n is broken. sapheni (fig. 96 see). At nerve damage above пупартовой ligaments join sensitivity disorders on a forward surface of a hip, and, at last, at the highest, most rare lesions, function m suffers. ilio-psoas, that causes impossibility of a flexion of a hip (its reduction to a stomach) and order ultram trunks in lying position. A gait of the patient is complicated. At a nerve boring symptom Вассермана is found out: in position of the patient on a stomach поднимание the straightened foot or the anticnemion flexion in a knee joint causes a pain in inguinal area or on a forward surface of a hip, on a nerve course (a stretching n. femoralis). The nerve admixed, is made of fibers LII, LIII and LIV roots. Impellent fibers иннервируют basically all group of muscles resulting a hip (mm. adductores) and m. obturator externus. Sensitive fibers (cutaneus n. obturatorii) иннервируют the bottom half of internal surface of a hip. At a lesion n. obturatorii foot

reduction is complicated, applying of one foot on another (mm is impossible. adductores); foot turn кнаружи (m is complicated also. obturator externus). Sensitive disorders are found out on an internal surface of a hip (fig. 96 see). N. genito-femoralis (genitocrural nerve) The admixed nerve from LI - LII roots. Impellent fibers (n. spermaticus externus) иннервируют m. crema. ster and tunica dartos, sensitive (subitem lumbo-inguinalis, spermaticus internus) - a skin of forward and internal surfaces of a hip in the top third. At a nerve lesion the reflex кремастера dies away and there are sensitivity disorders in a corresponding zone (fig. 96 see). the plexus is made of fibers of forward branches LV, SI, SII and parts of fibers LIV and SIII spinal nerves and consists of two bottom lumbar and two top крестцовых loops (ansae): from LIV - LV, LV - SI, SI - SII and SII - SIII. The plexus is located on a forward surface of a sacrum. Nerves starting with it leave through big sciatic. An aperture. At means of a part of fibers of forward branch Liv of a spinal nerve крестцовое the plexus is bridged with lumbar (fig. 95 see). The lesion крестцового a plexus or roots of which it is made, causes abaissement of function of all nerves, from it proceeding. The admixed, most powerful nerve of a human body made of fibers . Only its very high lesion above a cluneal cord gives, except abaissement of functions of tibial and fibular nerves, abaissement of function of muscles, иннервируемых a nerve on a hip, i.e. Impossibility of a flexion of an anticnemion (a lesion mm. biceps femoris, semitendinosus and semimembranosus). Such high lesions are often accompanied by a simultaneous lesion and n. cutanei femoris posterioris (see more low). It is natural, that at sciatic nerve utter defeat functions of its both branches - тибиального and peroneal nerves that gives the basic symptom-complex in the form of a full paralysis of foot and fingers, reflex loss ахиллова tendons suffer and. Anesthesias almost all anticnemion and foot vpxl (except a zone n. sapheni - fig. 96) see. Lesions n. ischiadici can be accompanied by severe pains. At a nerve boring symptom Ласега is characteristic: if to the patient in a dorsal decubitus to incurvate in a hip joint to (lift) the foot straightened in a knee joint there is a pain on a sciatic nerve course, i.e. On a back surface of a hip and an anticnemion (the first phase); if to incurvate a foot in a knee joint the further flexion in a hip joint occurs without serious consequences (the second phase of reception Ласега). Anatomic division sciatic on tibial and fibular nerves occurs, as a rule, in the top department of a popliteal space. However absolutely distinct субэпиневральное isolation тибиальной and peroneal portions of a nerve is carried out usually in a cavity of a small basin. Wounds of such large nerve as sciatic, seldom happen full. More its this or that portion is more often suffers.

Nov 15, 2008 at 16:34 o\clock

The cerebellum is located

The cerebellum is located in a back cranial fossa over an oblong brain and варолиевым the bridge. Up from it there are occipital shares of the big brain; between them and a cerebellum it is tense tentorium (намет) cerebelli. The cerebellum consists order ultram of average department, or a worm (vermis), and two hemispheres (hemispheria). Its Blanket is the cortex (grey substance). Besides, in white substance there are still clumps of grey substance - cerebellum kernels from which more important are nuclei dentati and nuclei tecti or fastigii (fig. 19). The cerebellum is bound To other departments of the central nervous system by three pairs legs (fig. 20): 1) the bottom legs, or corpora restiformia (brachia cerebelli ad medullam oblongatam), веревчатые bodies; 2) average legs, or brachia pontis (brachia cerebelli ad pontem), 3) top, or forward legs, or brachia conjunctiva (brachia cerebelli ad corporam quadrigeminam). more ancient department of a cerebellum (palaeocerebellum) - a worm closely bound to a vestibular mechanism. Cerebellum hemispheres are newer formation (neocerebellum), developed in parallel with development of a cortex of a brain and in connection with complicating and perfection of impellent certificates. Cerebellum including in system of coordination of movements is provided with its eisodic communications with the numerous proprioceptors which have been put in pawn in organs of movement, and with a vestibular mechanism perceiving changes of

position of a body (head) in space. Efferent influences of a cerebellum on a cross-section-striatal musculation are carried out through the special ways terminating at cells of a peripheric impellent neurone. Communications of a cortex of a brain with a cerebellum provide including of the last in the regulating system which is carrying out "any" movements (fig. 21). . n. The bridge - tractus fronto-pontinus; N. ruber - a red kernel; Br. con. - brachium conjunctivum: N. dent. - nucleus dentatus;. N. tecti - nucleus tecti; Зат. Century of the item of the bridge - tractus occipito-temporopontinus; N v. - nucleus vestibularis; Br. pontis - brachium pontis; Vest. - vestibulum; Sp. cer v. - tractus spino-cerebellaris ventralis; Sp. cer. d. - tractus spino-cerebellaris dorsalis; Ruhr. spin. - tractus rubro-spinalis. WAYS TO THE CEREBELLUM FROM THE SPINAL AND OBLONG BRAIN Tractus spino-cerebellaris In muscles, joints, ligaments, tendons vpxl and a periosteum the nervous terminations are located, conductors from which go in particular to a cerebellum. Cerebellar проприорецепция provides the constant information on a condition of organs of movement. The impulses arising in named organs, on centripetal fibers of a peripheric nerve reach the cells located in an intervertebral spinal ganglion, whence on corresponding fibers of a back sensitive root are spent to the basis of a back horn of a spinal cord. Here the first (peripheric) neurone of proprioceptors of a cerebellum comes to an end, and impulse is transferred to cells of the second neurones (fig. 1 see). Tractus spino-cerebellaris dorsalis, or fascicle Флексига, begins from the cells which are in the basis of a back horn. Axons of the named cells leave in a lateral column of the party and are referred on a spinal cord up, settling down on periphery of a back part of a lateral column. Reaching an oblong brain, fascicle Флексига in a kind fibrae arcuatae externae as a part of the bottom legs of a cerebellum or corpus restiforme enters into a cerebellum and comes to an end in its worm.

Nov 15, 2008 at 12:33 o\clock

Tractus spino-cerebellaris

Tractus spino-cerebellaris ventralis, or fascicle Говерса, begins from cells of an average part of grey substance of a spinal cord; axons also leave in a lateral column and settle down on its periphery, to front (ventrally) from fascicle Флексига. Fibers of fascicle Говерса pass a spinal, oblong brain, варолиев the bridge; in forward department of the last buy cipro they turn at first upwards, then кзади and as a part of the top legs of a cerebellum (brachia conjunctiva) enter the same as also fascicle Флексига, in a worm of a cerebellum (fig. 21 see) where come to an end. At a lesion of fascicles Флексига and Говерса and corpus restiforme cerebellar disorders arise on the lesion party.Tractus

vestibulo-cerebellaris Axons of cells of a vestibular kernel (mainly Bekhterev's kernels) enter through the bottom legs of a cerebellum, i.e. Through corpus restiforme, in a worm of a cerebellum, in particular, in it nucleus tecti (fig. 21 see). There are still similar ways from sensitive kernels of trigeminal and wandering nerves.Ways from kernels of back columns to a cerebellum From Gaulle's kernels and the buy rimonabant most part of fibers, as is known, in structure tractus bulbo-thalamicus (sustavno-muscular and tactile feeling) is referred to a visual hillock. Some part of axons from cells of kernels of back columns in a kind fibrae arcuatae externae posteriores through corpus restiforme passes also in a worm of a cerebellum.Tractus olivo-cerebellaris From the bottom olivas (olivae inferiores) through corpus restiforme there pass to a cortex of a cerebellum conductors of extrapyramidal system.FROM THE BRAIN CORTEX From various departments of a cortex of a brain, mainly from frontal lobes, begin tractus cortico-cerebellares, consisting of two neurones: tractus cortico-pontinus and tractus ponto-cerebellaris. 1. The frontal way of the bridge, or tractus fronto-pontinus, originates from forward departments top and average (I and II) frontal gyruses, passes through centrum semiovale, a forward hip of an internal capsule (fig. 55 see, X), internal department of the basis of legs of a brain and comes to an end in kernels of the bridge of the party. 2. The Occipitotemporal way of the bridge, or tractus occipito-temporo-pontinus, begins from back departments II and III temporal gyruses and occipital area of a cortex; in an internal capsule it settles down in back department of a back hip (fig. 55 see, VI), in an external part of the basis of legs of a brain; comes to an end also in kernels of the bridge of the party (fig. 21 see). Cells of kernels of the bridge are the second neurones; their axons make a decussation in the basis of the bridge and under the name tractus ponto-cerebellares through average legs of a cerebellum (brachia pontis) enter into an opposite hemisphere of a cerebellum where come to an end in its cortex. The following neurone binds a cortex of a hemisphere of a cerebellum with nucleus dentatus. Thus, hemicerebrums appear bound to opposite hemispheres of a cerebellum. The cerebellar disorders arising at a lesion of a cortex (mainly frontal and temporal shares), are found out on the party opposite to the centre.WAYS FROM THE CEREBELLUM The bottom and average legs of a cerebellum consist, basically, from the conductors referred to a cerebellum; the top legs are by on which its centrifugal fibers depart from a cerebellum. The main conductors of the top legs (brachia conjunctiva) is the following. Ways from nucleus dentatus, making a decussation (Вернекинка) and coming to an end in opposite red kernels (nucleus ruber) and partially referred further to a visual hillock. From red kernels the decussation (Фореля) and descending on a cerebral trunk and a spinal cord begins tractus rubro-spinalis, going from cells of the red kernel, making immediately after an exit from kernels. Settling down in its lateral column, to front from tractus cortico-spinalis, tractus rubro-spinalis finishes the fibers in forward horns of a spinal cord, coming into contact to cells of peripheric impellent neurones and, hence, with a musculation (fig. 1 and fig. 16 see). It is the basic tserebello-fugalnyj a way establishing communications of a cerebellum with musculation.

Nov 14, 2008 at 14:32 o\clock

Besides, from red kernels

Besides, from red kernels through a visual hillock there are ways to extrapyramidal system (binding it with a cerebellum) and to a brain cortex. To number церебеллофугальных conductors (through corpus restiforme) to сетевидной substances (formatio reticularis) an oblong brain and the fibers going from nucleus tecti of a cerebellum concern a vestibular kernel also. From a kernel of a vestibular order ultram nerve fibers tractus vestibulo-spinalis, going down on periphery of a frontlateral column of a spinal cord from top to bottom (fig. 16, 7) and coming to an end, as well as fibers tractus rubro-spinalis, at cells of forward horns begin. Thus, communication of a cerebellum with a spinal cord, its segments and a musculation is carried out not only through rubrospinal, but also through vestibulo-spinal ways. At last, through the same vestibular (дейтерсово) a kernel the cerebellum is bound by means of a back longitudinal fascicle to kernels of third cranial nerves and, hence, with an oculomotor musculation (fig. 38 see). Analyzing the listed communications, we can be convinced of the following. 1. The cerebellum receives continuously притекающие impulses from joints and muscles of all body: trunks, extremities, a head, eye muscles etc., and also from a vestibular mechanism. These impulses reach a cerebellum, mainly through the bottom legs, and come to an end in its more ancient

departments - palaeocerebellum, i.e. In a worm. Return regulating impulses go through the top legs to red kernels and through tractus rubro-spinalis, vestibulo-spinalis and a back longitudinal fascicle reach cells of forward horns of a spinal cord (or impellent kernels of cranial nerves) and via peripheric impellent neurones musculations reach. The named closed system (worm) serves as reflex system of balance of a body (a trunk and "roots" of the bottom extremities). 2. The cerebellum joins in extrapyramidal system, sending the impulses through the top legs in red kernels, and therefrom through visual hillocks - in striatum and pallidum. The Way back to a musculation passes through the same rubrospinal, vestibulo-spinal ways, a back longitudinal fascicle and a tekto-spinal way (fig. 56 see). 3. The cerebellum is bound to a brain cortex: from a cerebellum, from a cortex of its hemispheres to nucleus dentatus; therefrom through the top legs - to a red kernel, a visual hillock, and at last, to a cortex. From a brain cortex, mainly from frontal lobes, vpxl there are tractus cortico-cerebellares, reaching cortexes of a cerebellum through its average legs. The further way goes to nucleus dentatus and through the top legs - to red kernels. A way to a musculation - the same rubrospinal (монаковский) a fascicle, etc. New systems of a cerebellum, its hemisphere are bound to a brain cortex. Here regulation of movements of extremities is presented, apparently. In the surveyed cerebellar system there are three basic decussations: 1) the top legs (brachia conjunctiva) - 2) rubrospinal (монаковских) ways - 3) average legs of a cerebellum (brachia pontis) - ponto-tserebelljarnyh fibers. Thanks to presence of the named decussations becomes clear, that cerebellar disorders arise at a lesion: 1) the cerebellum - on the centre party, 2) cortexes of a brain and red kernels - on opposite. In a cerebellum there is a projection. It is necessary to believe, that in a worm the trunk musculation, in hemispheres - extremities, especially their distal departments is presented.

Nov 14, 2008 at 09:32 o\clock

Cerebellum function is reflex

Cerebellum function is reflex maintenance of a muscle tone, balance, coordination and a synergy of movements. At a cerebellum lesion there is buy cipro a number of impellent disorders and character. 1. Gait disorder. Atakticheski-mozzhechkovaja, or so-called "drunk", a gait grows out not only balance disturbances, but also an asynergia. The patient goes, widely placing feet and reeling, that especially sharply affects at turns. A deviation aside at walking, and in the expressed cases and falling, are observed more often towards a cerebellar lesion. 2. Интенционное the tremor is observed at movement and is absent in rest. It is found out most sharply in the end of movement and it is investigated in arms with the help a finger-nasal, and in feet by means of pjatochno-knee assay. The task blindly to get by an index finger in an end of the nose is given to the patient; the more close to the purpose, the the tremor of a finger or all brush and an arm is more distinctly and more sharply found out. It is even better found out интенционное a tremor in arms by a different way: the patient concerns with an index finger молоточка or a finger investigating with open eyes, and hammer

position some times varies. Pjatochno-knee assay is made at the laying patient who is offered to lift highly at first a foot, then to concern with a heel of a knee another and to spend a heel downwards on a forward surface of an anticnemion. It is necessary to specify, that the investigated should concern only with a heel of a surface of an anticnemion, instead of lean against it. 3. The nystagmus (twitching of eyeballs at their abduction), observed at a cerebellum lesion, happens horizontal, than vertical or ротаторным is more often; the indicating that it is more expressed at a view in the sick party, unreliably. There are doubts, whether the nystagmus can be a symptom of a lesion of the cerebellum in general and whether is it exclusively symptom стволового lesions. However it is admissible, that «the cerebellar nystagmus» is private implication интенционного tremors of eye muscles. 4. Адиадохокинез it is found out at attempt quickly to make alternately opposite movements. So, patients do not manage to change quickly a pronation for a brush supination: awkward, wrong movements turn out. The dysmetria or, more precisely, buy rimonabant movements can be found easily out following reception: investigated it is offered to hold brushes the palms extended forward up, with divorced fingers; it is necessary to turn quickly the order brushes palms downwards; on the party where there are cerebellar disorders, this movement is made with superfluous rotation of a brush. At the offer to concern with a heel of one foot of a knee another (in lying position) the patient brings feet at above knee and concerns with a hip heel (a hyperflexion phenomenon). 6. Мимопопадание, or промахивание, at so-called it is found out to "indication assay» as follows: to the patient an index finger 3 times are offered 2 - to get to the finger put before it investigating or in молоточек: after that the patient closes eyes and continues the same task. In an arm in which there are cerebellar disorders, it becomes perceptible промахивание wide of the mark, more often кнаружи. 7. The alalia is private implication of cerebellar disorder of movements; speech loses smoothness, becomes scanned, explosive, slowed down. 8. The hypotension of muscles affecting in slackness, flabbiness of muscles, in superfluous excursion in joints, is found out at research of passive movements. It can be accompanied by dropping сухожильных reflexes of extremities. At cerebellum lesions can be observed and other symptoms. The Asynergia is expressed in disturbance of coordination of work of some the muscular groups necessary for realisation of this or that movement. One of asynergia implications is so-called flexion combinee (сокращ.) - сочетанное a hip and trunk flexion. Investigated lays on a back, it is better on a rigid couch without a headboard and a pillow; at attempt to sit down with the arms crossed on a breast there is сочетанное to a flexion of a trunk a flexion one or both (at a bilaterial lesion) feet.