By D. Urkrass. Arizona State University West.

Modified Giemsa stain and Carbol fuchsin stain were superior to gram stain in the sense that a clear and distinctive spiral morphology was identified cheap red viagra 200 mg mastercard. Moreover buy red viagra 200 mg low cost, they are less expensive purchase red viagra 200 mg online, easily available and the techniques are uncomplicated and rapid to perform compared to that of the Warthin-Starry silver stain mentioned by others. However, Gram stain is useful for exclusion of other Gram positive and negative organisms and H & E stain for correlation of the severity of gastritis with bacterial colonization. A semiquantitation of bacterial colonization can also be done at the same time with identification. All of these staining methods can be applied as routine hospital laboratory without difficulity. The endoscopic findings were correlated with the radiologic features of lesion on upper gastrointestinal barium studies. On radiographs, this entity usually presented as sessile to pedunculated polypoid lesions with smooth surface above the normal mucosa; this was seen in 37%, the prevalence of which as equally highest as nonspecific polypoid growths among 79 solitary polypoid lesions. In the prospective study, the type, intensity of inflammation in antral biopsy specimens were correlated with the presence of H. A total of 20 patients completed the study without contravening the study protocol. Combined treatment with amoxillin and metronidazole gave an eradication rate of (57% whereas triple therapy with busmith, amoxillin and metronidazole gave a statistically higher eradication rate (93%). We conclude that standard triple therapy is promising concept with regard to effective treatment of H. Among 61 patients, 38 cases were operated after 12 hours of onset of symptoms and 8 cases were after 24 hours, three patients died. Seven patients had postoperative complications such as wound infection (5 cases), chest infection (one case), faecal fistula formation (one case). Most ulcers had lsee than 5mm in size, 51 cases were discharged from hospital at 7 days. The endocrine homeostatic mechanism may have been responsible for such an incidence and in the present study; the significant of blood aldosterone have been studied in children with or without malnutrition during diarrhoea and its relationship with the blood electrolyte levels in these 148 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar patients. The study included 31 children (age one to five years) who were hospitalized for malnutrition, malnutrition with diarrhoea and acute diarrhoea of less than 48 hours duration. The controls consisted of six children from the same locality as the patients, were apparently healthy and were of the same age group. Serum sodium and chloride tend to increase in the patients and increase was more pronounced in the group suffering from both malnutrition and diarrhoea. On the other hand, serum potassium tend to decrease and the decreases were significant in groups having malnutrition. Serum protein level was found to be most depleted in the malnutrition associated diarrhoea group. Serum aldosterone levels were raised in all the three groups of patients namely malnutrition, diarrhoea and malnutrition associated diarrhoea when compared with the control whether aldosterone levels were expressed as ng/100ml or ng/g protein. The increase was still observed even after exclusion of the subjects whose ages lied within first one and half year of life for whom the serum aldosterone levels were found to have a sharp rise. Among the electrolytes only serum K+ appeared to correlate with serum aldosterone. However, serum Na/K ratio also seemed to correlate with serum aldosterone but in an inverse manner. The results suggested that aldosterone, a mineralocorticoid secreted by adrenal cortex might be involved in the regulation of electrolyte levels in blood possibly through the so called electrolyte pump, Na-K exhange system. They were taken by endoscopic examination at Thingangyun General Hospital and Yangon General Hospital during July and August 2000. Processing for isolation of Helicobactor pylori was done within 3 to 6 hours of having biopsy from the patients. Among 35 cases of endoscopically and/or surgically confirmed gastric masses, thirty cases (85%) were primary gastric carcinoma which was the commonest type, one was lymphoma and other four cases were benign lesions Twenty seven out of thirty cases of histologically confirmed primary gastric carcinoma were adenocarcinoma which was the commonest histological pattern. Four out of 31 cases of advanced malignant gastric lesions presented with mild symptoms. So middle age patients presenting with loss of appetite, slight nausea and discomfort after meal should always require careful investigation to get early diagnosis. Primary gastric carcinoma were commonly found in 51 to 70 year age group (23 cases) and males were more affected than females (3:2). Three cases (10%) were found in 149 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar gastric cardia. Even small frequency occurred in gastric cardia, it can be missed occasionally on barium meal, so careful examination is needed. Eighteen out of 36 cases of radiologically diagnosed gastric masses were fungating/polypoid lesion which was the commonest morphological appearance. In these lesions, the surface pattern is important to differentiate between benign and malignant masses.

The arthralgia (pains with no evidence of acute inflammation or deformity on examination) can occur in sarcoid or tuberculosis but again they are commoner in sarcoid buy cheap red viagra 200 mg on-line. The serum level of angiotensin-converting enzyme would be raised in over 80 per cent of cases of sarcoidosis but often in tuberculosis also; the granuloma cells secrete this enzyme red viagra 200 mg mastercard. A bronchial or transbronchial lung biopsy at fibreoptic bron- choscopy would be another means of obtaining diagnostic histology 200 mg red viagra for sale. In patients with a cough and sarcoidosis the bronchial mucosa itself often looks abnormal, and biopsy will provide the diagnosis. Steroid treatment would not be necessary for the hilar lymphadenopathy alone, but would be indicated for the hypercalcaemia and possibly for the systemic symptoms. She also has a persist- ent frontal headache associated with early morning nausea. Eight years previously she had a left mastectomy and radiother- apy for carcinoma of the breast. She is a retired civil servant who is a non-smoker and drinks 10 units of alcohol per week. Her pulse rate is 72/min, blood pressure 120/84 mmHg, jugular venous pressure is not raised, heart sounds are normal and she has no peripheral oedema. It is more likely that she has polyuria due to neurogenic diabetes insipidus as a result of secondary metastases in her hypothalamus. The hypercalcaemia and raised alkaline phosphatase are suggestive of bony metastases secondary to her breast carcinoma. The recent-onset headache, worsened by coughing and lying down and associ- ated with vomiting is characteristic of raised intracranial pressure, which is confirmed by the presence of papilloedema. In some tumours around the pituitary there may be compression of the optic nerve causing visual field abnormalities. Patients with central diabetes insipidus typically describe an abrupt onset of polyuria and polydipsia. A water-deprivation test should be performed in this patient, measuring the plasma sodium, urine volume and urine osmolality until the sodium rises above 146 mmol/L, or the urine osmolality reaches a plateau and the patient has lost at least 2 per cent of body weight. An increase in urine osmolality #50 per cent indicates central diabetes insipidus and! She should be referred to an oncologist for treatment of her metastatic carcinoma. Otherwise, examination of his cardiovascular, respiratory, abdominal and neurological sys- tems is unremarkable. The high gamma-glutamyl transpeptidase level is compatible with liver disease related to a high alcohol intake. Commonest glomerular causes of microscopic haematuria Immunoglobulin A (IgA) nephropathy Thin basement membrane disease Alport s syndrome (predominantly affects males) IgA nephropathy is the commonest glomerulonephritis in developed countries, and is char- acterized by diffuse mesangial deposits of IgA. Patients often have episodes of macroscopic haematuria concurrent with upper respiratory tract infection. Most cases of IgA nephrop- athy are idiopathic, but this it is also commonly associated with Henoch Schnlein purpura and alcoholic cirrhosis. About 20 per cent of patients with IgA nephropathy will develop end-stage renal failure after 20 years of follow-up. Thin basement membrane disease is a familial disorder which presents with isolated micro- scopic haematuria, minimal proteinuria and normal renal function that does not deteri- orate. Electron microscopy shows diffuse thinning of the glomerular basement membranes (the width is usually between 150 and 225 nm versus 300 400 nm in normal subjects). Alport s syndrome is a progressive form of glomerular disease, associated with deafness and ocular abnormalities and is usually inherited as an X-linked dominant condition so that males are more seriously affected. As the patient is over 50 years old he should have urine cytology/prostate-specific antigen/cystoscopy per- formed to exclude concurrent bladder and prostatic lesions. The patient should be advised to abstain from alcohol, and needs his blood pressure con- trolling. He needs regular follow-up as he is at risk of progressing to dialysis and/or renal transplantation. The raised creatinine appears modest in terms of the actual figures, but as plasma/serum creatinine does not begin to rise until the glomerular filtration rate is reduced to 50 per cent of normal (irrespective of the patient s age), the raised creatinine in this case indicates a serious loss of renal function to approximately 40 per cent of normal. There is no convincing evidence for immunosuppression retarding the progression into renal fail- ure in most patients with IgA nephropathy. This has been associated with a decrease in appetite and an increasing problem with vomiting. During the last month he has noticed some weakness, particularly in his legs, climbing hills and stairs.

The expectation of medicalized death hooks the rich on unlimited insurance payments and lures the poor into a gilded deathtrap cheap red viagra 200mg mastercard. The contradictions of bourgeois individualism are corroborated by the inability of people to die with any possibility of a realistic attitude towards death buy red viagra 200 mg on-line. I wanted to know from him how people along the Niger could understand each other buy cheap red viagra 200mg on line, though almost every village spoke a different tongue. For him this had nothing to do with language: "As long as people cut the prepuce of their boys the way we do, and die our death, we can understand them well. For a generation people continue in their traditional beliefs; they know how to deal with death, dying, and grief. By their ministration they urge the peasants to an unending search for the good death of international description, a search that will keep them consumers forever. Like all other major rituals of industrial society, medicine in practice takes the form of a game. He is the agent or representative of the social body, with the duty to make sure that everyone plays the game according to the rules. Death no longer occurs except as the self-fulfilling prophecy of the medicine man. The struggle against death, which dominates the life-style of the rich, is translated by development agencies into a set of rules by which the poor of the earth shall be forced to conduct themselves. Only a culture that evolved in highly industrialized societies could possibly have called forth the commercialization of the death-image that I have just described. In its extreme form, "natural death" is now that point at which the human organism refuses any further input of treatment. People63 die when the electroencephalogram indicates that their brain waves have flattened out: they do not take a last breath, or die because their heart stops. Socially approved death happens when man has become useless not only as a producer but also as a consumer. It is the point at which a consumer, trained at great expense, must finally be written off as a total loss. Society felt threatened that the man on Death Row might use his tie to hang himself. Today, the man best protected against setting the stage for his own dying is the sick person in critical condition. Society, acting through the medical system, decides when and after what indignities and mutilations he shall die. Health, or the autonomous power to cope, has been expropriated down to the last breath. In order to focus on this specific counterproductivity of contemporary industry, frustrating overproduction must be clearly distinguished from two other categories of economic burdens with which it is generally confused, namely, declining marginal utility and negative externality. Direct costs reflect rental charges, payments made for labor, materials, and other considerations. The production cost of a passenger-mile includes the payments made to build and operate the vehicle and the road, as well as the profit that accrues to those who have obtained control over transportation: the interest charged by the capitalists who own the tools of production, and the perquisites claimed by the bureaucrats who monopolize the stock of knowledge that is applied in the process. The price is the sum of these various rentals, no matter whether it is paid by the consumer out of his own pocket or by a tax-supported social agency that purchases on his behalf. Negative externality is the name of the social costs that are not included in the monetary price; it is the common designation for the burdens, privations, nuisances, and injuries that I impose on others by each passenger-mile I travel. The dirt, the noise, and the ugliness my car adds to the city; the harm caused by collisions and pollution; the degradation of the total environment by the oxygen I burn and the poisons I scatter; the increasing costliness of the police department; and also the traffic-related discrimination against the poor: all are negative externalities associated with each passenger-mile. Some can easily be internalized in the purchase price, as for instance the damages done by collisions, which are paid for by insurance. Other externalities that do not now show up in the market price could be internalized in the same way: the cost of therapy for cancer caused by exhaust fumes could be added to each gallon of fuel, to be spent for cancer detection and surgery or for cancer prevention through antipollution devices and gas masks. But most externalities cannot be quantified and internalized: if gasoline prices are raised to reduce depletion of oil stocks and of atmospheric oxygen, each passenger- mile becomes more costly and more of a privilege; environmental damage is lessened but social injustice is increased. Beyond a certain level of intensity of industrial production, externalities cannot be reduced but only shifted around. Counterproductivity is something other than either an individual or a social cost; it is distinct from the declining utility obtained for a unit of currency and from all forms of external disservice. It exists whenever the use of an institution paradoxically takes away from society those things the institution was designed to provide. The price of a commodity or a service measures what the purchaser is willing to spend for whatever he gets; externalities indicate what society will tolerate to allow for this consumption; counterproductivity gauges the degree of prevalent cognitive dissonance resulting from the transaction: it is a social indicator for the built-in counterpurposive functioning of an economic sector. This specific counterproductivity constitutes an unwanted side-effect of industrial production which cannot be externalized from the particular economic sector that produces it. Fundamentally it is due neither to technical mistakes nor to class exploitation but to industrially generated destruction of those environmental, social, and psychological conditions needed for the development of nonindustrial or nonprofessional use- values. Counterproductivity is the result of an industrially induced paralysis of practical self-governing activity.