By Z. Marius. The Art Institute of Southern California.
Viral infections in immunocompromised patients: what’s new with respiratory viruses? Human metapneumovirus in lung transplant recipients and comparison to respiratory syncytial virus generic 500 mg robaxin fast delivery. Lower respiratory viral illnesses: improved diagnosis by molecular methods and clinical impact buy discount robaxin 500mg online. Incidence and management of abdominal closure-related complications in adult intestinal transplantation order 500mg robaxin free shipping. Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant robaxin 500 mg free shipping. Surgical site infection in liver transplant recipients: impact of the type of perioperative prophylaxis discount 500 mg robaxin otc. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy safe robaxin 500mg. Biliary tract complications following 52 consecutive orthotopic liver transplants. Preliminary study of choledochocholedochostomy without T tube in liver transplantation: a comparative study. Aspergillus mediastinitis following orthotopic heart trans- plantation: case report and review of the literature. Risk factors for early, cumulative, and fatal infections after heart transplantation: a multiinstitutional study. Management of urinary tract infections and lymphocele in renal transplant recipients. Complications of cyclosporine-prednisone immunosup- pression in 402 renal allograft recipients exclusively followed at a single center for from one to five years. Significance of pretransplant urinary tract infection in short- term renal allograft function and survival. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Effect of time after transplantation on microbiology of urinary tract infections among renal transplant recipients. Urinary tract infection due to Corynebacterium urealyticum in kidney transplant recipients: an underdiagnosed etiology for obstructive uropathy and graft dysfunction-results of a prospective cohort study. Incidence of urinary tract infections caused by germs resistant to antibiotics commonly used after renal transplantation. Clinically “silent” weight loss associated with mycophenolate mofetil in pediatric renal transplant recipients. Prevalence of cytomegalovirus in the gastrointes- tinal tract of renal transplant recipients with persistent abdominal pain. Gastroduodenal cytomegalovirus infection is common in kidney transplantation patients. Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single-center experience. Late cytomegalovirus disease with atypical presentation in renal transplant patients: case reports. Clinical microbiological case: a heart transplant recipient with diarrhea and abdominal pain. Clostridium difficile colitis requiring subtotal colectomy in a renal transplant recipient: a case report and review of literature. Clostridium difficile colitis in patients after kidney and pancreas-kidney transplantation. Pneumatosis intestinalis with Clostridium difficile colitis as a cause of acute abdomen after lung transplantation. Clostridium difficile colitis associated with inflammatory pseudotumor in a liver transplant recipient. Clinical manifestations, treatment and control of infections caused by˜ Clostridium difficile.
The patients given highest priority for transplant are those requiring vasopressor support with concomitant use of a pulmonary artery catheter or those requiring mechanical circulatory support 500 mg robaxin otc. Individuals requiring vasopressor support managed without pulmonary artery catheter are given second high- est priority generic 500mg robaxin with mastercard. Acute rejection and infection are the commonest causes of early transplant failure and death best robaxin 500 mg. Most programs perform routine endomyocardial bi- opsies to detect rejection for a period of 5 years after transplant 500mg robaxin otc. Mortality that occurs >1 year after transplant is most likely related to coronary artery disease robaxin 500 mg without prescription, which is accelerated posttransplant due to immunosuppression trusted robaxin 500mg. Average ef- ﬁcacy of these drug classes are as follows: nicotinic acid, 20–40%; ﬁbrate, 35–50%; statin, 7–30%). They lower choles- terol but often increase triglyceride levels and should not be used in patients with triglyc- erides >200 mg/dL. Nicotinic acid is effective for treating hypertriglyceridemia but may worsen glucose control and therefore should be used cautiously in patients with the metabolic syndrome. Balloon angioplasty reocclusion rates are up to two times higher com- pared to restenosis with stenting. This type of restenosis is mediated by hyperproliferation of smooth muscle cells into the intima as they react to the vascular injury induced by the balloon angioplasty. However, due to the delayed endothelial healing that is achieved with drug-eluting stents, the patient is exposed to a higher risk of subacute in-stent restenosis. This type of restenosis is mediated by thrombus formation as the denuded endothelium is exposed to the circulation. T-wave notching, or “humps,” may be common in asymptomatic patients and are of prognostic importance. Anti-ischemic therapy (nitrates, beta blockers) is important for symptom relief and to prevent recurrence of chest pain. Anti- thrombotic therapy is directed against the platelet aggregation at the site of the ruptured plaque. Continuation of treatment for up to 12 months confers addi- tional beneﬁt in patients treated conservatively and among those who underwent percutaneous coronary intervention. The major advantage of a bioprosthetic valve is the low incidence of thromboembolic phenomena, particularly 3 months after implantation. Although in the immediate postoperative period some anticoagulation may occur, after 3 months there is no further need for anticoagulation or monitoring. Therefore, these valves are useful in patients with contraindications to anticoagulation, such as elderly patients with comorbidities and younger patients who desire to become pregnant. Elderly people may also be spared the need for repeat surgery as their life span may be shorter than the natu- ral history of the bioprosthesis. Hemody- namic parameters are improved with double-disk valves compared with single-disk or ball-and-chain valves. Younger patients with no contraindications to anticoagulation may be better served by mechanical valve replacement. This designation is applied to patients with communications between the right and left circulations, pulmonary hypertension, and a predominantly right-to-left shunt. Eisen- menger’s syndrome can develop in patients with communication at the atrial, ventricu- 222 V. These shunts are initially left to right and therefore do not present with cyanosis.
What separated these groups was in essence philosophical issues to do with the nature of medical knowledge generic 500mg robaxin amex, how it is arrived at and how it is justiﬁed cheap 500mg robaxin overnight delivery. The precise chronological sequence of the various stages in this debate is difﬁcult to reconstruct discount robaxin 500mg amex, but the theoretical issues that were raised had a major impact on subsequent medical thinking generic robaxin 500 mg line, especially on the great medical systems of late antiquity purchase robaxin 500mg visa, namely Galen’s and Methodism cheap 500mg robaxin with amex. Galen is one of those authors who have been rediscovered by classicists and students of ancient philosophy alike, be it for his literary output, his mode of self-presentation and use of rhetoric, the picture he sketches of the intellectual, social and cultural milieus in which he works and of the traditions in which he puts himself, and the philosophical aspects of his thought – both his originality and his peculiar blends of Platonism, Hippocratism and Aristotelianism. Galen’s work, voluminous in size as well as in substance, represents a great synthesis of earlier thinking and at the same time a systematicity of enormous intellectual power, breadth and Introduction 29 versatility. In chapter 10, I shall consider Galen’s theoretical considerations about pharmacology, and in particular his views on the relationship between reason and experience. Although in the ﬁeld of dietetics and pharmacology he is particularly indebted to the Empiricists, his highly original notion of ‘qualiﬁed experience’ represents a most fortunate combination of reason and experience; and one of Galen’s particular strengths is his ﬂexibility in applying theoretical and experiential approaches to different domains within medical science and practice. Among Galen’s great rivals were the Methodists, a group of medical thinkers and practitioners that was founded in the ﬁrst century bce but came to particular fruition in the ﬁrst and second centuries ce, especially under their great leader Soranus. Although their approach to medicine was emphatically practical, empirical and therapy-oriented, their views present interesting philosophical aspects, for example in epistemology and in the as- sumption of some kind of corpuscular theory applied to the human body. Regrettably, most works written by the Methodists survive only in frag- ments, and much of the evidence is biased by the hostile ﬁlter of Galen’s perception and rhetorical presentation. Caelius has long been dismissed as an unoriginal author who simply translated the works of Soranus into Latin. However, recent scholarship has begun to appreciate Caelius’ originality and to examine his particular version of Methodism. This overlap not only concerned the ideas, concepts and method- ologies they entertained, but also the ways and forms in which they ex- pressed and communicated these ideas, the modalities of dissemination and persuasion, and the settings in which they had to work and present 32 For a collection of the fragments of the Methodists see now Tecusan (2004). I touch here on a further aspect in which the study of ancient medicine – and philosophy – has recently been contextualised, and in this case the impetus has come from a third area of research we need to consider brieﬂy because of its particular relevance to the papers collected in this volume, namely the ﬁeld of textual studies or, to use a more recent and speciﬁc term,‘discourse analysis’. One only needs to point to the twenty-two volumes of Kuhn’s¨ edition of the works of Galen or the ten tomes of Littre’s´ edition of the works of Hippocrates to realise that ancient medical literature has been remarkably well preserved, at least compared with many other areas of classical Greek and Latin literature. While much philological spade-work has been done to make these texts more accessible, especially in projects such as the Corpus Medicorum Graecorum or the Collection des Universites de France´ , many parts of this vast corpus of literature, to which newly discovered texts continue to be added, still await further investigation. There still is, of course, a great basic demand for textual studies, edi- tions, translations, commentaries and interpretative analyses – and in this respect, the triennial conferences on Greek and Latin medical texts have proved remarkably fruitful. Yet apart from this, there is an increasing in- terest being taken in medical, scientiﬁc and philosophical texts, not just because of their intellectual contents but also from the point of view of linguistics, literary studies, discourse analysis, narratology, ethnography of literature (orality and literacy), rhetoric and communication studies. This is related to a growing scholarly awareness of the communicative and com- petitive nature of Greek medicine and science. Greek doctors, philosophers, astronomers and mathematicians had to impress their audiences, to per- suade them of their competence and authority, to attract customers and to reassure them that they were much better off with them than with their rivals. Medical, scientiﬁc and philosophical texts functioned in a speciﬁc setting, with a particular audience and purpose, and served as vehicles not only for the transmission of ideas but also for the assertion of power and authority. These developments have given rise to a whole new ﬁeld of studies and questions regarding the ways in which knowledge was expressed and com- municated in the ancient world: the modes of verbal expression, technical idioms, stylistic registers and literary genres that were available to people who laid a claim to knowledge (healers, scientists, philosophers) in order to convey their views to their fellows, colleagues and their wider audiences; the rhetorical strategies they employed in order to make their ideas intel- ligible, acceptable, or even fashionable; the circumstances in which they Introduction 31 had to present their ideas, and the audio-visual means (writing facilities, diagrams, opportunities for live demonstration) they had at their disposal; the interests and the expectations of their audiences, and the ways in which these inﬂuenced the actual form of their writings; and the respects in which ‘scientiﬁc’, or ‘technical’, or ‘expert’ language or ‘discourse’ differed from ‘ordinary’ and ‘literary’ language and ‘discourse’. After many years of considerable neglect, the last two decades have thus seen a signiﬁcant increase in attention being given to the forms of ancient scientiﬁc writing, especially among students of the Hippocratic Corpus, but also, for example, on Latin medical literature, with some studies focusing on ‘strictly’ linguistic and textual characteristics, while others have attempted to relate such characteristics to the wider context in which the texts were produced. First, general trends in the study of rhetoric and discourse analysis, in particular the study of ‘non-literary’ texts such as advertisements, legal proceedings, minutes of meetings, political pamphlets and medical reports, the study of rhetoric and persuasive strategies in apparently ‘neutral’ scien- tiﬁc writings, and the development of genre categories based on function rather than form have led to a growing awareness among classicists that even such seemingly ‘unartistic’, non-presumptuous prose writings as the extant works of Aristotle, the Elements of Euclid and the ‘notebook-like’ Hippocratic Epidemics do have a structure which deserves to be studied in its own right, if only because they have set certain standards for the emergence and the subsequent development of the genre of the scientiﬁc treatise (‘tractatus’) in Western literature. It is clear, for example, to any student of Aristotle that, however impersonal the tone of his works may be and however careless the structure of his argument may appear, his writings nonetheless contain a hidden but undeniable rhetoric aimed at making the reader agree with his conclusions, for example in the subtle balance be- tween conﬁdent explanation and seemingly genuine uncertainty, resulting in a careful alternation of dogmatic statements and exploratory suggestions. The study of these formal characteristics has further been enriched by a growing appreciation of the role of non-literal, or even non-verbal as- pects of communication (and conversely, the non-communicative aspects of language). Aesthetics of reception, ethnography of literature and studies in orality and literacy have enhanced our awareness of the importance of 34 For more detailed discussion and bibliographical references see van der Eijk (1997), from which the following paragraphs are excerpted. Here, again, discourse studies and ethnogra- phy of literature have provided useful instruments of research, for example D. Hymes’ analysis of the ‘speech event’ into a number of components that can, not without some irony, be listed according to the initial letters of the word speaking: setting (time, place, and other circumstances), scene (e. A recent German collection of articles on ‘Wissensvermittlung’ (‘transmission of knowledge’) in the ancient world gives an impression of the kind of questions and answers envisaged from such an integrated approach.
Carvedilol also has mixed activity but is equiactive at b-receptors and a1-receptors buy robaxin 500 mg online. Timolol (Blocadren) robaxin 500mg overnight delivery, levobunolol (Betagan) discount 500 mg robaxin overnight delivery, nadolol (Corgard) discount robaxin 500 mg otc, and sotalol (Betapace) (1) These drugs are nonselective b-receptor antagonists discount robaxin 500mg with amex. Pindolol (Visken) generic robaxin 500 mg with amex, carteolol (Cartrol), and penbutolol (Levatol) are nonselective antagonists with partial b2-receptor agonist activity. Cardiovascular system (see also Chapter 4) (1) b-Adrenoreceptor antagonists are used to treat hypertension, often in combination with a diuretic or vasodilator. Long-term use of timolol, propranolol, and metoprolol may prolong survival after myocardial infarction. This effect is thought to be related to the slowing of ventricular ejection and decreased resistance to outflow. Eye (1) Topical application of timolol, betaxolol, levobunolol, and carteolol reduces intraocular pressure in glaucoma. Other uses (1) Propranolol is used to control clinical symptoms of sympathetic overactivity in hyper- thyroidism by an unknown mechanism, perhaps by inhibiting conversion of thyroxine to triiodothyronine. All agents (1) b-Adrenoreceptor antagonists should be administered with extreme caution in patients with preexisting compromised cardiac function because they can precipitate heart fail- ure or heart block. Nonselective adrenoceptor antagonists (1) These drugs may cause bronchoconstriction, and thus they are contraindicated for asth- matics. Propranolol, and other b-receptor blockers, cause sedation, sleep disturbances, and depression. What class of medications does bethanechol (A) Inhibiting choline acetyltransferase belong to? The (D) Norepinephrine patient is emergently intubated and given atro- (E) Serotonin pine and another medication that acts to reacti- vate acetylcholinesterase. Oxybutynin works by in nerve terminals (A) Inhibiting acetylcholinesterase at musca- (D) Potentiation of tyrosine hydroxylase, the rinic and nicotinic receptors rate-limiting enzyme in the synthesis of (B) Causing a neuromuscular blockade norepinephrine (C) Antagonizing a1-adrenoceptors (E) Promotion of release of norepinephrine (D) Binding to muscarinic receptors from adrenergic nerve endings (E) Activating b2-adrenoceptors 4. Since the disease is gated ion channel characterized by degeneration of dopaminergic (B) Activates G -protein, resulting in stimula- neurons, leading to the lack of inhibition of cho- s tion of adenylyl cyclase linergic neurons, the addition of which medica- (C) Activates G -protein, resulting in increase of tion is likely to help alleviate the patient’s q phosphatidylinositol and calcium symptoms? A 7-year-old boy is brought in by his parents heavy smoking presents to her doctor with com- for complaints of hyperactivity at school. He is plaints of shortness of breath and chronic also inattentive and impulsive at home. After a coughing that has been present for about 2 years detailed interview, the physician decides to give and has been worsening in frequency. The the boy amphetamine-containing medication doctor decides to prescribe a bronchodilator for presumed attention hyperactivity disorder. Which medication did the doctor likely (B) Indirectly acts on norepinephrine receptors prescribe? Which of the following medications is used (E) Pseudoephedrine to prevent premature labor? From the list below, choose the depolarizing (B) Cevimeline neuromuscular blocker most likely to be used in (C) Atracurium ‘‘rapid sequence intubation,’’ a procedure that (D) Tolterodine is done when the stomach contents have a high (E) Terbutaline risk of refluxing and causing aspiration. What significant side effect of terazosin (B) Succinylcholine should the doctor warn a 69-year-old patient (C) Neostigmine about? Ephedra (ephedrine) causes increased (D) Sedation blood pressure by (E) Drug abuse (A) Indirect action on cholinergic receptors (B) Blockade of adrenergic receptors 16. A floor nurse pages you about a patient who (C) Stimulation of release of epinephrine is having chest pain. You order an electrocar- (D) Inhibition of reuptake of catecholamines diogram and rush to see the patient. He (E) Direct action on dopamine receptors describes the pain as tight pressure and is demonstrably sweating and gasping for air. The local anes- another medication, which you have read may thetic used in the procedure did not contain prolong his survival in this dire situation. The reason for this is (A) b-Blocker (A) Epinephrine causes increased blood loss (B) a-Agonist during delicate surgery (C) Muscarinic agonist (B) Epinephrine causes swelling of the tissues, (D) Neuromuscular blocker making surgery more challenging (E) Dopamine agonist (C) Epinephrine is contraindicated in emer- gency surgery 17.