P [l.

Tension pneumoperitoneum

, pnevmomediastinuma, subcutaneous emphysema and cardiorespiratory collapse after gastroscopy. Pneumoperitoneum is a known complication of gastrointestinal perforation >>. << However, in the case of occult perforation, where

pneumoperitoneum did not initially obvious, endoscopy with gas insufflation

may cause tension pneumoperitoneum with

serious. 86-year-old woman presented to rural hospital with anorexia, diarrhea

,

adjective pain, sore right shoulder tip and signs correspond >> << with acute abdomen. It was translated into large regional hospital

, where upon arrival she Episode haematemesis. On examination she was

epigastrium and protection, not rebound tenderness or rigidity

. On rectal examination revealed melena. Right chest radiograph

not showed subdiaphragmatic free gas. It

find a bleeding ulcer and was prepared for

Looking stomach flexible instrument called a Gastroscopy view. gastroscopy,

l. Evaluation showed anesthesia in patients with marked

abdomen with cold peripheries and poor capillary refill >> << despite the generous amount of resuscitation. Its essential features are: BP

110/70 mmHg, heart rate 90 beats per minute, [S. sub. ] [O. sub. 2] 95% air. It was

) without fever. Anal. Bezlihoradochnyy. without fever. adjective. Gastroscopy was scheduled under general anesthesia with rapid induction of anesthesia with sequential perstnevydnoho pressure anesthesiology maneuvers, which rapidly induced anesthesia thiopental, succinylcholine is at the same time as surgical sister, anesthesia assistants or other concerns. It was complications from 0. 8 [micro] by [Kg. sub. 1] >> << fentanyl, 1. 3 mg. [Kg. sub. -1] And propofol 1. 2 mg. [Kg. sub. 1]

see succinylcholine. No longer relaxes muscles received. Her hemodynamic >> << parameters were stable during the 10-minute procedure. At gastroscopy >> << duodenum with old clots were found without active bleeding. After return of spontaneous ventilation, she developed marked tachypnea

with a small amount of breathing and low [S. sub. ] [O. sub. 2] 60%

([F. sub. I] [AN sub. 2] 1. 0). When she was still intubuvaty she was ventilation

help manually, achieving adequate respiratory volume, although with high

pressure in the airways (50-60 cm [N. sub. 2] O). It was noted that peryorbytalnoy

and facial swelling developed, which quickly turned into

generalized subcutaneous emphysema involving face, neck and chest. Tension pneumothorax was excluded clinically (Fig. 1). Trachea injuries >> << perforation of the esophagus were excluded from flexible bronchoscopy

and repeat gastroscopy. The patient remains hypotensive >> << At this time (70/40 mmHg), with severe acidosis (pH 6. << 94 >> [P. sub.] [Co. Sat. 2] 72 mmHg) and hypoxemia ([P. sub.] [AN sub. 2] 54 mm

on [FiO. sub. 2] 1. 0). Persistent hypotension followed by a sudden >> << profound bradycardia (HR 30). Adrenaline bolus improved

blood pressure and heart rate, but not saturated. Visceral injury

suspected and the patient was prepared for laparotomy. She was re

anesthesia and gave atrakuriyu then her belly >> << tension was much more noticeable. After laparotomy, an immediate reduction >> << intra-abdominal pressure has been achieved as a result of marked

improve airway pressure, saturation, and hemodynamics. Perforation

duodenum was identified and oversewn. Last >> << operation proceeded without complications and the patient was transferred to >> << intensive care unit for further management. Tension pneumoperitoneum in diagnostic gastroscopy

for peptic ulcer disease is extremely rare (1). As Taub et al (2)

ulcer perforation may sometimes be a wall spontaneously

), relating to the appendage. Anal. Related to the appendage. Relating to or arising from the appendage. wave. Subdiaphragmatic gas may not be radiographically as

enough time for gas absorption and re-signs the patient

improve spontaneously. Increase vnutrishlunkovoho pressure during gastroscopy

gives thin flap appendage that allows air insufflated >> << go out into the abdominal cavity. Omental flap, if present,

may also function as a one-way valve allows air to go with, but not >> << re-enter the gastrointestinal tract (3). In our case, tension pneumoperitoneum was further aggravated

on repeat gastroscopy and was exposed muscle relaxation with atrakuriyu.

Under high pressure, intraabdominal air can reach

me? where-a-stidnum

) Sq. mediastidna P [L. ]

1. The average partitioning or partition. 2. directly through diaphragmatic defects the drug lasix (4), or

retroperitoneal space and break the esophagus (5). Air from the

pnevmomediastinuma can track along fascial planes above the neck

face and chest, creating the observed subcutaneous emphysema. This case highlights the importance of tension pneumoperitoneum as >> << cause life-threatening cardiorespiratory compromise. As mentioned

recently Ternlund etc. surplice, the stomach should be always carefully

, check in intensive care, especially where history

indigestion marked by corrosion of the stomach due to acid in the digestive juices. See duodenal ulcer, gastric ulcer, GERD. , A tension pneumoperitoneum can camouflage blanket

side or the patient. Another point shown in the article

Ternlund was saving procedure inserts

wide diameter cannula in a tense pneumoperitoneum - a procedure that

had to be done at the beginning of this case quickly relieve

cardiorespiratory compromise . (1). Chan SY, Kirsch CM, Jensen WA, Sherck J. voltage

pneumoperitoneum. West J Med 1996; 165:61-64. (2). Taub SJ, Nagurka C, Raskin JB. Tension pneumoperitoneum as a nontraumatic complication >> << endoscopy of the upper gastrointestinal tract. Gastrointest Endosc 1980; 26:153-154. (3). Olinde AJ, Carpenter D, Maher JM. Tension pneumoperitoneum:

cause of acute aortic occlusion. Arch Surg 1983; 118:13471350. (4). Hutkin Z, Iellin, Meged S, P Sorkine, Geller E. Spontaneous pneumoperitoneum without

peritonitis. Int Surg 1992; 77:219. (5). Hillman KM. Pneumoperitoneum: a review. Critical Care Med 1982;

10:476. (6). Ternlund SP, Brock-Utne JG. Failure to recognize tension

pneumoperitoneum during resuscitation. Anaesth Intensive Care 2006;

34:517-518. W Y. There

D. Bertholini

Bendigo, Victoria.

One group took randomization, and was ...

Objective: To explore the possibility of hormone replacement in early after menopause the risk of fractures and changes in bone mineral density, and side effects. This project was designed as a comprehensive cohort lasix prescritpion trial. One group took randomization and randomized to hormone replacement therapy (HRT) or not (no placebo used). 502 were randomized to HRT, and 504 were randomized to nothing HRT) One of the groups were allowed to choose HRT or not. A total of 221 selected HRT, and 789 decided not to HRT. The first line was HRT consecutive estradiol / norethisterone in women with an intact uterus and oral continuous estradiol hysterectomy in women.

This study was initiated in 1990 and included over in 1993. .

Secondary osteoporosis occurs not only in

Taxel P, Kenny

Division of Endocrinology and Metabolism, University of Connecticut, Farmington, USA. Clin Cornerstone 2000; 2 (6)

:11-21. Secondary osteoporosis refers to osteoporosis, in which the primary cause or factor, other than those related to state or aging in lasix 50 mg iv postmenopausal women can be identified. Primary or idiopathic, osteoporosis means that secondary causes can not be found. Secondary osteoporosis occurs not only in postmenopausal women, but men and women before menopause. In the series recorded in specialized centers, at least 30% of postmenopausal women and 50% to 80% of men have a secondary cause of osteoporosis, although the frequency of secondary osteoporosis is probably much lower in the general population. When evaluating patients with osteoporosis, it is important to look for secondary causes and aggravating factors that are reversible and are therapy. In addition to the secondary forms, 2 metabolic bone disease, osteomalacia and primary hyperparathyroidism may mimic or exacerbate osteoporosis. This article briefly differential diagnosis and treatment of osteoporosis, osteomalacia and hyperparathyroidism and review the most common causes of secondary osteoporosis. .

Its ability to help regulate blood sugar

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Although the body uses bacteria for many functions, yeast infection occurs when the natural growth of bacteria is thrown off balance. This can lead to ... UV light therapy indicates allopathic health care providers for skin diseases such as psoriasis and mood disorders like seasonal affective disorder, or SAD. Homeopathic practice act UV therapy for a variety of diseases ... Adequate intake of magnesium is necessary for the body to function properly. He participates in the maintenance function can, and it is in products such as green vegetables, beans, peas, nuts, seeds and whole, unrefined grains. There are also ... Thrush is a result of accumulation of the yeast Candida Albicans in the tissues of the mouth, which leads to white patches on the tongue and mouth tissue. The condition can be painful and may bleed spots. Stomatitis is most common for ... Prostate gland is a small walnut shape gland in men to produce seminal fluid that nourishes and carries sperm. 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So, im working again.

Thats, hard to answer, Marilyn. My hips at 3. 0 and -3. A. Ive never broken a bone in my life. When I first received my diagnosis, I certify that I began to behave as if I made of glass. I stopped working. (Before diagnosis, I ran from 5 to 6 miles per day). I stopped jumping rope. Two years later, L4 went from -1. 9 3. Is 0. I think that the work was probably protect my bone density in L4, and without it Yikes. So, Im working again. And jumping. If I break something, I stop. I do crunches, only to trouble. Im very, very careful when cleaning the house / make bed / wear shoes / even washing your face all the daily routine things I am very lasix drug dose attentive to a flat back and bend from the hip loop. How much is too much? Who knows? That is why Dr. Fishman landed on yoga, because it does not force compression from running or weight lifting. Her gentle stretching and resistance creates one set of muscles pulling against the other muscle groups. People in this study had very good results. I had great results when I held poses for a minute and when I was religious to do it every day. Then in the second year, I was lazy. I hit menopause for real. And my density has decreased. So its back to be selected warrior bones this year. .

Since the original description of all parameters

Our ability to detect emphysema has changed dramatically in the early 1980s, when CT was used to demonstrate subtle

parenchymal patterns and objective measurement of lung density in units Haunsfild (HU) (BЂ "). Widespread implementation of high-resolution scanning put into the hands of each instrument to identify anatomical >> << emphysema until any clinical manifestations. BЂњEarlyBЂ "disease, not all diseases can be detected on CT, scattered

holes in the light of less than 5 mm is difficult or impossible to detect, but CT can detect the disease earlier than might >> << be detected by airway obstruction or changes in diffusion capacity (

). Sensitive method of sample volume, called sliding thin slab, minimum (or maximum, as first described above)

intensity projection was successfully tested for detection of minimal emphysema, but was not adopted widely, probably because << Difficulty >> additional steps and his inability to find much more than emphysema thin spiral scan because

from emphysema, simulating artifacts (

BЂ "). This requires a combination of thin slices of 3 - 8 mm pipe and choosing the minimum absorption of all the pieces to form an image in the stack in

. BЂњslidingBЂ "refers to the forming plate, adding one slice on top and remove one of >> << bottom and calculated density of the image. Qualitatively, with some thin slices, narrow window inhalation scan is best for detection and characteristics >> << emphysema. Representative idea of ​​the disease can be obtained with three or four pieces of distance through the lungs. The volume

and weakening of blood vessels is well supported conclusions, but the accuracy of routine scanning is reduced if the picture

considered too dark or blurry motion. Respiratory motion makes it almost impossible to detect even moderate emphysema. The window width 800 HU and level with the center in B € '800 HU much better showing minimal emphysema than normal 1500 HU,

B € '500 HU settings. The degree of emphysema can be assessed subjectively by visual inspection. In every region of the lung, which appears

emphysematous estimated (

1) less than 25% of the area (

2) 26% to 50% region (

3) 51 % to 75% of the area, or (

4) 76% to 100% of the (,

). This four-point scale can be expanded to five levels, identifying (0) as usual. The region may be one or both lungs on

cut or dorsal and ventral parts of each lung. It was the regional distribution of emphysema, which were most useful in NETT for predicting outcome after lung volume reduction surgery >> << (LVRS), as suggested in previous reports (

). The overwhelming share of the top emphysema was found to predict a successful outcome NETT LVRS.

Typically, scanning

pieces in 20-mm intervals were considered sufficient for this determination. Emphysema distribution can be determined enough

using this subjective qualitative method, but changes such as the construction of emphysema from top to bottom, in

helped characterize the individual degree of emphysema heterogeneity (

). The severity of emphysema was rarely quantified. The scheme used two decades ago (

) on (0) no (

1) low-attenuation area less than 5 mm (

2) describes the low-attenuation area over 5 mm in addition to smaller or (

3) diffuse low attenuation without normal lung or large drainage area is very small damping. It was used to scan the entire lung

but was applied at the regional lung scan. The technology that was used to quantify emphysema many workers density mask technique that allows

light pixels in the selected range of HU (

, ). Pixels less than certain value (first B € '910 HU) can be identified, perhaps in color, and their number in comparison with the

total number of pixels in the image of lungs. Since the original description of all parameters that can be updated

relevance were the inspiration compared with the end of 1. 5 mm compared with 3 or 5 mm or 10 mm collimation and reconstruction >> << intravenous contrast medium in comparison with noncontrast and wide (1500BЂ "2000 HU) compared with a narrow (800BЂ" 1000 HU) windows version

or viewed on the console. Threshold measurement points emphysematous change from the bottom B € '900 HU below B € '960 HU on

different researchers with different thicknesses and cut algorithms reconstruction (

). This method can more accurately estimate the density of points than before. Quantitative evaluation of severity and

degree of emphysema was used to assess suitability for patients LVRS, follow the natural history of emphysema,

and look for wear reduction and treatment of N ±-1BЂ purchase lasix "antitrypsin (

). .

In the 154 men was considered a breakthrough

, Osteoporosis can be classified as primary or secondary depending on the presence or absence of known cause. Previous studies have shown that men have secondary causes are common (50%). However, most studies were conducted in one

centers interested in metabolic bone disease, and it is possible that the direction of bias may explain, in particular, >> << high prevalence of secondary causes [

-]. The aim of our lasix for congestive heart failure study was to determine the relative proportions of vertebral fractures due to primary and secondary osteoporosis >> << men in several clinical settings, including teaching and district general hospitals. We also reviewed the main >> << secondary causes of osteoporosis. Descriptive survey method was used. Installation was medical (predominantly rheumatology) clinics in nine hospital

on the north-west England. These include education [

] and district general hospitals []. Consecutive men attending these clinics with radiographically confirmed vertebral fractures were included in the study. For each patient, the doctor have in common that they consider the main cause of fracture (osteoporosis / trauma / other). Fractures due to osteoporosis were classified as either primary or secondary consequence of osteoporosis. If the fracture was

through secondary osteoporosis, the reason (s) of osteoporosis was recorded. One hundred and fifty nine people with vertebral fractures (mean age 60 years. 8 years

SO = 13. 5 years) were included in the study. In the 154 men was considered a breakthrough because of osteoporosis. In the other five >> << fracture was due to injury (two), malignant neoplasm (two) and Paget's disease (one). With 154 cases of osteoporosis, 81 (53%)

considered in connection with primary or idiopathic osteoporosis and 73 (47%) to the main secondary causes. There

no distinction in some patients with secondary causes identified in the study hospital centers (43%) and

district general hospitals (55%) (χ

= 2. << 25 >> P = 0. 13). The most frequent causes were secondary corticosteroids [34 (47%)], an excess of alcohol [10 (14%)] and hypogonadism [7

(10%)]. Eight (11%) patients had other causes, and in 14 (19%) were more than one reason. The average age

those with primary osteoporosis were similar to those of secondary osteoporosis (61 5.

Against 59. 3 years). A recent comprehensive analysis of several studies show that 58% of men leading cause of secondary osteoporosis [-]. In a later study in the UK, Evans

al. [

] Showed that 52% of group 220 people were secondary cause. In our study the frequency of secondary causes was similar >> << (47%). In addition, there was no significant difference in the relative proportions of primary and secondary causes in you

go to hospital centers and those in district general hospitals, providing some assurance that in this study

shift directions not explain the results. Our data confirm the observation in previous studies that most often

underlying secondary causes of osteoporosis excess alcohol, corticosteroids, and hypogonadism [

]. Thus, men who attend hospital clinics with osteoporosis fractures of the spine in the north-west of England, about

50% will be the main cause of secondary osteoporosis. .