By F. Angir. State University of New York at Stony Brook.
At work in Clinical & Biological linked to intracavernous penile injections instead of the Examination 1991 300mg avapro with visa;370349-354 generic 150mg avapro overnight delivery. A prospective long-term bolstering contemplate of patients evaluated in search Stroberg P buy cheap avapro 300 mg line, Murphy A order avapro 150 mg with visa, Costigan T. Int J Impot with erectile dysfunction from sildenafil citrate to Res 1995;7(2):101-110. J Sex Marital Ther effects of transurethral alprostadil considered by color 2003;29(3):207-213. Assessment of the efficacy and refuge of Viagra (sildenafil citrate) in men with erectile Tam S W, Worcel M, Wyllie M. Papaverine hydrochloride in peripheral sildenafil dose optimization and monogrammed instruction blood and the caste of penile erection. Br J Urol improves the frequency, suppleness, and outcome of sexy 1990;143(6):1135-1137. Erectile dysfunction: Etiology and treatment in young and aged Stephenson R A, Mori M, Hsieh Y C et al. Front matter results with the nitric oxide supplier linsidomine chlorhydrate in the Taylor M J, Rudkin L, Hawton K. Br J Urol managing antidepressant-induced sensuous dysfunction: 1992;148(5):1437-1440. The Album of Mens Healthfulness & sildenafil citrate treatment on serum Gender 2005;2(3):325-332. Calcitonin-gene related peptide: a realizable position in human penile erection and its Telias Isaac, Darwin Kadmon-Telias, Ana E-Mail et therapeutic appositeness in ineffective patients. Int J Impot Res Lustful functioning in testosterone-supplemented 2001;13(2):125-129. Impression of erectile dysfunction and its successive treatment with van Moorselaar R J, Hartung R, Emberton M et al. Future between put down urinary parcel symptoms and procreant comprehensive assessment of propagative banquet after retropubic dysfunction: The gen or fiction?. Curr Opin Urol non daring sparing left-winger prostatectomy into localized prostate 2005;15(1):39-44. Cover and efficacy of alprostadil and survival scrutiny of 450 helpless patients treated sterile puissance (S. The clinical effectiveness of self- injection and exotic vacuum devices in the treatment of Virag R. Intracavernous injection of papaverine in spite of erectile dysfunction: a six-month balance. Twelve-month stress-mediated vasodilation of cavernous arteries in correspondence of two treatments an eye to erectile dysfunction: self- erectile dysfunction. A risk-benefit assessment of sildenafil in Urciuoli R, CanThisani T A, CarliniI M et al. Sildenafil citrate effectively Intracavernous pharmacotherapy pro ineffectiveness: reverses animal dysfunction induced during three-dimensional selection of pinch representative and administer. Perspicuity and sustentation of erection with vardenafil: a time-from-dosing investigation. A comparative about with living effects of alprostadil therapy in favour of erectile intracavernous injection of prostaglandin E1 versus papaverine dysfunction. Intraurethral prostaglandin E-2 cream: a possible variant Webb D J, Freestone S, Allen M J et al. Urology blood-pressure-lowering drugs: results of drug interaction 1993;42(1):73-75. Intracavernous diabetes mellitus treatment and decorous glycemic control pharmacotherapy in psychogenic inadequacy. Urology on the erectile occupation in men with diabetes mellitus- 1991;37(5):441-443. The synergism of penile venous surgery and oral sildenafil in treating patients with Yaman O, Tokatli Z, Akand M et al. Recovery of libidinous function dysfunction attending the Maudsley psychosexual clinic in in men with late-onset hypogonadism treated with 1999: The influence of sildenafil. J La Form Med Soc Sanatorium Practice (Employment Number) 1988;23(7):197, 200 1998;150(1):32-34. Clout of sildenafil in patients with erectile dysfunction after radiotherapy renal transplantation on sperm value and copulation on carcinoma of the prostate. Relocate Intracavernous injections of prostaglandin E1 for Proc 2005;37(5):2100-2103. Quantity and clinical pith of dignified macroprolactin levels Zippe C D, Kedia A W, Kedia K et al. Endocr Pract dysfunction after total prostatectomy with sildenafil citrate 2006;12(3):275-280. Sildenafil citrate (Viagra) upon weakness, incontinence and grade of life after elementary retropubic prostatectomy: pro. Observation with buccal phentolamine mesylate remedial programme and apparent vacuum devices in the treatment as a service to helplessness. Erratum: Efficacy and tolerability of 19-nortestosterone maintains carnal behavior and sense in sildenafil in Indian males with erectile dysfunction: A hypogonadal men. Support throughout Thissue 2004;36(6):391 selectivity of the man-made androgen 7 alpha-methyl-19 nortestosterone in hypogonadal men. Partnership struck between Bayer and Endocrinology & Metabolism 2003;88(6):2784-2793. Articulated analgesic treatment of erectile convenient, but sick assessed in organic disorders. Counselling and increased portion of Message on Drugs & Therapeutics 2003;45(1172):101-102. Elementary study of Viagra in jet-black men demonstrates effective, well-tolerated treatment. Inhaled apomorphine auspicious in place of Letter on Drugs & Therapeutics 1997;39(997):32 erectile dysfunction treatment. Sildenafil powerful for sensual 2005;275(7360):133 dysfunction associated with partake of of antidepressants. In truth of Can Pharm J 2001;267(7173):669 sildenafil (Viagra) on cerebral blood gurgle velocity: a cicerone ruminate on. Cardiovascular disorders and erectile Hospital Technic (Charge Print run) 1996;31(8):136-137. Antidepressant-related adverse effects impacting treatment compliance: Results of a unwavering assess. Indian J Med Around Restorative Research, Clinical & Sci 1999;53(5):236 Experiential 2005;66(2):96-106. Most favourable use of Vasoactive intracavernous pharmacotherapy for impotence: prilocaine-lidocaine cream in unripe ejaculation. Vasoactive intracavernous pharmacotherapy for inefficacy: Int J Impot Res 2005;17(2):201-203.
Investigations TheX-raytypicallydemonstratesadestructivelyticbone Underlying bone tumours lesion discount avapro 150mg without prescription, although some metastases manifest sclerotic (e trusted avapro 150mg. VasculiThis Bosses Symptomatic treatments number analgesia order 300mg avapro visa, local ra- VasculiThis is an inammatory inltration of the embankment of diotherapy and chemotherapy cheap avapro 150mg otc, internal xation of any blood vessels with associated web hurt. The underlying Investigations mechanisms of the disorders are not fully settled. There may ordersuchassystemiclupuserythematosus,rheumatoid be anaemia of chronic complaint. Vasculitides may be considered according to the measure assess of Administration craft hollow (imagine Table 8. Fair to middling dispense prednisolone is acclimated to, and the cure is monitored and tailored to the feedback of inamma- Polymyalgia rheumatica tory markers. Generally treatment is required for 915 months,andprophylaxisagainstosteoporosisisessential Denition (observe bellhop 373). Aclinicalsyndromecharacterisedbypainandstiffnessin the muscles of the pelvic and thrust aside girdle associated with the circumstance of amazon cell (secular) arteriThis. Lay (giant cell) arteriThis Prevalence Denition Public, affecting up to 1 in 150. A yesteryear of polymyalgia rheumatica is present in 50% of patients with giant chamber arteriThis, 15% of patients with polymyalgia rheumatica will-power improve giant cell arteriThis. Patientspresentwithfever,severeheadache Clinical features and scalp tenderness over the inamed supercial tem- Easy onset of exertion, stiffness and perceived symmetri- poral or occipital arteries. Although comes thickened and there may be overlying erythema- fevers strike they are not as severe or strike at as seen in tous fell. Inamma- tion may cause ark wall thickening, and narrowing, occlusion or dilation of affected vessels. T cells and Macroscopy/microscopy anti-endothelial antibodies have been implicated in the Patchy inammation of the arterial stockade drive crazy interspersed pathogenesis. False areas show necrosis, shrinkage of extensible bres and Clinical features lymphocytic and special superhuman cell inltration. Afteraninitial prodromal malady patients present with dialect heft reduction, myalgia and synoviThis. On cross-examination pa- tients turn up unwell, and the blood burden may be re- Investigations duced in one or both arms. Earthly artery biopsy may be diagnostic (see rial pulses in the limbs are repeatedly asymmetrically reduced exceeding). There may be features of ar- terial insufciency with limb claudication, cool extremi- Executives ties and in severe cases ischaemic ulceration or gangrene. Corticosteroids are acclimated to at high doses to bring to a halt pro- gression to unalterable visual diminution. These should be com- Microscopy menced without hesitation the diagnosis is suspected and Intimal increase with scarring of the media and disappearance should not be delayed past the artery biopsy. There is lymphocytic inltration and may nevertheless be of diagnostic value up to 5 days after com- brosis. Conclusively the inammatory markers secure settled, the dose is drop by drop reduced during a full stop of Investigations months. Denition Achronic inammatory arteriThis of little-known aetiology Directorate affecting the aorta and its vital branches. Corticosteroids are the main of treatment, with methotrexate and azathioprine reach-me-down in refractory cases. Incidence Percutaneous angioplasty or surgical evade of pretended 13 per 1,000,000 per year. PolyarteriThis nodosa Denition Geography PolyarteriThis nodosa is a rare intense necroThising vasculi- Largest number of cases in Asia and Africa. Aetiology/pathophysiology Associated with hepatiThis B infection in 1020% be- Time eon belief of hepatiThis B crop up antigen invulnerable complexes. Veins are also fake and the condition may M = F result in thrombosis and conglomeration infarction. Clinical features Aetiology/pathophysiology PolyarteriThis nodosa is as usual an sharp-witted disease charac- It is consideration to be an autoimmune disturbance. Serumconcentrations of IgA ammatory occlusion of minor and medium-sized pe- are raised in generally half of patients and IgA- ripheral arteries and veins of the ascendancy and bring limbs. Clusters of cases from been notorious with no obvious pre- Aetiology/pathophysiology cipitant. It occurs nearly exclusively in critical cigarette smokers and is therefore seen more in countries with great levels Pathophysiology of smoking. There is segmental long-lived inammatory The quarters results from inammation within the inltration of the barque walls with resultant obliteration walls of trivial blood vessels, predominantly capillaries of the lumen and alternative thrombosis. The make ready starts with digital ischaemia, ulceration The inammation of the vessels increases permeability preceded aside claudication in the feet, or relaxation pain in the resulting in a leaking of uid and cells from the circula- ngers or toes. IgA deposition within ankle pulses are mostly retire from but brachial and popliteal the glomeruli of the kidney causes a convergent segmental pat- pulses are nowadays. There may be a preceding adventures of tern of glomerulonephriThis with a resultant proliferation supercial thrombophlebiThis. Investigations Clinical features Arteriography shows narrowing or occlusion of small This mulThisystem bedlam may crop up with coinciding external arteries with flourishing mains vessels. The rash characteristically affects the modulate The health circumstances remits with quitting smoking; nicotine limbs and tushy, but is not on all occasions conned to these replacement remedy cannot be worn but bupropion areas. Prostaglandin infusions, thrombolytic puric and then goes completely the classic colour changes group therapy, surgical sympathectomy and revascularistion of a wound, lesions of varying ages are the moment at undivided procedures suffer with been tried. Clinical features Symptoms are well-proportioned with ngers mannered more Complications than toes, it normally begins in a one digit and then Gastrointestinal complications subsume infarction and becomes more generalised. Renal failure may scheduled to vasoconstriction progressing by way of cyanosis to crop up in the acute phase, or may progress more than divers hyperaemia (white to gloomy to red). Investigations The diagnosis is clinical; erythrocyte sedimentation in any event, Investigations snow-white cubicle enumerate and eosinophils may be raised. Urine Original Raynauds exception must be honoured microscopy should be performed looking on red and fromRaynaudssyndromeoccurringwithconnectiveThis- whey-faced blood cells, casts and protein. In more sorrow and devil-may-care may be achieved with nonsteroidal anti- severe cases calcium lead blockers such as nifedipine inammatory drugs. In austere cases prostacyclin infusions may be manifestations may be improved with the timely advantage of required. Complications such as intense renal omission and intussusception should be managed promptly. Behcets syndrome Prognosis Denition Inmostcasestheoverallprognosisisexcellent,thecourse Achronic,relapsingmulThisystemvasculiThischaracterised is variable with cases undying between a not many days and a at near voiced ulceration. Infrequently it may remain on account of up to a year and there may be a course of relapse and excuse. Denition An exaggerated vascular comeback to gelid, causing a Shagging burst of the arteries supplying the ngers and toes. M > F Frequency Geography Five to ten per cent of young women in self-denying cli- Much more plain in Turkey, Iran, China, Korea and mates. Patients evidence pathergy (a gered autoimmune reaction in a genetically susceptible papule or pustule forms at sites of strip puncturing) this idiosyncratic.
Preoperative symptoms of irritable bowel syndrome predict poor as a church-mouse outcome after laparoscopic cholecystectomy order 150 mg avapro fast delivery. Randomized controlled hassle comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy generic avapro 300 mg with visa. Laparoscopic intraoperative biliary ultrasonography: findings during laparoscopic cholecystectomy in search acute virus order avapro 300 mg with amex. A 24-year controlled support of patients with silent gallstones showed no long-term danger of symptoms or adverse events outstanding to cholecystectomy buy avapro 300mg amex. The causes and outcome of acute pancreatiThis associated with serum lipase > 10,00 U/L. The causes and outcome of acute pancreatiThis associated with serum lipase >10, et al. Pilot endoscopic necrosectomy an eye to the treatment of walled-off pancreatic necrosis: results from a multicenter U. A Conservative and Minimally Invasive Sound out to Necrotizing PancreatiThis Improves Outcome. Safety and efficacy of video-assisted retroperitoneal debridement recompense infected pancreatic collections: a multicenter, forthcoming, single-arm moment 2 study. A centralized mass-forming autoimmune pancreatiThis mimicking pancreatic cancer with hindering of the dominant pancreatic duct. Magazine Collapse and Infection of Pancreatic Necrosis as Determinants of Mortality in Patients With Acute PancreatiThis. A conservative and minimally invasive sound out to necrotizing pancreatiThis improves outcome. Asymptomatic Pancreatic Cystic Neoplasms: Maximizing Survival and Grade of Living Using Markov-Based Clinical Nomograms. Bestowal and outcome of pancreaticoduodenal endocrine tumors in multiple endocrine neoplasia breed 1 syndrome. In Vivo Molecular Imaging of Somatostatin Receptors in Pancreatic Islet Cells and Neuroendocrine Tumors alongside Miniaturized Confocal Laser-Scanning Fluorescence Microscopy. Continuous room gear up from a Sox9-expressing antecedent province in adult liver, exocrine pancreas and intestine. Cyst swelling rate predicts malignancy in patients with limb duct intraductal papillary mucinous neoplasms. Occurrence of and imperil factors as regards developing pancreatic cancer in patients with persistent pancreatiThis. Cold predictive value of positron emission tomography/computed tomography in patients with a clinical cautiousness of pancreatic cancer. Beta-catenin blocks Kras-dependent reprogramming of acini into pancreatic cancer see predecessor lesions in mice. Diagnostic transgastric endoscopic peritoneoscopy: volume of the introductory considerate trial against staging of pancreatic nut masses. Long-term support of patients with incidentally discovered pancreatic cystic neoplasms evaluated by endoscopic ultrasound. Minimal access retroperitoneal pancreatic necrosectomy: repair in morbidity and mortality with a less invasive come near. Cyst greatness indicates malign alteration in department duct intraductal papillary mucinous neoplasm of the pancreas without mural nodules. Asymptomatic pancreatic cystic neoplasms: maximizing survival and je sais quoi of life using Markov-based clinical nomograms. Endoscopic Pancreatic Duct Stents Rub the Quantity of PostEndoscopic Retrograde Cholangiopancreatography PancreatiThis in High-Risk Patients. Short 5Fr vs covet 3Fr pancreatic stents in patients at endanger for post-endoscopic retrograde cholangiopancreatography pancreatiThis. Endoscopic papillary beamy balloon dilation alone without sphincterotomy for the treatment of weighty garden-variety bile duct stones. Unmanageable biliary cannulation: advantage of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the worth of precut sphincterotomy (with video). Interobserver agreement looking for pancreatic endoscopic ultrasonography dogged nearby exact same light of day back-to-back examinations. Angiographic intervention in patients with a suspected visceral artery pseudoaneurysm complicating pancreatiThis and pancreatic surgery. Endoscopic retrograde cholangiopancreatography associated pancreatiThis: A 15-year re-examine. Endoscopic pancreatic duct stents up the amount of post-endoscopic retrograde cholangiopancreatography pancreatiThis in high-risk patients. Nafamostat mesilate on prevention of post-endoscopic retrograde cholangiopancreatography pancreatiThis: a incipient, randomized, double-blind, controlled effort. Prophylactic 5-Fr pancreatic duct stents are superior to 3-Fr stents: a randomized controlled grief. Pancreas divisum as a predisposing financier for persistent and incessant idiopathic pancreatiThis: approve in vivo size up. Nutritional assessment: a contrast of clinical intelligence and hope measurements. Natural orifice translumenal endoscopic surgery: development in humans since pasty paper. Shaffer 755 Index Note: Call out numbers followed by f or t assume the guise figures and tables each to each. Shaffer 758 superintendence of, 609610 Alcoholism, as malnutrition cause, 16 Alimentation. Envision Neuroendocrine tumours Carcinoma of esophagus, 76 of gallbladder, 576 of pancreas. Show also definitive disorders Original Principles of Gastroenterology and Hepatology A. Shaffer 791 vitamin and mineral deficiencies caused at hand, 202, 204t Malassimilation syndromes. See under Pancreas somatostatin-producing, 621 vasoactive intestinal peptide-secreting, 621 U Ulcer/Ulceration defined, 105 duodenal. The out of pocket salutary progress in the eld of to broaden unripe pathophysiology-oriented therapies. Variations in genes that encode antioxidant enzymes, ranging from simple fatty liver to more unbending forms of cytokines and other inammatory mediators, and alco- hol-metabolizing enzymes could have planned a role. Interestingly, obesity-associated fatty liver or levels of liver enzymes in mice fed a high-fat nutriment. Apoptosis toyltransferase 1; each has an noted role in the devel- results from multiple mechanisms, including ethanol-me- opment of barfly fatty liver. Moonshine consump- these genes also contributes to the pathogenesis of alco- tion not exclusive causes enteric dysbiosis and bacterial over- holic fatty liver. No matter how, the underlying mechanisms growth64 but also increases gut permeability and the be left to be determined. Booze consumption up-regulates a make of factors that get Kupffer cells, stellate cells, and hepatocytes, resulting in the manufacture of cytokines and chemokines. Studies from other liver impairment models in hepatocytes or biliary epithelial cells.
However open-handed lesions or those on cosmetically portentous sites require treatment either 0 Locally - aside surgery discount avapro 300mg, curettage discount avapro 150 mg without prescription, cryotherapy or hyperthermia (40-42 c) or Systemic remedy: with drugs like Pentostam buy avapro 150 mg without prescription. Treatment is less well-fixed than visceral leishmaniasis as antimonials are under the weather concentrated in the incrustation L buy 150mg avapro fast delivery. Bolivia, Uruguay and Northern Argentina) In the original juncture it affects the peel, but in unoriginal status of the plague it involves the upper respiratory mucosa. This leads to nasal restriction, ulceration, septal perforations and destruction of the nasal cartilage called Espundia. Death usually occurs from non-essential bacterial infection 62 Internal Panacea References: th 1. Tuberculosis Lore Objective: At the put paid to of this portion the swotter resolve be able to 1. Read the diverse treatment categories of Tuberculosis be accomplished to organize any breed of Tuberculosis 11. Refer elaborate cases of Tuberculosis diseases to hospitals for raise handling 14. Lay out appropriate methods of proscription and subdue of Tuberculosis Description: Tuberculosis is a Continuing necrotizing virus caused by means of Mycobacterium tuberculosis complex. The valuation of clinical virus is highest during late adolescence and initial adulthood, but the reasons are not free. Activated alveolar macrophages ingest the bacilli; after which they manumission chemicals to activate other exempt system components and turn to check the infection or multiplication of bacilli. These activated cells aggregate everywhere the lesion and the center becomes necrotic, soft cheese like physical called caseous necrosis. But if the bacteria private the macrophage multiply fast, they will denouement the macrophage and are released but to be captivated up 66 Internal Medicine by other macrophages again. Clinical Manifestations Pulmonary Tuberculosis: - This can be classified as primary or send primary (Unessential). Primary disability: Clinical infirmity as the crow flies after infection is called primordial tuberculosis; this is general in children <4 years of maturity. Register primary condition: -If no clinical cancer is developed after the primary infection, slumberous bacilli may persist for the benefit of years or decades in the past being reactivated, when this happens, it is called alternative (or post leading) tuberculosis. Most patients have in the offing cough, which may be biting at first, but later becomes productive of whiThish sputum; it is many times blood streaked. Chest x-ray findings are non-specific; infiltrations, consolidation or cavitory lesions may be present. Pleural tuberculosis:- Pleural involvement may be asymptomatic or patients could be subjected to fever, pleuritic trunk pest and dyspnea. Patients may present with tumour and sorrow on the backtrack from with or without paraparesis or paraplegia due to rope compression. Patients present with liberal combined lump, chiefly with pain and limitation of movement. Gastro Intestinal Tuberculosis:- Tuberculosis can attack anywhere from the debouch to the anus. Patients chiefly mete out with abdominal bump and hurt, onus squandering, fever and dusk sweating. Milliary tuberculosis:- This is second-line to hematogenous dissemination of the bacilli. Patients who have suggestive symptoms and signs after tuberculosis should endure moreover tests. If all 3 sputum smears are dissentious and the self-possessed has suggestive clinical and chest x-ray findings, before the patient should be treated with broad spectrum antibiotics to convention out other bacterial causes. At any rate the bacillus is slowly multiplying and it takes diverse weeks to spread the bacilli in a discernment media. Although any radiographic discovery is feasible, typically there see fit be nodular infiltrates and cavities in the four hundred advantage lobe; pleural effusion is also undistinguished. This coterie includes cases without smear culminate, which should be gifted in adults but are relatively more persistent in children. A patient who returns to treatment, useful bacteriologically, following gap of treatment quest of 2 months or more. This group includes Chronic example in any event, a constant who is sputum-positive at the aspiration of a re-treatment 4. Involvement of an anatomical locality results in classification as keen disease if there is a meaningful wise foreboding to vitality (e. This categorization helps in prioritizing patients and in selecting the sort regime to be second-hand in a steadfast. This is to taper off the bacterial encumbrance and make the unfaltering non-infectious quickly. During the continuation facet, the drugs be required to be composed every month and self-administered on the patient. If sputum is negative at the death of 8 weeks, the continuation occasion can be started. The reasons being rectal mucosa is scraggy and tenuous and there are susceptible cells ( Langerhans cells ) in the rectal mucosa Vaginal sex is also an noticeable from of transmission. Currently the jeopardize is darned minimal as blood and blood products are screened carefully using antibody and p24 antigen testing to identify donors in the widow patch. There may be a jeopardize of transporting from one tolerant to another or from an infected passive to health grief provider 3. They mostly unify the Stall mediated immune combination and also with the antibody mediated untouched system. Viral replication is non-stop in all stages (inopportune infection, during the big space of clinical latency, and in advanced trump up. Account for 15 % of all patients Normal Progressors: After the initial basic infection patients persist fettle for 6- 8 years in preference to they start having evident clinical manifestations: account in the service of 80 % of all patients Desire footing survivors: Patients who abide alive looking for 10-15 years after opening infection. In most the diseases might get progressed and there may be evidences of immunodeficiency. Asymptomatic tier Clinical latency In most ( 90 ) of patients, fundamental infection with or without the critical syndrome is followed nearby a prolonged spell of clinical latency 91 Internal Medicine The completely of interval from initial infection to the circumstance of clinical ailment varies greatly (median is 7-10 years. Enunciated thrush: o Appears as a ghastly, cheesy exudates, often on an erythematous mucosa (most commonly seen on the squashable palate) which gives an erythematous or bleeding crop up on scraping o When it involves the esophagus, patients bitch of jam and/or pain on swallowing o Is needed to Candida infection o Confirmatory diagnosis is on direct exploration of a scraping on pseudohyphal elements o Treatment - Try out 0. Oral dangerous leukoplakia: o Appears as a filamentous white lesion, generally along the lateral borders of the idiom. Dyspnea and fever are key symptoms Cough with scanty sputum in > 2/3 of cases Signs: Findings on solid examination are minimal, and the regular findings for pneumonia may not be acclaimed. Respiratory distress Cyanosis Little abnormality on casket quiz rhonchi or wheeze may be heard, conspicuously in patients with some other underlying pulmonary complaint, findings of consolidation are as per usual missing.
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