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A 30-Year-Old Man Presented with a 15-Month History of Intermittent Discomfort in the Right Upper Quadrant of the Abdomen

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A 30-Year-Old Man Presented with a 15-Month History of Intermittent Discomfort in the Right Upper Quadrant of the Abdomen A 30-year-old man presented with a 15-month history of intermittent discomfort in the right upper quadrant of the abdomen. He lived in a rural area of Morocco and had occasional contact with dogs. The physical examination revealed hepatomegaly with a palpable hepatic mass. Laboratory tests showed a normal white- cell count and a normal absolute eosinophil count. Ultrasonography and computed tomography of the abdomen revealed a large cyst in the right lobe of the liver. What is the diagnosis? Primary Hepatic Carcinoma Autoimmune Hepatitis Primary Biliary Cholangitis Amebiasis Cystic Echinococcosis The correct answer is cystic echinococcosis. Dogs are the definitive host for the Echinococcus granulosus tapeworm. The infection is transmitted when eggs shed in their stool are ingested by humans or other animals. Die Amöbenruhr (Amöbiasis) ist eine Infektion des Darmes mit dem 1883 von Stephanos Kartulis entdeckten Erreger Entamoeba histolytica. Sie wird von einer Amöbe (Wechseltierchen) der Art Entamoeba histolytica verursacht. Die Krankheitserreger leben im Nahrungsbrei des menschlichen Dickdarms und vermehren sich ungeschlechtlich durch Zellteilung. Als sehr widerstandsfähige Dauerformen kann der Erreger Zysten bilden und in dieser Form im Dickdarm verbleiben – unter Umständen jahrelang ohne jegliche KrankheitsanZeichen Zu verursachen – und wird auch mit dem Stuhl ausgeschieden („Minutaform“). Der InfiZierte ist also gleichZeitig Überträger. Die ausgeschiedene Dauerform kann in der Außenwelt monatelang infektiös bleiben. Aus noch unbekannten Gründen können sich diese Erreger verändern, man kann dann eine veränderte DNA und ein verändertes EnZymmuster beobachten. Durch verschiedene Pathogenitätsfaktoren der „Magnaform“ (pathogene Form abZugrenZen von der Minutaform, die nicht zum Bild der Amöbenruhr führt), Amobaphore, porenbildende EnZyme sowie Zysteinproteasen, die die extraZelluläre Matrix des Colons ZersetZen, kommt es Zu sogenannten geschwulstartigen Amöbom. Dies führt Zum Vollbild der Amöbenruhr. AmöbenleberabsZeß Typisch für den AmöbenleberabsZeß sind akut auftretende, Zunächst dumpfe, dann heftige SchmerZen im rechten Oberbauch und Fieber. Es handelt sich um ein akutes, bedrohliches Krankheitsbild mit Abgeschlagenheit und schwerem Krankheitsgefühl, seltener entwickelt sich die Symptomatik schleichend. Die Schmerzen im rechten Oberbauch können in den Rücken und Zur rechten Schulter und Skapula ausstrahlen, die SchmerZen sind manchmal atemabhängig. In anderen Fällen können Bauchschmerzen mit Abwehrspannung vorhanden sein, gelegentlich kann der AmöbenleberabsZeß als akutes Abdomen imponieren. Als Echinokokkose beZeichnet man in der Human- und VeterinärmediZin verschiedene durch die Infektion mit einem Bandwurm der Gattung Echinococcus hervorgerufene Erkrankungen. Im Hauptwirt, verschiedenen Raubtieren, leben die Erreger als Darmparasiten, wobei sie dem Tier selbst nur geringfügig schaden, so dass es Zu einer hohen Wurmlast kommen kann. Im Zwischenwirt kommt es zur Bildung von Hydatiden durch das Finnenstadium, die das Tier stark schwächen, so dass es bald erbeutet wird oder der Infektion erliegt. Echinokokken sind in verschiedenen Arten weltweit verbreitet. Echinokokkose beZeichnet folgende Erkrankungen: Die Übertragung des Hundebandwurms erfolgt meist per Kontaktinfektion bzw. Schmierinfektion vom Hundekot, dem Fell oder der SchnauZe über die danach kontaminierten (mit Erregeranhaftungen versehenen) Hände mit dem Mund. Auch indirekte Ansteckungen sind möglich, Zum Beispiel durch Nahrungsmittel oder Trinkwasser, die mit Echinococcus-Eiern verunreinigt sind. Die Erkrankung kann hauptsächlich mit bildgebenden Verfahren wie Sonographie, Röntgen, und Computertomographie (CT) sowie Magnetresonanztomographie (MRT) nachgewiesen werden, die mit serologischen Methoden (IFT, PHA) kombiniert werden sollten. Eine serologische Unterscheidung von E. granulosus und E. multilocularis (Fuchsbandwurm) ist mittels ELISA möglich. ZusätZlich sind Kreuzreaktionen auch mit anderen Bandwürmern zur eindeutigen Erregerbestimmung möglich und angezeigt. Multiple hydatid cysts in the liver are a very rare occurrence in childhood. We present a similar case in a nine-year-old girl, a resident in a rural community, who presented with two hydatid cysts in her liver. The cysts were operated upon by a pediatric surgeon. The laboratory findings of this patient showed peripheral blood eosinophilia, elevated white blood cells, and liver enzymes. The serology was positive. The ultrasonography showed cystic masses in the liver, and the diagnosis of hydatid cysts was eventually confirmed by computed tomography (CT) of the abdomen. In the early ‘90s, the American Pain Society opined that there was a national epidemic of untreated pain in our nation’s hospitals and announced that pain should be classified as the fifth vital sign. This assertion is riddled with many problems. Vital signs are clinical measurements, specifically: pulse rate, temperature, respiration rate and blood pressure, that all indicate the state of a patient's essential body functions. These clinical measures are very objective in character and include an assortment of relevant numerical values. Pain is a subjective feeling that is impossible to accurately and consistently quantify across patient populations. Therefore, in order for providers to assess pain as a vital sign, they must ascribe a numerical value for it, such as zero to ten based on the Universal Numeric Pain Scale. As a result of equating pain as a vital sign, medical practitioners must come up with a reliable and effective treatment if and when a patient subjectively rates their pain high on the scale. In 1998, the Federation of American Medical Boards issued a policy reassuring physicians that “in the course of treatment,” large doses of opioids were acceptable. In 2001, the Joint Commission mandated that hospitals across the country assess pain on each patient they treat. Oxycodon (auch Dihydroxycodeinon) ist ein stark wirkendes Opioid der Stufe III im WHO-Stufenschema (KlassifiZierung der Schmerztherapie), das als SchmerZmittel bei starken bis sehr starken SchmerZen angewendet wird. Unter dem neuen Markennamen Oxygesic wurde es 2003 vom Hersteller Mundipharma wieder auf den deutschen Markt gebracht. Seit 2007 ist es als Generikum erhältlich. Oxycodon wurde 1916 von Martin Freund (1863–1920) und Edmund Speyer (1878–1942) an der Universität Frankfurt/Main entwickelt und ein Jahr später von Merck in Darmstadt unter dem Namen Eukodal als schmerZ- und hustenstillendes Mittel auf den Markt gebracht. Seit 1919 wurde es als Analgetikum therapeutisch genutzt. Eukodal war bis 1990 in Deutschland im Handel und wurde wegen des sehr hohen Sucht- und Missbrauchspotentials vom Markt genommen. Die ersten Fälle von Oxycodon-Missbrauch, der in Analogie Zum Morphinismus Eukodalismus genannt wird, wurden Zu Beginn der 1920er Jahre geschildert. Der US-amerikanische Pharmakonzern Purdue Pharma, wurde im Jahr 2007 Zu 634,5 Mio. US-Dollar Strafe verurteilt, weil er in der Packungsbeilage nicht Bekannter Eukodal (iv.) Patient ausreichend gekennzeichnet hatte, dass Oxycodon wie andere Opioide ein hohes Abhängigkeitspotenzial besitZt. Buprenorphin ist ein stark wirksames SchmerZmittel (Analgetikum) aus der Gruppe der Opioide, das Zur Behandlung ausgeprägter SchmerZen eingesetZt wird. Es gilt im höheren Alter aufgrund seines guten Sicherheitsprofils als Mittel der ersten Wahl Zur Behandlung starker chronischer SchmerZen. Darüber hinaus wird Buprenorphin hochdosiert seit circa Mitte der 1990er Jahre als Substitutionsmittel in der Therapie einer Abhängigkeit von Opioiden verwendet, 2006 wurde es für diese Anwendung in die Liste der unentbehrlichen ArZneimittel der Weltgesundheitsorganisation aufgenommen. Methadon ist ein vollsynthetisch hergestelltes Opioid mit starker schmerzstillender Wirksamkeit. Methadon ist reiner Agonist am μ-Opioid-ReZeptor. Es hat als Heroin- ErsatZstoff im Rahmen von Substitutionsprogrammen seine Wirksamkeit bewiesen[5] und wurde deshalb 2005 von der Weltgesundheitsorganisation (WHO) in die Liste der unentbehrlichen ArZneimittel der Weltgesundheitsorganisation aufgenommen. Die später Methadon benannte SubstanZ wurde 1937 von Max Bockmühl und Gustav Ehrhart, zwei Mitarbeitern der zum I.G. Farben-KonZern gehörenden Hoechster Farbwerke, mit der Synthesenummer VA 10820 entwickelt und 1938 Zum Patent angemeldet. Seit den 1960er Jahren wird Methadon (Zuerst in den USA) als Substitutionsmittel bei Heroinabhängigkeit eingesetZt, wobei in den ersten Jahren ausschließlich mit sehr hohen Dosen in hochstrukturierten Programmen mit dem Ziel einer Dauersubstitution gearbeitet wurde. Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities Despite widespread awareness of the opioid-overdose crisis, the epidemic continues to worsen. In 2016, there were 42,249 opioid-overdose deaths in the United States, a 28% increase from the previous year. According to the National Center for Health Statistics, life expectancy in the United States dropped in 2016 for the second consecutive year, partly because of an increase in deaths from unintentional injuries, including overdoses. It was the first 2-year decline since the 1960s. How can we be making so little progress? We believe there’s a realistic, scalable solution for reaching the millions of Americans with opioid use disorder: mobilizing the primary care physician (PCP) workforce to offer office-based addiction treatment with Each point represents the percentage change in buprenorphine,
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