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A detailed history and physical examination will often help to identify the cause of the obstruction generic indocin 75mg otc arthritis healthy diet. History of previous instrumentation of the urinary tract effective 75 mg indocin arthritis eyes, trauma, neurologic disease, prostatectomy, urologic malignancy, or chronic systemic illness may aid in the proper diagnosis and treatment. Evaluation of med- ications taken may help in identifying pharmacologic agents that may contribute to urinary retention (Table 23–3). On physical examination, a palpable mass above the symphysis pubis that disap- pears after insertion of a urethral catheter is highly suggestive of a distended bladder (acute urinary retention). Digital rectal examination may reveal prostatic nodules, asymmetry, tenderness, bogginess, or the typical stony hard enlargement of prostate cancer. A benign prostate on examination does not elimi- nate it as a cause of obstruction. Testing rectal sphincter tone, perianal sensation, and the bulbocavernosus reflex can be important in cases of suspected neurogenic bladder. In females, a pelvic examination should be performed to rule out inflamma- tion, lesions, or an adenexal mass. Patient may also present febrile, tachypneic, or hypotensive suggesting an infection or sepsis. A urinalysis is helpful to rule out concomitant infec- tion, which would require antibiotics. Management Any patient with acute urinary retention requires relief of the obstruction as soon as possible in order to prevent progressive renal dysfunction. Lidocaine gel should be inserted into the urethra to anesthetize and lubricate the urethra before inserting a 16- or 18-F Foley catheter. A urethral catheter should never be forced because urethral trauma and false passages may be created. If consultation is not available, a suprapubic catheter may be placed or percutaneous bladder aspiration can be performed. After successful bladder drainage, complications may occur, including transient hematuria, hypotension, and postobstructive diuresis. Postobstructive diuresis can cause electrolyte abnormalities, profound fluid loss, and hypotension. Patients with this condition require monitoring of their urine output and fluid replacement. Risk factors for postobstructive diuresis include chronic bladder obstruction, fluid over- load, and chronic renal disease. Admission should be considered for patients with renal dysfunction, a serious infection, or volume overload and for those who are unable to care for themselves. She is afebrile with a blood pressure of 130/64 mm Hg, pulse of 74 beats per minute, and respiratory rate of 20 breaths per minute. She reports a history of increased fatigue with exertion and intermittent paresthesias but denies any history of diabetes, hypertension, or recurrent urinary infections. One year ago, she had some difficulty with double vision that had resolved spontaneously. This patient needs to be hospitalized because of a concomitant urinary tract infection and renal dysfunction. Decompression of the bladder with a urethral catheter should be performed before examination of the prostate. Percutaneous bladder aspiration is not indicated unless other attempts to decompress the bladder have failed. This is likely caused by herpes simplex virus with associated urethral irrita- tion and urinary retention. Bladder decompression should be performed as quickly as possible to prevent further damage to the urinary system. Consultation with a urologist may be necessary if urethral catheterization cannot be accomplished with a Foley or coudé catheter.

Infusion (1:40) — 1 wineglassful cheap indocin 25 mg without prescription arthritis pain onset, 3 times daily (corresponds Characteristics: The herb has a weak 75mg indocin with amex arthritis pain prevention, unusual smell to approximately 2 g drug per single dose) reminiscent of a cattle pen. Indian J Physiol Pharmacol, 32:299-304, Production: Java Tea consists of the dried leaf and stem tips 1988 Oct-Dec. The leaves are then dried in a well-ventilated Handbuch der Pharmazeutischen Praxis, 5. Wenzl H, Graf E, Nardostachys caryophyllene, alpha-humulene, caryophyllene-epoxide jatamansi: a chemical, pharmacological and clinical appraisal. Flavonoids: in particular more highly methoxylized exam- Spec Rep Ser Indian Counc Med Res, 28:1-117, 1978. See Colombo Diterpene ester: orthosiphole A to E, (diterpene dibenzoyl diacetyl ester of primarane type) Triterpene saponins: (up to 4. The calyx tube is short • Infections of the urinary tract with an upright-curved upper lip. The corolla tube is about 2 cm long with a broad upper lip that has 3 indentations. The lower lip is narrow and Unproven Uses: In folk medicine, it is used for the above ovate-lanceolate. One variety Mode of Administration: Comminuted herb for infusions and has white seeds. Leaves, Stem and Root: This deciduous climbing plant with How Supplied: Forms of commercial pharmaceutical prepa- compound leaves grows to about 4 m. Drops Habitat: The plant originated in India and is found today in all tropical regions of the world. Indian Medicine: Jequirity is used for coughs as well as Hiller K, Pharmazeutische Bewertung ausgewahlter Teedrogen. Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, Chinese Medicine: The drug is used in hepatitis and Nachdruck, Georg Olms Verlag Hildesheim 1979. The drug is very poisonous because it contains the toxic lectin abrine and isolectins. Teuber R, Neue Naturstoffe aus Orthosiphon stamineus Besides gastrointestinal emptying, counter-measures include, Bentham. Kormann K, Giftpflanzen, Pflanzengifte - with the proper administration of designated therapeutic Vorkommen, Wirkung. Biogene Gifte - Biologie, Chemie, Mode of Administration: Administered as the ground drug Pharmakologie, 2. Datura stramonium Flower and Fruit: The axillary flowers are orange-yellow with large reddish-brown spots. The fruit is an oblong capsule which, when ripe, bursts open Occasionally the fruit, the ripe seeds and the fresh, aerial at the slightest touch and spreads the seeds over large parts of the plant are used. Leaves, Stem and Root: The plant is a glabrous, fleshy Flower and Fruit: The flowers are large, white, solitary, annual 20 to 180 cm high. Habitat: Impatiens is common in the temperate regions and The numerous seeds are 3. Leaves, Stem and Root: The plant is an annual and grows to Production: Jewel Weed is the aerial part of Impatiens 1. The leaves are 20 cm long, long-petioled, ovate, dentate, glabrous and dark green. Homeopathic Uses: Used for infection with high tempera- Production: Jimson Weed leaf consists of the dried leaf, or tures, cramps and inflammations of the eyes. Chinese Medicine: Used in Chinese medicine for general Jimson Weed seed consists of the ripe seed of Datura states of pain. Accommodation disorders, heat build-up Indole alkaloids ($-carboline type): including, among others, through decline in sweat secretion, miction disorders and fluorodaturin (very fluorescent). Lectins Lethal dosages (for adults starting at 100 mg atropine, Fatty oil (15-45%) depending upon atropine content, 15 to 100 g of the leaf Proteins (12-25%) drug, 15 to 25 g of the seed drug, considerably less for children) carry with them the danger of asphyxiation. The effect is anticholiner- oxygen respiration for respiratory distress, intubation, paren- gic and parasympatholytic (see Belladonna); the scopola- teral physostigmine salts as antidote, diazepam for spasms mine fraction is more responsible for this effect.

Cough generic 25mg indocin with amex arthritis in the knee at 40, causing a sensation of soreness in the chest cheap indocin 25 mg overnight delivery tricompartmental arthritis definition, or at times stitches in the side of the chest or the abdomen. Often a slightly constrictive pain in the chest, which, when it does not quickly pass, causes the deepest dejection. Violent stitches in the side; with great heat of the body, it is almost impossible to breathe, on account of stitches in the chest with haemoptysis and headache; he is confined to his bed. Night-mare; he usually suddenly awakes at night from a frightful dream, but cannot move, nor call, nor speak, and when he endeavors to move, he suffers intolerable pains, as if he were being torn to pieces. Attacks of suffocation especially after midnight; the patient has to sit up, sometimes he has to leave his bed, stand stooping forward, leaning on his hands; he has to open the windows, or go out into the open air, etc. Dwindling of the breasts, or excessive enlargement of the same, with retroceding nipples. A hard, enlarging and indurating gland with lancinating pains in one of the mammae. In the small of the back, in the back and in the nape of the neck, drawing (tearing), tensive pains. Lancinating, cutting, painful stiffness of the nape of the neck; of the small of the back. In the limbs, drawing (tearing), tensive pains, partly in the muscles and partly in the joints (rheumatism). In the periosteum, here and there, especially in the periosteum of the long bones, pressive and pressive-drawing pains. After every attack, and when the inflammation is past, the joints of the hand are painful, as also those of the knee, the foot, those of the big toe when moved, when he stands up, etc. Such a tension or stretching of the muscles often then occasions long confinement to the bed, swoons, all grades of hysterical troubles,4 fever, haemoptysis, etc. Softening of the bones, curvature of the spine (deformity, hunchback), curvature of the long bones of the thighs and legs (morbus anglicus, rickets). Painful sensitiveness of the skin, the muscles and of the periosteum on a moderate pressure. It is usually woman (called a stroking woman) who makes with the tips of her thumbs passes over the shoulder blades toward the shoulders or along the spine, sometimes also from the pit of the stomach along below the ribs, only they usually exert too strong a. A crawling, or whirling, or an internally itching restlessness, especially in the lower limbs (in the evening in bed or early on awaking); they must be brought into another position every moment. Burning pains in various parts (frequently without any change in the usual external bodily temperature). Coldness, repeated or constant of the whole body, or of the one side of the body; so also of single parts, cold hands, cold feet which frequently will not get warm in bed. Frequent flushes of heat, especially in the face, more frequently with redness than without; sudden, violent sensation of heat during rest, or in slight motion, sometimes even from speaking, with or without perspiration breaking out. Warm air in the room or at church is exceedingly repugnant to her, makes her restless, causes her to move about (at times with a pressure in the head, over the eyes, not infrequently alleviated by epistaxis). Often burning, jerking, lancinating, but often also indescribable, are these pains which communicate a similar intolerable excessive sensitiveness to the mind. These pains thus affect chiefly the upper parts of the body, or the face (tic douloureux), or the skin of the neck, etc. Varices, varicose veins in the lower limbs (varices on the pudenda), also on the arms (even with men), often with tearing pains in them (during storms), or with itching in the varices. Chilblains (even when it is not winter) on the toes and fingers, itching, burning and lancinating pains. Boils (furuncles), returning from time to time, especially on the nates, the thighs, the upper arms and the body. Ulcers on the thighs, especially, also upon the ankles and above them and on the lower part of the calves, with itching, gnawing, tickling around the borders, and a gnawing pain as from salt on the base of the ulcer itself; the parts surrounding are of brown and bluish color, with varices near the ulcers, which, during storms and rains, often cause tearing pains, especially at night, often accompanied with erysipelas after vexation or fright, or attended with cramps in the calves. Tumefaction and suppuration of the humerus, the femur, the patella, also of the bones of the fingers and toes (spina ventosa). Eruptions, either arising from time to time and passing away again; some voluptuously itching pustules, especially on the fingers or other parts, which, after scratching, burn and have the greatest similarity to the original itch-eruption; or nettle- rash, like stings and water-blisters, mostly with burning pain; or pimples without pain in the face, the chest, the back, the arms and the thighs; or herpes in fine miliary grains, closely pressed together into round, larger or smaller spots of mostly reddish color, sometimes dry, sometimes moist, with itching, similar to the eruption of itch and with burning after rubbing them. They continually extend further to the circumference with redness, while the middle seems to become free from the eruption and covered with smooth, shining skin (herpes circinatus).