Radiograph of a lower left first molar with a very large distal decay (seen as an area of lost enamel and darkened dentin) that has reached (exposed) the pulp purchase cialis sublingual toronto impotence kidney disease. There is also mesial decay on this tooth that does not appear to have reached the pulp cheap 20mg cialis sublingual overnight delivery erectile dysfunction doctor in mumbai. Sometimes, however, signs (what is seen), symptoms (what the patient feels), and diagnostic tests may indicate 2. Irreversible pulpitis (inflammation of the pulp that When these signs, symptoms, and diagnostic test results cannot be healed) is a condition of the pulp tissue indicate a pulp is not likely to respond well by placing where the pulp will not heal and root canal treatment is just a filling (dental restoration of amalgam or compos- indicated. Teeth with irreversible pulpitis are unusually ite), the pulp tissue must be removed and a root canal sensitive to cold or hot, and sometimes either stimulus filling placed (endodontic therapy must be performed). The implications of dental anatomy on restorative den- The patient may also experience spontaneous pain in tistry are discussed in more detail in Chapter 10. The proximity of caries to the pulp can often be evaluated best using dental radio- 1. As the caries approaches the pulp, Endodontics is a specialty branch of dentistry con- a normal defense reaction will occur involving inflam- cerned with the morphology, physiology, and pathol- mation and eventually the formation of additional den- ogy of human dental pulp and periapical tissues. However, when the caries study and practice encompass the related basic and reaches or exposes the pulp, bacteria can overwhelm clinical sciences, including biology of the normal pulp; the defenses, and the tooth usually becomes painful. Access to and removal of affected pulp tissue pathologic conditions that occur around the root. The pulp tissue can- An endodontist is a dentist who specializes in endo- not be successfully treated with medications alone once dontics (root canal therapy). When the disease process in the Chapter 8 | Application of Root and Pulp Morphology Related to Endodontic Therapy 241 crown has overwhelmed the pulp, the pulp tissue in the pain. Once the bacteria and prod- infection will usually provide relief within two to three ucts of pulpal breakdown contained within the root days. A chronic inflammatory response in the bone tooth crown to a gray or brownish color, which indi- can lead to the formation of a granuloma (i. Since a granuloma is less dense than bone, canal, the discoloration can be greatly reduced by using a radiograph will usually reveal radiolucency (a peria- an intracoronal bleaching technique where the bleach pical radiolucency is the dark area at end of the root; is placed within the pulp chamber for a period of time. In some cases, the granuloma undergoes See the change of tooth color in Figure 8-16. When the bacteria from infection, and preserve the tooth so that it may function the root canal overwhelm the defenses of the periapical normally during mastication. A granuloma or cyst has developed in the bone, prob- Color as an indicator of pulpal pathology. Discolored tooth with pulp tissue damaged (tooth is devital) was removed and restored with a large amalgam filling (seen as after tooth trauma (such as being hit in the mouth with a base- a white outline) that covers the distal and occlusal surfaces of ball). Radiograph of a lower left first molar where endodontic files have been placed within the root canals approaching the cementodentinal junction apically. Finding the pulp may be difficult in older teeth, or Further, endodontic therapy is less expensive than hav- teeth that have large or deep restorations, since the for- ing a tooth extracted and subsequently replaced with a mation of secondary or reparative dentin may obliterate dental prosthesis (bridge) or an implant. The first step of the endodontic procedure is for the Further, if the tooth is covered with a metal crown, the dentist to gain access to the pulp chamber and the root pulp chamber will not be visible on the radiograph. On anterior teeth, the opening is made locates the root canal orifices on the floor of the pulp on the lingual surface and on posterior teeth through chamber. These access openings vary con- present in teeth is critically important to successful siderably from cavity preparations used in operative endodontic treatment. A lower left first molar where the root canals have been filled with gutta percha and sealer. The part of the crown that was lost has also been restored with a temporary filling. Both the gutta percha and the temporary filling appear whiter than enamel or dentin on the radiograph. Chapter 8 | Application of Root and Pulp Morphology Related to Endodontic Therapy 243 ensuing periapical disease. When the canal orifices canals are then cleaned and shaped at this length using have been located, endodontic files are used to remove incrementally larger diameter files until the root canal the diseased pulp tissue and to begin cleaning the system is ready to be filled. In order to approximate the file length, the Following this cleaning procedure, the root canals lengths of the corresponding root and crown are mea- may be filled with gutta percha (a rubber-type material) sured using a preoperative radiograph. Examples of sealers used today files carefully inserted into the root canals, a radiograph include resin, glass ionomer, zinc oxide and eugenol, is made with the files in the root (Fig. When there is sufficient tooth tions and lengths of the files are adjusted to extend to structure remaining, the opening through the crown approximately 1 mm short of the radiographic apex of used to access the pulp may be restored with a tooth- the root (which corresponds to the natural constric- colored composite or silver amalgam restorative mate- tion of the canal at the cementodentinal junction). The lingual access opening (cut into the lingual surface of the crown in order to reach and remove the pulp tissue) is filled with a provisional (temporary) restoration. The tooth is prepared for a crown with the post and core cemented in place to provide additional crown support and retention. Radiograph of a post and core with a metal ceramic crown showing the post extending over halfway into the endodontically treated root. Therefore, in order to provide adequate retention for the crown if the periodontium remains healthy, the treated tooth (Fig. M drawings are labeled with M for mesial, D for distal, F for facial, and L for lingual. L Tooth #25 Tooth #26 • There are no root grooves D M (depressions) on this incisor, F though the mesial surface may L D. D M • It has one root canal close to Tooth #8 • Developmental grooves (depres- 100% of the time. Tooth #6 • A shallow longitudinal root depres- L sion is sometimes found on the D M E. F • There is one root canal close to D M • Roots have prominent longitu- 100% of the time. L • In cross section, the cervical portion of the root is • There is most often one root ovoid, considerably broader labiolingually than Tooth #27 canal. Chapter 8 | Application of Root and Pulp Morphology Related to Endodontic Therapy 245 F. D D M • The root is rarely bifurcated M • Mesial and distal root depressions F and almost always has one root L occur on both one- and two- Tooth #5 S canal. Tooth #29 rooted first premolars (between the buccal and lingual roots or between the buccal J. Both roots are broad • When considering all premolars, the maxillary first buccolingually. The distal root surface • Although there is normally only one root, there may P contours are more variable but may be convex. L • The distal roots in the mandibular first and second • There may be a shallow depres- molars most often have one canal.

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However buy cialis sublingual 20 mg fast delivery erectile dysfunction causes uk, bleeding is much more likely if thrombo- cytopenia is not immune in origin (e order cialis sublingual uk erectile dysfunction urology tests. Not worth checking platelet-associated IgG or IgM since these are elevated in thrombocytopenia caused by immune and non- immune mechanisms, so they add no useful information. Patients with haematocrits above the normal reference range may or may not have an i red cell mass (real or relative polycythaemia, respectively) (see Table 1. The latter are also characterized by frequency, urgency, and nocturia, but usually small amounts of urine are passed at each void. If abnormal (reduced) sweating on ipsilateral side face (damage to cervical sympathetic chain) • Pancoast’s tumour. Impaired gas exchange occurs because of a mismatch between ventilation and perfusion. Pulse volume and additional characteristics are assessed from palpation of the brachial or carotid pulse (see Table 1. A hypercoagulable or thrombophilic risk factor is an inherited or acquired disorder of the haemostatic mechanisms, which may be associated with an i likelihood of a thrombotic event (venous or arterial) or recurrent thrombosis. This concept of risk factors for throm- bosis is analogous to that for heart disease, and similarly for most patients multiple causal factors operate (see Table 1. Hereditary thrombotic disease may be suggested by a positive family his- tory but should be tested for if the venous thrombotic events occur in the absence of acquired causes, at a younger age, at unusual sites (e. Investigations in recurrent thrombosis Inherited thrombophilia screening • Defciency of factors, e. Pitfalls Thrombophilia testing may be complicated if the patient is on warfarin/ heparin; discuss with the lab before sending samples. Rigors Fever is due to a resetting of the anterior hypothalamic thermostat, is medi- ated by prostaglandins (hence aspirin is benefcial), and is most commonly caused by infection. Psychosocial disease must be considered, but extensive investigation is required to rule out organic disease. If no cause is found, a period of observation may make the underlying cause apparent. Investigations • Current height + weight (compare to any previous data available; plot on growth charts). Increased pigmentation may also be found in association with chronic systemic disease • Addison’s disease (palmar creases, buccal pigmentation, recent scars). Contrast with hypopigmentation • Localized acquired depigmentation (vitiligo) is a marker of autoimmune disease. If foreign residence, consider infectious causes (malaria, leishmaniasis, schis- tosomiasis) and haemoglobinopathies (HbC, Hbe, thalassaemia). Causes • Any disorder that prevents absorption of micellar fat from the small bowel. It may be a high-pitched musical sound similar to wheeze but arising from constric- tion of the larynx or trachea. In young children Because of the smaller size of the larynx and trachea in children, stridor may occur in a variety of conditions: • Postural stridor (laryngomalacia). Patients may pre-sent with simple easy bruising—a common problem—or catastrophic post- traumatic bleeding. The best predictors of bleeding risk are found in taking an accurate history, focusing on past haemostatic challenges (e. Bleeding due to coagulation factor defciency tends to be associated with internal/deep muscle haematomas as the bleeding typically occurs in a delayed fashion after initial trauma and then persists. Inappropriate bleeding or bruising may be due to a local factor or an underlying systemic haemostatic abnormality. Systemic enquiry Do the patient’s symptoms suggest a systemic disorder, bone marrow fail- ure, infection, liver disease, or renal disease? If family history is negative, this could be a new mutation (one-third of new haemophilia is due to new mutations). Check size— petechiae (pinhead); purpura (larger ≤1cm); bruises (ecchymoses; ≥1cm). With sus- pected stroke, a full history and general physical examination are manda- tory. Hemiparesis can occur as a post-ictal phenomenon or a result of migraine or hypoglycaemia (see below). Hysterical or functional paralysis is also seen but should not be confdently assumed at presentation. Neuroanatomical localization of the defcit and the nature of the lesion(s) require appropri- ate imaging. Note: the post-ictal state may be associated with temporary (<24h) limb paresis (Todd’s paralysis) in focal epilepsy (suggests structural lesion—cranial imaging is mandatory). Take a venous sample in a fuoride– oxalate tube (+ serum for insulin concentration) if hypoglycaemia confrmed. Consider alternative diagnoses including • ° or 2° brain tumour (may present as acute stroke—search for °). It is a normal physiological response to exercise and to emotional stress but can also herald a cardiac rhythm disorder. One should always begin by assessing the nature of the tachycardia and identifying any underlying cause or contributing factor. One must then diferentiate between sinus tachycardia (which may or may not have a pathological cause) and tachycardias due to other (abnormal) cardiac rhythms. Broad- complex tachycardias • Narrow-complex tachycardia with aberrant conduction. Supraventricular tachycardias will usu- ally slow transiently, allowing clearer identifcation of the underlying atrial activity, and re-entry tachycardias may terminate altogether. Tinnitus may occur as a symp- tom of nearly all disorders of the auditory apparatus. Audiological assessment Specialist investigations include • Assessing air and bone conduction thresholds. A U&e is useful to exclude hyponatraemia or hypokalaemia (muscle weakness), as well as renal failure. Urgency forms part of a cluster of symptoms which include frequency of micturition (E Polyuria, p. Investigations to consider • Urinalysis—stick test for glucose, protein, blood, and nitrites. If persists for >24h and fades with brown staining, consider urticarial vasculitis (rare). Unilateral blindness is due to a lesion either of the eye itself or between the eye and the optic chiasm. Investigations will be determined by the history and examination fndings; a specialist opinion should be sought without delay.

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They show that anterior structures cause laxity when in fexion effective 20 mg cialis sublingual erectile dysfunction doctor in pakistan, whereas the release of the posterior-based structures causes laxity in extension discount cialis sublingual 20 mg with visa impotence bicycle seat. They also presented a surgical series where these principles were put into place in the operating room. Cut the distal femur at 3° to 5° of valgus relative to the intramedullary canal, rather than the standard 6°, to • Minimal medial release • Elevate lateral capsular sleeve from tibial joint line prevent undercorrection of valgus malalignment (Fig. The • Resect less bone with increasing deformity bone cut should be perpendicular to the mechanical axis of the tibia (Fig. Final components can be placed after the knee is found • Lamina spreader • #15 blade to have equal soft-tissue tension medially and laterally with the trial insert in place. Constrained implants, fxation with, in total standard, 55 Extension gap, in total knee arthroplasty, knee arthroplasty, 368, 368b positioning for, 55 374–375, 375f Index 387 K External rotation asymmetry Graft in multiple ligament knee injury, 228, 229f biomechanical properties of, 159 Knee, clinical examination of, 304 in posterolateral corner, 216, 217f choices of, 157–164 patellar glide in, 295, 296f External rotation dial test, 8, 8f fxation, 161–162, 163f–164f, 163t patellar tilt test in, 295, 296f External rotation recurvatum for osteochondral allograft Knee diagnostic arthroscopy, in in posterolateral corner, 217, 218f transplantation, 123–124, 124f primary anterior cruciate ligament test, for posterior cruciate ligament implantation, for osteochondral allograft reconstruction, 168, 168b repair, 195 transplantation, 123, 123b, 124f Knee dislocation. F cruciate ligament reconstruction, Knee examination, 1–13 Femoral avulsion, repair of, 282–283, 282b, 171, 171b–172b anterior drawer test in, 7, 7f 284f Guide pin external rotation dial test in, 8, 8f Femoral component rotation, for total knee insertion, in distal femoral osteotomy, gait in, 4 arthroplasty 148, 148f, 148b hamstring fexibility/popliteal angle in, 9 through gap balancing, 355–356, placement, for opening wedge high tibial hip examination in, 10 356f–357f, 356b osteotomy, 139, 139b, 140f–141f imaging for. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identifed, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Abbott Design Direction: Ellen Zanolle Working together to grow libraries in developing countries Printed in China www. We hope to provide concise review of techniques that will improve our clinical practice along with the background that forms the foundation for these approaches. Now included are summary tables of the more common regional blocks, with step-by-step instruction for quick reference. Admittedly, approaches to regional anesthesia with ultrasound are somewhat arbitrary, but it is good education to have a starting point and some reasons why such an approach is successful and safe. The fgure labeling has been revised to be less intrusive so as not to obscure underlying details. One of the biggest chal- lenges when learning ultrasound-guided regional anesthesia is to understand the structures that lie near but outside the plane of imaging. Long-axis views and 3-D imaging are used to give the big picture of the surrounding anatomy. Several have been rewritten (infraclavicular, neuraxial, and cervical plexus blocks) to refect advances from the most important articles in the past 3 years. There are four new chapters of blocking techniques (fascia iliaca, anterior sciatic nerve, transversus abdominis plane, and stellate ganglion) that are increasingly popular and guided by the soft tissue information that ultrasound imaging provides. Ultrasound is a wonderful tool for discovery, and the atlas strives to convey the essentials for safe and effective regional anesthesia. Gray xi 1 Ultrasound Ultrasound waves are high-frequency sound waves generated in specifc frequency ranges 1 and sent through tissues. How sound waves penetrate a tissue depends on the range of the frequency produced. Wave motion transports energy and momentum from one point in space to another without transport of matter. Any wave in which the distur- bance is parallel to the direction of propagation is referred to as a longitudinal wave. Sound waves are longitudinal waves of compression and rarefaction of a medium such as air or soft tissue. Compression refers to high-pressure zones, and rarefaction refers to low-pressure zones (these zones alternate in position). As the sound passes through tissues, it is absorbed, refected, or allowed to pass through, depending on the echodensity of the tissue. Substances low in water content or high in materials that are poor sound conductors (e. Substances with sound conduction properties between these extremes appear darker to lighter, depending on the amount of wave energy they refect. Audible sounds spread out in all directions, whereas ultrasound beams are well collimated. The frequency of sound does not change with propagation unless the wave strikes a moving object, in which case the changes are small. Because the speed of sound in soft tissue is nearly constant, higher-frequency sound waves have shorter wavelengths. Two adjacent structures cannot be identifed as separate entities on an ultrasound scan if they are less than one wavelength apart. Therefore, sound wave frequency is one of the main determinants of spatial resolution of ultrasound scans. The sound velocity equals (B/rho), where B equals the bulk modulus, and rho equals density. Because the velocity of sound in soft tissue is 1540 m/sec, 13 microseconds elapse for each centimeter of tissue the sound wave must travel (the back-and-forth time of fight). Speed of sound artifacts relates to both time of fight considerations and refraction that occurs at 1-3 the interface of tissues with different speeds of sound. Sonographically guided core-needle biopsy of breast masses: the “bayonet artifact”. Because the speed of sound is not neces- sarily homogeneous in soft tissue, the needle can sometimes appear to bend, similar to a bayonet. Actual mechanical bending of the needle typically appears as gentle bowing of the needle (C). The units of the attenuation coeffcient directly show the greater attenuation of high-frequency ultrasound beams. In soft tissue, 80% or more of the total attenuation is caused by absorption of the ultrasound wave, thereby generating heat. An acoustic shadow is said to exist when a localized object refects or attenuates sound to impede transmission. This phenomenon, originally described as posterior acoustic enhancement (also called increased 1 through-transmission), is due to lack of absorption of the sound waves by the fuid. This attenuation artifact is a potential source of problems, especially during regional blocks where nerves are situated close to blood vessels.

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Toxic cardiomyopathy order cialis sublingual 20mg without prescription impotence prozac, encephalitis 20mg cialis sublingual fast delivery erectile dysfunction medication with high blood pressure, post- avoided for fear of causing rash in cases of infec- influenzal demyelinating encephalopathy, Guillain tious mononucleosis. Oral Amantadine in doses of 100-200 mg per day in adults can reduce the duration of illness. Pneumonia used to be Acute Laryngotracheo-bronchitis (Croup) the leading cause of death prior to the introduction These conditions, which overlap frequently occur of effective antibiotic therapy and modern means of following infection with any of the common viruses. Cyanosis and contraction of of drug resistant organisms in hospitals and conta- accessory muscles of respiration may be seen in minated equipment, availability of newer anti children. Because discomfort or chest tightness are additional of the non-specificity of clinical and radiographic symptoms. Clinical examination is often normal or findings and limitations of diagnostic testing for occasionally wheeze and coarse crackles may be identifying the etiological organisms the initial noted. Pneumonia occurs when the oral/intravenous steroids may be used in severe lung defences are overcome leading to multi- cases. Other management includes temperature control The following classification is used for practical and oxygen administration in case of respiratory purposes, which is based on the etiological failure. Classification of Pneumonia Anatomical/Radiological Classification Etiological Classification a. Lobar: Resulting in homogenous opacification of Viral pneumonia, bacterial pneumonia, parasitic and segment and or lobe with air bronchogram on fungal pneumonia. Viral pneumonia: The organisms are influenza A and B, adenovirus, Varicella, respiratory syncitial virus, measles, parainfluenza, cytomegalovirus, corona virus, coxsackie virus and rhinovirus. Influenza is the most common in adults, occurring in epidemics while measles is common in childhood. Viral pneumonias are usually benign but occasionally may be complicated by bacterial pneumonias. Bacterial pneumonia: They are the commonest and the frequently encountered organisms as shown in Table 3. The most frequent way by which pneumonia occurs is thus by colonization of the oropharynx by the pathogenic organisms and subsequent aspiration. The routes of acquiring infection are: Aspiration: Aspiration of the oropharyngeal organisms is the commonest mechanism, which is increased by states in which ability to cough is depressed. In elderly people and in hospital patients in addition to the above gram-negative bacilli are Fig. Inhalation: Transmission of viral infections, infections by atypical organisms and tuberculosis is by this route. Blood spread: Hematogenous spread from a focus elsewhere may occur with gram-negative and Staphylococcal bacteremia. Lobular: Consists of nodular or patchy irregular opacities in involved areas of lung seen in Healthy young adults S. Interstitial: Resulting in interstitial (reticulo- > 45 years Mycoplasma nodular) pattern on radiographs as seen in Patients of diabetes S. In healthy Organ transplant, Legionella individuals aspiration of droplets from naso- renal failure pharynx occurs during sleep. Clinical history: Age > 65 years, presence of coexistent with adequate sensitivity and specificity. The failure, chronic liver failure, congestive heart failure, typical features include cough with purulent sputum previous hospitalization, post-splenectomy, chronic production, fever and dyspnea. Viral and atypical alcohol abuse and malnutrition pneumonias usually present with constitutional b. On examination, bronchial output < 20 ml/hr breath sounds and crackles may be noted. Atypical due to irregular filling in the background of presentations include fever, cough with mucoid emphysema. Coexisting conditions like bronchial sputum, myalgia, malaise and extra-pulmonary obstruction, pleural effusions may be also be symptoms like diarrhea and confusion. Current chest film should be characteristics like the sputum being usually rusty compared with old films to confirm the acute in Pneumococcal pneumonia, mucoid in viral and episode of illness. Sputum examination: Gram’s staining of expecto- pneumonia can act as aid to diagnosis. Elderly rated sputum should be performed prior to patients usually report fewer symptoms. Ideal sputum sample presen-ting clinical features including history, features more than 25 neutrophils, less than 5 physical examination, routine laboratory and squamous epithelial cells and presence of alveolar roentgenographic evaluation does not allow the macrophages. This ideal During the initial evaluation decision regarding the sputum sample can be cultured for aerobic and tests required, the severity of illness and the anaerobic organisms. Staphylococcus and emperical therapy to be instituted at home or Klebsiella are non-fastidious organisms, which hospital needs to be taken. Invasive the possibility of pneumonia the following investi- procedures like transtracheal aspiration, broncho- gations should be carried out. Pre-treatment, two blood cultures obtained from separate sites with a time gap of 10 minutes may be done. Serological testing, cold agglutinin measurements are not to be routinely performed. They may be occasionally useful for retrospective confirmation of suspected diagnosis or for epidemiological studies. The advanced diagnostic tests are primarily used for epidemiological evaluations and in the assessment of the patients whose illness does not resolve despite appropriate emperic therapy. Most potential pathogens recovered from expectorated sputum represent contaminants from the upper respiratory tract thus interpretation The rationale for obtaining etiological diagnosis should be on the basis of clinical correlation, Gram is to permit optimum antibiotic selection, to identify stain findings and culture quantification. The the prevalence of resistance and to identify epi- following chart can be used as a guide in the initial demiologically significant pathogens like Legionella. Beta lactamase inhibitor Additional therapy in the form of oxygen, hydration and ionotropes Miscellaneous: Moraxella, + Erythromycin or newer may be required in hospitalized patients. One of the other reasons for poor response to antibiotic therapy may Therapy should not be changed in the first 72 hours be non-infectious etiology of the chest radiograph, unless there is marked clinical deterioration. If which may be misdiagnosed as pneumonia (Table patient is showing good clinical response, radio- 3. Parenteral therapy started in hospitalized patients can be “switched” Therapy failure is defined as early (no clinical to oral therapy once the patient’s clinical condition response within 72 hours) or late (after 72 hours). Immunocompromised patients with tuberculosis or to diagnose associated endobronchial Legionella infections may require treatment up to obstruction. Abnormal physical findings can persist Mycoplasma (cold agglutinins) and viral agents beyond 7 days in 20-40 percent of the patients, while should be considered now. Thus response is seen on clinical grounds while In a certain percentage of cases, clinical response is resolution is judged radiologically at 4 weeks. In adequate but the chest radiographic clearance is Respiratory Tract Infections 93 Table 3.