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By E. Jorn. Lake Superior State University.

The This book is an authorized and updated authors and publishers request every user translation of the 10th German edition to report to the publishers any discrepancies published and copyrighted 2001 or inaccuracies noticed purchase glucophage 850mg without prescription. Title of the German edition: registered designs referred to in this book Medizinische Mikrobiologie are in fact registered trademarks or proprie- tary names even though specific reference to ª 2005 Georg Thieme Verlag quality glucophage 500mg, this fact is not always made in the text. Ru¨digerstraße 14, 70469 Stuttgart, Therefore, the appearance of a name without Germany designation as proprietary is not to be con- http://www. Any use, ex- Cover design: Cyclus, Stuttgart ploitation, or commercialization outside the Typesetting by Mitterweger & Partner narrow limits set by copyright legislation, GmbH, 68723 Plankstadt without the publisher’s consent, is illegal Printed in Germany by Appl, Wemding and liable to prosecution. Usage subject to terms and conditions of license V Preface Medical Microbiology comprises and integrates the fields of immunology, bacteriology, virology, mycology, and parasitology, each of which has seen considerable independent development in the past few decades. The com- mon bond between them is the focus on the causes of infectious diseases and on the reactions of the host to the pathogens. The objective of this textbook of medical microbiology is to instill a broad- based knowledge of the etiologic organisms causing disease and the patho- genetic mechanisms leading to clinically manifest infections into its users. This knowledge is a necessary prerequisite for the diagnosis, therapy, and prevention of infectious diseases. Beyond this academic purpose, its use- fulness extends to all medical professions and most particularly to physicians working in both clinical and private practice settings. This book makes the vast and complex field of medical microbiology more accessible by the use of four-color graphics and numerous illustrations with detailed explanatory legends. Most chapters begin with a concise summary, and in-depth and supplementary knowledge are provided in boxes separating them from the main body of text. This textbook has doubtless benefited from the extensive academic teaching and the profound research experience of its authors, all of whom are recognized authorities in their fields. The authors would like to thank all colleagues whose contributions and advice have been a great help and who were so generous with illustration material. The authors are also grateful to the specialists at Thieme Verlag and to the graphic design staff for their cooperation. Usage subject to terms and conditions of license Kayser, Medical Microbiology © 2005 Thieme All rights reserved. I Basic Principles of M edical icrobiologie and Im unology Macrophage hunting bacteria Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Kayser & Infectious diseases are caused by subcellular infectious entities (prions, viruses), prokaryotic bacteria, eukaryotic fungi and protozoans, metazoan an- imals, such as parasitic worms (helminths), and some arthropods. Definitive proof that one of these factors is the cause of a given infection is demon- strated by fulfillment of the three Henle-Koch postulates. For technical rea- sons, a number of infections cannot fulfill the postulates in their strictest sense as formulated by R. In the medical teachings of Hippocrates, the cause of infections occurring fre- quently in a certain locality or during a certain period (epidemics) was sought in “changes” in the air according to the theory of miasmas. This concept, still reflected in terms such as “swamp fever” or “malaria,” was the predominant academic opinion until the end of the 19th century, despite the fact that the Dutch cloth merchant A. At the time, general acceptance of the notion of “spontaneous generation”—creation of life from dead organic material—stood in the way of implicating the bacteria found in the corpses of infection victims as the cause of the deadly diseases. It was not until Pas- teur disproved the doctrine of spontaneous generation in the second half of the 19th century that a new way of thinking became possible. By the end of that century, microorganisms had been identified as the causal agents in many familiar diseases by applying the Henle-Koch postulates formulated by R. The History of Infectious Diseases 3 The Henle–Koch Postulates 1 The postulates can be freely formulated as follows: & The microorganism must be found under conditions corresponding to the pathological changes and clinical course of the disease in question. However, the fact that these conditions are not met does not necessarily exclude a contribution to disease etiology by a pathogen found in context. In particular, many infections caused by subcellular entities do not fulfill the postulates in their classic form. The Present The frequency and deadliness of infectious diseases throughout thousands of years of human history have kept them at the focus of medical science. The development of effective preventive and therapeutic measures in recent dec- ades has diminished, and sometimes eliminated entirely, the grim epidemics of smallpox, plague, spotted fever, diphtheria, and other such contagions.

The studies of macroscopic findings among complainants of sexual assault have also found that most of the injuries detected are located on the external genitalia (133 purchase glucophage 500 mg without a prescription,134) generic 500 mg glucophage otc. Healing of lacerations of the posterior fourchette is predominantly by first intention, with no residual scarring being detected at follow-up assess- ments (90). Nonetheless, scarring may occur occasionally in these areas, but it is important not to mistake a linear vestibularis, a congenital white line iden- tified in the fossa navicularis (present in 25% of neonates), for a scar (135). Accidental injuries of the external genitalia of female children are well documented in the literature. The site and nature of the injury will depend on the type of trauma and the conformation of any object involved (136,137). Hymen The hymen must be examined in detail after an allegation of a nonconsensual penetrative act. When the hymen is fimbriated, this assess- ment may be facilitated by the gentle use of a moistened swab to visualize the hymenal edges. When the hymenal opening cannot be seen at all, application of a few drops of warm sterile water or saline onto the hymen will often reveal the hymenal edges. Foley catheters are also a useful tool to aid hymenal visu- alization in postpubertal females (138). A small catheter is inserted through the hymenal opening, the balloon is then inflated with 10–20 mL of air, and the catheter is gently withdrawn so that the inflated balloon abuts the hymen. Obviously, in the acute setting, none of these maneuvers should be attempted until the relevant forensic samples have been retrieved. There is little specific information available regarding the type and fre- quency of acute hymenal injuries after consensual sexual acts, particularly regarding the first act of sexual intercourse. They found lac- erations (tears) with associated bruising at the 3-o’clock and 9-o’clock posi- tions on the hymen of a 14-year-old and bruises at the 6-o’clock and 7-o’clock Sexual Assualt Examination 95 positions on the hymens of two other females (aged 13 and 33 years). Unfortunately, no details regarding pre- vious sexual experience are recorded on their pro forma. In the same article, the hymen was noted to be one of the four most commonly injured genital sites among 311 postpubertal complainants of nonconsensual sexual acts. The hymenal injuries detected colposcopically were bruises (n = 28), lacerations (n = 22), abrasions (n = 13), swelling (n = 10), and redness (n = 4). The hymenal lacerations were either single (n = 12), nine of which were at the 6-o’clock position, or paired around the 6-o’clock position (n = 10). The authors found that hymenal lacerations were four times more common in the younger age groups. Bowyer and Dalton (133) described three women with hymenal lacerations (detected with the naked eye) among 83 complainants of rape who were examined within 11 days of the incident; two of the three women had not previously experienced sexual intercourse. One retrospective survey of the acute injuries noted among adolescent com- plainants of sexual assault (aged 14–19 years) found that hymenal tears were uncommon, even among the subgroup that denied previous sexual activity (132). Bruises, abrasions, reddening, and swelling completely disappear within a few days or weeks of the trauma (90,139). Conversely, complete hymenal lacerations do not reunite and thus will always remain apparent as partial or complete transections (123), although they may be partially concealed by the effects of estrogenization (140). However, lacerations that do not extend through both mucosal surfaces may heal completely (2). There is one case report of a 5-year-old who was subjected to penile penetration and acquired an imperforate hymen resulting from obliterative scarring (141). On the basis of the current literature, complete transections in the lower margin of the hymen are considered to provide confirmatory evidence of pre- vious penetration of the hymen. However, it is not possible to determine whether it was a penis, finger, or other object that caused the injury, and there is an urgent need for comprehensive research to determine whether sporting activi- ties or tampon use can affect hymenal configuration. Although partial or com- plete transections of the upper hymen may represent healed partial or complete lacerations beyond the acute stage, there is no method of distinguishing them from naturally occurring anatomical variations. Goodyear and Laidlaw (142) conclude that, “it is unlikely that a normal- looking hymen that is less than 10 mm in diameter, even in the case of an elastic hymen, has previously accommodated full penetration of an adult fin- ger, let alone a penis.

Spontaneous remission that tion purchase 500mg glucophage with mastercard, is legally responsible for evaluating and treating sometimes occurs in individuals with catastrophic patients or supervising physical therapy plans of care disease may be attributed to the placebo effect discount glucophage 850mg overnight delivery. A physical therapy diag- Also, detractors of homeopathy may claim that nosis refers to the decisions made by a physical ther- homeopathic remedies are placebos. Then Moss Pilates A method of exercise developed by requested that renowned bioenergetic healer Olga Joseph H. Pilates that has been very popular with Worrall hold her hand over the leaf in an effort to dancers since the 1940s. He graph, taken afterward, showed the leaf had developed a fitness regimen bearing his name and undergone significant energetic changes toward used it successfully to overcome his disabilities as a improvement. Lawrence emotional counseling developed by Randolph King) adapted by him from material he wrote for Stone, D. Stone also chotherapy is the art and science of easing emo- believed that the use of the hands—one electro- tional problems. Many forms of psychotherapy are magnetically positive, the other electromagneti- designed to help the client know and understand cally negative—helps release the blocked energy, what is in their unconscious. Very few are designed and that release in turn promotes better physical, to actually change what is in the unconscious. The American Polar- ever, if the material in the unconscious is not ity Therapy Association was established in 1984. The used as a therapeutic topical application to relieve unconscious is primarily a record of the past and a pain and promote circulation. These tensions can be triggered by present events prakruti The human constitution consisting of so that they are felt in the present. In fact, because one or more of the primary body/personality their origin is from the unconscious, and we are types—vata, pitta, and kapha, according to thus unaware of their actual source, these power- Ayurvedic medicine. Studies have been conducted in which one therapy: “Primal integration is a form of therapy group of ill individuals has been prayed for and brought over to Britain by Bill Swartley, one of its another group has not been prayed for; the group main originators, although it was also pioneered of people who were prayed for had a better and here by Frank Lake. It is not to be confused with faster recovery rate, indicating that prayer, particu- Primal Therapy, coming from Arthur Janov; it is a larly when it is done by large groups of people, has parallel development occurring at about the same beneficial effects. This often involves technique geared toward releasing old and intense a cathartic experience called a ‘primal. According to a winter-spring guage, and instead call what they do regression- 128 psychic surgery integration therapy. Other initiatives such as our web- about this, and his holotropic therapy is close to site, world-wide contact list, therapist referral list, what we call primal integration. Because of the annual conventions, and regional retreats are emphasis of primal integration on early trauma, intended to bring more primal people closer people sometimes think it is going to put all neuro- together, and make primal life more available to sis down to one trauma, happening just once in those in need. The commonest causes of neurosis are simply the common experiences of childhood— psychic surgery An alternative, highly contro- all the ways in which our child needs are unmet or versial therapy that originated in the Philippine frustrated. Psychic surgeons (shamans) who practice in the sense of a one-off event—that is much too there may be located through local hotels. Rather would we say with Balint surgery is performed through the mind and spirit of that the trauma may come from a situation of some the healer, who through a vision has proclaimed to duration, where the same painful lack of ‘fit’ have been given the gift of healing and psychic between needs and supplies is continued. While in a semitrance or Rowan added that the goal of primal integra- meditative state, the healer’ hands, guided by the tion is straightforward: to contact and release the spirit, “detect” parts of the body that are diseased real self. Practition- “enormously useful work can be done in enabling ers and individuals who have undergone this expe- the person to work through the implications of rience say blood, tissue, pus, cartilage, bone, that, and to support the person through any life worms, stones, or other substances may materialize changes that may result. At times, it is also claimed, been contacted, the process of working to release the spirit causes the healer’s hands to enter the it will continue. Obviously the main technique is body and extract diseased tissue without leaving a regression—that is taking the person back to the wound or scar. Pri- “opens” body tissue and is considered similar to a mal integration agrees with this, and finds that scalpel by enthusiasts of this procedure: energy recession and regression go very well together. It is a gestalt which keeps on reappearing organs remain, but free of disease, or “cleansed,” in the person’s life. The relaxation response (Acupuncture & ElectroTherapeutics Research 1997; of the patient carries the quick, painless process; no 22:17–33), Y. Omura writes: “Most patients recovery period is necessary, and enthusiasts say received injections of a dark-brown solution, there are no complications or risks involved. How- which, some of the visiting doctors speculated, may ever, the psychic surgeon’s hands, acting as a be an iodine solution mixed with either alcohol or scalpel, are reported to create to observers a a local anesthetic.