0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40
836 Influenza, Avian Inguinofemoral HerniaMolecular: H5N1 PCR – most sensitive test
Immunofluorescence antigen – less sensitive and specific than PCR
Paired serology – ELISA, Western blot. Not useful in the clinical set-
ting, but needed for epidemiology.
differential diagnosis
■Other causes of atypical pneumonia and respiratory viruses, includ-
ing SARS
management
■For hospitalized patients, full isolation measures as in SARS: stan-
dard and contact precautions, eye protection, airborne precautions,
including use of N95 masks
■Supportive care
specific therapy
■Neuraminidase inhibitors: Zanamivir (Relenza): inhalation drug;
Oseltamivir (Tamiflu): oral drug
➣Note that some resistance has been reported.
■No role for amantadine or rimantadine (virus resistant)
complications and prognosis
■High mortality rate of nearly 50%Inguinofemoral Hernia................................
BASSEM SAFADI, MD and ROY SOETIKNO, MD, MS
history & physical
Risk Factors
■male
■increased intra-abdominal pressure (COPD, ascites, chronic consti-
pation or urinary retention)
Types
■indirect: through internal ring due to patent processus vaginalis.
■direct: through transversalis fascia in the area of Hasselbach’s trian-
gle.
■femoral: through femoral canal (less frequent than inguinal hernias;
more common in women)
Symptoms & Signs
■groin pain or discomfort
■bulge/mass associated with straining, coughing, or valsalva