Al, justifying full investigations, including sural nerve biopsy. can you buy viagra over counter bangkok [5] [edit] diagnosis this section does not cite any references or sources. viagra discount online (august 2011) diagnosis is usually made through a clinical neurological examination. Patients usually present with a history of weakness, numbness, tingling, pain and difficulty in walking. They may additionally present with fainting spells while standing up or burning pain in extremities. Some patients may have sudden onset of back pain or neck pain radiating down the extremities, usually diagnosed as radicular pain. These symptoms are usually progressive and may be intermittent. On examination the patients may have weakness, and loss of deep tendon reflexes (rarely increased or normal). order viagra online There may be atrophy (shrinkage) of muscles, fasciculations (twitching) and loss of sensation. Patients may have multi-focal motor neuropathy, as they have no sensory loss. The patient may present with a single cranial nerve or peripheral nerve dysfunction. viagra canada stores Autonomic system dysfunction can occur; in such a case, the patient would complain of orthostatic dizziness, problems with bowel and bladder functions, and cardiac problems. Most experts consider the necessary duration of symptoms to be greater than 8 weeks for the diagnosis of cidp to be made. Electrodiagnostics - electromyography (emg) and nerve conduction study (ncs). women taking viagra recreationally In usual cidp, the nerve conduction studies show demyelination. generic viagra These findings include: a reduction in nerve conduction velocities; the presence of conduction block or abnormal temporal dispersion in at least one motor nerve; prolonged distal latencies in at least two nerves; absent f waves or prolonged minimum f wave latencies in at least two motor nerves. (in some case emg/ncv can be normal). Serum test to exclude other autoimmune diseases. Spinal tap and serum test for anti-ganglioside antibodies, which are one branch of the cidp diseases, as anti-gm1 anti-gd1a anti-gq1b. Sural nerve biopsy biopsy is considered for those patients in whom the diagnosis is not completely clear, when other causes of neuropathy (e. G. , hereditary, vasculitic) cannot be excluded, or when profound axonal involvement is observed on emg. [edit] treatment first-line treatment for cidp includes corticosteroids (e. viagra no prescription G. viagra online Prednisone), plasmapheresis (plasma exchange) and intravenous immunoglobulin (ivig) which may be prescribed alone or in combination with an immunosuppressant drug. age taking action viagra commercial [6] ivig and plasmapheresis have proven benefit in randomized, double-blind, placebo-controlled trials. Despite less definitive published evidence of efficacy, corticosteroids are considered standard therapies because of their long history of use and cost effectiveness. viagra canada stores Ivig is probably the first-line cidp treatment, but is extremely expensive (in the u. S. , a single 65 g dose of gamunex brand in 2010 might be billed at the rate of $8,000, just for the immunoglobulin, not including other charges such as nurse administration). Gamunex brand ivig is the only. Welcome to the home of
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