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eFigure 35–33. Life cycle of Paragonimus westermani (lung fluke). Ingestion of cysts in uncooked freshwater crab or crayfish meat is followed by excystation of juvenile worms in the duodenum and migration to the lungs, where they form worm pairs enclosed in host tissue. Eggs from adult worms are passed to the environment in sputum or stool and develop in the shell. Miracidia hatch and penetrate an appropriate snail (Semisulcospira). Massive multiplication of rediae occurs in the snail, which in turn produces many cercariae that leave the snail and crawl on the bottom of a pond in search of a crustacean intermediate host. 1–11: Metacercariae (1) in crab tissue undergo excystation (2) in the human duodenum; (3) and (4) show an adult worm in the lung and a cross section of a worm pair in a lung capsule. Undeveloped eggs (5) are carried to the mouth, swallowed, and passed in stool. Hatching of a miracidium (6) in suitable fresh water after development in the eggshell is followed by penetration of a snail by the miracidium, which changes into a mother sporocyst (7) in snail tissue. Rediae leave the sporocyst and initiate successive generations of redial progeny (8), which fill the snail. Cercariae emerge from the final redial generation (9) and move along the bottom of the pond, using an adhesive substance in a round bunny tail, toward an intermediate host, which they penetrate, aided by a penetration stylet (10, 11), whereupon a metacercaria encysts in the flesh of a crab. (Reproduced, with permission, from Goldsmith R, Heyneman D [editors]. Tropical Medicine and Parasitology. Originally published by Appleton & Lange. Copyright © 1989 by The McGraw-Hill Companies, Inc.)

Current Medical Diagnosis & Treatment 2018 > Protozoal & Helminthic Infections

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eFigure 9–41. Normal lung ventilation with xenon-133. With the patient's single full breath, inhaled radioxenon is evenly distributed to all lung areas, reaching the terminal airways and alveoli in the normal patient (A, posterior view). There is a less noticeable gradient of activity from the upper to the lower lung fields than is seen in perfusion lung images. Fifteen-second images obtained during closed-system rebreathing of a xenon–oxygen mixture show uniform distribution at 120 seconds (B). Serial 15-second frames after switching the patient to room air breathing (C to G) show a homogeneous pattern of washout from all lung areas. This sequence mainly evaluates the posterior lung regions. To better localize gas trapping in specific lung segments or more anterior regions, the acquisition may be modified after the rebreathing phase by rotating the patient into posterior oblique positions. Selected images from a complete study include single breath (H, posterior view), the late phase of rebreathing (I, posterior view), posterior washout (J), left posterior oblique washout (K), and right posterior oblique washout (L). No gas is retained in this patient, which is normal, but in obstructive airway disease gas retention persists and is better localized in the oblique views than in a posterior view alone. A small amount of alveolar xenon normally crosses the alveolar membrane to reach the blood and be distributed throughout the body. Because it is highly soluble in lipids, xenon accumulates in adipose tissue, including the liver, which is faintly seen with prolonged rebreathing. Liver activity should not be mistaken for delayed washout of xenon from the base of the lung. Occasionally, splenic blood pool radioactivity or swallowed xenon in the stomach may also be seen. (SIN BRE = single breath, L REB =late rebreathe, WO =washout.) (Reproduced, with permission, from Baum S et al. Atlas of Nuclear Medicine Imaging, 2nd ed. Originally published by Appleton & Lange. Copyright © 1993 by The McGraw-Hill Companies, Inc.)

Current Medical Diagnosis & Treatment 2018 > Pulmonary Disorders

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eFigure 9–41. Normal lung ventilation with xenon-133. With the patient's single full breath, inhaled radioxenon is evenly distributed to all lung areas, reaching the terminal airways and alveoli in the normal patient (A, posterior view). There is a less noticeable gradient of activity from the upper to the lower lung fields than is seen in perfusion lung images. Fifteen-second images obtained during closed-system rebreathing of a xenon–oxygen mixture show uniform distribution at 120 seconds (B). Serial 15-second frames after switching the patient to room air breathing (C to G) show a homogeneous pattern of washout from all lung areas. This sequence mainly evaluates the posterior lung regions. To better localize gas trapping in specific lung segments or more anterior regions, the acquisition may be modified after the rebreathing phase by rotating the patient into posterior oblique positions. Selected images from a complete study include single breath (H, posterior view), the late phase of rebreathing (I, posterior view), posterior washout (J), left posterior oblique washout (K), and right posterior oblique washout (L). No gas is retained in this patient, which is normal, but in obstructive airway disease gas retention persists and is better localized in the oblique views than in a posterior view alone. A small amount of alveolar xenon normally crosses the alveolar membrane to reach the blood and be distributed throughout the body. Because it is highly soluble in lipids, xenon accumulates in adipose tissue, including the liver, which is faintly seen with prolonged rebreathing. Liver activity should not be mistaken for delayed washout of xenon from the base of the lung. Occasionally, splenic blood pool radioactivity or swallowed xenon in the stomach may also be seen. (SIN BRE = single breath, L REB =late rebreathe, WO =washout.) (Reproduced, with permission, from Baum S et al. Atlas of Nuclear Medicine Imaging, 2nd ed. Originally published by Appleton & Lange. Copyright © 1993 by The McGraw-Hill Companies, Inc.)

Current Medical Diagnosis & Treatment 2018 > Pulmonary Disorders

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