Monday, December 13, 2010

Mesothelioma-Exposure To Asbestos


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Human ovulation captured on film

Infectious Diseases in Critical Care

Infections and their complications are a very important clinical area in the intensive care unit setting. Community-acquired infections and nosocomial infections both contribute to the high level of disease acquisition common among critically ill patients. The accurate diagnosis of nosocomial infections and the provision of appropriate therapies, including antimicrobial therapy effective against the identified agents of infection, have been shown to be important determinants of patient outcome.

Critical care practitioners are in a unique position in dealing with infectious diseases. They are often the initial providers of care to seriously ill patients with infections. Additionally, they have a responsibility to ensure that nosocomial infections are prevented and that antimicrobial resistance is minimized by prudently employing antibiotic agents. It is the editors’ hope that this book will provide clinicians practicing in the intensive care unit with a reference to help guide their care of infected patients. To that end they have brought together a group of international authors to address important topics related to infectious diseases for the critical care practitioner.

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Gynecomastia versus Carcinoma

WE can summarize presentation of male breast disease either as mass, pain or nipple discharge.
Gynecomastia and invasive ductal cancer are the most common lesions in the male breast, but there are other rarer benign and malignant lesions.
Gynecomastia and carcinoma can usually be differentiated, but biopsy is sometimes necessary to separate them.All lesions eccentric to the nipple need biopsy unless they are characteristically benign, i.e.contain fat or typical lymph node.

On this diagram a list of characteristics of gynecomastia versus carcinoma.Notice that there are many similarities.
Both gynecomastia and carcinoma occur mostly at the age of 60 and can be soft, mobile, subareolar and unilateral.
So that does not help.
$$Carcinoma is usually eccentric, while gynecomastia is never eccentric.
$$Gynecomastia has to have extensions into the surroundig fat.
$$Carcinoma sometimes may have spiculations, that can look the same.
Actually we call it extension into the fat, if we think it is gynecomastia and spiculation, if we think it is a carcinoma.

To differentiate between true gynecomastia and pseudogynecomastia


Ephelides (freckles)

Ephelides (also called freckles) are tanned macules seen on the skin. Ephelides are usually multiple in number. Although ephelides are predominantly benign, they may be found in association with systemic disease. Ephelides are associated with fair skin and red or blonde hair. In contrast to solar lentigines, ephelides are not strongly related to age.

Freckle Dermatology The most common pigmented lesion of young light-skinned Caucasians, often of Celtic stock, consisting in light brown 1-10 mm macules which fade in winter, and are accentuated in summer.

Clinically : Ephelides appear during childhood as scattered areas of increased pigmentation, mainly limited to the body regions above the waist.
* These macules are asymptomatic, more numerous on sun-exposed areas, and fade and become smaller in the winter.

On examination, Simple ephelides appear as multiple, small, tanned macules, ranging from 1-5 mm in diameter, with uniform pigmentation. They are most commonly found on sun-exposed areas, such as the nose, the cheeks, the shoulders, and the upper part of the back. The macules may be discrete or confluent.
* Sunburn freckles present similarly to that of simple freckles, but they are darker, have irregular borders, and may be as large as a few centimeters.

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250 Short Cases in Clinical Medicine

672 pages
Publisher: Saunders Ltd.; 3 edition (March 15, 2002)
Language: English
ISBN-10: 0702026247
ISBN-13: 978-0702026249

A collection of short cases arranged by clinical area,..................


Neutrophil Adhesion Migration and Phagocytosis

A neutrophil travels along the capillary endothelial layer. Endothelial cells are triggered to express selectins on their surface for neutrophil integrin-mediated adherence. Transendothelial migration allows the neutrophil to traverse the blood endothelial layer. Squeezing into the extra-capillary space where migration towards a chemotactic gradient (chemotaxis) helps it to locate the pathogen. Subsequent phagocytosis ensues.


Gynecomastia Versus Pseudogynecomastia

Gynecomastia is defined as a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast.Gynecomastia can clinically be detected by the presence of a rubbery or firm mass extending concentrically from the nipples.
Although gynecomastia is usually bilateral, it can be unilateral.

Pseudogynecomastia ( also called lipomastia ) is characterized by fat deposition without glandular proliferation.

TO SEE appearance of Pseudogynecomastia in x-ray

You can differentiate between true gynecomastia and pseudogynecomastia by a simple test made clinically by having the patient lie on his back with his hands behind his head. The examiner doctor then places a thumb on each side of the breast, and slowly brings the thumbs together. In true gynecomastia, a ridge of glandular tissue will be felt that is symmetrical to the nipple-areolar complex. With pseudogynecomastia, the fingers won't meet until they reach the nipple.
You can click on image to enlarge