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Physicians are unable to agree on the meaning of the statute because its words have no medical meaning hair loss in men rat generic propecia 1 mg overnight delivery. The statute cuts across those standards and requires physicians to apply an unclear legal test which supersedes and may negate their medical judgment. The Texas Anti-Abortion Statute Infringes Upon Constitutionally Protected Fundamental Rights of Physicians and of Patients. The practice of medicine clearly includes the treatment of pregnancy and its attendant conditions. But those physicians treating pregnant women run the risk of criminal charges as the result of their professional decisions. The statute unfairly discriminates against those physicians treating pregnant women and thus denies these physicians equal protection of the laws. The statute forbids all abortions except those necessary to save the life of the mother. T us a woman sufering from heart disease, diabetes or cancer whose pregnancy worsens the underlying pathology may be denied a medically indicated therapeutic abortion under the statute because death is not certain. The State of Texas may not in pursuit of its policy infringe upon the constitutionally protected right of its pregnant citizens to the medical treatment they require to maintain their good health. Statistics are necessarily uncertain, but a frequent estimate is that over one million criminal abortions occur in the United States each year, resulting in an estimated 5,000 maternal deaths annually. T at 5,000 American women a year should be denied medically safe procedures and thus be driven to their untimely deaths to avoid bearing unwanted children is unconscionable. Death due to complications following illegal abortion procedures are only part of the problem. Many thousands of other women needlessly sufer serious infections following these procedures in addition to pain, sufering and emotional trauma. A doctor has a direct, personal, substantial interest for his decision may send him to jail. The State says that only if the physician wrongly decides that the operation is needed to preserve her life is he criminally liable. If he wrongly decides the operation is not needed to preserve her life, he is subject to no criminal penalties. A doctor would have to be superhuman if he were able to ignore the fact that his decision can be second-guessed by a jury which may totally disregard medical evidence. T erefore, his patient cannot receive the impartial decision required by due process of law. The freedom to be the master of her own body, and thus of her own fate, is as fundamental a right as a woman can possess. The right of a woman to avoid pregnancy following conception has been recently recognized in State and Federal Courts. Amicus Curiae Brief in Support of Jane Roe National Legal Program on Health Problems of the Poor, National Welfare Rights Organization, and American Public Health Association The American Public Health Association had taken an early role in advocating for abortion reform. This brief stresses the practical consequences for the poor of laws prohibiting abor tion. It also fames the issue as one of discrimination, in violation of the constitutional guarantee of equal protection; middle-class white women could more easily obtain safe abortions than the poor and the non-white. It is the poor and non-white who suffer most from limited access to legal abortion, and it is they who incur greatly dispropor tionate numbers of deaths and crippling injuries as a result of being forced to seek criminal abortion. The State Has No Interest in Increasing Its Population; on the Contrary, Its Interest, if Any, Is in Limiting Population Growth. In view of the increasing public concern over our rapidly multiplying population, any supposed state interest in increasing the number of lives in being can hardly be raised as a justification for the prohibition of abortion. Indeed, the growing emphasis of both federal and state agencies upon preplanning of families and limitation of their size makes manifestly inconsistent treating the termination of pregnancy as a crime, while birth control devices are not merely permitted but are openly promoted and encouraged by the government. While amici contend that to receive proper medical care in the form of an abor tion approved and performed by a physician is, by itself, a fundamental interest protected by the Constitution, it is not necessary for abortion to be declared a constitutional right to hold that its discriminatory denial violates guarantees of equal protection. Presumably, therefore those women who qualify for a legal abortion according to the terms of the statute should be able to obtain one, regardless of their race or socio-economic status. There is nothing demonstrable in the diferences of skin color or economic condition which suggests that a substantially smaller propor tion of the poor or the non-white fall into this category than that of the white and the non-poor, or that the poor and non-white have a substantially diferent moral attitude on abortion. On the contrary, a recent study of births occurring between 1960 and 1965 led investigators to conclude that one-third of Negro (as contrasted with one-ffh of white) births were unwanted. Unwanted births were in general more than twice as high for families with incomes of less than $3,000 as for those with incomes of over $10,000; this diferential was particularly marked among Negroes. Data demonstrate that the poor and the non-white do not receive this medical treatment on the same terms as do others. They thus sufer a particularly harsh and adverse efect from the operation of this statute, as they do from that of the other restrictive abortion laws which have existed and currently exist in the United States. Because the poor rely primarily upon public hospitals for their medical ser vices, denials or delays at those institutions are tantamount to a denial of prompt medical care solely because these women are without funds. While socioeconomic conditions never per se legally warrant therapeutic abortion, socioeconomic status nevertheless frequently deter mines whether or not an abortion will be performed, and if performed, whether that self-same abortion will be therapeutic or criminal. Criminal abortion has been described as the greatest single cause of maternal mortality in the United States; it is one of the greatest cause of disease, infection, and resulting sterilization as well. The poor and the non-white sufer dispropor tionately from the back-alley abortionists, whose services they seek out in lieu of the medically safe hospital abortions generally denied them. In sharp contrast to the above data has been the experience in New York State since July 1, 1970, when categorical restrictions on abortion were eliminated. It is clear from this evidence that where the law has eliminated restrictions on the obtaining of abortions, the poor and non-white women who were previ ously unable to exercise the fnancial and other kinds of leverage required to have a therapeutic abortion, are able to obtain medically safe abortions on an equal basis with all other women, and they do obtain them to at least the same extent as their more privileged sisters. One result has been a drop in the maternal mortality rate: New York City hospitals now report treating far fewer victims of botched illegal abortions than they did in years past. It has been amply demonstrated above that poor and non-white women are not treated equally with other women in obtaining lawful abortions. The Equal Protection Clause of the Fourteenth Amendment requires the states to exercise their powers so as not to discriminate between their inhabitants except upon some reasonable differentiation fairly related to the object of regulations.

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Addition of bevacizumab to weekly paclitaxel significantly improves progression-free survival in heavily pretreated recurrent epithelial ovarian cancer hair loss after bariatric surgery buy cheap propecia online. The combination of intravenous bevacizumab and metronomic oral cyclophosphamide is an effective regimen for platinum-resistant recurrent ovarian cancer. Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum-sensitive ovarian carcinoma: a Gynecologic Oncology Group study. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline update. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. Fluorouracil-based chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma: 5-year analysis of the U. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta analysis. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: the Gastrointestinal Tumor Study Group. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. Second-line therapy after nab-paclitaxel plus gemcitabine or after gemcitabine for patients with metastatic pancreatic cancer. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology practice guideline. Clinical benefits of bicalutamide compared with flutamide in combined androgen blockade for patients with advanced prostatic carcinoma: final report of a double-blind, randomized, multicenter trial. Fifteen-year survival outcomes following primary androgen-deprivation therapy for localized prostate cancer. Duration of androgen suppression before radiotherapy for localized prostate cancer: Radiation Therapy Oncology Group randomized clinical trial 9910. Randomized phase 2 therapeutic equivalence study of abiraterone acetate fine particle formulation vs. Quality of life during treatment with chemohormonal therapy: analysis of E3805 chemohormonal androgen ablation randomized trial in prostate cancer J Clin Oncol. Abiraterone acetate for patients with metastatic castration-resistant prostate cancer progressing after chemotherapy: final analysis of a multicentre, open-label, early-access protocol trial. Systemic therapy in men with metastatic castration-resistant prostate cancer: American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. Response to flutamide withdrawal in advanced prostate cancer in progression under combination therapy. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Three-year safety of radium-223 dichloride in patients with castration-resistant prostate cancer and symptomatic bone metastases from phase 3 randomized Alpharadin in Symptomatic Prostate Cancer trial. Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: results from a phase 3, double-blind, randomised trial. Rational indication for docetaxel rechallenge in metastatic castration-resistant prostate cancer. Weekly docetaxel rechallenge in patients with hormone-resistant prostate cancer refractory to conventionally three weekly docetaxel. Nonmetastatic, castration-resistant prostate cancer and survival with darolutamide. Apalutamide and overall survival in non-metastatic castration-resistant prostate cancer. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Risk-adapted treatment in clinical stage I testicular seminoma: the third Spanish Germ Cell Cancer Group study. Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Paclitaxel plus Ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors. Sequential dose-intensive paclitaxel, ifosfamide, carboplatin, and etoposide salvage therapy for germ cell tumor patients. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Long-term survival with paclitaxel and gemcitabine for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. Combination chemotherapy with gemcitabine, oxaliplatin, and paclitaxel in patients with cisplatin refractory or multiply relapsed germ-cell tumors: a study of the German Testicular Cancer Study Group. Paclitaxel/carboplatin versus cyclophosphamide/adriamycin/cisplatin as postoperative adjuvant chemotherapy for advanced endometrial adenocarcinoma. Effect of taxane plus platinum regimens vs doxorubicin plus cisplatin as adjuvant chemotherapy for endometrial cancer at a high risk of progression: a randomized clinical trial. Weekly low-dose paclitaxel and carboplatin in the treatment of advanced or recurrent cervical and endometrial cancer. Paclitaxel and carboplatin in the treatment of advanced or recurrent endometrial cancer: a large retrospective study. Paclitaxel, carboplatin, and bevacizumab in advanced and recurrent endometrial carcinoma. A randomized comparison of doxorubicin alone versus doxorubicin plus cyclophosphamide in the management of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. Use of aromatase inhibitors as first and second-line medical therapy in patients with endometrial adenocarcinoma: a retrospective study. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. Challenging the paradigm of progesterone-only therapy for early endometrial cancer: results of a prospective trial of the levonorgestrel intrauterine system. Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: a meta-analysis and systematic review of the literature. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose-response study by the Gynecologic Oncology Group.

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In contrast to skin hair loss in men zumba buy propecia 5mg free shipping, the nail is not easy to biopsy and many physicians as well as patients are therefore reluctant to undertake this procedure. To obtain relevant results it is necessary to consider the following: 1 Nail changes usually reflect a pathological process of the matrix or (much less frequenly) of the nail bed. However, as in routine mycology, subungual keratotic material usually harbours the greatest amount of fungal elements. Even though they are usually easily diagnosable they may be indistinguishable from nail psoriasis and the conditions may in fact occur together. Superficial white onychomycosis is easy to diagnose: a tangential biopsy of the nail plate is taken with a no. Under the microscope, chains of small, regularly sized fungal spores are seen on the nail plate surface and in its splits, giving evidence of a Trichophyton mentagrophytes infection. Larger spores and short, thick-walled hyphae of irregular calibre are characteristic of a mould infection. The nail plate does not exhibit any further pathological alterations and the subungual structures remain normal. To diagnose distal and distal lateral subungual onychomycosis, either nail clippings with adherent subungual hyperkeratosis or a nail biopsy are necessary. Clipped material shows variable amounts of irregular masses of hyphae and often also thick-walled arthrospores. If there are only few fungi the wrong diagnosis of psoriasis unguium may then be made. For the diagnosis of proximal subungual onychomycosis, a disc of nail plate may be punched out of the nail plate; this is best done after soaking the digit in water for 10 minutes, to soften the nail plate. The punch is carefully advanced through the entire thickness of the nail plate until the reactive subungual keratosis is reached. The tissue A text atlas of nail disorders 270 sample is embedded, cut, and stained for fungi. In onychomycoses hyphae are seen to penetrate the entire thickness of the nail plate. Nail biopsies that include the proximal nail fold, nail plate, matrix and nail bed show hyphae in the stratum corneum of the underside of the proximal nail fold as well as fungi in different levels of the nail plate. Inflammatory changes are not pronounced as long as the fungi have not reached the nail bed epithelium. An intact nail plate is no longer seen, being replaced by irregular keratotic debris containing large amounts of fungal elements, both spores and hyphae. There is a considerable oedema in the papillary dermis and a variably dense lymphocytic infiltrate. Pits develop from tiny psoriatic lesions located in the most proximal matrix region. These produce parakeratotic mounds which remain on the nail plate surface as long as the growing nail is covered by the proximal nail fold; they then break off and leave a small depression in the nail surface. The depth of the pits reflects the severity of the lesion, their longitudinal diameter their duration. There is an inflammatory, mainly lymphocytic infiltrate in the upper dermis with wide capillaries, mild to moderate spongiosis with lymphocytic exocytosis and parakeratosis that may contain single neutrophils or small neutrophilic abscesses. Serum imbibition of the parakeratosis is probably the cause of their yellowish colour. When such a lesion reaches the hyponychium air penetrates under the nail plate and onycholysis develops. Psoriatic leukonychia is characterised by a more or less circumscribed area of parakeratosis in the nail plate. Acrodermatitis continua suppurative of Hallopeau may show different lesions: alterations known from pustular psoriasis, a spongiotic variant, or both spongiform pustules and spongiotic vesicles. It is characterized by subungual hyperkeratosis with alternating ortho and parakeratosis. A dense, band-like lymphocytic infiltrate is seen directly beneath the epidermis or matrix epithelium, respectively. Liquefaction degeneration of basal cells may be pronounced, causing extensive split formation between the dermis and epithelium. Involvement of the most proximal matrix is responsible for the frequent loss of nail sheen. With time, the cul-de-sac where the proximal nail plate is located flattens until it completely disappears and overgrows the matrix with loss of nail formation, which is clinically seen as a pterygium dorsale. Particularly in the matrix and proximal nail bed, spongiosis may be seen and even cause tiny spongiotic vesicles. Lichen striatus shows a band-like dense lymphocytic infiltrate of the affected nail portions with hydropic degeneration of basal cells, exocytosis, mild spongiosis, occasional dyskeratoses and granulosis. Histopathological examination shows irregular involvement of the matrix and nail bed. Orthokeratotic and parakeratotic keratinization are seen, as well as onycholysis and epithelial atrophy. The matrix and nail bed show a perivascular, band-like lymphocytic infiltrate that migrates into the spongiotic epithelium. Small spongiotic vesicles containing plasma are transported upwards and included in the nail plate, giving it its characteristic rough, opaque and thickened structure. Particularly in protein contact dermatitis due to food, there may also be a A text atlas of nail disorders 272 spongiotic dermatitis of the proximal nail fold. Pemphigus vulgaris may involve the matrix and nail bed with suprabasal acantholytic cleft formation and subsequent nail thinning. Bullous pemphigoid is characterized by a subepithelial cleft formation and an eosinophil-rich infiltrate. Cicatricial pemphigoid rarely involves the nail and may cause considerable nail dystrophy. Histologically, a pronounced subungual hyperkeratosis may be seen with dyskeratoses remaining identifiable. Furthermore, multinucleate epithelial cells, clumping cells and corps ronds are seen. Benign familiar pemphigus (Hailey-Hailey disease) is very similar, but multinucleate cells are usually not observed. Histological investigation reveals amyloid depositions around blood vessels and in the superficial dermis which interfere with nail substance formation. The amyloid exhibits positive Congo red staining and a bright light-green colour under polarization microscopy. Any recurrent blistering process around a finger nail, particularly when accompanied by early lymphangitis and radiating pain, should prompt a cytological examination. The blister roof is opened and a Tzanck smear taken for microscopic investigation as well as for virus culture or molecular biological tests. Early blisters with clear watery contents exhibit mainly keratinocytes, some of which are giant and multinucleated. Securing the blister roof for histological sections may be necessary to rule out an early bullous impetigo (run-around). Tzanck tests demonstrate an essentially similar picture to that of herpes simplex. Histology of early lesions reveals spongiosis, mononuclear exocytosis and an occasional large keratinocyte. Keratin cysts Various types of keratin-filled cysts may occur under or around the nail.

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Nocardiae are aerobic and acid-fast hair loss jaundice purchase propecia, in contrast to Actinomyces species, which are strict anaerobes and not acid-fast. Progressive pneumonia with purulent sputum and abscesses is suggestive of nocardiosis, especially if dissemination to the brain or subcutaneous tissue occurs. Nocardia is also one cause of myce toma, a form of chronic inflammation of the skin that causes indurated abscesses with multiple draining sinuses. These rods tend to arrange themselves at right angles, producing characteristic V or Y configurations described as Chinese characters. This toxin can produce a pseudomembrane covering the larynx, which is difficult to peel away without causing bleeding, and heart General Pathology Answers 147 damage with fatty change. Characteristics that are unique to Listeria include a tumbling motility on hanging drop and an umbrella-shaped motility pattern when a specimen is stabbed into a test tube agar slant. Infection results in a chronic disease that is characterized by superficial ulcers of the genital region. Regional lymph node involvement produces large nodular masses that develop extensive scarring. Instead, histologic examination is used to demonstrate Donovan bodies, which are organisms within the cytoplasm of macro phages. Chancroid is an acute venereal disease that is characterized by painful genital ulcers with lymphadenopathy. Gram stains of the suppurative lesions or cultures on spe cialized media may be used to make the diagnosis. Neisseria gonorrheae, a gram-negative diplococcus, causes gonor rhea, an acute suppurative infection of the genital tract. In women, it may be asymptomatic (50%), or it may produce infection of the cervix with accom panying vaginal discharge, dysuria, and abdominal pain. In newborns, infection acquired during birth can produce a purulent conjunctivitis (ophthalmia neonatorum). A Gram stain of the urethral or cervical exudate may reveal the intracytoplasmic gram negative diplococci, or the exudate can be cultured on special media. Dark-field or immunofluorescence examination may be used to detect organisms in the genital ulcers of primary syphilis. Antibodies to cardi olipin, a substance in beef heart that is similar to a lipoid released by T. Chlamydia species are obligate intracellular parasites that form elementary bodies and reticulate bodies. The former are small, extra cellular, and infectious, while the latter are intracellular and noninfectious. Specialized culture media and direct examination procedures are available to aid in the diagnosis of these diseases. The regional lymph nodes in patients with lymphogranuloma venereum have a characteristic histologic appearance typified by necrotizing granulomas forming stellate areas of necrosis. It is a chronic infection of the conjunctiva that eventu ally scars the conjunctiva and cornea. Lymphogranuloma venereum is a sexually transmitted disease that is characterized by the formation of a gen ital ulcer with local necrotizing lymphadenitis. It produces a severe pul monary disease and should be suspected in patients with a history of bird contact, such as pet shop workers or parrot owners. This disorder was first described in the mid-1970s in Connecticut General Pathology Answers 149 when small clusters of cases of children who developed an illness resem bling juvenile rheumatoid arthritis were first noted. The disease has now been shown to be caused by a spirochete, Borrelia burgdorferi, through the bite of a tick belonging to the genus Ixodes. The spirochete-infested ticks reside in wooded areas where there are deer and small rodents. In the spring the tick larval stage emerges and evolves into a nymph, which is infective for humans if they are bitten. The bite is followed by a rash called erythema chronicum migrans, which may resolve spontaneously. However, many patients have a transient phase of spirochetemia, which may allow the spread of the spiro chete to the meninges, heart, and synovial tissue. Originally thought to be confined to New England, Lyme disease has now been shown to be present in Europe and Australia as well. It may be an autoimmune reaction to previous gas trointestinal or genitourinary infections. Causes of these gastrointestinal infections include Shigella, Salmonella, Yersinia, and Campylobacter. Serologic tests for rickettsia include complement fixation tests and the Weil-Felix agglutination reaction. The basis for the latter test is the fact that the sera of infected patients can agglutinate strains of Proteus vulgaris. The vector in the Rocky Mountains is the wood tick (Dermacentor andersoni), while in the southeast it is the dog tick (Der macentor variabilis) and in the south central United States it is the Lone Star tick. Intracellular bacilli form parallel rows in an end-to-end arrangement (flotilla at anchor facing the wind). Histologically, this disease is characterized by the formation of stellate microabscesses with necrotizing granulomas. Numerous bacilli in packets within histiocytes (lepra cells) are also found in the lesions of lepromatous leprosy. Polyclonal hypergammaglobu linemia often occurs in lepromatous leprosy, in which patients do not have the adequate cellular immune response of the tuberculoid form. Large amounts of antilepra antibody occur in the lepromatous form with fre quent formation of antigen-antibody complexes and resultant disorders such as erythema nodosum. A clear zone between infiltrate and overlying epidermis is characteristic of lepromatous leprosy, unlike the encroach ment on basal epidermis of the tuberculoid infiltrate. Mycobacteriaceae are General Pathology Answers 151 slow-growing aerobic rods with cell walls rich in glycolipids, true waxes, and long-chain fatty acids called mycolic acids. The initial infection of primary tuberculosis, the Ghon com plex, consists of a subpleural lesion near the fissure between the upper and lower lobes and enlarged caseous lymph nodes that drain the pulmonary lesion. Although primary pulmonary tuberculosis is usu ally asymptomatic, systemic and localizing symptoms can occur. These symptoms include malaise, anorexia, weight loss, fever, night sweats, cough, and hemoptysis. The pulmonary lesion of secondary tuberculosis is usually located in the apex of one or both lungs. Progressive pulmonary tuberculosis may result in cavitary fibrocaseous tuberculosis, miliary tuber culosis, or tuberculous bronchopneumonia. Miliary tuberculosis consists of multiple small yellow-white lesions scattered throughout the entire lung. These lesions are the result of erosion of a granulomatous lesion into a blood vessel with subsequent lympho-hematogenous dissemination. Acid-fast stains of spu tum are followed with culture, not only to identify the species of mycobac terium but to determine the pattern of antibiotic sensitivity. This organism is almost ubiquitous in water and is spread by inhalation of contaminated airborne droplets. Infection results in a patchy bronchopneumonia, and microscopically the alveolar spaces are filled with an inflammatory exudate of neutrophils and macrophages. Organisms cannot be visual ized by routine stains, so instead a Dieterle silver stain is used. They are separated into different classes (Runyon classes) based on several culture characteristics, such as pigment produc tion, colony morphology, and rate of growth. Histologic sections in these immunosuppressed patients do not reveal granulomas because the cellular immune reactions of these patients are defective. It can cause superficial disease or skin and subcutaneous disease, and can be obtained from infected aquariums or swimming pools.

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Detection of cathepsin B up-regulation in biomarkers for papillary thyroid carcinoma using gene expression neoplastic thyroid tissues by proteomic analysis hair loss cure natural generic 1 mg propecia free shipping. Tissue and serum samples of patients with papillary thyroid cancer with and without benign background demonstrate different altered expression of proteins. Fine-needle aspiration of thyroid nodules: Proteomic analysis to identify cancer biomarkers. Proteomic study of thyroid tumors reveals frequent up-regulation of the Ca2+ -binding protein S100A6 in papillary thyroid carcinoma. Proteomics of thyroid tumours provides new insights into their molecular composition and changes associated with malignancy. Discovery and identification of potential biomarkers of papillary thyroid carcinoma. Decreased annexin A3 expression correlates with tumor progression in papillary thyroid cancer. Imaging mass spectrometry in papillary thyroid carcinoma for the identification and validation of biomarker proteins. Differential protein expression profiles of cyst fluid from papillary thyroid carcinoma and benign thyroid lesions. Damp-Heat in the triple Jiao (lower) Signs & symptoms: Headache and facial flushing, bitter taste in the mouth, conjunctivitis, swollen nd painful ears, hair dry stool, inflammation of the genitalia, groin rashes. Depression and binding of the Liver Qi due to emotional frustration and unresolved stress produces a soft or firm goitre which is painless and fixed 2. Chronic Yin Deficiency generates internal Heat producing a firm, painless goitre with palpitations, night sweats, insomnia etc 3. A Deficiency of Heart and Kidney Yang produces a swelling in the neck accompanied by arthralgia and myalgia, weakness and fatigue, cold limbs and body, bradycardia, puffy swelling in the eyes and face, physical and mental listlessness 5. The Spleen is weakened due to improper diet (gluten) and other factors like overwork, worry and lack of appropriate exercise. Signs & symptoms: poor appetite and digestion with bloating after meals, belching, flatulence, acid reflux or nausea, loose stools, distension in epigastrium with a sense of fullness, fatigue, pale tongue and a greasy, white coat. Antonio Cardesa Department of Pathological Anatomy Hospital Clinic University of Barcelona Villarroel 170 08036 Barcelona Spain Professor Pieter J. All rights are reserved, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other way and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Product liability: the publishers cannot guarantee the accuracy of any information about dosage and applica tion contained in this book. In every individual case the user must check such information by consulting the relevant literature. Foreword Pathology of the Head and Neck is an easy sounding pathology of the head and neck that remain an unex title for a complex subject matter. Examples include the never-ending prob accumulation of diverse diseases occurring in different lem of prognostication of tumour diseases, the patho organs whose relationship to each other consists in the genetic significance of tumour precursor lesions and fact that they are located between the base of the skull the validation of appropriate sets of tumour markers as and the thoracic aperture. As such surgical pathologist to focus on one of these organs and they are the main members of the Working Group on neglect the pathology of others, which are only a centi Pathology of the Head and Neck of the European Society metre apart. A second reason, however, is that the upper of Pathology, one of the first European working groups digestive tract and the upper respiratory tract, which to be founded under the auspices of the European Soci meet in the larynx, have some basic diseases in com ety of Pathology. Thus pathology tise of outstanding experts on the pathology of the head of the head and neck is both an arbitrary compilation of and neck in Europe is reflected. The chapters are char diseases and, at least to some extent, a group of disease acterised by the desire to correlate pathology with all entities with a common morphological and pathoge necessary information on clinical features, epidemiolo netic trunk. The authors of the past years have seen remarkable advances in these chapters have not attempted to be encyclopaedic, many fields of pathology, including that of the head and but rather have aimed at providing concise, yet adequate neck. They are therefore to be warmly commend pathology with molecular genetics, epidemiology, clin ed for providing us with an excellent book, which will ical behaviour and biology. This book provides a com prove useful to surgical pathologists involved in the pa prehensive description of the manifold aspects of the thology of the head and neck. The pathology of the thyroid and parathyroid chapters on Pathology of the Head and Neck, to be glands and lymph nodes is covered in greater detail published in German within the series of volumes of elsewhere. From the outset, the Since the authors selected for writing the different editorial approach was to concentrate on pathological chapters are international experts and members of the entities that are either unique to or quite characteristic of Working Group on Head and Neck Pathology of the the head and neck. At the same time, we strove to avoid European Society of Pathology, the chief editors of the as much as possible unnecessary details on systemic series, Prof. Gunter Kloppel, accepted that all manuscripts region, have their main focus of activity in other organs. Therefore, we want to thank the chief to distally the upper borders of the sternal manubrium, editors and the publisher Springer for their stimulating clavicles and first ribs. We add our special thanks to the au aerodigestive tract, salivary glands, dental apparatus, thors who produced such an excellent work, as well as to thyroid and parathyroid glands, as well as all the those secretaries, photographers and others who helped epithelial, fibrous, fatty, muscular, vascular, lymphoid, them. The ever written as a joint project by a Working Group of the first covers the spectrum of precursor and neoplastic European Society of Pathology, could serve as an example lesions of the squamous epithelium. Antonio Cardesa salivary glands, nasopharynx and Waldeyer`s ring, larynx and hypopharynx, ear and temporal bone, Nijmegen, the Netherlands Prof. Slootweg neck and neck dissection, as well as eye and ocular March 2006 Contents 1 Benign and Potentially Malignant 1. Box 21 (Haartmaninkatu 3) Villarroel 170, 08036 Barcelona, Spain 00014 University of Helsinki, Helsinki, Finland M. Physicians should be familiar with Metabolism,TheJohnsHopkins UniversitySchoolofMedicine,1830E the advantages and disadvantages of each therapy to best counsel their patients. It is the most common cause of hyperthyroidism with 20 references of selected articles, reviews, meta-analyses, and prac to30casesper100 000individualseachyear. Most patients with Graves disease have overt hyperthyroidism and a variety of characteristic symptoms and physical findings (Table 1). Methods Physical findings include tachycardia, proptosis, thyroid enlarge We searched PubMed and the Cochrane databases for English ment, and tremor. Older patients are less symptomatic than language studies published from June 2000 through October 1, younger patients. SymptomsandSignsofThyrotoxisosisa loss with a decrease in appetite is common among older patients 4 Prevalence, %b with hyperthyroidism. Possible laboratory findings in Graves disease include leukopenia, hypercalcemia due to increased Symptoms osteoclastic activity, increased bone alkaline phosphatase, and Fatigue 70 3 Weight loss (poor appetite)c 60 mild-to-moderate transaminase elevation. Substantially reduced bone mineral density should warrant thyroid function evaluation Heat intolerance 55 in postmenopausal women. Antithyroid drug therapy also is associated with ness, anxiety, and heat sensitivity. Most patients do pranolol or the rapidly acting cardioselective blocker esmolol is not require more than 30 to 40 mg per day. For the first 3 to 6 Antithyroid Drug Adverse Effects months,bothserumfreeT4andT3orfreeT3shouldideallybemoni Minor adverse effects such as pruritic rash and arthralgias occur in tored because some patients normalize their free T4levels but T3 approximately 5% of patients receiving methimazole, and typically levels remain elevated. After the first 6 months, the dose can usually be de antithyroid drugs include agranulocytosis, hepatotoxicity, and anti creased with maintenance doses of 5 to 10 mg per day. Prior to initia to maintain euthyroidism with low-dose antithyroid drugs is a pre tion of antithyroid drug therapy, the potential adverse effects dictor of remission. AdverseReactionstoAntithyroidDrugs Drug Reactions Methimazole/Carbimazole Propylthiouracil Comments Minor Rash, gastrointestinal Incidence 1% to 5% (dose-related)34 Incidence 1% to 5%34 Rash and itching may be manageable with distress antihistamine therapy; cross-reactivity for rash with the alternate drug in 30% to 50% of patients45 Major Agranulocytosis Incidence is approximately 0. Occasional Methimazole-inducedhepatotoxicityisfrequentlycholestatic,55 patients require a longer time, with repeat treatment generally not whereas propylthiouracil use has been associated with hepatocel considered before 6 months after the initial therapy. The reported that methimazole can produce hepatocellular toxicity destruction of thyroid tissue occasionally results in transient wors similar to that seen with propylthiouracil. EffectofRadioactiveIodineTherapyonGravesOrbitopathy a Allsourceswererandomizedclinical Developing New or Worsened Eye Disease Following Treatment, trials. Patientsshouldbestarted Drugs and as Primary Therapy on levothyroxine therapy immediately when free T4levels fall be Since the introduction of antithyroid drugs in the 1940s-1950s, low the normal range7 because untreated hypothyroidism is an potassium iodide has been avoided as primary medical therapy in otherriskfactorfortheworseningoforbitopathy. However, some patients,79likely due to the continued excessive caloric in in a 2014 report from Japan, 30 patients with mild Graves disease take despite a return to normal metabolism. After 12 months, control of thyroid function was comparable with Surgery for Hyperthyroidism Caused by Graves Disease that seen in patients receiving low-dose methimazole treatment.

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We submit also that no physician who understands this will argue that the law is vague hair loss cure 2015 1 mg propecia amex, uncertain or overbroad for he will understand that the law calls upon him to exercise his art for the beneft of his two patients: mother and child. By a natural and continuous process the single fertilized ovum will, over approxi mately nine months, develop into the trillions of cells of the newborn. At fertilization a new and unique being is created which, although receiving one-half of its chromo somes from each patient, it really unlike either. Tese were well-known images at the time, taken by the Swedish photographer Lennart Nilsson and published in A Child Is Born: The Drama of Life before Birth, by Axel Ingelman-Sundberg and Claes Wirsen [Dell Publishing Company, 1965]. The genetic pattern set down in the frst day of life instructs the development of a specifc anatomy. The ears are formed by seven weeks and are specifc, and may resemble a family pattern. The lines in the hands start to be engraved by eight weeks and remain a distinctive feature of the individual. By the end of the month he can kick his legs, turn his feet, curl and fan his toes, make a fst, move his thumb, bend his wrist, turn his head, squint, frown, open his mouth, press his lips tightly together. The frst respiratory motions move fuid in and out of his lungs with inhaling and exhaling respiratory movements. The alignment of the muscles of the face, for example, follow an inherited pattern. The facial expressions of the baby in his third month are already similar to the facial expressions of his parents. Sexual diferentiation is apparent in both internal and external sex organs, and primitive eggs and sperm are formed. In the absence of air they cannot produce sound; the child cannot cry aloud until birth, although he is capable of crying long before. Fine baby hair begins to grow on his eyebrows and on his head and a fringe of eyelashes appear. When he sleeps he invari ably settles into his favorite position called his lie. When he awakens he moves about freely in the buoyant fuid turning from side to side, and frequently head over heel. Movements of the mother, whether locomotive, car diac or respiratory, are communicated to the child. He also starts to breathe regularly and can maintain respiratory response for twenty-four hours if born prematurely. The youngest children known to survive were between twenty to twenty-fve weeks old. By this time the individual ity of this human being should be clear to all unbiased observers. When one views the present state of medical science, we fnd that the artifcial distinction between born and unborn has vanished. This review of the current medical status of the unborn serves us several pur poses. Firstly, it shows conclusively the humanity of the fetus by showing that human life is a continuum which commences in the womb. The child is as much a child in those several days before birth as he is those several days afer. The maturation process, commenced in the womb, continues through the post-natal period, infancy, adolescence, maturity and old age. Whatever personal right of privacy a pregnant woman may have with respect to the disposition and use of her body must be balanced against the personal right of the unborn child to life. Whatever the metaphysical view of it is, or may have been, it is beyond argu ment that legal concepts as to the nature and rights of the unborn child have dras tically changed, based on expanded medical knowledge, over the last 2,500 years. It is most seriously argued that the life protected by the Due Process of Law Clause of the Fifh Amendment includes the life of the unborn child. If it is a denial of equal protection for a statute to distinguish between a thief and an embezzler under a statute providing for the sterilization of the one and not the other, then it is surely a denial of equal protection for either the state or federal government to distinguish between a person who has been born and one living in the womb of its mother. Oklahoma, the Court had ruled that it violated equal protection for the state to punish by sterilization a person convicted of three or more felonies involving moral turpitude while not similarly punishing a felon convicted of embezzlement. If it be true that the compelling state interest in prohibiting or regulating abortion did not exist at one time in the stage of history, under the result of the fndings and research of modern medicine, a diferent legal conclusion can now be reached. The fact that a statute or law may originally have been enacted to serve one purpose does not serve to condemn it when the same statute, with the passage of time, serves a diferent but equally valid public purpose. Known in Supreme Court parlance as hand-downs, these summaries are not casual documents. Although it is not clear whether anyone on the Court anticipated the passionate and prolonged confict the abortion right has generated, the document indicates that Blackmun was aware that the decision would generate controversy; the previous week, he had sent a draf of the announcement to Chief Justice Warren E. Burger with the notation, I anticipate the headlines that will be produced over the country when the abortion decisions are announced. It incorporates the handwritten additions and changes that Blackmun made on his fnal typed draf. These are the two abortion cases that were argued first in December 1971 and again last October. They are appeals from three-judge federal courts in the North ern Districts of Texas and of Georgia respectively. The lawsuits attack the constitutionality of the Texas and Georgia abor tion statutes. The actions were instituted by pregnant women, both married and unmarried, by a married couple in the Texas case, and by physicians and others alleging an interest in the subject matter. The Texas statue is representative of those presently in efect in a majority of our states and that, for the most past, were enacted during the last half of the nine teenth century. The Texas statue prohibits any abortion, or any attempt at an abor tion, except where is it procured by medical advice for the purpose of saving the life of the woman. It makes no reference to health, as does the District of Columbia statute considered in United States v. It is representative of recent legislation enacted in approximately one-quarter of our states. These excep tions are where the abortion is performed by a licensed physician and, based upon his best clinical judgment, the abortion is necessary because the pregnancy if con tinued would endanger the life or health of the woman, or the fetus would very likely be born with a grave and permanent mental or physical defect, or the preg nancy resulted from forcible or statutory rape. The Georgia statute also imposes certain procedural conditions for the obtaining of the abortion. These are several in number, but among them are (1) Georgia residence, (2) concurrence in the abortion decision by two licensed physicians in addition to the attending [physi cian], (3) performance of the procedure in a hospital both licensed by the state and accredited by the Joint Commission on Accreditation of Hospitals, and (4) approval by a hospital abortion committee of 3 physicians. The Texas federal court held that a woman had a right, protected by the Ninth and Fourteen[th] Amendments, to choose whether to have children and that the Texas statute was therefore void on its face.

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The the capillaries into tissues in the development period of diastole (usually 95 mmHg) lasts of inflammation about 0 hair loss cure erectile purchase propecia now. Two large electrodes will in breathing, expands and contracts with the give a warming effect over a large area (med walls of the chest. The average rate of respi ical diathermy); if one of the electrodes is ration is about 16 times a minute. In the long term it is poten to reduce weight by reducing the amount of tially addictive. Compare mono physician] chromatism, trichromatism diet sheet diclofenac sodium diet sheet / dat i t/ noun a list of sugges diclofenac sodium /daklfen k tions for quantities and types of food given to sdim/ noun an anti-inflammatory drug someone to follow used to treat rheumatic disease differential dicrotic pulse differential / dffi renl/ adjective referring dicrotic pulse /dakrtk p"ls/, dicrotic to a difference wave /dakrtk wev/ noun a pulse which differential blood count occurs twice with each heartbeat differential blood count /dffirenl dicrotism bl"d kant/, differential white cell count / dicrotism / dakrtzm/ noun a condition dffirenl wat sel kant/ noun a test that in which the pulse occurs twice with each shows the amounts of different types of white heartbeat blood cell in a blood sample die differential diagnosis die /da/ verb to stop living His father died differential diagnosis /dffi renl last year. There ponents which are absorbed into the body are two types of fibre in food: insoluble fibre, digestible. Fibre is thought to be neces digestion /dad estn/ noun the process sary to help digestion and avoid developing by which food is broken down in the alimenta constipation, obesity and appendicitis. Also called alimentary sys dilute /dalu t/ adjective with water added i tem verb to add water to a liquid to make it less digestive tract concentrated Dilute the disinfectant in four digestive tract /dad estv tr kt/ noun same as alimentary canal parts of water. The Schick test bad light or to drugs is used to test if a person is immune or sus dilatation and curettage ceptible to diphtheria. In countries where in dilatation and curettage /daleten fants are immunised the disease is rare. Abbr D & C -dipine dilate -dipine /dpn/ suffix used in the names of cal dilate /dalet, dlet/ verb to become wider cium channel blockers nifedipine or larger, or make something become wider or dipl dipl /dpl/ prefix same as diplo (used before larger the veins in the left leg have become vowels) dilated. The drug is used to dilate the pupil diplacusis diplacusis /dplkju ss/ noun a disorder of the eye. Compare hemiplegia dilator pupillae muscle /daletpju pli diplegic m"sl/ noun a muscle in the iris which pulls diplegic /dapli d k/ adjective referring to the iris back and so makes the pupil expand diplegia 111 disinfection diplo diplo /dpl/ prefix double wound discharged a thin stream of pus. In humans number of patients with a particular type of the diploid number of chromosomes is 46. If the skin on the lips is discoloured it may tions showing how to use something and how indicate that the person has swallowed a poi much of it to use son. Diseases with dis ing from a physical or mental condition which tinct characteristics have individual names. For makes some activities difficult or impossible other terms referring to disease, see words be Disabled Living Foundation Disabled Living Foundation /ds ebld ginning with path-, patho-. Substances used displacement /ds plesmnt/ noun the fact to kill microorganisms inside infected people of being moved out of the usual position are antibiotics. Cardiac dissection takes about 20 someone has palpitations, breathlessness and minutes and lung dissection takes 60 to 90 minutes. Opposite the meibomian glands convergent strabismus distil diverticula distil /dstl/ verb to separate the component diverticula / davtkjl/ plural of diver parts of a liquid by boiling and collecting the ticulum condensed vapour diverticular disease distillation diverticular disease /davtkjlddistillation / dstlen/ noun the action zi z/ noun a disease of the large intestine, of distilling a liquid where the colon thickens and diverticula form distilled water distilled water /dstld wt/ noun water in the walls, causing pain in the lower abdo which has had impurities by distillation men distort diverticulitis distort /dstt/ verb to twist something into diverticulitis /davtkjlats/ noun in an unusual shape His lower limbs were dis flammation of diverticula formed in the wall of torted by the disease. The dos politely to the genital area (informal) age for children is half that for adults. Also called disease caused by the guinea worm Dracuncu iron lung drip lus medinensis which enters the body from in drip /drp/ noun a system for introducing liq fected drinking water and forms blisters on the uid slowly and continuously into the body, by skin, frequently leading to secondary arthritis, which a bottle of liquid is held above a person fibrosis and cellulitis and the fluid flows slowly down a tube into a Dracunculus Dracunculus /drk"kjls/ noun a para needle in a vein or into the stomach After her sitic worm which enters the body and rises to operation, the patient was put on a drip. The infection fre drip feed drip feed / drp fi d/ noun a drip containing quently leads to secondary arthritis, fibrosis nutrients and cellulitis. It who regularly uses drugs for non-medical pur usually affects boys and causes early death. Also duct /d"kt/ noun a tube which carries liquids, called drug dependence especially one which carries secretions drug allergy duct gland drug allergy / dr"& ld i/ noun a reaction duct gland / d"kt &l nd/ noun same as exo to a particular drug crine gland drug dependence ductless drug dependence / dr"& dpendns/ noun ductless / d"ktls/ adjective without a duct same as drug addiction ductless gland drug-related ductless gland /d"ktls &l nd/ noun drug-related / dr"& rletd/ adjective asso same as endocrine gland ciated with the taking of drugs ductule drug tolerance ductule / d"ktju l/ noun a very small duct drug tolerance / dr"& tlrns/ noun a ductus ductus / d"kts/ noun same as duct condition in which a drug has been given to ductus arteriosus ductus arteriosus / d"kts tri ss/ someone for so long that his or her body no noun in a fetus, the blood vessel connecting the longer reacts to it, and the dosage has to be in left pulmonary artery to the aorta so that blood creased does not pass through the lungs drunk ductus deferens drunk /dr"k/ adjective intoxicated with too ductus deferens / d"kts deffirnz/ noun much alcohol one of two tubes along which sperm pass from dry dry /dra/ adjective 1. Dwarfism duodenum can have other causes such as rickets or de duodenal ficiency in the pituitary gland. It der caused by differences between the atmos takes bile from the gall bladder and pancreatic pheric pressure outside the body and the pres juice from the pancreas and continues the di sure inside gestive processes started in the mouth and dysbasia dysbasia /ds bezi/ noun difficulty in stomach. The symptoms include diarrhoea, duty rota discharge of blood and pain in the intestines. Behind the eardrum, the three types and quantities of food regularly eaten by ossicles in the middle ear vibrate with sound and transmit the vibrations to the cochlea in a person the dietitian advised her to change the inner ear. Ebola virus Ebola virus /blvars/ noun a highly Ear, Nose & Throat contagious virus found in West Africa. Pa Ear, Nose & Throat /nz n rt/ nounthe study of the ear, nose and throat. Also called otorhinolarngology bloody diarrhoea and blood seeps through earache their skin. Also eburnation called otalgia eburnation / i bnen/ noun the conver ear canal sion of cartilage into a hard mass with a shiny ear canal / kn l/ noun one of several surface like bone passages in or connected to the ear, especially ecbolic the external auditory meatus, the passage from ecbolic /ek blk/ noun a substance which the outer ear to the eardrum produces contraction of the uterus and so in eardrum duces childbirth or abortion i adjective caus eardrum / dr"m/ noun the membrane at the ing contraction of the uterus end of the external auditory meatus leading ecchondroma ecchondroma /ekn drm/ noun a be from the outer ear, which vibrates with sound nign tumour on the surface of cartilage or bone and passes the vibrations on to the ossicles in ecchymosis the middle ear. Compare en ultrasound doparasite echocardiography ectopia echocardiography /ekkdi &rfi/ ectopia /ek tpi/ noun a condition in noun the use of ultrasound to examine the heart which an organ or part of the body is not in its echoencephalography usual position echoencephalography /eken keffi lectopic &rfi/ noun the use of ultrasound to examine ectopic /ek tpk/ adjective not in the usual the brain position. Opposite entopic echography ectopic heartbeat echography /e k&rfi/ noun same as ultra ectopic heartbeat /ek tpk htbi t/ sonography noun an unusual extra beat of the heart which echokinesis originates from a point other than the sinoatrial echokinesis / ekkani ss/ noun same as echopraxia node. Also called extrauterine pregnancy, ec teritis and respiratory infection in small chil cyesis ectro dren. Compare reovirus ectro /ektr/ prefix referring to a usually eclabium congenital absence or lack of something eclabium /klebim/ noun the turning out ectrodactyly wards of the lips. Also called embryonic ec chromosome 18 and those people who have it toderm usually die within six months. In some cir ulates too early during sexual intercourse cumstances these drugs can effect surprising ejaculatory ejaculatory /d kjltri/ adjective refer cures. Also called elec operation in which the surgeon uses an electri troplexy cal current to cut or cauterise tissue electrode electrotherapy electrode /lektrd/ noun the conductor of electrotherapy /lektrerpi/ noun the an electrical apparatus which touches the body treatment of a disorder such as some forms of and carries an electric shock paralysis by using low-frequency electric cur electrodesiccation rent to try to revive the muscles electrodesiccation /lektrdeselement element / elmnt/ noun a basic simple ken/ noun same as fulguration chemical substance which cannot be broken electroencephalogram electroencephalogram /lektrn down into simpler substances. Many different materi emission /mn/ noun a discharge or re als are used as the embolus. The variant St empathy / empi/ noun the ability to under Louis encephalitis is transmitted by mosqui stand the problems and feelings of another per toes. It encephalocele can be caused by smoking, living in a polluted encephalocele /en keffilsi l/ noun a con environment, old age, asthma or whooping dition in which the brain protrudes through a cough. Compare exo endanger crine gland endanger /n dend / verb to put someone endocrine system or something at risk the operation may en endocrine system / endkran sstm/ danger the life of the patient.