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Oct 20, 2013 (1 year and 7 days ago)

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Diagnosaurus





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Quick answers





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Taber ‘s dictionary





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Elsevier ‘s dictionary



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Stockley's Drug Interactions Pocket Companion
2010


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Stockley's Drug Interactions Pocket Companion
2009


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Bnf BLUE 2009





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Bnf pink 2009





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bnf orange 2009





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WHO model formulary




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Oxford Handbook of Practical Drug Therapy



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Pathology and Therapeutics for Pharmacists, 3rd edition

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Greek national formulary
2007




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Bratton's Family Medicine Board Review, 3 e 2007



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Family Practice Examination & Board Review, Second Edition (McGraw
-
Hill Specialty Board Review)



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Handbook of Diseases, Third Edition



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αττικο

νοσοκομειο



αλκης

μιχαλης



apostolidou
@
freemail
.
gr

civylla
@
gmail
.
com

ξανθη αποστολιδου
καρδιολογος για την εργασια με τις
αναπνοες ιπποκρατειο


αριστος

γαλανος

6948 00 38 62


γκαρμιρη

6973 828 255



anatomy

templates




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CNS







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Oral hypoglycemics and insulin analogs


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Ηπατοτοξικα

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Νεφροτοξικα

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Φαρμακα και εγκυμοσυνη



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Ototoxi
c

drugs





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Antithrombotics




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Major drug groups




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Frequently Used Neurologic Drugs


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Therapeutic Agents Used in Emergency Settings with Known
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List of bestselling drugs




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M

edical sign



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Medical signs





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Zoonosis





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Drug templates





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Drug templates by structure



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Otologicals





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list of
human eye

diseases and disorders

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Clinical biochemistry blood tests



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Template:Eye pathology




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Murtaght

Guidelines λιονης [ χαπ


ασθμα ]

Περιφερικο ιατρειο λιονης

[ εμβολια


ΚΑ


ΑΥ ]

Ημεριδες παπαδακη [ ΑΥ


λοιμωξεις αναπνευστικου


οστεοπορωση


ΣΔ


ινσουλινοθεραπεια


ΑΕΕ ]

Ηπατιτιδες

Φυματιωση

ΗΚΓ

Doatap
.
gr

Σπιρομετρηση

Ορμονες


εγκυμοσυνη



ΧΑΡΤΗΣ ΚΕΝΤΡΩΝ ΥΓΕΙΑΣ


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Portals :


//
Bmc family practice



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Username buzz@msn.com

Password Bugger



//
HNMC Library's Blog




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// electronic books




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// senior ‘s health




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// specific health websites



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// the online books page



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bOoKs :


1//
Rang et al
-

Pharmacology 5th ed


2006

|
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|


2// Clinical methods

Walker et al
-

The History, Physical, and Laboratory
Examination 3rd ed


Introduction


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|

Cardiovascular system

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Pulmonary system

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Nervous system


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Ear nose mouth throat

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Autonomic NS


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Gastrointestinal S

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Skin



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Eye



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Endo
crine S


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Hematopoietic S

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Musculoskeletal S

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Female genitalia and breasts

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Genitourinary S

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Psychiatry


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General exam


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|

Special groups


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3//
ΕΟΦ

2007

eof_




|
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|


4// The Washington Manual of Medical Therapeutics, 33
rd

Edition
2010





|
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|


5// Ferri's Clinical Advisor 2008



|
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|

Instant Diagnosis and Treatment


6// Rudolph ‘s pediatrics



|
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|

21
st

edition


7//
Evidence
-
Based Emergency Care


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|

Diagnostic Testing and Clinical Decision Rules


8// clinician ‘s pocket refe
rence



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|



9// cEciL 23
rd

edition




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10// bone and muscle




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11// the digestive system



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Some more books




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12//
The Brain and the Nervous System (The Human Body)






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|


13//
The Reproductive System (The Human Body)







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1
4//
The Respiratory System (The Human Body)

|
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|


15//
Musculoskeletal Examination 2nd Edition

|
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|


And

3
rd

edition



|
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|


16//
Blood: Physiology and Circulation (The Human Body)







|
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|


17// links to illustrated human body books

|
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|


18
//
Rosen and Barkin's 5
-
Minute Emergency
Medicine Consult, 3 e 2006









|
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|


19//
The Cardiovascular System (The Human Body)

|
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|


20// links to
focused medical info

books


|
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|


21//
Adolescent
Health Care: A Practical Guide, 5th Edition






|
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|


22// free download medical books


|
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|


23//
d
é
j
à

revie
w internal medicine

|
go
|


24//
d
é
j
à

emergency



|
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|


25//
d
é
j
à

pediatrics




|
go
|


26//
déjà obstetrics / gynecology


|
go
|


27/
déjà surgery




|
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|


28//
d
é
j
à

psychiatry




|
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|


29// Clinical Methods




|
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|


30// nice collection of notes



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|


31//
Screening Physical Exam


|
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|


32// Anatomy
-
Histology Tutorials


|
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|


33// the amazing brain




|
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|


34//
24 Professional Guide to Diseases, 9
th
|
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|


35// THE HARRIET LANE HANDBOOK


|
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|

pediatrics


36// critical care




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|


37// Assessing and Managing the Acutely Ill

Adult Surgical Patient




|
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|


38// adult medical emergencies



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|


39// Disease Markers in Exhaled Breath


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|


40// MUSCULOSKELETAL HISTORY


|
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|


41// pRacticaL insulin




|
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|


42
//
// Comcast.net anatomy


|
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|


43// Clinical Methods,
3rd edition


|
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|

The History, Physical, and Laboratory Examinations

44//
pathophysiology of the endocrine system


|
go
|


45//
The complete, authoritative, constantly updated source on
clinical endocrinology




|
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|


46// kidneyatLas online




|
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|


47//
tExtboOk of c
ArdiovascuLAr
mEdiciNe

|
go
|



48//
BLOOD DISORDERS AND DISEASES
BLOODBOOK.COM







|
go
|


49//
Tom Evans' ECG
Cribsheets
-

PDA Version

|
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|


// 50
CURRENT Practice Guidelines in
Primary Care, 2009




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|

Clinical Preventive
Services




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|

CDC A to Z






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|


inpatient and outpatient care that is
medically necessary
and considered proven
.





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|


A
-

Z Index for Clinical Preventive Services

|
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|


Epsom


stheiler A to Z




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|

Health Line A to Z




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|








Common OTC Analgesics and

Cough and Cold Medicati
ons



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|





Recommendations for

Clinical Preventive Services



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|





100 common diseases







|
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|

|
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|




Springhouse
-

Auscultation Skills Breath & Heart Sounds 2nd
Rev Ed


2002



|
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|

|
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|





Μερικα εργαστηριακα

Εχουν γινει τροποποιησεις στις κατευθυντηριες οδηγιες ;







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διαταραχές ύδατος και ηλεκτρολυτών

ηλιαδης φωτης





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Zzzzzz
/


Asd
/


Pdf maker





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Cytomegalovirus_

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Ποιους προσβαλλει ο ~ και πρ
οκαλει σοβαρη απειλητικη
λοιμωξη

:



Χειρουργημενοι γενικως



Καρδιοπαθεις



Τραυματιες



Ανοσοκατεσταλμενοι ????



Ολοι οι παραπανω



Hypergammaglobulinemia_

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Immunoglobulin
-
Lipoprotein Complex Disorders
|
go
|

Both polyclonal and monoclonal hypergammaglobulinemias
may cause hypertriglyceridemia.
IgG
, IgM, and IgA have each
been involved. Myeloma, macroglobulinemia, lymphomas, and
lymphocytic leukemias have been implicated. Lupus
erythematosus and other autoi
mmune disorders have been
associated with the polyclonal type. Binding of
heparin

by
immunoglobulin, with resulting inhibition of LPL, can cause
severe mixed lipemia.
More commonly, the triglyceride
-
rich
lipoproteins have an abnormally high density, probably as a
result of bound immunoglobulin, although some may be
remnant
-
like particles. These complexes usually have gamma
mobility on electrophoresis.

Xanthomatosis asso
ciated with immunoglobulin complex
disease includes tuberous and eruptive xanthomas,
xanthelasma, and planar xanthomas of large areas of skin. The
latter are otherwise seen only in patients with cholestasis.
Deposits of lipid
-
rich hyaline material can occu
r in the lamina
propria of the intestine, causing malabsorption and protein
-
losing enteropathy. Circulating immunoglobulin
-
lipoprotein
complexes can fix complement, leading to
hypocomplementemia. In such patients, administration of
whole blood or plasma ca
n cause anaphylaxis. Hence, washed
red cells or
albumin

are recommended when blood volume
replacement is required.

Treatment is directed at the underlying disorder.
Because the
critical temperature of cryoprecipitation of some of these
complexes is close to body temperature, plasmapheresis
should be done at a temperature above the critical
temperature measured in serum




-
Globulins are predominately immunoglobulins of the
IgG

class.


Increases in
-
globulins can be
monoclonal
, arising from a clonal
proliferation of plasma cells or

lymphocytes, or
polyclonal

reflecting an
inflammatory response.


Polyclonal
-
globulins produce a
broad
-
based pattern

in the gamma
zone, indicating the presence of proteins from many cell lines.


Plasma immunoglobulins are increased either from



acute a
nd chronic inflammatory conditions (polyclonal) or



neoplastic (benign or malignant) expansion of a single clone of
cells (monoclonal).


Increased Polyclonal
-
Globulins.




Cirrhosis,



myelocytic leukemia,



lupus erythematosus,



RA,



analbuminemia.


Decreased Polyclonal
-
Globulins.




Nephrotic syndrome,



lymphocytic leukemia,



common variable immunodeficiency,



hypogammaglobulinemia,



protein
-
losing enteropathies.


The difference between the values for total serum
protein and for serum
albumin

is referred to as the
serum globulin fraction of the total serum protein.
When the globulin level is increased, fractionation
of the globulins is indicated to id
entify each
component. This is accomplished by serum protein
electrophoresis (SPEP).





"etiology of Hypergammaglobulinemia "


|
google
|





In Renal and Perirenal Abscesses

:


hypergammaglobulinemia

in 79%




In Acute Poststreptoccal Glomerulonephritis

:

+

H
ypergammaglobulinemia

90%





Hypergammaglobulinemia
, which is common in Sjögren's
syndrome, has also been associated with RTA


It is
unlikely, however, that the development of RTA in
Sjögren's syndrome

is
simply due to the associated
hypergammaglobulinemia
.




Tubular dysfunction can occur in the absence of
hypergammaglobulinemia
, and



tubular dysfunction is frequently not present

despite significant degrees of
hypergammaglobulinemia






¢íäñáò 59 åôþí ìå íüóï Parkinson,

ðñüóöáôç ïõñïëïãéêÞ åðÝìâáóç

êáé ðáñáôåé
íüìåíï åìðýñåôï


|
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|




"Διάχυτη υπεργαμμασφαιριναιμια"

|
google
|




Διαχυτη [=πολυκλωνικη ??] υπεργαμμασφαιριναιμια
παρατηρειται σε ολα εκτος απο

:



χρονια πυελονεφριτιδα



κιρρωση ηπατος



σπλαχνικη λεισμανιαση



aids



πολλαπλο μυελωμα

[ = μονοκλωνικη ]


muehrcke
'
s

lines

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medicine
|

consult
|

|bestPractise|
google
|


Kimmelstiel
-
Wilson nodules_

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|bestPractise|
google
|





TRI 5/4/2011


Hypothenar_

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medic
ine
|

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Thenar_

|
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medicine
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Ο ασθενης με συνδρομο καρπιαιου σωληνα

:



Μπορει να εχει ατροφια υποθεναρος
\



Αιμωδια 5
ου

δακτυλου



Ατροφια θεναρος



Α+Γ



Ολα τα παραπανω




Deu 4/4/2011



Hypersplenism_

|
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FPN
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|ddb|Wikipedia|
def1
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medicine|

consult|

|bestPractise|




Classification and Most Common Causes of
Splenomegaly


|
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|acess
medicine
|



deglutition disorders_

|
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medicine
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|bestPractise|






Ποιο μπορει να ειναι αιτιο δυσκαταποσιας

:



Καρκινος οισοφαγου



Αμυλοειδωση



Διαχυτος οισοφαγικος σπασμος



Α+Γ



Α+Β+Γ ?????



Ecchymosis_

|
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Dyssomnia_




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obstructive sleep apnea_

|
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medicine
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consult
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bestPractise
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Complications of OSA




|
go
|



Διαταραχη

μεταβολισμου

γλυκοζης



Υπερταση


αρρυθμιες


στεφανιαια νοσος


ΚΑ



Καταθλιψη



Γνωσιακες δυσλειτουργιες



Ατυχηματα



Αυξημενη θνητοτητα απο καρδιαγγειακα αιτια


Υποξια


οξειδωτικο στρες

Ενδοθηλιακη δυσλειτουργια

Αυτοματη ενεργοποιησης του συμπαθητικου


Diuretics in Obstructive Sleep Apnea With Diastolic
Heart
Failure






|
go
|



Obstructive Sleep Apnea and Heart Failure:

Pathophysiologic and Therapeutic Implications

|
go
|



"heart failure induced from OSA"



|
go
|
go
|




Οι αποφρακτικες απνοιες μπορει να συνοδευονται απο τις
παρακατω επιλοκες

:



Αρρυθμιες στον υπνο



Υπερταση



Δεξια ΚΑ



Α+Γ



Α+Β+Γ


Kyr 3/4/2011



GENETIC SYNDROME OF THE ADOLESCENT_

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Agia Sophia





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Sab 2/4/2011



Relative lymphocytosis_

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|yahoo
answrers
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google
|







Leukocytosis: Basics of Clinical Assessment

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Tet 30/3/2011



Lead_

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|best
practice
|
screeining
|






Deu 28/3/2011



Leprosy_

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Tet 23/3/2011



erythropoiesis
-
stimulatin
g agents_


=

(ESAs)

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kidney, sponge_

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Autonomic Insufficiency
_

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waterhouse
-
friderichsen syndrome_

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ectopic Adrenocorticotropic hormone_

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Inappropriate_

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"provocation testing
_

"

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carcinoembryonic antigen_

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"RET
point mutations
_

"

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Diltiazem_

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Verapamil_

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Propranolol_

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" Albuminuria "

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" Globulinuria "

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medicine
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consult
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adrenal insufficiency_

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adrenal cortical hypofunction
_

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adrenal

glan
d

hypofunction
_

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addisonian crisis
_

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e|consult|


adrenocortical insufficiency syndrome, chronic
_

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adrenal medullary insufficiency
_

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adrenal insufficiency, acute


[ =

adrenal crisis

=

Adrenocortical Insufficiency, Acute ]


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Ασθενής με επινεφριδιακή ανεπάρκεια και

νευρολογική συνδρομή


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ΔΙΑΤΑΡΑΧΕΣ ΛΕΙΤΟΥΡΓΙΑΣ ΕΠΙΝΕΦΡΙΔΙΩΝ

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Γυναικα 69 ετων με καταβολη δυναμεων
-

ατομικο
αναμνηστικο φυματιωσης


με πιεση 100


νατριο 129


χλωριο 100



ουρια 60


η πιο πιθανη διαγνωση
ειναι

:



Απροσφορη εκκριση αντιδιουρητικης



Εκτοπος παραγωγη φλοιοτροπου



ΧΝΑ



Νεφρικη σωληναρικαη οξεωση τυπου ΙΙ



Επινεφριδιακη ανεπαρκεια


Η φυματιωση παραπεμπει σε μυελικη επινεφριδικη
υπολειτουργια

Adrenal Medullary Hypofunction (Epinephrine
Deficiency)


Epinephrine

is the major catecholamine secreted by the normal
adrenal medulla and its secretion is unique to the adrenal
medulla. Epinephrine deficiency is caused by b
ilateral
adrenalectomies, tuberculosis, or hemorrhage.


Epinephrine

is also deficient in patients with
cortisol

deficiency
of any cause, because high local concentrations of cortisol in
the adrenal medulla are necessary for transcription of the
enzyme

PNMT, which catalyzes the conversion of
norepinephrine

to epinephrine

in the catecholamine
biosynthetic pathway. Therefore, epinephrine deficiency is
found in patients with secondary hypoadrenalism due to
pituitary
ACTH

deficiency, cong
enital adrenal hypoplasia, and
congenital adrenal cortical enzyme deficiencies (congenital
adrenal hyperplasia)



Essentials of Diagnosis





Weakness
, abdominal pain, fever, confusion, vomiting

Low blood pressure
, dehydration

Skin pigmentation may be i
ncreased

Serum potassium high,
sodium low
, blood urea nitrogen
high


Cosyntropin

(
ACTH

1

24
) unable to stimulate an

increase in serum
cortisol

to > 20 mcg/dL


Symptoms and Signs





Headache, lassitude, nausea and vomiting, abdominal
pain, and diarrhea

Confusion or coma

Fever, as high as 40.6°C or more

Low blood pressure

Recurrent hypoglycemia and reduced insulin
requirements in patients with preexisting
type 1 diabetes
mellitus

Cyanosis, dehydration, skin hyperpigmentation, and
sparse axillary hair (if hypogonadism also present)

Meningococcemia may cause purpura and adrenal
insufficiency secondary to adrenal infarction
(Waterhouse
-
Friderichsen syndrome)






"

nodular shadowing of lung "

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Nephrocalcinosis_

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Σε ασθενη με υπερασβεστιαιμια ποιο απο τα παρακατω
ειναι συνηγ
ορητικο υπερ πρωτοπαθους
υπερπαραθυρεοειδισμου και οχι υπερ υπερασβεστιαιμιας
οφειλομενης σε κακοηθεια

:



Πολυουρια



Δυσκοιλιοτητα



Ναυτια



Οζωδης σκιαση του πνευμονα



νεφρασβεστωση




Notes


Patra





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"causes of nephrocalcinosis"


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wrongDiagnosis
|




Hypercalcemia




See also
underlying causes of hypercalcemia




Hyperparathyroidism




Paget's disease of bone




Bone cancer




Vitam
in A overdose




Vitamin D overdose




Aluminium antacid overuse




polycythemia vera_

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A nice article





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allopurinol

_

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"uric acid levels in treatment wit
h allopurinol "


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Indications of ~ :





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Treatment of
patients in the intercritical period of
gout

with
allopurinol
, as with uricosuric agents, is begun
with the expectation that it will be continued for years if not
for
life.


Allopurinol is often the first urate
-
lowering drug used. When
starting
allopurinol
,
colchicine

or an NSAID should also be
used until steady
-
state serum uric ac
id is normalized or
decreased to less than 6 mg/dL.


Thereafter colchicine or the NSAID can be stopped, while
allopurinol

is continued.


Aside from gout,
allopurinol

is used
as an
antiprotozoal

agent
(see
Chapter 52
) and



is indicated
to prevent the massive uricosuria
following therapy of blood dyscrasias
that could
otherwise lead to renal calculi.



Prazosin_

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nsult|



adrenergic antagonists_

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adrenergic alpha
-
antagonists_

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Ποιο απο τα παρακατω ειναι αναστολεας των αλφα
αδρενεργικων υποδοχεων

:



Προπρανολολη



Ατενολολη



Νιφεδιπινη



Κοκκαινη



Πραζοσινη



Osteolysis_

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Indomethacin_

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adverse effects of ~ :




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Frequently Used Neurologic Drugs


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pdf
|



Penicillin_

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Indications of ~ :





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Drugs of Choice for Suspected or Proved Microbial Pathogens

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pdf
|



Vincristine_

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Adverse effects of vincristine




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This drug is used in the treatment of acute
lymphoblastic leukemia, ly
mphomas, and some solid
tumors. Its most important toxic side effect, and the
one that limits its use as a chemotherapeutic agent, is
a peripheral neuropathy. Paresthesias of the feet,
hands, or both may occur within a few weeks of the
beginning of treatme
nt; with continued use of the
drug, a progressive symmetrical neuropathy evolves
(mainly sensory with reflex loss). Cranial nerves are
affected less frequently, but ptosis and lateral rectus,
facial, and vocal cord palsies have been observed.
Autonomic ner
vous system function may also be
affected: constipation and impotence are frequent
complications; orthostatic hypotension, atonicity of
the bladder, and adynamic ileus are less frequent. The
polyneuropathy caused by
vincristine

is described
more fully in
Chap. 46
. Inappropriate
antidiuretic
hormone

secretion and seizures have been reported
but are uncommon.

Although rarely noted in the literature, the authors
have seen an instance of reversible

posterior
leukoencephalopathy with cortical blindness and
headache after a single dose of
vincristine
, identical
to the syndrome reported with the use of calcineurin
inhibitors (see further on).

The neural complications of
vinblastine

are similar to
those of
vincristine

but are usually avoided because
bone marrow suppression limits the dose of the drug
that can safely be employed.
Vinorelbine

is a more
recen
tly introduced semisynthetic vinca alkaloid. It
has much the same antitumor activity as
vincristine

but is supposedly less toxic.





Common Toxicities of Antimitotic Agents


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Vinca alkaloids

:

Vincristine


vinblastine


vindesine
-

Vinorelbine




Bone marrow suppression

but

: vincristine
c
an be
given if leykopenia is present



Neurotoxicity


: peripheral neuropathy and cranial
palsies



If extravasation occurs



汯c慬 n散eosis




action of vincristine




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pdf
|



Tri 22/3/2011



hemorrhagic vomiting_

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Οξεία γαστρεντερίτιδα (Τροφική δηλητηρίαση)


|
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Οξεία διάρροια στα παιδιά




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"τροφικη δηλητηριαση αιμορραγικοι εμετοι "


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Men
_

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multiple endocrine neoplasia

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multiple endocrine neoplasia

type 2a

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Ανδρας 30 ετων διερευναται για οζο θυρεοειδους


ο
πατερας πεθανε απο καρκινο θυρεοειδους και ο αδελφος
του εχει ιστορικο υποτροπιαζουσης νεφρολιθιασης


η τιμη
καλσιτονινης ορου 200 [κτ = <100 ]


ασβεστιο και
φωσφορος ορου ειναι φυσιολογικα


η επομενη
εξεταση
θα πρεπει να ειναι

:



Υπερηχος ηπατος



Κορτιζολη ορου



Σπινθηρογραφημα θυρεοειδους



Αξονικη τομογραφια τραχηλου



Κατεχολαμινες ουρων ???????


Why Is This Patient Hypercalcemic If Calcitonin Lowers Serum

Calcium?

An excess or deficiency of
calcitonin
has minor effects in humans
compared with the effects

of parathyroid disorders. This patient's hypercalcemia may be due to
coexisting primary

hyperparathyroidism (MEN type

IIa).




Case Discussion: Multiple Endocrine Neoplasia


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Case Discussion: Pheochromocytoma



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|




Multiple Endocrine Neoplasia, Type 2A


|
merck
|

=

Sipple's Syndrome




Actions of calcitonin




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|

The overall importance of
calcitonin

in the maintenance of
calcium homeostasis is unclear. Serum calcium concentrations
are normal in patients after thyroidectomy, which removes all
functioning C cells.




thyroid hormones and catecholamines



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|

Although plasma catecholamine levels are normal in
hyperthyro
idism, the cardiovascular effects, tremulousness,
and sweating produced by thyroid hormones can be reduced or
abolished by sympathectomy. They can also be reduced by
drugs


However, even though
blockers are weak inhibitors of
extrathyroidal conversion of
T
4

to T
3
, and consequently may
produce a small fall in plasma T
3
, they have little effect on the
other actions of thyroid hormones. Presumably, the functional
synergism observed between
catecholamines

and thyroid
hormones, particularly in pathological settings, arises from
their overlapping biological functions as well as the ability of
thyroid hormones to increase expression of catecholamine
receptors and the signaling effectors to which they are link
ed.




Catecholamines_

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Mechanism of Action of Selected Small
-
Molecule
Transmitters

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Calcitonin_

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Workup of Elevated Calcitonin Overview


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|

In addition to thyroid cancer, elevated calcitonin levels
may
also be seen in cancers of

the



lungs,



breast, or



pancreas.



Sometimes levels are elevated in normal
pregnant females and in neonates.


Other causes for

calcitonin elevation include



kidney d
isease,



certain medications,



thyroid inflammation,



primary

hyperparathyroidism,



anemia, and



liver cirrhosis





"elavated calcitonin "




|
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|




Actions of calcitonin




|
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|







Deu

21/3/2011



fibrillary glomerulopathies
_

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|consult|






Notes






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|




monoclonal gammopathy of undetermined significance_

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|consult|



urinary casts_




= cylindruria

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|consult|





Λευκωματουρια και κυλινδρουρια δυνατον να ανευρεθουν
σε ασθενη με

:



Προηγηθεισα στρεπτοκοκκικη λοιμωξη



Παραπρωτειναιμια



Συνδρομο
Fanconi



Σε ολα τα ανωτερω

??????????????



Σε κανενα απο τα ανωτερω


Οι παραπρωτειναιμιες κανουν νεφρωσικο αλλα και
σωληναρικαες βλαβες και παχυνση βασικης μεμβρανης των
σωληναριων και νεφροσκηλρυνση παρομοια με εκεινη στον ΣΔ

Diagnosis

[=Monoclonal Immunoglobulin Deposition Disease ]

The diagnosis of MIDD must be suspected in any patient



with the nephrotic syndrome or




rapidly progressive tubulointerstitial nephritis or




with echocardiographic findings indicating diastolic
dysfunction and



the presence of a monoclonal Ig component in the
serum and/or the urine


Immunoglobulin Light (Heavy)
-
Chain Deposition Disease:

|
go
|

From Molecular Medicine to Pathophysiology
-
Driven

Therapy




Πρωτεινουρια μαζιμε πυουρια και μικροσκοπικη αιματουρια :


σκεφτομαστε διαμεση σωληναρικαη
διαταραχη


Πρωτεινουρια :

μηπως ειναι νεφρωσικο ;


Το νεφρωσικο συνηθως συνοδευεται απο αιματουρια
και κυτταρικους κιλυνδρους



"renal manifestations of paraproteinemias"


|
google
|

"urinalysis findings in paraproteinemias "


|
go
|

"etiology of cylindruri
a"




|
google
|

common paraproteinemias




|
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|

"etiology of combined cylindruria and proteinuria"

|
go
|



[
μετα απο στρεπτοκοκκικη λοιμωξη

παιδων





νεφροτοξικοτητα αντιμικροβιακων σκευασματων





καταστασεις με διαταραγμενη διαπερατοτητα των
σπειραματικων τριχοειδων





χρονικα παρατεταμενη χημειοθεραπεια εναντι της
φυματιωσης σε αιμοκαθαιρομενους





νεφρολιθιαση

]


"cylindruria"





|
google
|

Κυλινδρουρια





|
google
|

Σημαντικοί δείκτες νεφρικής νόσου




|
GO
|


Curehunter





|
go
|










Sickle cell glomerulopathy :

Other glomerular diseases
.


Proteinuria is a non
-
specific manifestation of glomerular
damage that occurs in a variety of kidney diseases.


A nephrology evaluation is necessary to rule out these
conditions such as



diabetes mellitus,



hypertensive




nephrosclerosis,



membranous nephrop
athy, and




amyloidosis


that cause a clinical presentation almost


|
go
|
indistinguishable from sickle cell glomerulopathy.



Glomerulonephritis

may present with

proteinuria. It is usually
associated with hematuria and a cellular sediment.


Chronic tubulointerstitial disease

may also present with non
-
nephrotic proteinuria, and variable pyuria and microscopic
hematuria



Acquired Fanconi syndrome



|
go
|

associated with IgG
k
multiple myeloma:

observations on the mechanisms of impaired renal acid excretion



Case Studies in Nephrology


|
go
|





Renal lesions of paraproteinemias and



|
go
|


fibrillary glomerulopathi
es


"renal manifestations of multiple myeloma"

|
google
|


"renal manifestations of macroglobulinemia Waldenström "
|
google
|


Correlation of
clinical,
biochemical
and functional


|
go
|

parameters

with
histological
lesions
in
secondary
renal
amyloidosis


"renal manifestations of amyloidosis "


|
google
|


"renal
manidestations of light chain deposition "

|
google
|


"renal manifestations of heavy cha
in deposition"
|
google
|


Kyr

20/3/2011



oral ulcer_

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++go
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|
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medicine|

|consult|







Σε ποια απο τις παρακατω καταστασεις δεν αναπτυσσονται
στοματικα ελκη

:



Ερπητικη λοιμωξη



Κοιλιοκακη



Συνδρομο
reiter



Νοσος
crohn



Υποθυρεοειδισμος ?????


Oral Manifestations of Systemic Diseases


|
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|

Common Causes of Oral Lesions in Children


|
go
|

"celiac disease oral manifestations


|
google
|


Management of





|
go
|

patients with thyroid

disease

Oral health considerations


Oral ulceration associated with hypothyroidism. Report of a case
|
go
|

"hypothyroidism induced oral
ulcers"



|
go
|




pleural fluid_

|
go
|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
e


medicine|

|consult|
////
|





Ποια ειναι η πιθανοτερη αιτια αιμορραγικου πλευριτικου
υγρου

:



Πνευμονικο οιδημα



Πλευριτιδα απο πνευμονια



Πλευριτιδα απο νοσο του κολλαγονου



Πνευμονικη εμβολη



Υπεζωκοτικες μεταστασεις απο κακοηθες νεοπλασμα


"etiology
hemorrhagic pleural fluid"


|
google
|



von willebrand disease_

|
go
|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
e


medicine|

|consult|
pubmed

health |



Interphalangeal_

|
go
|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
e


medicine|

|consult|



Phalangeal_

|
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|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
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medicine|

|consult|






Sab 19/3/2011



fractional sodium excretion_

|
go
|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
e


medicine|

|consult|



cystitis, hemorrhagic_

|
go

|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
e


medicine|

|consult|


It is an oncologic emergency

Hemorrhagic cystitis can develop in patients receiving
cyclophosphamide

or
ifosfamide


If hemorrhagic cystitis develops, the maintena
nce of a high
urine flow may be sufficient supportive care. If conservative
management is not effective, irrigation of the bladder with a
0.37

0.74% formalin solution for 10 min stops the bleeding in
most cases.
N
-
acetylcysteine

may also be an effective
irrigant
.
Prostaglandins (
carboprost
) can inhibit the process. In extreme
cases, ligation of the hypogastric arteries, urinary diversion, or
cystectomy may be necessary.


emorrhagic cystitis also

occurs in patients who undergo bone
marrow transplantation (BMT). In the BMT setting, early
-
onset
hemorrhagic cystitis is related to drugs in the treatment
regimen (e.g.,
cyclophosphamide
) and late
-
onset hemorrhagic
cystitis is usually due to the polyoma virus BKV or adenovirus
type 11. BKV load in urine alone or in combination with acute
graft
-
versus
-
host disease correlate with development of
hemorrhagic cystitis. Vir
al causes are usually detected by PCR
-
based diagnostic tests. Treatment of viral hemorrhagic cystitis
is largely supportive, with reduction in doses of
immunosuppressive agents, if possible. No antiviral therapy is
approved, though
cidofovir

is being tested.






Η αιμορραγικη κυστιτιδα παρατηρειται ως ανεπιθυμητη
ενεργεια σε ληψη

:



Αζαθειοπρινης



Κορτικοστεροειδων



Χλωραμβουκιλης



Κυκλοσπορινης



Κυκλοφωσφαμιδης





Etiology






|
go
|



Cystitis_

|
go
|
go
|
FPN
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|ddb|Wikipedia|
def1
|
def2
|
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medicine|

|consult|



Hypoparathyroidism_

|
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|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
e


medicine
|

|consult|



Hyperparathyroidism_

|
go
|
go
|
FPN
++go
|ddb|Wikipedia|
def1
|
def2
|
e


medicine|consult|



pseudoprimary aldosteronism
_

=
liddle's
syndrome_

|
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|
go
|
FPN
++
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|
ddb
|
Wikipedia
|
def
1
|
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2
|
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medicine
|

|consult|



secondary aldosteronism_

|
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|
go
|
FPN
++
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|
ddb
|
Wikipedia
|
def
1
|
def
2
|
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medicine
|

|consult|



conn a
denoma_

= primary aldosteronism

|
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|
go
|
FPN
++
go
|
ddb
|
Wikipedia
|
def
1
|
def
2
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medicine
|

|consult|



Captopril_

|
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|
go
|
FPN
++
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|
ddb
|
Wikipedia
|
def
1
|
def
2
|
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medicine
|

|consult|



captopril challenge_


|
go
|

"captopril test "




|
google
|

=
"captopril challenge "



|
google
|

[=
fo
r diagnosis of renal artery stenosis

]



"captopril suppression test "


|
google
|

[=
used to assist in the diagnososis of
primary
aldosteronism

(Conn Syndrome)

]





Inadequacy of captopril challenge test for diagnosing renovascular
hypertension in children and adolescents


|
go
|

The predictive value of the positive test was 43%. In conclusion,
we did not find the

CCT, as described for adults, to be of value in children and
adolescents





Η δοκιμασια κατοπριλης συμβαλλει σε διαγνωση

:



Δευτεροπαθους
υπεραλδοστερονισμου



Φαιοχρωμοκυτωματος



Ιδιοπαθους υπερτασης



Συνδρομου
cushing



Νεφραγγειακης υπερτασης






Επιπλέον

υλικό


: 22/3/2011

"captopril test in secondary hyperaldosteronism"

|
google
|

Re
-
evaluation of the captopril test for the diagnosis of primary

|
go
|

hyperaldosteronism

1.

C. Hambling
1
,

2.

R. T. Jung
1,*
,

3.

A. Gunn
2
,

4.

M. C. K. Browning
3
,

5.

W. A. Bartlett
3

Article first published online: 17
MAR 2008

DOI:

10.1111/j.1365
-
2265.1992.tb02252.x

CONCLUSION

Application of the captopril test to patients
identified as abnormal by screening confirms all
cases of primary hyperaldosteronism but false
positive or equivocal

results, necessitating further I
nvestigation, may
occur In some patients with esssential
hypertension


αντίθετη

άποψη

:

Functional tests for primary aldosteronism: Value of captopril
suppression



|
go
|

Marie
-
Claude Racine
,
Pierre Douville

and
Marcel Lebel

To this end, salt loading is widely used, but this
approach may be contraindi
cated in

patients with severe hypertension. The captopril
suppression test appears as effective as salt loading

in confirming a diagnosis of primary aldosteronism. In
addition, the captopril test is safe, well

tolerated, and cost
-
effective



Mosby's Manual

of Diagnosticand Laboratory Tests

plasma renin activity


|
go
|
go
|

A determination of the PRA and a measurement of the plasma
aldosterone

level are used in the differential diagnosis of
primary and secondary
hyperaldosteronism
. Patients with
primary hyperaldosteronism (caused by an adrenal tumor that
overprod
uces aldosterone) will have an increased aldosterone
level with decreased renin activity. Conversely, patients with
secondary hyperaldosteronism (caused by certain types of
kidn
ey disease
) will have increased levels of renin.

















Par 18/3/2011



intravascular volume

_

|
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Wikipedia
|
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1
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medicine
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|consult|


extravascular

volume

|
////

|

intracellular volume |
////

|




gingival hemorrhage_

|
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|
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++
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|
ddb
|
Wikipedia
|
def
1
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2
|
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medicine
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|consult|



Petechiae_

|
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FPN
++
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|
ddb
|
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|
def
1
|
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medicine
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|consult|






Ασθενης με αιμορραγια απο τα ου
λα και πετεχειες
στα κατω ακρα


ποια εξεταση ενδυκνειται κατα
κυριο λογο

:



Χρονος προνθρομβινης και
inr



Χρονος μερικης θρομβοπλαστινης



Ηπατικα ενζυμα



Ουρια και κρεατινινη ορου



Γενικη αιματος



"gingival hemorrhage Petechiae"


|
google
|

Το πρωτο που πρεπει να σκεφθουμε ειναι
θρομβοκυτταροπενια




human leukocyte antigens_

|
go
|
go
|
FPN
++
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|
ddb
|
Wikipedia
|
def
1
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2
|
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medicine
|

|consult|
//////
|





Αιμορραγικες

κενωσεις


|
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++
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1
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|consult|






Σε ποια απο τις παρακατω κατασταστασεις παρατηρουνται
~ :



Αμοιβαδικη δυσεντερια



Εντερικη λοιμωξη απο σιγκελλα



Φλεγμονωδης νοσος του εντερου



Ισχαιμικη κολιτιδα



Ολα τα παραπανω

???????


Risk factors for colonic ischemia



|
go
|




Shigella
dysenteriae / Clinical Findings


|
go
|

After an in
cubation period of 1 to 4 days, symptoms begin
with fever and abdominal cramps, followed by
diarrhea,
which may be watery at first but later contains blood
and mucus.

The disease varies from mild to severe
depending on two major factors: the species of
Shi
gella

and
the age of the patient, with young children and elderly
people being the most severely affected.
Shigella
dysenteriae,

which causes the most severe disease, is
usually seen in the United States only in travelers returning
from abroad.
Shigella so
nnei,

which causes mild disease, is
isolated from approximately 75% of all individuals with
shigellosis in the United States. The diarrhea frequently
resolves in 2 or 3 days; in severe cases, antibiotics can
shorten the course. Serum agglutinins appear aft
er recovery
but are not protective because the organism does not enter
the blood. The role of intestinal IgA in protection is
uncertain.




Mesenteric ischemia / Symptoms and Signs

|
go
|

Patients with colonic ischemia usually present with abrupt onset of
crampy left lower quadrant abdominal pain, and
mild to moderate
rectal bleeding or bloody diarrhea within the first 24 hours
. Over
90% of patien
ts are older than 60 years. Cardiovascular disease is
common, and frequent precipitating factors include hypotension,
cardiovascular surgery (coronary artery bypass grafting, aortic aneurism
repair), dialysis, and dehydration. Physical examination reveals
mild to
moderate abdominal tenderness over the affected bowel, most often
left
-
sided.

In contrast to patients with AMI, those with colonic ischemia do not
usually appear acutely ill.
Bleeding is usually mild, and patients
rarely require blood transfusion.
Peritoneal signs, if present, would
suggest perforation or peritonitis. Ischemic colitis is usually a singular
event, and only 5% of patients develop a recurrence.

The diagnosis is usually established on the basis of clinical history,
physical examination,

and endoscopic or radiologic studies. Although
most patients who develop colonic ischemia are elderly, the condition
can also occur in younger patients. For patients who are younger than
age 50, several precipitants of colonic ischemia should be considere
d
(see
Table 6

2
). In young women, the triad of smoking, use of oral
contraceptives, and carriage of the factor V Leiden mutation may be
associated with increased ri
sk of colonic ischemia. Recent reports
indicate that giving penicillin derivatives to patients who harbor
Klebsiella oxytoca

may precipitate hemorrhagic colitis.





Intestinal Amebiasis


|
go
|

The most common type of amebic infection is asymptomatic cyst
passage. Even in h
ighly endemic areas, most patients harbor
E. dispar
.

Symptomatic
amebic colitis

develops 2

6 weeks after the ingestion of
infectious cysts. A gradual onset of lower abdominal pain and mild
diarrhea is followed by malaise, weight loss, and diffuse lower abd
ominal
or back pain. Cecal involvement may mimic acute appendicitis. Patients
with full
-
blown dysentery may pass 10

12 stools per day. The stools
contain little fecal material
and
consist mainly of blood and mucus
.
In contrast to those with bacterial diarr
hea, fewer than 40% of patients
with amebic dysentery are febrile.
Virtually all patients have heme
-
positive stools.





Inflammatory Bowel Disease

|
go
|

IBD is usually diagnosed in older children
or teenagers, and commonly
the first presentation involves severe acute abdominal pain. In one large
series, 95% of children <10 years old with Crohn disease presented
initially with abdominal pain.
40

Often, the pain is described as colicky and
is associated with
diarrhea, which may be bloody
. Abdominal pain is
not the sole presenting symptom, and IBD is associated with fever,
weight loss, fatigue, and blood per

rectum.


Clinical Findings

The patient typically complains of abdominal cramps
and intermittent
bloody diarrhea
. A history of previous episodes may be given, and a
long history of colitis may be present. Weight loss, fever, and anemia
may be present. Cram
ps may develop gradually or suddenly. Abdominal
examination will vary with etiology and severity of disease. Infectious
causes (e.g.,
Shigella

sp.,
Clostridium difficile
,
Campylobacter

sp.,
Entamoeba histolytica
) should be systematically ruled out.





muc
ous membrane_

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|
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medicine
|

|consult|



Epithelium_

|
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|
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++
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|
ddb
|
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|
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medicine
|






Pem 17/3/2011


Osteocalcin_

|
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|
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++
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|
ddb
|
Wikipedia
|
def
1
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2
|
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medicine
|



cardiovascular mortality

|
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1
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|
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medicine
|





Associations of total osteocalcin with all
-
cause and cardiovascular
mortality in older men. The Health In Men Study

|
go
|




Δεξια

κολικη

καμπη


hepatic

flexure

|
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|
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|
FPN
++
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|
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1
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medicine
|



Αριστερη

κολικη

καμπη

splenic

flexure

|
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|
go
|
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++
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|
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|
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|
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1
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2
|
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medicine
|


Keloid
_

|
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|
go
|
FPN
++
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|
ddb
|
Wikipedia
|
def
1
|
def
2
|
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medicine
|


subcutaneous nodule_

|
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|
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|
FPN
++
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|
ddb
|
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|
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1
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|
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medicine
|


|
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|
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++
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|
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|
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|
def
1
|
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2
|
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medicine
|


Hypernatremia_

|
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|
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|
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++
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1
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medicine
|





Notes






|
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|





Περισσεια νατριου και υδατος δεν παρατηρειται σε

:



Καρδιακη ανεπαρκεια



Νεφρωσικο



Συνδρομο απροσφορης εκκρισης αντιδιουρητικης



Οξεια σπειραματονεφριτιδα



Νεφρογενη αποιο διαβητη

????

[
περισσεια υδατος και
↓υδωρ ]


"Excess sodium and water "



|
google
|


The edema states:




|
go
|

sodium and water retention










Υπερνατριαιμια με φυσιολογικο συνολικο νατριο του οργανισμου
παρατηρειται σε ολα εκτος απο

:



Ασθενης με πυρετο και εφιδρωσεις



Ασθενεις με αποιο διαβτη



Ουραιμικοι με υπερβολικη μετακινηση υγρων στη διαρκεια της
αιμοκαθαρσης / ή περιτοναικης καθαρσης



Ασθενεις με υπερβολικη ληψη υγρων ?????????



υπερκατατμητα πολυμορφοπυρηνα

?????????

|
go
|
go
|
FPN
++
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|
Wikipedia
|
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1
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|
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medicine
|


ankylosing spondylitis_

|
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|
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++
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|
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|
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|
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|
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|






Στην

~ :



Χαμηλη οσφυαλγια και δυσκαμψια ειναι συχνα τα πρωτα
ευρηματα



Περιφερικη αρθριτιδα στην εξελιξη της νοσου δεν ειναι σπανια



Η συχνοτερη εξωσκελετικη βλαβη ειναι η οξεια προσθια
ραγοειδιτιδα [ οξεια ιριδιτιδα και ιριδοκυκλιτιδα ]



Ολα τα παραπανω



Κανενα απο τα παραπανω


Εξιδρωμα


exudates and transudates
_

|
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|
go
|
FPN
++
go
|
ddb
|
Wik
ipedia
|
def
1
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medicine
|


διιδρωμα

Effusion_

|
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++
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1
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|
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medicine
|






Συχνα αιτια διιδρωματος ειναι τα παρακατω εκτος απο

:



Κιρρωση



Νεφρωσσικο



Καρδιακη ανεπαρκεια



Πνευμονικη εμβολη



Ολα τα παραπανω


inappropriate adh syndrome_

|
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|
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|
FPN
++
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|
ddb
|
Wikipedia
|
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1
|
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2
|
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medicine
|


legionella pneumophila_

|
go
|
go
|
FPN
++
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|
ddb
|
Wikipedia
|
def
1
|
def
2
|
e



medicine
|

|
best
practice
|





Χαρακτηριστικα τη ςλοιμωξης απο ~ ειναι τα ακολουθα
εκτος απο

:



Πενιχρη αποχρεμψη



Υπονατριαιμια



Διανοητικη συγχυση



Ανιχνευη του αντιγονου στα ουρα



Σπληνομεγαλια ?????




Ποιο απο τα παρακατω δεν ανευρισκεται συχνα στην νοσο
των λεγεωναριων

:



Τρανσαμινασαιμια



Διαρροια



Μειωμενο νατριο ορου



Πυρετος



Αυξημενο νατριο ορου



Look for hyponatremia
, since syndrome of
inappropriate
secretion of antidiuretic hormone

(SIADH
) has been
associated with this disease.

|
e


medicine

|


Hypoca
lcemia_

|
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|
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|
FPN
++
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ddb
|
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|
def
1
|
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2
|
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medicine
|


Hyperuricemia_

|
go
|
go
|
FPN
++
go
|
ddb
|
Wikipedia
|
def
1
|
def
2
|
e



medicine
|


alpha
-
fetoproteins_

|
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|
go
|
FPN
++
go
|
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|
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|
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1
|
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2
|
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medicine
|







Ασθενης με κιρρωση ηπατος παρουσιαζειμεγαλη αυξηση της
αλφα φετοπρωτεινης


αυτο ειναι πιθανο να οφειλεται σε

:



Εξαρση της νοσου



Αναπτυξη λοιμωξης



Ηπατικες μεταστασεις απο καρκινο του παχεος



Συνδρομο
budd


chiari



Αναπτυξη ηπατοκυτταρικου καρκινου




Συσχετίζονται

με



:



Ηπατοκυτταρικο καρκινωμα



Αξιολογηση αμνιακου υγρου



Χρωματοσωμικες ανωμαλιες



Νεοπλασιες των γεννητικων κυτταρων



Προγεννητικη διαγνωση



Προγεννητικη φροντιδα




The use of ~ in Prenatal Diagnosis

Currently the most common use for appl
ied genetics in
obstetrics and gynecology is in prenatal counseling,
screening, and diagnosis. Prenatal diagnosis first came into
use in 1977 with the discovery of the significance of serum
-
fetoprotein (AFP).



The United Kingdom Collaboration Study found that
elevated AFP in maternal serum drawn between
16 and 18 weeks of gestation correlated with an
increased incidence of neural tube defects (NTDs)
.
Since that time, much research effort has been aimed at
perfe
cting the technique. We now can screen not only for
NTDs but also for trisomy 21 and trisomy 18. In addition,
cystic fibrosis, sickle cell disease, and Huntington's disease,
as well as many inborn errors of metabolism and other
genetic disorders, can now b
e identified prenatally.



vocal cord_

|
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|
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++
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|
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|
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1
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|
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medicine
|


Atelectasis_

|
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|
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|
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++
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|
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|
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1
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|
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medicine
|



vena cava

|
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|
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++
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|
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|
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1
|
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2
|
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medicine
|


superior vena cava
syndrome_

|
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|
go
|
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++
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|
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|
Wikipedia
|
def
1
|
def
2
|
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medicine
|


Superior vena obstruction syndrome


|
go
|


Neutrophil_

|
go
|
go
|
FPN
++
go
|
ddb
|
Wikipedia
|
def
1
|
def
2
|
e



medicine
|


Polymorphonuclear|
go
|


diagnostic spinal puncture_

|
go
|
go
|
FPN
++
go
|
ddb
|
Wikipedia
|
def
1
|
def
2
|
e



medicine
|


PCR_

|
go
|
go
|
FPN
++
go
|
ddb
|
Wikipedia
|
def
1
|
def
2
|
e



medicine
|


idiopathic pulmonary fibrosis_

|
go
|
go
|
FPN
++
go
|
ddb
|
Wikipedia
|
def
1
|
def
2
|
e



medicine
|





Όλα είναι χαρακτηριστικα της ~ εκτος απο

:



α/α = εικονα μελισοκηρυθρας



ασθενεις με τη νοσο εμφανιζουν συχνοτερα καρκινο του
πνευμονα



η νοσος δεν ανταποκρινεται στη χορηγηση κορτικοστεροειδων
και ανοσοκ
ατασταλτικων



λεπτοι τελοεισπνευστικοι ηχοι αντιληπτοι στην ακροαση των
βασων των πνευμονων



ειναι συνηθως νοσος των καπνιστων





Idiopathic Pulmonary Fibrosis



|
go
|


pulmonary
fibrosis_

|
go
|
go
|
FPN
++
go
|
ddb
|
Wikipedia
|
def
1
|
def
2
|
e