approach to the patient with a sleep disorder

... >0.5 cm in diameter Wheal: A raised, erythematous, edematous papule or plaque, usually representing short-lived vasodilatation and vasopermeability Telangiectasia: A dilated, superficial blood vessel ... differential diagnosis (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than ... focuses on linear erosions overlying an area of erythema and scaling, he or she may incorrectly assume that the erosion is the primary lesion and the redness and scale are secondary, while the correct...

Ngày tải lên: 06/07/2014, 20:20

... epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character Sites on hair-bearing ... that elicits the desire to scratch Pruritus is often the predominant symptom of inflammatory skin diseases (e.g., atopic dermatitis, allergic contact dermatitis); it is also commonly associated ... hair-bearing areas may be characterized by destruction of hair follicles Table 52-3 Common Dermatologic Terms Alopecia: Hair loss; it may be partial or complete Annular: Ring-shaped lesions Cyst: A soft,...

Ngày tải lên: 06/07/2014, 20:20

... lesions, the shape of individual lesions, and the arrangement of the lesions An ideal skin examination includes evaluation of the skin, hair, and nails as well as the mucous membranes of the mouth, ... erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash limited to the sun-exposed portions of the face Once the distribution of the lesions has been established, ... the skin it is usually advisable to assess the patient before taking an extensive history This way, the entire cutaneous surface is sure to be evaluated, and objective findings can be integrated...

Ngày tải lên: 06/07/2014, 20:20

... A D The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques ... skin disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale Figure 52-8 ...

Ngày tải lên: 06/07/2014, 20:20

... contact (Fig 52-10) or primary irritant dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This ... This eruption is characterized by multiple erythematous plaques with a target or iris morphology It usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections ... reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... melanoma, atopy, psoriasis, or acne) 10 Social, sexual, or travel history as relevant to the patient DIAGNOSTIC TECHNIQUES Many skin diseases can be diagnosed on gross clinical appearance, but ... superficial anatomic structures in selected areas of the body In this procedure, a small area of skin is anesthetized with 1% lidocaine with or without epinephrine The skin lesion in question can be ... or saucerized with a scalpel or removed by punch biopsy In the latter technique, a punch is pressed against the surface of the skin and rotated with downward pressure until it penetrates to the...

Ngày tải lên: 06/07/2014, 20:20

... noting the amount of blanching that occurs Granulomas often have an opaque to transparent, brown-pink "apple jelly" appearance on diascopy Figure 52-11 Urticaria Discrete and confluent, edematous, ... edematous, erythematous papules and plaques are characteristic of this whealing eruption Wood's Light A Wood's lamp generates 360-nm ultraviolet (or "black") light that can be used to aid the evaluation ... Wood's lamp, and previously unsuspected areas of involvement often become apparent A Wood's lamp may also aid in the demonstration of tinea versicolor and in recognition of ash leaf spots in patients...

Ngày tải lên: 06/07/2014, 20:20

... remain functional and maintain a self-image as a fully intact person with just a malfunctioning part, a diseased organ ( "a bum ticker") By contrast, the patient with pancreatic cancer has a completely ... pain takes on desperate significance Cancer is an exception to the coordinated interaction among cells and organs In general, the cells of a multicellular organism are programmed for collaboration ... collaboration Many diseases occur because the specialized cells fail to perform their assigned task Cancer takes this malfunction one step further Not only is there a failure of the cancer cell to maintain...

Ngày tải lên: 07/07/2014, 01:20

... more common in Asia than North America or Africa The most common cancers in Africa are cervical, breast, and liver cancers It has been estimated that nine modifiable risk factors are responsible ... reveal the chronicity of disease The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side effects of treatment The ... lymphoma Increasing evidence links the expression of certain genes with the prognosis and response to therapy (Chaps 79, 80) Occasionally a patient will present with a metastatic disease process that...

Ngày tải lên: 07/07/2014, 01:20

... by the International Union Against Cancer and the American Joint Committee on Cancer (AJCC) The TNM classification is an anatomically based system that categorizes the tumor on the basis of the ... particular tumors for spread to adjacent or distant organs helps direct the staging evaluation Information obtained from staging is used to define the extent of disease either as localized, as ... Performance Functional Capability of the Patient 100 Normal; no complaints; no evidence of disease 90 Able to carry on normal activity; minor signs or Status symptoms of disease 80 Normal activity with...

Ngày tải lên: 07/07/2014, 01:20

... regular examinations, and taking time to talk 2 The National Cancer Institute maintains a database called PDQ (Physician Data Query) that is accessible on the Internet under the name CancerNet at ... guilt and frustration over the inability to cure the patient and the pressure of a busy schedule greatly limit the time a physician spends with a patient who is receiving only palliative care Resist ... complications of both the disease and its treatment as well as the complex psychosocial problems associated with cancer In the short term during a course of curative therapy, the patient' s functional...

Ngày tải lên: 07/07/2014, 01:20

... Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ Cirrhosis, cell tumor Carcinoembryonic antigen Adenocarcinomas ... Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel disease, smoking Enzymes Prostatic acid Prostate cancer phosphatase Prostatitis, prostatic ... enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific Prostate...

Ngày tải lên: 07/07/2014, 01:20

... breast cancer, melanoma, lung cancer, colon cancer, and lymphoma have all failed to support the notion that asymptomatic relapses are more readily cured by salvage therapy than symptomatic relapses ... year, every months for a year, every months for a year, every months for a year, and then annually At each visit, a battery of laboratory and radiographic and imaging tests were obtained on the ... that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity may be an indication that a supplemental therapy is being taken.3...

Ngày tải lên: 07/07/2014, 01:20

... few patients will have inadequate pain relief if appropriate measures are taken A specific approach to pain relief is detailed in Chap 11 Nausea Emesis in the cancer patient is usually caused ... be related to bowel inflammation from the therapy and can be controlled with oral dexamethasone and oral metoclopramide, a dopamine receptor antagonist that also blocks serotonin receptors at high ... location, character, temporal features, provocative and palliative factors, and intensity (Chap 12); a review of the oncologic history and past medical history as well as personal and social...

Ngày tải lên: 07/07/2014, 01:20

... difficulties Patients may have fears associated with the termination of a treatment they associate with their continued survival Adjustments are required to physical losses and handicaps, real and perceived ... acetate, a progestational agent, has been advocated as a pharmacologic intervention to improve nutritional status Research in this area may provide more tools in the future as cytokine-mediated ... Despite the fear of disseminating tumor cells into the circulation, widespread metastases are an unusual complication The major complications are occlusion, leakage, and fluid overload Patients with...

Ngày tải lên: 07/07/2014, 01:20

... how the patient has been affected by the diagnosis and is coping with it is an important goal of patient management It is best to speak frankly with the patient and the family regarding the likely ... of disease These discussions can be difficult for the physician as well as for the patient and family The critical features of the interaction are to reassure the patient and family that everything ... to provide the patient with the necessary medical care as well as the psychological and spiritual support that will prevent the isolation and depersonalization that can attend in-hospital death...

Ngày tải lên: 07/07/2014, 01:20

... doi:10.1016/j.na.2005.06.028 Bae, J-H, Park, W-G: On a cubic equation and a Jensen-quadratic equation Abstr Appl Anal 2007 (2007) Article ID 45179 Găvruta, P: A generalization of the Hyers-Ulam-Rassias stability of approximately ... Ω as n ® ∞ By using an idea of Cădariu and Radu (see [15]), we will prove the Hyers-Ulam stability of the functional equation related to quadratic forms Theorem 2.3 Assume that  satisfies the ... : = ax2 + bxy + cy2 is a solution of the Equation 1.1 The authors [12] acquired the general solution and proved the stability of the functional Equation 1.1 for the case that X and Y are real...

Ngày tải lên: 20/06/2014, 22:20

... transformations,” Bulletin of the American Mathematical Society, vol 57, pp 223–237, 1951 Th M Rassias, “On the stability of the linear mapping in Banach spaces,” Proceedings of the American Mathematical ... Hyers-Ulam-Rassias Stability of Functional Equations in Mathematical Analysis, Hadronic Press, Palm Harbor, Fla, USA, 2001 G L Forti, “Hyers-Ulam stability of functional equations in several variables,” ... Rassias, “On the stability of functional equations and a problem of Ulam,” Acta Applicandae Mathematicae, vol 62, no 1, pp 23–130, 2000 12 S.-M Jung and P K Sahoo, “Stability of a functional equation...

Ngày tải lên: 22/06/2014, 11:20

... paper, we will adopt the idea of C˘ dariu and Radu [12] and prove the Hyersa Ulam-Rassias stability and the Hyers-Ulam stability of the Volterra integral equation (1.2) Hyers-Ulam-Rassias stability ... Hyers-Ulam-Rassias Stability of Functional Equations in Mathematical Analysis, Hadronic Press, Palm Harbor, Fla, USA, 2001 [10] Th M Rassias, “On the stability of functional equations and a problem ... Point Theory and Applications and proved the Hyers theorem That is, Rassias proved the Hyers-Ulam-Rassias stability of the Cauchy additive functional equation Since then, the stability of several...

Ngày tải lên: 22/06/2014, 19:20

... patients with ARA were enrolled at a hospital-based allergy outpatient clinic Patients older than 18 years of age, with a medical diagnosis of ARA, able to read and fill the questionnaire and without ... the Formal Consensus Process Ana Arrobas Ana Todo-Bom Ângela Gaspar Aurora Carvalho Carlos Alves Carlos Lopes Fernando Calvário Authors' contributions LNS participated in data collection, analysis ... was developed to allow online interaction with the experts It gathered theirs input, provided them feedback at the end of each round, facilitated the data gathering and analysis, while maintaining...

Ngày tải lên: 12/08/2014, 14:20