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By: Jonathan Handy

  • Consultant in Intensive Care Medicine,Royal Marsden Hospital,Honorary Senior Lecturer,Imperial College London

Toxic adenoma the second most common cause of hyperthyroidism arthritis diet ginger discount celecoxib 200mg without prescription, toxic adenoma is a small septic arthritis in dogs treatment cheap celecoxib 200mg with amex, benign nodule in the thyroid gland that secretes thyroid hormone arthritis at 25 discount 100 mg celecoxib mastercard. The cause of toxic adenoma is unknown; its incidence is highest in elderly people rheumatoid arthritis wrist discount celecoxib 200 mg overnight delivery. A radioactive iodine (131I) uptake and a thyroid scan show a single hyperfunctioning nodule suppressing the rest of the gland. Treatment includes 131I therapy or surgery to remove the adenoma after antithyroid drugs restore normal gland function. Functioning metastatic thyroid carcinoma this rare disease causes excess production of thyroid hormone. Subacute thyroiditis A virus-induced granulomatous inflammation of the thyroid, subacute thyroiditis produces transient hyperthyroidism associated with fever, pain, pharyngitis, and tenderness of the thyroid gland. Understanding thyroid storm Thyrotoxic crisis-also known as thyroid storm- usually occurs in patients with preexisting, though often unrecognized, thyrotoxicosis. Pathophysiology the thyroid gland secretes the thyroid hormones triiodothyronine (T3) and thyroxine (T4). Assessment findings Initially, the patient may have marked tachycardia, vomiting, and stupor. If left untreated, he may experience vascular collapse, hypotension, coma, and death. Other findings may include a combination of irritability and restlessness, visual disturbance (such as diplopia), tremor and weakness, angina, shortness of breath, cough, and swollen extremities. Palpation may disclose warm, moist, flushed skin and a high fever that begins insidiously and rises rapidly to a lethal level. Precipitating factors Onset is almost always abrupt and evoked by a stressful event, such as trauma, surgery, or infection. Other less common precipitating factors include: insulin-induced ketoacidosis hypoglycemia or diabetic ketoacidosis stroke myocardial infarction pulmonary embolism sudden discontinuation of antithyroid drug therapy initiation of radioactive iodine therapy preeclampsia subtotal thyroidectomy with accompanying excessive intake of synthetic thyroid hormone. Taken by storm Thyrotoxic crisis, also known as thyroid storm, is an acute exacerbation of hyperthyroidism. Immunologic factors may also be the culprit; the disease occasionally coexists with other autoimmune endocrine abnormalities, such as type 1 diabetes mellitus, thyroiditis, and hyperparathyroidism. Hyperthyroidism in hiding In a person with latent hyperthyroidism, excessive iodine intake and, possibly, stress can cause active hyperthyroidism. What to look for the onset of signs and symptoms commonly follows a period of acute physical or emotional stress. Touch tells you On palpation, the thyroid gland may feel asymmetrical, lobular, and enlarged to three or four times its normal size. Hyperthyroidism may cause tachycardia, commonly accompanied by a full, bounding, palpable pulse. Listen and learn Auscultation of the heart may detect an accelerated heart rate, which may prove to be paroxysmal supraventricular tachycardia or atrial fibrillation when verified by electrocardiogram, especially in elderly patients. Drug therapy Antithyroid drugs, such as propylthiouracil and methimazole, are used for children, young adults, pregnant women, and patients who refuse other treatments. This form of therapy is contraindicated during pregnancy; therefore, pregnancy should be ruled out before the initiation of treatment. During treatment, the thyroid gland picks up the radioactive element as it would regular iodine. Subsequently, the radioactivity destroys some of the cells that normally concentrate iodine and produce thyroxine (T4), thus decreasing thyroid hormone production and normalizing thyroid size and function. Surgery Partial thyroidectomy is indicated for patients younger than age 40 who have a very large goiter and whose hyperthyroidism has repeatedly relapsed after drug therapy, for pregnant patients, and for patients allergic to 131I and other antithyroid drugs. The surgery involves removal of part of the thyroid gland, decreasing its size and capacity for hormone production. Other treatments Therapy for hyperthyroid ophthalmopathy includes local applications of topical drugs but may require high doses of corticosteroids. A patient with severe exophthalmos that causes pressure on the optic nerve may require surgical decompression to reduce pressure on the orbital contents. Supportive measures include the administration of nutrients, vitamins, fluids, oxygen, and sedatives. Other tests show increased serum protein-bound iodine and decreased serum cholesterol and total lipid levels. Hypothyroidism In thyroid hormone deficiency (hypothyroidism) in adults, metabolic processes slow down.

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Many distinct phenotypes have been described can arthritis in the knee cause numbness order celecoxib 100mg with visa, but as with the other connective tissue disorders arthritis yoga poses cheap celecoxib 200 mg without prescription, the majority of affected individuals do not fit into these groupings arthritis medication with coumadin cheap 100 mg celecoxib free shipping. Vascular fragility may be due to arthritis diet nhs buy 100 mg celecoxib with mastercard defects in collagen type 3, resulting in vessels with low tensile strength. In these individuals, aneurysms, arteriovenous malformations, and dissections are common. Hyperextensibility and joint hypermobility are caused by ligamentous laxity (which predisposes to dislocated hips in infants). Clubfoot, joint effusions, and spondylolisthesis (vertebral displacement) may also be present. The gastrointestinal tract can be similarly affected; decrease in tensile strength of the bowel walls predisposes to spontaneous rupture. Individuals diagnosed with E-D usually display one or a combination of these different symptoms. The most severe complications of disease result from bowel and vasculature weakness. Hypermobility syndromes represent the mild end of the spectrum described by the Ehlers-Danlos disorders. Vitamin C helps some individuals who are deficient in lysyl hydroxylase (which uses vitamin C as a cofactor in strengthening collagen fibers). Other Connective Tissue disorders: Homocystinuria is an inborn error of methionine metabolism which results in a Marfan-like syndrome. The two disorders are differentiated by the presence of mental retardation in homocystinuria. Stickler syndrome is a constellation of progressive myopia, sensorineural hearing loss and hypomobility associated with distinct facial features. The diagnosis is suspected in neonates with swollen wrists, ankles or knees, and in children with hearing loss and marfanoid characteristics. Connective Tissue and Its Heritable Disorders: Molecular, Genetic, and Medical Aspects 2nd edition. Location of fracture (femur and radius vs tibia and radius), type of fracture (comminuted mid shaft vs epiphyseal and greenstick). Careful fracture history, identifying weak bones, and targeting physical therapy to strengthen those bones. Any of the following: pectus carinatum (or excavatum sufficiently severe to require surgery), reduced upper to lower segment ratio, positive wrist and thumb signs, scoliosis greater than 20 degrees of curvature, reduced extension of elbows, medial displacement of medial malleolus causing pes planus, protrusio acetabuli. Any three of the following: hyperextensible doughy skin, atrophic scars, joint hypermobility, connective tissue fragility, and bruising. Marfan syndrome, unlike homocystinuria, is not associated with mental retardation. On the phone is a lab technician from another state who reports that a newborn screen reveals a positive test for galactosemia in one of your patients. The child was discharged home from the hospital at just under 48 hours of age, he appeared well with only a 3% weight loss and mild facial jaundice upon follow-up at day 4 of life. His parents reported no breast feeding difficulties and, despite their concern for the number of hours their new baby slept, the new family appeared to be thriving. Genetic testing has received much attention in the press, with interest focusing on the ethics and repercussions of genetic information. Despite this attention, most people do not realize that for the past twenty years, almost all newborns in the United States have been screened for a number of genetic diseases. Almost all newborn screen tests are quantitative tests for the presence or absence of metabolic or endocrine molecules. When the concentration of the tested molecule is greater or less than a level determined by the reference lab, the test is reported as positive. In order to provide 100% sensitivity for disease, the level of positive detection must be adjusted to a point at which specificity may be quite poor. Of these, 54 infants were confirmed to have the disease (positive predictive value 0. Improvements in mass spectroscopy are greatly increasing the number of inborn errors of metabolism that can be efficiently screened in all newborn infants.

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Gliomas make up about 60 percent of all primary brain tumors and are frequently malignant arthritis of the knee nz celecoxib 100 mg on line. It is caused by low levels or improper functioning of a protein called C1 inhibitor arthritis lotion discount 100 mg celecoxib visa, which affects the blood vessels natural arthritis relief dogs discount celecoxib 200mg with amex. People with hereditary angioedema can develop rapid swelling of the hands arthritis in fingers and knuckles celecoxib 100 mg generic, feet, limbs, face, intestinal tract, or airway (larynx or trachea). Hpv (human papillomavirus)-Viral agent of warts, believed to be contagious and usually harm-less, but it can lead to cervical cancer. Symptoms of hypophosphatasia in infants include poor feeding, failure to gain weight, failure to thrive, delayed development, loss of teeth, and bone pain. The reduced number of platelets may result in abnormal bleeding into the skin (purpura) and other parts of the body. The result is often muscle weakness, fa- tigue, and problems with the heart, eyes, and various other systems. Juvenile rheumatoid arthritis-Refers to arthritis or an arthritis-related condition (rheumatic disease) that occurs by age 15 or younger. A variety of other eye-related abnormalities including roving eye movements, deep-set eyes, and sensitivity to bright light also occur with this disease. Abnormally high uric acid levels can cause sodium urate crystals to form in the joints, kidneys, central nervous system, and other tissues of the body, leading to gout-like swelling in the joints and severe kidney problems. This leaves the patient highly susceptible to serious infections, anemia and bleeding episodes. B and T-cell lymphomas are caused by proliferation of the two principal types of white blood cells, called B- and T-lymphocytes. Mycosis fungoides is a type of lymphoma that primarily affects the skin of the buttocks, back or shoulders but can also occur in other sites. Mucositis can occur anywhere along the digestive tract from the mouth to the anus. It occurs in middle to old age and leaves patients vulnerable to increased infections and anemia. Neuroblastomas are the most common 54 Medicines in Development rare diseases 2013 glossary extra-cranial (outside the skull) solid tumors of childhood. Excessive amounts of glycogen accumulated everywhere in the body, but the cells of the heart and skeletal muscles are the most seriously affected. The symptoms of Pompe disease can vary widely in terms of age of onset and severity depending on the degree of enzyme deficiency. The first symptom is usually night blindness, progressing to a ring-shaped area of blindness that gradually extends to lessen the field of vision. Tourette syndrome (Ts)-A neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics. Medicines in Development rare diseases 2013 55 the drug discovery, development and approval process Developing a new medicine takes an average of 10-15 years; For every 5,000-10,000 compounds in the pipeline, only 1 is approved. It takes 10-15 years, on average, for an experimental drug to travel from lab to U. Only five in 5,000 compounds that enter preclinical testing make it to human testing. Once a new compound has been identified in the laboratory, medicines are usually developed as follows: Preclinical Testing. A pharmaceutical company conducts laboratory and animal studies to show biological activity of the compound against the targeted disease, and the compound is evaluated for safety. Clinical Trials, Phase I-Researchers test the drug in a small group of people, usually between 20 and 80 healthy adult volunteers, to evaluate its initial safety and tolerability profile, determine a safe dosage range, and identify potential side effects. They are the longest studies, and usually take place in multiple sites around the world. The applications contain all of the scientific information that the company has gathered. Discovering and developing safe and effective new medicines is a long, difficult, and expensive process. There are a number of important factors that could cause actual results to differ materially from the results anticipated by these forward-looking statements.

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Gardner Diamond syndrome

References:

  • https://carbonrecycling.net/wp-content/uploads/2018/04/simpson.pdf
  • https://www.aafp.org/afp/2017/0715/afp20170715p87.pdf
  • https://fetalmedicine.org/var/uploads/18-23_Weeks_Scan.pdf
  • https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/211675s000lbl.pdf