Manifest

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  • Why do so many people study books or programs like "The Secret," "Think and Grow Rich," "The Science of Getting Rich," and "The Master Key System?" Why do people want to understand the Law of Attraction? Why do people use tools like affirmations and vision boards? What is the "golden thread" or common desire behind all of this interest? I suggest that most people are trying to learn the science and art of manifesting or creating what they most desire. They want to figure out how to consistently achieve their goals. And to attract specific objects or circumstances into their personal world....

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  • Harrison's Internal Medicine Chapter 54. Skin Manifestations of Internal Disease Skin Manifestations of Internal Disease: Introduction It is now a generally accepted concept in medicine that the skin can show signs of internal disease. Therefore, in textbooks of medicine one finds a chapter describing in detail the major systemic disorders that can be identified by cutaneous signs. The underlying assumption of such a chapter is that the clinician has been able to identify the disorder in the patient and needs only to read about it in the textbook.

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  • Harrison's Internal Medicine Chapter 32. Oral Manifestations of Disease Oral Manifestations of Disease: Introduction As primary care physicians and consultants, internists are often asked to evaluate patients with disease of the oral soft tissues, teeth, and pharynx. Knowledge of the oral milieu and its unique structures is necessary to guide preventive services and recognize oral manifestations of local or systemic disease (Chap. e7).

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  • Erythroderma (Table 54-2) Erythroderma is the term used when the majority of the skin surface is erythematous (red in color). There may be associated scale, erosions, or pustules as well as shedding of the hair and nails. Potential systemic manifestations include fever, chills, hypothermia, reactive lymphadenopathy, peripheral edema, hypoalbuminemia, and high-output cardiac failure. The major etiologies of erythroderma are (1) cutaneous diseases such as psoriasis and dermatitis (Table 54-3); (2) drugs; (3) systemic diseases, most commonly CTCL; and (4) idiopathic.

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  • Migratory erythema with erosions; favors lower extremities and girdle area In erythema gyratum repens, one sees numerous mobile concentric arcs and wavefronts that resemble the grain in wood. A search for an underlying malignancy is mandatory in a patient with this eruption. Erythema migrans is the cutaneous manifestation of Lyme disease, which is caused by the spirochete Borrelia burgdorferi. In the initial stage (3–30 days after tick bite), a single annular lesion is usually seen, which can expand to ≥10 cm in diameter.

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  • Palpable purpura are further subdivided into vasculitic and embolic. In the group of vasculitic disorders, cutaneous small-vessel vasculitis, also known as leukocytoclastic vasculitis (LCV), is the one most commonly associated with palpable purpura (Chap. 319). Underlying etiologies include drugs (e.g., antibiotics), infections (e.g., hepatitis C virus), and autoimmune connective tissue diseases. Henoch-Schönlein purpura is a subtype of acute LCV that is seen primarily in children and adolescents following an upper respiratory infection.

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  • (BQ) Part 1 book "Harrison's principles of internal medicine" presents the following contents: Introduction to clinical medicine, cardinal manifestations and presentation of diseases, genes, the environment, and disease, regenerative medicine, aging, nutrition, oncology and hematology, infectious diseases.

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  • Great News! You now own full re-print and distribution rights for this amazing report (Value $97). This means you may re-print, re-sell and distribute this document however you wish. If you’re a publisher, you may sell or package this report with any paid product or program for whatever price you like and keep 100% of the profit. The only restriction is that you must not modify any of the content in any way.

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  • Telangiectasias (Table 54-8) In order to distinguish the various types of telangiectasias, it is important to examine the shape and configuration of the dilated blood vessels. Linear telangiectasias are seen on the face of patients with actinically damaged skin and acne rosacea, and they are found on the legs of patients with venous hypertension and essential telangiectasia. Patients with an unusual form of mastocytosis (telangiectasia macularis eruptiva perstans) and the carcinoid syndrome (see "Acne," above) also have linear telangiectasias.

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  • Table 54-12 Causes of Vesicles/Bullae I. Primary cutaneous diseases A. Primary blistering diseases (autoimmune) 1. Pemphigusa 2. Bullous pemphigoidb 3. Gestational pemphigoidb 4. Cicatricial pemphigoidb 5. Dermatitis herpetiformisb,c 6. Linear IgA bullous dermatosisb 7. Epidermolysis bullosa acquisitab,d B. Secondary blistering diseases 1. Contact dermatitisa 2. Erythema multiformea,b 3. Stevens-Johnson syndrome 4. Toxic epidermal necrolysisb C. Infections 1. Varicella/zoster virusa,e 2. Herpes simplex virusa,e 3. Enteroviruses, e.g., hand-foot-and-mouth disease 4.

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  • White Lesions In calcinosis cutis there are firm white to white-yellow papules with an irregular surface. When the contents are expressed, a chalky white material is seen. Dystrophic calcification is seen at sites of previous inflammation or damage to the skin. It develops in acne scars as well as on the distal extremities of patients with scleroderma and in the subcutaneous tissue and intermuscular fascial planes in DM. The latter is more extensive and is more commonly seen in children.

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  • In addition, although more rare, some patients might not present until weeks, if not longer, after their infarction with symptoms that prompt the discovery of a chronic PI- VSD. Early PI-VSDs tend to be catastrophic and typically result in early death.

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  • Latex intolerance has become an increasingly important concept and diagnosis. In this textbook, we have aimed to cover all aspects of latex allergy including contact urticaria, irritation, and allergic contact dermatitis. An evidence-based and practical approach has been taken to describe the epidemiology, basic science, clinical presentation, management, and prognosis of the varied manifestations of natural rubber latex intolerance.

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  • Dental Care of Medically Complex Patients Routine dental care (e.g., extraction, scaling and cleaning, tooth restoration, and root canal) is remarkably safe. The most common concerns regarding care of dental patients with medical disease are fear of excessive bleeding for patients on anticoagulants, infection of the heart valves and prosthetic devices from hematogenous seeding of oral flora, and cardiovascular complications resulting from vasopressors used with local anesthetics during dental treatment. Experience confirms that the risks of any of these complications are very low.

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  • Drug-induced erythroderma (exfoliative dermatitis) may begin as an exanthematous (morbilliform) eruption (Chap. 56) or may arise as diffuse erythema. A number of drugs can produce an erythroderma, including penicillins, sulfonamides, carbamazepine, phenytoin, gold, allopurinol, and zalcitabine. Fever and peripheral eosinophilia often accompany the eruption, and there may also be facial swelling, hepatitis, and allergic interstitial nephritis; this constellation is frequently referred to as drug reaction with eosinophilia and systemic symptoms (DRESS).

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  • Becoming less common. Poikiloderma is a term used to describe a patch of skin with (1) reticulated hypo- and hyperpigmentation, (2) wrinkling secondary to epidermal atrophy, and (3) telangiectasias. Poikiloderma does not imply a single disease entity—although becoming less common, it is seen in skin damaged by ionizing radiation as well as in patients with autoimmune connective tissue diseases, primarily dermatomyositis (DM), and rare genodermatoses (e.g., Kindler syndrome). In scleroderma, the dilated blood vessels have a unique configuration and are known as mat telangiectasias.

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  • Absence of melanocytes. b Normal number of melanocytes. c Platelet storage defect and restrictive lung disease secondary to deposits of ceroid-like material; one form due to mutations in β subunit of adaptor protein. d Giant lysosomal granules and recurrent infections. The differential diagnosis of localized hypomelanosis includes the following primary cutaneous disorders: idiopathic guttate hypomelanosis, postinflammatory hypopigmentation, tinea (pityriasis) versicolor, vitiligo, chemical leukoderma, nevus depigmentosus (see below), and piebaldism (Table 54-9).

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  • In tuberous sclerosis, the earliest cutaneous sign is an ash leaf spot. These lesions are often present at birth and are usually multiple; however, detection may require Wood's lamp examination, especially in fair-skinned individuals. The pigment within them is reduced but not absent. The average size is 1–3 cm, and the common shapes are polygonal and lance-ovate.

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  • Also lentigines. b Polyostotic fibrous dysplasia. c See also "Papulonodular Skin Lesions." d Late 1980s. A proliferation of melanocytes results in the following pigmented lesions: lentigo, melanocytic nevus, and melanoma (Chap. 83). In an adult, the majority of lentigines are related to sun exposure, which explains their distribution.

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  • In the diffuse forms of hyperpigmentation, the darkening of the skin may be of equal intensity over the entire body or may be accentuated in sun-exposed areas. The causes of diffuse hyperpigmentation can be divided into four major groups—endocrine, metabolic, autoimmune, and drugs. The endocrinopathies that frequently have associated hyperpigmentation include Addison's disease, Nelson syndrome, and ectopic ACTH syndrome. In these diseases, the increased pigmentation is diffuse but is accentuated in the palmar creases, sites of friction, scars, and the oral mucosa.

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