The skin

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  • Harrison's Internal Medicine Chapter 83. Cancer of the Skin Melanoma Pigmented lesions are among the most common findings on skin examination. The challenge is to distinguish cutaneous melanomas, which may be lethal, from the remainder, which with rare exceptions are benign. Examples of malignant and benign pigmented lesions are shown in Fig. 83-1. Figure 83-1 Atypical and malignant pigmented lesions. The most common melanoma is superficial spreading melanoma (not pictured). A.

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  • Clinical Characteristics There are four types of cutaneous melanoma (Table 83-2). In three of these—superficial spreading melanoma, lentigo maligna melanoma, and acral lentiginous melanoma—the lesion has a period of superficial (so-called radial) growth during which it increases in size but does not penetrate deeply. It is during this period that the melanoma is most capable of being cured by surgical excision. The fourth type—nodular melanoma—does not have a recognizable radial growth phase and usually presents as a deeply invasive lesion, capable of early metastasis.

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  • It has long been noted anecdotally that affect, psychological state and neurologic state have influences on inflammatory skin diseases. Disorders such as psoriasis, atopic dermatitis, acne and rosacea, among many others, are reported to become exacerbated by stress. Furthermore, it is widely believed that stress alters cutaneous immunity. However, mechanisms responsible for these effects have remained incompletely understood. Scientific evidence for an influence of the nervous system on immune and inflammatory processes in the skin has been developed only relatively recently.

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  • Other Nonmelanoma Cutaneous Malignancies Neoplasms of cutaneous adnexa and sarcomas of fibrous, mesenchymal, fatty, and vascular tissues make up 1–2% of NMSC (Table 83-6). Some can portend a poor prognosis such as Merkel cell carcinoma, which is a neural crestderived, highly aggressive malignancy that exhibits a metastatic rate of 75% and a 5-year survival rate of 30–40%. Others, such as the human herpes virus 8-induced, HIV-related Kaposi's sarcoma, exhibit a more indolent course.

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  • Prognostic Factors The most important prognostic factor is the stage at the time of presentation. Fortunately, most melanomas are diagnosed in clinical stages I and II. The revised American Joint Committee on Cancer (AJCC) staging system for melanoma is based on microscopic primary tumor depth (Breslow's thickness), presence of ulceration, evidence of nodal involvement, and presence of metastatic disease to internal sites (Table 83-3). Certain anatomic sites may affect the prognosis.

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  • Management The entire cutaneous surface, including the scalp and mucous membranes, should be examined in each patient. Bright room illumination is important, and a 7x to 10x hand lens is helpful for evaluating variation in pigment pattern. A history of relevant risk factors should be elicited. Any suspicious lesions should be biopsied, evaluated by a specialist, or recorded by chart and/or photography for follow-up. Examination of the lymph nodes and palpation of the abdominal viscera are part of the staging examination for suspected melanoma.

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  • A lifetime risk of melanoma development of 6% has been estimated. The risk is greatest before age 5 and next greatest between ages 5 and 10. Early detection of melanoma is difficult in these lesions because of the deep dermal or subcutaneous origin of primary melanoma and because of the large and varied surface of the nevus. Prophylactic excision early in life can be accomplished by staged removal with coverage by split-thickness skin grafts. Surgery cannot remove all at-risk nevus cells as some may penetrate into the muscles or central nervous system below the nevus. At present there are...

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  • Treatment of Metastatic Disease Melanoma can metastasize to any internal organ, the brain being a particularly common site. Metastatic melanoma is generally incurable, with survival in patients with visceral metastases generally

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  • Biopsy Any pigmented cutaneous lesion that has changed in size or shape or has other features suggestive of malignant melanoma is a candidate for biopsy. The recommended technique is an excisional biopsy, as that facilitates pathologic assessment of the lesion, permits accurate measurement of thickness if the lesion is melanoma, and constitutes treatment if the lesion is benign.

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  • Squamous Cell Carcinoma The natural history of SCC depends on both tumor and host characteristics. Tumors arising on actinically damaged skin have a lower metastatic potential than those on protected surfaces. The metastatic frequency of cutaneous SCC, reported at 0.3–5.2%, occurs most frequently in regional draining lymph nodes. Tumors occurring on the lower lip and ear have metastatic potentials approaching 13 and 11%, respectively. The metastatic potential of SCC arising in scars, chronic ulcerations, and genital or mucosal surfaces is higher.

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  • The skin plays an important role in maintaining the integrity of the living organism while allowing the interaction of the organism with its environment. To fulfill these functions, mechanical stability is as important as flexibility. The mechanical properties of skin are very diverse depending on the anatomical location, and they evolve throughout life from the fetus to old age. Both genetic and acquired skin diseases modify skin biomechanics, as do intrinsic and photoaging.

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  • Tham khảo sách 'nickel and the skin absorption, immunology, epidemiology, and metallurgy', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả

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  • For two main reasons, dermatology is one of the later medical disciplines to use imaging techniques: skin lesions are readily visible to the naked eye or through a magnifying glass, allowing clinical diagnosis with no invasive examination; skin lesions can easily be biopsied or removed for histological study. This approach has therefore remained the basis of clinicopathological diagnosis of skin diseases for a long time. There has also been a third factor.

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  • This account is confined to therapy directed primarily at the skin. • Pharmacokinetics of the skin • Topical preparations:Vehicles for presenting drugs to the skin; Emollients, barrier preparations and dusting powders;Topical analgesics; Antipruritics; Adrenocortical steroids; Sunscreens • Cutaneous adverse drug reactions • Individual disorders: Psoriasis.Acne, Urticaria, Skin infections It is easy to do more harm than good with potent drugs, and this is particularly true in skin diseases.

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  • In the five years since the first edition of this book was published, there has been an explosion in new information relating to the nature of dry skin and its treatment. Investigators from various disciplines, including dermatologists, pharmacists, chemists, biochemists, molecular biologists, physiologists, pharmacologists, and even psychologists have advanced our knowledge tremendously. We now understand that the stratum corneum has a surprisingly large number of functions in maintaining the physiologic stability and homeostasis of the skin and mind.

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  • Hispanic skin care, like the skin care for any “race” of people is not a one size fits all proposition. There is no “latina skin type”. Latina skin varies widely and your needs will be unique. Like African Americans, Latinas skin color and type varies. However, there are some useful generalities when it comes to the care of brown skin. Darker skinned Hispanics skin care will be very similar to the needs of African Americans. Treasured Locks is committed to helping people with all skin types. But, our particular focus is on African American and Hispanic skin and hair care needs....

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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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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: The use of some nanoemulsions based on aqueous propolis and lycopene extract in the skin’s protective mechanisms against UVA radiation

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  • Highlights in Skincancer is a companion handbook published expressly for all the practitionners who are interested in skin cancers: medical oncologists and dermatologists but also residents, general practitionners, surgeons, plastic surgeons. The book is designed to teach new aspects of skincancers in the context of practical clinical settings. Each topic is an expert view of a specific skincancer field.

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  • Harrison's Internal Medicine Chapter 52. Approach to the Patient with a Skin Disorder APPROACH TO THE PATIENT WITH A SKIN DISORDER: INTRODUCTION The challenge of examining the skin lies in distinguishing normal from abnormal, significant findings from trivial ones, and in integrating pertinent signs and symptoms into an appropriate differential diagnosis. The fact that the largest organ in the body is visible is both an advantage and a disadvantage to those who examine it.

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