Are you looking for ambiguous genitalia wiki and pictures? The first concept that an examiner might want to know if they were asking the question - or if you were approached with the clinical thing - is that there are many different levels of sex, and not just chromosomes. We all tend to focus on chromosomes but thatís just one. Gonads, ovaries or testes? What are the internal ducts? What do the external genitals look like? What is the hormonal sex; androgen or estrogen circulating? And what is the psychosocial sex? All these things must be consistent in order to have a successful outcome of sex assignment.
Ambiguous Genitalia Wiki and pictures
Starting with chromosomal sex, since thatís the thing we often think about first when we see a baby who has ambiguous genitalia. Let me tell you, the chromosomes wonít tell you everything. They arenít always perfect predictors of what the sex of the child is. I think one obvious example is that a karyotype only sees big changes. You might not see the missing piece that will turn an XY person into a perfectly normal looking female. You may not see extra pieces that will turn an XX person into a very normal looking male. What about the concept that if some of the cells are one type - say 45 X - and the other types are 46 XY, what actually happens. And thatís an important concept of mosaicism. Iím not sure they will ask you this on the Boards but in real life you have to remember that you can get mixes of chromosomes, and perhaps that explains some of the cases that we see that are very, very much in between. Now we do a lot of focusing on the gonadal sex. That is, is it an ovary or a testes? But guess what? Itís not always clear. While it normally follows the rules that if you have a Y chromosome you get a testes. Sometimes you do get a little of both. It may have ovarian and testicular tissue in the same gonad. You can imagine how that confuses issues. Sometimes the gonad is missing. It either never developed in the first place or else it was there and then it disappeared. Sometimes it just doesnít make the hormones it is expected to, even though itís there.
Now the third thing - and I think this is very important for diagnostic purposes - are the internal genital ducts, the tubing as you would have it. I donít know, maybe you have your mnemonic. I just remember that M stands for mother and W stands for wolf-whistle, to remember which ones are the "female" and which ones are the "male" structures. But really the thing that I think is important is that there are two mullerian structures that are diagnostically very very important, and I put them in orange. And one of them is the uterus. If you see a uterus on the ultrasound, there was something there that a male normally makes that wasnít made. If you see the upper two-thirds of the vagina is there, you know that that male factor wasnít active, that keeps that from being made. So itís very important because these are structures you can see on ultrasound, in the case of the uterus, or on your physical exam, if you do a pelvic exam.
Ambiguous Genitalia Causes
Now the thing that we see in the delivery room, the thing that I think really leads to a lot of the distress, is the external genitalia, the ambiguity of the external genitalia. The rule is - and this is what an examiner might try to ask a question, to see if you understand - is that for every female genital structure there is a male equivalent, and vice-versa. So the clitoris is the analog of the penis. On the other hand, sometimes you have something and you donít know whether itís a large clitoris or a small penis. There are also other analogs as well. The labia minora in a male would form a tube around the urethra and recall the corpus spongiosum. The labia majora would fuse in a male to become a scrotum. And the lower third of the vagina is a prostatic utricle. Thatís not as useful, but these other things are very very important to know. And in between you can get things like hypospadias, or you can get posterior fusion and you donít know if itís fused labia majora or actually a partially fused scrotum. Just the idea that all these things can be in between - and Iíll show you some clinical examples in just a little bit. Now there is obviously the idea of do you have estrogens or androgens in your system? And does your body respond? Iíll show you an example of when the body doesnít respond to androgens, you get a female outcome. What they call the androgen insensitivity syndrome.
There is also the psychosocial aspect and I wonít get into that now, but from a management point of view, this is very important; that whatever decision you finally make on a sex assignment case, that the family, the physicians, everybody is firmly on that same wave length.
So really the key concept, number two -which is just a corollary of concept number one - is that many of these different levels may be discordant. They donít always follow together. For example, if you have a question that asks, "Here is somebody with a uterus, do they definitely have a 46 XX karyotype?" I think you probably know the answer. Definitely no, they may not. Hereís another classic example. Somebody has well developed breasts, normal female genitalia, 100% female identity, does this automatically guarantee they have a 46 XX karyotype? Again, not necessarily. If they have primary amenorrhea, a blind short vagina, and no axillary or pubic hair, they may very well be 46 XY but they didnít respond to testosterone. In many cases this is the classic example of androgen insensitivity. Where somebody who looks like this turns out to have a hernia with a testes in place.
An important key concept, pathophysiologically, is that the default pathway for sexual differentiation is female. So that if you donít have any ovaries - if you have a fetus who has no gonads whatsoever - the default pathway will be female duct and genital development. On the other hand, the testes has to be there to suppress those mullerian ducts, those female ducts like the uterus and upper part of the vagina, and two, to stimulate the development of male genitals. So to make a male you have to have the right chromosomal signal, usually on the Y chromosome. You have to have two signals from the testes; one, the mullerian inhibiting substance to inhibit the female ducts, and two, testosterone to stimulate the male genitalia formation. You need to be able to convert testosterone one final step to dihydrotestosterone that finishes off the genital development, and you do also need pituitary signals to insure that the penis is full length, for example.
There is an important concept medically, that there is a critical period for external genitalia development and this is week 8-12. After the second month. Before that the male and female genitalia in the fetus look exactly alike. Between 8 and 12 weeks any androgen - whether itís something the mother took, whether itís a tumor the mother has, or whether itís an adrenal problem that gives the mother too much testosterone - will lead to full virilization, where if you had somebody who was a 46 XX female and was exposed to a lot of androgen in this critical period, they would end up looking quite male. After 12 weeks, the fetus is no longer quite as sensitive and while youíll get some virilization, you wonít get the extreme ambiguity you would at the earlier period.
You need to know what are some of the signs of virilization. Clitoromegaly is one. But I will tell you that there are standards, but itís very hard to measure a clitoris and itís sort of like the Supreme Court definition of pornography, "you know when you see it." Now I want to warn you that the clitoris of a premature infant can look very prominent because there isnít a lot of labial fat on the sides, so it looks like the clitoris is sticking out there. But I think most of us would realize that this is not clitoromegaly. But once in a while we get some calls because someone thinks the clitoris looks very prominent. Another thing that you have to be careful of; this is a normal female infant. Her labia minora are very stimulated, perhaps because of her motherís hormones, and this will go down as the infant grows up. This is not clitoromegaly. These are just very stimulated, estrogen-stimulated labia minora.
Another thing that is important is that if you see a migration of the urethral opening to the shaft of what would be the clitoris - and the urethral opening in a male should be at the tip of the corona, and in a female is down at the base of the phallic structure, but it could be anywhere in between depending on how much androgen the person has. Another very important feature for virilization is any kind of posterior fusion at the labia. One thing you can look at is see where the fusion is, or see where the posterior part of the vaginal opening, and see if itís closer to the base of the clitoris than it is to the anus. If it is, thatís a sign of significant posterior fusion and maybe a sign of virilization in a female.
You have to know the converse too. What does an under-virilized male look like? Obviously a small penis is one thing, and you can remember the one inch rule as a rule of thumb for a term newborn. A penis that is less than one inch in length is more than 2 Ĺ standard deviations below the mean. That should be easy to remember, hopefully. Obviously hypospadias can be a sign of under-virilization, although it may happen sporadically with no hormone problems. And another thing thatís come up - actually very recently we had a case - where a child may have a bifid scrotum. Iíll show you a picture of each of these in a second. I donít think any of us need to be told that this is a micropenis. You do need to push the suprapubic fat pad back to make sure that you are getting the full length of the penis, and you do need to measure the stretched penile length. Not just look at it and try to estimate. The hypospadias, or mild hypospadias, may be a sign of under-virilization. Certainly if the urethra is down here near the base of the penis, thatís a very distinct sign of under-virilization and should increase your level of suspicion for an androgen disorder.
Here is an example Ö this is a bifid scrotum where you actually have some fusion in the midline right here, and that can be a sign of under-virilization as well.
Now any exposure to excess androgens during that critical 8-12 week period will lead to virilization and the most common thing that you will run into, and have a very good chance of running into - particularly if you deal with a Hispanic population or you live in New York City - and that would be virilizing CAH, or congenital adrenal hyperplasia. And you should know this entity relatively well. Iíll cover that in a second. Obviously if mother had an androgen-excreting tumor and she herself was virilized, or if she were taking any androgenic meds, that would be a smoking gun as well. But much less common in our practice.
That's some stuff about Ambiguous Genitalia Wiki and pictures
Cold Sore Treatment Over the Counter Are you looking for cold sore treatment over the counter?A cold sore and a canker sore can come from the same herpes simplex virus, but they aren't the same thing. A cold sore is a small- to medium-size blister that appears on or around the mouth area. Cold sores can also appear in the nose. A canker sore is a virus-induced blister that is on the inside of the mouth. It usually takes 2 days to 2 weeks to heal. A cold sore, besides being red and painful, can also leak fluid.
Local Treatment of Allergic Dermatitis Most Persons who suffer with allergic dermatitis have accumulated numberless lotions, salves, ointments, and other local preparations. These have either been prescribed for them or suggested to them by their family or friends. For the most part, the effects of these long-continued local applications is to further irritate and traumatize the skin, so that in the end more harm than good is done. First take away all these various drugs and prescribe only such bland preparations as are least likely to injure the skin. These must be cautiously and carefully applied, observing their changing effect. Indeed, at times it is necessary to use the preparation of one area of the skin only, such as one arm or one leg, and observe the difference between the dermatitis on that are and on the area of the body where no preparation has been used.
US judge blocks graphic warning on cigarette U.S. District Judge Richard Leon, in a 29-page ruling Monday, granted the preliminary injunction because he believed there was a "substantial likelihood" the cigarette companies ultimately would win "on the merits of their position that these mandatory graphic images unconstitutionally compel speech."
Filariasis Symptoms and Treatment The species of mosquitoes that transmit malaria and yellow fever, disease caused by protozoa and viruses, also transmit filariasis, caused by a parasitic wormóa nematode or roundworm. Filariasis affects 300 million people living in tropical and subtropical areas of the world. The worm invades the subcutaneous tissues and lymph system of the human body, blocking the flow lymph and producing symptoms of inflammation, edema, abscesses, and, in one form of the disease, blindness. Filariasis is not unknown to Americans; some 15,000 soldiers contracted disease during World War II fighting in the Pacific Theater, and cases have been reported along the Carolina coast area. But most of the victims of filariasis live in a region extending from Africa through Asia to the islands of New Guinea and Borneo.
Radiation Safety Principles and Standard
The International Commission on Radiological Protection (ICRP) has
proposed that following principles should guide the use of ionizing
radiation safety standard:
No practice involving exposures to radiation should be adopted unless it
produces sufficient benefit to the exposed individuals or society to offset
the radiation detriment it causes (the justification of practice)
In relation to any particular source within a practice, the magnitude of
individuals doses, the number of people exposed, and the likelihood on
incurring exposures where these are not certain to be received should all kept
as low as reasonably achievable (ALARA), economic and social factors being
taken into account. This procedure should be constrained by restrictions of
the doses to individuals (dose constraint), so as to limit the inequity likely
to result from the inherent economic and social judgments.
The exposure of individuals resulting from the combination of all the
relevant practices should be subject to dose limits, or to some control of
risk in the case of potential exposures. These are aimed at ensuring that no
individual is exposed radiation risks that are judged to be unacceptable from
these practices in any normal circumstances. Not all sources are susceptible
of control by action at the source and it is necessary to specify the sources
to be included as relevant before selecting a dose limit.
Breast Cancer Facts and Statistics Breast cancer is the most common form of cancer in women. There are close to 200,000 new cases of breast cancer a year, and this results in about 47,000 deaths per year, although the mortality has fallen slightly in the 1990s.
The etiology of breast cancer remains unknown but at least two breast cancer genes have been clonedĖthe BRCA-1 and the BRCA-2 genes. Only about 10% of all breast cancers can be explained by hereditary mutations in these genes. Most of the sporadic cases, the other 90% of the cases of breast cancer, do not seem to have mutations in these genes so there does not seem to be a common pathway gene for both sporadic and hereditary cases.
IVF Treatment Cost and Process Are you looking for about ivf treatment cost and process? In vitro fertilisation (IVF) is a process by which egg cells are fertilised by sperm outside the body: in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Robert G. Edwards, the doctor who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. Before that, there was a transient biochemical pregnancy reported by Australian Foxton School researchers in 1953 and an ectopic pregnancy reported by Steptoe and Edwards in 1976. At the same time, Subash Mukhopadyay, a relatively unknown physician from Kolkata, India was performing experiments on his own with primitive instruments and a house hold refrigerator and this resulted in a test tube baby, later named as "Durga" (alias Kanupriya Agarwal) who was born on October 3, 1978
Types of Blood Cancer Symptoms and Treatments Overview of Blood Cancer
The major forms of blood cancer are lymphoma, leukemia and multiple myeloma. These cancers are formed either in the bone marrow or the lymphatic tissues of the body. They affect the way your body makes blood and provides immunity from other diseases.
Nervous System, Digestive System and Circulator System Nervous System
The body is provided with a sturdy frame in the form of a bony skeleton and hundreds of muscles are arranged in and around the body framework to provide a means of movement. This entire mechanism would be useless without some centralized means of control and coordination.
The human body depends upon its nervous system to control, regulate, and stimulate the many parts of the human machine.
Drugs for Depression Are you looking for drugs for depression? here is some good stuff about drug for depression.
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and physical well-being. It may include feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, irritability, or restlessness.
Hypertension treatment food and nutrients When pressure exerted by blood on the walls of the arteries is greater than normal, blood pressure rises. Usually, blood pressure falls when at rest. It rises in response to strenuous physical activity, stress, or a perceived danger in which the sympathetic nervous system dominates, arteries constrict and more blood is sent to the brain increasing blood pressure. This heightened state of the sympathetic system does not seem to retreat in individuals with hypertension and damage to the heart, kidney, arteries, and other organs becomes inevitable.
Blood pressure is considered high at a reading of 140/90. There are no symptoms of the illness and it is recommended individuals over 40 be checked. Hypertension can be controlled by permanent diet and lifestyle changes; this includes reducing stress, maintaining proper weight (not more than 5 lb overweight), and eating foods containing compounds that reduce blood pressure such as celery, garlic, and fresh fruits and vegetables. Having a home monitor is helpful. Smoking, alcohol, refined sugar, food allergies, and high sodium foods can contribute to hypertension. Some people may need extra calcium to stabilize blood pressure. Some individuals are salt sensitive which cause a rise in their blood pressure. Daily exercises and various stress reduction techniques lower systolic and diastolic blood pressure.
Osteoporosis Symptoms, Treatment and Prevention Osteoporosis is a widespread condition that causes fractures. Osteoporosis is defined as a systemic disease characterized by low bone mass, microarchitectural deterioration of bone tissue with the consequent increase in bone fragility and susceptibility of fracture. Osteoporosis is a disease of thin bones that break easily. We have nice strong vertebral structures on the left and thin porous bones that snaps easy. So the role really of your situation in this disease is trying to recognize these people before thereís a fracture, when you know theyíve got thin bones, and treat them and see if you can actually prevent the fracture.
Criteria for osteoporosis is based on bone densitometry readings and a standard deviation or two below your peak bone mass would be considered osteopenia, or thin bones but not osteoporotic. A value of two standard deviations below would be osteoporosis and worthy of investigation and/or treatment. The World Health Organization took a slightly different stance and most of the bone densitometry equipment manufacturers installed this definition in their software, and that is: osteoporosis really starts at 2 Ĺ standard deviations, or a T-score of -2.5, and severe osteoporosis means not only do you have a low T-score but youíve had a fragility fracture of some sort. Either a collapsed spine, a broken hip, a broken wrist with relatively mild trauma. So we have a functional definition, a quantitative definition, and I think we have a pretty good framework to work with in terms of understanding who we need to recognize and treat.
Codeine Cough Syrup and Side Effects Cough syrup with codeine
You have a hacking cough.Your chest hurts and your coughing is keeping you up at night. The over-the-counter cough drops and syrups are not doing it for you.As much as you hate going to see the doctor, you reluctantly decide that it is time to take a trip.The nurse takes your weight, takes your temperature, and takes your blood pressure.