By X. Jesper. Dominican College.

The treatment of choice for hereditary hemochromatosis is phlebotomy to reduce the body iron to normal or near-normal levels and to maintain it in that range zovirax 400mg discount. The phlebotomy program should remove 500 ml of blood once weekly or, for heavily loaded patients, twice weekly, until the patient is iron deficient. In patients with hereditary hemochromatosis, prolonged treatment is often needed. For example, if the initial body iron burden is 25 g, complete removal of the iron burden with weekly phlebotomy may require therapy for 2 years or more. If phlebotomy therapy removes the iron load before diabetes mellitus or cir- rhosis develops, the patient’s life expectancy is normal. If cirrhosis develops, however, the risk of hepatocellular carcinoma is increased by more than 200-fold. A 30-year-old African-American woman presents to your office with a chief complaint of weakness. She states that she has been feeling “run down” for several weeks now. Further questioning reveals that she is diffusely weak. She has experienced dyspnea on exertion, and she has a new rash. Physical examination is notable for mild tachycardia, pale conjunctiva, petechiae on her mucus membranes and lower extremities, and an absence of hepatomegaly or splenomegaly. Results of a complete blood cell count (CBC) are as follows: hematocrit, 21%; white blood cell count (WBC), 1,200 cells/mm3; and platelet count, 12,000 cells/mm3. The results of a bone marrow biopsy with aspirate are consistent with aplastic anemia. Which of the following statements regarding aplastic anemia is false? Aplasia can be a prodrome to hairy-cell leukemia, acute lymphoblastic leukemia, or acute myeloblastic leukemia B.

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The latest potential break- through is the remarkable efficacy of anti-TNF therapy in AS patients who do not respond ade- quately to NSAIDs and other conventional medica- tion (see Chapter 6) buy generic zovirax 800 mg online. The pain caused by sacroiliitis is usually a dull ache that is diffuse, rather than localized, and is felt deep in the buttock area. At first it may be intermittent or on one side only, or alternate between sides; however, within a few months it generally becomes persistent (chronic) and is felt on both sides (bilateral). Gradually the lower back becomes stiff and painful, as the inflammation extends to the spine in that area (lumbar spine). Over many months or years the back pain can gradually extend further up the spine to the area between the shoulder blades or even to the neck. These initial symptoms usually start in late adolescence or early adulthood. Most people with AS first seek medical help when the back pain and stiffness become persistent and troublesome. Their characteristic symptoms are chronic low back pain and stiffness that have come on gradually, for no apparent reason. Some people with AS have only transient episodes of thefacts 13 AS-03(13-18) 5/29/02 5:45 PM Page 14 Ankylosing spondylitis: the facts back pain with periods in between (remissions) when there are hardly any problems; others have more chronic back pain that leads to varying degrees of spinal stiffness and gradually decreasing spinal mobility. However, the spine will not always fuse completely: in some people the disease may stay limited to the sacroiliac joints and the lumbar spine. The disease may sometimes be associated with inflammation of hip or shoulder joints (called the girdle joints), or the more peripheral limb joints, such as knees, ankles, or elbows. In fact, for some people, the first symptoms may not be back pain but painful girdle or limb joints.

In lower concentra- It is applied locally on inflammatory lesions zovirax 800 mg free shipping. In higher concentrations they cause unroofing Lately, hydrogen peroxide cream was compared with of pustules and loosening of the corneocytes that line the fusidic acid in the treatment of impetigo. It is used for brief exposures, in con- and prolonged antimicrobial effect. The formulation is centrations of 30, 50 and 70% but it is considered a com- based on crystalline lipids and it is effective against gram- plement rather than a first-line treatment. It may there- fore be an additional topical treatment for patients with Corticosteroids gram-negative folliculitis in particular. A few topical preparations contain weak corticoste- roids, but proof of their efficacy is lacking. Clobetasol pro- Hydroxy Acids pionate is a potent corticosteroid that may help to reduce ß-Hydroxy Acid inflammation in nodular acne when applied twice a day Salicylic acid: This is the best known of the keratolytic for 5 days. This desquamative agent acts on the stratum corneum producing a dissolution of Dapsone the intercellular cement and, sometimes, a moderate peel- Dapsone in a gel formulation, at concentrations of 3 ing. It acts on the interfollicular epidermis and on the and 5% has been experimentally used for the last 3 years. In acne, it is the active ingredient in a It appears to be a new and promising therapeutic modali- variety of cleansers and astringent lotions and has a mild ty for moderate to moderately severe acne. It has not been comedolytic and anti-inflammatory effect. It is used in available in the past as it is highly insoluble in the aqueous concentrations of 1–3%.