Primary Biliary Cirrhosis

Primary biliary cirrhosis is an autoimmune disease where cytotoxic T-cells attack biliary endothelium causing granulomatous destruction of intrahepatic bile ducts. This destruction leads to cholestasis, then progressive cirrhosis, portal hypertension, and liver failure. Patients often complain of fatigue and pruritus and jaundice is evident. This process is most prevalent in middle-aged women, especially in those with other preexisting autoimmune disorders. Laboratory evaluation elicits an...

Breast Cancer Adjuvant Therapy

Chemotherapy is traditionally initiated six weeks postoperatively. This allows the tissue time to heal prior to the immunosuppression associated with chemotherapy. Chemotherapy was historically reserved for patients with a poor prognosis. This included patients with greater than 4 positive nodes, primary tumors greater than 4 cm, a grade III tumor, or any tumor with lymphatic or vascular invasion. All of these imply systemic spread of tumor. Neoadjuvant chemotherapy is used in women who desire...

Intradermal Radiocolloid Injection

Current recommended guidelines for performance ofradioguided sentinel lymphnode biopsy include intradermal injection of 0.5 mCi of 0.2 micron filtered technetium-99 sulfur colloid in a volume of 6 mL at least 1 h prior to operation. For intradermal injection, filtered technetium sulfur colloid is injected in four or five locations into the skin raise a wheal overlying the tumor. For tumor locations in which it is not possible to identify the area of skin overlying the tumor, peritumoral...

Dehydroepiandrosterone DHEA

DHEA is the major C-19 sex steroid produced by the zona reticularis of the adrenal cortex that acts as a weak androgen which promotes virilization in women. During fetal life, contributes to development of the male external genitalia, vas deferens, epididymis, seminal vesicles, and prostate. Insulin is a polypeptide hormone with two chains of amino acids linked by disulfide bridges synthesized in and secreted by the p cells of the islets of Langerhans in response to glucose. Insulin facilitates...