Δημοφιλείς αναρτήσεις

Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolao

Medicine by Alexandros G.Sfakianakis

Εμφανιζόμενη ανάρτηση

Non-invasive diagnostic tools in the field of head and neck oncology : A liquid biopsy for head and neck cancers

The development of a liquid biopsy for head and neck cancers via  ScienceDirect Publication: Oral Oncology Publication ...

Τρίτη, 18 Οκτωβρίου 2016

Predicting survival and monitoring chemotherapeutic effectiveness : The significance of the C-reactive protein to albumin ratio as a marker

The significance of the C-reactive protein to albumin ratio as a marker for predicting survival and monitoring chemotherapeutic effectiveness in patients with unresectable metastatic colorectal cancer:






  • Masatsune ShibutaniEmail author,
  • Kiyoshi Maeda,
  • Hisashi Nagahara,
  • Yasuhito Iseki,
  • Kosei Hirakawa and
  • Masaichi Ohira
SpringerPlus20165:1798
DOI: 10.1186/s40064-016-3529-y
Received: 8 March 2016
Accepted: 12 October 2016
Published: 18 October 2016

Abstract

Inflammation has been reported to play an important role in cancer progression and various inflammatory markers have been reported to be useful prognostic markers. The aim of this retrospective study was to evaluate the significance of the C-reactive protein to albumin (CRP/ALB) ratio in colorectal cancer patients who received palliative chemotherapy. We performed a retrospective review of 99 patients who underwent palliative chemotherapy for unresectable colorectal cancer between 2005 and 2010. The cutoff value of the CRP/ALB ratio was determined based on a receiver operating characteristics curve analysis. The relationship between the CRP/ALB ratio and survival was assessed. The cutoff value for the CRP/ALB ratio was 0.183. The high pretreatment CRP/ALB ratio group showed significantly worse overall survival. Patients with a high pretreatment CRP/ALB ratio and in whom the CRP/ALB ratio normalized after chemotherapy tended to have better overall survival than those in whom both the pretreatment and posttreatment CRP/ALB ratios were high. The CRP/ALB ratio is a useful marker for predicting survival and monitoring chemotherapeutic effectiveness in patients with unresectable metastatic colorectal cancer.

Keywords

Colorectal cancer Prognosis Unresectable C-reactive protein to albumin ratio Chemotherapeutic effectiveness

Background

Colorectal cancer (CRC) is one of the most common causes of cancer-related death worldwide (Edwards et al. 2014). Unresectable metastasis is one of the most important prognostic factors for patients with CRC (Shibutani et al. 2015b). In spite of advances in chemotherapy, which include new cytotoxic and molecular targeted therapies, the prognosis of patients with unresectable metastatic CRC remains poor, with a median survival time of approximately 30 months (Heinemann et al. 2014; Grothey et al. 2008). The assessment of prognostic factors is therefore important for the management of unresectable metastatic CRC patients.
It is well known that there is a close relationship between inflammation and cancer progression (Mantovani et al. 2008; Balkwill and Mantovani 2001) and some inflammatory markers have been investigated as prognostic factors in CRC (Shibutani et al. 20132014; McMillan et al. 2007; Maeda et al.2015). The C-reactive protein-to-albumin (CRP/ALB) ratio has been reported to be a more accurate prognostic value in patients with various malignancies than the modified Glasgow prognostic score (mGPS) (Kinoshita et al. 2015; Xu et al. 2015), which is also calculated from the serum CRP and ALB concentration, and we previously reported on the prognostic significance of the CRP/ALB ratio in patients with CRC who underwent curative surgery (Shibutani et al. 2016). However, aside from our report, there have only been a few reports regarding the prognostic significance of the CRP/ALB ratio in patients with CRC (Ishizuka et al. 2016). Moreover, to the best of our knowledge, there are no published studies regarding the prognostic significance of the CRP/ALB ratio in patients with unresectable metastatic CRC. Therefore, we applied this marker to patients with unresectable metastatic CRC and compared the usefulness of the CRP/ALB ratio with that of other inflammatory markers for predicting and monitoring the therapeutic outcome.
The aim of the present study is to evaluate the significance of the CRP/ALB ratio as a marker for predicting survival and monitoring chemotherapeutic effectiveness in patients with unresectable metastatic CRC.

Methods

Patients

We retrospectively reviewed a database of 99 patients who underwent palliative combination chemotherapy for unresectable metastatic colorectal cancer at the Department of Surgical Oncology of Osaka City University between 2005 and 2010.
The patient characteristics are listed in Table 1. The patient population consisted of 57 males and 42 females, with a median age of 63 years (range 27–86). Forty of the patients had metachronous unresectable cancer; 59 had synchronous unresectable cancer. Fifty-four patients had single organ metastasis and 45 patients multiple organs affected by metastases. All of the patients underwent combination chemotherapy with oxaliplatin, or irinotecan plus 5-fluorouracil/leucovorin, or a prodrug of 5-fluorouracil as a first-line chemotherapy. Regimens considered to have the same efficacy were used for all of the patients in this study (Cassidy et al. 2008; Tournigand et al. 2004; Yamada et al. 2013). Sixty-five patients received 5-fluorouracil + leucovorin + oxaliplatin (FOLFOX), 21 patients received capecitabine + oxaliplatin (CapeOX), nine patients received 5-fluorouracil + leucovorin + irinotecan (FOLFIRI) and four patients received S-1 + oxaliplatin (SOX). Sixty-nine patients underwent chemotherapy combined with molecular targeted therapy. The median follow-up period for the surviving patients was 20.8 months (range 2.6–73.2 months). Sixty-three patients died during the follow-up period.
Table 1
The patients’ characteristics
Age (years)
 Median (range)
63 (27–86)
Gender
 Male
57
 Female
42
Location of primary tumor
 Colon
57
 Rectum
42
Histological type
 Well, moderately
78
 Poorly, mucinous
12
 Unknown
9
Detection of unresectable tumor
 Synchronous
59
 Metachronous
40
The number of organs affected by metastasis
 One organ
54
 Multiple organs
45
First-line chemotherapy regimen
 FOLFOX
65
 CapeOX
21
 FOLFIRI
9
 SOX
4
Molecular targeted therapy
 Bevacizumab
50
 Cetuximab
15
 Panitumumab
4
 None
30
The pretreatment C-reactive protein level
 Median (range)
0.32 (0.02–13.46)
The pretreatment albumin level
 Median (range)
3.9 (2.4–4.7)
The pretreatment CRP/ALB ratio
 Median (range)
0.084 (0.004–5.608)
The pretreatment NLR
 Median (range)
2.788 (0.580–16.306)
mGPS
 0
69
 1
21
 2
9
FOLFOX 5-fluorouracil + leucovorin + oxaliplatin, CapeOX capecitabine + oxaliplatin, FOLFIRI 5-fluorouracil + leucovorin + irinotecan, SOX S-1 + oxaliplatin, CRP/ALB ratio C-reactive protein to albumin ratio, NLRneutriphil to lymphocyte ratio, mGPS modified Glasgow prognostic score

Evaluation

Response evaluations were performed every eight weeks. A variation of approximately one week was regarded as an allowable error. All of the patients were followed up with a physical examination, blood tests (these included measurements of tumor marker levels such as carcinoembryonic antigen [CEA]), computed tomography and ultrasonography.
The pretreatment blood samples were obtained within one week before the initiation of chemotherapy; the posttreatment blood samples were obtained eight weeks after the initiation of chemotherapy. The serum CRP and ALB concentrations were measured using a chemiluminescent immunoassay (Wako, Osaka, Japan) according to the manufacturer’s protocol. The differential white blood cell count was analyzed using an XE-5000 hematology analyzer (Sysmex, Kobe, Japan) based on the manufacturer’s protocol. The CRP/ALB ratio was calculated from the preoperative blood samples by dividing the serum CRP level by the serum ALB level. The mGPS was defined according to the methods of a previous report (Petrelli et al. 2015), using the combination of the serum CRP and ALB levels: patients with a CRP level of <1.0 mg/dl were allocated a score of 0; those in whom the CRP and ALB levels were ≥1.0 mg/dl and ≥3.5 g/dl, respectively, were allocated a score of 1; and those in whom the CRP and ALB levels were ≥1.0 mg/dl and ALB < 3.5 g/dl, respectively, were allocated a score of 2. The neutrophil to lymphocyte ratio (NLR) was calculated from a blood sample by dividing the absolute neutrophil count by the absolute lymphocyte count.

Statistical analysis

The significance of the correlations between the pretreatment CRP/ALB ratio and the clinicopathological characteristics were analyzed using the χ 2 test. The duration of survival was calculated according to the Kaplan–Meier method. Differences in the survival curves were assessed using the log-rank test. A multivariate analysis was performed according to the Cox proportional hazard model. All of the statistical analyses were conducted using the SPSS software package for Windows (SPSS Japan, Tokyo, Japan). p values of <0.05 were considered to indicate statistical significance.

Ethical consideration

This research was conformed to the provisions of the Declaration of Helsinki in 1975. All patients were informed of the investigational nature of this study and provided written informed consent. This retrospective study was approved by the ethics committee of Osaka City University.

Results

Classifications according to the pretreatment inflammatory markers

We used the CRP/ALB ratio, which was a continuous variable, as the test variable and the 24-month survival (median survival time: 24 months) as the state variable. When we investigated the cut-off value for the CRP/ALB ratio using the receiver operating characteristic (ROC) curve, we found that the appropriate cut-off value for the CRP/ALB ratio was 0.183 (sensitivity: 53.5 %; specificity: 72.1 %) (Fig. 1a). We therefore set 0.183 as the cut-off value and the patients were classified into the high-CRP/ALB ratio (n = 36) and low-CRP/ALB ratio (n = 63) groups. Using the ROC curve in the same manner, we set the cut-off value for the NLR at 3.0 (sensitivity: 65.0 %, specificity: 78.0 %) (Fig. 1b). In accordance with the findings of previous reports, the study population was classified into the patients with an mGPS of 0 or 1 and the patients with an mGPS of 2 (Sugimoto et al. 2012; Furukawa et al. 2012).
https://static-content.springer.com/image/art%3A10.1186%2Fs40064-016-3529-y/MediaObjects/40064_2016_3529_Fig1_HTML.gif
Fig. 1
a A receiver operating characteristic curve analysis of the C-reactive protein to albumin (CRP/ALB) ratio in patients with unresectable metastatic colorectal cancer. Area under the curve = 0.655; 95 % confidence interval = 0.539–0.772; p = 0.013. b A receiver operating characteristic curve analysis of the neutrophil to lymphocyte ratio (NLR) in patients with unresectable metastatic colorectal cancer. Area under the curve = 0.701; 95 % confidence interval = 0.582–0.820; p = 0.002

The correlations between the pretreatment CRP/ALB ratio and the clinicopathological factors

The correlations between the pretreatment CRP/ALB ratio and the clinicopathological factors are shown in Table 2. The pretreatment CRP/ALB ratio had no significant relationships with any of the clinicopathological factors except for the pretreatment mGPS and NLR.
Table 2
The correlations between the pretreatment CRP/ALB ratio and the clinicopathological factors
 
Pretreatment CRP/ALB ratio
Low
High
p value
Gender
 Male
36
21
 
 Female
27
15
1.000
Age
 <65
34
19
 
 ≥65
29
17
1.000
Location of primary tumor
 Colon
36
21
 
 Rectum
27
15
1.000
Detection of unresectable tumor
 Synchronous
34
25
 
 Metachronous
29
11
0.143
Histological type
 Well, moderately
51
27
 
 Poorly, mucinous
9
3
0.744
Peritoneal dissemination
 Negative
47
33
 
 Positive
16
3
0.061
The number of organs affected by metastasis
 One organ
36
18
 
 Multiple organs
27
18
0.534
Pretreatment CEA (ng/ml)
 ≤5
9
4
 
 >5
53
31
0.765
Molecular targeted therapy
 No
17
12
 
 Yes
46
24
0.503
Pretreatment mGPS
 0
63
6
 
 1
0
21
 
 2
0
9
<0.001
Pretreatment NLR
 <3
41
13
 
 ≥3
18
22
0.003
CRP/ALB ratio C-reactive protein to albumin ratio, CEA carcinoembryonic antigen, mGPS modified Glasgow prognostic score, NLR neutrophil to lymphocyte ratio

The survival analysis based on the pretreatment inflammatory markers

The overall survival rate was significantly worse in the high pretreatment CRP/ALB ratio group than in the low pretreatment CRP/ALB ratio group (p = 0.0009) (Fig. 2a). The overall survival rate was significantly worse in patients with an mGPS of 2 than in those with an mGPS of 0 or 1 (p = 0.0450) (Fig. 2b). The overall survival rate was significantly worse in the high neutrophil to lymphocyte ratio group than in the low neutrophil to lymphocyte group (p < 0.0001) (Fig. 2c).
https://static-content.springer.com/image/art%3A10.1186%2Fs40064-016-3529-y/MediaObjects/40064_2016_3529_Fig2_HTML.gif
Fig. 2
The Kaplan–Meier survival curves for overall survival. a The overall survival rate was significantly worse in the high-C-reactive protein to albumin (CRP/ALB) ratio group than in the low-CRP/ALB ratio group (p = 0.0009). b The overall survival rate was significantly worse in patients with a modified Glagow prognostic score (mGPS) of 2 than in those with an mGPS of 0 or 1 (p = 0.0450). c The overall survival rate was significantly worse in the high neutrophil to lymphocyte ratio (NLR) group than in the low NLR group (p < 0.0001). d Kaplan–Meier survival curves for overall survival in an analysis limited to the patients with a modified Glasgow prognostic score (mGPS) of 0 or 1. The overall survival rate was significantly worse in the high-C-reactive protein to albumin (CRP/ALB) ratio group than in the low-CRP/ALB ratio group (p = 0.0048)

The prognostic factors influencing long-term survival

The correlations between overall survival and the various clinicopathological factors are shown in Table 3. According to the results of a univariate analysis, overall survival showed significant relationships with the number of organs affected by metastasis (p = 0.024), the use of a molecular targeted therapy (p = 0.001), the pretreatment CRP/ALB ratio (p = 0.001) and the pretreatment NLR (p < 0.001). A multivariate analysis indicated that the use of a molecular targeted therapy (hazard ratio 0.341; 95 % confidence interval 0.186–0.626; p = 0.001), the pretreatment CRP/ALB ratio (hazard ratio 1.866; 95 % confidence interval 1.057–3.295; p = 0.031) and the pretreatment NLR (hazard ratio 2.706; 95 % confidence interval 1.483–4.939; p = 0.001) were independent prognostic factors for overall survival.
Table 3
The correlations between overall survival and various clinicopathological factors
 
Univariate analysis
Multivariate analysis
Hazard ratio
95 % CI
p value
Hazard ratio
95 % CI
p value
Gender (female vs. male)
1.473
0.895–2.423
0.128
   
Age (≥65 vs. <65)
1.492
0.907–2.454
0.115
   
Location of primary tumor (colon vs. rectum)
1.273
0.769–2.108
0.348
   
Detection of unresectable tumor (synchronous vs. metachronous)
1.595
0.946–2.688
0.080
1.099
0.595–2.030
0.763
Histological type (poorly, mucinous vs. well, moderately)
1.417
0.688–2.916
0.344
   
Peritoneal dissemination (yes vs. no)
1.124
0.609–2.075
0.708
   
The number of organs affected by metastasis (≥2 vs. <2)
1.775
1.078–2.923
0.024
1.115
0.622–1.997
0.715
Pretreatment CEA (>5 ng/ml vs. ≤5 ng/ml)
2.193
0.940–5.113
0.069
1.370
0.526–3.571
0.520
Molecular targeted therapy (yes vs. no)
0.391
0.227–0.676
0.001
0.341
0.186–0.626
0.001
Pretreatment CRP/ALB ratio (>0.183 vs. ≤0.183)
2.301
1.390–3.807
0.001
1.866
1.057–3.295
0.031
Pretreatment NLR (>3 vs. ≤3)
3.777
2.191–6.511
<0.001
2.706
1.483–4.939
0.001
CEA carcinoembryonic antigen, CRP/ALB ratio C-reactive protein to albumin ratio, NLR neutrophil to lymphocyte ratio

The survival analysis based on the pretreatment CRP/ALB ratio, limited to the patients with an mGPS of 0 or 1

We then performed a sub-analysis limited to patients with an mGPS of 0 or 1. Among these patients, the overall survival rate was significantly worse in the high-CRP/ALB ratio group than in the low-CRP/ALB ratio group (p = 0.0048) (Fig. 2d).

The correlation between the normalization of the CRP/ALB ratio at eight weeks after chemotherapy and survival

We evaluated the prognostic significance of the normalization of the CRP/ALB ratio at eight weeks after the initiation of chemotherapy. We categorized the patients into three groups according to their pretreatment and posttreatment CRP/ALB ratio values. Patients with a low pretreatment CRP/ALB ratio were categorized into group A. Patients with a high pretreatment CRP/ALB ratio and a normalized CRP/ALB ratio at eight weeks after the initiation of chemotherapy were categorized into group B. Patients with high pretreatment and posttreatment CRP/ALB ratio values were categorized into group C. The patients in group B tended to exhibit a better prognosis than those in group C (p = 0.0641) (Fig. 3).
https://static-content.springer.com/image/art%3A10.1186%2Fs40064-016-3529-y/MediaObjects/40064_2016_3529_Fig3_HTML.gif
Fig. 3
Overall survival according to the combination of the pretreatment and posttreatment C-reactive protein to albumin (CRP/ALB) ratio values. The prognosis of the patients in group B tended to be better than that in the patients of group C (p = 0.0641)

Discussion

There have been various studies on the close relationship between inflammation and cancer since the relationship was first reported by Virchow in 1863 (Mantovani et al. 2008; Balkwill and Mantovani 2001). Recently, inflammation has been widely recognized to contribute to cancer progression and various inflammatory markers, such as the NLR, CRP, GPS and mGPS have been reported to be correlated with the survival of patients with CRC (Shibutani et al. 20132014; McMillan et al. 2007; Sugimoto et al. 2012; Furukawa et al. 2012).
Inflammation induces an increase in the levels of cytokines, which play an important role in tumor proliferation, progression, invasion and metastasis, as well as in resistance to chemotherapy (Colotta et al. 2009; Coussens and Werb 2002; Heikkilä et al. 2007). Therefore, inflammatory markers are considered to reflect the momentum of cancer growth. Furthermore, the levels of systemic inflammatory markers have been reported to correlate with tumor volume (Shibutani et al. 2015b). In this way, inflammatory markers are considered to be useful for predicting and monitoring the therapeutic outcome in patients with malignancies.
The CRP/ALB ratio was primarily investigated for the purpose of predicting mortality in patients with sepsis. The CRP/ALB ratio was also applied to predicting the prognosis of patients with cancer and its usefulness has been reported in patients with various cancers, such as hepatocellular carcinoma, esophageal cancer and lung cancer (Kinoshita et al. 2015; Xu et al. 2015; Zhou et al. 2015). In previous reports, the CRP/ALB ratio was shown to have an outstanding prognostic value in comparison to other established inflammation-based prognostic markers (Kinoshita et al. 2015; Xu et al. 2015). Although the area under curve (AUC) value of the CRP/ALB ratio was lower than that of the NLR, the CRP/ALB ratio was shown to be a valuable marker and was thus found to be sufficient for predicting survival in the present study.
As Casadei Gardini reported, the serum CRP concentration alone is also significantly correlated with the survival (Casadei Gardini et al. 2016). We came to the same conclusion based on the findings in our previous study (Shibutani et al. 2015b). However, Ranzani reported that the CRP/ALB ratio was more closely correlated with survival than the CRP values alone (Ranzani et al. 2013). By combining the CRP and albumin values, which have both been reported to be independent prognostic factors for various types of cancer, the CRP/ALB ratio is believed to be a more useful marker.
The mGPS, which has been reported to be a useful prognostic marker in patients with CRC, is similar to the CRP/ALB ratio, as both results can be calculated from the serum CRP and albumin concentration. However, the majority of the patients are classified with an mGPS of 0 or 1, which is associated with a better prognosis (Sugimoto et al. 2012; Furukawa et al. 2012). In the present study, approximately 90 % of the patients were found to have an mGPS of 0 or 1. For this reason, most patients could not be classified by the mGPS. On the other hand, the patients who had an mGPS of 0 or 1 could be classified into two groups according to their CRP/ALB ratios and significant differences were observed between the two groups. It can therefore be said that the CRP/ALB ratio is a more accurate prognostic marker than the mGPS.
Moreover, the normalization of the CRP/ALB ratio at eight weeks after the initiation of chemotherapy tended to be correlated with an improvement in overall survival. Based on this result, the CRP/ALB ratio is considered to be a useful marker for monitoring the effectiveness of chemotherapy as well as for predicting survival. On the other hand, it has been reported that there is no relationship between the normalization of the NLR and survival, because the value is easily affected by chemotherapy-induced myelosuppression (Shibutani et al. 2015a). Therefore, the CRP/ALB ratio was believed to be superior to the NLR for evaluating the efficacy of chemotherapy. Although previous studies have primarily focused on the prognostic significance of the pretreatment CRP/ALB ratio, in the present study, the CRP/ALB ratio was revealed to be a useful marker for monitoring the effectiveness of chemotherapy as well as for predicting survival.
Although we set 0.183 as the CRP/ALB ratio cut-off value according to the results of the ROC analysis, other studies have used various cut-off values. Because the inflammatory markers were reported to be associated with the degree of tumor progression, such as the TNM stage (Shibutani et al. 2013; Xu et al.2015; Ishizuka et al. 2016), the appropriate cut-off value may change according to the background characteristics of the patients.
The present study is associated with some possible limitations. First, we evaluated a relatively small number of patients and the study design was retrospective in nature. Second, comorbidities that may have affected systemic inflammation and the serum albumin concentration (such as infection, ischemia, acute coronary disease, liver cirrhosis, and nephrotic syndrome) were not taken into consideration. A large prospective study should therefore be performed to confirm our findings.

Conclusions

The CRP/ALB ratio is a useful marker not only for predicting survival, but also for monitoring chemotherapeutic effectiveness in patients with unresectable metastatic colorectal cancer who receive palliative chemotherapy.

Abbreviations


CRP: 
C-reactive protein
 
ALB: 
albumin
 
mGPS: 
modified Glasgow prognostic score
FOLFOX: 
5-fluorouracil + leucovorin + oxaliplatin
 
CapeOX: 
capecitabine + oxaliplatin
FOLFIRI: 
5-fluorouracil + leucovorin + irinotecan
 
SOX: 
S-1 + oxaliplatin
CEA: 
carcinoembryonic antigen
 
NLR: 
neutrophil to lymphocyte ratio
ROC: 
receiver operating characteristic

Declarations

Authors’ contributions

MS and KM designed the study, performed the statistical analysis and draft the manuscript. HN and YI collected the clinical data. KH designed the study and critically reviewed the manuscript. MO critically reviewed the manuscript. All authors read and approved the final manuscript.

Acknowledgements

This research received no specific grants from any funding agency in the public, commercial or not-for-profit sectors. We thank Brian Quinn who provided medical writing services on behalf of JMC, Ltd.

Competing interests

The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

References

  1. Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357:539–545View ArticlePubMedGoogle Scholar
  2. Casadei Gardini A, Carloni S, Scarpi E, Maltoni P, Dorizzi RM, Passardi A et al (2016) Prognostic role of serum concentrations of high-sensitivity C-reactive protein in patients with metastatic colorectal cancer: results from the ITACa trial. Oncotarget 7:10193–10202PubMedGoogle Scholar
  3. Cassidy J, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R et al (2008) Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol 26:2006–2012View ArticlePubMedGoogle Scholar
  4. Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A (2009) Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis 30:1073–1081View ArticlePubMedGoogle Scholar
  5. Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420:860–867ADSView ArticlePubMedPubMed CentralGoogle Scholar
  6. Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ et al (2014) Annual Report to the Nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 120:1290–1314View ArticlePubMedGoogle Scholar
  7. Furukawa K, Shiba H, Haruki K, Fujiwara Y, Iida T, Mitsuyama Y et al (2012) The Glasgow prognostic score is valuable for colorectal cancer with both synchronous and metachronous unresectable liver metastases. Oncol Lett 4:324–328PubMedPubMed CentralGoogle Scholar
  8. Grothey A, Sugrue MM, Purdie DM, Dong W, Sargent D, Hedrick E et al (2008) Bevacizumab beyond first progression is associated with prolonged overall survival in metastatic colorectal cancer: results from a large observational cohort study (BRiTE). J Clin Oncol 26:5326–5334View ArticlePubMedGoogle Scholar
  9. Heikkilä K, Ebrahim S, Lawlor DA (2007) A systematic review of the association between circulating concentrations of C reactive protein and cancer. J Epidemiol Commun Health 61:824–833View ArticleGoogle Scholar
  10. Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE et al (2014) FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol 15:1065–1075View ArticlePubMedGoogle Scholar
  11. Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Shibuya N, Kubota K (2016) Clinical significance of the c-reactive protein to albumin ratio for survival after surgery for colorectal cancer. Ann Surg Oncol 23:900–907View ArticlePubMedGoogle Scholar
  12. Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Tanaka K et al (2015) The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 22:803–810View ArticlePubMedGoogle Scholar
  13. Maeda K, Shibutani M, Otani H, Nagahara H, Ikeya T, Iseki Y et al (2015) Inflammation-based factors and prognosis in patients with colorectal cancer. World J Gastrointest Oncol 7:111–117View ArticlePubMedPubMed CentralGoogle Scholar
  14. Mantovani A, Allavena P, Sica A, Balkwill F (2008) Cancer-related inflammation. Nature 454:436–444ADSView ArticlePubMedGoogle Scholar
  15. McMillan DC, Crozier JE, Canna K, Angerson WJ, McArdle CS (2007) Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis 22:881–886View ArticlePubMedGoogle Scholar
  16. Petrelli F, Barni S, Coinu A, Bertocchi P, Borgonovo K, Cabiddu M et al (2015) The Modified Glasgow prognostic score and survival in colorectal cancer: a pooled analysis of the literature. Rev Recent Clin Trials 10:135–141View ArticlePubMedGoogle Scholar
  17. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M (2013) C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One 8:e59321ADSView ArticlePubMedPubMed CentralGoogle Scholar
  18. Shibutani M, Maeda K, Nagahara H, Noda E, Ohtani H, Nishiguchi Y et al (2013) A high preoperative neutrophil-to-lymphocyte ratio is associated with poor survival in patients with colorectal cancer. Anticancer Res 33:3291–3294PubMedGoogle Scholar
  19. Shibutani M, Maeda K, Nagahara H, Ohtani H, Sugano K, Ikeya T et al (2014) Elevated preoperative serum C-reactive protein levels are associated with poor survival in patients with colorectal cancer. Hepatogastroenterology 61:2236–2240PubMedGoogle Scholar
  20. Shibutani M, Maeda K, Nagahara H, Ohtani H, Sakurai K, Yamazoe A et al (2015a) Significance of markers of systemic inflammation for predicting survival and chemotherapeutic outcomes and monitoring tumor progression in patients with unresectable metastatic colorectal cancer. Anticancer Res 35:5037–5046PubMedGoogle Scholar
  21. Shibutani M, Maeda K, Nagahara H, Noda E, Ohtani H, Nishiguchi Y, Sakurai K, Hirakawa K (2015b) Prognostic significance of the preoperative serum C-reactive protein level in patients with stage IV colorectal cancer. Surg Today 45:315–321View ArticlePubMedGoogle Scholar
  22. Shibutani M, Maeda K, Nagahara H, Iseki Y, Ikeya T, Hirakawa K (2016) Prognostic significance of the preoperative ratio of C-reactive protein to albumin in patients with colorectal cancer. Anticancer Res 36:995–1001PubMedGoogle Scholar
  23. Sugimoto K, Komiyama H, Kojima Y, Goto M, Tomiki Y, Sakamoto K (2012) Glasgow prognostic score as a prognostic factor in patients undergoing curative surgery for colorectal cancer. Dig Surg 29:503–539View ArticlePubMedGoogle Scholar
  24. Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22:229–237View ArticlePubMedGoogle Scholar
  25. Xu XL, Yu HQ, Hu W, Song Q, Mao WM (2015) A novel inflammation-based prognostic score, the C-reactive protein/albumin ratio predicts the prognosis of patients with operable esophageal squamous cell carcinoma. PLoS One 10:e0138657View ArticlePubMedPubMed CentralGoogle Scholar
  26. Yamada Y, Takahari D, Matsumoto H, Baba H, Nakamura M, Yoshida K et al (2013) Leucovorin, fluorouracil, and oxaliplatin plus bevacizumab versus S-1 and oxaliplatin plus bevacizumab in patients with metastatic colorectal cancer (SOFT): an open-label, non-inferiority, randomised phase 3 trial. Lancet Oncol 14:1278–1286View ArticlePubMedGoogle Scholar
  27. Zhou T, Zhan J, Hong S, Hu Z, Fang W, Qin T et al (2015) Ratio of C-reactive protein/albumin is an inflammatory prognostic score for predicting overall survival of patients with small-cell lung cancer. Sci Rep 5:10481ADSView ArticlePubMedPubMed CentralGoogle Scholar

Copyright

© The Author(s) 2016


Δεν υπάρχουν σχόλια:

Δημοσίευση σχολίου

Bookmark and Share

Auris Nasus Larynx

ScienceDirect Publication: Oral Oncology

ScienceDirect Publication: American Journal of Otolaryngology

American Journal of Roentgenology Head and Neck Imaging

American Journal of Roentgenology Pediatric Imaging

BMC Medical Genomics - Latest Articles

American Journal of Roentgenology Oncologic Imaging

PubMed Central News

Index medicines


A B C D E F G H I J K L M N O P Q R S T U V W Y Z

Stress Urinary Incontinence

Female SUI

Chapter 1: Diagnosis and Treatment Recommendations

Chapter 2: Methodology

Chapter 3: Outcomes Analysis for the Surgical Management of Stress Urinary Incontinence

Appendices

Ophthalmic Plastic & Reconstructive Surgery - Most Popular Articles

Twit This Button

Google+ Badge

Google+ Followers

Αναζήτηση αυτού του ιστολογίου

Φόρτωση...

First Aid,Emergency Guides

First Aid & Emergency Guides A-Z (PDF)

PubMed Central (PMC) is the U.S. National Institutes of Health

PubMed Central (PMC) is the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature.
Advanced search
Browse PMC journals:

Journal of Oral and Maxillofacial Surgery

Slideshows

Below is an alphabetical list of the educational picture slideshows available on eMedicineHealth. Each slideshow covers a medical or health topic and includes images, illustrations, or pictures and summary information discussing the topic. Scroll through each slide by clicking on the Next button. At the end of each slideshow you'll find links to additional related information on the topic.


Share/Bookmark

Tinnitus

1. Chadha NK, Gordon KA, James AL, Papsin BC. Tinnitus is prevalent in children with cochlear implants. International Journal of Pediatric Otorhinolaryngology. 2009;73:671-675. [abstract]

2. Akdogan O, Ozcan I, Ozbek C, Dere H. Tinnitus after cochlear implantation. Auris Nasus Larynx. 2009;36:210-212. [abstract]

3. Pan T, Tyler RS, Ji H, Coelho C, Gehringer AK, Gogel SA. Changes in the tinnitus handicap questionnaire after cochlear implantation. American Journal of Audiology. 2009;18:144-151. [abstract]

4. Andersson G, Freijd A, Baguley DM, Idrizbegovic E. Tinnitus distress, anxiety, depression, and hearing problems among cochlear implant patients with tinnitus. Journal of the American Academy of Audiology. 2009;20:315-319. [abstract]

5. Rothholtz VS, Tang Q, Wu EC, Fine EL, Djalilian H, Zeng F-G. Exploring the parametric space of tinnitus suppression in a patient with a cochlear implant. Laryngoscope. 2009;119.

6. Di NW, Cianfrone F, Scorpecci A, Cantore I, Giannantonio S, Paludetti G. Transtympanic electrical stimulation for immediate and long-term tinnitus suppression. International Tinnitus Journal. 2009;15:100-106.[abstract]

7. Litre CF, Theret E, Tran H et al. Surgical treatment by electrical stimulation of the auditory cortex for intractable tinnitus. Brain Stimulation. 2009;2:132-137. [abstract]

8. Evans RW, Ishiyama G. Migraine with transient unilateral hearing loss and tinnitus. Headache: The Journal of Head & Face Pain. 2009;49:756-759. [abstract]

9. Pirodda A, Brandolini C, Raimondi MC, Ferri GG, Borghi C. Tinnitus as a warning for preventing vasovagal syncope. Medical Hypotheses. 2009;73:370-371. [abstract]

10. Anderson JE, Teitel D, Wu YW. Venous hum causing tinnitus: case report and review of the literature. Clinical Pediatrics. 2009;48:87-89. [abstract]

11. Liess BD, Lollar KW, Christiansen SG, Vaslow D. Pulsatile tinnitus: a harbinger of a greater ill? Head & Neck. 2009;31:269-273. [abstract]

12. Singh DP, Forte AJ, Brewer MB, Nowygrod R. Bilateral carotid endarterectomy as treatment of vascular pulsatile tinnitus. Journal of Vascular Surgery. 2009;50:183-185. [abstract]

13. Delgado F, Munoz F, Bravo-Rodriguez F, Jurado-Ramos A, Oteros R. Treatment of dural arteriovenous fistulas presenting as pulsatile tinnitus. Otology and Neurotology. 2009;30:897-902. [abstract]

14. Cowley PO, Jones R, Tuch P, McAuliffe W. Pulsatile tinnitus from reversal of flow in an aberrant occipital artery: Resolved after carotid artery stenting. American Journal of Neuroradiology. 2009;30:995-997. [abstract]

15. Stimmer H, Borrmann A, Loer C, Arnold W, Rummeny EJ. Monaural tinnitus from a contralateral inferior colliculus hemorrhage. Audiology & Neurotology. 2009;14:35-38. [abstract]

16. Latifpour DH, Grenner J, Sjodahl C. The effect of a new treatment based on somatosensory stimulation in a group of patients with somatically related tinnitus. International Tinnitus Journal. 2009;15:94-99. [abstract]

17. Department of Health. Provision of services for adults with tinnitus: a good practice guide. 2009. [full text]

18. DH. Tinnitus Map of Medicine care pathway. 2010. [Full text]

19. BTA. Tinnitus: guidelines for primary care. 2010. [Full text]

20. Schneider P, Andermann M, Wengenroth M et al. Reduced volume of Heschl's gyrus in tinnitus. NeuroImage. 2009;45:927-939. [abstract]

21. Landgrebe M, Langguth B, Rosengarth K et al. Structural brain changes in tinnitus: grey matter decrease in auditory and non-auditory brain areas. NeuroImage. 2009;46:213-218. [abstract]

22. Melcher JR, Levine RA, Bergevin C, Norris B. The auditory midbrain of people with tinnitus: Abnormal sound-evoked activity revisited. Hearing Research. 2009;257:63-74. [abstract]

23. Lanting CP, de KE, van DP. Neural activity underlying tinnitus generation: Results from PET and fMRI. Hearing Research. 2009;255:1-13. [abstract]

24. Kaltenbach JA. Insights on the origins of tinnitus: an overview of recent research. Hearing Journal. 2009;62:26-31. [Full text]

25. Shulman A, Goldstein B, Strashun AM. Final common pathway for tinnitus: theoretical and clinical implications of neuroanatomical substrates. International Tinnitus Journal. 2009;15:5-50. [abstract]

26. Schutte NS, Noble W, Malouff JM, Bhullar N. Evaluation of a model of distress related to tinnitus. International Journal of Audiology. 2009;48:428-432. [abstract]

27. Hesser H, Pereswetoff-Morath CE, Andersson G. Consequences of controlling background sounds: the effect of experiential avoidance on tinnitus interference. Rehabilitation Psychology. 2009;54:381-390.[abstract]

28. Argstatter H, Krick C, Bolay HV. Music therapy for chronic tinnitus. Heidelberg treatment model. Psychotherapeut. 2009;54:17-26. [abstract]

29. Lugli M, Romani R, Ponzi S, Bacciu S, Parmigiani S. The windowed sound therapy: A new empirical approach for an effective personalized treatment of tinnitus. International Tinnitus Journal. 2009;15:51-61.[abstract]

30. Langguth B, Salvi R, Elgoyhen AB. Emerging pharmacotherapy of tinnitus. Expert Opinion on Emerging Drugs. 2009;14:687-702. [abstract]

31. Campbell KCM. Emerging pharmacologic treatments for hearing loss and tinnitus. ASHA Leader. 2009;14:14-18. [Full text]

32. Hesser H, Westin V, Hayes SC, Andersson G. Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behaviour Research & Therapy. 2009;47:523-528. [abstract]

33. Hesser H, Andersson G. The role of anxiety sensitivity and behavioral avoidance in tinnitus disability. International Journal of Audiology. 2009;48:295-299. [abstract]

34. Shulman A, Goldstein B. Subjective idiopathic tinnitus and palliative care: a plan for diagnosis and treatment. Otolaryngologic Clinics of North America. 2009;42:15-38. [abstract]

35. Forti S, Costanzo S, Crocetti A, Pignataro L, Del BL, Ambrosetti U. Are results of tinnitus retraining therapy maintained over time? 18-month follow-up after completion of therapy. Audiology & Neuro-Otology. 2009;14:286-289. [abstract]

36. Bessman P, Heider T, Watten VP, Watten RG. The tinnitus intensive therapy habituation program: a 2-year follow-up pilot study on subjective tinnitus. Rehabilitation Psychology. 2009;54:133-138. [abstract]

37. Gudex C, Skellgaard PH, West T, Sorensen J. Effectiveness of a tinnitus management programme: A 2-year follow-up study. BMC Ear, Nose and Throat Disorders. 2009;9. [Full text]

38. Henry J, Zaugg T, Myers P, Kendall C, Turbin M. Principles and application of educational counseling used in progressive audiologic tinnitus management. Noise and Health. 2009;11:33-48. [abstract]

1. Hazell JW, Jastreboff PJ. Tinnitus. I: Auditory mechanisms: a model for tinnitus and hearing impairment. J Otolaryngol. 1990;19:1-5. [Abstract]

2. Jastreboff PJ, Jastreboff MM. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol. 2000 Mar;11(3):162-77. [Abstract]

3. Marcondes RA, Sanchez TG, Kii MA, Langguth et al. Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study. Eur J Neurol. 2009. [Epub ahead of print] ) [Abstract]

4. Cannon SC Pathomechanisms in channelopathies of skeletal muscle and brain. Annu Rev Neurosci. 2006;29:387-415. [Abstract]

5. Davies E, Knox E, Donaldson I. The usefulness of nimodipine, an L-calcium channel antagonist, in the treatment of tinnitus. Br J Audiol. 1994;28:125-129. [Abstract]

6. Baguley DM, Jones S, Wilkins I, Axon PR, Moffat DA. The inhibitory effect of intravenous lidocaine infusion on tinnitus after translabyrinthine removal of vestibular schwannoma: a double-blind, placebo-controlled, crossover study. Otol Neurotol. 2005;26:169-176. [Abstract]

Eggermont JJ. Cortical tonotopic map reorganization and its implications for treatment of tinnitus. Acta Otolaryngol Suppl. 2006;9-12. [Abstract]

Hoke ES, Muhlnickel W, Ross B, Hoke M. Tinnitus and event-related activity of the auditory cortex. Audiol Neurootol. 1998;3:300-331. [Abstract]

Mirz F, Pedersen B, Ishizu K et al. Positron emission tomography of cortical centers of tinnitus. Hear Res. 1999;134:133-144. [Abstract]

Muhlnickel W, Elbert T, Taub E, Flor H. Reorganization of auditory cortex in tinnitus. Proc Natl Acad Sci U S A. 1998;95:10340-10343. [Abstract]

Norena AJ, Eggermont JJ. Enriched acoustic environment after noise trauma abolishes neural signs of tinnitus. Neuroreport. 2006;17:559-563. [Abstract]

Schlee W, Hartmann T, Langguth B, Weisz N. Abnormal resting-state cortical coupling in chronic tinnitus. BMC Neurosci. 2009;10:11. [Full text]

Schlee W, Mueller N, Hartmann T, Keil J, Lorenz I, Weisz N. Mapping cortical hubs in tinnitus. BMC Biol. 2009;7:80. [Full text]

Medicine News

Follow by Email

HIPPOCRATE'S OATH

"I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessaryto cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."

MAIMONIDE'S PRAYER

"Almighty God, Thou has created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve the whole in all its beauty the body which is the envelope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter or the unbridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it.

"Thou has blest Thine earth, Thy rivers and Thy mountains with healing substances; they enable Thy creatures to alleviate their sufferings and to heal their illnesses. Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill. In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures. I am now about to apply myself to the duties of my profession. Support me, Almighty God, in these great labors that they may benefit mankind, for without Thy help not even the least thing will succeed.

"Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures. Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let me see only the human being. Illumine my mind that it recognize what presents itself and that it may comprehend what is absent or hidden. Let it not fail to see what is visible, but do not permit it to arrogate to itself the power to see what cannot be seen, for delicate and indefinite are the bounds of the great art of caring for the lives and health of Thy creatures. Let me never be absent- minded. May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.

"Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of officious relatives and know-all nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.

"Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death.

"Imbue my soul with gentleness and calmness when older colleagues, proud of their age, wish to displace me or to scorn me or disdainfully to teach me. May even this be of advantage to me, for they know many things of which I am ignorant, but let not their arrogance give me pain. For they are old and old age is not master of the passions. I also hope to attain old age upon this earth, before Thee, Almighty God!

"Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained to sufficient knowledge, but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge. For art is great, but the mind of man is ever expanding.

"Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed."

Information for Health Professionals

Information for Patients

Modern challenged parts of the oath:

  1. To teach medicine to the sons of my teacher. In the past, medical schools gave preferential consideration to the children of physicians.
  2. To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them. This beneficial intention is the purpose of the physician. However, this item is still invoked in the modern discussions of euthanasia.
  3. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan. Physician organizations in most countries have strongly denounced physician participation in legal executions. However, in a small number of cases, most notably the U.S. states of Oregon,[10] Washington,[11]Montana,[12] and in the Kingdom of the Netherlands,[13] a doctor can prescribe euthanasia with the patient's consent.
  4. Similarly, I will not give a woman a pessary to cause an abortion. Since the legalization of abortion in many countries, the inclusion of the anti-abortion sentence of the Hippocratic oath has been a source of contention.
  5. To avoid violating the morals of my community. Many licensing agencies will revoke a physician's license for offending the morals of the community ("moral turpitude").
  6. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. The "stones" referred to are kidney stones or bladder stones, removal of which was judged too menial for physicians, and therefore was left for barbers (the forerunners of modern surgeons). Surgery was not recognized as a specialty at that time. This sentence is now interpreted as acknowledging that it is impossible for any single physician to maintain expertise in all areas. It also highlights the different historical origins of the surgeon and the physician.
  7. To keep the good of the patient as the highest priority. There may be other conflicting 'good purposes,' such as community welfare, conserving economic resources, supporting the criminal justice system, or simply making money for the physician or his employer that provide recurring challenges to physicians
http://www.worldallergy.org/educational_programs/world_allergy_forum/barcelona2008/rabe/

Images

Browse Categories by List Form:

Allergic Skin Disorders

Allergic conditions such as eczema and contact dermatitis

Bacterial Skin Diseases

Disorders caused by bacterial infections such as acne and folliculitis

Bites and Infestations

Insect bites, stings and infestations such as scabies & head lice

Diseases of Pigment

Pigment conditions such as jaundice, melasma and birthmarks

Fungal Skin Disease

Disorders such as ringworm, athletes foot and yeast infections

Medical Anatomy

Illustrations of various human anatomy

Noncancerous, Precancerous & Cancerous Tumors

Skin disorders such as moles, skin tags and various skin cancers

Papules, Scales, Plaques and Eruptions

Skin conditions such as psoriasis, diaper rash and poison ivy

Scalp, Hair and Nails

Conditions such as dandruff, ingrown toenails and premature gray hair

Vascular, Lymphatic and Systemic Conditions

Affecting the blood vessels, tissues, organs or the entire body

Viral Skin Disease

Disorders caused by viruses such as shingles, cold sores and measles

Additional Skin Conditions

A collection of various skin disorders and images

MedWorm: ENT & OMF

Archives of Facial Plastic Surgery recent issues

Archives of Otolaryngology recent issues

Archives of Dermatology recent issues

Archives of Pediatrics recent issues

ANATOMY

ANATOMY OF THE
HEAD AND NECK