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The children may also suffer from irritation of the bladder diabetes diet tracker app micronase 2.5 mg lowest price, causing frequent burning urination diabetes type 1 definition purchase micronase 2.5 mg free shipping. Senecio Aureus 621 Young girls may experience irritation of the throat diabetes in dogs sores discount 2.5 mg micronase overnight delivery, chest and bladder before the onset of periods diabetes mellitus clinical manifestations generic micronase 5 mg. In case the periods stop and the patient starts bleeding from the nose, then Senecio may be found useful. Displacement of the uterus, burning urination or stoppage of urine, severe inflammation of the kidneys and fever with chills are all the symptoms of Senecio, to be treated with Senecio. It has been a constant component of the conventional therapy for chronic cough, tuberculosis and other chest diseases. No doubt, it helps in the initial stage of treatment however, its prolonged use can be dangerous. On the other hand, the homoeopathic treatment with Senega can cure all these conditions, without any fear of harm. Senega is very closely related to pleurisy and has been successfully used in its treatment. Pleura are the outer covering of the lungs, which when inflamed is called pleurisy or pleural pneumonia. At times, it may not prove that effective in human beings due to a wrong diagnosis, but in the case of cattle, Senega has always worked as a sure shot remedy for pleurisy. In the cattle, the symptoms of an ailment are persistently universal and unlikely to change. So, if it works in one animal, it would certainly be found useful in other animals also. Senega offers a significant relief of phlegm, although it does not provide complete cure. The cough increases on movement, especially the cardiac asthma becomes much worse on movement. According to some homoeopaths, if the patient is of Senega constitution, it can cure his left-sided facial palsy, also. Once the symptoms of the disease have become manifest, Sepia may be used even in the absence of the constitution described above. It is important to keep the important symptoms in view, rather than the external appearance of the patient. The specific symptom of Sepia is the absence of sexual desire and lack of the emotions of love and affection, so much so, that an affectionate mother suddenly becomes indifferent to her child as well as her husband. She may even have the tendency to commit suicide, or she may become partially insane. In fact, these conditions develop as a result of having silently suffered over a long period. She does not pay attention towards her husband and children, which is the natural result of pressure building up. Any kind of uterine dysfunction will result in a variety of complications, both during pregnancy and after childbirth, which are accompanied by liver dysfunction. The hate and indifference make her feel frightened and this further aggravates her sickness. Another salient feature of Sepia is the formation of a dark, saddleshaped mark over the bridge of the nose like two wings of a bird. In view of this sign alone, like so many other homoeopaths, I have also treated many patients with Sepia, to no avail. But Sepia becomes effective only in the presence of liver derangement in a person of Sepia nature. Sepia proves to be very effective in the treatment of the afore-mentioned sensitive type of Sepia 625 woman, lacking emotions and showing the typical pigmented mark on the nose and the face. Whitish or light brown spots can also form over the body, indicative of a liver problem. She cannot effectively pass stools, due to the weak propulsive power of the intestines. Such a woman also faces difficulty during childbirth due to the weakness of pelvic and abdominal muscles i. In the presence of its other symptoms, Sepia will facilitate the birth of the child. If this type of woman also tends to have prolapse of the uterus or weakness of the muscles of the back, then Sepia will offer immediate relief. Sepia has been found very effective in the treatment of vomiting of pregnancy, as long as the patient is that of Sepia. Other characteristic features of Sepia are the vomiting of milky white material and whitish leucorrhoeal discharge. Sepia also can be useful in the treatment of herpes if other symptoms of Sepia are also present. Sepia offers immediate relief of headache associated with vomiting of bitter contents. Provided that the patient is of sepia constitution; Sepia can cure every eye condition and most of skin conditions of the patient. Skin diseases, in general are common in many remedies, however if the overall picture is of sepia type then sepia would be useful. Associated degradation of the skin and mucous membranes can also get better with Sepia. Retention of placenta (after childbirth) can be a source of many serious complications. However, Pulsatilla and Sepia can only be effective before the onset of the infection. Once the infection develops, Sulphur and Pyrogenium 200 happen to be the best standard remedy. During lactation in Sepia woman menstruation usually ceases, while they are irregular in Calc Carb. The vaginal discharge of a Sepia woman is acidic in nature, causing neuralgic pain. Moderate physical exercise aggravates the symptoms of Sepia while t strenuous exercise offers relief. Malarial fever of unpredictable timing may be made to behave more timely with Sepia therapy. In addition, the diagnosis as to the most appropriate treatment needed may also be established. The eyes become inflamed due to the general weakness and the diseases of the uterus. The patient becomes nauseated at the smell of food; more so while lying on the side. This element, along with clay, became the first building block for the creation of life. Through the work of some renowned homoeopaths, Silicea has been found to possess many qualities. Its symptoms and signs have been discovered on homoeopathic proving, over a long period. Silicea is one of those remedies in which proving is a very slow and time consuming process. On proving, it has been found to be a profoundly active remedy, capable of working for a long period of time. It stimulates the body defences to react against any foreign body and expel it as soon as possible. If the foreign material happens to be inanimate, then Silicea initiates the process of pus formation around it. The pus formed creates a soft resilient medium like Mobil oil, through which the foreign body gets expelled gradually and softly without further injury to the soft tissues. If the foreign body happen to be animate, such as bacteria, viruses or intestinal worms, etc.
Fulminant hepatitis of either of the two varieties can occur from viral and non-viral etiologies: B diabetes mellitus fisiopatologia purchase micronase 5 mg amex. In addition diabetes 97 discount 5 mg micronase overnight delivery, hepatitis are quite variable ranging from mild disease to fullherpesvirus can also cause serious viral hepatitis diabetes mellitus type 2 natural treatment generic 5 mg micronase free shipping. Non-viral causes include acute hepatitis due to drug i) Mild chronic hepatitis shows only slight but persistent toxicity (e diabetes mellitus with neurological manifestations cheap micronase american express. The patients present with features of hepatic failure with hepatic encephalopathy (page 602. The mortality rate is high iii) Laboratory findings may reveal prolonged prothrombin if hepatic transplantation is not undertaken. Grossly, the liver is small iv) Systemic features of circulating immune complexes due and shrunken, often weighing 500-700 gm. The sectioned surface shows diffuse complex vasculitis, glomerulonephritis and cryoglobulior random involvement of hepatic lobes. Fulminant Hepatitis Regeneration in submassive necrosis is more orderly and (Submassive to Massive Necrosis) may result in restoration of normal architecture. Fulminant hepatitis is the most severe form of acute hepatitis ii) In massive necrosis, the entire liver lobules are in which there is rapidly progressive hepatocellular failure. As a result of loss of hepatic parenchyma, all that Two patterns are recognised—submassive necrosis having a is left is the collapsed and condensed reticulin framework less rapid course extending up to 3 months; and massive and portal tracts with proliferated bile ductules plugged Figure 21. There is wiping out of liver lobules with only collapsed reticulin framework left out in their place, highlighted by reticulin stain (right photomicrograph. Regeneration, Cholangitis is the term used to describe inflammation of the if it takes place, is disorderly forming irregular masses of extrahepatic or intrahepatic bile ducts, or both. Fibrosis is generally not a feature of main types of cholangitis—pyogenic and primary sclerosing. While primary sclerosing cholangitis is discussed later with biliary cirrhosis (page 625), pyogenic cholangitis is described the clinicopathologic course in two major forms of below. Most prevention of its spread to the contacts after detection and commonly, the obstruction is from impacted gallstone; other identification of route by which infection is acquired such as causes are carcinoma arising in the extrahepatic ducts, from food or water contamination, sexual spread or carcinoma head of pancreas, acute pancreatitis and parenteral spread. Bacteria gain entry a few hepatitis vaccines have been developed and some more to the obstructed duct and proliferate in the bile. The principle underlying either of spreads along the branches of obstructed duct and reaches these two forms of prophylaxis is that the persons who the liver, termed ascending cholangitis. The common infecting develop good antibody response to the antigen of the bacteria are enteric organisms such as E. Immunoprophylaxis and hepatitis vaccination are small beaded abscesses accompanied by bile stasis along unnecessary if the pre-testing for antibodies is positive. Passive immunisation with immune in time are replaced by chronic inflammatory cells and globulin as well as active immunisation with a killed vaccine enclosed by fibrous capsule. Current Most liver abscesses are of bacterial (pyogenic) origin; less recommendations include pre-exposure and post-exposure often they are amoebic, hydatid and rarely actinomycotic. Ascending cholangitis through ascending infection in the with combination of hepatitis B immune globulin and biliary tract due to obstruction. Amoebae multiply and block small intrahepatic portal radicles resulting in infarction necrosis of the adjacent liver parenchyma. The patients, generally from tropical and subtropical countries, may give history of amoebic dysentery in the past. Intermittent low-grade fever, pain and tenderness in the liver area are common presenting features. A positive haemagglutination test is quite sensitive and useful for diagnosis of amoebic liver abscess. Grossly, amoebic liver abscesses are usually solitary and more often located in 2. Portal pyaemia by means of spread of pelvic or gastrothe right lobe in the posterosuperior portion. Amoebic intestinal infection resulting in portal pylephlebitis or septic liver abscess may vary greatly in size but is generally of emboli. The centre of the abscess contains diverticulitis, regional enteritis, pancreatitis, infected large necrotic area having reddish-brown, thick pus haemorrhoids and neonatal umbilical vein sepsis. Iatrogenic causes include liver biopsy, percutaneous biliary found in the liver tissue at the margin of abscess. The diagnosis is possible by liver right upper quadrant, fever, tender hepatomegaly and biopsy. There may be leucocytosis, elevated serum alkaline phosphatase, elevated serum alkaline phosphatase levels and hypoalbuminaemia and a positive blood culture. The basic lesion is the the cause for pyogenic liver abscess, they occur as single epithelioid cell granuloma characterised by central or multiple yellow abscesses, 1 cm or more in diameter, in an enlarged liver. There are multiple small neutrophilic abscesses with areas of extensive necrosis of the affected liver parenchyma. The adjacent viable area shows pus and blood clots in the portal vein, inflammation, congestion and proliferating fibroblasts. Direct extension from the liver may lead to subphrenic or pleuro-pulmonary suppuration or peritonitis. There may be small pyaemic abscesses elsewhere such as in the lungs, kidneys, brain and spleen. The dog is the common definite host, while man, sheep and cattle are the intermediate hosts. The infected faeces of the dog contaminate grass and farmland from where the ova are ingested by sheep, pigs and man. Thus, man can acquire infection by handling dogs as well as by eating contaminated vegetables. The ova ingested by man are liberated from the chitinous wall by gastric juice and pass through the intestinal mucosa from where they are carried to the liver by portal venous system. These are trapped in the hepatic sinusoids where they eventually develop into hydatid cyst. About 70% of hydatid cysts develop in the liver which acts as the first filter for ova. However, ova which pass through the liver enter the right side of the heart and are caught in the pulmonary capillary bed and form pulmonary hydatid Figure 21. Some ova which enter the systemic circulation give shows epithelioid granulomas with small areas of central necrosis and rise to hydatid cysts in the brain, spleen, bone and muscles. The disease is common in sheep-raising countries such as Australia, New Zealand and South America. The uncomplicated hydatid cyst of the liver may be silent or may caseation necrosis with destruction of the reticulin produce dull ache in the liver area and some abdominal framework and peripheral cuff of lymphocytes distension. Rare the peritoneal cavity, bile ducts and lungs), secondary lesions consist of tuberculous cholangitis and tuberculous infection and hydatid allergy due to sensitisation of the host pylephlebitis. The diagnosis is made by peripheral blood eosinophilia, radiologic examination and serologic tests such as indirect haemagglutination test and Casoni skin test. The cyst wall is composed of whitish membrane resembling the membrane of a hard boiled egg. Hydatid cyst grows existing liver disease, aging, female sex and genetic inability slowly and may eventually attain a size over 10 cm in to perform a particular biotransformation. Toxic liver injury produced by drugs multilocular or alveolar hydatid disease in the liver. In fact, any patient presenting with outer pericyst, intermediate characteristic ectocyst and inner liver disease or unexplained jaundice is thoroughly endocyst (Fig. Hepatotoxicity from drugs and chemicals is the consisting of fibroblastic proliferation, mononuclear cells, commonest form of iatrogenic disease. Severity of eosinophils and giant cells, eventually developing into hepatotoxicity is greatly increased if the drug is continued dense fibrous capsule which may even calcify. Ectocyst is the intermediate layer composed of Among the various inorganic compounds producing characteristic acellular, chitinous, laminated hyaline hepatotoxicity are arsenic, phosphorus, copper and iron. Endocyst is the inner germinal layer bearing daughter toxins such as pyrrolizidine alkaloids, mycotoxins and cysts (brood-capsules) and scolices projecting into the bacterial toxins. In addition, exposure Hydatid sand is the grain-like material composed of to hepatotoxic compounds may be occupational, numerous scolices present in the hydatid fluid. Hydatid environmental or domestic that could be accidental, fluid, in addition, contains antigenic proteins so that its homicidal or suicidal ingestion. The liver plays a central occur in most individuals who consume them and their role in the metabolism of a large number of organic and hepatotoxicity is dose-dependent. The main drug metabolising system resides in the drug or one of its metabolites acts as a hapten and induces microsomal fraction of the smooth endoplasmic reticulum hypersensitivity in the host.
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Lesions appear 1–3 days after the prodrome the diagnosis is clinical and biopsy is supportive M diabetes prevention program 2002 buy 2.5 mg micronase visa. Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: A pooled analysis diabetic nephropathy symptoms order micronase overnight delivery. Cellulitis: Difficult to distinguish between large local reactions and cellulitis Infections of hymenoptera envenomations are rare and usually caused by wasp envenomations diabetes diet food discount micronase 5 mg on-line. Discharge Criteria Minimal isolated local reaction Systemic reactions that resolve and do not recur during 6-hr observation period Issues for Referral Follow-up: Provide patients with life-threatening reactions international diabetes federation definition of metabolic syndrome buy micronase discount, emergency anaphylaxis kits (EpiPen; peds: EpiPen Jr if <15 kg), and medical identification bracelets (MediAlert. Provide prescriptions for EpiPen to patients discharged after presenting with lifethreatening reactions to bee stings. Additional doses may be used if needed; infuse 1 vial at a time at 30–60 min intervals. If antivenom is given with resolution of symptoms, observe for 1–2 hr if asymptomatic. If patient received antivenom, discuss signs and symptoms of delayed serum sickness. Pediatric Considerations Toddlers are more likely to have early airway involvement. Rapid progression of shock and multiorgan dysfunction, with death occurring within 1–2 days. Staphylococcus aureus, Clostridium species, and other enteric organisms Streptococcal toxic shock syndrome: Occurs when susceptible host is infected with virulent strain M protein types 1, 3, and 28 are most common. Treat shock with fluids and vasopressors as needed: Hypotension is often intractable, and up to 10–20 L/day may be required. Invasive group A streptococcal disease: Epidemiology, pathogenesis, and management. Use 100% nonrebreathing-type face mask Pulse oximetry to check oxygen saturation and monitoring of vitals. Oral awake intubation: Ketamine induction Patient is sedated but continues to ventilate during procedure. Provide surgical airway if intubation fails or sudden deterioration in respiratory status occurs. Postintubation ceftriaxone in cases of infectious cause Sedation/paralysis for duration of intubated status after airway is secured. Extubation could be attempted when an air leak develops around the tracheal tube, which can take around 2–10 days. Discharge Criteria Stridor fully resolved or identified as a nonstridorous abnormal breathing sound. Patients, especially children with stridor, often have associated abnormalities involving respiratory tract which mandates not only endoscopic exam of the larynx, but also the tracheobronchial system. Usually develops within seconds and peaks within minutes Distinct from prior headaches Headache often maximal at onset Sentinel headaches and minor bleeding occur in 20–50%: May occur days to weeks prior to presentation and diagnosis Seizures, transient loss of consciousness, or altered level of consciousness occur in more than 50% of patients. Diminishing erythrocyte count in successive tubes suggests but does not firmly establish a traumatic tap. Antifibrinolytic therapies: Discuss with neurosurgeon prior to initiation Consider administration immediately after aneurysmal rupture in patients at high risk of rebleeding when this is combined with treatment of aneurysm and monitoring for hypotension. When patient is stable, expedited transfer to hospital with neurosurgical capabilities is mandatory. In cases of sentinel bleed or early detection of aneurysmal rupture, outcomes are improved with early surgical or interventional approaches. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Acute: Most commonly due to acceleration–deceleration forces and less commonly from direct trauma Sagittal movement of the head causes stretch of parasagittal bridging veins. Presentation varied: Fluctuating mental status Unsteady gait Slow progression of deficits Pediatric Considerations Imaging is necessary in infants with persistent vomiting, new seizures, lethargy, irritability, bulging, or tense fontanels. Predictors of outcome in childhood intracerebral hemorrhage: A prospective consecutive cohort study. Classification and prediction of outcome in traumatic brain injury based on computed tomographic imaging. Potential stressors include anemia, congenital diseases, dysrhythmias, electrolyte abnormalities, genetic defects, infection, metabolic disorders, neurologic events, suffocation, trauma, upper airway obstruction. Physical-Exam Prior to the event, the infant is seemingly healthy and well appearing, well developed, and well nourished. If event was brief and self-limited, may appear well when evaluated after the episode. Potential complications for surviving infants include pulmonary edema, aspiration pneumonia, and neurologic sequelae secondary to hypoxia including seizures. Thorough investigation of the death scene: Conditions surrounding sleeping space (temperature, surface, bedding, bed sharing) Position in which infant was sleeping Interview of parents, family members, and caregivers Exam of potentially relevant items from the death scene Maintain sensitivity toward family as investigation may be difficult for them. Review infant and family histories: Prenatal, perinatal, and postnatal infant medical history Family medical and social histories, particularly mother Impact of investigation on family: Family is very vulnerable during the investigation May help them through the grieving process. On very rare occasion and under medical direction, resuscitations have been aborted and the infant is pronounced at the scene; consideration must be given to the emotional, social, and clinical circumstances. Conduct a thorough physical exam; look for unintentional as well as intentional traumas. A diagnosis cannot be made until completion of an autopsy, investigation of circumstances and death scene, and exploration of the medical histories of the infant and family. Family support: If resuscitation unsuccessful, attention should then focus on the family; if resuscitation ongoing, communication and support of family is essential. All family members and caregivers are affected; they experience grief, guilt, failure, and inadequacy. Some parents want to spend quiet time holding their infants after an unsuccessful resuscitation. Discharge Criteria Patients are generally admitted for observation and monitoring for documented episodes and support of family. Use available resources including social workers and chaplains as support for the family is crucial. Infant sleep location: Associated material and infant characteristics with sudden infant death syndrome prevention recommendations. Apparent life-threatening event: Multicenter prospective cohort study to develop a clinical decision rule for admission to the hospital. Sudden infant death syndrome and unclassified sudden infant deaths: A definitional and diagnostic approach. Risk factors for sudden infant death syndrome: Changes associated with sleep position recommendations. Depression—especially psychotic depression Anxiety and panic disorder Alcohol or drug intoxication Schizophrenia Adolescents Others at Risk for Completing Suicide Recent discharge from psychiatric facility History of suicidal ideation or suicide attempt Serious physical illness present in up to 70% of all suicides, particularly in elderly patients. Means available to complete plan Activity toward initiating plan Patients expectations of lethality of plan Intent: Reasons, goal Risk-to-rescue ratio Plan or intent to harm othersfi Presence of acute precipitants: Recent losses, lack of social supports Risk factors: History of past suicide attempts Psychiatric review of symptoms: Depression, psychosis, panic/anxiety Chronic medical illness Alcohol or drug abuse Serial assessment of mental status, consistency of responses Factors preventing suicide Physical-Exam As needed to address acute medical issues Look for evidence of injuries and signs of self-neglect. Elimination of means of suicide Access to other means of suicide Support and supervision in the outpatient setting Prompt outpatient follow-up with psychiatric therapy Patient investment in not attempting suicide Identifying reasons for living Safety contracts are no guarantee that individuals will not attempt suicide. Risk to medics on the scene in cases of firearms or other weapons Know state and local laws, availability of mobile crisis units, and when to involve the police. If impulsivity, anger, or aggression hinder ability to control behavior Discharge Criteria Patient has no suicidal ideation. Patient has good support network or placement in appropriate crisis housing Appropriate outpatient psychiatric follow-up is ensured. In some cases, patients who express suicidal ideation while intoxicated may be discharged if no longer suicidal once they are sober. Some patients with borderline personality disorder and chronic suicidal ideation are discharged after careful psychiatric evaluation in consultation with long-term outpatient caregivers. Access collateral sources of information about patients recent thoughts and behavior. Maintain patient safety during evaluation Hospital admission may be required if patient endorses suicidal ideation and plan. Factors that influence emergency department doctors assessment of suicide risk in deliberate self-harm patients. Literature-based recommendations for suicide assessment in the emergency department: A review.
Kienbock disease treated by excisional arthroplasty with a palmaris longus tendon ball: a comparative study of cases with or without bone core diabetes mellitus type 2 and obesity generic micronase 2.5mg mastercard. Vascularized capitate transposition for advanced Kienbock disease: application of 40 cases and their anatomy metabolic disease jobs order discount micronase online. Mallet-finger injuries: a prospective diabetes mellitus definition in medical buy discount micronase 5mg on line, controlled trial of internal and external splintage diabetes type 2 symbol order micronase online from canada. A comparative controlled trial of a new perforated splint and a traditional splint in the treatment of mallet finger. Mallet finger: comparison between operative and conservative management in those cases failing to be cured by splintage. Single blind, prospective, randomized controlled trial comparing dorsal aluminum and custom thermoplastic splints to stack splint for acute mallet finger. Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger. Effectiveness of cast immobilization in comparison to the goldstandard self-removal orthotic intervention for closed mallet fingers: a randomized clinical trial. Extension Block Pinning Versus Hook Plate Fixation for Treatment of Mallet Fractures. A prospective randomized controlled trial comparing night splinting with no splinting after treatment of mallet finger. Controlled study of the use of local steroid injection in the treatment of trigger finger and thumb. Corticosteroid injections effective for trigger finger in adults in general practice: a double-blinded randomised placebo controlled trial. Corticosteroid injection for trigger finger: blinded or ultrasound-guided injectionfi Study to outline the efficacy and illustrate techniques for steroid injection for trigger finger and thumb. The efficacy of local steroid injection in the treatment of stenosing tenovaginitis. Extra-articular steroid injection: early patient response and the incidence of flare reaction. Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery. Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial. Ultrasound-guided injection of a corticosteroid and hyaluronic acid: a potential new approach to the treatment of trigger finger. A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger. Intra-tendon sheath injection for trigger finger: the randomized controlled trial. Prospective randomized trial of open versus percutaneous surgery for trigger digits. Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone. Long-term results of percutaneous and open surgery for trigger fingers and thumbs. Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial. Long-term results of percutaneous and open surgery for trigger fingers and thumbs. Trigger finger: the effect of partial release of the first annular pulley on triggering. Revision of incompletely released trigger fingers by percutaneous release: results and complications. The effect of miniscalpel-needle versus steroid injection for trigger thumb release. Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. A prospective randomized clinical trial of prescription of full-time versus as-desired splint wear for de Quervain tendinopathy. Mardani-Kivi M, Karimi Mobarakeh M, Bahrami F, Hashemi-Motlagh K, Saheb-Ekhtiari K, Akhoondzadeh N. Corticosteroid injection with or without thumb spica cast for de Quervain tenosynovitis. Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K, Jianmongkol S, Chatuparisute P, Jung S. Treatment of de Quervain disease with triamcinolone injection with or without nimesulide. Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study. Effectiveness of 1% diclofenac gel in the treatment of wrist extensor tenosynovitis in long distance kayakers. Treatment of de quervain tenosynovitis: A prospective randomized controlled study comparing the results of steroid injection with and without immobilization in a splint. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervainfi s disease. A prospective study of the results of injection of steroids and immobilization in a splint. Surgical management of traumatic non-infective tenosynovitis of the wrist extensors. De qeurvian tenosynovitis: clinical outcomes of surgical treatment with longitudinal and transverse incision. An improved approach to the evaluation of the deep motor branch of the ulnar nerve. Neuropathy and the automatic analysis of electromyographic signals from vibration exposed workers. Exploratory electromyography in the study of vibration-induced white finger in rock drillers. Nerve conduction studies and current perception thresholds in workers assessed for hand-arm vibration syndrome. Sensory nerve conduction velocities of median, ulnar and radial nerves in patients with vibration syndrome. Decompression of multiple peripheral nerves in the treatment of diabetic neuropathy: a prospective, blinded study. Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Current evidence for effectiveness of interventions for cubital tunnel syndrome, radial tunnel syndrome, instability, or bursitis of the elbow: a systematic review. No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial. Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations. Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. Can a day 4 bone scan accurately determine the presence or absence of scaphoid fracturefi Cost effectiveness of adding magnetic resonance imaging to the usual management of suspected scaphoid fractures. Can follow-up radiography for acute scaphoid fracture still be considered a valid investigationfi Examination tests predictive of bone injury in patients with clinically suspected occult scaphoid fracture. Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture. The benefit of magnetic resonance imaging for patients with posttraumatic radial wrist tenderness. Diagnosis of occult carpal scaphoid fracture: a comparison of magnetic resonance imaging and computed tomography techniques.