American family physician
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Immunologically mediated renal diseases include Goodpasture's syndrome, systemic lupus erythematosus, membranoproliferative glomerulonephritis, membranous nephropathy, poststreptococcal glomerulonephritis, IgA-IgG nephropathy and anaphylactoid purpura. In Goodpasture's syndrome, antibodies are directed against the glomerular capillary basement membrane. The other disorders appear to result from circulating immune complexes which deposit in glomerular capillary walls or in the glomerular mesangium. Treatment with steroids and/or immunosuppressives is effective in lupus nephritis; in other diseases, the results are less certain.
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Fractures about the elbow are common in children. In addition to the more frequent humeral supracondylar type, fractures of the lateral humeral condyle, the medial humeral epicondyle and the proximal radius often occur. Fortunately, these latter types are rarely associated with neurovascular compromise, as seen with the supracondylar type. However, accurate anatomic reduction is required to permit appropriate growth at these epiphyseal sites and to prevent complications.
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Insulinoma, glucagonoma, gastrinoma (Zollinger-Ellison syndrome), vipoma, somatostatinoma and a tumor that secretes human pancreatic polypeptide are the primary endocrine-secreting tumors of the pancreas. hormones are produced by specific tumor cell types and cause a variety of dramatic clinical pictures. Diagnosis often requires hormone assays. Computerized tomography may be helpful. Definitive surgical treatment is possible, but metastases may be present.
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Conversion hysteria differs from hysteria in that it arises suddenly, rather than being a lifelong disorder. It is monosymptomatic rather than polysymptomatic, and is seen in men almost as frequently as in women. ⋯ Treatment may include removing the patient from a stressful environment and removing the "payoff" yielded by the illness. A confrontation with the patient is generally to be avoided.