NTIS refers to a syndrome found in seriously ill or starving patients with low fT3, usually elevated RT3, normal or low TSH, and if prolonged, low fT4. It is found in a high proportion of patients in the ICU setting, and correlates with a poor prognosis if TT4 is <4ug/dl. The patho-physiology includes suppression of TRH release, reducedT3 and T4 turnover, reduction in liver generation of T3, increased formation of RT3, and tissue specific down-regulation of deiodinases, transporters, and TH receptors. Although long debated, tissue TH levels are definitely reduced, and tissue hypothyroidism is presumably present. This is often not clinically evident because of the brief duration, and reduced but not absent tissue levels of TH. Although recognized for nearly 4 decades, interpretation of the syndrome is contested, because of lack of data. Some observes, totally without data, argue that it is a protective response and should not be treated. Other observers (as in this review) present available data suggesting, but not proving, that thyroid hormone replacement is appropriate, not harmful, and may be beneficial. The best form of treatment (TRH,TSH,or T3+T4) and possible accompanying treatments (GHRH, Cortisol, nutrition, insulin) lack consensus. In this review current data are laid out for reader’s review and judgment.

There are 3 genetic types of FHH based on chromosome location. FHH type 1 accounts for 65% of cases and is due to inactivating mutations in the CASR gene, localized to 3q21.1. This gene encodes the calcium-sensing receptor (CaSR). Loss of CaSR function results in a reduction in the sensitivity of parathyroid and renal cells to calcium levels so hypercalcemia is perceived as normal. The other 35% have either a mutation GNA11 (19p13.3) seen in FHH type 2 or AP2S1 (19q13.2-q13.3) seen in FHH type 3 (see these terms) or in genes not yet discovered. FHH is rarely caused by auto-antibodies against CaSR in those without a mutation.

How to Check Cervical Mucus

Insulin is a hormone made naturally in the pancreas that helps move sugar into the cells of your body. Your cells use the sugar as fuel to make energy. Without enough insulin, sugar stays in your bloodstream, raising your blood sugar. High blood sugar, or hyperglycemia, can lead to the signs and symptoms of diabetes:

Gallstone ileus is an important, though infrequent, cause of mechanical bowel obstruction, affecting older adult patients who often have other significant medical conditions. It is caused by impaction of a gallstone in the ileum after being passed through a biliary-enteric fistula. The diagnosis is often delayed since symptoms may be intermittent and investigations fail to identify the cause of the obstruction. The mainstay of treatment is removal of the obstructing stone after resuscitating the patient. Gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.

A foot of gauze out of nipple abscess

This video is really sad. You can literally watch this man dying. He was shot in the chest and rushed to the emergency room. His heart has stopped beating or has arrested. As a last resort, surgeons did an extreme procedure called an open thoracotomy which is that crazy tool you see there that basically splits the ribs open and allows easy open access to the heart. They did this so they could give him a cardiac massage. A cardiac massage is when surgeons are manually trying to pump the heart after it has stopped working on its own (cardiac arrest). Unfortunately he lost so much blood from his gun shot wound and he was pronounced dead. There are cases of patients surviving after having this kind of invasive resuscitation but it is rare.

Teratomas are tumors made up of tissues, such as hair, muscle, and bone. They occur most often in the ovaries in women, and the testicles in men. They may be benign or malignant. Symptoms vary depending on the location. A painful lump or swelling may be apparent. Some babies have a mass that can be seen on an ultrasound before birth. Treatment often involves surgery. In rare cases when a teratoma is malignant, chemotherapy or radiation may be needed.

The voice box, or larynx, has three important functions. It is necessary for breathing, voice and swallowing. The vocal folds have two positions, open (apart) for breathing (picture I) and closed (together) for making sound, coughing and sealing off the lungs when swallowing (picture II). When one of the vocal folds are paralyzed, it usually rests in an in-between position (picture III), and neither opens for breathing, nor closes for voicing, coughing, or swallowing. Usually, the effects on the voice are the most dramatic. The voice becomes weak and breathy. People can only say a few words per breath, and are frequently out-of-breath, or physically tired when trying to speak for more than a few minutes straight. The voice may also get somewhat high and squeaky, with a diminished range. Swallowing may be affected as well, where you may notice some choking or coughing with certain liquids. Your cough is frequently different and very weak. This is a serious problem for patients with with vocal fold paralysis because one of the most important functions of the larynx is to keep liquids out of the lungs, and to be able to cough up mucus. When this does not happen, you are at risk for getting an "aspiration" pneumonia. The surgical procedure to restore these important functions is called "medialization laryngoplasty"

all you need to know about the female orgasm

Sexual Desire & our Eating

A colonoscope is the special tool used to perform a colonoscopy. It is a thin, flexible, tubular ‘telescope’ with a light and video camera that your doctor carefully guides through your colon in order to see and determine the health of your colon. Watch this animation to learn about the features of the colonoscope, how the colonoscopy procedure is performed and how polyps are removed, and the follow-up care you and your doctor should talk about after your procedure.

Watch that video of The Most Invasive Parasites in the World

The Valsalva Maneuver is any attempt to exhale with the mouth and nose closed. Named after the Italian physician and anatomist, Antonio Maria Valsalva (1666-1723), it is also known as Valsalva's Test and Valsalva's Method.

All you need to know about Male vs Female Orgasms

While an anal abscess is an infection within one or more of the anal spaces, an anal fistula (Choice B) is a tunneling between the anus or rectum and another epithelial lined space (eg, the skin overlying the drainage site). Fifty percent of patients with anal abscesses will go on to develop a chronic fistula from the involved anal gland to the overlying skin. Patients with fistulas typically present with an anal abscess that persists after incision and drainage, or with a pustule-like lesion in the perianal or ischiorectal area that continually drains. Surgical repair is usually necessary to eliminate the fistula while preserving fecal continence.

Watch that video of Removal of a large epidermal cyst in the chest

Watch that Full Human Dead Body Decomposing Video

The fuel for the process leading to orgasm is testosterone, a hormone produced in steady supply by the testicles. The testicles also make millions of sperm each day, which mature and then are mixed with whitish, protein-rich fluids. These fluids nourish and support the sperm so they can live after ejaculation for a limited time. This mixture of fluid and sperm, known as semen, is what is moved through the urethra and out the penis during orgasm.

Animation explaining the pancreatic auto islet transplantation process with complete removal of the pancreas to treat pancreatitis.