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Numerous studies have tried to assess whether psychosocial distress is a cause or consequence of the dysregulated brain­gut axis depression without meds buy 50 mg amitriptyline with amex. However mood disorder education day generic 25 mg amitriptyline otc, it appears that psychosocial morbidity is just as prevalent before as after the medical presentation. Rodent studies show that acute infections of the colon and surgical procedures result in the development of persistent, long-term visceral hypersensitivity following the insult. The abdominal pain must have two or more of the following features 25% of the time: relief with defecation; onset associated with a change in frequency of stool; and/or onset associated with a change in the form of stool. In addition, there should be no evidence of structural or biochemical abnormalities to explain the symptoms. On the contrary, the classification of abdominal migraine includes a more specific clinical symptom pattern. Abdominal migraines are characterized by intense, discrete episodes of periumbilical pain, lasting at least 1 hour and with associated features (two or more) of anorexia, nausea, vomiting, headache, photophobia, or pallor. Specific reported alarm symptoms and signs from a large single center cohort, predicting organic disease in patients with chronic abdominal pain include anemia, hematochezia, and weight loss. Vomiting and night-time awakening from pain were not found to be predictors of organic disease. In the current approach, the absence of alarm symptoms allows the clinician to make a symptom-based diagnosis and avoid an extensive, costly, and invasive exclusionary diagnostic work-up. When the index of suspicion for an organic illness is low, the Rome criteria will help determine a positive diagnosis of a functional disorder. This may be due to misconceptions of both the physician and the family, that a functional disorder is primarily a psychologic problem. It is thus important to emphasize to families that symptoms are not imagined but due to altered physiologic cross-talk between the brain and the gut. Rapid bacterial fermentation of these substances that results in colonic luminal distention is the proposed underlying mechanism. These are all treatment options with few side-effects that should serve as first-line options. When first-line treatments fail or symptoms are severe and adversely affect the quality of life. However, these studies are limited by a substantial placebo effect, short duration of treatment, and a single low, fixed dose of antidepressant. One study that evaluated citalopram showed benefit in 84% of patients on a global improvement scale. Fat and carbohydrate are both absorbed through the small bowel but each has unique pathways with multiple required steps. However, lipid absorption requires extensive digestion by pancreatic enzymes and the presence of bile salts. The bipolar bile salts are required to form mixed micelles which allows these water insoluble nutrients to be absorbed. Thus, besides small bowel pathology, fat malabsorption is commonly encountered in pancreatic or biliary pathology. The clinical sequelae of malabsorption, the failure to utilize ingested nutrients, can be identical to malnutrition which is the failure to ingest required nutrients. Aside from widespread small bowel disease as in the short bowel syndrome, protein malabsorption rarely is a clinical concern. However, certain children with intestinal diseases that result in malabsorption also may have protein-losing enteropathy. In this condition, protein that has already been synthesized by the body is inappropriately lost. Since malabsorption is a heterogeneous term, the incidence is dependent on which nutrient one is examining. In addition, in the developing world where the burden of intestinal infections is high, the proportion of people with malabsorption is also much greater. The lack of nutrients further compromises intestinal function, thus further escalating the initial insult. While there are no accurate epidemiologic data on malabsorption, there is some related information. A common cause of both carbohydrate and fat malabsorption, celiac disease, can be screened for with serum tests such as the tissue transglutaminase and anti-endomysial immunoglobulin (Ig)A antibody titers. Utilizing this approach on large numbers of stored bloods has revealed that the prevalence of celiac disease is reportedly slightly more than 1 in a 100 people in the United States, Europe, and large parts of Asia. Since celiac disease only contributes to a fraction of all patients with malabsorption, the prevalence for malabsorption is much higher than this number. In the developing world, the percentage is much higher and is a major contributor to mortality. About 90% of adults throughout the world are believed to have lactose malabsorption. While few infants and toddlers have this problem, children approach adult values of lactose malabsorption during the early school years. Vitamin D is required to prevent rickets (bowing of legs, flaying of knees and wrists) in younger children, and osteopenia (frequent or atypical fractures) in adolescents. Inadequate amounts of vitamin D interferes with the normal deposition of calcium and phosphate into growing bone, leading to creation of the structurally abnormal and weaker bone. Our understanding of vitamin D activity is expanding and deficiencies have been identified with many diseased states. Vitamin K deficiency causes excessive bleeding with documentation of coagulopathy.

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This suggests that atomoxetine should be considered prior to the other nonstimulants bipolar depression wont go away order amitriptyline 50 mg on line. Atomoxetine may be considered first-line monotherapy for patients with comorbid tic or anxiety disorders depression hair loss cheap amitriptyline 50 mg buy on line. Nonstimulants may also be considered first-line treatments when there is high concern over potential stimulant misuse (see Chapters and 2). When monotherapy is partially effective or limited by side effects, combination stimulant and nonstimulant regimens can prove beneficial. Other medications commonly prescribed off-label include modafinil, tricyclic antidepressants, buproprion, and certain antipsychotic agents. While some research evidence supports their use, efficacy data are limited and heightened attention to safety monitoring is advised. The goal of initial titration is to determine as quickly and efficiently as possible the optimal dose of an effective and well-tolerated medication. Generally, 5­7 days on a fixed stimulant dose is sufficient to assess treatment response and develop some tolerance to side effects. Shorter trials do not provide a sufficient sampling of response to attribute changes to medication effects. Longer trials, such as providing an initial prescription of a low-dose stimulant for 30 days or more, fail to assess potential benefits with higher doses and unnecessarily delay the time to achieving symptom improvement. Medication titration can be constrained by local norms, clinician and patient time demands, and third-party payers. Insurance companies increasingly demand 30-day prescriptions for chronically administered medications and create obstacles for determination of optimal doses with an initial titration. Clinicians must devise titration methods that suit local circumstances, keeping in mind the need to assess a range of doses within a reasonable time frame. Patients are provided with a prescription for a low dose of the chosen stimulant and instructed to take as directed. A written information sheet given to patients can direct them to take one tablet or capsule daily for the first 5 days, two for the second 5 days, and three for the third 5 days. Absent significant difficulties, patients return for an office visit after 2­3 weeks to review responses and help the clinician determine which dose appears most effective and well tolerated. Clinicians may then provide a 30-day supply of the apparent best dose and schedule a -month follow-up visit to verify optimized response. If after the -month trial both patient and clinician are satisfied with treatment response, follow-up visits for ongoing stimulant management can be scheduled every 3 months. If a satisfactory medication and dose are not identified during initial titration, the process is repeated with a different agent. Problems with tolerability most frequently emerge when initial dose is too high or if doses are increased too quickly. This does not necessarily require an office assessment unless there are significant concerns about tolerability. Clinicians should assess response ­2 weeks after the dose is doubled, and then increase to the full target dose if well tolerated. Some benefit should be evident after a week at full dose, but improvements can continue to increase over several weeks. If there is insufficient improvement after a month at full dose, atomoxetine is unlikely to be beneficial and should be discontinued. Optimal titration requires weekly assessment of tolerability and symptom response until sufficient improvement is attained. Medication should be initiated at the lowest available dose and increased weekly by the same increment as tolerated. Combination Pharmacotherapy It is preferable to keep medication regimens as simple as possible. However, combination pharmacotherapies are appropriately utilized to address residual symptoms, problems with tolerability and side effects, and comorbid disorders. Stimulant and nonstimulant combinations are often useful when stimulant doses require reduction due to weight loss or when addressing tic exacerbations, rebound hyperactivity, late afternoon irritability, and sleep difficulties. Long-Term Maintenance Once an apparently optimal medication and dose have been identified, it is advisable to provide a -month prescription and then reassess to confirm that symptoms are adequately controlled. After the clinician and patient agree that clinical needs are well addressed, subsequent follow-up visits can be scheduled every 3 months. Assessment of height, weight, pulse, and blood pressure can be limited to every 6 months. As with all chronic conditions, patient adherence with prescribed treatment is improved by regular clinical contact and active inclusion of patients and families in their medical decision making. General management strategies include changes in dose or dose forms, switching to alternative medications, or combination drug treatments. Medications that cause unacceptable side effects or are not tolerated must be discontinued. Appetite Loss and Growth Delay It is advisable to anticipate appetite loss and recommend calorie supplementation when stimulant therapy is initiated, not after weight loss occurs. Medication is best taken after eating breakfast and other meals, and late evening meals and high-caloric snacks should be encouraged. Appetite, height, weight, and body mass index should be assessed at least every 6 months. Loss of 5% or more body weight from baseline or failure to gain height or weight over a year should be addressed with stimulant dose reductions, switch to shorter acting stimulant or alternative drug class, or medication holidays on weekends and vacations. Children who exhibit deceleration of growth rate usually make up their growth losses once medication is discontinued (see Chapter 2). Medication holidays over two, but not one, summer vacations promote successful recovery from lost growth. Children at or below the 3rd percentile for height at a given age should be referred for evaluation by a pediatric endocrinologist.

Miel Blanc (Honey). Amitriptyline.

• Wound healing. Applying honey preparations directly to wounds or using dressings containing honey seems to improve healing.
• What is Honey?
• Sunburn, foot ulcers caused by diabetes, asthma, allergies, breaking up thick mucus secretions, diarrhea, digestive tract ulcers, and cataracts.
• What other names is Honey known by?
• Cough. Taking a small amount of honey at bedtime appears to reduce the number of coughing spells.
• How does Honey work?
• Are there safety concerns?
• Dosing considerations for Honey.

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These animal derived reagents may be contaminated with potentially infectious agents that cannot be detected by currently available assays mood disorder hk cheap amitriptyline 25 mg without a prescription, for example prions that cause bovine spongiform encephalopathy bipolar depression laziness proven 25 mg amitriptyline. A non-homologous cellular therapy product performs a different function in the recipient than the donor. In some instances, cells or tissues may be obtained from a patient and returned to the same patient during a single procedure. Both require donor qualification, controlled environments, clean uncluttered work areas, procedures to prevent contamination and mix-up of products, use of sterile supplies and reagents, use of closed systems when possible, and assays to ensure the purity and potency of products. Donor Eligibility Qualification: Donor eligibility must be determined in order to prevent the spread of communicable diseases. First, donors must be evaluated by physical examination and review of health history and medical records for risk factors and symptoms of communicable diseases. For some of these, there are no tests available, such as human transmissible spongiform encephalopathy, including Creutzfeldt-Jakob disease. Testing for other relevant diseases, which are also licensed, include West Nile virus and Trypanosoma cruzi. Assays can be appropriate laboratory tests or controlled clinical data obtained by administering the product. Assays should identify the cell types and viability of the cells and should also rule out contamination with foreign material and or microbial agents. Microbial Contamination: Products that depend on function of living cells cannot be sterilized. The final product should be assayed for bacterial and fungal contamination, and in the case of 351 products endotoxin and mycoplasma. Sources of Cells: When selecting a cell type for the development of a cellular therapy the goals and purpose of the therapy must be considered. The starting cells should be readily available in sufficient quantities to provide the desired effects. Cellular therapies have been developed using either stem cells or adult tissue specific differentiated cells (Table 81. Stem cells are undifferentiated cells that are capable of unlimited self-renewal and under the appropriate conditions can be induced to differentiate into specific cell type(s). Stem cells are most useful for repair or repopulation of damaged tissues, and can be derived from embryonic or adult tissues. The dogma surrounding the use of adult stem cells is that adult stem cells have limited differentiation capacity, usually restricted to the tissue from which they are derived. However, this has been blurred by reports of bone marrow stem cells being used to repair other tissues, such as in cardiac repair. Multi-potent: differentiate into red blood cells, white blood cells and megakaryocytes. Derived from the inner cell mass of an embryonic blastocyst five days after fertilization. Differentiate into bone, cartilage, and fat (mesodermal origin tissues) and also neural, hepatic, and renal tissue. Induced pluripotent stem cells Potential to repair or replace any damaged cells or tissue. Mesenchymal stem cells Potential to repair or replace bone, cartilage, fat, and neural, hepatic, and renal tissue. Differentiated cells Immunomodulatory cells: T-, Natural Killer, and dendritic cells No self-renewal Derived from blood. To prevent immune reactions in the recipient and/or graft rejection, the immunogenicity of allogeneic cells must be considered. Stem Cells: Stem cell based cellular therapies offer the promise of repair and replacement of all tissues. In order for these therapies to be safe and effective, the development process must include carefully controlled in vitro studies followed by preclinical studies in animals to evaluate the in vivo behavior and safety of cells that cannot be predicted by in vitro studies, and, ultimately, carefully controlled clinical trials that are vigilantly monitored for safety and efficacy. The International Society for Stem Cell Research recognized the uniqueness of stem cell therapies and published strict guidelines for the development of stem cell products. Unique qualities of stem cells addressed in these guidelines include: difficulties controlling stem cell self-renewal, differentiation, and tumorgenicity; limitations of animal models; a recognition that effects may be unpredictable, irreversible and persistent for many years requiring long-term safety and efficacy monitoring. Included are recommendations for strict oversight of product development, extensive pre-clinical animal testing models that provide proof of principle and safety data, clinical trials, and safety monitoring by individuals with stem cell specific scientific and ethical expertise; informed consent for allogeneic donors; donor infectious disease testing; establishment of surrogate markers of cellular identity and potency of the products; elimination of xenogeneic components of culture media; and harmonization of international standards to improve accessibility to cellular therapies. Today it is a frequently used, life-saving treatment for hematologic malignancies, bone marrow failure syndromes, genetic disorders such as hemoglobinopathies, and in conjunction with high dose chemotherapy for a variety of malignancies. Initially, regulatory signaling pathways are manipulated to induce the formation of mesoderm, endoderm, or ectoderm germ layers in vitro. Hematopoietic, vascular, and cardiac cells can be obtained from mesoderm; hepatocytes and pancreatic cells from endoderm; and neural cells from ectoderm. Purity and potency assays for these products must include safeguards to ensure that the final cellular therapy product does not contain undifferentiated tumorigenic stem cells. Lamberth of the Federal District Court blocked the Obama order, stating that it violated the Dickey-Wicker amendment. The long-term goal is also to provide donor specific cells able to replace defective cells and tissues such as nerve cells and pancreatic islet cells. These cells can be expanded and maintain their phenotype in tissue culture Overview of Cellular Therapy 539 medium. When exposed to the appropriate factors in vitro, they can differentiate into mesodermal origin cell lineages (bone, cartilage, and fat) as well as other tissues such as neural, hepatic, and renal tissues. Differentiated Cells: Immunomodulatory Cells: T-, natural killer, and dendritic cells are essential to the functioning immune system. These cells can be incubated with tumor cells or antigens to make vaccines comprised of activated immune cells that recognize and kill tumor cells. Current Status: Approved/Licensed Cellular Therapies: Stem cell and other cellular therapies hold promise of cures for diseases.

Syndromes

• Confusion or decreased consciousness
• Lung tissue death (pulmonary infarction)
• Age 4-8 years: 12* mcg/day
• Anaphylactic shock (caused by allergic reaction)
• Paralysis
• Wearing too much clothing
• Constrictive pericarditis
• Arrange to have your snow shoveled.
• Myeloproliferative disorders (for example, polycythemia vera and chronic myelocytic leukemia)

Other diagnoses that might be considered are anorexia nervosa (her age and sex depression severe joint pain generic amitriptyline 25 mg on-line, commitment to exercise); she does not appear depressed (a common cause of weight loss and bowel disturbance) lethargic depression definition order amitriptyline 50 mg overnight delivery, and the laboratory findings clearly indicate physical disease. Diagnosis of coeliac disease can be confirmed by endoscopy, at which a biopsy can be taken from the distal duodenum. IgA anti-tissue transglutaminase and IgA endomysial antibodies are usually positive when the patient is still in a gluten containing diet and are a useful screening test. Treatment is a gluten-free diet with a repeat of the biopsy some months later to show improvement in the height of the villi in the small bowel. A common cause of failure to recover the villus architecture is poor compliance to the difficult dietary constraints. Symptoms may persist if patients have lactose intolerance or irritable bowel syndrome. She has had three episodes of cough, fever and purulent sputum over the last 6 months. Recently she has had trouble with regurgitation and vomiting of recognizable food. She lived in the north-western coast of the United States for 4 years until 10 years ago. She has always tended to be constipated, and this has been a little worse recently. There are no abnormalities in the cardiovascular system, abdomen or other systems. The X-ray shows a dilated, fluid-filled oesophagus with no visible gastric air bubble. The oesophagus has now dilated, and there has been spillover of stagnant food into the lungs, giving her the episodes of repeated respiratory infections. Such aspiration is most likely to affect the right lower lobe because of the more vertical right main bronchus, although the result of aspiration at night may depend on the position of the patient. It tends to be present for all foods, indicating a motility problem, and there may initially be some relief from the mechanical load as the oesophagus fills. The diagnosis can be made at this stage by a barium swallow showing the dilated oesophagus. Earlier, it may require careful cine-radiology with a bolus of food impregnated with barium or oesophageal motility studies using a catheter fitted with a number of pressure sensors to detect the abnormal motility of the oesophageal muscle. Other common causes of dysphagia are benign oesophageal structures from acid reflux, malignant structures, external compression or an oesophageal pouch. Achalasia may be managed by muscle relaxants when mild, but often requires treatment to disrupt the lower oesophageal muscle by endoscopic dilation or surgery. Key Points · the subjective site of blockage in dysphagia may not reflect accurately the level · Persistent dysphagia without explanation needs investigation by barium swallow or endoscopy. The ambulance was called by the neighbours who witnessed the woman having generalised seizures. The typical presentation is of mild to moderate headache, nonthrobbing, bilateral with no associated symptoms. Cluster headaches are characterised by attacks of severe unilateral orbital or temporal pain, accompanied by autonomic features such as nasal congestion, lacrimation and rhinorrhoea. Migraines are often preceded by characteristic symptoms such as flashing lights and are often unilateral. The headache is worse after coughing and is often associated with nausea and vomiting. The onset of headache may be localised to the side of the aneurysm and may be associated with a brief loss of consciousness, seizure, nausea and vomiting and neck stiffness. Risk factors include smoking, heavy alcohol consumption, uncontrolled hypertension and a family history. The usual findings are an elevated opening pressure and an elevated red blood cell count that does not decease after the initial few drops. Xanthochromia (red/yellow) suggests haemoglobin degradation products and is also suggestive of a recent subarachnoid haemorrhage. Once subarachnoid haemorrhage is confirmed digital subtraction angiography is performed to identify a potential bleeding point for intervention. Complications include rebleeding, cerebral infarction, hydrocephalus, cardiac ischaemia and hypothalamic dysfunction. Key Points · Sudden onset of severe headache should trigger investigation to rule out subarachnoid haemorrhage. The symptoms have been present for 2 months and have increased slightly over that time. He had noticed some skin lesions on the edge of the hairline and around his nostrils. Examination There is no deformity of the joints and no evidence of any acute inflammation. In the skin there are some slightly raised areas on the edge of the hairline posteriorly and at the ala nasae. The age is typical, and sarcoidosis is more common in those of African-Caribbean origin. The blood results show a slightly raised calcium level, which is related to vitamin D sensitivity in sarcoidosis, in which the granulomas hydroxylate 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol. The skin lesions at the hairline and the nostrils are typical sites for sarcoid skin problems.

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Bone marrow examination shows micromegakaryocytes and electron microscopy of the platelets shows abnormally large platelet granules anxiety workbook purchase amitriptyline discount. There is often a platelet function defect with the thrombocytopenia depression test clinical 50 mg amitriptyline buy with amex, which may persist even 606 Michele P. In Jacobsen syndrome, there is a larger deletion and associated cardiac anomalies, facial dysmorphism, mental retardation, and trigonocephaly predominate. Clinically, these patients present with mild to moderate thrombocytopenia and normal sized platelets associated with mild bleeding symptoms. There may be a mild decrease in alpha granule content and associated mild defects in platelet function. Heterozygous deletions or missense mutations result in somewhat decreased expression of the complex on platelet surfaces, fairly normal platelet function and mild thrombocytopenia without significant bleeding previously called Mediterranean thrombocytopenia. Clinically, patients present with varying degrees of macrothrombocytopenia (some may Congenital Thrombocytopenia 607 have severe thrombocytopenia), leukocyte inclusions, sensorineural hearing loss, cataracts and glomerulonephritis. The thrombocytopenia may result in a bleeding diathesis, which is generally mild, although a few patients have severe thrombocytopenia and significant bleeding. Gray Platelet Syndrome: the Gray platelet syndrome is an autosomal dominant or autosomal recessive disorder causing mild to moderate thrombocytopenia with platelet dysfunction due to the absence of platelet alpha granules, giving the characteristic gray appearance on May-Grünwald-Geimsa staining. Because of the abnormal packaging of alpha granule contents, proteins are instead redirected to the demarcation membrane lumen and are secreted into the extracellular marrow space resulting in bone marrow reticular fibrosis. The lack of platelet alpha granule contents results in mild, variable platelet dysfunction and bleeding manifestations. Patients present in early childhood with bleeding diathesis which results from the thrombocytopenia and concomitant platelet dysfunction. Other Macrothrombocytopenias: Several other macrothrombocytopenias have been described, including hereditary macrothrombocytopenia with aberrant expression of glycophorin A, macrothrombocytopenia with mutations in platelet 1 tubulin, and macrothrombocytopenia with Filamin A mutations. Many patients present with macrothrombocytopenia and have no currently identifiable explanation for the disorder. New genome-wide assessment techniques may help to define these disorders as well as increase our knowledge about what polymophisms affect platelet count and size. Physicians should consider referring patients with these disorders to a center specializing in platelet disorders that has the ability to do genome-wide studies so that we may learn more about these diseases. Treatment of the undefined thrombocytopenia that is thought to be congenital is supportive. Congenital amegakaryocytic thrombocytopenia and thrombocytopenia with absent radii. Gray platelet syndrome: natural history of a large patient cohort and locus assignment to chromosome 3p. Prompt investigation of thrombocytopenia is critical for management of the neonate and future pregnancies. Significant improvement in fetal/neonatal outcome has occurred with maternal intravenous immune globulin treatment. These IgG antibodies are transported across the placenta and bind to fetal platelets. These antibody coated platelets are removed from fetal circulation by the reticuloendothelial system with resultant fetal thrombocytopenia. These alloantibodies may also damage fetal megakaryocytes, a likely but unproven hypothesis. In untreated cases, intracranial hemorrhage occurs in 10­20% of affected fetuses/neonates with a 15% fatality, and may present with fetal distress, encephalomalacia, intracranial cysts, and focal neurological exam including a full fontanelle, anemia, or poor feeding. Consideration should be given to alternative diagnoses, through review of maternal history with specific attention to maternal infections, hypertension, platelet count, autoimmune disorders and neonatal clinical course/associated abnormalities. Initial evaluation should include confirmation of thrombocytopenia and review of peripheral smear. Diagnosis is confirmed by demonstrating a platelet antigen incompatibility and the presence of maternal antibody directed against that specific antigen (versus nonspecific platelet alloantibodies). Testing should only be performed by an experienced reference laboratory and diagnosis can usually be made with maternal and paternal samples (as a surrogate for the neonatal/fetal sample). The demonstration of a maternal alloantibody that is specific to the paternal platelet is essential to confirm the diagnosis. Since specialized testing will not typically produce results immediately, management needs to be initiated based on clinical suspicion. Differential Diagnosis: Thrombocytopenia is non-specific and can be the manifestation of many disease processes within the neonatal period. Full maternal and neonatal history and physical exam should be included in the assessment of thrombocytopenia, including review of timing related to the presentation of thrombocytopenia and peripheral smear. Management: Therapy should be initiated in the newborn with severe thrombocytopenia prior to confirmation of the diagnosis. In a recent change, the cornerstone of initial therapy is infusion of random donor platelets. Random donor platelets are effective at raising the platelet count in >90% of cases, despite immunological incompatibility, and are readily available. If available, antigen negative platelets from a donor without antibodies or washed and irradiated maternal platelets produce greater post-transfusion platelet count increases. Antigen matched or maternal platelets are reserved for patients who do not respond or may require additional transfusions. If paternity is assured and he is a homozygote for the corresponding platelet antigen, then the fetus can be assumed to be at least as severely affected as the previous fetus. Recently, alternative non-invasive treatment strategies have been advocated for the empiric antenatal management of at-risk pregnancies. The goal of antenatal management is to minimize treatment side effects and invasive procedures, but maximize effective platelet count in the fetal and perinatal period.

References

• Shoskes DA, Altemus J, Polackwich AS, et al: The urinary microbiome differs significantly between patients with chronic prostatitis/chronic pelvic pain syndrome and controls as well as between patients with different clinical phenotypes, Urology 92:26n32, 2016.
• Terzolo M, Angeli A, Fassnacht M, et al: Adjuvant mitotane treatment for adrenocortical carcinoma, N Engl J Med 356(23):2372n2380, 2007.
• Fornara P, Doehn C, Friedrich HJ, et al: Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease, Eur Urol 40(1):24n31, 2001.
• Noseworthy JH, Lucchinetti C, Rodriguez M, et al: Multiple sclerosis, N Engl J Med 343(13):938n952, 2000.
• Davis, D.M., Strong, G.H., Drake, W.M. Intubated ureterotomy; experimental work and clinical results. J Urol 1948;59:851-862.