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??????????? This can be present with or without pain and may be continuous or intermittent. If visible to the naked eye it is termed macroscopic or gross haematuria.; if only detected by stick tests or microscopy it is called microscopic haematuria.

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Causes of Haematuria:

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Sytemic Purpura Sickle cell trait Bleeding disorders, including angicoagulant drugs Renal Infarct / papillary necrosis Trauma Tuberculosis Stones Renal pelvis ca. and other ?renal tumours Wilms’ tumour (in children) Acute glomerulonephritis ?

Post-Renal Ureteric Stones Ureteric neoplasms Bladder tumours (transitional cell carcinoma) Bladder tuberculosis and bilharziasis Radiation cystitis Drug-induced cystitis,e.g. cyclophosphamide Prostatic enlargement Urethral neoplasms Bacterial cystitis ? ? ?

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HERMAPHRODITISM

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Syn: Intersex

??????????? In the true sense intersex signifies the presence of intersexual genitalia. However, abnormalities of sexual differentiation may involve the genetic, phenotypic or gender sex. Intersex is classified in to the following categories.

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1. True hermaphroditism – Abnormal gonadal development with the presence of ovarian and testicular tissue leading on to abnormal genitalia.

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2. Male pseudohermaphroditism – Abnormal genital development in the presence of normal testis (46 XY)
3. Female pseudohermaphroditism – abnormal genital development in the presence of normal ovaries (46 XX)

Acquired forms of intersex – hirsutism and virilism in women, feminization and gynecomastia in males, psychosexual disorders.

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Hirsuitism

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Growth of terminal hair in a male pattern in a female

1. Idiopathic (or) familial
2. PCOP (Stein-Levintrial syndrome)
3. Classic 21-hydroxylene deficiency
4. IIb Hydroxylase deficiency
5. Ovarian tumours – Arrhenoplastomas; Sertoclicell tumours, Dysgerminomas
6. ACTH induced lustings, Syndrome actomegaly,
7. Drugs : Minoxidil, Lyalosporine, Phenytoin, Anabolic steroids, diagnoxide progestins

Treatment:

1. Any remediable endocrinological cause to be treated
2. Oral antiandrogens (Cypoterone acetates)
3. Electrolysis, Shaving, Naxing
4. Depilatory Creams are useful

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HYPOXIA OF THE BRAIN

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??????????? Brain can survive hypoxia only for a short period of < 4 min. If hypoxia is prolonged for more than 4 min, the patient suffers irreversible brain damage with neuronal loss. In new born if hypoxic encephalopathy occurs the child can develop cerebral palsy, mental retardation.

??????????? In adults if the patient develops prolonged hypoxia due to respiratory failure due to poisoning by OPC or opiates, permanent brain damage occurs and patient can go into a vegetative state.

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Treatment

??????????? Prompt respiratory support with assisted ventilation should be started in patients with respiratory failure

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HALITOSIS

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Halitosis means bad odour in breath, it can be due to the following causes.

1. Anaerobic infections of the oral acvity (eg) Fusobacterium.
2. Vincents angina – Fusobacterium & Borrelia vincenti.
3. Ludwigs angina – due to anaerobic infection of the sub mandibular spaces.
4. Periodontitis
5. Cancrum oris
6. Bronchiectais
7. Lung abscess with anaerobic bacteria

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HYPOGONADISM

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??????????? It is characterized by absence of secondary sexual characteristics like growth of pubic and axillary hair, absence of development of the genitalia during puberty, absence of breast development and failure to achieve menstruation absence of libido.

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Causes:

1. Hypothalamic lesions – results in reduced amount of GnRH
2. Hypogondotrophic hypogonadism (Kallman Syndrome) – reduced gonadotrophin due to pituitary failure
3. Absence of sexual hormones – Either estrogen or testosterone due to failure of gonads.

Chromosomal disorders- - Klinefelter syndrome, turner syndrome

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