Breast Cancer - Is there a link to endocrine disrupting chemicals?

Breast cancer is a cancer that starts in the cells of the breast in women and men. Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death. In 2005, breast cancer caused 502,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths)

A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism or due to a hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech or inability to see one side of the visual field. In the past, stroke was referred to as cerebrovascular accident or CVA, but the term "stroke" is now preferred.

Aortic valve stenosis (AS) is a valvular heart disease caused by the incomplete opening of the aortic valve.

The aortic valve controls the direction of blood flow from the left ventricle to the aorta. When in good working order, the aortic valve does not impede the flow of blood between these two spaces. Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood.

An echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonogram of the heart. Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart. The latest ultrasound systems now employ 3D real-time imaging.

In addition to creating two-dimensional pictures of the cardiovascular system, an echocardiogram can also produce accurate assessment of the velocity of blood and cardiac tissue at any arbitrary point using pulsed or continuous wave Doppler ultrasound. This allows assessment of cardiac valve areas and function, any abnormal communications between the left and right side of the heart, any leaking of blood through the valves (valvular regurgitation), and calculation of the cardiac output as well as the Ejection fraction.

A sleep disorder (somnipathy) is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. A test commonly ordered for some sleep disorders is the polysomnogram.


Autoimmune hepatitis has an incidence of 1-2 per 100,000 per year, and a prevalence of 10-20/100,000. As with most other autoimmune diseases, it affects women much more often than men (70%). Liver enzymes are elevated, as may be bilirubin. Autoimmune hepatitis can progress to cirrhosis.


Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease. Prominent examples include Coeliac disease, diabetes mellitus type 1 (IDDM), systemic lupus erythematosus (SLE), Sjögren's syndrome, Churg-Strauss Syndrome, Hashimoto's thyroiditis, Graves' disease, idiopathic thrombocytopenic purpura, and rheumatoid arthritis (RA). 

The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to (below) the thyroid cartilage (also known as the Adam's apple in men) and at approximately the same level as the cricoid cartilage. The thyroid controls how quickly the body burns energy, makes proteins, and how sensitive the body should be to other hormones.


Migraine is a neurological syndrome characterized by altered bodily experiences, painful headaches, and nausea. It is a common condition which affects women more frequently than men.
The typical migraine headache is one-sided and pulsating, lasting 4 to 72 hours. Accompanying complaints are nausea and vomiting, and a heightened sensitivity to bright lights (photophobia) and noise (hyperacusis). Approximately one third of people who experience migraines get a preceding aura, in which a patient may sense a strange light or unpleasant smell.

The first anesthesia (a herbal remedy) was administered in prehistory. Opium poppy capsules were collected in 4200 BC, and opium poppies were farmed in Sumeria and succeeding empires. The use of opium-like preparations in anaesthesia is recorded in the Ebers Papyrus of 1500 BC. By 1100 BC poppies were scored for opium collection in Cyprus by methods similar to those used in the present day, and simple apparatus for smoking of opium were found in a Minoan temple. Opium was not introduced to India and China until 330 BC and 600–1200 AD respectively, but these nations pioneered the use of cannabis incense and aconitum.

Syncope  is the medical term for fainting, a sudden, usually temporary, loss of consciousness generally caused by insufficient oxygen in the brain either through cerebral hypoxia or hypotension but possibly for other reasons. Typical symptoms progress through dizziness, clamminess of the skin, a dimming of vision or brownout, possibly tinnitus, complete loss of vision, weakness of limbs to physical collapse. These symptoms falling short of complete collapse, or a fall down, may be referred to as a syncoptic episode.

Diabetes - Pathology

Diabetes mellitus  often referred to simply as diabetes  is a syndrome of disordered metabolism usually due to a combination of hereditary and environmental causes, resulting in abnormally high blood sugar levels (hyperglycemia). Blood glucose levels are controlled by a complex interaction of multiple chemicals and hormones in the body, including the hormone insulin made in the beta cells of the pancreas. Diabetes mellitus refers to the group of diseases that lead to high blood glucose levels due to defects in either insulin secretion or insulin action.


Terms To Remember

Natural Immunity: Immunity from disease can be provided by vaccination or by exposure to the disease. Some people believe that immunity is best gained by exposure to the actual disease, not by vaccination.
Shingles: A painful nerve inflammation occurring in people who have had chickenpox
National Immunization Project: An organization which can direct people to health clinics offering no- or low-cost vaccinations

Dennis L. Hufford, CDR, MC, USN
Faculty Development Fellowship
Madigan Army Medical Center

This lecture is based on the studies conducted and published by the team in the Karim Centre at Queen Charlotte's and Chelsea Hospital in London.

 We are grateful for financial support provided by the Al-Fayed Charitable Foundation.

Pathology Slides

ENT Emergencies Overview:-

Otologic Disorders
Nasal Disorders
Facial, Oral and Pharyngeal Infections
Airway Obstruction

Traumatic Disorders of the Auricle:-

- cartilaginous necrosis
- drain, antibiotics, bulky ear dressing close follow up
Lacerations - single layer closure, pick up perichondrium, bulky ear dressing
Use posterior auricular block for anesthesia

What is Retinoblastoma?:-

“Retinoblastoma is a disease that causes the growth of malignant tumors in the retinal cell layer of the eye.” (3)
It is the most common eye tumor in children.

Dissociated deviation. A strabismus of cortical origin:-

What Causes Retinoblastoma?:-

Retinoblastoma is caused by a mutation on the 13th chromosome.
“Possibly environmental factors increase mutational events at the retinoblastoma gene locus.” (2)

Health Problems

Health Problems More Common Among Women Than Men- Examples:-

Autoimmune Diseases/Lupus
Immune system attacks healthy cells in the body; can effect the joints, skin, kidneys, brain, heart, lungs and blood
9 out of 10 people who have lupus are women
Lupus is 3 times more common in black women than in white women
Afflicts almost 2 million Americans; death rates are on the rise
Onset usually occurs between the ages of 15 and 40;  a leading cause of kidney disease, stroke and premature cardiovascular disease in women of childbearing age.

Health Care 101: Women's Health:-

Paula A. Johnson, MD, MPH
Executive Director, Connors Center for Women’s Health and Gender Biology
Chief, Division of Women’s Health
Brigham and Women’s Hospital

PowerPoint Slide Presentation on Advances in autism genetics


Migraine Facts:-

Migraine is one of the common causes of recurrent headaches
According to IHS, migraine constitutes 16% of primary headaches
Migraine afflicts 10-20% of the general population
More than 2/3 of migraine sufferers either have never consulted a doctor or have stopped doing so
Migraine is underdiagnosed and undertreated
Migraine greatly affects quality of life. The WHO ranks migraine among the world’s most disabling medical illnesses
Burden Of Migraine
World - 15-20% of women and 10-15% of men suffer from migraine
In India, 15-20% of people suffer from migraine
Adults – Female: Male ratio is 2 : 1
In childhood migraine, boys and girls are affected equally until puberty, when the predominance shifts to girls.

Internal Medicine Slide For Doctor

The History of Medicine:-

By George Sarka MD,MPH,FACP,FACR
DrPH Candidate in Public Health at UCLA
Assistant Clinical Professor in Medicine at UCLA
Governor-Elect of the ACP Southern CA, Region 2
President of the LA Neurological Society
President of LA County Medical Association-District 1
Staff Neurologist at SMMC
Staff Rheumatologist at CSMC
Staff Physician at the Klotz SHC at CSUN
Medical Historian and Medical Lecturer
Diplomate in Internal Medicine, Rheumatology,
Neurology, Headache Medicine, Sports Medicine, Geriatrics and Emergency Medicine

The Future of Family Medicine Project:-

7 organizations came together to explore our future
Extensive research by 2 firms
Medical students, residents, active FP’s
Other physicians
The general public
Creation of 5 task forces

Steps in dermatology diagnosis:-

You can get the much more Power Point Presentation on slide world

Powerpoint slide Presentation on Dental

Dental Workforce Supply and Demand:-

What causes osteoporosis:-

Scientist have not yet learned all the reasons this occurs. 
When you are young your body makes new bone faster than it breaks down old bones. 
As you get older, this process slows down and you start losing bone density.
The risk for osteoporosis depends on how much  bone mass you attained between ages 25 and 35 and how fast you lose it.

Teeth Development:-
Bud stage :
Characterized by formation of a tooth bud.
The epithelial cells  begin to proliferate into the ectomesenchyme of the jaw

Dental Implant & Patient Dental

Slide Presentation on cardiology:-

Cardiac CT-Calcium scoring 2008:-

ACC Heart Failure Guidelines Slide Deck:-

Based on the ACC/AHA 2005 Guideline Update
for the Diagnosis and Management of
Chronic Heart Failure in the Adult

Heart Failure is Primarily a Condition of the Elderly:-

The incidence of HF approaches 10 per 1000 population after age 65
HF is the most common Medicare diagnosis-related group
More dollars are spent for the diagnosis and treatment of HF than any other diagnosis by Medicare

Guideline Scope:-

Document focuses on :
Prevention of HF
Diagnosis and management of chronic HF in the adult

Definition of Heart Failure:-

HF is a complex clinical syndrome that can
result from any structural or functional
cardiac disorder that impairs the ability of
the ventricle to fill with or eject blood.

Stages of Heart Failure:-

At Risk for Heart Failure:
STAGE A High risk for developing HF
STAGE B Asymptomatic LV dysfunction
Heart Failure:
STAGE C Past or current symptoms of HF
STAGE D End-stage HF

Anesthesiology Ppt Slides

Anesthesiology Ppt Slides:-

Therapeutic Armamentarium:-

Morphine, Fentanyl
Succinylcholine, Curare, Pancuronium, Metocurine

Routine Monitors:-

Inspired oxygen
Blood pressure cuff
Finger on the pulse

Basics of Anesthesia:-

Delivery of oxygen
Support of intravascular volume and tissue perfusion

Therapeutic Armamentarium:-

Therapeutic ArmamentariumThiopental, propofol
Isoflurane, sevoflurane, desflurane
Morphine, fentanyl, alfentanil, sufentanil, remifentanil
Succinylcholine, pancuronium, vecuronium, rocuronium, atracurium, mivacurium, doxacurium, and pipecuronium

New Therapeutics:-

Central 2 adrenergic agonist
Profound postoperative analgesia in the ICU
Profound anti-ischemic properties
Modest sedation
Rapid offset
Demonstrated improved outcome after major surgery

PowerPoint Slide Presentation on Allergy:-

Milk allergy:-

A milk allergy is different from lactose intolerance. It is an allergic reaction to the protein components, such as casein, in cow’s milk. Usually, people who have a milk allergy must avoid all milk products. People with lactose intolerance can eat dairy products in varying amounts.

About 30% to 40% of infants who are allergic to cow’s milk are also allergic to the protein in soy formulas.

It is also called formula protein allergy.

Asthma in Children:-

Treatment of children with asthma should begin with the most aggressive therapy necessary to achieve control, followed by "stepping down" to the minimal therapy that will maintain control

Allergic Diseases:-

Learning Objectives:-

Identify symptoms, diagnosis and treatment courses for allergic and non-allergic rhinitis
Recognize signs, symptoms, diagnosis, and treatment of food allergy
Recognize signs, symptoms, and treatment for anaphylaxis
Identify mechanisms of drug allergy and its signs, symptoms, and treatment courses
Determine signs, symptoms, and treatment courses for stinging insect allergy
Determine diagnosis and treatment of urticaria and angioedema
Understand hereditary angioedema

Allergic Rhinitis:-

Rhinitis- definition
Inflammation of the membranes lining the nose
Characterized by nasal congestion, rhinorrhea, sneezing, itching of the nose, and/ or post nasal drainage
Allergic rhinitis- definition
Rhinitis that is caused by an IgE-mediated reaction to an aeroallergen

Other Allergic Eye Disorders:-

Atopic keratoconjunctivitis
Chronic inflammation of the eye (lower lid conjunctiva)
Severe itching burning, tearing
Associated with atopic dermatitis (95%) and asthma (85%)
Can cause anterior cataracts
Tranta’s-Horner’s dots- discrete swelling with white dots around iris

Allergic Conjunctivitis:-

Giant Papillary Conjunctivitis
Associated with contact lens use Symptoms of mild pruritus, abnormal thickening of conjunctiva, mucus stranding
Giant papillae and micropapillae on the upper tarsal conjunctiva
Reaction to foreign proteins on surface of contact lens

Allergic Rhinitis:-

Oral Allergy Syndrome
Occurs in 30-70% of patients with pollen allergy
Symptoms occur after oral mucosa contacts certain foods (fruits, celery)
Symptoms are itching of palate, throat, lips; may lead to angioedema in minority
Due to cross-reactivity between pollens and substances in certain foods