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nephropathy Women with gonadal dysgenesis (Turner s syndrome) have a 15% incidence of significant thyroid dysfunction by age 40 years Thyroiditis is also commonly seen in patients with hepatitis C Women with Hashimoto s thyroiditis have an increased risk of miscarriage in the first trimester of pregnancy Painless postpartum thyroiditis refers to autoimmune thyroiditis that occurs soon after delivery in 72% of women Women in whom postpartum thyroiditis develops have a 70% chance of recurrence after subsequent pregnancies It occurs most commonly in women who have high levels of thyroid peroxidase antibody in the first trimester of pregnancy or immediately after delivery It is also more common in women with other autoimmunity or a family history of Hashimoto s thyroiditis There is some evidence that the autoimmunity may be triggered by the accumulation of fetal cells in the maternal thyroid during pregnancy, a condition known as microchimerism Postpartum thyroiditis is typically accompanied by hyperthyroidism that begins 1 6 months after delivery and persists for only 1 2 months Then, hypothyroidism tends to develop in affected women beginning 4 8 months after delivery Although 80% of affected women subsequently recover normal thyroid function, permanent hypothyroidism eventually develops in about 50% within 7 years Permanent hypothyroidism is more common in women who are multiparous or who have had a spontaneous abortion Painless sporadic thyroiditis is thought to be a subacute form of Hashimoto s thyroiditis that is similar to painless postpartum thyroiditis except that it is not related to pregnancy It accounts for about 1% of cases of thyrotoxicosis Thyrotoxic symptoms are usually mild; a small, nontender goiter may be palpated in about 50% of such patients High serum thyroid peroxidase antibody concentrations are found in only 50% of such patients The course is similar to painless postpartum thyroiditis 2 Subacute thyroiditis Subacute thyroiditis also called de Quervain s thyroiditis, granulomatous thyroiditis, and giant cell thyroiditis is relatively common, accounting for about 5% of clinical thyroid disease It usually presents as an acute, usually painful enlargement of the thyroid gland, often with dysphagia The pain may radiate to the ears Patients usually manifest a low-grade fever and fatigue The manifestations may persist for weeks or months and may be associated with malaise In patients who experience pain, it is called painful subacute thyroiditis If there is no pain, it is called silent thyroiditis Subacute thyroiditis often follows an upper respiratory infection and its incidence peaks in the summer A viral etiology has been proposed but not firmly established Thyrotoxicosis develops in 50% of affected patients and tends to last for several weeks Subsequently, hypothyroidism develops that lasts 4 6 months Normal thyroid function typically returns within 12 months, but persistent hypothyroidism develops in 5% of patients Young and middle-aged women are most commonly affected 3 Suppurative thyroiditis Suppurative thyroiditis is caused by an infection of the thyroid gland, usually bacterial However, low-grade mycobacterial, fungal, and parasitic (eg, Pneumocystis jiroveci) infections have been described, fre-.

The principal symptoms are burning and stinging Neuralgia may precede or accompany attacks The lesions consist of small, grouped vesicles that can occur anywhere but which most often occur on the vermilion border of the lips, the penile shaft, the labia, the perianal skin, and the buttocks Any erosion in the genital region can be due to HSV-2 (or HSV-1) Regional lymph nodes may be swollen and tender The lesions usually crust and heal in 1 week Herpes simplex is the most common cause of painful genital ulcerations in patients with HIV infection

You can also create an unconditional branch by using one of the unconditional branch keywords: goto, break, continue, return, or throw. The first three of these are discussed later in this chapter, the return statement is discussed in 7, and the final statement, throw, is discussed in 16.

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Intertrigo is caused by the macerating effect of heat, moisture, and friction It is especially likely to occur in obese persons and in humid climates The symptoms are itching, stinging, and burning The body folds develop fissures, erythema, and sodden epidermis, with superficial denudation Candidiasis may complicate intertrigo Inverse psoriasis, seborrheic dermatitis, tinea cruris, erythrasma, and candidiasis must be ruled out Maintain hygiene in the area, and keep it dry Compresses may be useful acutely Hydrocortisone 1% cream plus an imidazole or nystatin cream is effective Recurrences are common

Lesions of herpes simplex must be distinguished from chancroid, syphilis, pyoderma, or trauma Direct immunofluorescent antibody slide tests offer rapid, sensitive diagnosis Viral culture may also be helpful Herpes serology is not used in the diagnosis of an acute genital ulcer However, specific HSV-2 serology by Western blot assay or enzyme-linked immunosorbent assay (ELISA) can determine who is HSV-infected and potentially infectious Such testing is very useful in couples in which only one partner reports a history of genital herpes

By the end of 1971, three users within Bell Labs were running UNIX. UNIX was first described at the Operating Systems Principles Conference (Ritchie 1985, 28) in 1973.8 A development group was created within Bell Labs to support UNIX, and that group began supporting and developing commercial versions of UNIX (System III/System V) in 1982. (See http://perso.wanadoo.fr/levenez/unix and http:// minnie.tuhs.org/TUHS/Images/unixtimeline.gif for diagrams of UNIX releases.) Many of the technical features embodied in UNIX were evolutionary, but some were truly groundbreaking. One of these was the reimplementation of the UNIX kernel in C, which constituted a major event in the history of operating systems. Up until this time, operating systems were written in assembly language, causing them to be strongly coupled to specific hardware architectures. With the advent of C, it was now possible to write an operating system kernel in a high-level language. Consequently, the operating system was loosely coupled to the hardware on which it ran, and could be easily ported to other hardware architectures. This feature significantly contributed to the popularity of UNIX. Traditionally, there were two main lines of UNIX releases: the Bell Labs research versions, which led to the commercial releases of System V Release 4 (SVR[N]); and versions from the University of California at Berkeley (BSD). Over the past several years, many free UNIX-like operating systems have emerged, including Minix, Linux, FreeBSD, and OpenBSD. Tables D.1 through D.3 highlight the technical features of various UNIX releases between 1971 and 1990.9

VESICULAR DERMATOSES HERPES SIMPLEX (COLD OR FEVER SORE; GENITAL HERPES)

Recurrent small grouped vesicles on an erythematous base, especially in the orolabial and genital areas (Plate 10)

Although methods branch unconditionally, often you will want to branch within a method depending on a condition that you evaluate while the program is running. This is known as conditional branching. Conditional branching statements allow you to write logic such as If you are over 25 years old, then you may rent a car. This is where the comparison operators you learned about in 4 become really useful. C# provides a number of constructs that allow you to write conditional branches into your programs, including the if, else, and switch statements.

Complications include pyoderma, eczema herpeticum, herpetic whitlow, herpes gladiatorum (epidemic herpes in wrestlers transmitted by contact), esophagitis, neonatal infection, keratitis, and encephalitis

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