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Breast cancer in men

Infiltrating ductal carcinoma - male; Ductal carcinoma in situ - male; Intraductal carcinoma - male; Inflammatory breast cancer - male; Paget disease of the nipple - male; Breast cancer - male

Breast cancer is cancer that starts in breast tissue. Both males and females have breast tissue. This means that anyone, including men and boys, can develop breast cancer. Breast cancer in men is rare. Male breast cancer accounts for less than 1% of all breast cancers.

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  • Abdominal aortic aneurysm - Animation

    Abdominal aortic aneurysm

    Animation

  • Abdominal aortic aneurysm - Animation

    Your blood vessels are the transport system that carries blood to and from your heart, to the rest of your body. Usually, everything runs pretty smoothly with this system, but sometimes there can be a problem. For example, one of the large blood vessels that supplies blood to your abdomen and lower body can swell up or bulge. This bulge is called an abdominal aortic aneurysm, and it can be pretty serious if it breaks open, or ruptures. Let's talk about abdominal aortic aneurysm. This is the descending aorta, one of the large blood vessels that sends blood to your abdomen and legs. Over a period of many years, this blood vessel can start to bulge. Although doctors aren't sure exactly what causes an aneurysm, they do know that it's more common in males over 60 and people who are overweight, who smoke, or who have high blood pressure or cholesterol. Eventually, if not treated, the aneurysm can pop open or rupture, and spill blood into your abdominal cavity or into the wall of the artery. If an aneurysm ruptures, it is considered a true medical emergency. So, how do you find out if you have an aneurysm?You may not realize that you have one, because often aneurysms don't cause any symptoms until they rupture. An imaging test like a CT scan or ultrasound may help in finding a suspected aneurysm. If it does break open, you may feel severe pain in your stomach. That pain may spread to your groin, buttocks, or legs. You could also feel sick to your stomach, have clammy skin, and your heart may beat faster than normal. If you have any of these symptoms, see your doctor, who can examine you. Your doctor may also recommend an imaging test to see for sure if you have an aneurysm. Treatments for aneurysms vary depending on how severe the aneurysm is. If you're not having symptoms, and your aneurysm is small and hasn't broken open, your doctor may suggest just checking it every six months to make sure it doesn't get bigger. If it's bigger than 2 inches, you'll probably need to have surgery. The goal is to perform surgery before complications and symptoms develop. The surgeon will replace the damaged, bulging section of blood vessel with a section of man-made vessel, commonly called a graft. It's better to avoid getting an aneurysm than to have to treat it. Eat a healthy diet, watch your cholesterol and blood pressure levels, and quit smoking to help prevent an aneurysm from forming in the first place. Men who are over the age of 65 and have ever smoked or who have a close relative who's had an abdominal aortic aneurysm should have one screening ultrasound done to check for an abdominal aortic aneurysm. If you're having any symptoms of an abdominal aneurysm, like severe pain in your belly or back, it's very important that you get medical help right away. Go to the emergency room or call your health care provider for immediate help. Small aneurysms are easy to treat with surgery. But once they get larger and rupture, they can be life threatening.

  • Migraine - Animation

    Migraine

    Animation

  • Migraine - Animation

    Migraines aren't your average, run-of-the-mill headaches. When you have a migraine, it feels like your head is throbbing, every light is glaring, and all you want to do is lie down in a dark room. Let's talk about migraines. We know that migraines are more common in women than in men. But what exactly triggers these severe headaches is less clear, and it's different in different people. For some people the trigger is stress. For others, it's strong odors like perfumes. Changing hormones around the time of a woman's menstrual period can set off a migraine. So can certain foods like chocolate, cured meats, red wine, and aged cheese. Doctors believe that whatever triggers a migraine sets off a chain of abnormal activities in brain chemicals and nerves. These activities affect the flow of blood through the brain. A migraine feels different than a regular headache. For one thing, it often comes with a warning. Some people get a sign that their migraine is coming, called an aura. About 10 to 15 minutes before the actual headache hits, their vision gets blurry or narrowed, and they may see stars or zigzag lines. A migraine feels like a throbbing or pounding pain that tends to be worse on one side of the head. You may also have symptoms like nausea, vomiting, numbness, chills, and sensitivity to light or sound. A migraine can typically last anywhere from 6 hours to 2 days. When it's over, people get what's described as a "hangover," in which they feel tired and can't think clearly. If you're plagued by migraines, your doctor will help you figure out the cause. You may need to have a brain scan such as an MRI or CT, especially if you have other symptoms like memory problems or weakness with your migraines. So, what can be done to treat migraines? Doctors use a few different types of medicines to prevent and treat migraines. You can take antidepressants, blood pressure medicines, or seizure medicines every day to prevent migraines from starting. Some people have great success preventing migraines using biofeedback devices or hypnosis. Once you do get a migraine, you can take medicines right away to stop it. Triptans such as Imitrex and Maxalt are the most commonly prescribed medicines for stopping a migraine. Depending on your migraine symptoms and how bad they are, your doctor may also recommend a pain reliever such as ibuprofen, or a nausea medicine. To prevent migraines, you also need to avoid your triggers, but first you need to identify what they are. Your doctor may recommend keeping a headache diary, in which you write down when your headaches occur and what you were eating or doing when you got a migraine. Take care of yourself when you have a migraine. If you only get them occasionally, there's probably no cause for worry. But if you get migraines often, and they're interfering with your life or they're getting worse, talk to your doctor about ways to prevent and treat them.

  • Cholesterol and triglyceride test - Animation

    Cholesterol and triglyceride test

    Animation

  • Cholesterol and triglyceride test - Animation

    Maybe you've been eating fast food more often than you should, or you're not getting your recommended two-and-a-half hours of exercise each week. Or, it could be that you smoke, or your blood pressure is too high. Well, for whatever reason, you may be concerned about your risk of getting heart disease. Well, a few tests can help you learn that risk, so you can start making healthy lifestyle changes to reduce it. A coronary risk profile is a group of blood tests that measure your cholesterol and triglyceride levels. Why is it important to know these levels? Because if you have too much of these substances in your blood from eating foods like burgers and French fries, they can clog your arteries. Eventually your arteries can become so clogged that you'll have a heart attack or stroke. Men should have their cholesterol tested by the time they're 35. Women should have it checked by age 45. If you have a condition like diabetes, heart disease, stroke, or high blood pressure, have your cholesterol checked now, no matter what your age. To measure your cholesterol, your doctor will give you a blood test. If you're also having your triglyceride level checked, you may be told not to eat or drink anything for 8 to 12 hours before the test. Depending upon your heart risk, the doctor may measure just your total cholesterol level, or your total cholesterol along with your LDL, or "bad" cholesterol, HDL, or "good" cholesterol, and triglycerides. If you're of average risk of getting heart disease, your goal is to have total cholesterol of less than 200 milligrams per deciliter, LDL cholesterol lower than 130 milligrams per deciliter, HDL cholesterol higher than 40 milligrams per deciliter if you're a man, or 50 if you're a woman -- the higher the better, and triglycerides of less than 150 also, the lower the better. Although some illnesses, like arthritis, can raise your cholesterol level, generally having high cholesterol means that you're at increased risk for heart disease and stroke. It's a sign you need to work harder to keep your heart healthy. If your cholesterol levels are normal, that's great! That means that you're eating right, you're exercising, and you're taking good care of your health. You don't need to have another cholesterol test for about five years. But if your cholesterol level is high, or you've already got heart disease, high blood pressure, or diabetes, you'll need to have your cholesterol levels checked more often. Keeping close tabs on your cholesterol and triglyceride levels is one way that you can take charge of your health, and change it for the better.

  • Kidney stones - Animation

    Kidney stones

    Animation

  • Kidney stones - Animation

    If you ever have severe pain in your belly or one side of your back that comes and goes suddenly, you may be passing a kidney stone. Let's talk about the painful condition of kidney stones. A kidney stone is a mass of tiny crystals in your kidney or urinary tract. Stones are quite common, and tend to run in families. They can form in weeks or months when your urine contains too much of certain substances. There are several kinds of kidney stones. Calcium stones are by far the most common kind. They often form in men between the ages of 20 to 30. Calcium can combine with other substances found in your food, like oxalate, phosphate, or carbonate, to form stones. Cystine stones can form in people who have cystinuria, a condition passed down through families in which stones are made from an amino acid called cystine. Struvite stones are found mostly in women who have urinary tract infections. These stones can grow very large and can block the kidney, ureter, or bladder. Uric acid stones are more common in men than in women. They can occur in people who have a history of gout or are going through chemotherapy. So, how do you know if you have kidney stones?Well, you may not have symptoms until the stone move down the ureter tubes through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of your kidneys. The main symptom is severe sharp pain that starts suddenly, usually in your belly or one side of your back, and it may go away just as quickly. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. So, what do you do about kidney stones?Well, your health care provider will perform a physical exam. You may need blood tests, kidney function tests, and tests that look for crystals in your urine. Several imaging tests, like a CT scan, can see stones or a blockage in your urinary tract. Treatment will depend on the type of stone you have, and how bad your symptoms are. Small kidney stones that are less than 5 mm in diameter will usually pass on their own. You should drink at least 6 to 8 glasses of water per day to produce a large enough amount of urine to help bring the stone out. Pain can be pretty bad when you pass a kidney stone, so your doctor may prescribe pain medicines to help as well as medications that will help the stone pass. Other medicines can decrease stone formation or help break down and remove the material that is causing you to make stones. You may need surgery if the stone is too large to pass, the stone is growing, or the stone is blocking your urine flow. Kidney stones are painful, but you can usually pass them without causing permanent harm. However, kidney stones often come back, so you and your doctor will need to work on finding the cause of your stone. Lastly, delaying treatment can lead to serious complications, so if you think that you have kidney stones see your doctor right away.

  • Depression and men

    Depression and men

    Depression is less reported in the male population, but this may be caused by male tendency to mask emotional disorders with behavior such as alcohol abuse.

    Depression and men

    illustration

  • Types of health care providers

    Types of health care providers

    Health care providers range from generalists to providers who specialize in certain areas of the body or disease. Any category of medicine or care such as cancer or anesthesia can have a specialist. Nurses also can specialize in certain areas of medical care.

    Types of health care providers

    illustration

  • Urine sample

    Urine sample

    A "clean-catch" urine sample is performed by collecting the sample of urine in midstream. Men or boys should wipe clean the head of the penis. Women or girls need to wash the area between the lips of the vagina with soapy water and rinse well. A small amount of urine should initially fall into the toilet bowl before it is collected (this clears the urethra of contaminants). Then, in a clean container, catch about 1 to 2 ounces of urine and remove the container from the urine stream. The container is then given to the health care provider.

    Urine sample

    illustration

  • Denture care

    Denture care

    Dentures are used when an individual is missing his natural teeth. It is just as important to take care of dentures as it is to take care of natural teeth, since problems such as gingivitis can still occur.

    Denture care

    illustration

  • Infant dental care

    Infant dental care

    Even though newborns and infants do not have teeth, care of the mouth and gums is important. Use a damp washcloth to wipe your infant's gums after each meal and do not put your infant or young child to bed with a bottle of milk, juice, or sugar water. As the child grows, establishing proper dental hygiene will promote healthy teeth and gums which are essential to overall good health. Poor dental development, dental disease, and dental trauma can result in poor nutrition, painful and dangerous infections, problems with speech development, and problems with self image.

    Infant dental care

    illustration

  • Diabetic foot care

    Diabetic foot care

    People with diabetes must take special care of their fingers and toes to be sure they are receiving adequate blood supply.

    Diabetic foot care

    illustration

  • Diabetic foot care

    Diabetic foot care

    People with diabetes are prone to foot problems because the disease can cause damage to the blood vessels and nerves, which may result in decreased ability to sense a trauma to the foot. The immune system is also altered, so that the person with diabetes cannot efficiently fight infection.

    Diabetic foot care

    illustration

  • Infant care following delivery

    Infant care following delivery

    An evaluation of the newborn's condition is done immediately after delivery and again at five minutes, to determine the APGAR scores. If some cyanosis (bluish skin) is present, the APGAR scores are lower and oxygen may be administered. The oxygen can often be merely blown by the newborn's face, through the mask in front of the infant.

    Infant care following delivery

    illustration

  • Osmolality urine - series

    Osmolality urine - series

    Presentation

  • Abdominal aortic aneurysm - Animation

    Abdominal aortic aneurysm

    Animation

  • Abdominal aortic aneurysm - Animation

    Your blood vessels are the transport system that carries blood to and from your heart, to the rest of your body. Usually, everything runs pretty smoothly with this system, but sometimes there can be a problem. For example, one of the large blood vessels that supplies blood to your abdomen and lower body can swell up or bulge. This bulge is called an abdominal aortic aneurysm, and it can be pretty serious if it breaks open, or ruptures. Let's talk about abdominal aortic aneurysm. This is the descending aorta, one of the large blood vessels that sends blood to your abdomen and legs. Over a period of many years, this blood vessel can start to bulge. Although doctors aren't sure exactly what causes an aneurysm, they do know that it's more common in males over 60 and people who are overweight, who smoke, or who have high blood pressure or cholesterol. Eventually, if not treated, the aneurysm can pop open or rupture, and spill blood into your abdominal cavity or into the wall of the artery. If an aneurysm ruptures, it is considered a true medical emergency. So, how do you find out if you have an aneurysm?You may not realize that you have one, because often aneurysms don't cause any symptoms until they rupture. An imaging test like a CT scan or ultrasound may help in finding a suspected aneurysm. If it does break open, you may feel severe pain in your stomach. That pain may spread to your groin, buttocks, or legs. You could also feel sick to your stomach, have clammy skin, and your heart may beat faster than normal. If you have any of these symptoms, see your doctor, who can examine you. Your doctor may also recommend an imaging test to see for sure if you have an aneurysm. Treatments for aneurysms vary depending on how severe the aneurysm is. If you're not having symptoms, and your aneurysm is small and hasn't broken open, your doctor may suggest just checking it every six months to make sure it doesn't get bigger. If it's bigger than 2 inches, you'll probably need to have surgery. The goal is to perform surgery before complications and symptoms develop. The surgeon will replace the damaged, bulging section of blood vessel with a section of man-made vessel, commonly called a graft. It's better to avoid getting an aneurysm than to have to treat it. Eat a healthy diet, watch your cholesterol and blood pressure levels, and quit smoking to help prevent an aneurysm from forming in the first place. Men who are over the age of 65 and have ever smoked or who have a close relative who's had an abdominal aortic aneurysm should have one screening ultrasound done to check for an abdominal aortic aneurysm. If you're having any symptoms of an abdominal aneurysm, like severe pain in your belly or back, it's very important that you get medical help right away. Go to the emergency room or call your health care provider for immediate help. Small aneurysms are easy to treat with surgery. But once they get larger and rupture, they can be life threatening.

  • Migraine - Animation

    Migraine

    Animation

  • Migraine - Animation

    Migraines aren't your average, run-of-the-mill headaches. When you have a migraine, it feels like your head is throbbing, every light is glaring, and all you want to do is lie down in a dark room. Let's talk about migraines. We know that migraines are more common in women than in men. But what exactly triggers these severe headaches is less clear, and it's different in different people. For some people the trigger is stress. For others, it's strong odors like perfumes. Changing hormones around the time of a woman's menstrual period can set off a migraine. So can certain foods like chocolate, cured meats, red wine, and aged cheese. Doctors believe that whatever triggers a migraine sets off a chain of abnormal activities in brain chemicals and nerves. These activities affect the flow of blood through the brain. A migraine feels different than a regular headache. For one thing, it often comes with a warning. Some people get a sign that their migraine is coming, called an aura. About 10 to 15 minutes before the actual headache hits, their vision gets blurry or narrowed, and they may see stars or zigzag lines. A migraine feels like a throbbing or pounding pain that tends to be worse on one side of the head. You may also have symptoms like nausea, vomiting, numbness, chills, and sensitivity to light or sound. A migraine can typically last anywhere from 6 hours to 2 days. When it's over, people get what's described as a "hangover," in which they feel tired and can't think clearly. If you're plagued by migraines, your doctor will help you figure out the cause. You may need to have a brain scan such as an MRI or CT, especially if you have other symptoms like memory problems or weakness with your migraines. So, what can be done to treat migraines? Doctors use a few different types of medicines to prevent and treat migraines. You can take antidepressants, blood pressure medicines, or seizure medicines every day to prevent migraines from starting. Some people have great success preventing migraines using biofeedback devices or hypnosis. Once you do get a migraine, you can take medicines right away to stop it. Triptans such as Imitrex and Maxalt are the most commonly prescribed medicines for stopping a migraine. Depending on your migraine symptoms and how bad they are, your doctor may also recommend a pain reliever such as ibuprofen, or a nausea medicine. To prevent migraines, you also need to avoid your triggers, but first you need to identify what they are. Your doctor may recommend keeping a headache diary, in which you write down when your headaches occur and what you were eating or doing when you got a migraine. Take care of yourself when you have a migraine. If you only get them occasionally, there's probably no cause for worry. But if you get migraines often, and they're interfering with your life or they're getting worse, talk to your doctor about ways to prevent and treat them.

  • Cholesterol and triglyceride test - Animation

    Cholesterol and triglyceride test

    Animation

  • Cholesterol and triglyceride test - Animation

    Maybe you've been eating fast food more often than you should, or you're not getting your recommended two-and-a-half hours of exercise each week. Or, it could be that you smoke, or your blood pressure is too high. Well, for whatever reason, you may be concerned about your risk of getting heart disease. Well, a few tests can help you learn that risk, so you can start making healthy lifestyle changes to reduce it. A coronary risk profile is a group of blood tests that measure your cholesterol and triglyceride levels. Why is it important to know these levels? Because if you have too much of these substances in your blood from eating foods like burgers and French fries, they can clog your arteries. Eventually your arteries can become so clogged that you'll have a heart attack or stroke. Men should have their cholesterol tested by the time they're 35. Women should have it checked by age 45. If you have a condition like diabetes, heart disease, stroke, or high blood pressure, have your cholesterol checked now, no matter what your age. To measure your cholesterol, your doctor will give you a blood test. If you're also having your triglyceride level checked, you may be told not to eat or drink anything for 8 to 12 hours before the test. Depending upon your heart risk, the doctor may measure just your total cholesterol level, or your total cholesterol along with your LDL, or "bad" cholesterol, HDL, or "good" cholesterol, and triglycerides. If you're of average risk of getting heart disease, your goal is to have total cholesterol of less than 200 milligrams per deciliter, LDL cholesterol lower than 130 milligrams per deciliter, HDL cholesterol higher than 40 milligrams per deciliter if you're a man, or 50 if you're a woman -- the higher the better, and triglycerides of less than 150 also, the lower the better. Although some illnesses, like arthritis, can raise your cholesterol level, generally having high cholesterol means that you're at increased risk for heart disease and stroke. It's a sign you need to work harder to keep your heart healthy. If your cholesterol levels are normal, that's great! That means that you're eating right, you're exercising, and you're taking good care of your health. You don't need to have another cholesterol test for about five years. But if your cholesterol level is high, or you've already got heart disease, high blood pressure, or diabetes, you'll need to have your cholesterol levels checked more often. Keeping close tabs on your cholesterol and triglyceride levels is one way that you can take charge of your health, and change it for the better.

  • Kidney stones - Animation

    Kidney stones

    Animation

  • Kidney stones - Animation

    If you ever have severe pain in your belly or one side of your back that comes and goes suddenly, you may be passing a kidney stone. Let's talk about the painful condition of kidney stones. A kidney stone is a mass of tiny crystals in your kidney or urinary tract. Stones are quite common, and tend to run in families. They can form in weeks or months when your urine contains too much of certain substances. There are several kinds of kidney stones. Calcium stones are by far the most common kind. They often form in men between the ages of 20 to 30. Calcium can combine with other substances found in your food, like oxalate, phosphate, or carbonate, to form stones. Cystine stones can form in people who have cystinuria, a condition passed down through families in which stones are made from an amino acid called cystine. Struvite stones are found mostly in women who have urinary tract infections. These stones can grow very large and can block the kidney, ureter, or bladder. Uric acid stones are more common in men than in women. They can occur in people who have a history of gout or are going through chemotherapy. So, how do you know if you have kidney stones?Well, you may not have symptoms until the stone move down the ureter tubes through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of your kidneys. The main symptom is severe sharp pain that starts suddenly, usually in your belly or one side of your back, and it may go away just as quickly. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. So, what do you do about kidney stones?Well, your health care provider will perform a physical exam. You may need blood tests, kidney function tests, and tests that look for crystals in your urine. Several imaging tests, like a CT scan, can see stones or a blockage in your urinary tract. Treatment will depend on the type of stone you have, and how bad your symptoms are. Small kidney stones that are less than 5 mm in diameter will usually pass on their own. You should drink at least 6 to 8 glasses of water per day to produce a large enough amount of urine to help bring the stone out. Pain can be pretty bad when you pass a kidney stone, so your doctor may prescribe pain medicines to help as well as medications that will help the stone pass. Other medicines can decrease stone formation or help break down and remove the material that is causing you to make stones. You may need surgery if the stone is too large to pass, the stone is growing, or the stone is blocking your urine flow. Kidney stones are painful, but you can usually pass them without causing permanent harm. However, kidney stones often come back, so you and your doctor will need to work on finding the cause of your stone. Lastly, delaying treatment can lead to serious complications, so if you think that you have kidney stones see your doctor right away.

  • Depression and men

    Depression and men

    Depression is less reported in the male population, but this may be caused by male tendency to mask emotional disorders with behavior such as alcohol abuse.

    Depression and men

    illustration

  • Types of health care providers

    Types of health care providers

    Health care providers range from generalists to providers who specialize in certain areas of the body or disease. Any category of medicine or care such as cancer or anesthesia can have a specialist. Nurses also can specialize in certain areas of medical care.

    Types of health care providers

    illustration

  • Urine sample

    Urine sample

    A "clean-catch" urine sample is performed by collecting the sample of urine in midstream. Men or boys should wipe clean the head of the penis. Women or girls need to wash the area between the lips of the vagina with soapy water and rinse well. A small amount of urine should initially fall into the toilet bowl before it is collected (this clears the urethra of contaminants). Then, in a clean container, catch about 1 to 2 ounces of urine and remove the container from the urine stream. The container is then given to the health care provider.

    Urine sample

    illustration

  • Denture care

    Denture care

    Dentures are used when an individual is missing his natural teeth. It is just as important to take care of dentures as it is to take care of natural teeth, since problems such as gingivitis can still occur.

    Denture care

    illustration

  • Infant dental care

    Infant dental care

    Even though newborns and infants do not have teeth, care of the mouth and gums is important. Use a damp washcloth to wipe your infant's gums after each meal and do not put your infant or young child to bed with a bottle of milk, juice, or sugar water. As the child grows, establishing proper dental hygiene will promote healthy teeth and gums which are essential to overall good health. Poor dental development, dental disease, and dental trauma can result in poor nutrition, painful and dangerous infections, problems with speech development, and problems with self image.

    Infant dental care

    illustration

  • Diabetic foot care

    Diabetic foot care

    People with diabetes must take special care of their fingers and toes to be sure they are receiving adequate blood supply.

    Diabetic foot care

    illustration

  • Diabetic foot care

    Diabetic foot care

    People with diabetes are prone to foot problems because the disease can cause damage to the blood vessels and nerves, which may result in decreased ability to sense a trauma to the foot. The immune system is also altered, so that the person with diabetes cannot efficiently fight infection.

    Diabetic foot care

    illustration

  • Infant care following delivery

    Infant care following delivery

    An evaluation of the newborn's condition is done immediately after delivery and again at five minutes, to determine the APGAR scores. If some cyanosis (bluish skin) is present, the APGAR scores are lower and oxygen may be administered. The oxygen can often be merely blown by the newborn's face, through the mask in front of the infant.

    Infant care following delivery

    illustration

  • Osmolality urine - series

    Osmolality urine - series

    Presentation

Review Date: 7/26/2018

Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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