Si può desiderare di provare un trattamento naturale disfunzione erettile come un diverso per i problemi di costruzione. Al giorno d oggi ci sono diverse terapie sul mercato, ma un trattamento naturale disfunzione erettile è stato confermato qualche ora e ora di nuovo per dare risultati efficienti e permanenti. Cos è la disfunzione sessuale? L incapacità di sviluppare o sostenere una costruzione abbastanza lungo per fare l amore è chiamato disfunzione erettile, ED https://farmacia-senzaricetta.it/ o (maschio) problemi di erezione. Tutti gli uomini possono avere problemi di costruzione di volta in volta e gli scienziati considerano ED essere presenti se si verificano problemi di costruzione almeno il 25% del tempo. Alcuni fatti duri: ED Può essere dovuto a problemi emotivi. Stress, pressione, giltiness, depressione, bassa autostima e ansia prestazioni può essere la causa dei vostri problemi di costruzione. La ricerca ha confermato che il 90 per cento della disfunzione erettile è fisica in origine, non emotiva. L impotenza colpisce la maggior parte degli uomini durante la loro vita e può essere dovuto a troppo colesterolo, problemi cardiaci, diabete, ipertensione, fumo o alcol. Alcuni rimedi possono essere la ragione. Le questioni legate al movimento sono collegate. Se ti occupi dei tuoi problemi di movimento, hai piu possibilita di risolvere questo problema. Qui ci sono 5 consigli facili su come aumentare la circolazione: 1. Mangia i pasti giusti. Questo ti rendera il flusso sanguigno ovvio. Una grande parte di rimanere sani e anche mantenere il flusso sanguigno ovvio è legato al vostro piano di alimentazione quotidiana e quello che si mangia. Una buona cura per la disfunzione erettile è mangiare un piano a basso contenuto di grassi e grande alimentazione di fibre. Mangiare fibre tutti i giorni e questo viene scoperto in prodotti cerealicoli cereali integrali, frutta e verdura. Evitare il più possibile pasti pronti o pasti non sani. 2. Wonder herbal rimedi. Molti rimedi vegetali per ED eseguire bene come possono migliorare il movimento. Hanno molto meno reazioni avverse rispetto ai farmaci convenzionali e si svolgono in modo efficiente per migliorare hardons e la forza, troppo. Erbe naturali come Ginkgo Biloba sono utilizzati come una strategia per ED. Gli specialisti di erboristeria credono anche che le spezie o le erbe come noce moscata, portano al movimento intorno al corpo, tra cui il pene. 3. Vitamine naturali vitali. Gli scienziati sanitari hanno scoperto che una mancanza di supplemento è tipico tra gli uomini con ED in particolare vitamina A. Se si ha una mancanza del nutriente ossido di zinco, Questo è stato confermato per portare alla disfunzione erettile. Queste inadeguatezze derivano dal fatto che molti valori nutrizionali in quello che mangiamo piano non sono sufficienti. Aggiungere al vostro fabbisogno di nutrienti aumenterà la circolazione del sistema e migliorare questa condizione. Gli integratori alimentari sono completamente naturali, quindi non dovrete preoccuparvi dei rischi di reazioni avverse. Inoltre, queste vitamine naturali sono utili per il vostro benessere over-all. Oltre a questi vantaggi benessere, disfunzione erettile vitamine naturali e integratori costano molto meno di farmaci rimedi. 4. Esercitare. Fai una mossa e non un tablet vibrante. Camminare farà di più per migliorare e sostenere hardons di qualsiasi altra compressa chimica nel lungo periodo. Il fitness fisico manterrà bassi livelli di pressione e mantenere grandi stadi di movimento. Andando per un 20-30 minuti di movimento rapido ogni giorno, può affrontare questo problema e può sostenere la vostra libido senza l uso di qualsiasi farmaco. 5. Sottolineare. Questo è il peggior attaccante per problemi di erezione. Scopri diversi metodi per riposare. Alcuni metodi tipici per riposare includono la lettura di un libro, la meditazione, un bagno rilassante o allenamenti di respirazione. Sto solo imparando alcuni semplici allenamenti di respirazione che possono migliorare significativamente il movimento nel reparto pantaloni. Una naturale disfunzione erettile soluzioni di trattamento stanno diventando sempre più popolare con gli uomini. Questi rimedi a base di erbe sono preferiti perché non hanno reazioni avverse e sono confermati essere efficiente come il farmaco. La maggior parte degli uomini combattere parlano dei loro problemi, in particolare la disfunzione erettile come c è poca discussione sui problemi di erezione. La verita e che ED ha un impatto su piu di dieci milioni di uomini solo negli Stati Uniti. Non siete soli e l aiuto è disponibile.
Dbs.umt.edu
American Family Physician March 1, 1999 v59 i5 p1190(1) Congenital Adrenal Hyperplasia: Not Really a Zebra.
by Michael A. Deaton, John E. Glorioso and David B. Mclean
COPYRIGHT 1999 American Academy of Family
hyperplasia have 21- hydroxylase deficiency.2-4,6
Physicians
Because this enzyme functions in both glucocorticoid and mineralocorticoid synthesis, some patients with 21-
Congenital adrenal hyperplasia was once considered a
hydroxylase deficiency have insufficient amounts of
rare inherited disorder with severe manifestations. Mild
cortisone and aldosterone (Figure 2). These persons have
congenital adrenal hyperplasia, however, is common,
the "salt-wasting" form of congenital adrenal hyperplasia,
affecting one in 100 to 1,000 persons in the United States
with hyponatremia, hypovolemia, hyperkalemia and
and frequently eluding diagnosis. Both classic and
hypotension.1-4,6 The enzyme 21-hydroxylase is a
nonclassic forms of the disease are caused by deficiencies chromosome 6, human leukocyte antigen (HLA)Elinked, in the adrenal enzymes that are used to synthesize
cytochrome P450 enzyme that is found in the smooth
glucocorticoids. The net result is increased production
endoplasmic reticulum. Its DNA sequence can be altered
from the adrenal gland of cortisol precursors and
by at least nine mutations, many of which leave the
androgens. Even mild congenital adrenal hyperplasia can
enzyme impaired but not totally inactive.2,3,6 The
result in life-threatening sinus or pulmonary infections,
incidence of classic congenital adrenal hyperplasia is
orthostatic syncope, shortened stature and severe acne.
especially high in Madagascar and certain areas of Alaska.
Women with mild congenital adrenal hyperplasia often
Mild congenital adrenal hyperplasia occurs more
present with hirsutism, oligomenorrhea or infertility.
frequently in Ashkenazi Jews, and in Hispanic, Slavic and
Congenital adrenal hyperplasia is diagnosed by
demonstration of excess cortisol precursors in the serum during an adrenal corticotropic hormone challenge.
Diagnosis of congenital adrenal hyerplasia in fetuses that are at risk for congenital adrenal hyperplasia can be
Deficiency of 11-b hydroxylase is found in 8 to 9 percent of
determined using human leukocyte antigen haplotype or
patients with congenital adrenal hyperplasia.2,5
by demonstration of excess cortisol precursors in amniotic
Glucocorticoid synthesis remains impaired but, in this
fluid. Treatment includes carefully monitored hormone
disorder, deoxycortisol accumulates (Figure 3).
replacement therapy. Recognition of the problem and
Deoxycortisol and its metabolites have mineralocorticoid
timely replacement therapy can reduce morbidity and
properties and may cause hypertension when they
enhance quality of life in patients that are affected by
accumulate.2,3,7 Thus, simple blood pressure
measurements may help determine the underlying type of congenital adrenal hyperplasia. The enzyme 11-b
Classical congenital adrenal hyperplasia is rare, affecting
hydroxylase is a chromosome 8, cytochrome P450
only one in 14,000 patients, but mild forms of the disease
enzyme located in the mitochondria. Known gene
may occur in one of every 100 to 1,000 persons.1,2 The
abnormalities include insertions, deletions,
condition is caused by a deficient synthesis of cortisol;
mis-sense/nonsense codons, and point mutations. Some
most cases are related to 21-hydroxylase or 11-b
of these abnormalities result in severe dysfunction of the
hydroxylase deficiency3-5 (Figure 1). The affected enzyme enzyme while others result in only partial impairment.3-5 can be totally or partially impaired. The degree of enzyme
Classic 11-b hydroxylase deficiency occurs in
insufficiency determines the severity of the condition.2,5
approximately one per 100,000 births and occurs more frequently in Moroccan Jews. Mild congenital adrenal
The hallmark of congenital adrenal hyperplasia is
hyperplasia due to 11-b hydroxylase deficiency is more
inadequate production of glucocorticoids.1 Patients with
common, however, and may be responsible for 1 to 2
mild congenital adrenal hyperplasia are frequently unable
percent of cases of hirsutism and oligomenorrhea in
to mount sufficient stress responses to trauma and
infection. Glucocorticoid precursors accumulate in these persons and are converted to androgenic steroids, causing Manifestations and Recognitionshortened stature, early puberty, severe acne, and virilization and infertility in females.2,3,5,6
Mineralocorticoid synthesis can also be affected, resulting in electrolyte disturbances, hypotension and syncope.5,6
The classic form of congenital adrenal hyperplasia occurs when cortisol synthesis is extremely low. The disorder
Enzyme Pathways and Genetics 21-hydroxylase
usually manifests in childhood. Hypersecretion of adrenal androgens causes masculinization of the external genitalia
Ninety percent of patients with congenital adrenal
of the female fetus. Affected infants can have ambiguous
- Reprinted with permission. Additional copying is prohibited. - American Family Physician March 1, 1999 v59 i5 p1190(1) Congenital Adrenal Hyperplasia: Not Really a Zebra.
genitalia or even erroneous gender assignment. Because
acting and can be given in pulses that mimic natural
testicles are not present to produce mullerian inhibiting
cortisol secretion. Equivalent dosages of prednisone or
factor, the internal female organs are intact.1,2,4
dexamethasone can be used to simplify dosing regimens in noncompliant patients; however, hydrocortisone is more
Children with classic congenital adrenal hyperplasia may
physiologically similar to cortisol and has a lower potential
lack sufficient amounts of cortisol to mount a stress
for growth suppression in children.3,4 Periods of
response, and they frequently succumb to minor illnesses.
physiologic stress, such as severe illness or surgery,
Those who survive to adulthood experience premature
require transient dosages of three to 10 times that used for
puberty. Premature closure of the epiphyses results in
maintenance therapy.1,3,4,8 Stress dosages are usually
short stature even though these children grow at an
not needed in mild illnesses such as colds or otitis
accelerated rate when young. Severe acne is also a
frequent problem. Adult women with classic congenital adrenal hyperplasia may have pronounced hirsutism and
Corticosteroid replacement therapy must be approached
carefully. Hydrocortisone dosages that return 17-hydroxyprogesterone/11- deoxycortisol levels to normal
frequently induce Cushingoid features, whereas lower dosages may leave the effects of excess androgen
Mild congenital adrenal hyperplasia is much more common
production unchecked. Consultation with an
than the classic form.2,3,5,6 Men and women with mild
endocrinologist is recommended for patients who require
congenital adrenal hyperplasia may have normal height
compared with the general population, yet shortened stature when compared with their parents. Near-syncope
Many patients benefit from multidrug therapy. Even
may be a chronic or recurrent problem in these patients,
normotensive patients with 21-hydroxylase deficiency
and they frequently have a history of severe acne and mild
(Figure 2) may have improved adrenal suppression with
hyperpigmentation. Some people with mild congenital
the addition of the aldosterone analog fludrocortisone
adrenal hyperplasia can mount limited glucocorticoid
(Florinef) at dosages of 0.05 to 0.2 mg per day to their
stress responses and are thus never recognized as having
the disorder. Others, however, have frequent illnesses and decompensate when challenged by common infections or
The use of flutamide (Eulexin), an androgen inhibitor, in a
minor trauma.1-4,6 Women with congenital adrenal
dosage of approximately 10 mg per kg per day in three
hyperplasia may have clitorimegaly and poorly developed
divided doses, in patients with all types of congenital
vaginal labia. These women may also be hirsute and
adrenal hyperplasia may permit hydrocortisone to be given
frequently present with oligomenorrhea, infertility or
at lower dosages.8,9 Aromatase inhibitors that prevent
conversion of androgens to estrogen (such as testolactone [Teslac], in a dosage of 40 mg per kg per day), may help
children with mild congenital adrenal hyperplasia to achieve their height potential.1,8,9
When mild congenital adrenal hyperplasia is suspected, elevated serum levels of 17-hydroxyprogesterone suggest
If one child in a family is already affected by congenital
adrenal hyperplasia, the HLA haplotypes of the parents
deoxycorticosterone/ 11-deoxycortisol levels suggest 11-b
and the affected child should be determined. Subsequent
hydroxylase deficiency (Table 1; Figures 4 and 5). In
pregnancies can then be accurately evaluated for
patients who have few or no symptoms of mild congenital
congenital adrenal hyperplasia by HLA haplotype analysis
hyperplasia, the risks of treatment may outweigh the
of chorionic villus or amniotic cells.2,3 In families at risk
benefits. Patients who require treatment should be given
(e.g., one or both parents affected by some form of
glucocorticoid replacement therapy at the lowest dosage
congenital adrenal hyperplasia) but with no affected
that achieves adrenal suppression; higher dosages can
children, congenital adrenal hyperplasia can be diagnosed
cause Cushingoid features and growth retardation.
during pregnancy by DNA analysis of chorionic villus or amniotic fluid cells or by measuring 17-hydroxy steroids in
Maintenance therapy is generally achieved with
the amniotic fluid.10 All women with fetuses at risk for
hydrocortisone, in a dosage of 6 to 25 mg per m2 per day
congenital adrenal hyperplasia should receive
given in two to three divided doses.1,3,4,8 Hydrocortisone
dexamethasone in a dosage of 0.02 mg per kg per day,
is preferred over other glucocorticoids because it is short
divided into two or three daily doses. - Reprinted with permission. Additional copying is prohibited. - American Family Physician March 1, 1999 v59 i5 p1190(1) Congenital Adrenal Hyperplasia: Not Really a Zebra.
Treatment should be initiated immediately on confirmation
treatment of congenital adrenal hyperplasia. JAMA
of pregnancy.4,10 Dexamethasone readily crosses the
placenta and suppresses the fetal adrenal gland. If the fetus is male, dexamethasone therapy can be stopped
9. Laue L, Merke DP, Jones JV, Barnes KM, Hill S, Cutler
until after the infant is born. Affected female fetuses,
GB Jr. A preliminary study of flutamide, testolactone, and
however, require treatment throughout pregnancy.
reduced hydrocortisone dose in the treatment of congenital adrenal hyperplasia. J Clin Endocrinol Metab
Treatment of affected fetuses with maternal
dexamethasone reduces the incidence and severity of virilization of female fetuses. Birth weight, length, head
10. Karaviti LP, Mercado AB, Mercado MB, Speiser PW,
circumference and congenital anomalies of affected infants
Buegeleisen M, Crawford C, et al. Prenatal
whose mothers are treated with dexamethasone during
diagnosis/treatment in families at risk for infants with
pregnancy are comparable to those of infants who do not
steroid 21-hydroxylase deficiency (congenital adrenal
have congenital adrenal hyperplasia.10 Maternal
hyperplasia). J Steroid Biochem Mol Biol 1992;41:445-51.
complications from treatment with dexamethasone can be expected and include excess weight gain, mood swings
11. Seckl JR, Miller WL. How safe is long-term prenatal
glucocorticoid treatment? JAMA 1997;277:1077-9.
The authors thank Daniel Kopp, M.D., and Fred Pfalzgraf,
M.D., for their thoughtful reviews of the manuscript.
MICHAEL A. DEATON, M.D, PH.D., is currently Chief of
The opinions and assertions contained herein are the
Primary Care and Community Medicine at General
private views of the authors and are not to be construed as
Leonard Wood Army Community Hospital, Fort Leonard
official positions of the Department of Defense, the
Wood, Mo. He received a doctorate in anatomy from
Department of the Army or the Department of the Navy.
Vanderbilt University School of Medicine, Nashville, Tenn., and a medical degree from the Uniformed Services
University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, Md. Dr. Deaton completed
1. Cutler GB Jr, Laue L. Congenital adrenal hyperplasia
a residency in family practice at Tripler Medical Center,
due to 21- hydroxylase deficiency. N Engl J Med
JOHN E. GLORIOSO, M.D., is currently Chief of Family
2. New MI. Genetic disorders of adrenal hormone
Practice and Aviation Medicine at Yuma Proving Grounds,
synthesis. Horm Res 1992;37(suppl 3):22-33.
Yuma, Ariz. He graduated from the University of Maryland School of Medicine, Baltimore, and completed a residency
3. Miller WL. Congenital adrenal hyperplasias. Endocrinol
in family practice at Tripler Medical Center. He is a
graduate of the Army Aviation Medicine Course.
4. New MI. Congenital adrenal hyperplasia. In: DeGroot
DAVID B. MCLEAN, M.D., is currently a family physician
LJ, ed. Endocrinology. 3d ed. Philadelphia: Saunders,
on staff at Makalapa Clinic, Pearl Harbor, Hawaii. He
received a medical degree from Virginia Commonwealth University Medical College of Virginia School of Medicine,
5. White PC, Speiser PW. Steroid 11 beta-hydroxylase
Richmond, and completed a residency in family practice at
deficiency and related disorders. Endocrinol Metab Clin
Address correspondence to Michael A. Deaton, M.D.,
6. Migeon CJ, Donohoue PA. Congenital adrenal
Ph.D., Division of Primary Care and Community Medicine,
hyperplasia caused by 21- hydroxylase deficiency.
USA MEDDAC, General Leonard Wood Army Community
Endocrinol Metab Clin North Am 1991;20:277-96.
Hospital, 126 Missouri Ave., Fort Leonard Wood, MO 65473. Reprints are not available from the authors.
7. Baskin HJ. Screening for late-onset congenital adrenal hyperplasia in hirsutism or amenorrhea. Arch Intern Med 1987;147:847-8.
8. Merke DP, Cutler GB Jr. New approaches to the
- Reprinted with permission. Additional copying is prohibited. -
REPORTE DIARIO: Abril 14, 2009. MERCADO DE DEUDA SOBERANA ÍNDICES BURSÁTILES Cierre** Anterior Var. Abs. Índice Bursátil Caracas Anterior Var. Rel. Argentina Índices Internacionales Anterior Var. Rel. PETRÓLEO Colombia Anterior Var. Abs. Var. Rel. TASAS DE INTERÉS (%) Locales BCV Anterior Var. Abs. Venezuela Overn
Marginal annotations on the classification of plants found in Christoph Jakob Trew’s Plantae selectae (1750-1773) [Norimbergae] [Nuremberg]: s.n., 1750 (-1773). The annotations are found in copy 1 of this work. NB. Plates 101-120 form the Supplementum to Plantae Selectae (1790) Trew’s title Annotations in copy 1 Modern name if different Cedrus foliis rigidis acumina