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Treatments for Wegener's granulomatosis

Contents
  1. Wegener's granulomatosis: Introduction
  2. Treatment list for Wegener's granulomatosis
  3. Discussion of treatments for Wegener's granulomatosis
  4. Buy Products Related to Treatments for Wegener's granulomatosis
  5. Wegener's granulomatosis: Introduction

Treatments for Wegener's granulomatosis

The list of treatments mentioned in various sources for Wegener's granulomatosis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Wegener's granulomatosis: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Wegener's granulomatosis may include:

Wegener's granulomatosis: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Wegener's granulomatosis:

Wegener's granulomatosis: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Wegener's granulomatosis:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Wegener's granulomatosis include:

Hospitals & Medical Clinics: Wegener's granulomatosis

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Wegener's granulomatosis:

Hospital & Clinic quality ratings » »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Wegener's granulomatosis, on hospital and medical facility performance and surgical care quality:

Discussion of treatments for Wegener's granulomatosis:

In most cases, standard therapy consists of a combination of a glucocorticoid drug that reduces inflammation and a cytotoxic drug that interferes with the abnormal growth of cells.

Prednisone is the most common glucocorticoid drug (a steroid) that is used. Prednisone is similar to hydrocortisone, the natural glucocorticoid hormone produced by the body. It is chemically different from the anabolic steroids that have been used by athletes and is given in doses much higher than the body normally produces. Prednisone is usually administered as a single morning dose in an attempt to imitate how the body normally secretes hydrocortisone. When the person’s illness improves, the prednisone dose is gradually decreased and converted to an every other day dosing schedule, usually over a period of 3 to 4 months. With further improvement in the disease, the prednisone is very gradually decreased and discontinued completely after approximately 6 to 12 months. When prednisone is taken by mouth, the body stops making its own natural hydrocortisone. As the prednisone dose is gradually reduced the body will resume making hydrocortisone again. It is extremely important that prednisone never be stopped suddenly because the body requires prednisone (or hydrocortisone) for its function and may not be able to immediately make what it needs.

Cyclophosphamide (CytoxanÔ) is the most commonly used cytotoxic drug. Cyclophosphamide is taken once a day by mouth. It is important for a patient to take the drug all at once in the morning followed by drinking a large amount of fluid. Although the initial dose of cyclophosphamide is based on the patient’s weight and kidney function, the doctor may adjust the dosage based on the blood counts, which are monitored closely to be sure that the white blood cell count is maintained at a safe level. Cyclophosphamide is continued for a full year beyond that point at which the disease has become quiet (is in remission). The dose of cyclophosphamide is then decreased gradually and eventually discontinued.

Cyclophosphamide and prednisone are both powerful drugs that suppress the immune system. Although these medications are beneficial in treating Wegener’s granulomatosis, patients and their doctors should be aware that the drugs potentially have serious side effects. Careful monitoring by the doctor is very important. Because these drugs suppress the immune system, they can affect the body’s ability to fight off infection. Patients should report immediately any symptoms of infection and, specifically, any fever to their doctors. Prednisone can cause weight gain, cataracts, brittle bones, diabetes, and alterations in mood and personality. Cyclophosphamide can cause bone marrow suppression (lowering of blood counts), sterility, hemorrhagic cystitis (bleeding from the bladder) as well as other serious side effects.

Approximately half of people with Wegener’s granulomatosis may experience a return (relapse) of their disease. This occurs most frequently within two years of stopping medication, but potentially can occur at any point both during treatment or after stopping treatment. Thus, it is extremely important that patients continue to see their physicians regularly, both while they are on these medications, as well as after the medications have been stopped. Even while on medication, many patients are able to lead relatively normal lives and will remain in remission after therapy has been stopped completely.

Research

Since the 1970s, research physicians at the National Institute of Allergy and Infectious Diseases (NIAID), a component of NIH, have been interested in Wegener’s granulomatosis. NIAID scientists first introduced the combination of a glucocorticoid with cyclophosphamide for treating people with this disease. This dramatic breakthrough remains the standard of treatment. Despite this, researchers realize that these medicines have serious side effects and cannot be tolerated by all people. Therefore, NIH researchers continue to study Wegener’s granulomatosis to understand the causes of the disease and to develop new treatments. NIAID is conducting several studies to investigate new treatment regimens. These studies each have individual entry criteria but are open to patients who have a definitive diagnosis of Wegener’s granulomatosis and who have active disease.

Further Information

For information about enrolling in an NIAID clinical study at NIH's facility in Bethesda, Maryland, the patient's personal physician should call or write to:

Dr. Michael C. Sneller
Head, Immunologic Diseases Section
or
Dr. Carol A. Langford
Immunologic Diseases Section
Laboratory of Immunoregulation
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Building 10, Room 11B-13, MSC 1876
10 Center Drive
Bethesda, MD 20892-1876
301/496-1124

For more information on patient support groups, contact:

Wegener's Foundation, Inc.
Attention: Ms. Linda Baltrusch
3705 South George Mason Drive
Suite 1813 South
Falls Church, VA 22041
703/931-5852

Wegener's Granolomatosis Support Group, Inc. (International)
P.O. Box 28660
Kansas City, MO 64188-8660
800/277-WGSG (9474)
http://www.wgsg.org/

(Source: excerpt from Wegener's Granulomatosis, NIAID Fact Sheet: NIAID)

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Book Excerpts: Treatment of Wegener's granulomatosis

Treatments of Wegener's granulomatosis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Wegener's granulomatosis.

Hematuria: Treatment
(In a Page: Signs and Symptoms)

  • Older patients with transient hematuria should always be evaluated due to increased risk of urinary tract cancers; refer to urologist for further evaluation and treatment
  • UTI: Start appropriate antibiotics and follow up with urinalysis to see if hematuria resolves
  • Glomerular sources (RBC casts, protein excretion >500 mg/dL, dysmorphic RBCs): Follow BUN/creatinine, blood pressure, creatinine clearance, and 24-hour urine protein, and refer for biopsy if worsening
  • Nonglomerular source (no RBC casts or dysmorphic RBCs in the urine): Urologic consult if imaging indicates a lesion (renal, bladder, or urethral)
  • Stones: Increase hydration, analgesics, urology referral for large or persistent stones
  • Myoglobinuria/hemoglobinuria: Treat underlying cause
  • Beeturia: Evaluate for iron deficiency or achlorhydria due to pernicious anemia, as treating these disorders may eliminate beeturia; eating foods high in oxalate (spinach, oysters) with beets can also cause beeturia

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hematuria: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • UTI: Empiric antibiotic (e.g., co-trimoxazole)
  • Manage hypertension
    –ACE inhibitors or calcium channel blockers
    –Consider diuretics if edematous
    • Suspected acute glomerulonephritis
      –Low C3, evidence of recent strep or other infection
      –Monitor urine output, weight, BP closely
      –Daily outpatient visits until stable
      –Inpatient admission if oliguria/edema is severe
      –Once acute phase is over, monitor every 1–2 weeks and recheck C3 in 6–8 weeks
  • Nephrolithiasis: Increase fluid intake
    –Sodium-restrict (do not calcium-restrict)
    –Consult urology for severe pain or obstruction
  • Consult nephrology if hematuria persists or is associated with proteinuria, hypertension, persistently decreased C3, or abnormal creatinine

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Acute pyelonephritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment centers on antibiotic therapy appropriate to the specific infecting organism after identification by urine culture and sensitivity studies. When the infecting organism can’t be identified, therapy usually consists of a broad-spectrum antibiotic. Urinary analgesics are also appropriate.

Alert If the patient is pregnant, antibiotics must be prescribed cautiously.

Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 10 to 14 days. Follow-up treatment may include reculturing urine 1 week after drug therapy stops, then periodically for the next year to detect residual or recurring infection. Most patients with uncomplicated infections respond well to therapy and don’t suffer reinfection.

In infection from obstruction or vesicoureteral reflux, antibiotics may be less effective; treatment may then necessitate surgery to relieve the obstruction or correct the anomaly. Patients at high risk of recurring urinary tract and kidney infections, such as those with prolonged use of an indwelling catheter or maintenance antibiotic therapy, require long-term follow-up. Recurrent episodes of acute pyelonephritis can eventually result in chronic pyelonephritis. (See Chronic pyelonephritis.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Nephrotic syndrome: Treatment
(Professional Guide to Diseases (Eighth Edition))

The goals of treatment of nephrotic syndrome are to relieve symptoms, prevent complications, and delay progressive kidney damage. Treatment of the causative disorder — possibly lifelong — is necessary to control nephrotic syndrome. Corticosteroid, immunosuppressive, antihypertensive, and diuretic medications may help control symptoms. Antibiotics may be needed to control infections. Angiotensin-converting enzyme inhibitors may significantly reduce the degree of protein loss in urine and are therefore typically prescribed for the treatment of nephrotic syndrome.

Treatment of hypertension and of high cholesterol and triglyceride levels are also recommended to reduce the risk of atherosclerosis and complications. Dietary limitation of cholesterol and saturated fats may be of little benefit because the high levels that accompany this condition seem to result from overproduction by the liver rather than from excessive fat intake. High-protein diets are of debatable value. In many patients, reducing the amount of protein in the diet produces a decrease in urine protein. In most cases, a moderate-protein diet (1 g/kg of body weight per day) is usually recommended. Sodium may be restricted to help control edema. Vitamin D may need to be replaced if nephrotic syndrome is chronic and unresponsive to therapy. Blood thinners may be required to treat or prevent clot formation.

Supportive treatment consists of protein replacement with infusion of salt-poor albumin or with a nutritional diet of 1.5 g protein/kg of body weight, with restricted sodium intake of 0.5 to 1 g/day; diuretics for edema; and antibiotics for infection.

Some patients respond to an 8-week course of corticosteroid therapy (such as prednisone), followed by a maintenance dose. Others respond better to a combination course of prednisone and azathioprine or cyclophosphamide.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Acute respiratory failure in COPD: Treatment
(Professional Guide to Diseases (Eighth Edition))

ARF in patients with COPD is an emergency that requires cautious O2 therapy (using nasal prongs or Venturi mask) to raise the PaO2. In patients with chronic hypercapnia, O2 therapy can cause hypoventilation by increasing Paco2 and decreasing the respiratory drive, necessitating mechanical ventilation. The minimum fraction of inspired air (FIO2) required to maintain ventilation or O2 saturation greater than 85% to 90% should be used. If significant uncompensated respiratory acidosis or unrefractory hypoxemia exists, mechanical ventilation (through an endotracheal [ET] or a tracheostomy tube) or noninvasive ventilation (with a face or nose mask) may be necessary. Treatment routinely includes antibiotics for infection, bronchodilators, and possibly steroids.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Infant respiratory distress syndrome: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment of an infant with IRDS requires vigorous respiratory support. Warm, humidified, oxygen-enriched gases are administered by oxygen hood or, if such treatment fails, by mechanical ventilation. Severe cases may require mechanical ventilation with PEEPor continuous positive airway pressure (CPAP), administered by nasal prongs or, when necessary, endotracheal (ET) intubation. Special ventilation techniques are now used on the patients refractory to conventional mechanical ventilation. These include high-frequency jet ventilation and high-frequency oscillatory ventilation. Extracorporeal membrane oxygenation is the last choice for ventilation and is only available in certain specialized facilities. Treatment of IRDS also includes:

❑ a radiant warmer or isolette for thermoregulation

❑ I.V. fluids and sodium bicarbonate to control acidosis and maintain fluid and electrolyte balance

❑ tube feedings or total parenteral nutrition if the neonate is too weak to eat

❑ administration of surfactant by an ET tube (Studies show that this treatment can prevent or improve the course of IRDS as well as reduce mortality.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Acute poststreptococcal glomerulonephritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

The goals of treatment are relief of symptoms and prevention of complications. Vigorous supportive care includes bed rest, fluid and dietary sodium restrictions, and correction of electrolyte imbalances (possibly with dialysis, although this is rarely necessary). Therapy may include diuretics to reduce extracellular fluid overload and an antihypertensive. The use of antibiotics is recommended for 7 to 10 days if staphylococcal infection is documented. Otherwise, antibiotic use is controversial.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Acute respiratory distress syndrome: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Treatment of underlying disorder, supportive care (oxygen, mechanical ventilation with positive end-expiratory pressure, diuretics), correction of acid-base and electrolyte abnormalities, chemical paralysis if necessary

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Acute respiratory failure: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Oxygen therapy, antibiotics, supportive care (bed rest, nutritional therapy, fluid replacement)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Respiratory alkalosis: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Treatment of underlying cause, mechanical ventilation to produce hyperventilation

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Respiratory syncytial virus infection: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment aims to support respiratory function, maintain fluid balance, and relieve symptoms. Ribavirin in aerosol form may be administered to severely ill patients or those at high risk for complications.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Chronic glomerulonephritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment is essentially nonspecific and symptomatic, with its goals to control hypertension with antihypertensives and a sodium-restricted diet, to correct fluid and electrolyte imbalances through restrictions and replacement, to reduce edema with diuretics such as furosemide, and to prevent heart failure. Treatment may also include antibiotics (for symptomatic urinary tract infections [UTIs]), dialysis, or transplantation.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Severe acute respiratory syndrome: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment is symptomatic and supportive and includes maintenance of a patent airway and adequate nutrition. Other treatment measures include supplemental oxygen, chest physiotherapy, or mechanical ventilation. In addition to standard precautions, contact precautions requiring gowns and gloves for all patient contacts and airborne precautions utilizing a negative-pressure isolation room and properly fitted N-95 respirators are recommended for patients who are hospitalized. Quarantine may be used to prevent the spread of infection.

Antibiotics may be given to treat bacterial causes of atypical pneumonia. Antiviral medications have also been used. High doses of corticosteroids have been used to reduce lung inflammation. In some serious cases, serum from individuals who have already recovered from SARS (convalescent serum) has been given. The general benefit of these treatments hasn’t been determined conclusively.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Respiratory acidosis: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Mechanical ventilation, bronchodilators, corticosteroids, or antibiotics to treat underlying source of hypoventilation

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Hematuria: Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))

Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Nephrotic syndrome: Treatment
(Handbook of Diseases)

Effective treatment of nephrotic syndrome necessitates correction of the underlying cause, if possible. Supportive treatment consists of protein replacement with a nutritional diet of 1 g protein/kg of body weight, with restricted sodium intake; a diuretic for edema; and an antibiotic for infection. Immunosuppressants, antihypertensives, and diuretics can also help control symptoms. Angiotension-converting enzyme inhibitors can decrease protein loss in urine.

Some patients respond to a course of corticosteroid therapy (such as prednisone), followed by a maintenance dose. Patients with chronic nephrotic syndrome that’s unresponsive to therapy may require vitamin D replacement.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Acute respiratory failure in COPD: Treatment
(Handbook of Diseases)

In a COPD patient, ARF is an emergency that requires cautious oxygen therapy (using nasal prongs or a Venturi mask) to raise the patient’s Pao2. If significant respiratory acidosis persists, a bidirectional positive-pressure airway mask over the oronasal region or mechanical ventilation through an endotracheal or a tracheostomy tube may be necessary. High-frequency ventilation may be used if the patient doesn’t respond to conventional mechanical ventilation. Treatment routinely includes an antibiotic for infection, a bronchodilator, an anxiolytic and, possibly, a steroid.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Respiratory alkalosis: Treatment
(Handbook of Diseases)

The goal of treatment is to eradicate the underlying condition — for example, to remove ingested toxins or to treat fever, sepsis, or CNS disease.

CLINICAL TIP: With severe respiratory alkalosis, the patient may be instructed to breathe into a paper bag, which helps relieve acute anxiety and increases carbon dioxide levels.

Prevention of hyperventilation in patients receiving mechanical ventilation requires that ABG values be monitored and dead space or minute ventilation volume be adjusted.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Respiratory distress syndrome: Treatment
(Handbook of Diseases)

An infant with respiratory distress syndrome requires vigorous respiratory support. Warm, humidified, oxygen-enriched gases are administered by oxygen hood or, if such treatment fails, by mechanical ventilation. Severe cases may require mechanical ventilation with PEEP or continuous positive airway pressure (CPAP), administered by a tightly fitting face mask or, when necessary, endotracheal (ET) intubation.

Treatment also includes:

❑ a radiant infant warmer or Isolette for thermoregulation

❑ I.V. fluids and sodium bicarbonate to control acidosis and maintain fluid and electrolyte balance

❑ tube feedings or total parenteral nutrition if the neonate is too weak to eat

❑ administration of surfactant by an ET tube.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Respiratory syncytial virus infection: Treatment
(Handbook of Diseases)

Among the goals of treatment are support of respiratory function, maintenance of fluid balance, and relief of symptoms. Mild cases resolve without treatment. Severe infections require hospitalization to provide supplemental oxygen, humidified air, and hydration by I.V. fluids. Respiratory support using mechanical ventilation may be needed. Ribavirin aerosol may be used in those who have severe RSV or are immunocompromised.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Pyelonephritis, acute: Treatment
(Handbook of Diseases)

Effective treatment centers on antibiotic therapy appropriate to the specific infecting organism after identification by urine culture and sensitivity studies.

Antibiotic therapy

I.V. antibiotics are used initially to control bacterial infection. Chronic pyelonephritis may require long-term antibiotic therapy. Commonly used antibiotics include sulfa drugs, amoxicillin, cephalosporins, levofloxacin, and ciprofloxacin. If the patient is pregnant, antibiotics must be prescribed cautiously. Urinary analgesics such as phenazopyridine are also appropriate.

Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 10 to 14 days.

Follow-up treatment

Follow-up treatment includes reculturing urine after drug therapy stops. Most patients with uncomplicated infections respond well to therapy and don’t suffer reinfection.

CLINICAL TIP: In infection from obstruction or vesicoureteral reflux, antibiotics may be less effective; treatment may then necessitate surgery to relieve the obstruction or correct the anomaly. Patients at high risk for recurring urinary tract and kidney infections — such as those with prolonged use of an indwelling urinary catheter or maintenance antibiotic therapy — require long-term follow-up.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Respiratory acidosis: Treatment
(Handbook of Diseases)

Effective treatment of respiratory acidosis is designed to correct the underlying source of alveolar hypoventilation. Significantly reduced alveolar ventilation may require mechanical ventilation until the underlying condition can be treated.

In patients with COPD, treatment includes a bronchodilator, oxygen, a corticosteroid and, commonly, an antibiotic; drug therapy for conditions such as myasthenia gravis; removal of foreign bodies from the airway; an antibiotic for pneumonia; dialysis or charcoal to remove toxic drugs; and correction of metabolic alkalosis. An elevated Paco2 may persist in a patient with COPD despite optimal treatment.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Hematuria: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination. Encourage the patient to drink plenty of fluids, unless contraindicated.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Hematuria: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Check vital signs frequently.

▪ Monitor intake and output, including the amount and pattern of hematuria.

▪ If the patient has an indwelling urinary catheter in place, ensure its patency and irrigate it if necessary to remove clots and tissue that may impede urine drainage.

▪ Administer prescribed analgesics, and enforce bed rest as indicated.

▪ Prepare the patient for diagnostic tests, such as blood and urine studies, cystoscopy, and renal X-rays or biopsy.

▪ Monitor hemoglobin level and hematocrit; administer blood products as ordered.

Patient teaching

▪ Show the patient how to collect urine specimens.

▪ Emphasize the need to increase fluid intake.

▪ Explain the underlying cause of hematuria and its treatment.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007



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