1. Brain Tumors
3. Glial Tumors
2. Immunophenotypic Characterization of Infiltrating Poly- and Mononuclear Cells in Childhood Brain Tumors
2. The Significance of Immunohistochemistry
3. Original Immunohistochemical Observations
4. Intermediate filaments (IFs)
5. Expression of Homeobox B3, B4, and C6 Gene Products
6. Cell proliferation
7. Epidermal growth factor (EGF) and its receptor (EGFR)
8. p53, the guardian of the integrity of the genome
9. Apoptosis in Brain Tumors
11. Tumor-related Neoangiogenesis in Childhood Brain Tumors
12. Presence of Matrix Metalloproteinases (MMPs)
13. The MAGE gene family
II. ANTI-NEOPLASTIC BIOLOGICAL THERAPIES
3. Experimental Therapies in Brain Tumors
4. Biologic Anti-Neoplastic Therapies
2. Active nonspecific immunomodulation of natural immunity
3. Thymic hormones
4. Interferons: basic and preclinical studies
5. Tumor Necrosis Factors
6. The discovery of interleukin-2: basic principles
5. The lymphokine activated killer (LAK) cell phenomenon
1. Administration of rIL-2 and LAK cells: preclinical trials
6. Angiogenesis Inhibition in Anti-Neoplastic Therapy
7. Antigen Presentation by Dendritic Cells and Their Significance in Anti-Neoplastic Immunotherapy
1. Active antigen specific immunotherapy (tumor vaccines)
2. Antigen Presentation within Childhood Brain Tumors
3. Immunosuppression within the Cellular Microenvironment of Childhood Brain Tumors
4. The Dendritic Cell Network
5. Antigen Presentation by DCs
6. The Significance of DCs in Anti-Neoplastic Immunotherapy
8. Genetically Engineered Antibodies for Direct Anti-Neoplastic Treatment and Systematic Delivery of Various Therapeutic Agents to Cancer Cells
2. Human Cancer Cell Related Antigens
3. Oncogenes and Growth Factors in Neoplastic Cells
4. Antibodies and Neoplastic Cells
5. Anti-neoplastic Immunotherapeutical Regiments Influenced by Immunohistochemistry
6. Human Antibodies
7. Anti-Idiotypic Antibodies
8. Bispecific Antibodies
9. Radiolabeled Antibodies
10. Construction of Immunotoxins
11. Monoclonal Antibodies: Carriers of Drugs, Toxins and Cytotoxic Cells
12. Clinical Trials with Monoclonal Antibodies and their Minimal Toxicity
9. Cancer-Testis Antigens: Promising Targets for Antigen Directed Anti-neoplastic Immunotherapy
2. Cancer/Testis Antigens
3. Detection of Cancer/Testis Antigens in Various Malignant Neoplasms and their Therapeutic Significance
10. Materials and Methods
1. Tissues and Tissue Handling
2. Libraries of Antibodies
3. Antigen Retrieval Technique
4. Immunoalkaline Phosphatase Antigen Detection Technique
5. Immunoperoxidase Antigen Detection Technique
6. Controls in Immunocytochemistry
7. Evaluation of the Immunoreactivity (immunostaining)
8. Tissue Processing for Tissue Culture Experiments
9. Preparation of Thymic, Peripheral Blood and Bone Marrow Cell Suspensions
10. Isolation of Cortical Thymocytes
11. Isolation of Thymic Nurse Cells (TNCs)
12. Thymic Stromal Cell (RE & DC) Cultures
13. Proliferation Assay (PA) for Thymocytes and Peripheral Blood Hematopoietic Cells
14. Transmission Electronmicroscopy (TEM) of Cultured Thymic Medullary Cells (RE, DC, including LC, & IDC) and Macrophages
15. Scanning Electronmicroscopic (SEM) Procedure for Tissue Samples
Just two months before the September 11 terrorist attacks, Dr. Judy Melinek began her training as a New York City forensic pathologist. While her husband and their toddler held down the home front, Judy threw herself into the fascinating world of death investigation—performing autopsies, investigating death scenes, counseling grieving relatives. Working Stiff chronicles Judy’s two years of training, taking readers behind the police tape of some of the most harrowing deaths in the Big Apple, including a firsthand account of the events of September 11, the subsequent anthrax bio-terrorism attack, and the disastrous crash of American Airlines Flight 587.
An unvarnished portrait of the daily life of medical examiners—complete with grisly anecdotes, chilling crime scenes, and a welcome dose of gallows humor—Working Stiff offers a glimpse into the daily life of one of America’s most arduous professions, and the unexpected challenges of shuttling between the domains of the living and the dead. The body never lies—and through the murders, accidents, and suicides that land on her table, Dr. Melinek lays bare the truth behind the glamorized depictions of autopsy work on television to reveal the secret story of the real morgue. “Haunting and illuminating...the stories from her average workdays…transfix the reader with their demonstration that medical science can diagnose and console long after the heartbeat stops” (The New York Times).
Presents information in a concise, at-a-glance format.
Fits into your pocket, for a convenient reference any time.
Offers abundant page references to the parent text, making additional information easy to find.Completely updated to reflect the latest knowledge and techniques across all areas of pathology.
The AJCC Cancer Staging Atlas, 2nd Edition, is an official publication of the American Joint Committee on Cancer, the recognized international leader in state-of-the-art information on cancer staging. This Atlas has been created as a companion to the updated 7th Edition of the AJCC Cancer Staging Manual, which continues to disseminate the importance of anatomical and pathological staging in the management of cancer. This state-of-the-art, invaluable 2nd Edition includes a CD containing PowerPoint slides of all illustrations, additional color, and a user-friendly, easy-to-read layout. The AJCC Cancer Staging Atlas, 2nd Edition will serve as an indispensable reference for clinicians, registrars, students, trainees, and patients.
Lange Pathology Flash Cards, Third EditionComplete coverage of all major topics covered in medical school pathology courses Each disease-specific card features a clinical vignette and details of the disorder, including: Etiology and epidemiology Pathologic or histologic findings Classic clinical presentations Current medical treatments Perfect for disease comparisons
Designed to complement Robbins and Cotran Pathologic Basis of Disease, 8th Edition and Robbins Basic Pathology, 8th Edition, this full-color atlas offers more than 1,500 outstanding full-color illustrations that vividly depict the diseases you need to know for pathology courses and USMLE exams. A quick visual reference or review of material for students and professionals alike.Includes gross, microscopic, and radiologic images correlated with examples of normal organs and tissues for comparison.Extensive legends summarize the key information you need to know.Correlates pathology with clinical history, physical exam findings, and clinical laboratory tests.A perfect study complement to Robbins and Cotran Review of Pathology. Includes many new and improved images.
Visually grasp and retain difficult concepts easilythanks to a user-friendly color-coded format, key concept boxes, explanatory diagrams, and over 190 photos to help you visualize tissues and diseases.
Put concepts into practice. "Critical Thinking Boxes" and 25 online cases encourage you to "think immunologically" while anchoring your understanding of immunology through clinical application.
Gauge your mastery of the materialand build confidence with high-yield style chapter-opening summaries and case-based and USMLE-style questions that provide effective chapter review and quick practice for your exams.
Access the full contents online at www.studentconsult.comwhere you'll find the complete text and illustrations, USMLE-style questions, clinical cases, and much more! Get the depth of coverage you need in a smaller, more manageably sized book. Through meticulous editing and reorganization, primary material remains in the book while more specialized and clinical material has been moved online.
Master the most cutting-edge concepts in immunology.Thorough updates throughout provide the timely knowledge you need ace your exams.
Thoroughly revised and up-dated edition of the standard reference work in histotechnology that successfully integrates both theory and practice.Provides a single comprehensive resource on the tried and tested investigative techniques as well as coverage of the latest technical developments.
Over 30 international expert contributors all of whom are involved in teaching, research and practice.Provides authoritative guidance on principles and practice of fixation and staining.
Extensive use of summary tables, charts and boxes.Information is well set out and easy to retrieve.
Six useful appendices included (SI units, solution preparation, specimen mounting, solubility). Provides practical information on measurements, preparation solutions that are used in daily laboratory practice.
Color photomicrographs used extensively throughout. Better replicates the actual appearance of the specimen under the microscope.
Brand new co-editors.
New material on immunohistochemical and molecular diagnostic techniques.Enables user to keep abreast of latest advances in the field.
Forensic Science Under Siege is the first book to integrate and explain these problematic trends in forensic science. The issues are timely, and are approached from an investigatory, yet scholarly and research-driven, perspective. Leading experts are consulted and interviewed, including directors of highly visible forensic laboratories, as well as medical examiners and coroners who are commandeering the discussions related to these issues. Interviewees include Henry Lee, Richard Saferstein, Cyril Wecht, and many others.
The ultimate consequences of all these pressures, as well as the future of forensic science, has yet to be determined. This book examines these challenges, while also exploring possible solutions (such as the formation of a forensic science consortium to address specific legislative issues). It is a must-read for all forensic scientists.Provides insight on the current state of forensic science, demands, and future direction as provided by leading experts in the fieldConsolidates the current state of standards and best-practices of labs across disciplinesDiscusses a controversial topic that must be addressed for political support and financial funding of forensic science to improve
This third edition is thoroughly revised and expanded with new chapters in different fields. Topics covered address automotive, aviation, military and other environments. Field data collection; injury coding/scaling; injury epidemiology; mechanisms of injury; human tolerance to injury; simulations using experimental, complex computational models (finite element modeling) and statistical processes; anthropomorphic test device design, development and validation for crashworthiness applications in topics cited above; and current regulations are covered. Risk functions and injury criteria for various body regions are included. Adult and pediatric populations are addressed. The exhaustive list of references in many areas along with the latest developments is valuable to all those involved or intend to pursue this important topic on human injury biomechanics and prevention.
The expanded edition will interest a variety of scholars and professionals including physicians, biomedical researchers in many disciplines, basic scientists, attorneys and jurists involved in accidental injury cases and governmental bodies. It is hoped that this book will foster multidisciplinary collaborations by medical and engineering researchers and academicians and practicing physicians for injury assessment and prevention and stimulate more applied research, education and training in the field of accidental-injury causation and prevention.
This much praised and widely used reference manual on has been extensively revised and expanded to cover the entire field of anatomic pathology. The Third Edition features the incorporation of full-color images in the text with updates of new diagnostic and prognostic information. New classifications and numerous new entities and histologic variants are fully explored. Useful immunostaining biomarkers and emerging molecular targets and relevant molecular findings that have emerged from recent genomic studies are incorporated in each chapter.
Written by internationally recognized authorities, the comprehensive, evidence-based practice information is presented in an outline format that is clear and easy to follow. Up-to-date and richly detailed, Essentials of Anatomic Pathology, Third Edition offers both the pathologist-in-training and the practicing pathologist a concise summary of all the critical information needed to recognize, understand and interpret anatomic pathology.
Grasp the connections between basic science and clinical medicine with clinicopathologic correlations throughout. Learn core concepts quickly and efficiently with a highly templated design that highlights pathogenesis and morphology.
Artwork revised and updated for a more modern look and more three-dimensional feel
Targeted Therapy boxes provides clinical information on appropriate therapy related to the disease under discussion
All photomicrographs and gross photos reviewed and improved to ensure excellent quality
You'll never find an easier, more efficient, and more focused way to ace pathology and pathology-related questions on the USMLE and course examinations than USMLE Road Map. Designed to provide maximum learning in minimum time this unique review offers a concise, creative, and well-illustrated new approach to mastering pathology.
FeaturesUSMLE Shortcuts for effective USMLE preparation Outline Format with a two-color presentation guides you through the most important areas in pathology Hi-Yield Facts promote comprehension and recall Over 90 Images , including photomicrographs and clinical pictures Rapid Review Glossary defines common terms, diseases, signs, syndromes, and bodies Learning tips and tricks garnered from years of interaction with students just like you Clear explanations from instructors with the experience to know the questions you would ask
Dail and Hammar’s Pulmonary Pathology has set the standard for which all other pathology texts strive to achieve. From stellar reviews of the Second Edition:
"When the first edition of Pulmonary Pathology by David H. Dail and Samuel P. Hammar was published in 1988, it was clear that it was to become the reference book for pulmonary pathology. It was difficult to conceive then that a better book on the subject could be assembled. The second edition of this encyclopedic work proved convincingly that improvement could occur. Indeed, the new revised edition is more complete and better illustrated...I consider this book to be an outstanding contribution to the pathology literature and a must in the library of surgical and pulmonary pathologists." -- Human Pathology
Written by internationally recognized authorities, the comprehensive, evidence-based practice information is presented in an outline format that is clear and easy to follow. Up-to-date and richly detailed, Essentials of Anatomic Pathology, Fourth Edition offers both the pathologist-in-training and the practicing pathologist a concise summary of all the critical information needed to recognize, understand and interpret anatomic pathology.
• Features more than 150 tables that examine the interpretation of histochemical stains, immunohistochemical studies, electron microscopy findings, cytogenetic changes, and much more.
• Presents a user-friendly design, concise paragraphs, numbered lists, and bulleted material throughout the text that makes information easy to find.
• Offers detailed instructions on the dissection, description, and sampling of specimens.
• Includes useful guidance on operating room consultations, safety, microscope use, and error prevention.
• Explains the application of pathology reports to patient management.
• Discusses how to avoid frequent errors and pitfalls in pathology specimen processing.
• Includes all updates from the last three revisions of the Brigham & Women's Hospital in-house handbook, ensuring you have the best knowledge available.
• Features new and updated tables in special studies sections, particularly immunohistochemistry with an increased number of antibodies covered, keeping you absolutely up to date.
• Provides new tables that cover the histologic appearance of viruses and fungi and a table covering the optical properties of commonly seen noncellular material for easy reference.
• Incorporates the TNM classification systems from the new 7th edition AJCC manual, including additional guidelines for the assessment of critical pathologic features.
• Presents four new full size illustrations by Dr. Christopher French and Mr. Shogun G. Curtis, as well as 39 illustrations for the new tables on viruses, fungi, and noncellular material to aid in their recognition.
Taking a unique multi-disciplinary approach, the book covers conventional histopathology and cytopathology, as well as all important complementary diagnostic tests, such as immunophenotyping (immunohistochemical stains and flow cytometry), karyotyping, FISH and DNA/molecular studies. It offers concise textual and extensive visual coverage of both neoplastic and non-neoplastic hematology disorders, with the neoplastic hematology sections presented according to the most recent WHO classifications. There is also an introduction to the normal structures of hematopoietic tissues and the various multidisciplinary techniques.
The atlas contains more than 900 high-quality color images that mirror the findings that fellows and clinicians encounter in practice. It provides information in a quick, simple and user-friendly manner, attracting those who are in training or are not considered experts in the field. Residents, fellows, practicing clinicians, and researchers in pathology, hematology, hematology/oncology, as well as graduate students in pathology and other clinicians workings in clinical hematology laboratories will all find it useful.Saves clinicians and researchers time in quickly accessing the very latest details on the diverse clinical and scientific aspects of hematopathology, as opposed to searching through thousands of journal articles For clinicians, fellows, and residents, correct diagnosis (and therefore correct treatment) of diseases depends on a strong understanding of the molecular basis for the disease – hematologists, pathologists, oncologists, and other clinicians will benefit from this clear, focused, annotated format
Companion web site features over 900 images from the book!
Each section will be comprehensively revised by an international team of authors. Over 900 high quality colour images will accompany each diagnostic entity. There will be coverage of cytology in sections relating to myeloid dysplasias and acute leukaemias, as well as incorporating new WHO classification of lymphomas and leukaemias.
The digitally photographed and remastered images in this new edition will be of the highest quality, put onto disk directly from the microscope in digital format and reproduced in print form. The text will give comparisons of the common methods of sample collection, fixation and staining, and a clear description of how to examine a trephine section. It will cover the disorders of bone marrow, discussing the clinical features, histopathology of bone marrow and diagnostic problems of each condition. Chapters close with a summary of key points. The consistent approach to describing each condition makes this a valuable reference tool for the trainee and practicing histopathologists, pathologists and haematologists.
Compare your findings to more than 3,300 outstanding illustrations that capture the characteristic presentation of every type of lesion.
Avoid diagnostic pitfalls using Dr. Rosai's expert observations on what to look for, what to be careful about, and which presentations can be misleading.
Find quick answers on tumor staging, quality control procedures, and the handling of gross specimens through valuable appendices.
Make optimal use of all the very latest advances including our increased understanding of the genetic basis of inherited and acquired disease, the newest molecular genetic and immunohistochemical techniques, and the most recent WHO disease classification schemes.
Get optimal test results with guidance on error detection, correction, and prevention as well as cost-effective test selection.
Reference the information you need quickly and easily thanks to a full-color layout, many new color illustrations and visual aids, and an organization by organ system.Master all the latest approaches in clinical laboratory medicine with new and updated coverage of:
the chemical basis for analyte assays and common interferences;
lipids and dyslipoproteinemia;
markers in the blood for cardiac injury evaluation and related stroke disorders;
coagulation testing for antiplatelet drugs such as aspirin and clopidogrel;
biochemical markers of bone metabolism;
hematology and transfusion medicine;
body fluid analysis;
and many other rapidly evolving frontiers in the field.
Effectively monitor the pace of drug clearing in patients undergoing pharmacogenomic treatments with a new chapter on this groundbreaking new area.
Apply the latest best practices in clinical laboratory management with special chapters on organization, work flow, quality control, interpretation of results, informatics, financial management, and establishing a molecular diagnostics laboratory.
Confidently prepare for the upcoming recertification exams for clinical pathologists set to begin in 2016.
A masterful synchronization of history and cutting-edge science shines new light on humanity's darkest diagnosis.
In the wake of the Cancer Genome Atlas project's failure to provide a legible roadmap to a cure for cancer, science writer Travis Christofferson illuminates a promising blend of old and new perspectives on the disease. Tripping over the Truth follows the story of cancer’s proposed metabolic origin from the vaunted halls of the German scientific golden age to modern laboratories around the world. The reader is taken on a journey through time and science that results in an unlikely connecting of the dots with profound therapeutic implications.
Transporting us on a rich narrative of humanity’s struggle to understand the cellular events that conspire to form malignancy, Tripping over the Truth reads like a detective novel, full of twists and cover-ups, blind-alleys and striking moments of discovery by men and women with uncommon vision, grit, and fortitude. Ultimately, Christofferson arrives at a conclusion that challenges everything we thought we knew about the disease, suggesting the reason for the failed war against cancer stems from a flawed paradigm that categorizes cancer as an exclusively genetic disease.
For anyone affected by this terrifying disease and the physicians who struggle to treat it, this book provides a fresh and hopeful perspective. It explores the new and exciting non-toxic therapies born from the emerging metabolic theory of cancer. These therapies may one day prove to be a turning point in the struggle against our ancient enemy. We are shown how the metabolic theory redraws the battle map, directing researchers to approach cancer treatment from a different angle, framing it more like a gentle rehabilitation rather than all-out combat. In a sharp departure from the current “targeted” revolution occurring in cancer pharmaceuticals, the metabolic therapies highlighted have one striking feature that sets them apart—the potential to treat all types of cancer because they exploit the one weakness that is common to every cancer cell: dysfunctional metabolism.
With contributions from Thomas Seyfried, PhD, author of Cancer as a Metabolic Disease; Miriam Kalamian, EdM, MS, CNS, author of Keto for Cancer; and Beth Zupec Kania, consultant nutritionist of The Charlie Foundation.
3rd edition changes:
The field of oncology massage is maturing into a discipline with a deeper and deeper body of knowledge. The 3rd edition of Medicine Hands reflects this maturation. Every chapter contains updated information and insights into massaging people affected by cancer. New chapters have been added to cover each stage of the cancer experience: treatment, recovery, survivorship, side effects from the disease, and end of life. These new chapters and organizational structure will make it easier for the reader to find the information needed to plan the massage session for a given client. As well, a new chapter has been added that focuses on the Pressure/Site/Positioning framework. This is the clinical framework around which the massage session is planned.
The scientific research on the effects of massage for people with cancer is updated to 2013. New in the 3rd edition is material devoted to massaging young adult survivors, the person with breast reconstruction, cording, and late effects as well as thoughts for therapists and clients who are considering the use of massage as part of a detoxification process.
All of the features most enjoyed by past readers have been retained—the inspirational sidebar quotes, client and therapist anecdotes, info boxes, and therapists questions and answers. To augment the learning process, written exercises have been added for student therapists and all of those who want to participate in their own learning. As well, sample session write-ups have been included to show the reader the variety of touch modalities that can be used to for people living with cancer.
Finally, the 3rd edition will be full color with new color photographs.
The first main part of the book is subdivided into blood banking and transfusion medicine. Under blood banking, the chapters cover blood collection, donation process, component manufacturing, donor testing and storage; transfusion-medicine chapters examine the components for transfusion, pre-transfusion immunohematology testing, blood groups, blood products and their modifications, approaches to transfusion therapy in specific clinical settings, and transfusion reactions and complications. In addition, chapters that talk about apheresis, cellular therapy, and tissue banking in the hospital setting are included.
Hemostasis, the second main part of the book, is subdivided into three sections. The first section, clinical coagulation, includes chapters about neonatal thrombocytopenia, inherited platelet function disorders, immune thrombocytopenia, immune-mediated coagulopathies, congenital bleeding disorders, and acquired bleeding disorders. The second section relates to laboratory testing of coagulation, with chapters about laboratory assessments of platelet disorders, von Willebrand disease, coagulation factor disorders, fibrinogen and fibrinolysis, tests for hypercoagulable state and for activation of the coagulation system, and laboratory support for anticoagulation. The third section discusses coagulation factor products.
This book will be valuable for the education of trainees, practitioners, and future leaders in these fields.
In telling these stories, Lippe and Le alternate chapters. Lippe writes about the early signs that something was wrong; Le continues with a description of pancreatic cancer, its symptoms, and its treatments. Lippe talks about his prognosis, contemplates the prospect of death, and describes how he began to cope; Le explains the importance, for both doctor and patient, of balancing hope and truth. Lippe speaks frankly about the toll the disease takes on his marriage and family; Le offers a general picture of what most patients can expect with their illness. The book concludes with Lippe and Le’s reflections on their partnership in treating cancer, lessons they have learned, and their thoughts about the positive things that sometimes emerge from illness.
Pancreatic Cancer offers clear explanations of what the disease is, describes what people with the disease will feel physically and mentally, and discusses current treatments and future directions of research. The authors hope that their honest yet hopeful perspective will help all people with cancer and those who care about them.
50 Critical Cancer Answers provides the essential information a person needs to create a personal action plan to deal with cancer effectively. Each of the 50 short, easy-to-digest chapters includes a concise explanation of the most effective and sought after cancer treatment in the realms of traditional medicine, natural medicine, emotional support and spiritual care. A succinct commentary is provided to help the reader understand potential benefits, and if it is a realistic treatment option or not. Each chapter includes:
- An interview with an expert in the field of the chapter's topic
- A "smartphone scannable" QR code linking the reader to You Tube video containing author commentary on the relevant topic
- 5 tips from cancer survivors--all 50 cancer survivors have received treatment from the authors' Oasis of Hope cancer centers.
Don't let a cancer diagnosis define your circumstances. Instead, develop a plan to identify, attack, and beat cancer.
Gather step-by-step techniques for assessing and implementing radiotherapeutic options with this comprehensive, full-color, clinically oriented text.
Review the basic principles behind the selection and application of radiation as a treatment modality, including radiobiology, radiation physics, immobilization and simulation, high dose rate, and more.Use new imaging techniques to anatomically locate tumors before and during treatment.
Apply multidisciplinary treatments with advice from experts in medical, surgical, and radiation oncology.
Explore new treatment options such as proton therapy, which can facilitate precise tumor-targeting and reduce damage to healthy tissue and organs.
Stay on the edge of technology with new chapters on IGRT, DNA damage and repair, and molecularly targeted therapies.
Since the third edition (2003), there have been significant changes in treatment and resources. Working with Dr. Judd Moul, the Chairman of Urology at Duke and one of the world's top experts on prostate cancer, Marks provides the most up-to- date information on diagnosis, treatment, and common questions.
Faithful to its title, this text espouses a truly multidisciplinary approach, integrating information from the fields of oncology, neurosurgery, radiation oncology, and neurology. Experts in each specialty have gathered that information which is most important for all physicians caring for patients with brain metastasis.
Brain Metastasis includes complete discussions for all situations in which radiosurgery might be recommended, including for the treatment of gross brain metastasis; for the prevention of tumor-related injury of brain function; and as an alternative to whole-brain radiotherapy.
Features of this uniquely accessible guide include:
A timely discussion of exciting recent developments in aggressive care An emphasis on quality-of-life issues and palliative care Special chapters on radiosurgery for both brain metastasis and spinal tumors Full color insert of high-quality images
This concise and comprehensive text provides a multidisciplinary information source for brain metastasis. It is an essential resource for any practitioner who cares for patients with this devastating yet surprisingly common condition.