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The bowels were disturbed symptoms vaginitis buy lithium line, the stools being large in quantity and thin in consistency. Fourteenth day: many convulsions, extremities cold, still no trace of lucidity, suppression of urine. From the start she used to wrap herself up, always remaining silent while she groped about, scratching and plucking out hair, and alternately wept and laughed. She drank a little when reminded to do so; the urine was thin and small in quantity. Ninth day: much random talking, but subsequently she quietened down and fell silent. Fourteenth day: respiration infrequent; deep for a while and then the breaths would be short. Twentieth day: much talking and then quietened down again; loss of voice, respiration in short breaths. She was insensible to everything, always kept herself wrapped up and either talked at random or kept silence. On the first day, his bowels passed a large quantity of solid faeces accompanied by much fluid. There was a somewhat flabby distension of the upper part of the abdomen extending laterally towards the flanks. Twentieth day: went mad, much tossing about, passed no urine, kept down a small amount of fluid. The title is often rendered the Art, but this gives the wrong impression, fo r it is the writer’s main contention that Medicine is an exact science, not an undefinable art. There are men who have turned the abuse of the arts and sciences into an art in itself and, although they would not con fess it themselves, their aim nevertheless is simply to display their own knowledge. But it seems to me that it is the aim and function of an intelligent mind to make new discoveries in whatever field such investigations may be useful, and also to bring to completion tasks that are but half-finished. On the other hand, a desire to use the art of abuse to belittle the scienti fic discoveries of others and to slander the discoveries of the learned to the illiterate, rather than to offer constructive criticism, is not so much the aim and function of an intelligent mind, as a proof of warped character and want of skill. Those who have the ambition to be scientists but not the necessary ability are equipped for the malicious habit of slandering their neighbours’ work if it be right, or of censuring it if it be wrong. This thesis aims at answering the opponents of the science of medicine, deriving boldness from the character of those it censures, facility from the subject it defends and strength from its trained judgement. For what being could anyone ascribe to a non-existent thing as a proof of its existence? If it were possible to see what has no substance, just as we see what does exist, then one could no longer call such a thing non-existent because it would then appear alike to the eye and the mind existent. The activities of the sciences that are taught are things that can be seen and there is none that is not visible in one form or another. I at least am of the opinion that it is from the visible forms of things that they take their names.
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This delivery of the oxygen to treatment xerophthalmia purchase genuine lithium line the cells and tissues is essential for creating the oxygen boost necessary to maintaining a healthy environ ment that is inhospitable to disease. Because its use threatened the British monopoly drug sales, they hired a news reporter disguised as a doctor to fabricate a story about a child who supposedly died of brain damage as a result of taking hydrogen peroxide. Coming from a “doctor,” the story was accepted as the truth, even if it never happened. The misinformation tactic worked and the Indian people abandoned the practice of taking hydrogen peroxide in favor of buying British drugs. During World War I, doctors used intravenous injections of hydrogen peroxide to successfully treat pneumonia. In fact, it was a key treatment for people who became ill during the pneumonia epidemic that broke out shortly after the war. Oliver was the first to use an intravenous infusion of hydrogen peroxide to treat a group of 25 Indian patients who were critically ill with pneumonia. Since then, hydrogen peroxide therapy has been studied in major medical research centers throughout the world, 56 including Baylor University, Yale University, the University of California (Los Angeles) and Harvard University in the U. Another person who is also considered a pioneer in the use of hydrogen peroxide therapy is Father Richard Willhelm. He found hydrogen peroxide especially helpful in the treatment of skin diseases, polio and mental illness brought on by bacterial infections, and believed it would prove an integral treatment for many more ailments. He created his non-profit organization hoping to inform the world about proper dosing and methods for using the treatment. Therefore, much of the attention that should have been placed on developing new ways to administer hydrogen peroxide became focused on the development and uses of prescription drugs instead. In the 1960s, European physicians began prescribing hydrogen peroxide to their patients. Before long, the use of hydrogen peroxide became an accepted part of the medical mainstream in Germany and Russia, as well as Cuba. Over 6,100 articles in scientific literature attesting to the success of ozone and hydrogen peroxide therapy are presently in circulation (with an additional 50 to 100 scientific articles published each month about the chemical and biological effects of ozone and hydrogen peroxide), but still a large portion of the medical community continues to overlook or purposely ignore this incredibly simple and inexpensive treatment option that could potentially solve the health care crisis. To date, although over 15,000 European doctors, naturopaths and homeopaths are routinely administering medical ozone and hydrogen peroxide to millions of patients, there are fewer than 500 doctors in the U. One reason for this is because information about medical ozone and hydrogen peroxide is deliberately excluded from the 58 curriculum in medical schools. Furthermore, medical boards do not look favorably upon licensed physicians who use bio oxidative therapies in their medical practice, and have been known to threaten doctors with a revocation of their license (or even jail time) if they administer hydrogen peroxide or ozone. Current Applications Hydrogen peroxide therapy has an incredible number of applications. Alternative health practitioners, as well as researchers and doctors have yet to find a disease that does not respond well to it, and when used properly there are no known risks. The only people for whom hydrogen peroxide administration is not recommended are individuals who have undergone organ transplants. Hydrogen peroxide stimulates the immune system, and since the immune system attacks any foreign body that is different from what is normally present in your body, it identifies a transplanted organ as a foreign substance that needs to be eliminated.
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It is mostly linalool and it does not have a reputation as an antimicrobial oil or as an insecticide medications contraindicated in pregnancy buy online lithium. I am staggered at such a highly qualified homeopath making such a huge error unless of course it is another transcription error. This therapist admits she has no training in the use of essential oils, yet seems to be using them to treat medical conditions: Page 19. If so that displays a complete lack of knowledge on essential oils as Cypress being astringent is a fairy tale. I am puzzled why this speaker is involved in this conference as it is supposed to be about essential oils and she gives hardly any information on that. Biblically Based Essential Oils By Jordan Rubin this speaker sounds like someone who only knows about essential oils via multi level oil sellers. Misinformation, there is no evidence that essential oils were used during the thousands of years of history in the Bible. Typical nonsense over skin absorption and confusing the use of water based or specially prepared medical patches, with the use of essential oils. Absolutely no attempt to give information on the volumes to be consumed, or that both these oils are powerful mucus membrane irritants. If thyme essential oil contains phytoprogesterone then it would need to be drunk in toxic amounts to have any effect. Josh Axe Please see the separate pdf file Essential Oils for Ear, Nose, and Throat Health Dr. Josh Yorgason Here we go again, yet another doTerra oils distributor, agent or whatever you want to call them. So maybe a real doctor, but certainly promoting all the hogwash on his website that doTerra promote. That information is frequently twisted to suit their purpose of selling you the oils. Huge amounts of good information on essential oils are not to be found on the Internet, but are in medical and scientific journals and books going back over 100 years. Yes but the main reason for this is the fact that many on the market are adulterated. But of course as this Doctor has learnt from the Internet and doTerra it is not surprising he knows so little about real essential oils safety. Thyme, cinnamon bark, clove and even peppermint will burn the mucus membrane covering the eye. Some of those different over-the counter medications are candy flavored or fruit flavored. I can see them being much more apt to try to down a bottle of that versus like you said the peppermint or eucalyptus, which is there’s no way they’re going to drink that whole bottle”. This is correct, but it is often the parents who believe in the trash disseminated by the multi level oil sellers and quacks who will use excessive amounts of essential oils on their children. There is published evidence in the toxicicological reports where children have been poisoned by their parents.
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Pain Management in Low-Resource Set availability of opioids to treatment anemia discount 150mg lithium with mastercard patients, especially cancer tings intends to contribute to this goal in settings patients, on the other. A second meeting took place where the poor ﬁnancing of health care systems high in Geneva in 1984. As a result, the brochure “Cancer lights the importance of pain management in pallia Pain Relief” was published in 1986. Critical issues on opioids in chronic non Krankheitsbehandlung in der vormodernen Medizin (ca. Uganda: Delivering analgesia in rural Africa: opioid availability and nurse prescribing. Guide to Pain Management in Low-Resource Settings Chapter 2 Obstacles to Pain Management in Low-Resource Settings Olaitan A Soyannwo Why is effective pain management of diseases even in poor countries is now noticeable as noncommunicable diseases, injuries, and violence are as diﬃcult to achieve in low-resource important as communicable diseases as causes of death countries? Many of these conditions have accompa Low-income and middle-income economies of the nying pain (acute and chronic), which is inadequately ad world are sometimes referred to as developing coun dressed and treated. While there is consensus that stron tries, although there are wide differences in their eco ger health systems are key to achieving improved health nomic and development status, politics, population, and outcomes, there is less agreement on how to strengthen culture. Malnutrition, infections, and parasitic diseases are prevalent, with high rates of morbidity and mortal Is pain management a problem ity, especially in rural areas and among pregnant wom in resource-poor countries? Although communicable Usually, the ﬁrst attempt at pain management in these diseases are the emphasis, a transition in the epidemiology patients is the use of home remedies, including herbal Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. This material may be used for educational 9 and training purposes with proper citation of the source. Tese can be postgraduate health care students, and also incorpo simple analgesics, herbal preparations, or complementa rated into continuing education programs. Such recommendations items must be adapted to be cost effective and culturally may be effective for simple, uncomplicated pain, but appropriate. In the hospital setting, most pain problems are treated by general medical practi Often patients are denied appropriate analgesics when tioners, family physicians, or ﬁrst-line specialists such prescribed because the health professionals who are as orthopedic surgeons, neurologists, and oncologists. Tus, although re lief of pain is part of the fundamental right to the high Due to staﬃng, equipment, and ﬁnancial constraints, est attainable standard of health, this aim is diﬃcult to facilities for pain services are grossly inadequate or non achieve in low-resource countries, where most of the existent in many developing countries. Frequently, health care is resources preclude the organization of acute pain teams delivered by a network of small clinics—some without and chronic pain clinics, which are widely used in de doctors or essential analgesics. Even when doctors are veloped countries to provide effective pain control using available, for example for surgery, patients expect pain evidence-based methods, education, advice on diﬃcult as an inevitable part of surgical intervention, and de pain problems, and research. In the developing world, spite the high incidence of reported pain, may still rate improvements in acute pain management are most like “pain relief” as satisfactory. Comprehensive many low-resource countries, fears (opiophobia), con pain assessment and multimodal treatment approach cerns, and myths about opioid use focus more on toler es are poorly understood since pain is mostly taught ance, dependence, and addiction, which should normal as a symptom of disease rather than an experience ly not preclude appropriate medical use of opioids. Patients may also have a poor understanding plains the rationale and imperative for the use of opioid of their own medical problems, and may expect pain, analgesics. Hence appropriate education is essential for National policies are the cornerstone for implementa all health professionals involved in pain management, tion of any health care program, and such policies are and multidisciplinary teamwork is central to successful lacking in many low-resource countries.
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Let us consider the science of medicine treatment uti infection cheap 300mg lithium with visa, since that is my own subject, by way of illustration. First of all I would define medicine as the complete removal of the distress of the sick, the alleviation of the more violent diseases and the refusal to undertake to cure cases in which the disease has already won the mastery, knowing that everything is not possible to medicine. And as I describe the science I shall at the same time disprove the arguments of her traducers, whatever way each prides himself on his attack. My first premise is one that everyone accepts; for it is admitted that some who have received medical attention have been restored to health. But the fact that everyone is not cured is reckoned an argument against the science, while those who recover from their diseases, so the traducers of the science assert, owe their cure to good fortune rather than to medical skill. Even I do not exclude the operations of fortune, but I think that those who receive bad attention usually have bad luck, and those who have good attention good luck. Secondly, what else but medical skill can be responsible for the cures of patients when they have received medical attention? Such, not content to wait on the shadowy form of Fortune, entrusted themselves to the science of medicine. My opponents will say that many sick men have never seen a doctor and yet have recovered from their illnesses. But it seems to me that even those who do not employ a doctor may chance upon some remedy without knowing the right and wrong of it. Should they be successful, it is because they have employed the same remedy as a doctor would use. And this is a considerable demonstration of the reality and the greatness of the science, when it be realized that even those who do not believe in it are nevertheless saved by it. For when those who employ no doctors fall sick and then recover, they must know that their cure is due either to doing something or to not doing it. It may be fasting or eating a great deal, drinking largely or taking litde fluid, bathing or not bathing, exercise or rest, sleep or wakefulness, or perhaps it is a mixture of several of these that is responsible for their cure. If they benefit, they cannot help but know what benefited them; if they are harmed, what harmed them; but everyone cannot tell what is going to bring benefit or harm beforehand. If a sick man comes to praise or to blame the remedies by which he is cured, he is employing the science of medicine. Remedies are beneficial only through correct applications, but they are harmful when applied wrongly. Where there are procedures which can be right or wrong, a consideration of these must constitute a science. I assert that there is no science where there is neither a right way nor a wrong way, but science consists in the discrimination between different procedures.
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It seems fairly certain at this point that medicine and science in sports and exercise 150mg lithium, in fact, both mechanisms contribute to a general stress response in which it is the uncapping of telomeres rather than their overall length that induces senescence (Ben-Porath and Weinberg, 2004). In other words, telomeres are not a clock-like mechanism for cell senescence (and thus for a decline in cell replication) or a mechanism to determine our place in the aging process, but rather they are part of a dynamic symphony that we can help conduct by monitoring the extrinsic and stress-related factors to which our bodies are exposed. Studies do not agree on the specifcs, except that there is a preponderance of evidence that telomere length is paternally inherited (Njajou et al. It is quite rapid during in utero development and the frst decade of life, it slows down or stabilizes in the adult years, which is followed by a more gradual but also more variable telomere decline during old age (Njajou et al. Interestingly, sperm cells show increasing rather than decreasing telomere length with age, so researchers investigated whether the age of 92 the Scientifc Basis of Integrative Medicine the father can affect the telomere length “in blood” of the offspring; it can (Unryn et al. There was not a signifcant correlation between maternal age and male or female off spring, although a trend toward the same was noted. The investigators suggest that the positive correlation between paternal age and telomere length of both male and female offspring may reveal a key underlying factor in the variability of telomere length among humans—especially if the effect can be passed on to future generations. Similarly, this study found telomere length (in leu kocytes) of adult offspring to be positively correlated with paternal age at the time of birth of the offspring; however, the fnding was signifcant for males only in two of the subjects. While these investigators stated that the relationship between leuko cyte telomere length and human lifespan has been repeatedly investigated and has yielded “conficting results,” they nonetheless state that it “is apparently a biomarker of aging and a forecaster of longevity in humans. In addition, this study found that mean telomere length of leukocytes was positively correlated between the daughter’s telomere length and the father’s lifespan, but not the mother’s (Njajou et al. It is possible that the study was even underpowered to draw such a fnding, given the size of the subject pool. In addition, there are various factors that can infuence telomere length, from increased telomerase activity that occurs as cells move through the thymus to oxidative damage, age (which exhibits signifcant the Stress System 93 interindividual differences), or disease. If not controlled for, any one of these varia tions could confound data outcomes of a study comparing telomere length to human lifespan. However, the fact that age correlates to telomere length does not necessarily make telomere length a biomarker for human longevity, as there is a complex network of actions involved (Aviv and Lansdorp, 2004). The l o m e r e s : sT r e s s, di s e a s e Telomere length also has been proposed as a biomarker for disease risk or staging in diseases that are as disparate in their symptomology as dementia (Grodstein et al. In addition, a recent study involving caregivers of Alzheimer’s disease patients (compared with age and gender-matched controls) recognizes the negative impact of chronic stress on T-cell function (as reviewed in Chapter 2), but adds that cytokines. In other words, telomerase was doing its job of trying to compensate for the telomere shortening occurring in the caregivers. While caregivers of Alzheimer’s patients had signifcant telomere shortening compared with controls, the rate of attri tion could not be determined. As stated, it is attrition or uncapping that seems to be the factor that induces senescence. Although these fndings demonstrate that chronic stress is associated with altered T-cell function and telomere shortening, again, it cannot be extrapolated that these actions decrease the lifespan of the organism. They deduced that the deleterious effects of these highest levels were equivalent to a “decade of additional aging,” as compared with women reporting low levels of stress. The researchers acknowledged that they could not con trol for the possibility that subjects who are psychologically more resistant to stress simply have longer telomere length.
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The enzyme ptyalin (salivary amylase) starts the digestion of starch in the mouth 7r medications purchase discount lithium on-line. It hydrolyses starch to dextrins, isomaltose and maltose in neutral or alkaline pH in the mouth. The activity of amylase continues in its movement from the mouth to the upper part of the stomach. But as soon as the food mass comes in contact with hydrochloric acid secreted there, this action ceases. Very little digestion of carbohydrate occurs in the stomach as the pH is unfavourable. Small portion of chyme are released through the pyloric sphincter into the duodenum, the first part of the small intestine. Most of the digestive activity takes place in its three compartments namely the duodenum, the jejunum and ileum. Carbohydrate digestion occurs almost completely in the small intestine, mainly in the duodenum. The brush border, on the surface of the epithelial cells lining the intestines, is the site of this enzyme action. The enzymes sucrase, lactase, maltase, and isomaltase, found on the outer cell membranes of the intestines, act on the sugars sucrose, lactose, maltose and isomaltose respectively. The monosaccharides formed—glucose, galactose and fructose—pass through the mucosal cell and via the capillary into the blood stream. Some glucose is stored in the liver and muscles as glycogen, the rest is transported to tissues to be used for their activities. Digestion, Absorption and Utilisation of Nutrients 1717171717 Cellulose, hemicellulose, lignin and other forms of carbohydrate, which are collectively known as fibre, are not split by human amylases. Proteins Digestion of proteins starts in the stomach, which serves as a storehouse, where some protein hydrolysis begins. Gastric juice, which is secreted by the stomach, contains hydrochloric acid, pepsin, rennin, mucin and other substances. Hydrochloric acid has several important functions: (1) it swells the proteins, thus increasing their surface area for enzyme action, (2) it converts the inactive pepsinogen to the enzyme pepsin, (3) it provides the acid medium necessary for the action of pepsin, (4) it provides acidic pH for solution of calcium and iron salts, (5) it reduces or destroys the activity of many pathogens (harmful bacteria) present in the food. Pepsin is the only proteolytic enzyme, which is able to digest collagen, the main protein in connective tissue. The contribution of the stomach to the total process of protein digestion is small, as most protein digestion occurs in the duodenum. As soon as the chyme enters the duodenum, it stimulates the intestinal mucosa to release an enzyme enterokinase, which converts inactive trypsinogen into active trypsin. Trypsin activates other proteolytic enzymes—chymotrypsin and carboxypolypeptidases.
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Can we get enough of these in foods or do we need pills to medicine 666 buy lithium 300mg cheap meet our needs of some vitamins? Definition A substance can be classified as a vitamin if it satisfies the two criteria: 1. It must be a vital, organic dietary substance, which is neither a carbohydrate, fat, protein, or mineral and is necessary in only very small amounts to perform a specific metabolic function or to prevent an associated deficiency disease, and 2. It cannot be manufactured by the body, and, therefore, must be supplied by the diet. Nature of Vitamins Vitamins are organic substances, which occur in small amounts in foods. Chemical structure of each vitamin is specific; some like vitamin C have a simple structure, while others such as vitamin D have a complex structure. Vitamins do not provide calories, but are essential in the metabolic reactions, which release energy from carbohydrates, fats and proteins. Each vitamin has specific functions and so one vitamin cannot substitute for another in the body. Vitamins may occur in preformed or its active form in the food, or as a precursor compound which can be changed into active form in the body. Vitamins are conveniently classified into two groups on the basis of their solubility into fat soluble and water-soluble vitamins. Selection and intake of foods according to the food guide (chapter 14) can help to meet one’s need of the various vitamins. Fat-soluble Vitamins 8989898989 Fat-Soluble Vitamins Fat-soluble vitamins can only be absorbed in the presence of fat. Therefore, the presence of some fat in the diet is essential for their absorption. Fat-soluble vitamins can be stored in the body and hence occasional intake of very high sources may help the body tide over periods of low intake. The requirement for fat-soluble vitamins may be met by intake of a precursor or the vitamin itself. Plants provide a source of vitamin A for animals in the form of orange-yellow pigments called the carotenoids. The chief source in human nutrition is beta-carotene, which the body converts to vitamin A in the intestinal mucosa during absorption. As, you may have noted, the amount of vitamin ester and carotenoids provided decreases with increasing weight of the vitamin A compound. The Sight and Life Manual on Vitamin A Deficiency Disorders has updated the information about the major functions of vitamin A.
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It may be noted that many food preparations are made by using more than one method of heat transfer xerogenic medications buy lithium toronto. What is the function of two of these in preparation of an acceptable food product? Food Selection and Preparation Practical Work to include Methods of food preparation: (i) Cereals (ii) Pulses and legumes (iii) Vegetables and salads (iv) Fruit (v) Meat and eggs (vi) Milk (vii) Snacks (viii) Desserts. It is necessary to understand and manipulate the changes to obtain an acceptable food product. The major constituents of food are carbohydrates, proteins, fats and their derivatives and water. In addition, a number of inorganic mineral components and a diverse group of organic substances are present in very small amounts in foods. Let us consider their properties and the changes that occur in these components during handling, cooking and processing. Carbohydrates Starch, sugars, pectins, gums, celluloses and hemicelluloses are the important carbohydrates found in foods. Starches are the major component of cereals, millets, dals, roots, tubers, and sago. Starches are bland in taste, not readily soluble in cold water but absorb water when soaked in cold water. When starch granules are added to cold water, a temporary suspension is formed, the starch tends to settle out as soon as the mixture is allowed to stand. Heating does not help to separate the granules, because once formed the lumps stay intact. Lump formation can be prevented by mixing starch with a little cold water before introducing it into the hot water; roasting a little before addition of hot water or addition of a little fat, helps to separate the starch granules and allows them to gelatinise separately. When a starch and water mixture is heated, it becomes translucent and forms a paste. This property is used when starch is used as a thickener in soups, starch puddings and other preparations. The change in texture, colour and physical state, which occurs when starch is heated in water, is known as gelatinisation of starch. In roots and tubers, the presence of starch, which absorbs the water during cooking, results in retention of size. Sugars: About 5–11 per cent are present in ripe fruits, malted beverages and in milk. Sucrose the sugar we use in food preparations is one of the pure, manufactured (extracted) foods we use daily. When a high concentration of sugar is used it acts as a preservative by binding moisture. In the presence of acids, the sugar (sucrose) is partially hydrolysed to form glucose and fructose, which is known as invert sugar, which is more soluble than sucrose. Sugars are readily fermented by microorganisms, thus causing spoilage of food products containing it.
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However symptoms joint pain cheap lithium online mastercard, these risk factors have not been validated in a prospective setting except that the absence of both factors indicated a low recurrence rate (6%) . For non-seminoma stage I, vascular invasion of the primary tumour in blood or lymphatic vessels is the most important predictor of occult metastatic disease. The proliferation rate, as well as the percentage of embryonal carcinoma, are additional predictors that improve upon the positive and negative predictive value of vascular invasion . Whether the absence of teratoma (as qualitative data, as opposed to the more subjective assessment of percentage of embryonal carcinoma) can independently complement vascular invasion as a predictive factor of relapse requires validation . If cryopreservation is desired, it should preferably be performed before orchiectomy, but in any case prior to chemotherapy treatment [68, 75-77]. Patients with unilateral or bilateral orchiectomy should be offered a testicular prosthesis . Previous analyses from four studies showed an actuarial 5-year relapse-free rate of 82. The Princess Margaret Hospital series (n = 1559) showed an overall relapse rate in unselected patients of 16. The actuarial relapse rate is in the order of 15-20% at 5 years, and most of the relapses are first detected in infra-diaphragmatic lymph nodes . In patients with low risk (tumour size < 4 cm and no rete testis invasion), the recurrence under surveillance is as low as 6% . However, 70% of patients with relapse are suitable for treatment with radiotherapy alone because of small volume disease at the time of recurrence. Patients who relapse after salvage radiotherapy can be effectively treated with chemotherapy . The main drawback of surveillance is the need for more intensive follow-up, especially with repeated imaging examinations of the retroperitoneal lymph nodes. Two courses of adjuvant carboplatin seem to further reduce the relapse rate to the order of 1-3% [72, 88], but additional experience and long-term observation is needed. Adjuvant irradiation of supradiaphragmatic lymph nodes is not indicated in seminoma stage I. The main concern surrounding adjuvant radiotherapy is the increased risk of radiation-induced second non-germ cell malignancies [92-94]. A scrotal shield should be considered during adjuvant radiotherapy in order to prevent scattered radiation toxicity in the contralateral testis . Patients with and without both risk factors have a 32% and 12% risk of occult disease respectively. These risk factors were introduced through an analysis of retrospective trials . Early data with limited follow up indicate that patients without either risk factor have a very low risk, 6. The decision regarding adjuvant treatment should always be based on a thorough discussion with the patient, taking into account the described advantages and disadvantages, as well as the individual situation of the patient. The largest reports of the surveillance strategy indicate a cumulative relapse rate of about 30%, with 80% of relapses occurring during the first 12 months of follow-up, 12% during the second year and 6% during the third year, decreasing to 1% during the fourth and fifth years, and occasionally even later [96, 97].