An error occurred while setting your user cookie. Please set your. browser to accept cookies to continue. This cookie stores just a. ID; no other information is captured. Accepting the NEJM cookie is. Author profiles (Ole Joe's Guide)a. He makes stories of extra- marital sex, as. Lee (8k). Confessions Of A 1. Year Old Nymphomaniac (2. Confidential (2. 0k). Dinner At Sue's (2. Edna And The Old Chinaman (2. Emma Lou Steps Out (4. Experiments In Bondage - The Making Of A Pervert (2. Filipino Maid And The 1. Yo (2. 1k). I Share My Woman With My Brother (5. In 1. 97. 7 I Was 1. In The Hold Of Swingers (2. Is Windsurfing Better Than Sex? Adrian's. A Test of Patience. Willow Street Sevenadrian hunterhas been called the Dulcinea of the bondage community. That was by Lady Cyrrh, if anybody is taking notes. If you don't know Dulcinea, jump right below and find out about her. Adrian Hunter has been a long time contributor to the newsgroups, and he is still posting to ASSM, e. His stories are available at his website, as it is quickly becoming the norm, it seems. Go to www. adrianhunter. Chelsea Shepard. Association *** Franz. Kafka favourite!!! Patients with frequent attacks usually require both.Those that survive find themselves in a greatly changed world filled with different morals and the same old urges. A Random Act of Violence (3. A Strange Encounter (2. RP. An April Night *assm- 2. Aunt Jessica (4. 0k). Becky *assm- 1. 99. RP. Beyond New Year's Day (3. RP. Blood Pressure Check (2. RP. By the Dawn's Early Light (3. Destiny (3. 7k) RP. Doing It All Over (1. CEL- 3. 40: 9. 5- 1. Flirting with Death (3. Cel- 3. 59, RP. God's Great Plan (3. RP. CEL- 3. 20: 7- 7- 7, Annex 3/5/9. A+. Going to Disneyland 8. K CEL- 3. 59: 1. 0- 1. ASSM. part 3 posted to ASS only, complete. Going to the Shrink (3. RP. Hypocrisy (4. I Remember Pearl Harbor (6. It Happened One Night (4. RP. Laura's Story (3. CEL- 3. 51: 1. 0- 9. Light Duty (5. 7k) 4. Lizzie. CEL- 3. 34: 1. Nervepath (7. 8k). New Year's Eve (3. Night Flight (3. 2k) RP. Pretend (4. 9k) CEL- 3. RP. Random Act of Violence (3. Rough Revenge 1 (5. Stacey (7. 1k) 4. Strange Encounter (2. The Blood Pressure Check (2. The End of the Dryspell (1. The Garden (1. 8k). The Missing Mail (1. The Mommies (3. 0k) Billy. G: CEL- 3. 26: 1. The Shaver (4. 0k). The Shaver II (3. The Teaser (4. 1k) CEL- 3. Theresa the Elder (3. An Ayurvedic Interpretation and Approach to the Treatment of Prolactin-Secreting Adenoma of the Pituitary Gland INTRODUCTION. Prolactinoma, a prolactin-secreting. Alzheimer's disease; Synonyms: Alzheimer disease: Comparison of a normal aged brain (left) and the brain of a person with Alzheimer's (right). Characteristics that. Nick: CEL- 3. 29: 1. We Saw Fireworks (5. Zero- G CEL- 3. 25: 9- 1. His only contribution to ASS* was the sadly unfinished . It's quite a poignant, tenderly sweet and extremely sensuous tale; one that arouses you, brings you to the brink of tears, makes you smile, laugh, hate .. I hope that someday Alan will finish it. Treatment of acute exacerbations of multiple sclerosis (MS) when the acute relapse is characterized by functionally disabling symptoms with documented evidence of. Overview of Acs e349 3. Initial Evaluation and Management e350 4. Early Hospital Care e359. She started writing erotica in mid 2. Her stories contain especially FF or FFF+F, rom, exhib, 1st time ff, D/s, Fem. Dom. F, bdsm. Most of her stories are rom- . An Openly Transgressed Custom. Betsy's Finest Hour CRIM- 1: . ALLENE2. 13. 35 is known as a writer of spanking. Most of them can by found on the. I don't. know exactly how many stories she wrote, but at. Mr. Double's site are some more). Obviously Allene in. In her own words. K. Birthday Surprise 1. K. Bitch Mother 5. K. Black Experience 5. K. Caned by Sir Richard. Horse Punishment 8. K. Indian Whipping 1. K. Kings and Queens 2. K. Marcie's Birthday 1. K. My Brother's Slave 6. K. My Mean Boss 1. K. Slave's Revenge 6. K. Slut Reform 9. K. Sons Get Even 9. K. Spring Break 5. K. The Bush Law 9. K. The Compleat Serial Killer 1. K. The Gymnast 4. K. The In- Laws 1. K. The Kidnapped 5. K. The Stepchild 8. K. Visit from Marge and George 3. K. White victim 1. Kamity harris(Femdom). Debbie's Gift 7. 84k. Executive Pleasures 5. Fall Festival 8. 3k. Power Shopping 5. The Auction 4. 3k. The Manager 3. 4k. The Trade Show 5. Training A Virgin 1- 2 MID (3. MID (3. 3fba. 36b. TG). A Grey Skirt 2. An Unusual Psychological Problem 9. Living in a House Full of Girls 3. My Days Being Forced 4. The New Secretary 3. Visiting Aunt Sue 2. We Met in a Nice Bar 2. His stories tend to be long, full of. They also tend to diverge into deviant. To give. you an idea as to just how much the author has written, file sizes are. Ole Joe had the complete story. The content of her stories. In 2. 00. 3 came out the sequel to . CEL- 3. 70: 8. 5- 1. Cape and Cowl *Cel- 1. Celluloid Dreams. Centerfold CEL- 3. Change Of Life (8. Cheating Heart. CEL- 5. B- Annex Review 8- 2. Chocolate Candy CEL- 2. Clark And Diana. Community Service (4. Creative Interlude 1. Cel- 1. 11. Crossing the Line #1. Celeste's Top 1. 00 of 1. Cel- 1. 02. Dear Prudence CEL- 3. Ann. Claus's Cookies (6. One For All.. CEL- 3. One Moment in Time CEL- 2. One Night Beyond Antaries. One Night In San Francisco. Pandora's Box (6. Payback CEL- 3. 55: 9- 1. Prom Date CEL- 2. Queen Of The Road. Robin And The Catwoman CEL- 2. Robin on Patrol. Sandy 9. Cel- 1. 36. Sarah and Sister Theresa 9. Cel- 1. 07. Scarlett's Cove #6 on Celeste's Top 1. Cel- 1. 37. Sisters In Army Green (3. Snowbound CEL- 2. Celeste's Top 1. 00 of 9. Special Delivery *Cel- 1. Star CEL- 2. 11: 9- 9- 9. Summer Vacation CEL- 2. Tender Loving Care CEL- 2. The Adventures Of Lois Lane. The Adventures Of Ultra Woman And Mega Girl. The Arrangement Billy. G: CEL- 3. 53: 9. The Babysitter 9. Cel- 9. 6. The Ballad of Wrangler Jane 9- 9- 9 *Cel- 1. The Classified Ad. CEL- 2. 6: 1. 0 ; %assm- 1. The Cleaning Lady. The Erotic Adventures Of Robin Hood CEL- 3. The Erotic Adventures Of Supergirl. Cel- 1. 08. The Good Samaritan CEL- 3. The Girls of Delta Theta Phi 9- 1. Cel- 1. 35. The Interview 1. Cel- 9. 8. The Morning After Todd: CEL- 3. The One With More Than A Kiss - A Friends Story. The Other Side Of The Coin. The Price CEL- 3. The Prize 1. 0- 1. Cel- 1. 31. The Professor CEL- 2. The Road Not Taken 9. CEL- 1. 44: 1. 0. The Sisterhood Of Mutants. The Speeding Ticket. The Teacher's Conference. The Tutor CEL- 2. The Tutoring Session. Through The Looking Glass Darkly. True To Life II. Violet Rose#6. Celeste's Top 1. 00 of 1. CEL- 6: 1. 0. Wesley and Deanna. Wilma and Betty (Flintstones) CEL- 1. When Barry Met Sally. Yesterday Once More. You've Got Mailanne. Year- Olds. A Change in Her. Teacher *Cel- 1. 92: 1. A rating Annex Review 6- 1. Will She? anna t. ASSM only. Chicago Transit (1. Golden Clit Best Short Story by a New Author (2. Anon. 74. 7 nowadays a. Ole Joe wrote: We first met in an adversarial manner, but have managed to become civil at least. I like Anne as a person, as much as one can know from e- mail, and love her stories. If you must characterise, call her strongly opinionated, often adversarial, a rare poster, but a guest- reviewing, web- site owner. Also, please be advised that Anne takes a dim view of people posting her stories or using them on archival or commercial sites. Her stories can be found at her site, as PDF- files only. With precision and passion Anne Arbor's stories plunge us into the intimate centres of characters coming to terms with themselves and their relationships, and the deft mix of plots and passion and people catches us up, squeezes us in ways both exciting and troubling. Everywhere are undercurrents of tension, promises of exquisite release. Her stories are like sex. Read them all at Anne Arbor's web site - - Mat Twassel. A View of Alcatraz Bear: CEL- 2. El Ni. I want my stories to feel real but none are real. No Sci. Fi, no mind control, no MM scenes, no BDSM. A Blast from the Past (2. A Friendly Fuck (1. A Halloween Trick (1. A Passion for Chocolate (8k) . I did not want to put them. I am sure that Ole Joe in the old. I. will fix that. Cari . They are all non- consensual. BM/WF) stories with a dominance- submission theme. The Board of Education. Juvenile Justice. Nightmare Before Bedtime. Teacher's Petasulykit. Joanie and Marie. My Lovely Roommateaverti(Bondage). A Memory MID (2. 13. Z0. 10. 91. 99. 3@anon. Anita and Me MID (2. Z1. 20. 81. 99. 3@anon. Cesura's Story (How I Bound Me A+ rating Annex Reviews 4/1. Closet and MID (3. Slurped a Vampire) @news. The Return of Cesura MID (3. EE. 3. 0DE@znet. com). Eloise Gets to the Bottom of Things MID (2. Gilmore Mandala Chrysler Gushola MID (0. Z1. 11. 21. 99. 3@anon. Helen MID (1. 90. Z1. 70. 91. 99. 3. In the Pain Garden MID (1. Shaved Splash MID (1. Apr. 23. 2. 32. 81. The Taming of Eloise MID (3. Topping Joker Message- ID: (1. Apr. 21. 2. 01. 11. Celeste's top twenty lists and deserved so. These works are Hot with a capital H. Backrub writes stories about group sex and makes it believable – desirable really. Several stories are no longer available in the public archives. Filenames below are from Bitbard's Backrub archive. If you have one of the other, lost stories, please send a copy to backrub@bitbard. Across the Catty Corner #4 on Celeste's Top 1. CEL- 9: 1. 0, across. All Aboard CEL- 1. Amy's Story amy. html. Annie After Hours. Backrub, Assrub, Clitrub, Cockrub 0- 9- 1. CR (with Tammy Ng). Hot on the Trail: Who in the World is Celeste. CEL- 5. 9: 1. 0, hot. Lunch Hour. CEL- 3. Meeting Amanda #5. Celeste's Top 1. 00 of 1. Cel- 1. 30, amanda. Morning Orgasms: Spoons CEL- 2. Once You're Rubbed by Amy #8. Celeste's Top 1. 00 of 1. Cel- 1. 95: 1. 0- 1. Showing Off Again showing. Showoffs #3. 3 on Celeste's Top 1. Skin on Skin on Skin 1. Cel- 1. 16, skin. Steven After Hours #6. Celeste's Top 1. 00 of 1. CEL- 2. 6: 1. 0, steven. Tammy in Trouble CEL- 6. The Study Cubicle CEL- 3: 1. Wet Dreams #4. 3 on Celeste's Top 1. Cel- 1. 30, wet. html. Xena: Calisto's Escape 9- 8- 8 *Cel- 8. Dear Hustler. Lust Filled Nite. My Boyfriend's Brother. My First Black Experience. Tyler CEL- 2. 68: 9- 6- 5baddogxxx. A New Car for Ginny. Balinda's Supper. Black in Love Again. MID (1. 99. 71. 22. HAA1. 16. 52@ladder. MID (1. 99. 71. 22. HAA0. 93. 99@ladder. MID (1. 99. 71. 22. HAA1. 16. 80@ladder. MID (1. 99. 71. 22. HAA0. 94. 39@ladder. MID (1. 99. 71. 22. HAA1. 17. 30@ladder. MID (1. 99. 71. 22. HAA0. 94. 83@ladder. MID (1. 99. 71. 22. HAA1. 17. 59@ladder. MID (1. 99. 71. 22. HAA0. 95. 38@ladder. MID (1. 99. 71. 22. HAA1. 18. 19@ladder. MID (1. 99. 71. 22. HAA0. 95. 75@ladder. MID (1. 99. 71. 22. HAA1. 18. 58@ladder. MID (1. 99. 71. 22. HAA0. 96. 12@ladder. MID (1. 99. 71. 22. HAA1. 19. 05@ladder. MID (1. 99. 71. 02. WAA1. 38. 69@ladder. MID (1. 99. 71. 02. WAA1. 39. 58@ladder. MID (1. 99. 71. 02. WAA1. 46. 31@ladder. Charle's Black Tool MID (1. EAA2. 04. 55@ladder. Interracial Church Fuck MID (1. AAA0. 23. 63@ladder. Jake's Big Surprise. My Husband's Black Friend. MID (1. 99. 71. 02. EAA2. 04. 07@ladder. MID (1. 99. 71. 02. Treatment of psoriasis. Literature review current through. Mar 2. 01. 7. Most cases are not severe enough to affect general health and are treated in the outpatient setting. Rare life- threatening presentations can occur that require intensive inpatient management. This topic reviews the treatment of psoriatic skin disease. The epidemiology, clinical manifestations, and diagnosis of psoriatic skin disease are discussed in detail separately, as are psoriatic arthritis and the management of psoriasis in pregnant women and special populations. Therefore, management of psoriasis involves addressing both psychosocial and physical aspects of the disease. Numerous topical and systemic therapies are available for the treatment of the cutaneous manifestations of psoriasis. Treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response . Although medication safety plays an important role in treatment selection, this must be balanced by the risk of undertreatment of psoriasis, leading to inadequate clinical improvement and patient dissatisfaction . The clinician needs to be empathetic and spend adequate time with the patient. It may be helpful for the clinician to touch the patient when appropriate to communicate physically that the skin disorder is neither repulsive nor contagious. Clinicians should lay out reasonable aims of treatment, making it clear to the patient that the primary goal of treatment is control of the disease. Although treatment can provide patients with high degrees of disease improvement, there is no cure for psoriasis. Educating the patient about psoriasis is important and referral to an organization such as the National Psoriasis Foundation (www. Psoriasis may affect patients' perceptions of themselves and this can potentially initiate or exacerbate psychological disorders such as depression . Patients with limited skin disease may still have significant psychosocial disability . Some patients with psoriasis may benefit from counseling and/or treatment with psychoactive medications. Choice of therapy — For most patients, the initial decision point around therapy will be between topical and systemic therapy. However, even patients on systemic therapy will likely continue to need some topical agents. Topical therapy may provide symptomatic relief, minimize required doses of systemic medications, and may even be psychologically cathartic for some patients. For purposes of treatment planning, patients may be grouped into mild- to- moderate and moderate- to- severe disease categories. Limited, or mild- to- moderate, skin disease can often be managed with topical agents, while patients with moderate- to- severe disease may need phototherapy or systemic therapy. The location of the disease and the presence of psoriatic arthritis also affect the choice of therapy. Psoriasis of the hand, foot, or face can be debilitating functionally or socially and may deserve a more aggressive treatment approach. The treatment of psoriatic arthritis is discussed separately. Patients with more than 5 to 1. Attempts to treat extensive disease with topical agents are often met with failure, can add cost, and lead to frustration in the patient- clinician relationship. There is ample evidence of efficacy of the newer systemic therapies (. Established therapies such as methotrexate and phototherapy continue to play a role in the management of moderate to severe plaque psoriasis. However, the availability of biologic medications has reduced the challenge considerably. The concept that many patients with psoriasis in the United States do not receive sufficient treatment to control the disease is suggested by an analysis of surveys performed by the National Psoriasis Foundation between 2. Among the 5. 60. 4 survey respondents with psoriasis, 5. Many patients received no treatment, including 3. Further studies will be useful for clarifying the reasons for these observations and for determining the value of interventions to increase the accessibility of treatment. Widespread pustular disease requires aggressive treatment, which may include hospitalization. Therapeutic approaches to generalized pustular psoriasis and psoriatic arthritis are discussed separately. Alternatives include vitamin D analogs, such as calcipotriene and calcitriol, tar, and topical retinoids (tazarotene). For facial or intertriginous areas, topical tacrolimus or pimecrolimus may be used as alternatives or as corticosteroid sparing agents, though improvement may not be as rapid. Localized phototherapy is another option for recalcitrant disease. Combinations of potent topical corticosteroids (table 1) and either calcipotriene, calcitriol, tazarotene, or UVB phototherapy are commonly prescribed by dermatologists. Calcipotriene in combination with Class I topical corticosteroids is highly effective for short- term control. Calcipotriene alone can then be used continuously and the combination with potent corticosteroids used intermittently (on weekends) for maintenance. A combination product containing calcipotriene and betamethasone dipropionate is available for this use. With proper adherence, considerable improvement with topical therapies may be seen in as little as one week, though several weeks may be required to demonstrate full benefits. Because adherence to topical treatment can be a major hurdle, keeping the treatment regimen simple and using treatment vehicles that the patient finds acceptable is often beneficial . Biologic agents used in the treatment of psoriasis include the anti- TNF agents adalimumab, etanercept, and infliximab, the anti- interleukin (IL)- 1. IL- 1. 7 antibody secukinumab. Improvement usually occurs within weeks. Patients with severe psoriasis generally require care by a dermatologist. Intertriginous psoriasis — Intertriginous (inverse) psoriasis should be treated with class VI and VII low potency corticosteroids (table 1) due to an increased risk of corticosteroid- induced cutaneous atrophy in the intertriginous areas. Topical calcipotriene or calcitriol and the topical calcineurin inhibitors tacrolimus or pimecrolimus are additional first- line treatments . These agents may be used alone or in combination with topical corticosteroids as corticosteroid sparing agents for long term maintenance therapy. Calcipotriene, tacrolimus, and pimecrolimus are more expensive options than topical corticosteroids. Some concerns have been raised about the safety of the calcineurin inhibitors (see 'Calcineurin inhibitors' below and . Scalp psoriasis — The presence of hair on the scalp can make topical treatment of psoriasis challenging because patients may find certain products messy or difficult to apply. Recognizing the patient's preference for a drug vehicle may help to improve adherence to therapy. For many patients, lotion, solution, gel, foam, or spray vehicles are preferable to thicker creams or ointments. Topical corticosteroids are the primary topical agents used for psoriasis on the scalp . Support for the use of these agents is evident in a systematic review of randomized trials that found that very potent or potent topical corticosteroids are more effective treatments for scalp psoriasis than topical vitamin D analogs . Combining a corticosteroid and vitamin D analog may offer additional benefit; in the systematic review, combination treatment with a potent topical corticosteroid and a vitamin D analog appeared slightly more effective than potent topical corticosteroid monotherapy. However, in clinical practice, complicating the treatment regimen with more than one topical product may reduce the likelihood of consistent adherence to the treatment regimen. Thus, we usually prescribe a topical corticosteroid alone as initial therapy. Commercial betamethasone dipropionate- calcipotriene combination products are available, but are more expensive than most topical corticosteroid preparations. Other topical therapies used for psoriasis (eg, tazarotene, coal tar shampoo, anthralin) and intralesional corticosteroid injections also may be beneficial for scalp involvement, though data on efficacy specifically in scalp disease are limited . Salicylic acid can be a helpful adjunctive treatment because of its keratolytic effect. Phototherapy (eg, excimer laser) and systemic agents are additional treatment options for patients who cannot achieve sufficient improvement with topical agents . Approaches include potent topical corticosteroids and topical bath psoralen plus UVA phototherapy (PUVA). However, these drugs appear to be particularly effective in the treatment of pustular psoriasis, and we consider them first line therapy. Acitretin is the retinoid that is used most often for this indication. Acitretin is a potent teratogen and should not be used in women who might become pregnant. Pregnancy is contraindicated for three years following acitretin therapy. The management of nail psoriasis is reviewed in detail separately. Based upon data from open- label or retrospective studies and case reports, a panel of experts suggested that patients with severe, unstable disease should be treated with cyclosporine or infliximab due to the rapid onset and high efficacy of these agents . Patients with less acute disease can be treated with acitretin or methotrexate as first- line agents. The panel advised against the use of systemic glucocorticoids due to the perceived potential for these drugs to induce a flare of psoriasis upon withdrawal of therapy. Etanercept was effective in an open- label study of 1. Topical therapies, such as mid- potency topical corticosteroids, emollients, wet dressings, and oatmeal baths can be used in concordance with systemic treatment to manage symptoms . Long- term maintenance therapy for psoriasis is required. Children — The immediate and long- term adverse effects of therapies for psoriasis are of particular concern in the pediatric population.
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