Friday, April 11, 2014

Renal Cysts: Cause for Concern?

A cyst is a thin-walled, cell-lined collection of fluid.  They can occur in nearly every tissue type and many places in the body including the brain, lung, nerve tissue and skin. Renal cysts are incredibly common, affecting up to 50% of 50-year olds in the United States and increasing in prevalence with age.[1]  Renal cysts represent upwards of 70% of the asymptomatic, benign renal masses discovered incidentally.[2]  Risk factors for cyst formation include:

  • increasing age
  • male gender
  • hypertension
  • chronic kidney disease (renal insufficiency) [3]

The main concern of patients and physicians is that renal cysts are cancerous or will develop into a cancer.  In an excellent study of the natural history of renal cysts, with increasing time cysts are demonstrated to grow slowly (average 1.9mm/year), increase in number and only rarely develop into cancers.[4]  Predicting which cysts are potentially malignant is a tough task.

The Bosniak Classification System

Bosniak I
In 1986, Dr. Bosniak, radiologist at New York University in New York City, defined the characteristics of simple and complex renal cysts to reduce unnecessary surgery on benign lesions.  Thus the Bosniak System was created, categorizing each renal cyst into four (and then five in 1993) categories that predict malignant behavior.[5] The single-most important imaging characteristic that predicts malignancy is enhancement (brightening) on contrast-based CT imaging.
Bosniak II: hyperdense cyst (right)


Bosniak I

Risk of Malignancy: 0-1.7%

Non-enhancing
Benign simple cyst
Water density
Hairline thin cyst wall
No septa, calcifications, or solid components

Bosniak II

Bosniak IIF

Risk of Malignancy: 0-18.5%

Non-enhancing
Benign cyst
May have a few thin septa
May have fine calcification in wall or septa
May be hyperdense (uniformly high attenutation lesions) if <3cm
Perceived enhancement may be present

Bosniak IIF

Bosniak III
Bosniak IV

Risk of Malignancy: 5-18.5%

Non-enhancing
May have a few thin septa
May have minimal wall thickening in wall or septa
May have thin or nodular calcifications
Perceived enhancement may be present
May be hyperdense (uniformly high attenutation lesions) if ≥3cm
Require follow-up studies to prove benignity

Bosniak III

Risk of Malignancy: 33-82%

Indeterminate cystic mass
Thickened and/or irregular walls/septa
Measurable enhancement
Surgical lesion


Bosniak IV

Risk of Malignancy: 92-93%

Clearly malignant cystic masses
Enhancing soft tissue components
Surgical lesion


Management of Renal Cysts

Most Bosniak I and II cysts do not require follow-up or treatment due to the low rate of documented progression to malignancy.  There is an association between renal cysts, chronic kidney disease and renal cell carcinoma; therefore it is reasonable to follow patients with Bosniak I and II lesions with serial ultrasounds and labs for renal function (creatinine, urinalysis) on an annual or biannual basis.  

Bosniak IIF cysts, however, should have repeat imaging on a regular basis to ensure they do not progress to malignant disease.  Progression of a cyst is defined by an increase in the Bosniak Classification Score.  In studies of Bosniak IIF cysts, 13-15% progress to Bosniak III lesions while under observation and 50-100% of the resected cysts were renal cancers.[6-8]

Bosniak III and IV cysts warrant consideration of surgical treatment.  Treatments may include partial nephrectomy (removal of the cyst only), radical nephrectomy (removal of the entire kidney) or ablative therapies.  While it is generally believed that most complex renal cysts are low-grade renal cell carcinomas, there is a significant proportion that are high-grade tumors.  


Summary

  • Renal cysts are the most common benign lesion in the kidney.  
  • The risk of malignancy increases with increasing complexity of the cyst.
    • Bosniak I, II and IIF cysts have low-risk of malignancy and should be observed.
    • Bosniak III and IV cysts have a higher risk of malignancy and therefore warrant surgical treatment.
  
This blog entry was written by Debasish Sundi, MD, Senior Assistant Resident at the Brady Urological Institute at Johns Hopkins University.  Dr. Sundi is pursuing a career in urological oncology.








[1] Torres VE, Grantham JJ. Cystic diseases of the kidney. In: Brenner BM, ed. Brenner & Rector’s The Kidney. Vol. 2. 8th ed. Philadelphia: Saunders Elsevier; 2008: 1451–1453.
[2] Terada N, Ichioka K: The natural history of simple renal cysts. J Urol 2002; 167: 21-2
[3] Terada N, Arai Y: Risk factors for renal cysts. BJU Int 2004; 93: 1300-1302
[4] Terada N, Arai Y: The 10-year natural history of simple renal cysts. Urology 2008; 71: 7-11discussion 11–12
[5] Israel GM, Bosniak MA: An update of the Bosniak renal cyst classification system. Urology 2005; 66: 484-488
[6] O'Malley RL, Godoy G, Hecht EM, Stifelman MD, Taneja SS.Bosniak category IIF designation and surgery for complex renal cysts.  J Urol. 2009 Sep;182(3):1091-5. doi: 0.1016/j.juro.2009.05.046. Epub 2009 Jul 18.
[7] Smith AD, Remer EM, Cox KL, Lieber ML, Allen BC, Shah SN, Herts BR.Bosniak category IIF and III cystic renal lesions: outcomes and associations.  Radiology. 2012 Jan;262(1):152-60. doi: 10.1148/radiol.11110888. Epub 2011 Nov 21.
[8] El-Mokadem I, Budak M, Pillai S, Lang S, Doull R, Goodman C, Nabi G.  Progression, interobserver agreement, and malignancy rate in complex renal cysts ( ≥ Bosniak category IIF).  Urol Oncol. 2014 Jan;32(1):24.e21-7. doi: 10.1016/j.urolonc.2012.08.018. Epub 2013 Feb 6.

15 comments:

  1. - Chứng bệnh tăng huyết áp hiện nay rất phổ biến tại Việt Nam, bệnh huyết áp chủ yếu xảy ra ở người lớn tuôi.
    - Hiện giờ số lượng người mắc bệnh tim tương đối lớn, con số đáng báo động kịp thời.
    - Điều trị bệnh máu nhiễm mỡ tại bệnh viện Thu Cúc uy tín và chất lượng tốt nhất.
    - cách chăm sóc người bị huyết áp thấp cũng đóng vai trò quan trọng giúp cải thiện nhanh chóng tình trạng sức khỏe.
    - Chứng bệnh rối loạn thần kinh thực vật có ảnh hưởng đến chức năng tự động cơ thể bao gồm nhịp tim, huyết áp, mồ hôi và tiêu hóa…
    - Bệnh lý huyết áp thường không bỏ qua ai, vì vậy việc theo dõi huyết áp bình thường là cần thiết để bảo vệ sức khỏe.
    - Chỉ số nhịp tim bình thường là bao nhiêu, các bạn nên tham khảo kỹ để biết cách chăm lo sức khỏe.
    - Tìm hiểu thông tin kiến thức về bệnh viện tim hà nội
    - Triệu chứng thiếu máu não là những căn bệnh rất nguy hiểm hiện nay.

    - Tìm hiểu cao huyết áp nên ăn gì để có những kiến thức cần thiaats cho các bạn.
    - Chỉ số huyết áp bình thường là bao nhiêu rất quan trọng cho mỗi chúng ta để biết tình hình sức khỏe của mình.
    - Tìm hiểu triệu chứng cao huyết áp để có biện pháp chữa trị hiệu quả nhất.
    - Cách giảm mỡ máu hiệu quả tốt nhất hiện nay là gì, mời các bạn tham khảo.
    - Căn bệnh mỡ máu cao ăn gì là tốt nhất và đảm bảo cho sức khỏe nhất hiện nay.
    - Cùng tìm hiểu nguyên nhân tăng huyết áp là gì và cách điều trị thế nào tốt.
    - biến chứng tăng huyết áp rất nguy hiểm cho người bệnh, các bạn không nên coi thường.

    ReplyDelete
    Replies
    1. My name is Bruce Scott am from U.S.A. I want to share a testimony of how Dr.john herbal mixture cream saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I can't make love to my wife and my penis was just too small a full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.john herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 8 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. You can contact him via {Drjohnenlargementhome@gmail.com) or call or what-apps him through +2348060259313. .he also specialize on the following things BREAST ENLARGEMENT BREAST LIFT & REDUCTION PENILE/PENIS ENLARGEMENT GENERAL BODY SLIMMING HIPS & THIGH REDUCTION Thanks for the Enlarging my penis sir, you indeed save my marriage...I am really grateful sir,

      Delete
    2. hello everyone My name is imaan rahman from the united states ,i just want to share my testimony with the world on how Doctor HARRY Help me to enlarge my penis. Please read my good news carefully and i am sure it will affect your life positively on how you will also enlarge your pines,because i know some many people out there also need his help!

      I came across so many comments about Dr HARRY Penis Enlargement Medicine cream some weeks ago, on his website http://drharrysolutio.wixsite.com/dr-harry though I had really wanted my penis to be large, long and thick,because i was not able to have sex with my wife..It was really affecting our marriage and my wife was about to divorce me. I had about 8.128cm – 3.2 inches before. Am really amazed on the fast results achieved within 7 days of using Dr. harry Penis Enlargement Medicine. It work and now I have got 22.87cm – 10.5 inches now. And my wife love it more now, i began to feel the enlargement of my penis, This went on for a little period of about 14 days and to my surprise my wife keeps screaming that she love my big dick now. And my penis is now 10.5 inches long on erection and off course very large round. I am very happy for this Penis Enlargement experience. He can help with all kinds of cure you may need as follows

      Penis Enlargement
      Low sperm count
      Weak Erection
      diabetes type 1and 2
      Herpes spell
      HIV spell
      Pregnancy spell
      Marriage for spell
      cancer
      ALS
      watering sperm
      womb fertilization
      penis erection
      witch craft attack
      s t d diseases
      internal heat
      swollen body
      low sperm count
      long time sickness
      kidney,heart,lungs,problem
      with doctor,Dr. HARRY you are in safe hands your healing is assured
      Email:drharrysolution@gmail.com
      Website http://drharrysolutio.wixsite.com/dr-harry
      Call or whatsapp +2348143240563 thanks

      Delete
  2. Really awesome blog. Your blog is really useful for me. Thanks for sharing this informative blog. Keep update your blog.Plz visit us:
    Best Urologist in Delhi

    ReplyDelete
  3. My name is Gary David,i just want to share my testimony with the world on how Doctor Trust Help me to enlarge my pines. Please read my good news carefully and i am sure it will affect your life positively on how you will also enlarge your pines,because i know some many people out there also need his help!

    I came across so many comments about Dr Trust Penis Enlargement Medicine some weeks ago, though I had really wanted my penis to be large, long and thick,because i was not able to have sex with my wife..It was really affecting our marriage and my wife was about to divorce me. I had about 8.128cm – 3.2 inches before. Am really amazed on the fast results archived within 3 days of using Dr. Trust Penis Enlargement Medicine. It work and now I have got 22.87cm – 10.5 inches now. And my wife love it more now, i began to feel the enlargement of my penis, This went on for a little period of about 5 days and to my surprise my wife keeps screaming that she love my big dick now. And my penis is now 10.5 inches long on erection and off course very large round. I am very happy for this Penis Enlargement experience. He can help with all kinds of cure you may need as flows:

    Pines Enlargement
    Low sperm count
    Weak Erection
    Love spell
    Herpes spell
    HIV spell
    Pregnancy spell
    Marriage for spell
    cancer
    watering sperm
    womb fertilization
    penis erection
    witch craft attack
    s t d diseases
    internal heat
    rashes
    low sperm count
    dairy
    long time sickness
    kidney,heart,lungs,problem
    with doctor,Dr. Trust you are in safe hands your healing is assured
    Email:Ultimatespellcast@gmail.com or Ultimatespellcast@yahoo.com
    Web site http://ultimatespellcast8.wix.com/ultimatespellcas
    Call +2348156885231

    ReplyDelete
  4. I would like to let all know that the size of your Penis really matters in your relationship or marriage. I got married to my wife about 1 month after we met on a photo studio, we lived happily for the first 3 months of our marriage until i and my wife started having quarrels at home because i couldn't satisfy her on bed with my little penis. Actually my penis was very small, it measured about 4.5 inch long on erection and i am 39 years old. My wife said it was forbidden by the women of this world. My wife started sleeping with other men outside. Sometimes i will return from work without finding my wife at home and whenever i call or ask her where she was, she will always snub at me and sometimes just tell me to go get a larger dick. All this continued for a long time and it hurt me so much that i was at the edge of breaking up on the marriage till when i read about a doctor called DR.Moses Buba. online. I never thought i could smile and be in a happy marriage again if not for the help of DR.Moses Buba. I got the doctors Emails:(buba.herbalmiraclemedicine@gmail.com ) on the internet and i emailed him, and he got back to me with some encouraging words, he got me some herbs cream which i use for just 8 days and i began to feel the enlargement of my penis, and without surgery. This went on for a little period of about 10 days and to my surprise my wife keeps screaming that she love my big dick now. Now my wife no longer cheat on me, and my penis is now about 10.5 inches long on erection and off course very large round. And now my wife uses breasts, hips and bums enlargement. I and my wife are very happy for the help rendered to me by DR.Moses Buba, and i want to say a big thanks to Doctor for the help. You can contact the Doctor now on his Email:( buba.herbalmiraclemedicine@gmail.com ) Am thankful to the doctor for helping me.

    ReplyDelete
  5. My husband left me and our 6 month old daughter at the end of last month. I was and still am devesated. He said he fell out of love with me and that we were no good for each other since all we did was argue and fight. He then changed his story before he left saying he would come back for us after 2 weeks of working and saving up and move us all down to flordia to live so we could raise our daughter without my family’s meddling in our business. Well once he was down there I found this wasn’t true. He told me it was over and that he wanted to sign his rights away to our daughter and he wants to divorce. He claims he is very happy down there and I am happy for him. Turns out I found from one of his friends that he had no intention of coming back and he said that stuff so I wouldn’t over react and cause a scene. I miss him so terribly much..we’ve only been married since Septmeber 2014 and he’s about to turn 21 next month and I am 22. My family says it’s his age that caused this and that he’s scared. I’ve prayed to god every single night to be there for him and to help him grow up and understand what it is he’s doing. Meanwhile my heart..it’s not feeling broken like it first was..yes I’m sad and miss my husband terribly but it’s like my heart is full of hope..even after us bickering on the phone 2 days ago I still feel hope that things will get better and we can save our marriage and Dr.OOMIRIMIRI spell brought smile back in our marriage contact him today on his email: OOMIRIMIRI@GMAIL.COM OR CALL +2349073244122

    ReplyDelete
  6. I'm Here to tell people over the world Dr.SABU is real herbalist that we help you in any situation problem...my testimony is about a herbalist Doctor called Dr.SABU I was heartbroken because i had a very SMALL PENIS, not big enough to satisfy a Woman, i have been in so many relationship,but cut off because of my situation, i have used so many product which doctors prescribe for me, but none could offer me the help i searched for. i saw some few comments on the internet about this specialist called Dr.SABU and decided to email him on his email i saw on the internet, (drsabuspelltemple@gmail.com) so I decided to give his herbal medicine a try. i emailed him and he got back to me, he gave me some comforting words with his herbal medicine for Penis Enlargement,Within 2week of it, i began to feel the Enlargement of my penis, ”and now it just 3weeks of using his herbal medicine my Penis is about 10 inches longer, and i had to settle out with my Ex (Girlfriend) i was surprised when she said that she is satisfied with my sex and i have got a large penis,Am so happy..email him to help you too.his WhatsApp number:+2347057624993 visit his website: https://drsabuspelltemple.wixsite.com/dr-sabu

    ReplyDelete
  7. I used to suffer from HERPES GENITAL for about 3 years so I can relate to people who have the cured. No medications or treatments ever really did anything for me (i tried them all no one work. but I was actually able to completely cure HERPES naturally after countless hours of online research. What worked for me is as follows: I saw Dr IDAHOSA Information online that he normally cure and treat disease and infirmities with his Herbal Medicine, I never really believed the people who where recommending him thou i saw on blog about 6 people where also testifying on how they were cured by Dr IDAHOSA,and still Ellen recommend Dr IDAHOSA who uses herbal medication to cure HERPES GENITAL VIRUS and gave me his email, so i mail him He told me all the things I need to do and also give me instructions to take, which I followed properly. Before I knew what is happening after two weeks the HERPES GENITAL VIRUS that was in my body got vanished . so if you are also heart broken and also need a help, you can also email him: hsvnaturalremedyclinic@gmail.com .. if you are infected with any disease like HIV, AIDS,CANCER, HERPES.PVC, or any other disease you can also be happy like me by contacting.....
    Name: Dr.IDAHOSA
    What apps Number: +2347033330164
    Email: hsvnaturalremedyclinic@gmail.com

    I’m given you 100% grantee, soon as you have getting in touch with Dr.IDAHOSA your problems will be solved accurately.

    Thanks

    ReplyDelete
  8. Do you know that many men today are suffering of weak erection of the penis, some men can only sex only one round & get tired, they can't go more than that one round of sex, before the penis will relax, while some men their penis's always weak even when it raise, it still looks soft. It can't go more than that one minute sex before the penis will relax. While some men their penis's very small, some ladies out there never enjoy those kind of penis. Some men have low sperm count which can't produce children, while some men have watery sperm (light sperm). This kind of sperm can't produce children too. If you are facing this kind of problem, pleased treat yourself & free from this problems. visit our website http://olihawonderfulherbs.webs.com or oliha.miraclemedicine@gmail.com or call him +2349038382931
    NOTE THAT THIS GREAT MAN CAN CURE ANY TYPES OF SICKNESS OKAY
    (1) hiv
    (2) herpes
    (3) penis enlargement
    (4) hepatitis A B C
    (5) pregnancy
    (6) molluscum
    (7) plantar wart
    AND OTHERS

    ReplyDelete
  9. Hello every one out there, My name is Johnson Adams am here to testify of the wonderful work Dr James has done for me with is herbal medicine, in the past years i have being going through hard times in any relationship am into, because of the small size of my penis which was not big enough to satisfy a woman, so which always end up in series of breakup in my relationship with women,because of this i have tried so many drugs to enlarge my penis but did not work out, then i decided to search online for solution to my problem and than came across so many testimony on how Dr James have helped them find solution to their problems,so i contacted him on his email and told him about my small penis and ejaculation issue, he told me not to worry that he will help me be a real man again, i did not believe he can help me but i gave him a try,he told me what to do and then send me his herbal cream and medicine which i used and it worked for me,now am a happy man. He can also cure diabetes, back pain, ex back, herpes,hepatitis and any kind of sickness you have. you can contact him on his email on (drjamesherbalhome@gmail.com). or through is whatsapp +2348106467120 or his web site https://drjamesherbalhome.wixsite.com/james This will be the end of your sexual problems and other problems

    ReplyDelete
  10. :EASY WAY TO CURE HERPES:

    i am millian josh, you can also add me on Facebook or send me an email via millianjosh@gmail.com. the main reason why i publish my email and Facebook account out, is that there are several scam on the internet who claim that they have the cure of herpes.i am here to share a marvel testimony,because i have being scam of $1800 by DR odogu. who so ever that claim such email is a scam.but i thank a kind Godsent man who cure my herpes without collecting money from me,his name is doctor OOSA. i never believed that their could be any complete cure for Herpes or any cure for herpes,i saw people’s testimony on blog sites and Facebook page of how Dr OOSA prepare herbal cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually and i had to leave without the herpes the doctor gave to me. Right now i can tell you that few months now i have not had any pain, and i have just went for text last week and the doctor confirmed that there is no trace of any herpes system on my body. Glory be to God for leading me to this genuine to Dr OOSA I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for herpes that is Not true ,just contact him and get cure from Dr OOSA via doctoroosaherbalhome@gmail.com and you will be free and free forever, Try it and you will not regret it because it truly works. One thing i have come to realize is that you never know how true it is until you try. There is no harm in trying. Remember, delay in treatment leads to something else.and i wonder why the USA doctor are not doing anything about this herpes and it spreading so fast.Here is his email: doctoroosaherbalhome@gmail.com Contact him and be free from herpes!thank you for helping me to cure my HERPES.

    ReplyDelete
  11. :EASY WAY TO CURE HERPES:

    i am millian josh, you can also add me on Facebook or send me an email via millianjosh@gmail.com. the main reason why i publish my email and Facebook account out, is that there are several scam on the internet who claim that they have the cure of herpes.i am here to share a marvel testimony,because i have being scam of $1800 by DR odogu. who so ever that claim such email is a scam.but i thank a kind Godsent man who cure my herpes without collecting money from me,his name is doctor OOSA. i never believed that their could be any complete cure for Herpes or any cure for herpes,i saw people’s testimony on blog sites and Facebook page of how Dr OOSA prepare herbal cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually and i had to leave without the herpes the doctor gave to me. Right now i can tell you that few months now i have not had any pain, and i have just went for text last week and the doctor confirmed that there is no trace of any herpes system on my body. Glory be to God for leading me to this genuine to Dr OOSA I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for herpes that is Not true ,just contact him and get cure from Dr OOSA via doctoroosaherbalhome@gmail.com and you will be free and free forever, Try it and you will not regret it because it truly works. One thing i have come to realize is that you never know how true it is until you try. There is no harm in trying. Remember, delay in treatment leads to something else.and i wonder why the USA doctor are not doing anything about this herpes and it spreading so fast.Here is his email: doctoroosaherbalhome@gmail.com Contact him and be free from herpes!thank you for helping me to cure my HERPES.

    ReplyDelete
  12. :EASY WAY TO CURE HERPES:

    i am millian josh, you can also add me on Facebook or send me an email via millianjosh@gmail.com. the main reason why i publish my email and Facebook account out, is that there are several scam on the internet who claim that they have the cure of herpes.i am here to share a marvel testimony,because i have being scam of $1800 by DR odogu. who so ever that claim such email is a scam.but i thank a kind Godsent man who cure my herpes without collecting money from me,his name is doctor OOSA. i never believed that their could be any complete cure for Herpes or any cure for herpes,i saw people’s testimony on blog sites and Facebook page of how Dr OOSA prepare herbal cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually and i had to leave without the herpes the doctor gave to me. Right now i can tell you that few months now i have not had any pain, and i have just went for text last week and the doctor confirmed that there is no trace of any herpes system on my body. Glory be to God for leading me to this genuine to Dr OOSA I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for herpes that is Not true ,just contact him and get cure from Dr OOSA via doctoroosaherbalhome@gmail.com and you will be free and free forever, Try it and you will not regret it because it truly works. One thing i have come to realize is that you never know how true it is until you try. There is no harm in trying. Remember, delay in treatment leads to something else.and i wonder why the USA doctor are not doing anything about this herpes and it spreading so fast.Here is his email: doctoroosaherbalhome@gmail.com Contact him and be free from herpes!thank you for helping me to cure my HERPES.

    ReplyDelete
  13. I GOT CURED FROM HERPES WITHIN 8 DAYS, AFTER USING DR OOSA HERBAL MEDICINE.

    I caught genital herpes from my ex boyfriend who never had any symptoms. I have had it for 4 months now,and it has affected my life. I have told my husband who I trusted about it and I have never had a bad reaction, it has affected my new relationships with my husband. People think herpes is really a minor skin irritation herpes has a long term effects on health. The stigma attached to this virus by ignorant people is ridiculous. Most people have herpes in one form or another. I would like to advise people on how i get rid of my herpes.i was reading a comment on the internet,and i saw a testimony posted by a woman from island that she get rid of her herpes with the help of doctor oosa. so i was so happy when i saw that post,that his herbal medication is free.i quickly collect the herbal doctor email and i email him within 5 hr he respond to my email.i explain things to him he told me not to worry that i should fill his herbal form wish i did.he only request for little money that he will use to buy the items for the preparation of the herbal medicine,wish i send to him because the pain was too much for me to bear.after some days he told me that he has prepare the herbal medicine,that i should send him my address that he want to sent it to me via DHL or FED-EX that was how i got the herbal medication.and i use it as i was told.after few days i found out that my herpes was no more.when some of my friend who has herpes saw me they were surprise and i also introduce them to the man and they are also cure from the same herpes.if you have herpes,kindly contact doctor oosa via this email doctoroosaherbalhome@gmail.com . i know people might be wondering why posting such things online but i am gland and i want each and everyone living with herpes to know that there's herpes cure because i have suffer for so many years searching for this cure.?

    ReplyDelete