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Brain Tumor

2010-05-04T22:15:00.001-07:00

A brain tumor is an abnormal growth of cells within the brain, which can be cancerous(malignant) or non-cancerous (benign). It is defined as any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes,oligodendrocytes, ependymal cells, myelin-producing Schwann cells), lymphatic tissue, blood vessels), in the cranial nerves, in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adult, although they can affect any part of the brain.

In the United States in the year 2005, it was estimated there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005–2006),^[1] which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths,^[2] and 20–25 percent of pediatric cancers.^[2]^[3] Ultimately, it is estimated there are 13,000 deaths per year in the United States alone as a result of brain tumors.^[1]

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[edit]Causes

Metastatic cancers are far more common than primary tumors of the brain and spinal cord.

Apart from exposure to vinyl chloride or ionizing radiation, there are no known environmental factors associated with brain tumors. Mutations and deletions of so-called tumor suppressor genes are thought to be the cause of some forms of brain tumors. Patients with various inherited diseases, such as Von Hippel-Lindau syndrome, multiple endocrine neoplasia, neurofibromatosis type 2 are at high risk of developing brain tumors. It is alleged that mobile phones/cell phones might be a cause of brain tumors, according to one report.^[4] (see Mobile phone radiation and health) There is an association of brain tumor incidence and malaria, suggesting that the anopheles mosquito, the carrier of malaria, might transmit a virus or other agent that could cause a brain tumor.^[5] Malignant brain tumor incidence and Alzheimer's disease prevalence are associated in 19 US states. The two diseases may share a common cause, possibly inflammation.^[6]

[edit]Signs and symptoms

Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor ("benign", i.e. slow-growing/late symptom onset, or malignant, fast growing/early symptom onset) is a frequent reason for seeking medical attention in brain tumor cases..

Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic eye examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increasedintracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporaluncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of theskull and bulging of the fontanelles.

Depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment, personality changes, hemiparesis,hypoesthesia, aphasia, ataxia, visual field impairment, facial paralysis, double vision, tremor etc. These symptoms are not specific for brain tumors—they may be caused by a large variety of neurologic conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects.

A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

[edit]Types of brain tumors

[edit]Diagnosis

Micrograph of an oligodendroglioma, a type ofbrain cancer. Brain biopsy. H&E stain.

Although there is no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, suddenintracranial hypertension (this may be due to bleeding within the tumor, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Glioblastoma multiforme and anaplastic astrocytoma have been associated in case reports onPubMed^[who?] with the genetic acute hepatic porphyrias (PCT, AIP, HCP and VP), including positive testing associated with drug refractory seizures. Unexplained complications associated with drug treatments with these tumors should alert physicians to an undiagnosed neurological porphyria.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI, although the appearance is variable. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is because these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability. However it is not possible to diagnose high versus low grame gliomas based on enhancement pattern alone.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histological examination is essential for determining the appropriate treatment and the correct prognosis. This examination, performed by a pathologist, typically has three stages: interoperative examination of fresh tissue, preliminary microscopic examination of prepared tissues, and followup examination of prepared tissues after immunohistochemical staining or genetic analysis.

Another possible diagnosis would be neurofibromatosis which can be in type one or type two.

ganglion cyst (Tendon Cyst)

2010-05-04T22:12:00.001-07:00

A ganglion cyst (also known as a bible cyst) is a swelling that often appears on or around jointsand tendons in the hand or foot. The size of the cyst can vary over time. It is most frequently located around the dorsum of wrist and on the fingers. The term "Bible Bump" comes from a common urban legend that treatment in the past consisted of pounding on the cyst with a Bible or another large book.^[1]

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[edit]Cause

Ganglion cysts are idiopathic, but presumably reflect a variation in normal joint or tendon sheathfunction. Cysts near joints are connected to the joint and the leading theory is that a type of check valve forms that allows fluid out of the joint, but not back in. The cyst contains clear fluid similar to, but thicker than, normal synovial fluid. They are most often found around the wrist joint, especially at the scapho-lunate joint, which accounts for 80% of all ganglion cysts.

[edit]Treatment

If a ganglion cyst is symptomatic, it can be managed by aspiration or excision. Aspiration and injection of hylase into the cyst is the simpler of the two procedures, but cysts recur in more than 50% of cases. With surgery, the recurrence rate is reduced to only 5 to 10% if the check valve at the joint capsule is removed.

Arthroscopy of the wrist is becoming available as an alternative to open excision of ganglion cysts. During arthroscopy, the origin of the cyst can be seen within the joint.

The traditional method of treating a ganglion cyst was to strike the lump with a large heavy book, causing the cyst to rupture and drain into the surrounding tissues. An urban legend states that since even the poorest households often possessed a Bible (referring to the large family Bibles), this was commonly used, which led to the nicknaming of ganglion cysts as "Jillian's lump" "Bible Bumps" or "Gideon's Disease."^[1]This type of treatment is not recommended by some doctors as it can damage the area around the cyst and the cyst may come back anyway.

[edit]Epidemiology

The epidemiology is not well studied, but some have stated that they occur most often in the 20–40 age group and are three times more common in women.^[2]

[edit]Image gallery

Gallstone

2010-05-04T22:09:00.000-07:00

Gallstones Overview

Gallstones (commonly misspelled gall stones) are solid particles that form frombile in the gallbladder.

The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.
The gallbladder is part of the biliary system, which includes the liver and thepancreas.
The biliary system, among other functions, produces bile and digestive enzymes.

Bile is a fluid made by the liver to help in the digestion of fats.

It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.
Bile is stored in the gallbladder until needed.
When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct. The bile then assists in the digestive process.

There are two types of gallstones: 1) cholesterol stones and 2) pigment stones.

Patients with cholesterol stones are more common in the United States, making up approximately 80% of all gallstones. They form when there is too much cholesterol in the bile.
Pigment stones form when there is excess bilirubin in the bile.

Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.
If stones are very small, they may form a sludge.
Whether gallstones cause symptoms depends partly on their size and their number, although no combination of number and size can predict whether symptoms will occur or the severity of the symptoms.

Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they move out of the gallbladder.

If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.
Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.
This can cause inflammation and ultimately severe pain, infection, and organ damage.
If these conditions go untreated, they can even cause death.

Up to 20% of adults in the United States may have gallstones, yet only 1%-3% develop symptoms.

Hispanics, Native Americans, and Caucasians of Northern European descent are most likely to be at risk for gallstones. African Americans are at lower risk.
Gallstones are most common among overweight, middle-aged women, but the elderly and men are more likely to experience more serious complications from gallstones.
Women who have been pregnant are more likely to develop gallstones. The same is true for women taking birth control pills or on hormone/estrogen therapy as this can mimic pregnancy in terms of hormone levels.

http://www.emedicinehealth.com/gallstones/article_em.htm

Clavicle Fracture

2008-01-27T23:34:00.001-08:00

What is a broken collarbone?

The collarbone, also called the clavicle, is the bone over the top of your chest, between your breastbone (sternum) and shoulder blade (scapula). It is easy to feel the clavicle, because unlike other bones which are covered with muscle, only skin covers a large part of the bone.

Clavicle fractures are extremely common. Broken collarbones occur in babies (usually during birth), children and adolescents (because the clavicle does not completely ossify, or develop, until the late teens), athletes (because of the risks of being hit or falling), or during many types of accidents and falls.

How does a collarbone fracture occur?
Clavicle fractures are common injuries, and they can occur different ways. Some patients fall on an outstretched hand, others fall and hit the outside of their shoulder.

Broken collarbones can also occur from a direct hit to the clavicle. In babies, clavicle fractures occur at birth during passage through the birth canal.

What are the symptoms of a broken collarbone?
Most often, patients have shoulder pain, and difficulty moving their arm. Swelling and bruising around the broken bone are also quite common. After the swelling has subsided, the fracture is often easily felt through the skin.

At the doctor's office or in the emergency room, an x-ray will show the fracture. Your doctor will also perform an examination to ensure the nerves and blood vessels surrounding the clavicle are in tact. The nerves and vessels are rarely injured because of a broken collarbone.

What is the treatment for a clavicle fractures?
Treatment of clavicle fractures most commonly involves resting the affected extremity. There are several types of slings available; one commonly used is called a"figure-of-8" splint. This is a brace that wraps around the shoulders to keep them back--like a soldier standing at attention.

It is unusual for a clavicle fracture to require surgery, and most often an attempt at treatment in a sling is made. Surgery is required in some situations when either the skin is broken or if the fracture is severely displaced or shortened.

How long does it take to recover from a collarbone fracture?
Clavicle fractures should heal completely within 12 weeks, but the pain usually subsides within a few weeks. Often patients are back to full activities before 12 weeks has passed, especially with younger patients.

As a general guide to return to activities, nothing should cause worsening pain. If not wearing a sling causes pain, wear a sling. If driving hurts the fracture site, don't drive. If throwing a ball hurts, don't throw. Once an activity doesn't cause significant pain, a gradual return can be attempted.

Recovery is usually complete, with a full return expected. Patients may notice a persistent bump where the fracture was (often for months or longer), but this should not be bothersome.

Gestational diabetes

2008-01-17T01:24:00.000-08:00

Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.^[1] No specific cause has been identified, but it is believed that the hormones produced during pregnancy reduce a woman's sensitivity to insulin, resulting in high blood sugar levels.

Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during pregnancy. Diagnostic tests detect high levels of glucose in blood samples.

Babies born to mothers with gestational diabetes are at increased risk of complications, primarily growth abnormalities and chemical imbalances such as low blood sugar. Gestational diabetes is a reversible condition and women who have adequate control of glucose levels can effectively decrease the associated risks and give birth to healthy babies.

Women with gestational diabetes are at high risk of developing type 2 diabetes mellitus after pregnancy, while their offspring are prone to developing childhood obesity, with type 2 diabetes later in life. Most patients are treated only with diet modification and moderate exercise but some take anti-diabetic drugs, including insulin therapy.

Polycystic Ovary Syndrome

2007-10-10T23:56:00.001-07:00

It is possible that the main title of the report Polycystic Ovary Syndrome is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

Bilateral Polycystic Ovarian Syndrome
Ovarian Hyperthecosis
Ovarian Syndrome
PCOS
Polycystic Bilateral Ovarian Syndrome
POS
Sclerocystic Ovarian Disease
Stein-Leventhal Syndrome
anovulation with hyperandrogenism

Disorder Subdivisions

None

General Discussion

Polycystic ovary syndrome (PCOS) affects women and is a complex of symptoms that are not necessarily all present in all cases. Some, but not all, affected women have multiple cysts on the ovaries (polycystic ovaries). Other characteristics include the absence of menstruation (amenorrhea) or irregular menstruation, failure of the ovary to release eggs (anovulation), elevated levels of the male hormones known as androgens (hyperandrogenism), excessive amounts of body hair (hirsutism), a high rate of miscarriage, and infertility. Three criteria often used for a diagnosis are menstrual irregularity, hyperandrogenism, and exclusion of other disease. There is some evidence that PCOS is an inherited condition.

Breast Lumps

2007-10-02T23:24:00.000-07:00

Breast mass

Definition
A breast lump is a swelling, protuberance, or lump in the breast.

Considerations

Normal breast tissue is present in both males and females of all ages. This tissue responds to hormonal changes and, therefore, certain lumps can come and go.

Breast lumps may appear at all ages:

* Infants may have breast lumps related to estrogen from the mother. The lump generally goes away on its own as the estrogen clears from the baby's body. It can happen to boys and girls.
* Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
* Teenage boys may develop breast enlargement and lumps because of hormonal changes in mid-puberty. Although this may distress the teen, the lumps or enlargement generally go away on their own over a period of months.
* Breast lumps in an adult woman raises concern for breast cancer, even though most lumps turn out to be not cancerous.

Causes

Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts.

Fibrocystic changes can occur in either or both breasts. These changes occur in many women (especially during the reproductive years) and are considered a normal variation of breast tissue. Having fibrocystic breasts does not increase your risk for breast cancer. It does, however, make it more difficult to interpret lumps that you or your doctor find on exam. Many women feel tenderness in addition to the lumps and bumps associated with fibrocystic breasts.

Fibroadenomas are non-cancerous lumps that feel rubbery and are easily moveable within the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender and, except in rare cases, do not become cancerous later. A doctor may feel fairly certain from an exam that a particular lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy them.

Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period. Cysts may be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears completely after it is drained, no further treatment is needed. If the fluid is bloody, it is sent to the lab to look for cancer cells. If the lump doesn't disappear, or recurs, it is usually removed surgically.

Other causes of breast lumps include:

* Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.
* Breast cancer, detectable by mammogram or ultrasound, then a biopsy. Men can get breast cancer.
* Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These tend to resolve on their own in a matter of days or weeks. If not, the blood may have to be drained by your doctor.
* Lipoma -- a collection of fatty tissue.
* Intraductal papilloma -- a small growth inside a milk duct of the breast. Often occurs near the areola, the colored part of the breast surrounding the nipple, in women between the ages of 35 and 55. It is harmless and frequently cannot be felt. In some cases the only symptom is a watery, pink discharge from the nipple. Since a watery or bloody discharge can also be a sign of breast cancer, this must be evaluated by your doctor.

Home Care

Treatment of a breast lump depends on the cause. Solid breast lumps are often removed surgically, or at least a biopsy is taken. The biopsy is to check whether it is cancerous or not. Cysts can be drained. Breast infections require antibiotics.

For fibrocystic changes, birth control pills are often helpful. Other women are helped by:

* Avoiding caffeine and chocolate
* Taking vitamin E, vitamin B complex, or evening primrose oil supplements
* Limiting fat and increasing fiber in the diet

If breast cancer is diagnosed, most women receive a combination of surgery, radiation, chemotherapy, and hormonal therapy. These options would be carefully assessed and thoroughly discussed with your doctor.

When to Contact a Medical Professional

Call your doctor if:

* You find a new breast lump during your monthly self-exam
* You have bruising on your breast but did not experience any injury
* You have nipple discharge, especially if bloody or pinkish (blood tinged)
* The skin on your breast appears dimpled or wrinkled (like the peel of an orange)
* Your nipple is inverted (turned inward) but normally is not inverted

Also call if:

* You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination
* You are a woman over age 40 and have not had a mammogram in the past year

What to Expect at Your Office Visit

Your doctor will obtain a complete history from you, with special attention to factors that may increase your risk of breast cancer. A thorough breast examination will be performed. If you don't know how to perform breast self-examination, ask your health care provider to teach you the proper method.

Medical history questions regarding breast lumps include:

* When and how did you first notice the lump?
* Do you have other symptoms such as pain, nipple discharge, or fever?
* Where is the lump located?
* Do you do self-breast exams and is this lump a recent change?
* Have you had any type of injury to your breast?
* Are you taking any hormones, medications, or supplements?

Tests that may be performed include:

* Study of nipple discharge under the microscope
* Needle aspiration of a cyst with examination of the fluid under a microscope
* Biopsy of the lump
* Ultrasound to see if the lump is solid or cystic
* Mammogram

If you have a family history of breast cancer, your doctor may also suggest testing for genes that predispose you to breast cancer.

Prevention

Breast cancer screening is an important way to find breast cancer early, when it is most easily treated and cured.

* If you are over age 20, consider doing a monthly breast self-exam. See: Breast self exam
* If you are over age 20, have a complete breast exam by your provider at least every 3 years -- every year if you are over 40.
* If you are over age 40, get mammogram once a year. If you are high risk, experts say you should start getting a mammogram at age 30.

Having fibrocystic breast tissue, mastitis, or breast tenderness related to PMS does NOT put you at greater risk for breast cancer. Having fibrocystic breasts does, however, make your self-exam more confusing since there are many normal lumps and bumps.

To prevent breast cancer:

* Exercise regularly
* Reduce fat intake
* Eat lots of fruits, vegetables, and other high fiber foods
* Do not drink more than one or one and a half glasses of alcohol a day

Mittelschmerz

2007-10-02T03:00:00.000-07:00

Mittelschmerz (German: "middle pain") is a medical term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently.

Mittelschmerz is characterised by lower abdominal and pelvic pain that occurs roughly midway through a woman's menstrual cycle. The pain can appear suddenly and usually subsides within hours, although it may sometimes last two or three days.^[1] In some women, the mittelschmerz is localized enough so that they can tell which of their two ovaries provided the egg in a given month. Because ovulation occurs on a random ovary each cycle, the pain may switch sides or stay on the same side from one cycle to another.

Diagnosis of mittelschmerz is generally made if a woman is mid-cycle and a pelvic examination shows no abnormalities. If the pain is prolonged and/or severe, other diagnostic procedures such as an abdominal ultrasound may be performed to rule out other causes of abdominal pain.

The pain of mittelschmerz is sometimes mistaken for appendicitis and is one of the differential diagnoses for appendicitis in women of child-bearing age.

The pain is not harmful and does not signify the presence of disease. No treatment is usually necessary. Pain relievers (analgesics) may be needed in cases of prolonged or intense pain.

Hormonal forms of contraception can be taken to prevent ovulation -- and therefore ovulatory pain -- but otherwise there is no known prevention.

Mittelschmerz is believed to have a variety of causes:

The swelling of follicles in the ovaries prior to ovulation. While only one or two eggs mature to the point of being released, a number of follicles grow during the follicular phase^[2] of the menstrual cycle (non-dominant follicles atrophy prior to ovulation). Because follicles develop on both sides, this theory explains mittelschmerz that occurs simultaneously on both sides of the abdomen.

The ovaries have no openings; at ovulation the egg breaks through the ovary's wall. This may make ovulation itself painful for some women.^[2]

At the time of ovulation, blood or other fluid is released from the ruptured egg follicle. This fluid may cause irritation of the abdominal lining.^[1]^[2]

After ovulation, the fallopian tubes contract (similar to peristalsis of the esophagus), which may cause pain in some women.^[1]

At ovulation, this pain may be related to smooth muscle cell contraction in the ovary as well as in its ligaments. These contractions are in response to an increased level of prostaglandin F2-alpha mediated by the surge of leutinizing hormone (LH).^[3]

Women charting with some form of fertility awareness may find mittelschmerz to be a helpful secondary sign in detecting ovulation. Because normal sperm life is up to five days, however, mittelschmerz alone does not provide sufficient advance warning to avoid pregnancy. Because other causes of minor abdominal pain are common, mittelschmerz alone also cannot be used to confirm the beginning of the post-ovulatory infertile period.

Women may notice other physical symptoms associated with their mittelschmerz, or near ovulation. The most common sign is the appearance of fertile cervical mucus in the days leading up to ovulation. Cervical mucus is one of the primary signs used by various fertility awareness methods. Other symptoms are sometimes called secondary fertility signs to distinguish from the three primary signs.^[2]

Mid-cycle or ovulatory bleeding is thought to result from the sudden drop in estrogen that occurs just before ovulation. This drop in hormones can trigger withdrawal bleeding in the same way that switching from active to placebo birth control pills does. The rise in hormones that occurs after ovulation prevents such mid-cycle spotting from becoming as heavy or long lasting as a typical menstruation. Spotting is more common in longer cycles.^[2]

A woman's vulva may swell just prior to ovulation, especially the side on which ovulation will occur.^[2]

One of the groin lymph nodes (on the side on which ovulation will occur) will swell to about the size of a pea, and may become tender.

Melatonin

2007-09-23T23:05:00.000-07:00

Melatonin, 5-methoxy-N-acetyltryptamine, is a hormone found in all living creatures from algae[1] to humans, at levels that vary in a diurnal cycle.

Many biological effects of melatonin are produced through activation of melatonin receptors,[2] while others are due to its role as a pervasive and extremely powerful antioxidant[3] with a particular role in the protection of nuclear and mitochondrial DNA.[4]

Melatonin was released into the general health supplement market in the United States in 1993, and met with good consumer acceptance and enthusiasm.[5]

In higher animals, melatonin is produced by pinealocytes in the pineal gland (located in the brain) and also by the retina, lens and GI tract. It is naturally synthesized from the amino acid tryptophan (via synthesis of serotonin) by the enzyme 5-hydroxyindole-O-methyltransferase.

Production of melatonin by the pineal gland is under the influence of the suprachiasmatic nucleus (SCN) of the hypothalamus which receives information from the retina about the daily pattern of light and darkness.

Melatonin is also synthesized by various plants, such as rice, and ingested melatonin has been shown to be capable of reaching and binding to melatonin binding sites in the brains of mammals.[6][7]

A study indicates that patients with nocturnal asthma may experience adverse effects from melatonin supplements. According to the study “Immunomodulatory Effects of Melatonin in Asthma”, even small amounts of supplemental melatonin worsen the symptoms of the inflammatory disease asthma by causing the body to release chemicals which provoke inflammation. The inflammatory chemicals include increased production of interleukin-1, interleukin-6, and tumor necrosis factor-alpha [8].

Melatonin produced in the pineal gland acts as an endocrine hormone since it is released into the blood. By contrast, melatonin produced by the retina and the gastrointestinal (GI) tract acts as a paracrine hormone.

Biological clock

See also: Phase response curve

In humans, melatonin is produced by the pineal gland, a gland about the size of a pea, that is located in the center of the brain, on the dorsal surface of diencephalon. The melatonin signal forms part of the system that regulates the circadian cycle, but it is the Central nervous system that controls the daily cycle in most components of the paracrine and endocrine systems[9][10] rather than the melatonin signal (as was once postulated).

Normally, the production of melatonin by the pineal gland is inhibited by light and permitted by darkness. For this reason melatonin has been called "the hormone of darkness." The secretion of melatonin peaks in the middle of the night, and gradually falls during the second half of the night. Until recent history, humans in temperate climates were exposed to up to eighteen hours of darkness in the winter. In this modern world, artificial lighting typically reduces this to eight hours or less per day all year round. Even low light levels inhibit melatonin production to some extent, but over-illumination can create significant reduction in melatonin production. Reduced melatonin production has been proposed as a likely factor in the significantly higher cancer rates in night workers,[11] and the effect of modern lighting practice on endogenous melatonin has been proposed as a contributory factor to the larger overall incidence of some cancers in the developed world.[12] As inadequate as blood concentrations may be in brightly-lit environments, some scientists now believe that people's overnight output of melatonin can be further jeopardized each time they interrupt their sleep and turn on a bright light (suggesting that the lower brightness level of a nightlight would be safer). Others suggest that such short exposures do no harm.[13]

Although the primary site of melatonin's action in humans is the melatonin receptors, it first evolved as an antioxidant. In many lower life forms, it serves only this purpose.[14]

Melatonin is a powerful antioxidant that can easily cross cell membranes and the blood-brain barrier.[3] Unlike other antioxidants, melatonin does not undergo redox cycling, the ability of a molecule to undergo reduction and oxidation repeatedly. Redox cycling may allow other antioxidants (such as vitamin C) to act as pro-oxidants, counterintuitively promoting free radical formation. Melatonin, once oxidized, cannot be reduced to its former state because it forms several stable end-products upon reacting with free radicals. Therefore, it has been referred to as a terminal (or suicidal) antioxidant.[15]

Recent research indicates that the beginning of the melatonin antioxidant pathway may be N(1)-acetyl-N(2)-formyl-5-methoxykynuramine or AFMK rather than the common, excreted 6-hydroxymelatonin sulfate. AFMK alone is detectable in unicellular organisms and metazoans. A single AFMK molecule can neuralize up to 10 ROS/RNS since many of the products of the reaction/derivatives (including melatonin) are themselves antioxidants, and so on. This capacity to absorb free radicals extends at least to the quaternary metabolites of melatonin, a process referred to as "the free radical scavenging cascade". This is not true of other, conventional antioxidants.[14]

In animal models, melatonin has been demonstrated to prevent the damage to DNA by some carcinogens, stopping the mechanism by which they cause cancer.[16]

The antioxidant activity of melatonin may reduce damage caused by some types of Parkinson's disease, may play a role in preventing cardiac arrhythmia and may increase longevity; it has been shown to increase the average life span of mice by 20% in some studies.[17][18][19]

Immune system
While it is clear that melatonin interacts with the immune system,[20][21] the details of those interactions are unclear. There have been few trials designed to judge the effectiveness of melatonin in disease treatment. Most existing data are based on small, incomplete, clinical trials.

Melatonin is an immunoregulator that can enhance T cell production. When taken in conjunction with calcium, it is an immunostimulator and is used as an adjuvant in some clinical protocols; conversely, the increased immune system activity may aggravate autoimmune disorders.

Many supplemental melatonin users have reported an increase in the vividness or frequency of dreams. High doses of melatonin (50mg) dramatically increased REM sleep time and dream activity in both narcoleptics and normal people.[22]

Many psychoactive drugs, such as LSD and cocaine, increase melatonin synthesis.[22] It has been suggested that nonpolar (lipid-soluble) indolic hallucinogenic drugs emulate melatonin activity in the awakened state and that both act on the same areas of the brain.[22]

In a 2005 editorial of the British Journal of Psychiatry, Ben Sessa suggested that psychotropic drugs be readmitted in the field of scientific enquiry and therapy.[23] Melatonin, being two endogenous hallucinogenic indoles like N,N-dimethyltryptamine (DMT), is likely to be research priorities in this reemerging field of psychiatry.[24]

Melatonin appears to have some use against circadian rhythm sleep disorders, such as jet lag and delayed sleep phase syndrome. It has been studied for the treatment of cancer, immune disorders, cardiovascular diseases, depression, seasonal affective disorder (SAD), and sexual dysfunction. A study by Alfred J. Lewy and other researchers at Oregon Health & Science University found that it may ameliorate SAD and circadian misalignment,[25] but as of 2006 it is known to affect the timing of endogenous melatonin production, raising the risk that it can exacerbate both clinical depression and SAD.[26] Basic research indicates that melatonin may play a significant role in modulating the effects of drugs of abuse such as cocaine.[27]

Melatonin has been shown to reduce tissue damage in rats due to ischemia in both the brain[28] and the heart;[29] however, this has not been tested in humans.

Melatonin receptors appear to be important in mechanisms of learning and memory in mice,[30] and melatonin can alter electrophysiological processes associated with memory, such as long-term potentiation (LTP). Melatonin has been shown to prevent the hyperphosphorylation of the tau protein in rats. Hyperphosphorylation of tau protein can result in the formation of neurofibrillary tangles, a pathological feature seen in Alzheimer's disease. Thus, melatonin may be effective for treating Alzheimer's Disease.[31] These same neurofibrillary tangles can be found in the hypothalamus in patients with Alzheimer's, adversely affecting their body's production of melatonin. Those Alzheimer's patients with this specific affliction often show heightened afternoon agitation, called "sundowning," which has been shown in many studies to be effectively treated with melatonin supplements in the evening.[32]

ADHD is most commonly treated with methylphenidate which may cause insomnia in approximately 94% of its users. Research shows that after melatonin is administered to the patients, the time needed to fall asleep is significantly reduced. Before the melatonin was administered, the time needed to fall asleep ranged from 15 minutes to 240 minutes. After the melatonin was administred, the time needed to fall asleep ranged from 15 minutes to 64 minutes. Furthermore, the effects of the melatonin after three months showed no change from its effects after one week of use.[33]

Recent research has concluded that melatonin supplementation in perimenopausal women produces a highly significant improvement in thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing the depression associated with the menopause.[34]

Some resources warn women trying to conceive not to take a melatonin supplement.[35]

Melatonin has been shown to be effective in treating one form of depression, Seasonal Affective Disorder. [1]

Some studies have shown that melatonin has potential for use in the treatment of various forms of cancer, HIV, and other viral diseases; however, further testing is necessary to confirm this.[38]

Histologically speaking, it is also believed that melatonin has some effects for sexual growth in higher organisms. (*Quoted from Ross Histology and Wheather's Functional Histology.)

The primary motivation for the use of melatonin as a supplement is as a natural aid to better sleep, with other incidental benefits to health and well-being due to its role as an antioxidant and its stimulation of the immune system and several components of the endocrine system.

Victor Herbert, M.D., J.D., of the Mt. Sinai School of Medicine, cites studies from Massachusetts Institute of Technology that say melatonin pills sold as supplements contain three to 10 times the amount needed to produce the desirable physiologic nocturnal blood melatonin level for enhancement of nighttime rest. Dosages are designed to raise melatonin levels for several hours to enhance quality of sleep, but some studies suggest that smaller doses are just as effective at improving sleep quality.[39] High dose melatonin can even be counterproductive: Lewy & al[40] provide support to the "idea that too much melatonin may spill over onto the wrong zone of the melatonin phase-response curve." In their study, 0.5 mg of melatonin was effective while 20 mg wasn't. A practical implication of these results is that effective melatonin supplementation (for sleep problems) thus becomes very accessible: it costs a fraction of what most researchers thought it might cost. Melatonin supplementation for sleep problems is available without prescription in most cases in the United States. Melatonin supplements are available as oral supplements and transdermal melatonin or "melatonin sleep patch".

Melatonin is involved in the regulation of body weight, and may be helpful in treating obesity (especially when combined with calcium).[41]

Melatonin is practically nontoxic and exhibits almost no short-term side effects. However, melatonin derived from animal sources may be contaminated with viral material; synthetic melatonin may be taken to avoid this risk.[42] No studies have been conducted yet to determine whether there are any long-term side effects.

Even though it is seen as a relatively safe, benign drug, especially to herbal enthusiasts, it can cause some unwanted side effects, especially at high doses. The bodies of people under age 35 are usually able to produce an adequate supply of melatonin on their own.[citation needed] Ingesting melatonin supplements can cause hormone fluctuations,[2] irritability,[3] reduced blood flow (see below), and increased sleep disturbances, including vivid nightmares.[4]

Melatonin taken in combination with monoamine oxidase inhibitors (MAOIs) can lead to overdose because MAOIs inhibit the breakdown of melatonin by the body. Exogenous melatonin normally does not affect the endogenous melatonin profile in the short or medium-term, merely advancing the phase of endogenous melatonin production in time.

In individuals with auto-immune disorders, there is concern that melatonin supplementation may exacerbate symptoms due to stimulation of the immune system.[43]

Melatonin causes somnolence, and therefore should not be taken within five hours[citation needed] before driving, operating machinery, etc. As melatonin is almost always taken at the end of the waking day, this is generally not an issue.

Individuals who experience orthostatic intolerance, a cardiovascular condition that results in reduced blood pressure and blood flow to the brain when a person stands, may experience a worsening of symptoms when taking melatonin supplements, a study at Penn State College of Medicine's Milton S. Hershey Medical Center suggests. Melatonin can exacerbate the symptoms by reducing nerve activity in those who experience the condition, the study found.[44]

Melatonin has been classified as a dietary supplement and made freely available in the USA.[45]

Many animals use the variation in duration and quantity of melatonin production in each day as a seasonal clock.[46] In seasonal breeders which do not have long gestation periods, and which mate during longer daylight hours, the melatonin signal controls the seasonal variation in their sexual physiology, and similar physiological effects can be induced by exogenous melatonin in animals including mynah birds[47] and hamsters.[48] Melatonin can suppress libido by inhibiting secretion of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the anterior pituitary gland, especially in mammals that have a breeding season when daylight hours are long. The reproduction of long-day breeders is repressed by melatonin and the reproduction of short-day breeders is stimulated by melatonin.

Melatonin is also related to the mechanism by which some amphibians and reptiles change the color of their skin.[49][50]

Leukemia

2007-09-20T20:37:00.000-07:00

What is leukemia?

Leukemia is a type of cancer. Cancer is a group of many related diseases. All cancers begin in cells, which make up blood and other tissues. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. Leukemia is cancer that begins in blood cells.

Normal Blood Cells

Blood cells form in the bone marrow. Bone marrow is the soft material in the center of most bones.

Immature blood cells are called stem cells and blasts. Most blood cells mature in the bone marrow and then move into the blood vessels. Blood that flows through the blood vessels and heart is called the peripheral blood.

The bone marrow makes different types of blood cells. Each type has a special function:

White blood cells help fight infection.

Red blood cells carry oxygen to tissues throughout the body.

Platelets help form blood clots that control bleeding.

Leukemia Cells

In people with leukemia, the bone marrow produces abnormal white blood cells. The abnormal cells are leukemia cells. At first, leukemia cells function almost normally. In time, they may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for blood to do its work.

What are the types of leukemia?

The types of leukemia are grouped by how quickly the disease develops and gets worse. Leukemia is either chronic (gets worse slowly) or acute (gets worse quickly):

Chronic leukemia — Early in the disease, the abnormal blood cells can still do their work, and people with chronic leukemia may not have any symptoms. Slowly, chronic leukemia gets worse. It causes symptoms as the number of leukemia cells in the blood rises.

Acute leukemia — The blood cells are very abnormal. They cannot carry out their normal work. The number of abnormal cells increases rapidly. Acute leukemia worsens quickly.

The types of leukemia are also grouped by the type of white blood cell that is affected. Leukemia can arise in lymphoid cells or myeloid cells. Leukemia that affects lymphoid cells is called lymphocytic leukemia. Leukemia that affects myeloid cells is called myeloid leukemia or myelogenous leukemia.

There are four common types of leukemia:

Chronic lymphocytic leukemia (chronic lymphoblastic leukemia, CLL) accounts for about 7,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.

Chronic myeloid leukemia (chronic myelogenous leukemia, CML) accounts for about 4,400 new cases of leukemia each year. It affects mainly adults.

Acute lymphocytic leukemia (acute lymphoblastic leukemia, ALL) accounts for about 3,800 new cases of leukemia each year. It is the most common type of leukemia in young children. It also affects adults.

Acute myeloid leukemia (acute myelogenous leukemia, AML) accounts for about 10,600 new cases of leukemia each year. It occurs in both adults and children.

Hairy cell leukemia is a rare type of chronic leukemia. This booklet does not deal with hairy cell leukemia or other rare types of leukemia. Together, these rare leukemias account for about 5,200 new cases of leukemia each year.

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Who is at risk for Leukemia?

No one knows the exact causes of leukemia. Doctors can seldom explain why one person gets this disease and another does not. However, research has shown that people with certain risk factors are more likely than others to develop leukemia. A risk factor is anything that increases a person’s chance of developing a disease.

Studies have found the following risk factors for leukemia:

Very high levels of radiation — People exposed to very high levels of radiation are much more likely than others to develop leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) and nuclear power plant accidents (such as the Chernobyl [also called Chornobyl] accident in 1986).

Medical treatment that uses radiation can be another source of high-level exposure. Radiation used for diagnosis, however, exposes people to much lower levels of radiation and is not linked to leukemia.

Working with certain chemicals — Exposure to high levels of benzene in the workplace can cause leukemia. Benzene is used widely in the chemical industry. Formaldehyde is also used by the chemical industry. Workers exposed to formaldehyde also may be at greater risk of leukemia.

Chemotherapy — Cancer patients treated with certain cancer-fighting drugs sometimes later develop leukemia. For example, drugs known as alkylating agents are associated with the development of leukemia many years later.

Down syndrome and certain other genetic diseases—Some diseases caused by abnormal chromosomes may increase the risk of leukemia.

Human T-cell leukemia virus-I (HTLV-I)—This virus causes a rare type of chronic lymphocytic leukemia known as human T-cell leukemia. However, leukemia does not appear to be contagious.

Myelodysplastic syndrome — People with this blood disease are at increased risk of developing acute myeloid leukemia.

In the past, some studies suggested exposure to electromagnetic fields as another possible risk factor for leukemia. Electromagnetic fields are a type of low-energy radiation that comes from power lines and electric appliances. However, results from recent studies show that the evidence is weak for electromagnetic fields as a risk factor.

Most people who have known risk factors do not get leukemia. On the other hand, many who do get the disease have none of these risk factors. People who think they may be at risk of leukemia should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

What are symptoms of leukemia?

Like all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms.

Common symptoms of leukemia:

Fevers or night sweats
Frequent infections
Feeling weak or tired
Headache
Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
Pain in the bones or joints
Swelling or discomfort in the abdomen (from an enlarged spleen)
Swollen lymph nodes, especially in the neck or armpit
Weight loss

Such symptoms are not sure signs of leukemia. An infection or another problem also could cause these symptoms. Anyone with these symptoms should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.

In the early stages of chronic leukemia, the leukemia cells function almost normally. Symptoms may not appear for a long time. Doctors often find chronic leukemia during a routine checkup—before there are any symptoms. When symptoms do appear, they generally are mild at first and get worse gradually.

In acute leukemia, symptoms appear and get worse quickly. People with this disease go to their doctor because they feel sick. Other symptoms of acute leukemia are vomiting, confusion, loss of muscle control, and seizures. Leukemia cells also can collect in the testicles and cause swelling. Also, some patients develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.

Amyloidosis

2007-09-18T02:47:00.000-07:00

In medicine, amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues, causing disease. A protein is amyloid if, due to an alteration in its secondary structure, it takes on a particular insoluble form, called the beta-pleated sheet.

Approximately 25 different proteins are known that can form amyloid in humans, most of them are constituents of the plasma.

Different amyloidoses can be systemic (affecting many different organ systems) or organ-specific. Some are inherited, due to mutations in the precursor protein. Other, secondary forms are due to different diseases causing overabundant or abnormal protein production-such as with over production of immunoglobulin light chains in multiple myeloma (termed AL amyloid), or with continuous overproduction of acute phase proteins in chronic inflammation (which can lead to AA amyloid).

Amyloid can be diagnosed on histological examination of affected tissue. Amyloid deposits can be identified histologically by Congo red staining and viewing under polarized light where amyloid deposits produce a distinctive 'apple green birefringence'. Further, specific, tests are available to more precisely identify the amyloid protein. Biopsies are taken from affected organs (for example, the kidney), or often in the case of systemic amyloid, from the rectum or anterior abdominal adipose tissue. In addition, all amyloid deposits contain serum amyloid P component (SAP), a circulating protein of the pentraxin family. Radionuclide SAP scans have been developed which can anatomically localize amyloid deposits in patients.

Primary/Hereditary amyloidosis

These rare hereditary disorders are usually due to point mutations in precursor proteins, and are also usually autosomal dominantly transmitted.The precursor proteins are;

transthyretin-the most commonly implicated protein.
lysozyme
apolipoprotein B
fibrinogen
apolipoprotein A1
gelsolin

Secondary amyloidosis

These are far more common than the primary amyloidoses.

AL amyloidosis (immunoglobulin light chains are the precursor protein, overproduced in multiple myeloma). This is sometimes, confusingly and erroneously, called 'primary amyloidosis'.
AA amyloidosis (the precursor protein is serum amyloid A protein (SAA), an acute-phase protein due to chronic inflammation). In contrast to AL amyloid, this has previously been termed 'secondary amyloidosis'.These occur with a wide variety of diseases associated with chronic inflammation, such as Rheumatoid arthritis, Familial Mediterranean fever or chronic infection.
Dialysis related amyloidosis (the precursor protein is beta-2-microglobulin which is not removed with dialysis, and thus accumulates in patients with end stage renal failure on dialysis).

Organ-specific amyloidosis

In almost all of the organ-specific pathologies, there is significant debate as to whether the amyloid plaques are the causal agent of the disease or instead a downstream consequence of a common idiopathic agent. The associated proteins are indicated in parentheses.

Neurological amyloid

Alzheimer's disease (Aβ 39-43)
Parkinson's disease (alpha-synuclein)
Huntington's disease (huntingtin)
Transmissible spongiform encephalopathies caused by prion protein (PrP) were sometimes classed as amyloidoses, as one of the four pathological features in diseased tissue is the presence of amyloid plaques. These diseases include;
- Creutzfeldt-Jakob disease (PrP in cerebrum)
- Kuru (diffuse PrP deposits in brain)
- Fatal Familial Insomnia (PrP in thalamus)
- Bovine spongiform encephalopathy (PrP in cerebrum of cows)

Cardiovascular amyloid

Cardiac amyloidosis
- Senile cardiac amyloidosis-may cause heart failure
Congophilic angiopathy

Other

Amylin deposition can occur in the pancreas in some cases of type 2 diabetes mellitus

Non-Hodgkin lymphoma

2007-09-06T21:50:00.000-07:00

Non-Hodgkin lymphoma (NHL) describes a group of cancers arising from lymphocytes, a type of white blood cell. It is distinct from Hodgkin lymphoma in its pathologic features, epidemiology, common sites of involvement, clinical behavior, and treatment. The non-Hodgkin lymphomas are a diverse group of diseases with varying courses, treatments, and prognoses.

Non-Hodgkin lymphoma may develop in any organ associated with the lymphatic system (e.g. spleen, lymph nodes, or tonsils). Most cases start with infiltration of lymph nodes, but some subtypes may be restricted to other lymphatic organs.

The diagnosis of non-Hodgkin lymphoma requires a biopsy of involved tissue. The numerous subtypes of non-Hodgkin lymphoma are typically grouped into three distinct categories based on their aggressiveness, or histologic grade. These categories are indolent (or low-grade), aggressive (or intermediate-grade), and highly aggressive (or high-grade). The treatment of indolent or low-grade lymphoma may initially involve a period of observation, while aggressive or highly aggressive non-Hodgkin lymphoma is typically treated with chemotherapy and/or radiation therapy.

The most common symptom of non-Hodgkin's lymphoma is a painless swelling of the lymph nodes in the neck, underarm (axilla), or groin.

Other symptoms may include the following:

Unexplained fever
Unexplained weight loss and anorexia (poor appetite)
Constant fatigue
Itchy skin
Reddened patches on the skin

Such symptoms are non-specific and may be caused by other, less serious conditions.

If non-Hodgkin's lymphoma is suspected, the doctor asks about the person's medical history and performs a physical exam. The exam includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged. In addition to checking general signs of health, the doctor may perform blood tests.

Excisional biopsy NHL specimen

The doctor may also order tests that produce pictures of the inside of the body. These may include:

X-rays: Pictures of areas inside the body created by high-energy radiation.
CT scan (computed tomography scan, also known as a "CAT scan"): A series of detailed pictures of areas inside the body. The pictures are created by a computer linked to an x-ray machine.
PET scan (positron emission tomography scan): This is an imaging test that detects uptake of a radioactive tracer by the tumor. More often, the PET scan can be combined with the CT scan.
MRI (magnetic resonance imaging): Detailed pictures of areas inside the body produced with a powerful magnet linked to a computer.

Less commonly used

Lymphangiogram: Pictures of the lymphatic system taken with x-rays after a special dye is injected to outline the lymph nodes and vessels. This test is not used as often because of the adoption of CT scan and the PET scan technologies.
Gallium scan: Gallium is a rare metal that behaves in the body in a fashion similar to iron, so that it concentrates in areas of inflammation or rapid cell-division, and hence is useful for imaging the entire lymphatic system for staging of lymphoma once the presence of the disease has been confirmed. PET scans have supplanted gallium scans for evaluation and follow up of NHL.

Biopsy

A biopsy is needed to make a diagnosis. A surgeon removes a sample of tissue, which a pathologist can examine under a microscope to check for cancer cells. A biopsy for non-Hodgkin's lymphoma is usually taken from lymph nodes that are enlarged, but other tissues may be sampled as well. Biopsies in internal lymph nodes can also taken as needle biopsies under the guidance of CT scans. Rarely, an operation called a laparotomy may be performed. During this operation, a surgeon cuts into the abdomen and removes samples of tissue to be checked under a microscope.

Types of non-Hodgkin's lymphoma

Over the years, doctors have used a variety of terms to classify the many different types of non-Hodgkin's lymphoma . Most often, they are grouped by how the cancer cells look under a microscope and how quickly they are likely to grow and spread. Current lymphoma classification is complex.

MeSH includes four different criteria for classifying NHL. (It is possible to be classified under more than one.)

High-grade vs. intermediate vs. low-grade: Aggressive lymphomas, also known as intermediate and high-grade lymphomas, tend to grow and spread quickly and cause severe symptoms. Indolent lymphomas, also referred to as low-grade lymphomas, tend to grow quite slowly and cause fewer symptoms. One of the paradoxes of non-Hodgkin's lymphoma is that the indolent lymphomas generally cannot be cured by chemotherapy, while in a significant number of cases aggressive lymphomas can be.

Diffuse vs. follicular: Follicular lymphoma tends to be indolent, and diffuse lymphoma tends to be aggressive.

T-cell lymphoma vs. B-cell lymphoma
- Gluten-sensitive enteropathy associated T-cell lymphoma or EATL

Large cell lymphoma (such as anaplastic large cell lymphoma) vs. Small cell lymphoma vs. Mixed cell lymphoma

Details of the most popular classifications of lymphoma can be found in the lymphoma page.

Causes

The etiology, or cause, of most lymphomas is not known. Some types of lymphomas are associated with viruses. Burkitt's lymphoma, extranodal NK/T cell lymphoma, classical Hodgkin's disease and most AIDS-related lymphoma are associated with Epstein-Barr virus. Adult T-cell lymphoma/leukemia, endemic in parts of Japan and the Caribbean, is caused by the HTLV-1 virus. Lymphoma of the stomach (extranodal marginal zone B-cell lymphoma) is often caused by the Helicobacter bacteria.

The incidence of non-Hodgkin's lymphoma has increased dramatically over the last couple of decades. This disease has gone from being relatively rare to being the fifth most common cancer in the United States. At this time, little is known about the reasons for this increase or about exactly what causes non-Hodgkin's lymphoma.

Doctors can seldom explain why one person gets non-Hodgkin's lymphoma and another does not. It is clear, however, that cancer is not caused by an injury, and is not contagious; no one can "catch" non-Hodgkin's lymphoma from another person.

By studying patterns of cancer in the population, researchers have found certain risk factors that are more common in people who get non-Hodgkin's lymphoma than in those who do not. However, most people with these risk factors do not get non-Hodgkin's lymphoma, and many who do get this disease have none of the known risk factors.

The following are some of the risk factors associated with this disease:

Age/sex. The likelihood of getting non-Hodgkin's lymphoma increases with age and is more common in men than in women.
Weakened immune system (AIDS-related lymphoma). Non-Hodgkin's lymphoma is more common among people with inherited immune deficiencies, autoimmune diseases, or HIV/AIDS, and among people taking immunosuppressant drugs following organ transplants. (see Post-transplant lymphoproliferative disorder)
Viruses. Human T-lymphotropic virus type I (HTLV-1) and Epstein-Barr virus are two infectious agents that increase the chance of developing non-Hodgkin's lymphoma.
Environment. People who work extensively with or are otherwise exposed to certain chemicals, such as pesticides, solvents, or fertilizers, have a greater chance of developing non-Hodgkin's lymphoma.

People who are concerned about non-Hodgkin's lymphoma should talk with their doctor about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the person's age, medical history, and other factors.

Staging

If non-Hodgkin's lymphoma is diagnosed, the doctor needs to learn the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Treatment decisions depend on these findings.^[1]

The doctor considers the following to determine the stage of non-Hodgkin's lymphoma:

The number and location of affected lymph nodes;
Whether the affected lymph nodes are above, below, or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen);
Whether the disease has spread to the bone marrow, spleen, or to organs outside the lymphatic system, such as the liver;

and the testes.

Whether B symptoms (systemic symptoms) such as fever, chills, night sweats, or weight loss are present.

In staging, the doctor may use some of the same tests used for the diagnosis of non-Hodgkin's lymphoma. Other staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone. A pathologist examines the sample under a microscope to check for cancer cells.

Stages of NHL

The various stages of NHL (the Ann Arbor staging classification, developed for Hodgkin's lymphoma) are based on how far the cancer has spread throughout and beyond the lymphatic system, and whether constitutional symptoms (fever, night sweats, or weight loss) are present.

Stage I: "Stage I" indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.
Stage II: "Stage II" indicates that the cancer is located in two separate regions, an affected lymph node or organ within the lymphatic system and a second affected area, and that both affected areas are confined to one side of the diaphragm - that is, both are above the diaphragm, or both are below the diaphragm.
Stage III: "Stage III" indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.
Stage IV: "Stage IV" indicates that the cancer has spread beyond the lymphatic system and involves one or more major organs, possibly including the bone marrow or skin.

The absence of constitutional symptoms is denoted by adding an "A" to the stage; the presence is denoted by adding a "B" to the stage (hence the name B symptoms).

Staging in non-Hodgkin's lymphomas is far less significant in determining therapy than it is in Hodgkin's lymphoma

Prognosis

See also: International Prognostic Index

The most significant factor in overall prognosis is the grade, or aggressiveness, of the lymphoma. Indolent (low-grade) non-Hodgkin's lymphoma is generally not curable, but is typically slowly progressive and responds temporarily to therapy. Aggressive and highly aggressive (intermediate- and high-grade) NHL's are potentially curable with combination chemotherapy. Long-term survival or cure rates for these diseases vary with a number of prognostic factors.

International Prognostic Index

The International Prognostic Index, or IPI, is the most widely used prognostic system for non-Hodgkin's lymphoma. This system uses 5 factors:

Age
Lactate dehydrogenase level (a blood test)
Performance status
Clinical stage
Sites of extranodal disease

However, it should be noted that the IPI was developed prior to the introduction of rituximab. As rituximab has become a standard part of therapy for B-cell NHL's, the impact on the prognostic value of the IPI is unclear.

FLIPI

For the subtype of NHL known as follicular lymphoma, a modified version of the IPI called the FLIPI (follicular lymphoma international prognostic index) has been developed. The factors which figure into the FLIPI are age, clinical stage, lactate dehydrogenase level, hemoglobin rituximab, so the same caveats apply as were mentioned with the IPI above. level, and number of nodal sites involved. As with the IPI, the FLIPI was developed and validated prior to the widespread use of

Treatment

The doctor develops a treatment plan to fit each patient's needs. Treatment for non-Hodgkin's lymphoma depends on the stage of the disease, the type of cells involved, whether they are indolent or aggressive, and the age and general health of the patient.

Non-Hodgkin's lymphoma is often treated by a team of specialists that may include a hematologist, medical oncologist, and/or radiation oncologist. Non-Hodgkin's lymphoma is usually treated with chemotherapy, radiation therapy, or a combination of these treatments. In some cases, bone marrow transplantation, biological therapies, or surgery may be options. For indolent lymphomas, the doctor may decide to wait until the disease causes symptoms before starting treatment. Often, this approach is called "watchful waiting."

Taking part in a clinical trial (research study) to evaluate promising new ways to treat non-Hodgkin's lymphoma is an important option for many people with this disease.

Chemotherapy and radiation therapy

Chemotherapy and radiation therapy are the most common treatments for non-Hodgkin's lymphoma, although bone marrow transplantation, biological therapies, or surgery are sometimes used. CHOP, with rituximab added in certain circumstances, is the most commonly used combination of chemotherapy.

Rituximab is an antibody-based therapy. Zevalin and Bexxar are government-approved options, requiring a Nuclear Medicine facility, but only two shots 1 week apart. There is mounting evidence that more patients have long-term remission if they use radioimmunotherapy first.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. Treatment with radiation may be given alone or with chemotherapy. Radiation therapy is local treatment; it affects cancer cells only in the treated area. Radiation therapy for Non Hodgkin's lymphoma comes from a machine that aims the high-energy rays at a specific area of the body. There is no radioactivity in the body when the treatment is over.

Sometimes patients are given chemotherapy and/or radiation therapy to kill undetected cancer cells that may be present in the central nervous system (CNS). In this treatment, called central nervous system prophylaxis, the doctor injects anticancer drugs directly into the cerebrospinal fluid.

Hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation (HSCT), or Bone marrow transplantation (BMT) may also be a treatment option, especially for patients whose non-Hodgkin's lymphoma has recurred (come back). BMT provides the patient with healthy stem cells (very immature cells, found in the marrow, that produce blood cells), the function of which is to replace white blood cells that are damaged or destroyed by treatment with very high doses of chemotherapy and/or radiation therapy. The healthy bone marrow may come from a donor, or it may be "autologous" (marrow that was removed from the patient, stored, and then given back to the person following the high-dose treatment). Autologous transplants are preferred, as the recipient is less likely to reject the cells, the origins of which were the same entity. However, in order for an autologous transplant to be performed, certain physiological conditions must be optimal within the patient. If these conditions are not present, transplanted stem cells can come from other donors. Until the transplanted bone marrow begins to produce enough white blood cells, patients have to be carefully protected from infection due to the virtual elimination of the auto-immune system resulting from the high-intensity treatment. Without the introduction of the stem cells following the high dose treatment, the patient will not survive as the body will be unable to produce infection-fighting white blood cells. Patients usually stay in the hospital for several weeks and will be monitored for transplant rejection and overall health.

Immunotherapy

Biological therapy (also called immunotherapy) is a form of treatment that uses the body's immune system, either directly or indirectly, to fight cancer or to lessen the side effects that can be caused by some cancer treatments. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. This approach is under close investigation. Biological therapy is sometimes also called biological response modifier therapy.

Measuring response to treatment

After treatment for non-Hodgkin's lymphoma, the response is classified as follows:

Complete Response (CR). This indicates the disappearance of all detectable disease.
Partial Response (PR). A reduction in the bulk of disease by at least 50%, but with some remaining disease.
Stable Disease. Less than a partial remission, but no progression of disease and no new sites of disease.
Progressive Disease. Growth in bulk of disease by >50%, or the appearance of new sites of disease.

If a complete remission is achieved, the patient is watched closely for any evidence of recurrent disease. Standard guidelines dictate that a patient be monitored for relapse every three months in the first year following a complete remission, every six months in the second year, and finally once annually in the third and later years. Diffuse large b-cell lymphoma is the most common type of lymphoma that is considered curable. Currently, if a patient maintains a complete remission for 3 years, the patient is considered cured. Generally most relapses of diffuse large b-cell lymphoma occur within the first year after a complete remission is obtained. Reoccurences after 3 years are rare but they do occur. The effect of Rituximab on relapse rates for diffuse large b-cell lymphoma is still largely unknown, though initial relapse rates since 2003 have been much lower than expected.

Patients with follicular lymphoma are generally not considered cured. Instead, they are categorized as in ongoing complete remission. Relapses occur steadily over time. Relapse rates are estimated to be 33%, 66%, and 100% for follicular lymphoma's Grades I, II, and III respectively.

Research has indicated that relapse rates can be lowered on patients with follicular lymphoma by giving supplemental radiation therapy, however, it is known that this additional therapy increases the chances of a second malignancy of unknown type later in life.

If the response to treatment falls short of a complete response, more treatment may be administered (using a different chemotherapy regimen), or watchful waiting may be utilized, depending on the goals of treatment.

Nutrition during treatment

Eating well during cancer treatment means getting enough food energy and protein to help prevent weight loss and regain strength. Good nutrition often helps people feel better and have more energy.

Some people with cancer find it hard to eat a balanced diet because they may lose their appetite. In addition, common side effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult. Often, foods may taste or smell different. Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.

Doctors, nurses, and dietitians can offer advice on how to get enough food energy and protein during cancer treatment. Patients and their families also may want to read the National Cancer Institute (USA) booklet Eating Hints for Cancer Patients, which contains many useful suggestions.^[2]

Followup care

People who have had non-Hodgkin's lymphoma should have regular followup examinations after their treatment is over. Followup care is an important part of the overall treatment plan, and people should not hesitate to discuss it with their health care provider. Regular followup care ensures that patients are carefully monitored, any changes in health are discussed, and new or recurrent cancer can be detected and treated as soon as possible. Between followup appointments, people who have had Non Hodgkin's lymphoma should report any health problems as soon as they appear.

Hodgkin's lymphoma

2007-09-06T21:48:00.000-07:00

Hodgkin's lymphoma, also known as Hodgkin's disease, is a type of lymphoma first described by Thomas Hodgkin in 1832. Hodgkin's lymphoma is characterized clinically by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. Pathologically, the disease is characterized by the presence of Reed-Sternberg cells. Hodgkin's lymphoma was one of the first cancers to be cured by radiation. Later it was one of the first to be cured by combination chemotherapy. The cure rate is about 93%, making it one of the most curable forms of cancer.

Unlike some other lymphomas, whose incidence increases with age, Hodgkin's lymphoma has a bimodal incidence curve; that is, it occurs most frequently in two separate age groups, the first being young adulthood (age 15–35) and the second being in those over 55 years old although these peaks may vary slightly with nationality.^[1] Overall, it is more common in men, except for the nodular sclerosis variant (see below), which is more common in women.

The annual incidence of Hodgkin's lymphoma is about 1/25,000 people, and the disease accounts for slightly less than 1% of all cancers worldwide.

The incidence of Hodgkin's lymphoma is increased in patients with HIV infection.^[2] In contrast to many other lymphomas associated with HIV infection it occurs most commonly in patients with higher CD4 T cell counts.

Swollen but painless lymph nodes are the most common sign of Hodgkin's lymphoma, often occurring in the neck. The lymph nodes of the chest are often affected and these may be noticed on a chest x-ray.

Splenomegaly, or enlargement of the spleen, occurs in about 30% of people with Hodgkin's lymphoma. The enlargement, however, is seldom massive. The liver may also be enlarged due to liver involvement in the disease in about 5% of cases.

About one-third of people with Hodgkin's disease may also notice some systemic symptoms, such as low-grade fever, night sweats, weight loss, itchy skin (pruritus), or fatigue. Classically, involved nodes are painful after alcohol consumption, though this phenomenon is rare. Patients may also present with a cyclic high-grade fever known as Pel-Ebstein fever, although there is debate as to whether or not this truly exists. ^[3] Systemic symptoms such as fever and weight loss are known as B symptoms.

Hodgkin's lymphoma must be distinguished from non-cancerous causes of lymph node swelling (such as various infections) and from other types of cancer. Definitive diagnosis is by lymph node biopsy (removal of a piece of lymph node tissue for pathological examination). Blood tests chemotherapy. Positron emission tomography (PET) is used to detect small deposits that do not show on CT scanning. In some cases a Gallium Scan may be used instead of a PET scan. are also performed to assess function of major organs and to assess safety for

Abdominal pain

2007-09-03T19:47:00.001-07:00

Abdominal pain

From MayoClinic.com
Special to CNN.com

You've had abdominal pain for several hours, and there doesn't seem to be any relief in sight. Should you wait it out or seek help right away?

Abdominal pain is common. Episodes often stem from overeating or eating too much of a certain type of food. Sometimes a viral or bacterial infection is responsible. In other cases, the pain may be an early warning sign of something more serious.

Where does it hurt?

The number of organs in your abdomen and the complex signals they send can make it tough to pinpoint the cause of abdominal pain. Sometimes, the location of your pain can help narrow the list.

Navel area

Pain near your bellybutton can be related to a small intestine disorder or an inflammation of your appendix (appendicitis).

The appendix is a small, finger-shaped pouch that projects out from your colon on the lower right side of your abdomen. If it gets clogged or obstructed, it may become inflamed and filled with pus. Without treatment, an infected appendix can burst and cause a serious infection (peritonitis). In addition to abdominal pain, appendicitis may cause nausea, vomiting, loss of appetite, fever, and the urge to pass gas or have a bowel movement.

Upper middle abdomen

The epigastric area — directly above the navel in the upper middle section of the abdomen — is where you might feel pain associated with stomach disorders. Persistent pain in this area may also signal a problem with your upper small intestine (duodenum), pancreas or gallbladder.

Upper left abdomen

It's uncommon to experience pain here. When you do, it may suggest a colon, stomach, spleen or pancreas problem.

Upper right abdomen

Intense pain in the upper right abdomen is often related to inflammation of the gallbladder. The pain may extend to the center of your abdomen and penetrate to your back. Occasionally, an inflamed pancreas or duodenum can cause pain in this area as well.

Lower middle abdomen

Pain below the navel that spreads to either side may signify a colon disorder. For women, pain in this area may also indicate a urinary tract infection or pelvic inflammatory disease.

Lower left abdomen

Pain here most often suggests a problem in the lower colon, where food waste is expelled. Possible causes include inflammatory bowel disease or an infection in the colon known as diverticulitis.

Lower right abdomen

Inflammation of the colon may cause pain in your lower right abdomen. The pain of appendicitis may also spread to the lower right abdomen.

Migrating pain

Abdominal pain has the unusual ability to travel along deep nerve pathways and emerge at sites away from the source of the problem. Pain related to gallbladder inflammation, for example, can spread to your chest and your right shoulder. Pain from a pancreas disorder may radiate up between your shoulder blades. This is often called "referred pain."

Managing the pain

For mild abdominal pain caused by something you ate, it may help to sip water or suck on ice chips. When you feel better, try small amounts of bland foods, such as toast, applesauce or bananas. If stomach acid is an issue, an antacid may help.

When to see your doctor

Though most cases of abdominal pain aren't serious, sometimes medical treatment is essential. Consult your doctor if:

The pain is severe, recurrent or persistent
The pain gets worse
The pain is accompanied by shortness of breath, dizziness, bleeding, vomiting or a high fever

Seek emergency help if:

The abdominal pain is sudden and sharp
The pain radiates to your chest, neck or shoulder
You vomit blood
You find blood in your stool or your stool turns black
Your abdomen is swollen and tender

Be prepared to describe the pain, including where it hurts and what it feels like. Proper diagnosis and treatment can help you feel your best again.

Dyspepsia

2007-09-03T19:44:00.001-07:00

What is dyspepsia?

Dyspepsia is a pain or an uncomfortable feeling in the upper middle part of your stomach. The pain might come and go, but it's usually there most of the time.

People of any age can get dyspepsia. Both men and women get it. About 1 of every 4 persons gets dyspepsia at some time.

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What are the signs of dyspepsia?

Here are some of the signs of dyspepsia:

A gnawing or burning stomach pain
Bloating
Heartburn
Nausea (upset stomach)
Vomiting
Burping

If you have these signs, or any kind of stomach pain or discomfort, talk to your family doctor.

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What causes dyspepsia?

Often, dyspepsia is caused by a stomach ulcer or acid reflux disease. If you have acid reflux disease, stomach acid backs up into your esophagus (the tube leading from your mouth to your stomach). This causes pain in your chest. Your doctor may do some tests to find out if you have an ulcer or acid reflux disease.

Some medicines, like anti-inflammatory medicines, can cause dyspepsia. Sometimes no cause of dyspepsia can be found.

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Is dyspepsia a serious condition?

Sometimes dyspepsia can be the sign of a serious problem--for example, a deep stomach ulcer. Rarely, dyspepsia is caused by stomach cancer, so you should take this problem seriously.

If you have dyspepsia, talk to your family doctor. This is especially important if any one of the following is true for you:

You're over 50 years of age
You recently lost weight without trying to
You have trouble swallowing
You have severe vomiting
You have black, tarry bowel movements
You can feel a mass in your stomach area

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How is dyspepsia treated?

Most often, medicine can take care of this condition.

If you have a stomach ulcer, it can be cured. You may need to take an acid-blocking medicine. If you have an infection in your stomach, you may also need to take an antibiotic.

If your doctor thinks that a medicine you're taking causes your dyspepsia, you might take another medicine.

A medicine that cuts down on the amount of acid in your stomach might help your pain. This medicine can also help if you have acid reflux disease.

Your doctor might want you to have an endoscopy if:

You still have stomach pain after you take a dyspepsia medicine for 8 weeks.
The pain goes away for a while but comes back again.

In an endoscopy, a small tube with a camera inside it is put into your mouth and down into your stomach. Then your doctor can look inside your stomach to try to find a cause for your pain.

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Do the medicines for dyspepsia have side effects?

The medicines for dyspepsia most often have only minor side effects that go away on their own. Some medicines can make your tongue or stools black. Some may cause headaches, nausea or diarrhea.

If you have side effects that make it hard for you to take medicine for dyspepsia, talk to your family doctor. Your doctor may have you take a different medicine or may suggest something you can do to make the side effects less bothersome.

Remember to take medicines just the way your doctor tells you. If you need to take an antibiotic, take all of the pills, even when you start feeling better.

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Can I do anything else to avoid dyspepsia?

You can do quite a bit to help yourself feel better:

If you smoke, stop smoking.
If some foods bother your stomach, try to avoid eating them.
Try to reduce the stress in your life.
If you have acid reflux, don't eat right before bedtime. Raising the head of your bed with blocks under two legs may also help.
Unless your doctor tells you otherwise, don't take a lot of anti-inflammatory medicines like ibuprofen (one brand: Motrin), aspirin, naproxen (brand name: Aleve) and ketoprofen (brand name: Orudis). Acetaminophen (brand name: Tylenol) is a better choice for pain, because it doesn't hurt your stomach.

Dermoid Cyst

2007-09-02T20:56:00.000-07:00

A dermoid cyst is a teratoma that contains developmentally mature skin, with hair follicles and sweat glands, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Because it contains mature tissue, a dermoid cyst almost always is benign. The rare malignant dermoid cyst usually develops squamous cell carcinoma.

Some authors use the term dermoid cyst as a frank synonym for teratoma, meaning any teratoma, regardless of its histology or location. Others use it to mean any mature, cystic teratoma. These uses appear to be most common in gynecology and dermatology.

The term dermoid is sometimes used to mean dermoid cyst but this is unfortunately vague.

_________________________________________________________________

Dermoid cyst of the ovary : A bizarre tumor, usually benign, in the ovary that typically contains a diversity of tissues including hair, teeth, bone, thyroid, etc.

A dermoid cyst develops from a totipotential germ cell (a primary oocyte) that is retained within the egg sac (ovary). Being totipotential, that cell can give rise to all orders of cells necessary to form mature tissues and often recognizable structures such as hair, bone and sebaceous (oily) material, neural tissue and teeth.

Dermoid cysts may occur at any age but the prime age of detection is in the childbearing years. The average age is 30. Up to 15% of women with ovarian teratomas have them in both ovaries. Dermoid cysts can range in size from a centimeter (less than a half inch) up to 45 cm (about 17 inches) in diameter.

These cysts can cause the ovary to twist (torsion) and imperil its blood supply. The larger the dermoid cyst, the greater the risk of rupture with spillage of the greasy contents which can create problems with adhesions, pain etc. Although the large majority (about 98%) of these tumors are benign, the remaining fraction (about 2%) becomes cancerous (malignant).

Removal of the dermoid cyst is usually the treatment of choice. This can be done by laparotomy (open surgery) or laparoscopy (with a scope). Torsion (twisting) of the ovary by the cyst is an emergency and calls for urgent surgery.

Dermoid cysts of the ovary are also called simply dermoids or ovarian teratomas.

Profile of the Sociopath

2007-08-18T03:52:00.001-07:00

This website summarizes some of the common features of descriptions of the behavior of sociopaths.

Glibness and Superficial Charm

Manipulative and Conning
They never recognize the rights of others and see their self-serving behaviors as permissible. They appear to be charming, yet are covertly hostile and domineering, seeing their victim as merely an instrument to be used. They may dominate and humiliate their victims.

Grandiose Sense of Self
Feels entitled to certain things as "their right."

Pathological Lying
Has no problem lying coolly and easily and it is almost impossible for them to be truthful on a consistent basis. Can create, and get caught up in, a complex belief about their own powers and abilities. Extremely convincing and even able to pass lie detector tests.

Lack of Remorse, Shame or Guilt
A deep seated rage, which is split off and repressed, is at their core. Does not see others around them as people, but only as targets and opportunities. Instead of friends, they have victims and accomplices who end up as victims. The end always justifies the means and they let nothing stand in their way.

Shallow Emotions
When they show what seems to be warmth, joy, love and compassion it is more feigned than experienced and serves an ulterior motive. Outraged by insignificant matters, yet remaining unmoved and cold by what would upset a normal person. Since they are not genuine, neither are their promises.

Incapacity for Love

Need for Stimulation
Living on the edge. Verbal outbursts and physical punishments are normal. Promiscuity and gambling are common.

Callousness/Lack of Empathy
Unable to empathize with the pain of their victims, having only contempt for others' feelings of distress and readily taking advantage of them.

Poor Behavioral Controls/Impulsive Nature
Rage and abuse, alternating with small expressions of love and approval produce an addictive cycle for abuser and abused, as well as creating hopelessness in the victim. Believe they are all-powerful, all-knowing, entitled to every wish, no sense of personal boundaries, no concern for their impact on others.

Early Behavior Problems/Juvenile Delinquency
Usually has a history of behavioral and academic difficulties, yet "gets by" by conning others. Problems in making and keeping friends; aberrant behaviors such as cruelty to people or animals, stealing, etc.

Irresponsibility/Unreliability
Not concerned about wrecking others' lives and dreams. Oblivious or indifferent to the devastation they cause. Does not accept blame themselves, but blames others, even for acts they obviously committed.

Promiscuous Sexual Behavior/Infidelity
Promiscuity, child sexual abuse, rape and sexual acting out of all sorts.

Lack of Realistic Life Plan/Parasitic Lifestyle
Tends to move around a lot or makes all encompassing promises for the future, poor work ethic but exploits others effectively.

Criminal or Entrepreneurial Versatility
Changes their image as needed to avoid prosecution. Changes life story readily.

Other Related Qualities:

Contemptuous of those who seek to understand them

Does not perceive that anything is wrong with them

Authoritarian

Secretive

Paranoid

Only rarely in difficulty with the law, but seeks out situations where their tyrannical behavior will be tolerated, condoned, or admired

Conventional appearance

Goal of enslavement of their victim(s)

Exercises despotic control over every aspect of the victim's life

Has an emotional need to justify their crimes and therefore needs their victim's affirmation (respect, gratitude and love)

Ultimate goal is the creation of a willing victim

Incapable of real human attachment to another

Unable to feel remorse or guilt

Extreme narcissism and grandiose

May state readily that their goal is to rule the world

List of Pscychological Adult Disorders

2007-08-18T03:44:00.000-07:00

List of Adult Disorders

Adjustment Disorder

Agoraphobia

Alcohol/Substance Abuse

Anorexia Nervosa

Antisocial Personality Disorder

Attention-Deficit Disorder (ADD, ADHD)

Autistic Disorder

Avoidant Personality Disorder

Bipolar Disorder

Borderline Personality Disorder

Dementia (Alcoholic, Alzheimer's type)

Dependent Personality Disorder

Dissociative Identity Disorder

Dysthymic Disorder

Generalized Anxiety Disorder

Histrionic Personality Disorder

Major Depressive Disorder

Narcissistic Personality Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Personality Disorder

Oppositional-Defiant Disorder

Panic Disorder

Paranoid Personality Disorder

Post-Traumatic Stress Disorder (PTSD)

Schizoaffective Disorder

Schizoid Personality Disorder

Schizophrenia

Schizotypal Personality Disorder

Separation Anxiety Disorder

Social Phobia

Specific Phobia

Tourette's Disorder

Bleeding During Pregnancy Causes

2007-08-16T22:12:00.001-07:00

Bleeding During Pregnancy Causes

First trimester bleeding

Vaginal bleeding in the first trimester of pregnancy can be caused by several different factors. Bleeding affects 20-30% of all pregnancies. Up to 50% of those who bleed may go on to have a miscarriage (lose the baby). Of even more concern, however, is that about 3% of all pregnancies are ectopic in location (the fetus is not inside the uterus). An ectopic pregnancy may be life threatening to the mother. All bleeding associated with early pregnancy should prompt a call to your health care provider for immediate evaluation.

Implantation bleeding: There can be a small amount of spotting associated with the normal implantation of the embryo into the uterine wall, called implantation bleeding. This is usually very minimal, but frequently occurs on or about the same day as your period was due. This can be very confusing if you mistake it for simply a mild period and don't realize you are pregnant. This is a normal part of pregnancy and no cause for concern.
Threatened miscarriage: You may be told you have a threatened miscarriage if you are having some bleeding or cramping. The fetus is definitely still inside the uterus (based usually on an exam using ultrasound), but the outcome of your pregnancy is still in question. This may occur if you have an infection, such as a urinary tract infection, get dehydrated, use some drugs or medications, are involved in physical trauma, if the developing fetus is abnormal in some way, or for no apparent reason at all. Other than these reasons, threatened miscarriages are generally not caused by things you do, such as heavy lifting or having sex, or by emotional stress.
Completed miscarriage: You may have a completed miscarriage (also called a spontaneous abortion) if your bleeding and cramping have slowed down and the uterus appears to be empty based on ultrasound evaluation. This means you have lost the pregnancy. The causes of this are the same as those for a threatened miscarriage. This is the most common cause of first trimester bleeding.
Incomplete miscarriage: You may have an incomplete miscarriage (or a miscarriage in progress) if the pelvic exam shows your cervix is open and you are still passing blood, clots, or tissue. The cervix should not remain open for very long. If it does, it indicates the miscarriage is not completed. This may occur if the uterus begins to clamp down before all the tissue has passed, or if there is infection.
Blighted ovum: You may have a blighted ovum (also called embryonic failure). An ultrasound would show evidence of an intrauterine pregnancy, but the embryo has failed to develop as it should in the proper location. This may occur if the fetus were abnormal in some way and not generally due to anything you did or didn't do.
Intrauterine fetal demise: You may have an intrauterine fetal demise (also called IUFD, missed abortion, or embryonic demise) if the developing baby dies inside the uterus. This diagnosis would be based on ultrasound results and can occur at any time during pregnancy. This may occur for any of the same reasons a threatened miscarriage occurs during the early stages of pregnancy. It is very uncommon for this to occur during the second and third trimesters of pregnancy. If it does, the causes also include separation of the placenta from the uterine wall (called placental abruption) or because the placenta didn't get sufficient blood flow.
Ectopic pregnancy: You may have an ectopic pregnancy (also called tubal pregnancy). This would be based on your medical history and ultrasound, and in some cases laboratory results. Bleeding from an ectopic pregnancy is the most dangerous cause of first trimester bleeding. An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, most often in the fallopian tube. As the fertilized egg grows, it can rupture the fallopian tube and cause life-threatening bleeding. Symptoms are often variable and may include pain, bleeding, or lightheadedness. Most ectopic pregnancies will cause pain before the tenth week of pregnancy. The fetus is not going to develop and will die because of lack of supply of nutrients. This condition occurs in about 3% of all pregnancies.
- There are risk factors for ectopic pregnancy. These include a history of prior ectopic pregnancy, history of pelvic inflammatory disease, history of fallopian tube surgery or ligation, history of infertility for more than 2 years, having an IUD (birth control device placed in the uterus) in place, smoking, or frequent (daily) douching. Only about 50% of women who have an ectopic pregnancy have any risk factors, however.
Molar pregnancy: You may have a molar pregnancy (technically called gestational trophoblastic disease). Your ultrasound results may show the developing fetus is not actually a baby but is abnormal tissue. This is actually a type of cancer that occurs as a result of the hormones of pregnancy and is usually not life-threatening to you. However, in rare cases the abnormal tissue is cancerous. It can invade the uterine wall and spread throughout the body. The cause of this is generally unknown.
Postcoital bleeding is vaginal bleeding after sexual intercourse. It may be normal during pregnancy.
Bleeding may also be caused by reasons unrelated to pregnancy. For example, trauma or tears to the vaginal wall may bleed, and some infections may cause bleeding.

Late-pregnancy bleeding

The most common cause of late-pregnancy bleeding is problems with the placenta. Some bleeding can also be due to an abnormal cervix or vagina.

Placenta previa: The placenta, which is a structure that connects the baby to the wall of your womb, can partially or completely cover the opening of your womb. When you bleed because of this, it is called placenta previa. Late in pregnancy as the opening of your womb, called the cervix, thins and dilates (widens) in preparation for labor, some blood vessels of the placenta stretch and rupture. This causes about 20% of third-trimester bleeding and happens in about 1 in 200 pregnancies. Risk factors for placenta previa include these conditions:
- Multiple pregnancies
- Prior placenta previa
- Prior Cesarean delivery

Placental abruption: This condition occurs when a normal placenta separates from the wall of the womb (uterus) prematurely and blood collects between the placenta and the uterus. Such separation occurs in 1 in 200 of all pregnancies. The cause is unknown. Risk factors for placental abruption include these conditions:
- High blood pressure (140/90 or greater)
- Trauma (usually a car accident or maternal battering)
- Cocaine use
- Tobacco use
- Abruption in prior pregnancies (you have a 10% risk it will happen again)

Uterine rupture: This is an abnormal splitting open of the uterus, causing the baby to be partially or completely expelled into the abdomen. Uterine rupture is rare but very dangerous for both mother and baby. About 40% of women who have uterine rupture had prior surgery of their uterus, including Cesarean delivery. The rupture may occur before or during labor or at the time of delivery. Other risk factors for uterine rupture are these conditions:
- More than 4 pregnancies
- Trauma
- Excessive use of oxytocin (Pitocin), a medicine that helps strengthen contractions
- A baby in any position other than head down
- Having the baby's shoulder get caught on the pubic bone during labor
- Certain types of forceps deliveries

Fetal vessel rupture: This condition occurs in about 1 of every 1,000 pregnancies. The baby's blood vessels from the umbilical cord may attach to the membranes instead of the placenta. The baby's blood vessels pass over the entrance to the birth canal. This is called vasa previa and occurs in 1 in 5,000 pregnancies.

Less common causes of late-pregnancy bleeding include injuries or lesions of the cervix and vagina, including polyps, cancer, and varicose veins.

Inherited bleeding problems, such as hemophilia, are very rare, occurring in 1 in 10,000 women. If you have one of these conditions, such as von Willebrand disease, tell your doctor.

Abdominal aortic aneurysm

2007-08-16T07:19:00.000-07:00

Abdominal aortic aneurysm, also written as AAA and often pronounced 'triple-A', is a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%. The normal diameter of the infrarenal aorta is 2cm. It is caused by a degenerative process of the aortic wall, however the exact etiology remains unknown. It is most commonly located infrarenally (90%), other possible locations are suprarenal and pararenal. The aneurysm can extend to include one or both of the iliac arteries. An aortic aneurysm may also occur in the thorax.

History

The first historical records about AAA are from Ancient Rome, more precisely from the 2nd century AD, when Greek surgeon Antyllus tried to treat the AAA with proximal and distal ligature, central incision and evacuation of thrombotic material from the aneurysm. However, attempts to treat the AAA surgically were unsuccessful until 1923. In that year, Rudolph Matas (who also proposed the concept of endoaneurysmorrhaphy), performed the first successful aortic ligation on a human.^[1] Other methods that were successful in treating the AAA included wrapping the aorta with polyethene cellophane, which induced fibrosis and restricted the growth of the aneurysm. Albert Einstein was operated on by Rudolf Nissen with use of this technique in 1949, and survived five years after the operation.^[2]

[edit] Epidemiology

AAA is uncommon in individuals of African, African American, Asian and Hispanic heritage. The frequency rate varies strongly between males and females. The peak incidence is among males around 70 years of age, the prevalence among males over 60 years totals 2-6%. The frequency is much higher in smokers than in non-smokers (8:1). Other risk factors include hypertension and male sex.^[3] In the US, the incidence of AAA is 2-4% in the adult population. ^[4]. Rupture of the AAA occurs in 1-3% of men aged 65 or more, the mortality is 70-95%^[5].

[edit] Etiology

The exact causes of the degenerative process remain unclear. There are, however, some theories and risk factors defined.

Genetic influences: The influence of genetic factors is highly probable. The high familial prevalence rate is most notable in male individuals.^[6] There are many theories about the exact genetic disorder that could cause higher incidence of AAA among male members of the affected families. Some presumed that the influence of alpha 1-antitrypsin deficiency could be crucial, some experimental works favored the theory of X-linked mutation, which would explain the lower incidence in heterozygous females. Other theories of genetic etiology were also formulated.^[4]

Hemodynamic influences: Abdominal aortic aneurysm is a focal degenerative process with predilection for the subrenal aorta. The histological structure and mechanical characteristics of subrenal aorta differ from those of the thoracic aorta. The diameter decreases from the root to the bifurcation, and the wall of the abdominal aorta also contains a lesser proportion of elastin. The mechanical tension in abdominal aortic wall is therefore higher than in the thoracic aortic wall. The elasticity and distensibility also decline with age, which can result in gradual dilatation of the segment. Higher intraluminal pressure in patients with arterial hypertension markedly contributes to the progression of the pathological process.^[3]

Atherosclerosis: The AAA was long considered to be caused by atherosclerosis, because the walls of the AAA are frequently affected heavily. However, this theory cannot be used to explain the initial defect and the development of occlusion, which is observed in the process.^[4]

Other causes: Other causes of the development of AAA include: infection, trauma, arteritis, cystic medial necrosis (m. Erdheim) and connective tissue disorders (e.g. Marfan syndrome, Ehlers-Danlos syndrome).^[3]

[edit] Pathophysiology

The most striking histopathological changes of aneurysmatic aorta are seen in tunica media and intima. These include accumulation of lipids in foam cells, extracellular free cholesterol crystals, calcifications, ulcerations and ruptures of the layers and thrombosis. There is an adventitial inflammatory infiltrate.^[3] However, the degradation of tunica media by means of proteolytic process seems to be the basic pathophysiologic mechanism of the AAA development. Some researchers report increased expression and activity of matrix metalloproteinases in individuals with AAA. This leads to elimination of elastine from the media, rendering the aortic wall more susceptible to the influence of the blood pressure. ^[4] Other pathophysiological cause for development of the AAA is inflammation.

[edit] Screening

A clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF) 'recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men age 65 to 75 years who have ever smoked'.^[7]^[8] This is a grade B recommendation. An re-analysis of the meta-analysis estimated a number needed to screen of approximately 850 patients.^[9]

The largest of the randomized controlled trials on which this guideline was based studied a screening program that consisted of^[10]:

Screening men ages 65-74 years (not restricted to ever smokers). 'Men in whom abdominal aortic aneurysms (> or =3 cm in diameter) were detected were followed-up... Patients with an aortic diameter of 3·0–4·4 cm were rescanned at yearly intervals, whereas those with an aortic diameter of 4·5–5·4 cm were rescanned at 3-monthly intervals ... Surgery was considered on specific criteria (diameter > or =5.5 cm, expansion > or =1 cm per year, symptoms)'.

This trial reported significant short^[10] ( number needed to screen after 4 years of approximately 590 to prevent nonfatal ruptured AAA plus AAA-related deaths^[11]) and long term^[12] ( number needed to screen after 7 years of approximately 280 to prevent nonfatal ruptured AAA plus AAA-related deaths) benefit and cost effectiveness.^[13] Subsequent randomized controlled trials also found benefit:

number needed to screen after 4 years of 300^[14]
number needed to screen after and after 7 years of 563 (calculation).^[15]

[edit] Manifestations and Diagnosis

AAAs are commonly divided according to their size and symptomatology. An aneurysm is usually considered to be present if the measured outer aortic diameter is over 3 cm (normal diameter of aorta is around 2 cm). The natural history is of increasing diameter over time, followed eventually by the development of symptoms (usually rupture). If the outer diameter exceeds 5 cm, the aneurysm is considered to be large. For aneurysms under 5 cm, the risk of rupture is low, so that the risks of surgery usually outweigh the risk of rupture. Aneurysms less than 5cm are therefore usually kept under surveillance until such time as they become large enough to warrant repair, or develop symptoms.^[3]^[5] The vast majority of aneurysms are asymptomatic. The risk of rupture is high in a symptomatic aneurysm, which is therefore considered an indication for surgery. Possible symptoms include low back pain, flank pain, abdominal pain, groin pain or pulsating abdominal mass.^[16] The complications include rupture, peripheral embolisation, acute aortic occlusion, aortocaval or aortoduodenal fistulae. On physical examination, a palpable abdominal mass can be noted. Bruits can be present in case of renal or visceral arterial stenosis.^[4]

As most of the AAAs are asymptomatic, their presence is usually revealed during an abdominal examination for another reason - the most common being abdominal ultrasonography. A physician may also detect the presence of an AAA by abdominal palpation. Ultrasonography provides the initial assessment of the size and extent of the aneurysm, and is the usual modality for surveillance. Preoperative examinations include CT, MRI and special modes thereof, like CT/MR angiography. Angiography may be useful also, as an additional method of measurement for the planning of endoluminal repair. Note that an aneurysmal aorta may appear normal on angiogram, due to thrombus within the sac.

[edit] Rupture

The clinical manifestation of ruptured AAA can include low back, flank, abdominal or groin pain, but the bleeding usually leads to a hypovolemic shock with hypotension, tachycardia, cyanosis, and altered mental status. The mortality of AAA rupture is 75-90%, with 65% of patients dying before they arrive at hospital.^[16] The bleeding can be retroperitoneal or intraperitoneal, or the rupture can create an aortocaval or aortointestinal fistula.^[3]. Flank ecchymosis is a sign of retroperitoneal hemorrhage, and is also called the Grey-Turner sign.^[4] Ruptured AAA is a clinical diagnosis: the presence of the triad of abdominal pain, shock and pulsatile abdominal mass makes the diagnosis; no further investigations are required for diagnostic purposes, and imaging should be avoided unless specifically requested by a vascular surgeon.

[edit] Treatment

The treatment options for asymptomatic AAA are immediate repair, surveillance with a view to eventual repair, and conservative. There are currently two modes of repair available for an AAA: open aneurysm repair (OR), and endovascular aneurysm repair (EVAR).

Conservative treatment is indicated in patients where repair carries a high risk of mortality and also in patients where repair is unlikely to improve life expectancy. The two mainstays of the conservative treatment are smoking cessation and blood pressure control.
Surveillance is indicated in small aneurysms, where the risk of repair exceeds the risk of rupture. As an AAA grows in diameter the risk of rupture increases. Although some controversy exists around the world, most vascular surgeons would not consider repair until the aneurysm reached a diameter of 5cm. The threshold for repair varies slightly from individual to individual, depending on the balance of risks and benefits when considering repair versus ongoing surveillance. The size of an individual's native aorta may influence this, along with the presence of comorbitities that increase operative risk or decrease life expectancy.
Open repair (operation) is indicated in young patients as an elective procedure, or in growing or large, symptomatic or ruptured aneurysms. Open repair has been the mainstay of intervention from the 1950's until recently.
Endovascular repair first became practical in the 1990's and although it is now an established alternative to open repair, its role is yet to be clearly defined. It is generally indicated in older, high-risk patients or patients unfit for open repair. However, endovascular repair is feasible for only a proportion of AAA's, depending on the morphology of the aneurysm. The main advantage over open repair is that the peri-operative period has less impact on the patient (less time in intensive care, less time in hospital overall, earlier return to normal activity). Disadvantages of endovascular repair include a requirement for more frequent ongoing hospital reviews, and a higher chance of further procedures being required. According to the latest studies, the EVAR procedure doesn't offer any overall survival benefit.^[17] Regarding unruptured aneurysms, EVAR is associated with lower operative mortality than open repair but unknown long-term mortality^[18]

Ovarian Cyst

2007-08-16T07:17:00.000-07:00

What is an ovarian cyst?

An ovarian cyst is a fluid-filled sac in the ovary. Many cysts are completely normal. These are called functional cysts. They occur as a result of ovulation (the release of an egg from the ovary). Functional cysts normally shrink over time, usually in about 1 to 3 months. If you have a functional cyst, your doctor may want to check you again in 1 to 3 months to make sure the cyst has gotten smaller. In certain cases, your doctor may want you to take birth control pills so you won't ovulate. If you don't ovulate, you won't form cysts.

If you are menopausal and are not having periods, you shouldn't form functional cysts. If you do have a cyst, your doctor will probably want you to have a sonogram so he or she can look at the cyst. What your doctor decides to do after that depends on your age, the way the cyst looks on the sonogram and if you're having symptoms such as pain, bloating, feeling full after eating just a little, and constipation.

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What is a sonogram?

A sonogram uses sound waves to make "pictures" of organs in the body. It's a good way for your doctor to "look" at your ovaries. This kind of sonogram can be done 2 ways, either through your abdomen or your vagina. Neither type is painful. The sonogram usually lasts about 30 minutes. It will give your doctor valuable information about the size and the appearance of your cyst.

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Are there any other tests I might have?

Your doctor might test the level of a protein called CA-125 in your blood. Sometimes this blood test is done in women with an ovarian cyst to see if their cyst could be cancerous. A normal CA-125 level is less than 35. However, this test is not always an accurate way to tell if a woman has ovarian cancer. For example, some women who do have ovarian cancer have a normal CA-125 level. Also, this level can sometimes be high in women who do not have cancer, particularly if they are in their childbearing years. For these reasons, the CA-125 blood test is usually only recommended for women who are at high risk for ovarian cancer.

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Do I need surgery for an ovarian cyst?

The answer depends on several things, such as your age, whether you are having periods, the size of the cyst, its appearance and your symptoms.

If you're having periods and the cyst is functional, you probably won't need to have surgery. If the cyst doesn't go away after several menstrual periods, if it gets larger or if it doesn't look like a functional cyst on the sonogram, your doctor may want you to have an operation to remove it. There are many different types of ovarian cysts in women of childbearing age that do require surgery. Fortunately, cysts in women of this age are almost always benign (not cancer).

If you're past menopause and have an ovarian cyst, your doctor will probably want you to have surgery. Ovarian cancer is rare, but women 50 to 70 years of age are at greater risk. Women who are diagnosed at an early stage do much better than women who are diagnosed later.

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What type of surgery would I need?

If the cyst is small (about the size of a plum or smaller) and if it looks benign on the sonogram, your doctor may decide to do a laparoscopy. This type of surgery is done with a lighted instrument called a laparoscope that's like a slender telescope. This is put into your abdomen through a small incision (cut) just above or just below your navel (belly button). With the laparoscope, your doctor can see your organs. Often the cyst can be removed through small incisions in the pubic hair line.

If the cyst looks too big to remove with the laparoscope or if it looks suspicious in any way, your doctor will probably do a laparotomy. A laparotomy uses a bigger incision to remove the cyst or possibly the entire ovary. While you are under general anesthesia (puts you in a sleep-like state) the cyst can be tested to find out if it is cancer. If it is cancer, your doctor may need to remove both of the ovaries, the uterus, a fold of fatty tissue called the omentum and some lymph nodes. It's very important that you talk to your doctor about all of this before the surgery. Your doctor will also talk to you about the risks of each kind of surgery, how long you are likely to be in the hospital and how long it will be before you can go back to your normal activities.

Blisters:

2006-11-08T19:49:00.000-08:00

Common causes of blisters include friction and burns. If the blister isn't too painful, do everything possible to keep it intact. Unbroken skin over a blister provides a natural barrier to bacteria and decreases the risk of infection. Cover a small blister with an adhesive bandage, and cover a large one with a porous, plastic-coated gauze pad that absorbs moisture and allows the wound to breathe.

Don't puncture a blister unless it's painful or prevents you from walking or using one of your hands. If you have diabetes or poor circulation, call your doctor before considering the self-care measures below.

To relieve blister-related pain, drain the fluid while leaving the overlying skin intact. Here's how:
Wash your hands and the blister with soap and warm water.
Swab the blister with iodine or rubbing alcohol.
Sterilize a clean, sharp needle by wiping it with rubbing alcohol.
Use the needle to puncture the blister. Aim for several spots near the blister's edge. Let the fluid drain, but leave the overlying skin inplace.
Apply an antibiotic ointment to the blister and cover with a bandage or gauze pad.
After several days, use tweezers and scissors sterilized with rubbing alcohol to cut away all the dead skin. Apply more ointment and a bandage.

Call your doctor if you see signs of infection around a blister — pus, redness, increasing pain or warm skin.

To prevent a blister, use gloves, socks, a bandage or similar protective covering over the area being rubbed. Special athletic socks are available that have extra padding in critical areas. You might also try attaching moleskin to the inside of your shoe where it might rub, such as at the heel.

Shoe-shopping tips
Remember the following when you shop for shoes:
Shop during the middle of the day. Your feet swell throughout the day, so a midday fitting will probably give you the best fit.
Wear the same socks you'll wear when walking, or bring them with you to the store.
Measure your feet. Shoe sizes change throughout adulthood.
Measure both feet and try on both shoes. If your feet differ in size, buy the larger size.
Go for flexible but supportive shoes with cushioned insoles.
Be sure that you can comfortably wiggle your toes.
Avoid shoes with seams in the toe box, which may irritate bunions or hammertoes.

Esophagitis

2006-08-16T18:15:00.000-07:00

Esophagitis is an inflammation and swelling of the esophagus. It is most often caused by acid-containing stomach contents refluxing back up into the esophagus. The most significant cause of acid reflux is gastroesophageal reflux disease. Other causes of reflux are hernias, vomiting, medications and surgery.
Esophagitis can be caused by other conditions also. These include an infection that can develop in individuals with weakened immune systems, such as caused by HIV or certain medications such as corticosteroids. The infection can be caused by viruses, including herpes and cytomegalovirus, and fungi or yeast, especially Candida infections.
Whether the condition is caused by the irritation from reflux of stomach contents or by infection, in either case the tissues of the esophagus become inflamed.

Hiatal Hernia

2006-08-16T18:14:00.000-07:00

Hernias occur when one part of the body protrudes through a gap or opening into another part. And although a hernia can theoretically develop almost anywhere, most are in the abdominal area. This includes hiatal hernias — also known as diaphragmatic hernias — which form at the opening in your diaphragm where your food pipe joins your stomach.
Most small hiatal hernias don't cause any problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition. But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn and chest pain. Self-care measures or medications can usually alleviate these symptoms, although very large hiatal hernias sometimes need surgical repair.
Most small hiatal hernias cause no problems. But larger hernias may cause heartburn, belching or chest pain when stomach acids back up into your food pipe (esophagus). These signs and symptoms tend to become worse when you lean forward, strain, lift heavy objects or lie down, and they can also worsen during pregnancy.
In rare cases, the part of your stomach that protrudes into your chest cavity may become twisted (strangulated) or have its blood supply cut off, leading to:
Severe chest pain
Difficulty swallowing (dysphagia)
Obstruction of your esophagus
Your chest cavity and abdomen are separated by your diaphragm — a large dome-shaped muscle that's responsible for a good part of normal breathing. Your esophagus passes into your stomach through an opening in the diaphragm. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak and the upper part of your stomach bulges through the diaphragm into your chest cavity. Anything that puts intense pressure on your abdomen — including persistent or severe coughing or vomiting, pregnancy, straining while going to the bathroom, or lifting heavy objects — can contribute to hiatal hernias.
A hiatal hernia in turn can cause or contribute to gastroesophageal reflux. This happens when a hernia slightly displaces the lower esophageal sphincter, a circular band of muscle around the bottom of the esophagus.
Ordinarily, the diaphragm is aligned with the lower esophageal sphincter, which relaxes to allow food and liquid to flow into your stomach when you swallow. The diaphragm supports and puts pressure on the sphincter to keep it closed when you're not swallowing. But a hiatal hernia raises the sphincter above the diaphragm, reducing pressure on the valve. This causes the sphincter muscle to open at the wrong time, allowing stomach acid to flow up into the esophagus.
A hiatal hernia can also cause heartburn if the herniated portion of your stomach becomes a reservoir for gastric acid, which can then easily travel up your esophagus.

Gastroscopy

2006-08-15T17:39:00.000-07:00

What is gastroscopy?
Gastroscopy is an examination of the inside of the gullet, stomach and duodenum. It is performed by using a thin, flexible fibre-optic instrument that is passed through the mouth and allows the doctor to see whether there is any damage to the lining of the oesophagus (gullet) or stomach, and whether there are any ulcers in the stomach or duodenum.
The GP will decide when drug treatment alone is sufficient or whether an investigation by gastroscopy at the local hospital is necessary. The procedure is painless and is usually done under a light sedative as a day-case patient in a specialised endoscopy unit. Occasionally, after a discussion with the endoscopist, the procedure will be performed without sedation. When sedation is used, the patient will not be able to drive or operate machinery for the rest of the day. Anyone suffering from stomach problems should consult a doctor who will, in most cases, treat the symptoms without a major examination.

How is a gastroscopy performed?
After explaining the procedure, the endoscopist will spray the back of the throat with a local anaesthetic. This is similar to the anaesthetic used by dentists. It numbs the throat and may make it difficult to swallow. When sedation is used, it is not a full anaesthetic and the patient will still be conscious and aware. A nurse will lie the patient on their left side and the endoscopist will then gently place the end of the instrument into the mouth and ask the patient to swallow it, which feels like swallowing a large piece of food.The endoscopist may need to put some air into the stomach to perform the examination effectively and this can cause discomfort or even a need to belch. This is perfectly normal. The endoscopist will closely examine the lining of the gullet, stomach and duodenum to identify the cause of the symptoms. It will take about 10 to 15 minutes.

Why is gastroscopy useful?
The doctor can study the mucous membrane of the stomach from the top to the bottom, and see irritation, wounds, or tumours. Gastroscopy is effective, and has now replaced the use of X-rays in many cases. It helps the doctor see any abnormalities in the gullet, the stomach and the duodenum. It is precise and safe.
Through the gastroscope, the doctor can take samples or photographs of the mucous membrane. The most modern gastroscopes can also show the areas in the stomach on a TV screen, so that the mucous membrane can be studied thoroughly. This can be recorded on a videotape, and used for later comparison. Patients are often given a gastroscopic examination because of their indigestion symptoms, which can usually be treated with tablets. Occasionally, the cause of indigestion is an ulcer and it is now known that many ulcers are due to bacterial infection in the stomach. A biopsy (a small piece of the lining of the stomach) may be removed during an endoscopy and examined under the microscope in the laboratory to pinpoint an infection. A very small number of patients with indigestion will turn out to have cancer and, again, the diagnosis can be made accurately by biopsy. Further investigation can then be planned to ensure the most effective treatment.

Can gastroscopy be used to examine other parts of the body?
On the way down towards the stomach, gastroscopy can also be used to examine the mucous membrane of the gullet - there are several diseases with symptoms that are easily mistaken for diseases in the stomach. If this examination is performed independently it is called oesophagoscopy, after oesophagus, the medical name for the gullet.

How far can a gastroscope see?
A gastroscope can only examine the lining of the oesophagus (gullet) stomach and duodenum. It will detect conditions in those organs that are causing symptoms but will not, for example, detect gallstones or pancreatic disease.

Are there other uses for gastroscopy?

An increasing use for gastroscopy is to obtain biopsies from the top of the small bowel, mainly to rule out a condition called coeliac disease. This is usually arranged at a hospital clinic but in some areas the test may be available to local doctors.

Why doesn't my doctor just send me for an X-ray?
This is a good point. Barium meals were used for many years for the diagnosis of indigestion symptoms. However, the small disadvantages of gastroscopy - special units, day-case admission and the need for sedation - are far outweighed by the increased accuracy of diagnosis and the ability to take biopsies at gastroscopy. As a result relatively few barium meals are performed nowadays. Is gastroscopy safe? All procedures carry some risk but outpatient diagnostic gastroscopy is very safe. Minor complications are uncommon and major complications are very rare.

Gastritis

2006-08-03T02:11:00.000-07:00

Gastritis isn't one disease but a group of conditions, all of which are characterized by inflammation of the lining of your stomach. Commonly, the inflammation results from infection with the same bacterium that causes most stomach ulcers. Yet other factors — including traumatic injury and regular use of certain pain relievers — also can contribute to gastritis.
In spite of the many conditions associated with gastritis, the signs and symptoms of the disease are very similar: A burning pain in your upper abdomen and occasionally, bloating, belching, nausea or vomiting.
In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis isn't serious and improves quickly with treatment.

The signs and symptoms of gastritis, which are often relatively mild and short-lived, include:
A gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better when you eat
Nausea
Vomiting
Loss of appetite
Belching or bloating
A feeling of fullness in your upper abdomen after eating
Weight loss
Gastritis that occurs suddenly (acute gastritis) usually results in the classic combination of nausea and burning pain or discomfort in your upper abdomen, whereas chronic gastritis, which develops gradually, is more likely to cause a dull pain and a feeling of fullness or loss of appetite after a few bites of food. For many people, though, chronic gastritis causes no problems at all.
Occasionally, gastritis may cause stomach bleeding, but it's rarely severe unless there's also ulceration of your stomach lining. Bleeding in your stomach can cause you to vomit blood or pass black, tarry stools and may require immediate medical care.
Because gastritis is one of many common digestive problems with similar signs and symptoms, it's easy to confuse with other conditions, including:

Gastroenteritis. Also called stomach flu, gastroenteritis usually results from a viral infection of your intestines. Signs and symptoms include diarrhea, abdominal cramps, and nausea or vomiting, as well as indigestion. Symptoms of gastroenteritis often resolve within a day or two, whereas the discomfort of gastritis may be ongoing.

Heartburn. This painful, burning sensation behind your breastbone usually occurs after a meal. It develops when stomach acid backs up into your esophagus, the tube that connects your throat to your stomach. Heartburn can also lead to a sour taste and the sensation of partially digested food re-entering your mouth.

Stomach ulcers. If a gnawing or burning pain in your stomach is persistent and severe, you may have an ulcer. Stomach (peptic) ulcers are open sores that develop on the inside lining of the stomach. The most prominent symptom is pain, which is frequently worse at night or when your stomach is empty. Gastritis and stomach ulcers share some of the same causes — especially H. pylori infection — and the one may be a precursor to the other.

Nonulcer dyspepsia. Commonly referred to as indigestion, nonulcer dyspepsia is a functional disorder and not necessarily related to a particular disease. The exact cause isn't known, but stress and overindulging in fried, spicy or fatty foods can aggravate or trigger the upper abdominal pain, bloating, belching and nausea that characterize the condition.

Causes
Your stomach — a hollow, muscular sac — sits in the upper left corner of your abdomen, just under your rib cage. The typical adult stomach is around 10 inches long and can expand to hold about 1 gallon of food and liquid. When your stomach is empty, its tissues fold in on themselves, a bit like a closed accordion. As your stomach fills and expands, the folds gradually disappear.
Your stomach processes and stores food, which it gradually releases into your small intestine. When food arrives from your esophagus, a muscular ring at the joining of your esophagus and stomach (lower esophageal sphincter) relaxes to let it in. Your stomach walls, lined with layers of powerful muscles, then begin churning the food, mixing it into smaller and smaller pieces. At the same time, glands in the wall of your stomach pump out gastric juices — including enzymes and stomach acids — that help break food down further.
One of these, hydrochloric acid, is so caustic that it can dissolve iron nails. Your stomach's tissues are protected from this corrosive acid by the mucous-bicarbonate barrier — a layered buffering system in which bicarbonate regulates the stomach's acid-alkaline balance, and mucous provides a thick, sticky coating for the stomach walls.

Acute gastroenteritis

2006-06-13T02:44:00.000-07:00

Acute gastroenteritis

Acute diarrhoea or gastroenteritis is the passage of loose stools more frequently than what is normal for that individual. This increased frequency is often associated with stools that are watery or semisolid, abdominal cramps and bloating.. Acute watery diarrhoea is an extremely common problem, and can be fatal due to severe dehydration, in both adults and children, especially in the very young and the old or in those who have poor immunity such as individuals with HIV infection or patients who are using certain medications that suppress the immune system. In healthy adults, however, it is often no more than a nuisance. Because it may interfere with ones ability to work, it can also adversely affect the individual’s income.

How does it occur?
Acute diarrhoea is most often due to an infection. Bacteria such as E. coli and Vibrio cholerae, certain viruses and parasites such as Giardia can cause diarrhoea and vomiting. Certain medications and allergies to certain food ingredients are some non-infectious causes of acute gastroenteritis.

What are the symptoms?
Diarrhoea is the most troublesome symptom and may be associated with nausea and vomiting. The frequency of stools varies depending on the cause and the severity of the illness. It is usually also associated with abdominal cramps, and symptoms of gas. When the vomiting and diarrhoea are severe it is not uncommon for the individual with the illness to get dehydrated and this in turn may lead to light-headedness, weakness, confusion, kidney failure and even death.

How is it diagnosed?
When acute diarrhoea is due to an infectious agent, it is usually not necessary to find out the cause, because the diarrhoea is self-limiting and often resolves in the majority of patients within a few days. If the diarrhoea becomes chronic (more than two weeks) then special tests may be necessary. For non-infectious causes of acute diarrhoea it is important to find the underlying cause so that the causative agent can be appropriately treated or eliminated.

What is the treatment?
It is important to remember that acute gastroenteritis is an illness that lasts only a few days and does not, in general, require antibiotic or anti-microbial treatment. Correcting water and electrolytes deficits that occur, because they are lost in the stools and vomitus, is best done with an oral rehydration solution. This is a solution made up of glucose and electrolytes such as sodium, potassium and bicarbonate. This solution should be given to all patients who can take fluids by mouth including those who are vomiting. Usually enough water and electrolytes are absorbed to prevent the patient becoming dehydrated despite the vomiting. One can buy packets of oral rehydration salts, which are dissolved in safe drinking water. A simple and effective solution can be made cheaply and easily at home by adding one flat teaspoon of sugar, one eighth tip of a teaspoon of salt to eight ounces (240 ml/glass) of water. It is important that this solution be drunk frequently to ensure that the patient does not get dehydrated. Medicines to decrease the diarrhoea and vomiting may be used when symptoms are severe. Food can be given with no restrictions as soon as the patient is able to eat without discomfort. It is a common misconception that foods worsen diarrhoea but this has not been shown to be the case in carefully done studies.

Is hospitalisation necessary for acute gastroenteritis?
Admission to a hospital for intravenous fluids may be necessary if dehydration occurs despite drinking the oral rehydration solution.

How can it be prevented?
Since most cases of acute watery diarrhoea are infectious, especially in developing countries, the majority of such illnesses can be prevented by drinking water or eating foods that are not contaminated with infectious agents. Washing hands frequently with non-contaminated water, when caring for a patient with diarrhoea as also always before eating is important. Proper storage of food and water is also important to prevent harmful bacteria from contaminating them.

TB

2005-12-26T17:34:00.000-08:00

Tuberculosis
From Wikipedia, the free encyclopedia.
Tuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) but can also affect the central nervous system (meningitis), lymphatic system, circulatory system (miliary TB), genitourinary system, bones and joints.
Tuberculosis is the most common major infectious disease today, infecting two billion people or one-third of the world's population, with nine million new cases of active disease annually, resulting in two million deaths, mostly in developing countries.
Most of those infected (90 percent) have asymptomatic latent TB infection (LTBI). There is a 10 percent lifetime chance that LTBI will progress to active TB disease which, if left untreated, will kill more than 50 percent of its victims. TB is one of the top three infectious killing diseases in the world: HIV/AIDS kills 3 million people each year, TB kills 2 million, and malaria kills 1 million.
The neglect of TB control programs, HIV/AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) are emerging. The World Health Organization declared TB a global health emergency in 1993.

Other names for the disease
TB (short for tuberculosis and also for Tubercle Bacillus)
Consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor, and long relentless wasting)
Wasting disease
White plague (TB sufferers appeared markedly pale)
Phthisis (Greek for consumption) and phthisis pulmonalis
Scrofula (swollen neck glands)
King's evil (so called because it was believed that a king's touch would heal scrofula)
Pott's disease of the spine
Miliary TB (x-ray lesions look like millet seeds)
Tabes mesenterica (TB of the abdomen)
Lupus vulgaris (the common wolf - TB of the skin)
Prosector's wart, also a kind of TB of the skin, transmitted by contact with contaminated cadavers to anatomists, pathologists, veterinarians, surgeons, butchers, etc.

The bacterium

Acid-fast bacilli (AFB) (shown in red) are tubercle bacilli Mycobacterium tuberculosis.
The cause of tuberculosis, Mycobacterium tuberculosis (MTB), is a slow-growing aerobic bacterium that divides every 16 to 20 hours. This is extremely slow compared to other bacteria, which tend to have division times measured in minutes (among the fastest growing bacteria is a strain of E. coli that can divide roughly every 20 minutes). It is not classified as either Gram-positive or Gram-negative because it does not have the chemical characteristics of either, although it contains peptidoglycan in their cell wall. If a Gram stain is performed, it stains very weakly Gram-positive or not at all. It is a small rod-like bacillus which can withstand weak disinfectants and can survive in a dry state for weeks but, spontaneously, can only grow within a host organism (in vitro culture of M. tuberculosis took a long time to be achieved, but is nowadays a normal laboratory procedure).
MTB is identified microscopically by its staining characteristics: it retains certain stains after being treated with acidic solution, and is thus classified as an "acid-fast bacillus" or "AFB". In the most common staining technique, the Ziehl-Neelsen stain, AFB are stained a bright red which stands out clearly against a blue background. Acid-fast bacilli can also be visualized by fluorescent microscopy, and by auramine-rhodamine stain.
The M. tuberculosis complex includes 3 other mycobacteria which can cause tuberculosis: M. bovis, M. africanum, and M. microti. The first two are very rare causes of disease and the last one does not cause human disease.
Nontuberculous mycobacteria (NTM) are other mycobacteria (besides M. leprae which causes leprosy) which may cause pulmonary disease resembling TB, lymphadenitis, skin disease, or disseminated disease. These include Mycobacterium avium, M. kansasii, and others.

The disease
Transmission
TB is spread through aerosol droplets which are expelled when persons with active TB disease cough, sneeze, speak, or spit. Close contacts (people with prolonged, frequent, or intense contact) are at highest risk of becoming infected (typically 22 percent infection rate but everything is possible, even up to 100%). A person with untreated, active tuberculosis can infect an estimated 20 other people per year. Others at risk include foreign-born from areas where TB is common, immunocompromised patients (eg. HIV/AIDS), residents and employees of high-risk congregate settings, health care workers who serve high-risk clients, medically underserved, low-income populations, high-risk racial or ethnic minority populations, children exposed to adults in high-risk categories, and people who inject illicit drugs.
Transmission can only occur from people with active TB disease (not latent TB infection).
The probability of transmission depends upon infectiousness of the person with TB (quantity expelled), environment of exposure, duration of exposure, and virulence of the organism.
The chain of transmission can be stopped by isolating patients with active disease and starting effective anti-tuberculous therapy.

Pathogenesis
While only 10 percent of TB infection progresses to TB disease, if untreated the death rate is 51 percent.
TB infection begins when MTB bacilli reach the pulmonary alveoli, infecting alveolar macrophages, where the mycobacteria replicate exponentially. Bacteria are picked up by dendritic cells, which can transport bacilli to local (mediastinal) lymph nodes, and then through the bloodstream to the more distant tissues and organs where TB disease could potentially develop: lung apices, peripheral lymph nodes, kidneys, brain, and bone.
Tuberculosis is classed as one of the granulomatous inflammatory conditions. Macrophages, T lymphocytes, B lymphocytes and fibroblasts are among the cells that aggregate to form a granuloma, with lymphocytes surrounding infected macrophages. The granuloma functions not only to prevent dissemination of the mycobacteria, but also provides a local environment for communication of cells of the immune system. Within the granuloma, T lymphocytes secrete cytokine such as interferon gamma, which activates macrophages and make them better able to fight infection. T lymphocytes can also directly kill infected cells.
Importantly, bacteria are not eliminated with the granuloma, but can become dormant, resulting in a latent infection. Latent infection can be diagnosed only by tuberculin skin test, which yields a delayed hypertype sensitivity response to purified protein derivatives of M. tuberculosis in an infected person.
Another feature of the granulomas of human tuberculosis is the development of cell death, also called necrosis, in the center of tubercles. To the naked eye this has the texture of soft white cheese and was termed caseous necrosis.
If TB bacteria gain entry to the blood stream from an area of tissue damage they spread through the body and set up myriad foci of infection, all appearing as tiny white tubercles in the tissues. This is called miliary tuberculosis and has a high case fatality.
In many patients the infection waxes and wanes. Tissue destruction and necrosis are balanced by healing and fibrosis. Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material. During active disease, some of these cavities are in continuity with the air passages bronchi. This material may therefore be coughed up. It contains living bacteria and can pass on infection.
Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Affected areas are eventually replaced by scar tissue.

Progression
In those people in whom TB bacilli overcome the immune system defenses and begin to multiply, there is progression from TB infection to TB disease. This may occur soon after infection (primary TB disease – 1 to 5 percent) or many years after infection (post primary TB, secondary TB, reactivation TB disease of dormant bacilli – 5 to 9 percent). The risk of reactivation increases with immune compromise, such as that caused by infection with HIV. In patients co-infected with M. tuberculosis and HIV, the risk of reactivation increases to 10 percent per year, while in immune competent individuals, the risk is between 5 and 10 percent in a lifetime.
About five percent of infected persons will develop TB disease in the first two years, and another five percent will develop disease later in life. In all, about 10 percent of infected persons with normal immune systems will develop TB disease in their lifetime.
Some medical conditions increase the risk of progression to TB disease. In HIV infected persons with TB infection, the risk increases to 10 percent each year instead of 10 percent over a lifetime. Other such conditions include drug injection (mainly because of the life style of IV Drug users), substance abuse, recent TB infection (within two years) or history of inadequately treated TB, chest X-ray suggestive of previous TB (fibrotic lesions and nodules), diabetes mellitus, silicosis, prolonged corticosteroid therapy and other immunosuppressive therapy, head and neck cancers, hematologic and reticuloendothelial diseases (leukemia and Hodgkin's disease), end-stage renal disease, intestinal bypass or gastrectomy, chronic malabsorption syndromes, or low body weight (10 percent or more below the ideal).
Some drugs, including rheumatoid arthritis drugs that work by blocking tumor necrosis factor-alpha (an inflammation-causing cytokine), raise the risk of causing a latent infection to become active due to the importance of this cytokine in the immune defense against TB.
TB disease most commonly affects the lungs (75 percent or more), where it is called pulmonary TB. Symptoms include a productive, prolonged cough of more than three weeks duration, chest pain, and hemoptysis. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, and easy fatigability. The term consumption arose because sufferers appeared as if they were "consumed" from within by the disease. People from Asian and African descent may have more often lymph node TB than Caucasians.
Extrapulmonary sites include the pleura, central nervous system (meningitis), lymphatic system (scrofula of the neck), genitourinary system, and bones and joints (Pott's disease of the spine). An especially serious form is "disseminated", or "miliary" TB, so named because the lung lesions so-formed resemble millet seeds on x-ray. These are more common in immunosuppressed persons and in young children. Pulmonary TB may co-exist with extrapulmonary TB.

Drug resistance
Drug-resistant TB is transmitted in the same way as drug-susceptible TB. Primary resistance develops in persons initially infected with resistant organisms. Secondary resistance (acquired resistance) may develop during TB therapy due to inadequate treatment regimen, not taking

Diagnosis
A complete medical evaluation for TB includes a medical history, a physical examination, a tuberculin skin test, a serological test, a chest X-ray, and microbiologic smears and cultures. The measurement of a positive skin test depends upon the person's risk factors for progression of TB infection to TB disease.
See: tuberculosis diagnosis, tuberculosis radiology

Treatment
Persons with TB infection (class 2 or class 4 TB), but who do not have TB disease (class 3 or class 5 TB), cannot spread the infection to other people. TB infection in a person who does not have TB disease is not considered a case of TB and is often referred to as latent TB infection (LTBI). This distinction is important because treatment options will be different for a person who has LTBI instead of active TB disease.
See: tuberculosis treatment

Prevention
Prevention and control efforts include three priority strategies:
identifying and treating all persons who have TB disease
finding and evaluating persons who have been in contact with TB patients to determine whether they have TB infection or disease, and treating them appropriately, and
testing high-risk groups for TB infection to identify candidates for treatment of latent infection and to ensure the completion of treatment.
In tropical areas where the incidence of atypical mycobacteria is high, exposure to nontuberculous mycobacteria gives some protection against TB.

BCG vaccine
Many countries use BCG vaccine as part of their TB control programs, especially for infants. The protective efficacy of BCG for preventing serious forms of TB (e.g. meningitis) in children is high (greater than 80 percent). However, the protective efficacy for preventing pulmonary TB in adolescents and adults is variable, from 0 to 80 percent. In the United Kingdom, children aged 10-14 were typically immunized during school until 2005. (Routine BCG vaccination was stopped as it was no longer cost-effective. The incidence of TB in people born in the UK, and with parents and grandparents who were born in the UK, was at an all time low, and falling. Others continue to be offered BCG vaccination.)
The effectiveness of BCG is much lower than in areas where mycobacteria are much less prevalent. In the USA, BCG vaccine is not routinely recommended except for selected persons who meet specific criteria:
Infants or children with negative skin-test result who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to multidrug-resistant TB.
Healthcare workers considered on individual basis in settings in which high percentage of MDR-TB patients has been found, transmission of MDR-TB is likely, and TB control precautions have been implemented and not successful.

Tuberculosis vaccine
The first recombinant tuberculosis vaccine entered clinical trials in the United States in 2004 sponsored by the National Institute of Allergy and Infectious Diseases (NIAID). [1]
A 2005 study showed that a DNA TB vaccine given with conventional chemotherapy can accelerate the disappearance of bacteria as well as protecting against re-infection in mice; it may take four to five years to be available in humans. PMID 15690060.
Because of the limitations of current vaccines, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and advance market commitments.

Animals
Tuberculosis can be carried by many mammals. Domesticated species, such as cats and dogs, are generally free of tuberculosis, but wild animals may be carriers. As a result, many places have regulations restricting the ownership of novelty pets, possibly including such partially domesticated species as pet skunks; for example, the American state of California forbids the ownership of pet gerbils. The strictness of such restrictions generally depends on the public health policies adopted for fighting tuberculosis.
An effort to eradicate bovine tuberculosis from the cattle and deer herds of New Zealand is underway. It has been found that herd infection is more likely in areas where infected vector species such as Australian brush-tailed possums come into contact with domestic livestock at farm/bush borders. Controlling the vectors through possum eradication and monitoring the level of disease in livestock herds through regular surveillance are seen as a "two-pronged" approach to ridding New Zealand of the disease.
In both the Republic of Ireland and Northern Ireland, badgers have been identified as a vector species for the transmission of bovine tuberculosis. As a result, the government in both regions has mounted an active campaign of eradication of the species in an effort to reduce the incidence of the disease. Badgers have been culled primarily by snaring and gassing. It remains a contentious issue, with proponents and opponents of the scheme citing their own studies to support their position.

Pain Pain Go Away

2005-12-21T21:27:00.000-08:00

Ovulation pain

Ovulation is a phase of the female menstrual cycle, which involves the release of an egg (ovum) from one of the ovaries. For most women, ovulation occurs about once every month until menopause, apart from episodes of pregnancy and breastfeeding. About one in five women experience pain and discomfort during ovulation. The duration of the pain varies from one woman to the next, but ranges from a few minutes to 48 hours. In most cases, ovulation pain doesn't mean that anything is wrong. However, severe pain may sometimes be symptomatic of gynaecological conditions including endometriosis. See your doctor if your ovulation pain lasts longer than three days or is associated with other unusual menstrual symptoms, such as heavy bleeding. Ovulation pain is also known as mid-cycle pain and mittelschmerz (German for 'middle pain').

Symptoms
The symptoms of ovulation pain can include:
Pain in the lower abdomen, just inside the hip bone.
The pain typically occurs about two weeks before the menstrual period is due.
The pain is felt on the right or left side, depending on which ovary is releasing an egg.
The pain may switch from one side to the other from one cycle to the next, or remain on one side for a few cycles.
The pain sensation varies between individuals - for example, it could feel like uncomfortable pressure, twinges, sharp pains or cramps.
The duration of pain ranges anywhere from minutes to 48 hours.

Theories on possible causes
The exact cause of ovulation pain is not clear, but theories include:

Emerging follicle - hormones prompt the ovaries to produce around 20 follicles. Each follicle contains an immature egg (ovum) but only one follicle usually survives to maturity. It is supposed that ovulation pain is caused by the expanding follicle stretching the membrane of the ovary.
Ruptured follicle - when the egg is mature, it bursts from the follicle. This may cause slight bleeding. The peritoneum (abdominal lining) could be irritated by the blood or fluids from the ruptured follicle, and this may trigger the pain.

Underlying medical problems

In most cases, ovulation pain is harmless. However, severe and prolonged ovulation pain, or other pains felt in the lower abdomen, can be symptomatic of various medical conditions including:

Salpingitis - inflammation of the fallopian tubes following an infection.
Chronic pelvic inflammatory disease - inflammation following an infection.
Endometriosis - the lining of the womb (endometrium) grows in other locations, such as the bowel. Other symptoms include painful periods and painful sex.
Ovarian cyst - an abnormal pocket of fluid that develops on the ovary.
Ectopic pregnancy - a pregnancy that develops outside of the womb, most commonly in one of the fallopian tubes. Symptoms include cramping, abdominal pain and vaginal bleeding. Seek urgent medical help.
Appendicitis - inflammation of the appendix can sometimes be confused with ovulation pain. Seek urgent medical help if the pain is on the right side of your abdomen and you are experiencing nausea and vomiting.
Other gastrointestinal problems - lower abdominal pain can be symptomatic of a range of gastrointestinal problems, including perforated ulcer, gastroenteritis and inflammatory bowel disease.

Diagnosis methods

Tests that help determine whether ovulation pain is harmless or caused by infection or disease may include:
Medical history
Physical examination, including an internal pelvic examination
Blood tests
Cervical cultures
Abdominal ultrasound
Vaginal ultrasound
Exploratory surgery (laparoscopy or 'keyhole' surgery).Taking care of yourselfConsult with your doctor to make sure that your ovulation pain isn't caused by any underlying medical problem.

Suggestions on taking care of benign ovulation pain yourself include:
Relax. If the pain is particularly bothersome, rest in bed whenever you can.
Use pain-killing medication.
Warmth on the lower abdomen may help. Use heat packs, hot water bottles or warm baths.
Take anti-inflammatory drugs. See your doctor or pharmacist for recommendations.
The Pill and other forms of hormonal contraceptive can prevent ovulation pain because they stop ovulation. Talk over this option with your doctor.

See your doctor if you experience ovulation pain that lasts longer than three days, or if you have other symptoms such as heavy bleeding or discharge.

Family planning

Chances of conception are high if a couple have sex in the days before, during and after ovulation. Some women rely on ovulation pain to help them plan a pregnancy. However, it is unwise to rely on ovulation pain alone if you're trying to avoid pregnancy. Always use other methods of birth control.

Where to get help
Your doctor
Gynaecologist
Women's health clinic
Family Planning Victoria Tel. (03) 9257 0100
Women's Health Victoria Tel. (03) 9662 3755
Women's Health Information Centre Information line Tel. (03) 9344 2007, TTY (03) 9344 2849, Country callers Tel. 1800 442 007

Things to remember
About one in five women experience pain during ovulation that can last from a few minutes to 48 hours.
Ovulation pain is usually harmless, but can sometimes indicate various medical conditions such as endometriosis.
See your doctor if your ovulation pain lasts longer than three days or is associated with other unusual menstrual symptoms, such as heavy bleeding.

2005-12-21T18:48:00.001-08:00

2005-12-21T18:48:00.000-08:00

2005-12-21T18:46:00.000-08:00

2005-12-21T18:45:00.000-08:00

2005-12-21T18:43:00.000-08:00

2005-12-20T22:35:00.000-08:00

Ringworm -- pag nahawa talaga ako uupakan kita...

2005-12-20T01:43:00.000-08:00

What you don't know wont hurt you...>>This is so wrong! Especially with individuals who know little or nothing...

Ringworm

Ringworm is a contagious fungus infection that can affect the scalp, the body, the feet (athlete's foot), or the nails.
People can get Ringworm from:
1) direct skin-to-skin contact with an infected person or pet,
2) indirect contact with an object or surface that an infected person or pet has touched, or
3) rarely, by contact with soil.

Ringworm can be treated with fungus-killing medicine.
To prevent Ringworm,
1) make sure all infected persons and pets get appropriate treatment,
2) avoid contact with infected persons and pets,
3) do not share personal items, and 4) keep common-use areas clean.

What is Ringworm?
Ringworm is a contagious fungus infection that can affect the scalp, the body (particularly the groin), the feet, and the nails. Despite its name, it has nothing to do with worms. The name comes from the characteristic red ring that can appear on an infected person's skin. Ringworm is also called Tinea.

What is the infectious agent that causes Ringworm?
Ringworm is caused by several different fungus organisms that all belong to a group called "Dermatophytes." Different Dermatophytes affect different parts of the body and cause the various types of Ringworm:
Ringworm of the scalp
Ringworm of the body
Ringworm of the foot (athlete's foot)
Ringworm of the nails

Where is Ringworm found?
Ringworm is widespread around the world and in the United States. The fungus that causes scalp Ringworm lives in humans and animals. The fungus that causes Ringworm of the body lives in humans, animals, and soil. The fungi that cause Ringworm of the foot and Ringworm of the nails live only in humans.

How do people get Ringworm?
Ringworm is spread by either direct or indirect contact. People can get Ringworm by direct skin-to-skin contact with an infected person or pet. People can also get Ringworm indirectly by contact with objects or surfaces that an infected person or pet has touched, such as hats, combs, brushes, bed linens, stuffed animals, telephones, gym mats, and shower stalls. In rare cases Ringworm can be spread by contact with soil.

What are the signs and symptoms of Ringworm?
Ringworm of the scalp usually begins as a small pimple that becomes larger, leaving scaly patches of temporary baldness. Infected hairs become brittle and break off easily. Yellowish crusty areas sometimes develop.
Ringworm of the body shows up as a flat, round patch anywhere on the skin except for the scalp and feet. The groin is a common area of infection (groin Ringworm). As the rash gradually expands, its center clears to produce a ring. More than one patch might appear, and the patches can overlap. The area is sometimes itchy.
Ringworm of the foot is also called athlete's foot. It appears as a scaling or cracking of the skin, especially between the toes.
Ringworm of the nails causes the affected nails to become thicker, discolored, and brittle, or to become chalky and disintegrate.

How soon after exposure do symptoms appear?
Scalp Ringworm usually appears 10 to 14 days after contact, and Ringworm of the skin 4 to 10 days after contact. The time between exposure and symptoms isnot known for the other types of Ringworm.

How is Ringworm diagnosed?
A health-care provider can diagnose Ringworm by examining the site of infection with special tests.

Who is at risk for Ringworm?
Anyone can get Ringworm. Scalp Ringworm often strikes young children; outbreaks have been recognized in schools, day-care centers, and infant nurseries. School athletes are at risk for scalp Ringworm, Ringworm of the body, and foot Ringworm; there have been outbreaks among high school wrestling teams. Children with young pets are at increased risk for Ringworm of the body.

What is the treatment for Ringworm?
Ringworm can be treated with fungus-killing medicine. The medicine can be in taken in tablet or liquid form by mouth or as a cream applied directly to the affected area.

What complications can result from Ringworm?
Lack of or inadequate treatment can result in an infection that will not clear up.

Is Ringworm an emerging infection?
Although Ringworm is not tracked by health authorities, infections appear to be increasing steadily, especially among pre-school and school-age children. Early recognition and treatment are needed to slow the spread of infection and to prevent re-infection.

How can Ringworm be prevented?
Ringworm is difficult to prevent. The fungus is very common, and it is contagious even before symptoms appear.
Steps to prevent infection include the following:
Educate the public, especially parents, about the risk of Ringworm from infected persons and pets.
Keep common-use areas clean, especially in schools, day-care centers, gyms, and locker rooms. Disinfect sleeping mats and gym mats after each use.
Do not share clothing, towels, hair brushes, or other personal items.

Infected persons should follow these steps to keep the infection from spreading:
Complete treatment as instructed, even after symptoms disappear.
Do not share towels, hats, clothing, or other personal items with others.
Minimize close contact with others until treated.
Make sure the person or animal that was the source of infection gets treated.

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have any questions about the disease described above or think that you might have a fungus infection, consult a health-care provider.

2005-12-14T23:54:00.000-08:00

My Tummy hurts...

2005-12-12T01:31:00.000-08:00

What is a peptic ulcer?
A peptic ulcer is a sore in the lining of your stomach or duodenum.

* The duodenum is the first part of your small intestine. If peptic ulcers are found in the stomach, they're called gastric ulcers. If they're found in the duodenum, they're called duodenal ulcers. You can have more than one ulcer.

Many people have peptic ulcers. Peptic ulcers can be treated successfully. Seeing your doctor is the first step.

Peptic ulcers occur in the wall of the stomach and duodenum.

What are the symptoms of peptic ulcers?
A burning pain in the gut is the most common symptom. The pain feels like a dull ache that comes and goes for a few days or weeks starts 2 to 3 hours after a meal comes in the middle of the night when your stomach is empty usually goes away after you eat

Other symptoms are:
losing weight
not feeling like eating
having pain while eating
feeling sick to your stomach
vomiting

Some people with peptic ulcers have mild symptoms. If you have any of these symptoms, you may have a peptic ulcer and should see your doctor.

What causes peptic ulcers?
Peptic ulcers are caused by bacteria called Helicobacter pylori, or H. pylori for short
nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen
other diseases

Nonsteroidal anti-inflammatory drugs can cause peptic ulcers.

Your body makes strong acids that digest food. A lining protects the inside of your stomach and duodenum from these acids. If the lining breaks down, the acids can damage the walls. Both H. pylori and NSAIDs weaken the lining so acid can reach the stomach or duodenal wall.
H. pylori causes almost two-thirds of all ulcers. Many people have H. pylori infections. But not everyone who has an infection will develop a peptic ulcer.

Most other ulcers are caused by NSAIDs. Only rarely do other diseases cause ulcers.

Do stress or spicy foods cause peptic ulcers?
No, neither stress nor spicy foods cause ulcers. But they can make ulcers worse. Drinking alcohol or smoking can make ulcers worse, too.

What increases my risk of getting peptic ulcers?
You're more likely to develop a peptic ulcer if you have an H. pylori infection, use NSAIDs often
smoke cigarettes, drink alcohol, have relatives who have peptic ulcers, are 50 years old or older
Having relatives with peptic ulcers puts you at risk of having them too.

Can peptic ulcers get worse?
Peptic ulcers will get worse if they aren't treated. Call your doctor right away if you have any of these symptoms:
sudden sharp pain that doesn't go away
black or bloody stools
bloody vomit or vomit that looks like coffee grounds
Call your doctor if the pain gets worse.

These could be signs that
the ulcer has gone through, or perforated, the stomach or duodenal wall
the ulcer has broken a blood vessel
the ulcer has stopped food from moving from the stomach into the duodenum

These symptoms must be treated quickly. You may need surgery.

How can I find out whether I have peptic ulcers?
If you have symptoms, see your doctor. Your doctor may
Peptic ulcers can show up on x rays.
take x rays of your stomach and duodenum, called an upper GI series. You'll drink a liquid called barium to make your stomach and duodenum show up clearly on the x rays.
use a thin lighted tube with a tiny camera on the end to look at the inside of your stomach and duodenum. This procedure is called an endoscopy. You'll take some medicine to relax you so your doctor can pass the thin tube through your mouth to your stomach and duodenum. Your doctor may also remove a tiny piece of your stomach to view under a microscope. This procedure is called a biopsy.

If you do have a peptic ulcer, your doctor may test your breath, blood, or tissue to see whether bacteria caused the ulcer.

How are peptic ulcers treated?
Peptic ulcers can be cured. Medicines for peptic ulcers are
proton pump inhibitors or histamine receptor blockers to stop your stomach from making acids
antibiotics to kill the bacteria

Depending on your symptoms, you may take one or more of these medicines for a few weeks. They'll stop the pain and help heal your stomach or duodenum.
Ulcers take time to heal. Take your medicines even if the pain goes away. If these medicines make you feel sick or dizzy, or cause diarrhea or headaches, your doctor can change your medicines.

If NSAIDs caused your peptic ulcer, you'll need to stop taking them. If you smoke, quit. Smoking slows healing of ulcers.

Can I use antacids?
Yes. If you have a peptic ulcer, taking antacids will stop the acids from working and reduce the pain, help ulcers heal

You can buy antacids at any grocery store or drugstore. But you must take them several times a day. Also, antacids don't kill the bacteria, so your ulcer could come back even if the pain goes away.

Can peptic ulcers come back?
Yes. If you stop taking your antibiotic too soon, not all the bacteria will be gone and not all the sores will be healed. If you still smoke or take NSAIDs, your ulcers may come back.[Top]
What happens if peptic ulcers don't heal? Will I need surgery?

In many cases, medicine heals ulcers. You may need surgery if your ulcers
don't heal keep coming back perforate, bleed, or obstruct the stomach orduodenum
Surgery can remove the ulcers reduce the amount of acid your stomach makes[Top]

What can I do to prevent peptic ulcers?
Stop using NSAIDs. Talk with your doctor about other pain relievers. [Top]
What can I do to lower my risk of getting peptic ulcers?
Don't smoke.
Don't drink alcohol.

Tummy...

2005-12-12T01:26:00.000-08:00

Dysmenorrhea
Also found under: Menstrual Disorders

What is it?
The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Dysmenorrhea is the term used to describe painful menstrual periods. There are two types of dysmenorrhea. Primary dysmenorrhea has no underlying cause. Secondary dysmenorrhea is caused by an underlying gynecological disorder.

Who gets it?
Primary dysmenorrhea affects more than 50 percent of all women who have a menstrual period. Approximately 5 to 15 percent of these women have severe pain that interferes with daily activities. Only about one-fourth of all women with dysmenorrhea have secondary dysmenorrhea, meaning there is an underlying cause of their symptoms. Dysmenorrhea usually begins during adolescence.

What causes it?
To understand dysmenorrhea, it's important to understand how the menstrual cycle works. Each month, the lining of the uterus, the endometrium, thickens to prepare for the egg that is released by the fallopian tubes. If the woman does not become pregnant during that cycle, then most of the endometrium is shed and bleeding occurs. The blood flows from the uterus, through the cervical canal, and out through the vagina. Primary dysmenorrhea occurs when the uterus contracts because the blood supply to the endometrium is reduced. This pain occurs only during a menstrual cycle where an egg is released. If the cervical canal is narrow, the pain may be worse as the endometrial tissue passes through the cervix. Pain can also be caused by a uterus that tilts backward instead of forward, low levels of physical activity, and emotional stress. Secondary dysmenorrhea can be caused by the growth of uterine tissue outside the uterus, called endometriosis; non-cancerous growths of muscle and fibrous tissue in the uterus, called fibroid tumors; the non-cancerous growth of the uterine lining in the muscular wall of the uterus, called adenomyosis; inflammation of the fallopian tubes; and the growth of scar tissue, or adhesions, between organs.

What are the symptoms?
Shortly before or in the beginning of the menstrual period, a woman with dysmenorrhea experiences cramps in the lower abdomen. The pain can be continuous, or may come and go, and may extend to the lower back and legs. The pain can be accompanied by headache, nausea, diarrhea or constipation, and the need to urinate frequently. In severe cases, dysmennorhea also causes vomiting and makes it difficult for the woman to participate in her normal activities. Symptoms are usually at their worst 24 hours after beginning, and stop after 2 days. Women with dysmenorrhea are more likely to pass blood clots from the lining of the uterus, which causes more pain.

How is it diagnosed?
To diagnose dysmenorrhea, your doctor will take a complete medical history and will perform a physical examination, including a pelvic, or internal, exam. This doctor would most likely be your gynecologist, a doctor who specializes in women's reproductive health. He or she will ask questions about your lifestyle, diet, sexual activity, and any medications you are taking. Fibroid tumors can usually be felt during a pelvic exam, but may need to be confirmed by an ultrasound scan of the abdomen. To make sure any growths are non-cancerous, your doctor may look inside the uterus using a hysteroscope, a small tube with a light that is inserted through the vagina and cervix and into the uterus. He or she may also look for abnormalities in the uterine tissue by removing a tiny sample of tissue from the inside of the uterus, called a biopsy, for examination under a microscope. Endometriosis is usually diagnosed through a combination of biopsy and laparoscopy. With laparoscopy, the doctor makes a small cut in the navel through which he or she inserts a small instrument called a laparoscope. With the laparoscope, the doctor can examine the uterus and other female organs, such as the fallopian tubes, in the pelvic area.

What is the treatment?
The treatment of dysmenorrhea depends on the cause of the problem. In most cases, symptoms are relieved by nonprescription anti-inflammatory drugs such as ibuprofren, naproxen, and mefanamic acid. If you know you have a history of dysmenorrhea, your doctor may recommend taking these medications up to two days before your menstrual period begins, and continuing them for one to two days after it begins. It's important to continue to get plenty of rest, follow a good diet, and exercise during your period. Women with primary dysmenorrhea that is so severe it interferes with daily activities may benefit from a low-dose birth control pill. Because birth control pills prevent an egg from being released each month, the menstrual period is generally lighter and lasts for a shorter time. Secondary dysmenorrhea is relieved by treating the cause. For example, fibroid tumors can be shrunk with hormone therapy, or may be surgically removed. Where fibroids are extremely large or cause severe pain, the entire uterus may need to be surgically removed. This procedure is called a hysterectomy, and is also used to treat severe endometriosis. A woman who has had a hysterectomy can no longer conceive a child. Inflammation of the fallopian tubes is treated with antibiotics.

Self-care tips
See your doctor if you have a pattern of severe pain at the beginning of and during your menstrual period. A thorough exam will help determine if your pain is caused by some underlying condition that may need immediate treatment. Remember, rest, diet, and exercise play an important role in your overall health, and may help relieve premenstrual and menstrual symptoms.

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

**http://www.hmc.psu.edu/healthinfo/d/dysmenorrhea.htm

Please...let it not be chicken pox...

2005-02-01T02:10:00.000-08:00

Varicella (Chicken Pox)

Chicken pox (Varicella) is a highly communicable viral disease that occurs most often during the winter and spring. Once you have had chicken pox, you are usually immune to it. However, if you have never had the disease, you can get it at any age.

SYMPTOMS
If you have chicken pox, you may have a slight fever and cold-like symptoms. However, you may not realize that you have the disease until you notice a red rash on your face, trunk, scalp, or in your mouth. Later, you may find lesions on your arms and legs. Your rash will go through three stages: initially, it will be a red spot, next a blister (vesicle), and finally a scab. You may have "old" spots that are healing and "new" spots that are just beginning to blister. Your rash will probably itch. In fact, it may begin to itch before you notice the rash. Scratching your lesions can lead to infection and the development of crater-like scars. After your lesions have healed, you may notice "red spots." These spots are not scars and will fade within a few weeks.

HOW IS CHICKEN POX SPREAD?
Chicken pox can be spread by direct person-to-person contact droplet or airborne spread of vesicle fluid or secretions of the respiratory tract, such as coughing and sneezing. It is contagious from 1-2 days before the onset of the rash and may be spread until all lesions have dried up and become scabs. After you are exposed to the disease, it may take from 10 days to three weeks before you notice a rash. These two facts may make it hard for you to identify when and where you were exposed to the illness.

HOW CAN THIS DISEASE BE PREVENTED?
For those individuals who do not have a known history of varicella, a blood titer is recommended, followed by the live varicella vaccine if the titer is negative. The chicken pox virus can be spread through contact with fluid from your blisters. It can also live for long periods of time on inanimate objects. Therefore, to reduce your chance of spreading this disease, use the following guidelines:

To avoid spreading the illness, stay in your room or apartment until all your lesions have dried up (approx. 5-7 days). Do not use public transportation, attend classes or social events. You may have visitors who have had chicken pox in the past. Avoid friends who have not had the disease.

Do not share eating utensils, food, smoking materials or allow others to drink after you. Use plastic utensils and paper plates. Place all paper products that you handle (including tissues) in a plastic bag for disposal. You should also keep your own supply of toilet items (including soap) that are stored away from the items used by others.

Your used bedsheets are another potential source of infection. Place these linens in a plastic bag. At the washer, you or a friend (preferably one who has had chicken pox) can dump the sheets from the bag without touching them. Be sure to use hot water, a strong detergent and a hot dryer setting. After the sheets are washed, they no longer carry the disease.

Non-immune students who are exposed to chicken pox and are pregnant or have some form of immunosuppression may consider receiving varicella zoster immune globulin (VZIG). The expense of this vaccine limits its use to cases at "special risk." VZIG is most effective if given within three days of exposure.

WHAT ARE THE COMPLICATIONS OF CHICKEN POX?
Chicken pox can lead to fetal death if the disease is acquired by a pregnant woman within four days before the baby's birth. Although young adults are less susceptible to varicella than children, their chance of experiencing serious complications is much higher.

Therefore, YOU SHOULD REPORT THE FOLLOWING SYMPTOMS TO YOUR PHYSICIAN IMMEDIATELY: severe chest pain, difficult or labored breathing, blood when you cough, sudden onset of severe headache, unexplained drowsiness (some medications, including decongestants and medications to relieve itching, can cause drowsiness) or severe vomiting.

WHAT SHOULD I DO IF I HAVE CHICKEN POX?
For older adolescents and adults, many physicians recommend starting on oral acyclovir within 24 hours of development of rash; so contact your physician right away to see if you are a candidate. Acyclovir may decrease the total number of lesions, the time to cessation of newly-formed lesions, and the need for pain relievers and fever reducers. It may also reduce the possibility of serious complications. The following measures may help you feel more comfortable:

Cool compresses and cool to tepid baths with baking soda and calamine lotion can help soothe itching.

DO NOT SCRATCH YOUR LESIONS.

Using a humidifier, sleeping with your head elevated, and taking decongestants can help relieve your stuffy nose.

Acetaminophen (Tylenol, Panadol, Datril) can help relieve body aches and fevers. AVOID ASPIRIN PRODUCTS.

Cool juice, popsicles and cool liquids can soothe your throat. Avoid spicy foods, citrus drinks, chocolate and hot sauces.

Clean cotton sheets can increase your comfort. Wear cotton T-shirts or gowns. Polyester can be too warm and other fabrics can irritate your lesions.

ADDITIONALLY:

Stay confined to your room until the lesions are all scabbed over. Keep any follow-up appointment before returning to class.

Make sure any visitor is aware you have chicken pox and allow only visitors that have had chicken pox or are know to be immune.

Do not allow any visitor who may be pregnant or have an immunosuppressed illness, such as cancer, AIDS, Lupus, organ transplants.

You need to make food service arrangements. Do not go to the dining area.

When showering, use the community bathroom when there are the least number of other people present.

Wear a mask when going to and from the bathroom – leave unless you are showering or brushing your teeth. A mask is not necessary when you are confined to your room.

Notify your instructors that you will be confined for 7-10 days.

Do not leave your residence room unless there is a fire. You should not go to public places such as movie theaters, restaurants, or use buses or other public transportation.

Follow any instructions given to you by your provider as to medication, showering, diet and return visits.

When you have been cleared by a provider, wash all bed linens and personal clothing items in a washer with hot, soapy water. Keep all items separate from other laundry.

I think I have chickenpox...

2005-02-01T02:06:00.000-08:00

Chickenpox is a common disease caused by the varicella-zoster virus (VZV), which is part of the herpesvirus family. Although many people associate the word herpes with genital herpes, the herpesvirus family is made up of nearly 100 kinds of viruses, eight of which cause disease in humans. Examples of different herpesviruses are herpes simplex virus (which causes cold sores and genital herpes infections), Epstein-Barr virus (which causes infectious mononucleosis), and varicella-zoster virus (which causes chickenpox and shingles). Varicella-zoster virus spreads in the air through coughs or sneezes or through contact with fluid from inside the chickenpox blisters.

Chickenpox, which occurs most often in the late winter and early spring, is very contagious - if exposed to an infected family member, about 80% to 90% of those in a household who haven't had chickenpox will get it. However, immunization of children with the chickenpox vaccine that's now available is expected to decrease cases of the disease dramatically over the next few years.

Although it's more common in kids under the age of 15, anyone can get chickenpox. A person usually has only one episode of chickenpox in his or her lifetime. But the virus that causes chickenpox can lie dormant within the body and can cause a different type of skin eruption later in life called shingles, also referred to as herpes-zoster.

Signs and Symptoms
Chickenpox is a viral infection that causes a red, itchy rash on the skin. The chickenpox rash usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.

The rash begins as multiple small, red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which then becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry, brown scabs. One of the most characteristic features of the chickenpox rash is that all stages of the lesions can be present at the same time.

Chickenpox blisters are about a quarter to half an inch wide, have a reddish base, and appear in bouts over 2 to 4 days. Some children have only a few blisters, whereas others have several hundred. The rash may be more extensive or severe in kids who have skin disorders such as eczema.

Some children have a fever, abdominal pain, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100 to 102 degrees Fahrenheit (37.7 to 38.8 degrees Celsius), although it may occasionally be higher. Younger children often have milder symptoms and fewer blisters than older children or adults.

Normally, chickenpox is a mild illness, but certain groups of people are more likely to have a more severe illness that could lead to complications. These include infants, adolescents, adults, and people with weak immune systems from either illnesses or from medications such as long-term steroid use. The most common complication of severe chickenpox illness in these groups of people is a bacterial infection that can involve many sites of the body including the skin around the blisters, bones, lungs, joints, and the blood. Other serious complications are due to the virus itself infecting the organs and include viral pneumonia, bleeding problems, and inflammation of the brain (encephalitis).

Anyone who has had chickenpox as a child is at risk for a complication later in life called shingles. After an infection, some of the varicella-zoster virus may remain inactive in nerve cells near the spinal cord. Many years later, the virus can reactivate and resurface as shingles. When it reactivates, it affects the nerve to the skin. Symptoms, such as a tingling feeling, itching, or pain followed by a rash with red bumps and blisters appear only in the area of the skin that the nerve goes to.

Contagiousness
The contagious period for chickenpox begins about 2 days before the rash appears and lasts until all the blisters are crusted over. A child with chickenpox should be kept out of school until all of the blisters have dried, which is usually about 1 week, but you don't have to wait until all the scabs fall off to let your child get back to a normal schedule.

Pregnant women, as well as people with diseases or problems with their immune system, should not be near a person with chickenpox. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially before 20 weeks), the fetus is at risk for birth defects. If she develops chickenpox 5 days before to 2 days after delivery, the newborn is at risk for life-threatening varicella (the mother has transferred the virus to the baby, but she hasn't had time to produce and transfer antibodies, which fight off infection, to the baby before it's born).

If the mother had chickenpox in the past (before the pregnancy or any time more than a week before delivery), then the fetus receives antibodies through the placenta. That means the mom's immunity gets passed on to the baby through the placenta and breast milk, so it would be unlikely for the infant to get sick. But antibodies are not fail-safe; there is no 100% guarantee that a baby won't get the infection - it's just less likely. Or, the infant might have the disease, but it won't be as severe. It's also important for pregnant women to realize that they're at increased risk of chickenpox complications if they catch it for the first time while pregnant.

People who haven't had chickenpox can also catch it from someone with shingles, but they cannot catch shingles itself. Why can't a person catch shingles from someone else? It's because shingles can only develop from a reactivation of the varicella-zoster virus in a person who has previously had chickenpox.

Incubation
The incubation period for chickenpox is 10 to 21 days after exposure; most cases appear in 14 to 17 days. For example, if one child in a family breaks out with chickenpox picked up at school, siblings probably will show symptoms about 2 weeks later.

Duration
Chickenpox usually lasts 7 to 10 days in children, but typically lasts longer in adults.

Professional Treatment
A virus causes chickenpox, so your child's doctor won't prescribe antibiotics (which are for bacterial infections). However, your child may require antibiotics if the sores become infected by bacteria, a common complication.

An antiviral medicine known as acyclovir may be prescribed for anyone over the age of 12, people with weakened immune systems (from diseases or medications), and those with long-term lung or skin diseases. The drug, which can make the chickenpox less severe, must be given within the first 24 hours after the rash appears. Acyclovir is not prescribed for children younger than 12 because the drug can have side effects. Your child's doctor can tell you if the medication is right for your child.

What age do you act?

2005-01-24T19:25:00.000-08:00

You Are 22 Years Old

22

Under 12: You are a kid at heart. You still have an optimistic life view - and you look at the world with awe.
13-19: You are a teenager at heart. You question authority and are still trying to find your place in this world.
20-29: You are a twentysomething at heart. You feel excited about what's to come... love, work, and new experiences.
30-39: You are a thirtysomething at heart. You've had a taste of success and true love, but you want more!
40+: You are a mature adult. You've been through most of the ups and downs of life already. Now you get to sit back and relax.

What Age Do You Act?

Dizziness

2004-12-22T22:47:00.000-08:00

Dizziness

People use the word dizzy to describe a variety of sensations. Some people use the word dizzy to refer to feeling lightheaded or faint. Others use it when they feel imbalance or a spinning sensation (vertigo). Dizziness is a symptom.

Mild dizziness, or lightheadedness, can occur when you move your head side to side, or just change the position of your head, or get up from sitting or lying down. This type of dizziness lasts a minute or less.

Dizziness that lasts minutes, hours or days can be more serious. Other symptoms that can occur with this type of dizziness include loss of balance (with a risk for falls), unsteady gait, loss of hearing, nausea, ringing in the ears and blurry vision.Problems with your inner ear's balance mechanism, certain medications and medical conditions can cause dizziness. Upper respiratory allergies affecting your ears and motion sickness may also cause dizziness. Dizziness may also be caused by depression, agoraphobia or hyperventilation.

Older adults may have dizziness when they suddenly move their heads or look up, because of atherosclerosis or osteoarthritis of the neck. Rarely, dizziness is caused by a brain tumor or multiple sclerosis.Our sense of balance depends on brain's receiving information from our eyes, nerves in our skin, muscles and joints, and organs of the inner ear. Dizziness can be a symptoms of a problem with one or more of these systems.

Knee Pain

2004-12-22T22:46:00.000-08:00

Knee Pain

The knees are regularly under stress, not only from high-impact sports but also from everyday activities such as squatting, stooping, kneeling, and climbing stairs. The knees get bent, twisted, and occasionally banged into during sports.CausesKnee joint: three-quarter view of front right kneeMost knee injuries involve a blow, a sudden twist, or a hard landing after a jump. A single strong blow in just the right place can tear cartilage and sprain several ligaments.

Runner's Knee

Runner's knee, also called patellofemoral pain syndrome or anterior knee pain, is the most common cause of knee pain and the most common overuse injury in the knee. Runner's knee can occur from repeated direct blows to the front of the knee or for no apparent reason. It can be brought on by a number of activities that place stress on the knee -- or even by wearing shoes that don't support the foot adequately during sports. It can also develop because the kneecap doesn't fit correctly in its groove at the end of the femur. The area around the kneecap or at the back of the knee may ache or swell, especially during and after activity. Squatting or sitting with the knees bent for a long time can be painful. You may feel grinding or popping when you bend or straighten the knee. Strengthening exercises can help correct runner's knee and prevent it in the future.

Jumper's Knee

Jumper's knee, or patellar tendinitis, is an inflammation of the quadriceps tendon at the top ofthe kneecap, or of the patellar tendon at the bottom of the kneecap. Jumping or a direct blow to the knee are the common causes of inflammation and tearing of these tendons.

Styes

2004-12-22T22:45:00.001-08:00

Styes

A stye is a red, tender bump on the eyelid that appears when an oil gland at the base of an eyelash becomes clogged. Styes can make your eyelid swell and itch. They are normally smaller than a pebble, but the discomfort and swelling can make them feel huge.Growths on the eyelid that are not red and painful are usually cysts, not styes. Although any unusual lump or growth should be checked by a doctor, most eyelid cysts are harmless and don't need to be removed.

Tooth Grinding

2004-12-22T22:45:00.000-08:00

Tooth Grinding

Bruxism, also known as tooth grinding, is a sleep disorder in which a person frequently clenches or grinds his or her teeth. It can cause excessive wear on tooth surfaces and lead to dental problems. It can also cause jaw pain or even jaw dislocation. It is more common in children than in adults, and frequently ceases when the child's permanent molars appear.

What causes a person to grind his or her teeth isn't known, but dental experts say the behavior in adults is linked to tension, aggression or anxiety. Rarely, people grind their teeth during the day, instead of at night. Adults who have bruxism often also have other sleep disorders, such as sleep apnea or snoring. They often feel fatigued after a night's sleep or experience headaches in the morning.A dentist diagnoses bruxism by a patient's medical history or by noting abnormal wear on the teeth. A spouse may complain of the grinding noise, often loud enough to be heard across a room.Bruxism can be treated in several ways.

Behavior-modification techniques teach the patient to relax the jaw and practice keeping the teeth apart while the lips are together. A mouth guard can be worn at night to keep the teeth from touching. For a person who grinds his or her teeth during the day, biofeedback can be useful. An electronic device can signal when the jaw is clenched and help change behavior.

Astigmatism

2004-12-22T22:44:00.001-08:00

Astigmatism

Astigmatism can cause areas of blurry vision at any distance because the cornea or lens of your eye is not perfectly spherical (circular) as it should be. People with astigmatism may find it hard to see vertical, horizontal, or diagonal lines clearly. Astigmatism can be accompanied by nearsightedness or farsightedness.

Anemia

2004-12-22T22:44:00.000-08:00

Anemia

Anemia is a condition characterized by too little hemoglobin or too few red blood cells in the blood. It is considered a symptom of an underlying disease or condition rather than a disease itself. The most common causes of anemia are deficiencies of iron, vitamin B12 and folic acid. Anemia may also be caused by loss of blood through gastrointestinal bleeding; common causes are medications such as aspirin and ibuprofen, and cancer.

Two other forms anemia are hemolytic anemia, in which red blood cells are destroyed more quickly than normal; and sickle-cell anemia, in which the body produces abnormal hemoglobin. Anemia occurs when there is too little iron stored in the body. Young children and adults on restricted diets may not get enough iron in the foods they eat; this can lead to anemia.

The digestive system may not be able to absorb enough iron; this occurs most often when part of the stomach has been removed. A person may become anemic through excessive loss of blood; this can affect women with heavy menstrual periods, and people with a stomach ulcer, duodenal ulcer, hemorrhoids, or cancer of the stomach or large intestine.If you suspect that you have anemia, it's important to visit your doctor.

Anemia can weaken body's resistance to illness or injury, and limits your energy and productivity. It can also indicate a more serious medical condition. Anemia is confirmed through a blood test. Treatment for anemia may be iron supplements or injections.

hm..

2004-12-22T19:04:00.000-08:00

Disorder	Rating
Paranoid:	Very High
Schizoid:	Low
Schizotypal:	Moderate
Antisocial:	High
Borderline:	Very High
Histrionic:	Very High
Narcissistic:	High
Avoidant:	High
Dependent:	Very High
Obsessive-Compulsive:	Moderate
-- Personality Disorder Test - Take It! --

I think I'm sick...

Brain Tumor

Contents

[edit]Causes

[edit]Signs and symptoms

[edit]Types of brain tumors

[edit]Diagnosis

ganglion cyst (Tendon Cyst)

Contents

[edit]Cause

[edit]Treatment

[edit]Epidemiology

[edit]Image gallery

Gallstone

Gallstones Overview

Clavicle Fracture

What is a broken collarbone?

Gestational diabetes

Polycystic Ovary Syndrome

Synonyms

Disorder Subdivisions

General Discussion

Breast Lumps

Mittelschmerz

Melatonin

Leukemia

Amyloidosis

Primary/Hereditary amyloidosis

Secondary amyloidosis

Organ-specific amyloidosis

Non-Hodgkin lymphoma

Less commonly used

Biopsy

Types of non-Hodgkin's lymphoma

Causes

Staging

Stages of NHL

Prognosis

International Prognostic Index

FLIPI

Treatment

Chemotherapy and radiation therapy

Hematopoietic stem cell transplantation

Immunotherapy

Measuring response to treatment

Nutrition during treatment

Followup care

Hodgkin's lymphoma

Abdominal pain

Dyspepsia

What is dyspepsia?

What are the signs of dyspepsia?

What causes dyspepsia?

Is dyspepsia a serious condition?

How is dyspepsia treated?

Do the medicines for dyspepsia have side effects?

Can I do anything else to avoid dyspepsia?

Dermoid Cyst

Profile of the Sociopath

List of Pscychological Adult Disorders

List of Adult Disorders

Bleeding During Pregnancy Causes

Bleeding During Pregnancy Causes

Abdominal aortic aneurysm

History

[edit] Epidemiology

[edit] Etiology

[edit] Pathophysiology

[edit] Screening

[edit] Manifestations and Diagnosis

[edit] Rupture

[edit] Treatment

Ovarian Cyst

What is an ovarian cyst?

What is a sonogram?

Are there any other tests I might have?

Do I need surgery for an ovarian cyst?

What type of surgery would I need?

Blisters:

Esophagitis