DISEASE MANIA

Dyspepsia

2008-04-15T20:20:00.000-07:00

Dyspepsia, meaning hard or difficult digestion, is chronic or recurrent pain or discomfort centered in the upper abdomen Discomfort, in this context, includes mild pain, upper abdominal fullness and feeling full earlier than expected with eating. It can be accompanied by bloating, belching, nausea or heartburn. Many people get dyspepsia. It is often caused by lifestyle factors, such as smoking and diet, but there are some serious causes such as cancer of the stomach, peptic ulcer disease and some medications. When people have dyspepsia but no risk factors for any of the serious causes, it can be labeled undifferentiated dyspepsia and treated without further investigations. When people have been investigated for dyspepsia but no cause has been found it can be labeled as functional dyspepsia.

Symptoms:
It is essential to inquire about the following ALARMS Symptoms when assessing dyspepsia

* Anaemia.
* Loss of Weight.
* Anorexia.
* Recent onset of progressive symptoms.
* Melaena or haematemesis.
* Swallowing difficulties.

Treatment:
Functional and undifferentiated dyspepsia have similar treatments. Decisions around the use of drug therapy are difficult because trials included heartburn in the definition of dyspepsia. This led to the results favoring proton pump inhibitors (PPIs), which are questionably effective for the treatment of heartburn.

Traditional therapies used for this diagnosis include lifestyle modification, antacids, H2-receptor antagonists (H2-RAs), prokinetic agents, and antiflatulents. It is has been noted that one of the most frustrating aspects of treating functional dyspepsia is that these traditional agents have been shown to have little or no efficacy.

Antacids and sucralfate were found to be no better than placebo in a literature review. H2-RAs have been shown to have marked benefit in poor quality trials (30% relative risk reduction), but only a marginal benefit in good quality trials. Prokinetic agents would empirically seem to work well since delayed gastric emptying is considered a major pathophysiological mechanism in functional dyspepsia. They have been shown in a meta-analysis to produce a relative risk reduction of up to 50%, but the studies evaluated to come to this conclusion used the drug cisapride which has since been removed from the market (now only available as an investigational agent due to serious adverse events such as torsades¬, and publication bias has been cited as a potential partial explanation for such a high benefit. Modern prokinetic agents such as metoclopramide, erythromycin and tegaserod have little or no established efficacy and often result in substantial side effects. Simethicone has been found to be of some value, as one trial suggests potential benefit over placebo and another shows equivalence with cisapride. So, with the somewhat recent advent of the proton pump inhibitor (PPI) class of medications, the question of whether these new agents are superior to traditional therapy has arisen.

A 2004 meta-analysis pooling data from three double-blind placebo-controlled studies found the multiple herbal extract Iberogast to be significantly more effective than placebo (p value = 0.001) at treating patients with functional dyspepsia through the targeting of multiple dyspeptic pathologies. This German-made phytopharmaceutical was found to be equivalent to cisapride and significantly superior to metochlopramide at reducing the symptoms of functional dyspepsia over a four week period. Retrospective surveillance of 40,961 children (12 years and under) found no serious side-effects.

Currently, PPIs are, depending on the specific drug, FDA indicated for erosive esophagitis, gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, eradication of H. pylori, duodenal and gastric ulcers, and NSAID-induced ulcer healing and prevention, but not functional dyspepsia. There are, however, evidence-based guidelines and literature that evaluate the use of PPIs for this indication. A helpful chart summarizing the major trials is available from the functional dyspepsia guidelines published in the World Journal of Gastroenterology in 2006.

The CADET study was the first to compare a PPI (omeprazole 20mg daily) to both an H2-RA (ranitidine 150mg BID) as well as a prokinetic agent (cisapride 20mg BID) alongside placebo. The study evaluated these agents in patients at 4 weeks and 6 months and noted that omeprazole had a significantly better response at 6 months (31%) than cisapride (13%) or placebo (14%) (p = 0.001) while it was just above the cutoff for being statistically significantly better than ranitidine (21%) (p = 0.053). Omeprazole also showed a significant increase in quality of life scores over the other agents and placebo in all but one category measured (p = 0.01 to 0.05).

The ENCORE study, which was a follow-up of patients from the OPERA study, showed responders to omeprazole therapy had fewer clinic visits than non-responders (1.5 vs 2.0) over a three month period (p < 0.001).

Dyspareunia

2008-04-15T20:06:00.000-07:00

Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus.

Painful intercourse can be difficult to talk about. If you're experiencing painful intercourse, you may wonder if the pain is all in your head or the result of something you're doing wrong in bed. After all, sex is supposed to be pleasurable, right?

The truth is that sex isn't pleasurable or pain-free for all women all the time. In fact, many women experience painful intercourse at some point in their lives, for a variety of very normal reasons. The medical term for painful intercourse is dyspareunia — which is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse and that causes you personal distress. And painful intercourse is worth talking about, because there are treatments that can help eliminate or reduce this common problem.

Causes:
Causes of painful intercourse vary by the location of the pain.

Causes of entry pain-
Pain during penetration may be associated with a range of factors, including:

* Inadequate lubrication. This is often the result of not enough foreplay. Inadequate lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding. In addition, certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
* Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision, episiotomy or a congenital abnormality.
* Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.
* Reactions to birth control products. It's possible to have an allergic reaction to foams, jellies or latex. Pain may also be caused by an improperly fitted diaphragm or cervical cap.
* Vaginusmus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.
* Vestibulitis. Painful penetration also occurs in a condition called vestibulitis, which is characterized by unexplained stinging or burning around the opening of your vagina.

Causes of deep pain-
Deep pain usually occurs with deep penetration and may be more pronounced with certain positions. Causes include:

* Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.
* Infections. An infection of your cervix, uterus or fallopian tubes can cause deep pain.
* Surgeries or medical treatments. Scarring from surgeries that involve your pelvic area, including hysterectomy, can sometimes cause painful intercourse. In addition, medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

Emotional factors-
Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain. Emotional factors include:

* Psychological problems. If you experience anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems, it can contribute to painful intercourse.
* Stress. Your pelvic floor muscles are very sensitive to stress. So stress can lead to painful intercourse.
* History of sexual abuse. Most women with dyspareunia don't have a history of sexual abuse, but if you have been abused, it may play a role.

Sometimes, it can be difficult to tell whether psychological factors are a cause or result of dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain.

Symptoms:
Researchers estimate that up to 60 percent of women experience episodes of genital pain that occurs just before, during or after intercourse. But the location of pain and frequency of pain varies greatly. If you experience painful intercourse, you may feel:

* Pain with every penetration, even while putting in a tampon.
* Pain with certain partners or just under certain circumstances.
* New pain after previously pain-free intercourse.
* Superficial (entry) pain.
* Deep pain during thrusting, which is often described as "something being bumped".
* Burning pain or aching pain.

Most women with dyspareunia complain of superficial pain, which occurs upon penetration.

Diagnosis:
If you have recurrent pain during sex, talking to your doctor is the first step in resolving it. Primary care doctors and gynecologists often ask about sex and intimacy as part of a routine medical visit, and you can take this opportunity to discuss your concerns. Your regular doctor may diagnose and treat the problem or refer you to a specialist who can.

A medical evaluation for dyspareunia usually consists of:

A thorough medical history- Your doctor may ask when your pain began, exactly where it hurts, how it feels, and if it happens with every sexual partner and every sexual position. Your doctor may also inquire about your sexual history, surgical history and previous childbirth experiences. Don't let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your pain.
A pelvic examination- During a pelvic exam, your doctor can check for signs of skin irritation, infection or anatomical problems. He or she may also try to identify the location of your pain through gentle touch of the genital area and pelvic muscles, and a speculum examination of the vagina. Some women who experience painful intercourse are also uncomfortable during a pelvic exam, no matter how gentle the doctor is. You can ask to stop the exam at any time if it's too painful.
Additional tests- If your doctor suspects certain causes of painful intercourse, he or she might also recommend a pelvic ultrasound or laparoscopy — a minor surgical procedure in which a slender viewing instrument (laparoscope) is used to view your pelvic organs.

Treatment:
Painful intercourse used to be viewed primarily as a psychological problem that required psychological treatment. Fortunately, that view is outdated. Researchers and doctors now understand the many causes of dyspareunia and recommend an integrated, multifaceted treatment approach. Your particular treatment depends on the underlying cause of your pain, but treatment may include:

Hygiene habits
Avoid scented bath products, such as body washes and shower gels. These products can irritate your genital area and zap your natural lubrication, particularly if you overuse them. Skip douching as well.

Sexual techniques and counseling
You and your partner may be able to minimize pain with a few changes to your sexual routine:

Switch positions- If you experience sharp pain during thrusting, the penis may be striking your cervix or stressing the pelvic floor muscles, causing aching or cramping pain. Changing positions may help. You can try being on top of your partner during sex. Women usually have more control in this position, so you may be able to regulate penetration to a depth that feels good to you.
Communicate- Talk about what feels good and what doesn't. If you need your partner to go slow, say so.
Don't rush to the main event- Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused.
Use lubricants- A water-based lubricant, such as K-Y jelly or Astroglide, can make sex more comfortable. If contraceptive creams cause irritation or dryness, try a different preparation or ask your doctor about switching to another type of birth control.

Medications and therapies
In some cases, medications or therapy are necessary to treat painful intercourse.

Treating underlying conditions- If an infection or medical condition is contributing to your pain, treating the underlying cause may resolve your problem. Changing medications known to cause lubrication problems also may eliminate your symptoms.
Estrogen therapy- For most postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with a prescription cream, tablet or flexible vaginal ring.
Other medications- In some cases, your doctor may suggest an oral prescription pain medication or injections of pain medications into the site of the pain.
Desensitization therapy- During this therapy, you learn vaginal relaxation exercises that can decrease pain. Your therapist may recommend pelvic floor exercises (Kegel exercises) or other techniques to decrease pain with intercourse.
Counseling or sex therapy- If sex has been painful for a long time, you may experience a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you may also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.

Dysmenorrhea

2008-04-15T19:47:00.000-07:00

Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe uterine pain during menstruation. While many individuals experience minor pain during menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities, or require medication.

Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.

Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these are detected.

Primary dysmenorrhoea-
The main symptom of dysmenorrhea is pain centering in the lower abdomen, which may radiate to the thighs and lower back. Other symptoms may include nausea and vomiting, diarrhea, headache, and fatigue. Symptoms of dysmenorrhea usually begin a few hours before the start of menstruation, and may continue for a few days.
In one research study using MRI, visible features of the uterus were compared in dysmenorrheic and eumenorrheic (normal) participants. The study concluded that in dysmenorrheic patients, visible features on cycle days 1-3 correlated with the degree of pain, and differed significantly from the control group.
Several nutritional supplements have been indicated as effective in treating dysmenorrhea, including omega-3 fatty acids, magnesium, vitamin E, zinc, and thiamine (vitamin B1).
Research indicates that one mechanism underlying dysmenorrhea is a disturbed balance between antiinflammatory, vasodilator eicosanoids derived from omega-3 fatty acids, and proinflammatory, vasoconstrictor eicosanoids derived from omega-6 fatty acids. Several studies have indicated that intake of omega-3 fatty acids can reverse the symptoms of dysmenorrhea, by decreasing the amount of omega-6 FA in cell membranes. The richest dietary source of omega-3 fatty acids is found in flax oil.
Oral intake of magnesium has also been indicated in providing relief: two double-blind, placebo-controlled studies demonstrated a positive therapeutic effect of magnesium on dysmenorrhea. A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss. A review of case histories indicated that zinc, in 1 to 3 30-milligram doses given daily for one to four days prior to onset of menses, prevents essentially all to all warning of menses and all menstrual cramping. Intake of thiamine (vitamin B1) was demonstrated to provide "curative" relief in 87% of females experiencing dysmenorrhea, in a controlled study.

Secondary dysmenorrhoea-
The symptoms of secondary dysmenorrhea vary with the underlying cause, but are similar to those of primary dysmenorrhea. While the symptoms of primary dysmenorrhea are generally limited to the time around menses, in secondary dysmenorrhea, they may extend further through the menstrual cycle.
The most effective treatment of secondary dysmenorrhea is the identification and treatment of the underlying cause of the pain. The first line of treatment is medical; if possible, the underlying medical disorder or anatomic abnormality is corrected. Dilation of a narrow cervical os may give 3 to 6 months of relief, and allows diagnostic curettage if needed. Myomectomy, polypectomy, or dilation and curettage may be needed. In patients with adenomyosis, the levonorgestrel intrauterine system (Mirena) was observed to provide relief.

Dyslexia

2008-04-15T19:40:00.000-07:00

Dyslexia is a learning disability that manifests primarily as a difficulty with written language, particularly with reading and spelling. It is separate and distinct from reading difficulties resulting from other causes, such as a non-neurological deficiency with vision or hearing, or from poor or inadequate reading instruction.

Evidence suggests that dyslexia results from differences in how the brain processes written and/or verbal language. Although dyslexia is the result of a neurological difference, it is not an intellectual disability. Dyslexia occurs at all levels of intelligence; sub-average, average, above average, and highly gifted.

According to the findings of a University of Hong Kong study, dyslexia affects different structural parts of children's brains depending on the language they read. The study focused on comparing children that were raised reading English and children raised reading Chinese. Using MRI technology researchers found that the children reading English used a different part of the brain than those reading Chinese. Researchers were surprised by this discovery and hope that the findings will help lead them to any neurobiological cause for dyslexia.

Causes:
A learning disability is a condition that produces a gap between someone's ability and his or her performance. Most people with dyslexia are of average or above-average intelligence, but read at levels significantly lower than expected. Other types of learning disabilities include attention difficulties, an inability to perform well at writing skills and an inability to perform well at math skills.

The cause of dyslexia seems to be a malfunction in certain areas of the brain concerned with language. The condition frequently runs in families.

Symptoms:
Dyslexia can be difficult to recognize before your child enters school, but some early clues may indicate a problem. If your young child begins talking late, adds new words slowly and has difficulty rhyming, he or she may be at increased risk of dyslexia.

Once your child is in school, dyslexia symptoms may become more apparent, including:

* The inability to recognize words and letters on a printed page.
* A reading ability level well below the expected level for the age of your child.

Children with dyslexia commonly have problems processing and understanding what they hear. They may have difficulty comprehending rapid instructions, following more than one command at a time or remembering the sequence of things. Reversals of letters (b for d) and a reversal of words are typical among children who have dyslexia. Reversals are also common for children age 6 and younger who don't have dyslexia. But with dyslexia, the reversals persist.

Children with dyslexia may fail to see (and occasionally to hear) similarities and differences in letters and words, may not recognize the spacing that organizes letters into separate words, and may be unable to sound out the pronunciation of an unfamiliar word.

Diagnosis:
Dyslexia diagnosis involves an evaluation of medical, cognitive, sensory-processing, educational and psychological factors. Your doctor may ask about your child's developmental and medical history as well as your family medical history.

Your doctor may also suggest that your child undergo:

* Vision, hearing and neurological evaluations. These evaluations can help determine whether another disorder may be causing or contributing to your child's poor reading ability.
* A psychological assessment. This can help determine whether social problems, anxiety or depression may be limiting your child's abilities.
* An evaluation of educational skills. Your child may take a set of educational tests and have the process and quality of his or her reading skills analyzed by an expert.

Treatment:
There's no known way to correct the underlying brain malfunction that causes dyslexia. Dyslexia treatment is by remedial education. Psychological testing will help your child's teachers develop a suitable remedial teaching program.

Multisensory approach
Teachers may use techniques involving hearing, vision and touch to improve reading skills. Helping a child use several senses to learn — for example, by listening to a taped lesson and tracing with a finger the shape of the letters used and the words spoken — can help him or her process the information. The most important teaching approach may be frequent instruction by a reading specialist who uses these multisensory methods of teaching.

You can help your child learn by reading to him or her often and helping your child pronounce letters and spell out words. If your child learns best by hearing new information first, listen to books on tape with him or her and then read the same story in written form together.

If your child has a severe reading disability, tutoring may involve several individual or small-group sessions each week, and progress may be slow. A child with severe dyslexia may never be able to read well and may need training for vocations that don't require strong reading skills. Children with milder forms of dyslexia often eventually learn to read well enough to succeed in school.

Dysentery

2008-04-15T19:34:00.000-07:00

Dysentery (formerly known as flux or the bloody flux) is an infection of the digestive system that results in severe diarrhea containing mucus and blood in the feces and is typically the result of unsanitary water containing micro-organisms which cause significant inflammation of the intestinal lining. There are two major types of dysentery due to micro-organisms: amoebic dysentery, and bacillary dysentery mainly due to one of three bacteria (diaria). Dysentery can also be caused by certain medications; for example, some steroids can impact bowel movements.

Amoebic dysentery is caused by the amoeba Entamoeba histolytica. Amoebic dysentery is transmitted through contaminated food and water. From ingestion, the infecting organisms move into the intestines via the stomach. Amoebae spread by forming infective cysts which can be found in stools and spread if whoever touches them does not sanitize their hands. There are also free amoebae, or trophozoites, that do not form cysts.

Amoebic dysentery is well known as a "traveler's dysentery" because of its prevalence in developing nations, or "Montezuma's Revenge" although it is occasionally seen in industrialized countries. Liver infection, and subsequent amoebic abscesses can occur.

Bacillary dysentery is mostly commonly associated with three bacterial groups:
* Shigellosis is caused by one of several types of Shigella bacteria.
* Campylobacteriosis caused by any of the dozen species of Campylobacter that cause human disease.
* Salmonellosis caused by Salmonella enterica (serovar Typhimurium).

Symptoms:
Symptoms include frequent passage of feces/stool, loose motion and in some cases associated vomiting. Variations depending on parasites can be frequent urge with high or low volume of stool, with or without some associated mucus and even blood.

Once recovery starts, early refeeding is advocated avoiding foods containing lactose due to temporary lactose intolerance.

Treatment:
The first and main task in managing any episode of dysentry is to maintain fluid intake using oral rehydration therapy. If this can not be adequately maintained, either through nausea and vomiting or the profuseness of the diarrhea, then hospital admission may be required for intravenous fluid replacement. Ideally no antimicrobial therapy is started until microbiological microscopy and culture studies have established the specific infection involved. Where laboratory services are lacking, it may be required to initiate a combination of drugs including an amoebicidal drug to kill the parasite and an antibiotic to treat any associated bacterial infection.

Amoebic dysentery can be treated with metronidazole. Mild cases of bacillary dysentry are often self-limiting and do not require antibiotics, which are reserved for more severe or persisting cases; campylobacter, shigella and salmonella respond to ciprofloxacin or macrolide antibiotics.

Dwarfism

2008-04-15T18:55:00.000-07:00

Dwarfism refers to a condition in individual plants or animals characterized by extreme small size. In older popular and medical usage, any type of marked human smallness could also be termed dwarfism. The term as related to human beings (the major subject of this article) is often used to refer specifically to those forms of extreme shortness characterized by disproportion of body parts, typically due to an inheritable disorder in bone or cartilage development.

Forms of extreme shortness in humans characterized by proportional body parts usually have a hormonal or nutritional cause. An example is growth hormone deficiency, once known as "pituitary dwarfism".

The Little People of America (LPA) defines dwarfism as a medical or genetic condition that usually results in an adult height of 4'10" (147 cm) or shorter.

Types:
* rhizomelic = root, e.g. bones of upper arm or thigh.
* mesomelic = middle, e.g. bones of forearm or lower leg.
* acromelic = end, e.g. bones of hands and feet.

When the cause of dwarfism is understood, it may be classified according to one of hundreds of names, which are usually permutations of the following roots:

* chondro = of cartilage.
* osteo = of bone.
* spondylo = of the vertebrae.
* plasia = form.
* trophy = growth.

Examples include achondroplasia, osseous dysplasia, chondrodystrophy, and osteochondrodystrophy.

The most recognizable and most common form of dwarfism is achondroplasia, which produces rhizomelic short limbs, increased spinal curvature, and distortion of skull growth. It accounts for 70% of dwarfism cases. Other relatively common types include spondyloepiphyseal dysplasia congenita (SED), diastrophic dysplasia, pseudoachondroplasia, hypochondroplasia, and osteogenesis imperfecta (OI). Severe shortness with skeletal distortion also occurs in several of the mucopolysaccharidoses and other storage diseases.

The average adult height of male and females with dwarfism is 132 cm and 123 cm respectively. The average weight of an adult may range from 100 to 150 pounds (45-68 kg).

Causes:
Most dwarfism-related conditions are genetic disorders, but the causes of some disorders are unknown. Most occurrences of dwarfism result from a random genetic mutation in either the father's sperm or the mother's egg — rather than being in one of the parent's complete genetic makeup.

Achondroplasia
For example, about 80 percent of people with achondroplasia are born to parents of average height. A person with achondroplasia and with two average-size parents received one mutated copy of the gene associated with the disorder and one normal copy of the gene. A person with the disorder may pass along either a mutated or normal copy to his or her own children.

Turner syndrome
Turner syndrome occurs because of a random deletion or severe alteration of an X chromosome, either in the sperm or egg. (The X chromosome is one of two chromosomes that determine the sex of a person. A female inherits an X chromosome from each parent, and a male inherits a Y chromosome from his father and an X chromosome from his mother.) A girl with Turner syndrome has only one fully functioning copy of the female sex chromosome rather than two.

Growth hormone deficiency
The cause of growth hormone deficiency can sometimes be traced to a genetic mutation or injury, but for most people with the disorder, no cause can be identified.

Other causes of dwarfism include deficiencies in other hormones and poor nutrition.

Symptoms:
More than 200 different medical conditions cause dwarfism. Therefore, dwarfism symptoms — other than short stature — vary considerably across the spectrum of disorders. In general, the disorders are divided into two broad categories.

Disproportionate dwarfism- If body size is disproportionate, some parts of the body are small and others are of average size or above-average size. Disorders causing disproportionate dwarfism inhibit the development of bones.
Proportionate dwarfism- A body is proportionately small if all parts of the body are small to the same degree and appear to be proportioned like a body of average stature.

Disproportionate dwarfism
Most people with dwarfism have disorders that cause disproportionately short stature. Usually, this means that a person has an average-size trunk and very short limbs, but some people may have a very short trunk and shortened (but disproportionately large) limbs. The other common characteristic of these disorders is the head being disproportionately larger than the body.

Almost all people with disproportionate dwarfism have normal intellectual capacities. Rare exceptions are usually the result of a secondary factor, such as excess fluid in the brain (hydrocephalus).

About 70 percent of all people with dwarfism have a disorder called achondroplasia, which causes disproportionately short stature. This disorder usually results in:

* An adult height of approximately 4 feet.
* An average-size trunk.
* Short arms and legs, with particularly short upper arms and legs.
* Short fingers, often with a wide separation between the middle and ring fingers.
* Limited mobility at the elbows.
* A disproportionately large head, with a prominent forehead and flattened bridge of the nose.
* Progressive development of bowed legs (genu varum).
* Progressive development of swayed lower back (lordosis).

A disorder called spondyloepiphyseal dysplasia congenita (SEDC), while rare, is the most common cause of disproportionate dwarfism with a short trunk. Signs and symptoms may include:

* Adult height ranging from 3 feet to just over 4 feet.
* A very short trunk, which may or may not be apparent in infancy.
* A short neck.
* Shortened arms and legs.
* Average-size hands and feet.
* Slightly flattened cheek bones.
* Hip deformities that result in thigh bones turning inward (coxa vara).
* Feet twisted or out of shape (clubfoot).
* Progressive hunching curvature of the upper spine (kyphoscoliosis).
* Progressive development of lordosis.
* Vision and hearing problems.

Proportionate dwarfism
Proportionate dwarfism results from medical conditions present at birth or during early childhood that limit overall growth and development. Therefore, the head, trunk and limbs are all small but of average proportions relative to each other.

Most of these disorders are uncommon, and signs and symptoms of the disorders vary greatly. Because these disorders affect overall growth, many of them result in poor development of one or more body systems. A few disorders causing proportionate dwarfism result in mental retardation.

Growth hormone deficiency is a relatively common cause of proportionate dwarfism. It occurs when the pituitary gland fails to produce an adequate supply of growth hormone, which is essential for regular childhood growth. Signs and symptoms include:

* Height below the fifth percentile on standard pediatric growth charts.
* Slowed growth before age 5.
* Periods of little or no change in height.
* Adult height usually less than 5 feet.
* Delayed or no sexual development during adolescence.

Turner syndrome, also relatively common, is a disorder that results in short stature and impaired sexual maturation in females. Signs and symptoms of the disorder may include:

* An average adult height of 4 feet 8 inches.
* Undeveloped ovaries.
* Excess skin at the neck at birth that usually becomes less noticeable over time.
* Puffy hands and feet at birth and during infancy.
* Heart and blood vessel defects.
* Kidney problems.
* No development of breasts or onset of menstruation during adolescence.
* Infertility.
* Possible difficulty with intellectual tasks dependent on visualizing objects in relation to one another.

Diagnosis:
Your pediatrician will examine a number of factors in order to assess your child's growth and determine if he or she has a dwarfism-related disorder. For some assessments, your pediatrician may refer you to other doctors, such as pediatricians specializing in bone abnormalities (orthopedics) or hormone dysfunction (endocrinology).

Measurements- A regular part of a well-baby medical examination is the measurement of height, weight and head circumference. At each visit, your pediatrician will plot these measurements on a chart, which indicates the percentile ranking for each measurement and expected growth curve in the future. This information is important for identifying abnormal growth, such as delayed growth or a disproportionately large head. If any trends in these charts are a concern, your pediatrician may make more frequent measurements over a period of several months.
Appearance- Many distinct facial and skeletal features are associated with each of several dwarfism disorders. Therefore, your child's appearance may also assist your pediatrician in making a diagnosis.
Imaging technology- Your doctor may order radiographic studies, such as X-rays, because certain abnormalities of the skull and skeleton can indicate which disorder your child may have. Various imaging devices may also reveal delayed maturation of bones, as is the case in growth hormone deficiency. A magnetic resonance imaging (MRI) scan may reveal abnormalities of the pituitary gland or hypothalamus, both of which play a role in hormone function.
Genetic tests- Genetic tests are available for many of the known causal genes of dwarfism-related disorders, but these tests often aren't necessary to make an accurate diagnosis. Your doctor is likely to suggest a test only to distinguish among possible diagnoses when other evidence is unclear or as a part of further family planning. If your pediatrician believes your daughter may have Turner syndrome, then he or she will order special laboratory tests that assess the state of X chromosomes extracted from blood cells.
Family history- Your pediatrician may take a history of stature in siblings, parents, grandparents or other relatives to help determine whether the average range of height in your family includes short stature.
Hormone tests- Your doctor may order tests that assess levels of growth hormone or other hormones that are critical for childhood growth and development.

Treatment:
Most dwarfism treatments don't increase stature but may alleviate problems caused by complications.

Common surgical treatments
Surgical procedures that may correct problems with bones in people with disproportionate dwarfism include:

* Inserting metal staples into the ends of long bones where growth occurs (growth plates) in order to correct the direction in which bones are growing.
* Dividing a limb bone, straightening it and inserting metal plates to hold it in place.
* Inserting rods or staples to help correct the shape of the spine.
* Increasing the size of the opening in bones of the spine (vertebrae) to alleviate pressure on the spinal cord.

Limb lengthening
Some people with dwarfism elect to undergo limb-lengthening surgery. With this procedure, the surgeon divides a long bone into two or more sections, separates the sections slightly and braces the bone and limb with metal "scaffolding." Pins and screws on this frame are adjusted to keep tension between the sections, enabling the bone to grow back together gradually into a complete but longer bone.

This procedure is controversial for many people with dwarfism because, as with all surgeries, there are risks, and because the "correction" in stature may imply there's something wrong with being short.

Hormone therapy
Growth hormone deficiency is treated with injections of a synthetic version of the hormone. Most children receive daily injections for several years until they reach a maximum adult height — often within the average adult range for one's family. Treatment may continue throughout adolescence and early adulthood to ensure adult maturation, such as appropriate gain in muscle or fat. The treatment may be supplemented with other related hormones if they are also deficient.

Treatment for Turner syndrome usually begins in the preteen years with small doses of a male hormone (androgen) and a female hormone (estrogen) to increase height. A second course of treatment with estrogen and another female hormone (progesterone) will occur in the early teen years to promote breast development and sexual maturation. Adult women usually use a hormone therapy until the average age for the onset of menopause.

Down Syndrome

2008-04-14T20:47:00.000-07:00

Down syndrome is a genetic disorder that causes mental retardation and other problems. The condition varies in severity, so developmental problems may range from mild to serious.

Down syndrome is the most common genetic cause of severe learning disabilities in children, occurring in one in every 700 infants. Every year, as many as 6,000 babies are born with Down syndrome in the United States. The condition is named after John Langdon Down, the doctor who first identified the syndrome.

There's no medical cure for this condition. But increased understanding of Down syndrome and early interventions make a big difference in the lives of both children and adults with Down syndrome.

Causes:
Human cells normally contain 23 pairs of chromosomes. One chromosome in each pair comes from your father, the other from your mother.

The cause of Down syndrome is one of three types of abnormal cell division involving the 21st chromosome. All three abnormalities result in extra genetic material from chromosome 21, which is responsible for the characteristic features and developmental problems of Down syndrome. The three genetic variations that can cause Down syndrome include:

Trisomy 21- More than 90 percent of cases of Down syndrome are caused by trisomy 21. A child with trisomy 21 has three copies of chromosome 21 — instead of the usual two copies — in all of his or her cells. This form of Down syndrome is caused by abnormal cell division during the development of the sperm cell or the egg cell.
Mosaic Down syndrome- In this rare form of Down syndrome, children have some cells with an extra copy of chromosome 21, but not all. This mosaic of normal and abnormal cells is caused by abnormal cell division after fertilization.
Translocation Down syndrome- Down syndrome can also occur when part of chromosome 21 becomes attached (translocated) onto another chromosome, before or at conception. Children with translocation Down syndrome have the usual two copies of chromosome 21, but they also have additional material from chromosome 21 stuck to the translocated chromosome. This form of Down syndrome is uncommon.

Symptoms:
Children with Down syndrome have a distinct facial appearance. Though not all children with Down syndrome have the same features, some of the more common features are:

* Flattened facial features.
* Protruding tongue.
* Small head.
* Upward slanting eyes, unusual for the child's ethnic group.
* Unusually shaped ears.

Children with Down syndrome may also have:

* Poor muscle tone.
* Broad, short hands with a single crease in the palm.
* Relatively short fingers.
* Excessive flexibility.

Infants born with Down syndrome may be of average size, but typically they grow slowly and remain smaller than other children of similar age. Children with Down syndrome also have some degree of mental retardation, ranging from mild to moderate.

Diagnosis:
Various screening tests can help identify whether you have a high risk of carrying a baby with Down syndrome. Blood tests, such as the quad screen, have typically been offered around the 16th week of pregnancy to screen for Down syndrome, spina bifida and various other chromosomal disorders. These tests are still available. But the most effective screening is done in two steps between the 11th and 14th week of pregnancy:

Ultrasound- The doctor uses ultrasound to measure a specific region on the back of a baby's neck. This is known as a nuchal translucency screening test. When abnormalities are present, more fluid than usual tends to collect in this tissue.

Blood tests- Results of the ultrasound are paired with blood tests that measure levels of pregnancy-associated plasma protein-A (PAPP-A) and a hormone known as human chorionic gonadotropin (HCG). Abnormal levels of PAPP-A and HCG may indicate a problem with the baby.

Diagnostic tests during pregnancy
If your screening tests are positive or worrisome or you're at high risk of having a baby with Down syndrome, you might consider further testing to confirm the diagnosis. Diagnostic tests that can identify Down syndrome include:

Amniocentesis- A sample of the amniotic fluid surrounding the fetus is withdrawn through a needle inserted into the mother's uterus. This sample is then used to analyze the chromosomes of the fetus. Doctors usually perform this test after 15 weeks of gestation. The test carries a risk of miscarriage of one in 200.
Chorionic villus sampling (CVS)- Cells taken from the mother's placenta can be used to analyze the fetal chromosomes. Typically performed between the ninth and 14th week of pregnancy, this test carries a risk of miscarriage of one in 100.
Percutaneous umbilical blood sampling (PUBS)- Blood is taken from a vein in the umbilical cord and examined for chromosomal defects. Doctors generally perform this test after 18 weeks of gestation. This test carries a greater risk of miscarriage than does amniocentesis or chorionic villus sampling. Generally, this test is only done when speed of diagnosis is essential.

Each of these three tests is 98 percent to 99 percent accurate in diagnosing Down syndrome before birth.

Treatment:
There's no medical treatment for Down syndrome that will provide a cure. But children with Down syndrome do benefit from medical help and early interventions, starting in infancy.

If your child has Down syndrome, you'll likely become acquainted with a team of doctors that may include a pediatric cardiologist, a gastroenterologist, a developmental pediatrician and other specialists. These doctors can detect and treat complications of Down syndrome, such as heart defects, gastrointestinal problems and hearing problems.

Your child's care team may also include a physical therapist, speech pathologist, occupational therapist and others. These specialists can help your child develop skills as fully as possible. For example, babies with Down syndrome don't have good muscle tone, so a physical therapist can help your baby learn to roll over, sit up and walk. Meanwhile, a speech pathologist or occupational therapist may help with feeding, hand coordination and language skills.

Ask your doctor about early intervention programs available in your area. These specialized programs — in which children with Down syndrome are stimulated at an early age with appropriate sensory, motor and cognitive activities — are available in most states. Programs vary from location to location, but they usually involve therapists and special educators whose goal is to help your baby develop motor skills, language, social skills and self-help skills.

In general, children with Down syndrome usually meet developmental milestones, but it may take them a little longer than it does for children without Down syndrome. For example, children with Down syndrome may take twice as long to sit, crawl, walk or say a first word. However, early intervention programs, started as soon as possible, may give kids with Down syndrome the best chance of success.

Dizziness

2008-04-14T20:38:00.000-07:00

Many different terms are often used to describe what is collectively known as dizziness. Common descriptions include words such as lightheaded, floating, woozy, giddy, confused, helpless or fuzzy. Vertigo, Disequilibrium and Pre-syncope are the terms in use by most doctors. Dizziness is sometimes a symptom of a balance disorder.
Dizziness is one of the most common reasons older adults visit their doctors. Aging increases the risk of developing any of several conditions that may cause dizziness. Although it may be disabling and incapacitating, dizziness rarely signals a serious, life-threatening condition. Treatment of dizziness depends on the cause and your symptoms.

Causes:
Under normal circumstances, your sense of balance is controlled by a number of signals that your brain receives from several locations:

Eyes- No matter what your position, visual signals help you determine where your body is in space and how it's moving.
Sensory nerves- These are in your skin, muscles and joints. Sensory nerves send messages to your brain about body movements and positions.
Inner ear- The organ of balance in your inner ear is the vestibular labyrinth. It includes loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head. Near the semicircular canals are the utricle and saccule, which contain tiny particles called otoconia. These particles are attached to sensors that help detect gravity and back-and-forth motion.
Good balance depends on at least two of these three sensory systems working well. For instance, closing your eyes while washing your hair in the shower doesn't mean you'll lose your balance. Signals from your inner ear and sensory nerves help keep you upright.
However, if your central nervous system can't process signals from all of these locations, if the messages are contradictory, or if the sensory systems aren't functioning properly, you may experience loss of balance.

Symptoms:
Characteristics of dizziness may include:

* A sense that you or your surroundings are spinning or moving (vertigo)
* A loss of balance
* Nausea
* Unsteadiness
* Wooziness
* Lightheadedness
* Faintness
* Weakness
* Fatigue
* Difficulty concentrating
* Blurred vision after quick head movements

Diagnosis:
Your doctor will likely ask you a number of questions about your dizziness. In trying to determine the cause, your doctor may ask if your dizziness:

* Causes the room to spin or produces a sensation of motion.
* Is associated with a feeling of faintness or lightheadedness.
* Causes you to lose your balance.
* Is accompanied by ringing or fullness in your ears (tinnitus) or trouble hearing.

Your doctor will want to know what medications you're taking. He or she will also ask you when you experience dizziness, how long it lasts and how often it occurs. Your doctor can narrow down possible causes of dizziness after determining the type of dizziness you're experiencing, reviewing your medical history and current medications, conducting a physical examination, and ordering further testing based on your signs and symptoms.

Doctors can usually determine the cause of dizziness. Doing so may require a consultation with an ear, nose and throat (ENT) specialist or a neurologist. But even if no cause is found or if your dizziness persists, prescription drugs and other treatments may make your symptoms more manageable.

Treatment:
Doctors base treatment of dizziness on the cause and your symptoms.

* BPPV- Treatment of BPPV is with canalith repositioning, a simple procedure that involves your doctor or physical therapist maneuvering the position of your head. The goal is to move the loose particles in your ear to a place within your ear where they won't cause dizziness and will be reabsorbed into your body's fluids. The success rate of this procedure may be as high as 90 percent. You may need to have the procedure repeated.
* Inner ear conditions- Balance retraining exercises (vestibular rehabilitation) are used to treat acute vestibular neuronitis or labyrinthitis. These are exercises you learn from a physical therapist or occupational therapist and then do at home. This rehabilitation involves movements of your head and body to correct loss of balance.
* Meniere's disease- Treatment of Meniere's disease involves reducing your body's retention of fluids through diuretics or dietary changes, such as a low-salt diet. Occasionally, surgery is an option.
* Vestibular migraine- To combat vertigo associated with a vestibular migraine, your doctor will likely try to help you determine and avoid the triggers for your attacks. He or she may suggest that you avoid certain foods, reduce stress in your life, develop a regular sleep pattern and practice aerobic exercise. You may also be taught specific exercises to help make your balance system less sensitive to motion (vestibular rehabilitation). Certain medicines may help prevent attacks of migrainous vertigo or make them less uncomfortable by providing relief for nausea and vomiting.
* Anxiety disorders- Your doctor may suggest counseling to help you deal with your anxiety and manage your dizziness.
* Other contributing health conditions- Your doctor will recommend treatment of an existing disease or disorder that may be causing or contributing to your dizziness, such as ear infection, stroke, heart problems or multiple sclerosis.

Diverticulitis

2008-04-14T20:32:00.000-07:00

Diverticulitis develops from a condition called diverticulosis. If you're older than age 40, it's common for you to have diverticulosis — small, bulging pouches (diverticula) in your digestive tract. In the United States, more than 50 percent of people older than 60 have diverticula. Although diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestine. Because these pouches seldom cause any problems, you may never know you have them.

Sometimes, however, one or more pouches become inflamed or infected, causing severe abdominal pain, fever, nausea and a marked change in your bowel habits. When diverticula become infected, the condition is called diverticulitis. Mild cases of diverticulitis can be treated with rest, changes in your diet and antibiotics. But serious cases of diverticulitis may eventually require surgery to remove the diseased portion of your colon.

Fortunately, most people with diverticulosis never develop diverticulitis. Best of all, you can help prevent both types of diverticular disease by including more high-fiber foods in your diet.

Causes:
Diverticula usually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. In Western populations, pouches are most common in your sigmoid and descending colon — the lower portions of your large intestine just above your rectum. In Asian populations, pouches in the right colon (cecum and ascending colon) are more common.

Increased pressure in the colon can lead to breakdown of the wall of the diverticula leading to infection. A small tear or perforation can also develop in an infected pouch, which in turn can cause an infection within your abdomen (peritonitis). If the infection is limited to an area around the wall of your colon where the diverticula are inflamed, you may develop a localized collection of pus known as an abscess.

Symptoms:
Diverticulitis symptoms can feel like appendicitis, except you'll generally have pain in the lower left side of your abdomen, instead of the lower right side. The pain is usually severe and comes on suddenly, but sometimes you may have mild pain that becomes worse over several days and fluctuates in intensity. You may also have abdominal tenderness, fever, nausea, and constipation or diarrhea.

Less common signs and symptoms of diverticulitis may include:

* Vomiting.
* Bloating.
* Bleeding from your rectum.
* Frequent urination.
* Difficulty or pain while urinating.
* Tenderness in your abdomen when wearing a belt or bending over.

Diagnosis:
he differential diagnosis includes colon cancer, inflammatory bowel disease, ischemic colitis, and irritable bowel syndrome, as well as a number of urological and gynecological processes. Some patients report bleeding from the rectum.

Patients with the above symptoms are commonly studied with a computed tomography, or CT scan. The CT scan is very sensitive (98%) in diagnosing diverticulitis. In order to extract the most information possible about the patient's condition, thin section (5mm) transverse images are obtained through the entire abdomen and pelvis after the patient has been administered oral and intravascular contrast. Images reveal localized thickening and hyperemia (increased blood flow) involving a segment of the colon wall, with inflammatory changes extending into the fatty tissues surrounding the colon. The diagnosis of acute diverticulitis is made confidently when the involved segment contains diverticulae. CT may also identify patients with more complicated diverticulitis, such as those with an associated abscess. It may even allow for radiologically guided drainage of an associated abscess, sparing a patient from immediate surgical intervention.

Other studies, such as barium enema and colonoscopy are contraindicated in the acute phase of diverticulitis due to the risk of perforation.

Treatment:
In general, treatment depends on the severity of your signs and symptoms and whether this is your first attack of diverticulitis. If your symptoms are mild, a liquid or low-fiber diet and antibiotics may be all you need. But if you're at risk of complications or have recurrent attacks of diverticulitis, you may need more advanced care.

Home care
If your condition calls for home treatment, expect to remain quiet for a few days. You'll also temporarily need to avoid all whole grains, fruits and vegetables so that your colon can rest and heal. Once your symptoms improve — often in two to four days — you can gradually start increasing the amount of high-fiber foods in your diet.

In addition, your doctor will likely prescribe antibiotics to help kill the bacteria causing your infection. Even if you start feeling better, be sure to finish your entire course of medication. Stopping too soon could cause your infection to come back or could contribute to creating strains of bacteria that are resistant to antibiotics.

If you have moderate or severe pain, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others). Your doctor may also prescribe a more potent pain medication, although these medications tend to be constipating and may aggravate the problem.

Hospitalization
If you have a more severe attack that includes or puts you at risk of bowel obstruction or peritonitis, you may require hospitalization and intravenous antibiotics.

Surgery
If you have a fistula or recurring diverticulitis, your doctor may recommend surgery to remove the diseased part of your colon. There are two types of surgery:

Primary bowel resection- This is the standard surgery for people with diverticulitis. Your surgeon removes the diseased part of your intestine and then reconnects the healthy segments of your colon (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open (traditional) surgery or laparoscopic surgery. In open surgery, your surgeon makes one long incision in your abdomen, while laparoscopic surgery is performed through three or four tiny incisions. You'll heal faster and recover more quickly with laparoscopic surgery. Laparoscopic surgery may not be an option if you are very overweight or have extensive inflammation.
Bowel resection with colostomy- This surgery may be necessary if you have so much inflammation in your colon that it's not possible to rejoin your colon and rectum. During a colostomy, your surgeon makes an opening (stoma) in your abdominal wall. The unaffected part of your colon is then connected to the stoma, and waste passes through the opening into a bag. A colostomy may be temporary or permanent. Several months later — once the inflammation has healed — your surgeon may be able to perform a second operation to reconnect your colon and rectum.

Diphtheria

2008-04-13T00:59:00.000-07:00

Diphtheria is a serious bacterial infection, usually affecting the mucous membranes of your nose and throat. Diphtheria typically causes a bad sore throat, fever, swollen glands and weakness. But the hallmark sign is a thick, gray covering in the back of your throat that can make breathing difficult. Diphtheria can also infect your skin.

Years ago, diphtheria was a leading cause of death among children. Today, diphtheria is very rare in the United States and other developed countries thanks to widespread vaccination against the disease.

Medications are available to treat diphtheria. However, in advanced stages, diphtheria can cause damage to your heart, kidneys and nervous system. Even with treatment, diphtheria can be deadly — nearly one out of every 10 people who get diphtheria die of it.

Causes:
The bacterium Corynebacterium diphtheriae causes diphtheria. Usually the bacteria multiply on or near the surface of the mucous membranes of the throat, where they cause inflammation. The inflammation may spread to the voice box (larynx) and may make your throat swell, narrowing your airway. Disease-causing strains of C. diphtheriae release a poison (toxin), which can also damage the heart, brain and nerves.

The bacteria may cause a thick, gray covering to form in your nose, throat or airway — a marker of diphtheria that separates it from other respiratory illnesses. This covering is usually fuzzy gray or black and causes breathing difficulties and painful swallowing.

You contract diphtheria by inhaling airborne droplets exhaled by a person with the disease or by a carrier who has no symptoms. Diphtheria passes from an infected person to others through:

* Sneezing and coughing, especially in crowded living conditions.
* Contaminated personal items, such as tissues or drinking glasses that have been used by an infected person.
* Contaminated household items, such as towels or toys.

You can also come in contact with diphtheria-causing bacteria by touching an infected wound.

People who have been infected by the diphtheria bacteria and who haven't been treated can infect nonimmunized people for up to six weeks — even if they don't show any symptoms.

Symptoms:
Signs and symptoms of diphtheria may include:
A sore throat and hoarseness, Painful swallowing, Swollen glands (enlarged lymph nodes) in your neck, A thick, gray membrane covering your throat and tonsils, Difficulty breathing or rapid breathing, Nasal discharge, Fever and chills, Malaise, etc.

Signs and symptoms usually begin two to five days after a person becomes infected, but they may take as many as 10 days to appear.

Some people become infected with diphtheria-causing bacteria, but they develop only a mild case of the illness and show no signs or symptoms of the disease. They're said to be carriers of the disease, because they may spread the disease without showing signs or symptoms of illness.

Skin (cutaneous) diphtheria
A second type of diphtheria can affect the skin. A wound infected with bacteria is typically red, painful and swollen. A wound infected with diphtheria-causing bacteria also may have patches of a sticky, gray material.
Although it's more common in tropical climates, cutaneous diphtheria also occurs in the United States, particularly among people with poor hygiene who live in crowded conditions. In rare instances, diphtheria affects the eye.

Diagnosis:
Doctors may suspect diphtheria in a sick child who has a sore throat with a gray membrane covering the tonsils and throat. Doctors confirm the diagnosis by taking a sample of the membrane from the child's throat with a swab and having the sample grown (cultured) in a laboratory.

Doctors can also take a sample of tissue from an infected wound and have it tested in a laboratory, to check for the type of diphtheria that affects the skin (cutaneous diphtheria).

If a doctor suspects diphtheria, treatment begins immediately, even before the results of bacterial tests are available.

Treatment:
The disease may remain manageable, but in more severe cases lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. In addition, an increase in heart rate may cause cardiac arrest. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital intensive care unit (ICU) and be given a diphtheria anti-toxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.

Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends either:

Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10>10 kg).
Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

Diarrhea

2008-04-13T00:49:00.000-07:00

Acute diarrhea is an unpleasant digestive disorder that nearly everyone experiences at one time or another. In fact, it's estimated that most Americans can expect to have diarrhea about four times every year.

The loose-stool consistency that characterizes diarrhea usually lasts a few days at most. Diarrhea often means more-frequent trips to the toilet and a greater volume of stool. Some common causes of loose, watery stools and abdominal cramps are infections from viruses, bacteria or parasites. Other causes include medications — particularly antibiotics — and artificial sweeteners.

Chronic diarrhea lasts much longer than does acute diarrhea, generally longer than four weeks. It can be a sign of a serious disorder, such as inflammatory bowel disease, or it may be due to a less serious condition, such as irritable bowel syndrome. Chronic or recurrent diarrhea may signal poor absorption of nutrients (malabsorption).

Diarrhea may cause a loss of significant amounts of water and salts. Most cases of diarrhea clear on their own without treatment. But if diarrhea persists, you become dehydrated or you pass blood in your stool, see your doctor.

Causes:
The most common causes of diarrhea include:
* Viruses- Common viruses that cause diarrhea are the Norwalk virus, cytomegalovirus, viral hepatitis and the herpes simplex virus. Rotavirus is the most common cause of acute childhood diarrhea. Viral diarrhea spreads easily.
* Bacteria and parasites- Contaminated food or water can transmit bacteria and parasites to your body. Parasites such as Giardia lamblia and cryptosporidium can cause diarrhea. Common bacterial causes of diarrhea include campylobacter, salmonella, shigella and Escherichia coli. This type of diarrhea can be common for people traveling to developing countries.

Other causes
* Lactose- A sugar found in milk and milk products, lactose is a common cause of diarrhea in some people.
* Medications- Diarrhea can also be a side effect of many medications, particularly antibiotics. Antibiotics destroy both good and bad bacteria, which can disturb the natural balance of bacteria in your intestines. This disturbance sometimes leads to an infection with bacteria called Clostridium difficile, which can also cause diarrhea.
* Artificial sweeteners- Sorbitol and mannitol, artificial sweeteners found in chewing gum and other sugar-free products, can cause diarrhea in some otherwise healthy people.
* Surgery- Some people may experience diarrhea after undergoing abdominal surgery or gallbladder removal surgery.
* Other digestive disorders- Chronic diarrhea has a number of other causes, such as Crohn's disease, ulcerative colitis, celiac disease and irritable bowel syndrome.

Symptoms:
Signs and symptoms associated with diarrhea may include:
Frequent, loose, watery stools, Abdominal cramps, Abdominal pain, Fever, Blood in the stool, Bloating, etc.
In addition, other signs and symptoms such as nausea and vomiting may precede diarrhea that's caused by, for example, an infection. Bacterial or parasitic infections sometimes cause bloody stools, and fever may accompany these infections as well.

Diagnosis:
If you have diarrhea that requires medical attention, your doctor will ask about your symptoms and will want to determine if you're dehydrated. Tell your doctor about any medications you're taking, including over-the-counter medications — they may have caused the diarrhea.

Your doctor may examine your abdomen to determine the location of your pain, may listen to your abdomen with a stethoscope and may perform a rectal exam. Your doctor may suggest blood or stool tests to check for signs of infection or other abnormalities.

Treatment:
Most cases of diarrhea clear on their own within a few days without treatment. If you seek medical attention, your doctor likely will advise you to take steps to replace the fluids and salts lost during diarrhea.

Your body needs adequate levels of salts and electrolytes — minerals such as sodium and potassium — in order to maintain the electric currents that keep your heart beating. Disruption of your body's fluid and mineral levels creates an electrolyte imbalance. Unless restored by replacing fluids and drinking an electrolyte mixture, this imbalance can be serious.

If your doctor determines that an antibiotic medication caused your diarrhea, you'll need to stop taking that medication and modify your treatment plan.

If a parasitic infection caused your diarrhea, prescription antibiotics may ease your symptoms. Antibiotics sometimes, but not always, help ease signs and symptoms of bacterial diarrhea. However, antibiotics won't help viral diarrhea.

If you have chronic diarrhea, treating the underlying disease may help ease your diarrhea.

Diabetes mellitus

2008-04-12T23:32:00.001-07:00

Diabetes mellitus , often referred to simply as diabetes, is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycaemia) resulting from low levels of the hormone insulin with or without abnormal resistance to insulin's effects. The characteristic symptoms are excessive urine production (polyuria), excessive thirst and increased fluid intake (polydipsia), blurred vision, unexplained weight loss and lethargy. These symptoms are likely to be absent if the blood sugar is only mildly elevated.

The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy), which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different. Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition.

Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions. All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter.

Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly, the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.

In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses — attacks and destroys the insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. The exact cause of type 1 diabetes is unknown. Genetics may play a role. Exposure to certain viruses may serve as a trigger as well.

When you have type 2 diabetes, your body is resistant to the effects of insulin — a hormone that regulates the absorption of sugar into your cells — or your body produces some, but not enough, insulin to maintain a normal glucose level. Left uncontrolled, the consequences of type 2 diabetes can be life-threatening. There's no cure for type 2 diabetes, but there's plenty you can do to manage — or prevent — the condition. Start by eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight. If diet and exercise aren't enough, you may need diabetes medications or insulin therapy to manage your blood sugar. In type 2 diabetes, this process works improperly. Instead of moving into your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin. Exactly why this happens is uncertain, although excess fat — especially abdominal fat — and inactivity seem to be important factors.

Symptoms:
The classical triad of diabetes symptoms is polyuria, polydipsia and polyphagia, which are, respectively, frequent urination; increased thirst and consequent increased fluid intake; and increased appetite. Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes the symptoms develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled.

When the glucose concentration in the blood is raised beyond the renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits the reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells, causing dehydration and increased thirst.

Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change whereas type 2 is generally more gradual, but should still be suspected.

Patients (usually with type 1 diabetes) may also present with diabetic ketoacidosis (DKA), an extreme state of metabolic dysregulation characterized by the smell of acetone on the patient's breath; a rapid, deep breathing known as Kussmaul breathing; polyuria; nausea; vomiting and abdominal pain; and any of many altered states of consciousness or arousal (such as hostility and mania or, equally, confusion and lethargy). In severe DKA, coma may follow, progressing to death. Diabetic ketoacidosis is a medical emergency and requires hospital admission.

A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration due to loss of body water. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss.

Diagnosis:
The diagnosis of type 1 diabetes, and many cases of type 2, is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. These symptoms typically worsen over days to weeks; about a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:
* fasting plasma glucose level at or above 126 mg/dL (7.0 mmol/l).
* plasma glucose at or above 200 mg/dL (11.1 mmol/l) two hours after a 75 g oral glucose load as in a glucose tolerance test.
* random plasma glucose at or above 200 mg/dL (11.1 mmol/l).

A positive result, in the absence of clinical symptoms of diabetes, should be confirmed by another of the above-listed methods on a different day. Most physicians prefer to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete. According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/l) is considered diagnostic for diabetes mellitus.

Patients with fasting glucose levels between 100 and 125 mg/dL (6.1 and 7.0 mmol/l) are considered to have impaired fasting glycemia. Patients with plasma glucose at or above 140 mg/dL or 7.8 mmol/l two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.

While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycosylated hemoglobin or HbA1c) of 6.0% or higher is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is <7.0%, which is considered good glycemic control, although some guidelines are stricter (<6.5%). People with diabetes who have HbA1c levels within this range have a significantly lower incidence of complications from diabetes, including retinopathy and diabetic nephropathy.

Treatment:
There is no practical cure now for type 1 diabetes. The fact that type 1 diabetes is due to the failure of one of the cell types of a single organ with a relatively simple function (i.e. the failure of the islets of Langerhans) has led to the study of several possible schemes to cure this form diabetes mostly by replacing the pancreas or just the beta cells. Only those type 1 diabetics who have received either a pancreas or a kidney-pancreas transplant (when they have developed diabetic nephropathy) and become insulin-independent may now be considered "cured" from their diabetes. A simultaneous pancreas-kidney transplant is a promising solution, showing similar or improved survival rates over a kidney transplant alone. Still, they generally remain on long-term immunosuppressive drugs and there is a possibility that the immune system will mount a host versus graft response against the transplanted organ.

Type 2 diabetes can be cured by one type of gastric bypass surgery in 80-100% of severely obese patients. The effect is not due to weight loss because it usually occurs within days of surgery, which is before significant weight loss occurs. The pattern of secretion of gastrointestinal hormones is changed by the bypass and removal of the duodenum and proximal jejunum, which together form the upper (proximal) part of the small intestine. One hypothesis is that the proximal small intestine is dysfunctional in type 2 diabetes; its removal eliminates the source of an unknown hormone that contributes to insulin resistance. This surgery has been widely performed on morbidly obese patients and has the benefit of reducing the death rate from all causes by up to 40%. A small number of normal to moderately obese patients with type 2 diabetes have successfully undergone similar operations.

Diabetes insipidus

2008-04-12T23:19:00.000-07:00

When you hear the term "diabetes insipidus," you may immediately assume the condition is related to what's commonly known as "sugar" diabetes, or type 1 and type 2 diabetes mellitus. While the disorders share a name and have some common signs, in actuality diabetes mellitus (type 1 and type 2) and diabetes insipidus are unrelated.

Diabetes insipidus (DI) is a disorder characterized by intense thirst and by the excretion of large amounts of urine (polyuria). In most cases, it's the result of your body not properly producing, storing or releasing a hormone that increases water absorption by your kidneys and decreases urine flow. This form of diabetes insipidus is often called central diabetes insipidus, or sometimes neurogenic diabetes insipidus.

Diabetes insipidus can also occur when your kidneys are unable to properly respond to the hormone — a condition referred to as nephrogenic insipidus. Still rarer forms can occur during pregnancy (gestational diabetes insipidus).

Treatment depends on which type of diabetes insipidus you have.

Causes:
Diabetes insipidus occurs when this system is disrupted and your body can't regulate how it handles fluids. The way in which your system is disrupted determines which form of diabetes insipidus you have.

Central DI- The cause of central diabetes insipidus is damage to the pituitary gland or hypothalamus due to surgery, a tumor, illness (such as meningitis), inflammation or a head injury. In some cases the cause is unknown. This damage disrupts the normal production, storage and release of ADH.
Nephrogenic DI- Nephrogenic diabetes insipidus occurs when there's a defect in the kidneys tubules — the structures in your kidneys that cause water to be excreted or reabsorbed. This defect makes your kidneys unable to properly respond to ADH. The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium and tetracycline, also can cause nephrogenic DI. In about one in four cases of nephrogenic DI, doctors never determine a cause.
Gestational DI- Gestational diabetes insipidus occurs only during pregnancy and when an enzyme made by the placenta — the system of blood vessels and other tissue that allows the exchange of nutrients and waste products between a mother and her baby — destroys ADH in the mother.

Symptoms:
The two most common signs of diabetes insipidus are:
* Extreme thirst
* Excretion of an excessive volume of diluted urine

Depending on the severity of the condition, urine output can range from 2.5 liters per day if you have mild diabetes insipidus to 15 liters per day if the condition is severe and if you're taking in a lot of fluids. In comparison, the average urine output for a healthy adult is in the range of 1.5 to 2.5 liters a day.

Other signs may include needing to get up at night to urinate (nocturia) and bed-wetting.

Infants and young children who have diabetes insipidus may have the following signs and symptoms:
Unexplained fussiness or inconsolable crying, Unusually wet diapers, Fever, vomiting or diarrhea, Dry skin with cool extremities, etc.

Diagnosis:

Some of the tests that doctors commonly use to determine the type of diabetes insipidus and in some cases, its cause, include:
Water deprivation test- This test helps determine the cause of diabetes insipidus. You'll be asked to stop drinking fluids two to three hours before the test so that your doctor can measure changes in your body weight, urine output and urine composition when fluids are withheld. In some cases your doctor may also measure blood levels of ADH during this test.
In children, the water deprivation test is performed under close medical supervision so that they don't lose more than 5 percent of their body weight during the test.
Urinalysis- Urinalysis is the physical and chemical examination of urine. If your urine is less concentrated (meaning the amount of water excreted is high and the salt and waste concentrations are low), it could be due to diabetes insipidus.
Magnetic resonance imaging (MRI) scan- An MRI of the head is a non-invasive procedure that uses powerful magnets and radio waves to construct detailed pictures of brain tissues. Your doctor may want to perform an MRI to look for abnormalities in or near the pituitary gland.

Treatment:
Treatment of diabetes insipidus depends on what form of the condition you have, so your doctor will want to determine which form of DI is present before beginning treatment. Following are the treatment options for the most common types of diabetes insipidus:
Central DI- Because the cause of this form of diabetes insipidus is a lack of antidiuretic hormone (ADH), treatment is usually with a synthetic hormone called desmopressin. You can take desmopressin as a nasal spray, oral tablets, or by injection. The synthetic hormone will eliminate the increase in urination. For most people with central DI, desmopressin is a safe and effective treatment. If the condition is caused by an abnormality in the pituitary gland or hypothalamus (such as a tumor), however, your doctor will first treat the abnormality. If you have central DI, be sure to replace any fluid that you do lose; however, while you're taking desmopressin, drink fluids or water only when you're thirsty. This is because the drug prevents excess water excretion, which means your kidneys are making less urine and are less responsive to changes in body fluids. In mild cases of central DI, increased water intake may be all that you need. Your doctor may suggest a certain amount of water intake (usually more than 2.5 liters a day) to ensure proper hydration.

Nephrogenic DI- This condition is the result of your kidneys not properly responding to ADH, so desmopressin is not a treatment option. Instead your doctor may prescribe a low-salt diet to help reduce the amount of urine your kidneys make. You'll also need to be sure to drink enough water to avoid dehydration. The drug hydrochlorothiazide, used alone or with other medications, may improve symptoms. Although hydrochlorothiazide is a diuretic (usually used to increase urine output), in some cases it can reduce urine output for people with nephrogenic DI.
If symptoms from nephrogenic diabetes insipidus are due to medications you're taking, stopping these medicines may help; however, don't stop taking any medication without talking with your doctor first.

Gestational DI- Treatment for most cases of gestational DI is with the synthetic hormone desmopressin. In rare cases, an abnormality in the thirst mechanism causes gestational DI. In these rare cases, doctors don't prescribe desmopressin.

Dermatitis

2008-04-12T23:06:00.000-07:00

Dermatitis is a general term that describes an inflammation of the skin. There are different types of dermatitis, including seborrheic dermatitis and atopic dermatitis (eczema). Though the disorder can have many causes and occur in many forms, it usually involves swollen, reddened and itchy skin.

Dermatitis is a common condition that isn't life-threatening or contagious. But, it can make you feel uncomfortable and self-conscious. A combination of self-care steps and medications can help you treat dermatitis.

Causes:

A number of health conditions, allergies, genetic factors, physical and mental stressors, and irritants can cause dermatitis:
Contact dermatitis results from direct contact with one of many irritants or allergens. Common irritants include laundry soap, skin soaps or detergents, and cleaning products. Possible allergens include rubber; metals, such as nickel; jewelry; perfume; cosmetics; weeds, such as poison ivy; and neomycin, a common ingredient in topical antibiotic creams.
It takes a greater amount of contact with an irritant over a longer time to cause dermatitis than it takes for an allergen. If you're sensitized to an allergen, just brief exposure to a small amount of it can cause dermatitis. Once you develop sensitivity to an allergen, you typically have it for life.

Neurodermatitis typically develops when something has created an itchy sensation in a specific area of your skin. This irritation may lead you to rub or scratch your skin repeatedly in that area. Common locations include ankles, wrist, outer forearm or arm, and the back of your neck. Neurodermatitis may also be associated with other skin conditions, such as dry skin, eczema or psoriasis. Contact dermatitis caused by allergens doesn't seem to be a factor, though.
Seborrheic dermatitis causes a red rash with yellowish and somewhat "oily" scales, usually on the scalp. It's common in people with oily skin or hair, and it may come and go depending on the season of the year. It may occur during times of physical stress, travel or in people who have neurological conditions, such as Parkinson's disease. In infants, this disorder is known as cradle cap.
Stasis dermatitis can occur when fluid accumulates in the tissues just beneath your skin, and typically involves the lower leg. The extra fluid interferes with your blood's ability to nourish your skin and places extra pressure against your skin from underneath. Varicose veins and other chronic conditions that affect circulation in your legs often cause this fluid buildup.
Atopic dermatitis often occurs with allergies and frequently runs in families in which members have asthma or hay fever. It usually begins in infancy and may vary in severity during childhood and adolescence. It tends to become less of a problem in adulthood, unless you're exposed to allergens or irritants in the workplace. The exact cause of this disorder is unknown, but is likely due to a combination of dry, irritable skin together with a malfunction in the body's immune system. Stress can exacerbate atopic dermatitis, but it doesn't cause it.
Perioral dermatitis may be a form of the skin disorder rosacea, adult acne or seborrheic dermatitis, involving the skin around the mouth or nose. The exact cause is unknown, but makeup, moisturizers, topical corticosteroids or some dental products containing fluoride may play a role.

Symptoms:

There are several types of dermatitis, including:
* Contact dermatitis, a rash that results from either repeated contact with irritants or contact with allergy-producing substances, such as poison ivy.
* Neurodermatitis, a chronic itchy skin condition localized to certain areas of the skin.
* Seborrheic dermatitis, a common scalp condition that often causes dandruff.
* Stasis dermatitis, a skin condition that's caused by a buildup of fluid under the skin of the legs.
* Atopic dermatitis, more commonly known as eczema or atopic eczema, a chronic itchy rash that tends to come and go.
* Perioral dermatitis, a bumpy rash around the mouth.

Each has distinct signs and symptoms. Common signs and symptoms include:
Redness, Swelling, Itching, Skin lesions, etc.

Diagnosis:
Your doctor may diagnose dermatitis after talking to you about your signs and symptoms and examining your skin.

Patch testing
In the case of contact dermatitis, your doctor may conduct patch testing on your skin to see which substances inflame your skin. In this test, your doctor applies small amounts of various substances to your skin under an adhesive covering. During return visits, your doctor examines your skin to see if you've had a reaction to any of the substances.

Treatment:
Dermatitis treatment varies, depending on the cause:

Contact dermatitis- Treatment consists primarily of identifying the cause of the rash and then avoiding it. Sometimes, creams containing hydrocortisone or other stronger steroidal creams with or without wet dressings may help relieve redness and itching. It can take as long as two to four weeks for this type of dermatitis to clear up.
Neurodermatitis- Getting you to stop scratching and to avoid further aggravating your skin are the treatment objectives. Accomplishing this may mean covering the affected area to prevent you from scratching it. Hydrocortisone and similar lotions and creams may help soothe your skin. You also may find that wet compresses provide relief. Antidepressants or anti-anxiety medications are helpful for some people. Also, counseling can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching.
Seborrheic dermatitis- Medicated shampoos are usually the first treatment choice. Commonly used shampoos contain tar, pyrithione zinc, salicylic acid or ketoconazole as the active ingredient. Hydrocortisone creams and lotions may soothe nonscalp seborrheic dermatitis. If you develop a secondary infection, you may need treatment for this, too.
Stasis dermatitis- Treatment consists of correcting the condition that causes fluid to accumulate in your legs or ankles for extended periods. This may mean wearing elastic support hose or even having varicose vein surgery. You may also use wet dressings to soften the thickened yet fragile skin and to control infection.
Atopic dermatitis- Treatment typically consists of applying hydrocortisone-containing lotions to ease signs and symptoms. If your skin cracks open, your doctor may prescribe wet dressings with mildly astringent properties to contract your skin, reduce secretions and prevent infection. If itching is severe, your doctor may suggest you take antihistamines. Light therapy, which involves exposing your skin to controlled amounts of natural or artificial light, also may help prevent recurrences.
Perioral dermatitis- Treatment for this condition is usually with the oral antibiotic tetracycline. You may need to continue this treatment for several months to prevent a recurrence. Your doctor may prescribe a very mild corticosteroid cream in the initial phase of treatment to reduce signs and symptoms of perioral dermatitis. When stronger corticosteroids are used, the condition may return temporarily and even worsen when the medication is stopped.

For all types of dermatitis, occasional use of over-the-counter antihistamines can reduce itching.

Immunomodulators
A class of nonsteroidal medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), may help treat seborrheic dermatitis and atopic dermatitis. These medications affect the immune system and have anti-inflammatory and mild antifungal properties.

Due to possible concerns about the effect of prolonged use of these medications on the immune system, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed, or if someone can't tolerate other treatments.

Depression

2008-04-12T06:36:00.000-07:00

Depression is one of the most common health conditions in the world. Depression isn't a weakness, nor is it something that you can simply "snap out of." Depression, formally called major depression, major depressive disorder or clinical depression, is a medical illness that involves the mind and body. It affects how you think and behave and can cause a variety of emotional and physical problems. You may not be able to go about your usual daily activities, and depression may make you feel as if life just isn't worth living anymore.

Most health professionals today consider depression a chronic illness that requires long-term treatment, much like diabetes or high blood pressure. Although some people experience only one episode of depression, most have repeated episodes of depression symptoms throughout their life.

Effective diagnosis and treatment can help reduce even severe depression symptoms. And with effective treatment, most people with depression feel better, often within weeks, and can return to the daily activities they previously enjoyed.

Causes:
It's not known specifically what causes depression. As with many mental illnesses, it's thought that a variety of biochemical, genetic and environmental factors may cause depression:

Biochemical- Some evidence from high-tech imaging studies indicates that people with depression have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. The naturally occurring brain chemicals called neurotransmitters, which are linked to mood, also may play a role in depression. Hormonal imbalances also could be a culprit.
Genes- Some studies show that depression is more common in people whose biological family members also have the condition. Researchers are trying to find genes that may be involved in causing depression.
Environment- Environment is also thought to play a causal role in some way. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems and high stress.

Symptoms:
Symptoms of depression include:
Loss of interest in normal daily activities, Feeling sad or down, Feeling hopeless, Crying spells for no apparent reason, Problems sleeping, Trouble focusing or concentrating, Difficulty making decisions, Unintentional weight gain or loss, Irritability, Restlessness, Being easily annoyed, Feeling fatigued or weak, Feeling worthless, Loss of interest in sex, Thoughts of suicide or suicidal behavior, Unexplained physical problems, such as back pain or headaches, etc.

Diagnosis:
When doctors suspect someone has depression, they typically run a battery of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

Physical exam- This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
Laboratory tests- These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
Psychological evaluation- A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide or self-harm.

There are several other conditions whose symptoms may include depression. It's important to get an accurate diagnosis so you can get the appropriate treatment. Your doctor or mental health provider's evaluation will help determine if you have major depression or one of these other conditions that can sometimes resemble major depression:

Adjustment disorder- An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect your feelings, thoughts and behavior.
Bipolar disorder- This type of depression is characterized by mood swings that range from highs to lows. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's very important to get the right diagnosis so that you can get the proper treatment and medications.
Cyclothymia- Cyclothymia, or cyclothymic disorder, is a milder form of bipolar disorder.
Dysthymia- Dysthymia is a less severe but more chronic form of depression. While it's usually not disabling, dysthymia can prevent you from functioning normally in your daily routine and from living life to its fullest.
Postpartum depression- This is depression that occurs in a new mother usually within a month of having a baby.
Psychotic depression- This is severe depression accompanied by psychosis, such as delusions or hallucinations.
Schizoaffective disorder- Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder.
Seasonal affective disorder- This type of depression is related to changes in seasons and a lack of exposure to sunlight.

Treatment:
Numerous treatments for depression are available. Standard depression treatment options include:
Medications-
Dozens of medications are available to treat depression. Most people find the best relief of depression symptoms by combining medications and psychotherapy. Some medications for depression are antidepressants that have been specifically approved by the Food and Drug Administration (FDA) to treat depression. Doctors also can use their medical judgment to prescribe other medications that haven't been FDA approved to treat depression but that may be effective anyway — a common and perfectly legal practice called off-label use.

There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring biochemicals in your brain to change your mood. To determine which antidepressant may be best for you, doctors typically follow general practice guidelines. They may also ask you to take a blood test called the cytochrome P450 test, which can help identify genetic factors that influence your response to certain antidepressants (as well as some other medications).

SSRIs (selective serotonin reuptake inhibitors) include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

Other common first choices for antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), combined reuptake inhibitors and receptor blockers, and tetracyclic antidepressants.

Monoamine oxidase inhibitors (MAOIs) is often prescribed as a last resort, when other medications haven't worked. That's because MAOIs, while generally effective, can have serious harmful side effects. They also require strict dietary restrictions because of rare but potentially fatal interactions with certain foods. Newer versions of MAOIs that you stick on your skin as a skin patch rather than swallowing may have fewer side effects.

Psychotherapy
Psychotherapy is another key depression treatment. It's often used along with medication treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help alleviate depression symptoms, such as hopelessness and anger. It also may help you adjust to a crisis or other current difficulty.

Electroconvulsive therapy
In electroconvulsive therapy (ECT), electrical currents are passed through the brain to trigger a seizure. Although many people are leery of ECT and its side effects, it typically offers fast, effective relief of depression symptoms. Experts aren't sure how this therapy relieves the signs and symptoms of depression. The procedure may affect levels of neurotransmitters in your brain. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also experience partial memory loss, but memory often returns.

ECT is usually used for people who don't get better with medications and for those at high risk of suicide. It may be the only treatment available for older adults with severe depression who can't take medications because of heart disease.

Dengue

2008-04-12T06:18:00.000-07:00

Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics and Africa, and caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. The geographical spread is similar to malaria, but unlike malaria, dengue is often found in urban areas of developed tropical nations, including Singapore, Taiwan, Indonesia, India and Brazil. Each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes aegypti (rarely Aedes albopictus) mosquito, which feeds during the day.

Causes:
Dengue fever is caused by any one of four dengue viruses spread by the Aedes aegypti mosquito. These mosquitoes thrive in and near human habitations where they breed in even the cleanest water.

Mosquitoes transmit the virus back and forth between humans. When a mosquito bites a person infected with a dengue virus, the virus enters the mosquito's bloodstream. It then circulates before settling in the salivary glands. When the infected mosquito then bites another person, the virus enters that person's bloodstream, where it may cause the serious illness.

You can become infected with dengue fever more than once. This happens when you're exposed to a different one of the four dengue viruses than one to which you were previously exposed. Infection a second time is typically what causes the more severe form of the disease — dengue hemorrhagic fever.

Symptoms:
Signs and symptoms of dengue fever usually begin four to seven days after you've been bitten by a mosquito carrying a dengue virus. These signs and symptoms can vary, depending on the form of the disease. More severe forms of the disease usually begin the same way as the mild form (dengue fever), then become worse after several days.

Dengue fever signs and symptoms typically include:
High fever, up to 105 F, A rash over most of your body, which may subside after a couple of days and then reappear, Severe headache, backache or both, Pain behind your eyes, Severe joint and muscle pain, Nausea and vomiting, etc.

Dengue fever rarely causes death, and symptoms usually get better after five to seven days.

Dengue hemorrhagic fever — a more severe form of the disease — can also cause:

* Significant damage to your blood and lymph vessels.
* A decrease in the number blood cells that help your blood clot (platelets).
* Bleeding from the nose, mouth and under the skin, creating the appearance of bruising.
* Death.

Dengue shock syndrome — the most severe form of the disease — may also cause:

* Blood vessel fluid (plasma) leakage.
* Heavy bleeding.
* A sudden drop in blood pressure (shock).
* Death.

Diagnosis:
Diagnosing dengue fever can be difficult. That's because its signs and symptoms can be easily confused with those of other diseases, such as malaria, leptospirosis and typhoid fever. Still, diagnosis of dengue fever is typically done by evaluating your signs and symptoms along with your medical and travel history. To diagnose your condition, your doctor will likely ask about these. In addition, your blood may be tested for evidence of a dengue virus.

Medical history
Your doctor will likely ask about your medical and travel history and any exposure to mosquitoes. Be sure to describe international trips in detail, including the countries you visited and the dates, as well as any contact you may have had with mosquitoes.

Blood tests
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis of dengue fever. If you have dengue fever, your blood may reveal the virus itself. If not, blood tests known as hemagglutination inhibition (HI) assay, enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase-polymerase chain reaction (RT-PCR) also can detect antigens, antibodies or nucleic acids specific to the viruses. These tests may take several days.

Treatment:
No specific treatment for dengue fever exists.

If you have a mild form of the disease, your doctor will recommend making sure to drink enough fluids to avoid dehydration from vomiting and high fever. You can also take acetaminophen (Tylenol, others) for pain and fever. Avoid aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These can increase the risk of bleeding complications.

If you have a more severe form of the disease, treatment consists of supportive care in a hospital. Such care includes intravenous fluids and electrolyte replacement, maintaining adequate blood pressure and replacing blood loss.

If you have any form of dengue fever, you may also be kept away from mosquitoes, to avoid transmitting the disease to others.

Dementia

2008-04-12T05:52:00.000-07:00

Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood. This age cutoff is defining, as similar sets of symptoms due to organic brain dysfunction are given different names in populations younger than adulthood.

In dementia, affected areas in cognition may be memory, attention, language, and problem solving. Higher mental functions are affected first in the process. Especially in the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the month, month, or even what year it is), in place (not knowing where they are), and in person (not knowing who they are).

Symptoms of dementia can be classified as either reversible or irreversible depending upon the etiology of the disease. Less than 10 percent of cases of dementia are due to causes which may presently be reversed with treatment. Of these cases almost 100% are elderly people. Dementia is a term for a non-specific illness syndrome (set of symptoms) which is caused by many different specific disease processes, in the same way that symptoms of organ dysfunction such as shortness of breath, jaundice, or pain are attributable to many etiologies.

Without careful assessment of history, the short-term syndrome of delirium can easily be confused with dementia, because many of the symptoms of these are also present in dementia. Some mental illnesses including depression and psychosis may also produce symptoms which must be differentiated from both delirium and dementia.

Types:
Cortical dementias-
1) Alzheimer's disease.
2) Vascular dementia (also known as multi-infarct dementia), including Binswanger's disease.
3) Dementia with Lewy bodies (DLB).
4) Alcohol-Induced Persisting Dementia.
Korsakoff's syndrome
Wernicke's encephalopathy
5) Frontotemporal lobar degenerations (FTLD), including Pick's disease.
Frontotemporal dementia (or frontal variant FTLD)
Semantic dementia (or temporal variant FTLD)
Progressive non-fluent aphasia
6) Creutzfeldt-Jakob disease.
7) Dementia pugilistica.
8) Moyamoya disease.

Subcortical dementias-
* Dementia due to Huntington's disease.
* Dementia due to Hypothyroidism.
* Dementia due to Parkinson's disease.
* Dementia due to Vitamin B1 deficiency.
* Dementia due to Vitamin B12 deficiency.
* Dementia due to Folate deficiency.
* Dementia due to Syphilis.
* Dementia due to Subdural hematoma.
* Dementia due to Hypercalcaemia.
* Dementia due to Hypoglycemia.
* AIDS dementia complex.
* Pseudodementia (associated with clinical depression and bipolar disorder).
* Substance-induced persisting dementia (related to psychoactive use and formerly Absinthism).
* Dementia due to multiple etiologies.

Causes:
The slowly progressing destruction of nerve cells in the brain leads to the previously mentioned symptoms of Alzheimer's disease. It is a natural phenomenon to loose a certain number of nerve cells during ageing but this loss occurs much more rapidly in people suffering from Alzheimer's disease. As a result the brain of the patient does not function normally any longer.

In rare cases, the disease is caused by genetic changes (mutations) in the family. In these cases symptoms usually occur before the age of 60 and progress rapidly. All currently known mutations result in an overproduction of a protein which destroys the nerve cells. In most cases the exact cause remains largely unexplained; interaction of several factors probably leads to the onset. Everybody is at risk of developing this disease. Several genetic factors are known to increase the risk, without themselves being the cause. These include a (normal) variant of the gene apolipoprotein E which encourages the deposition of the harmful protein.

The probability of developing Alzheimer's disease increases with advancing age. The probability is higher for women and for people having a lower standard of education.

Symptoms:
Alzheimer's disease was first described in 1907 by the physician Alois Alzheimer. The most commonly known symptom of Alzheimer's disease is confusion. This behaviour in particular causes us to become 'estranged' from others and to be unpredictable in our interactions. Confusion can also occur 'acutly' i.e. suddenly and limited in time - for example triggered by a hospital stay, directly after heart surgery etc. It is difficult to understand this estrangement and it cannot be explained away - on the other hand everybody also experiences similar situations from time to time: we forget, misplace, can not remember names, cannot find our car in the car park and similar lapses. So both aspects are present: dementia is not familiar but also not entirely alien to us.

People with Alzheimer suffer mainly from impaired memory and orientation, limitations of concentration, planning and judgement, personality changes and later also perceptual, speech and walking disorders; in the final stage, various other body functions such as swallowing and the excretion process are also affected. During the course of Alzheimer's disease, patients lose their independence in managing everyday life. There are effects on perception and social relationships; people become more and more dependent on care.

Diagnosis:
Proper differential diagnosis between the types of dementia will require, at the least, referral to a specialist,
e.g. geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist. However, there exist some brief tests (5-15 minutes) that have reasonable reliability and can be used in the office or other setting to screen cognitive status for deficits which are considered pathological. Examples of such tests include the abbreviated mental test score (AMTS), the mini mental state examination (MMSE), Modified Mini-Mental State Examination (3MS), the Cognitive Abilities Screening Instrument (CASI), and the clock drawing test. An AMTS score of less than six (out of a possible score of ten) and an MMSE score under 24 (out of a possible score of 30) suggests a need for further evaluation. Scores must be interpreted in the context of the person's educational and other background, and the particular circumstances; for example, a person highly depressed or in great pain will not be expected to do well on many tests of mental ability.

Laboratory tests:
Routine blood tests are also usually performed to rule out treatable causes. These tests include vitamin B12, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, full blood count, electrolytes, calcium, renal function, and liver enzymes. Abnormalities may suggest vitamin deficiency, infection or other problems that commonly cause confusion or disorientation in the elderly. The problem is complicated by the fact that these cause confusion more often in persons who have early dementia, so that "reversal" of such problems may ultimately only be temporary.
Chronic use of substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia.

Imaging:
A CT scan or magnetic resonance imaging (MRI scan) is commonly performed, although these modalities do not have optimal sensitivity for the diffuse metabolic changes associated with dementia in a patient who shows no gross neurological problems (such as paralysis or weakness) on neurological exam. CT or MRI may suggest normal pressure hydrocephalus, a potentially reversible cause of dementia, and can yield information relevant to other types of dementia, such as infarction (stroke) that would point at a vascular type of dementia. However, the functional neuroimaging modalities of SPECT and PET have shown similar ability to diagnose dementia as clinical exam. The ability of SPECT to differentiate the vascular cause from the Alzheimer disease cause of dementias, appears to be superior to differentiation by clinical exam.

Treatment:
Except for the treatable types listed above, there is no cure to this illness, although scientists are progressing in making a type of medication that will slow down the process. Cholinesterase inhibitors are often used early in the disease course. Cognitive and behavioral interventions may also be appropriate. Educating and providing emotional support to the caregiver (or carer) is of importance as well.

A Canadian study found that a lifetime of bilingualism has a marked influence on delaying the onset of dementia by an average of four years when compared to monolingual patients. The researchers determined that the onset of dementia symptoms in the monolingual group occurred at the mean age of 71.4, while the bilingual group was 75.5 years. The difference remained even after considering the possible effect of cultural differences, immigration, formal education, employment and even gender as influences in the results.

Medications:
Tacrine (Cognex), donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon) are approved by the United States Food and Drug Administration (FDA) for treatment of dementia induced by Alzheimer disease. They may be useful for other similar diseases causing dementia such as Parkinsons or vascular dementia.

N-methyl-D-aspartate Blockers like Memantine (Namenda) is a drug representative of this class. It can be used in combination with acetylcholinesterase inhibitors.

Haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel) are frequently prescribed to help manage psychosis and agitation. Treatment of dementia-associated psychosis or agitation is intended to decrease psychotic symptoms (for example, paranoia, delusions, hallucinations), screaming, combativeness, and/or violence.

Dehydration

2008-04-10T00:34:00.000-07:00

Dehydration occurs when you lose more fluid than you take in and your body doesn't have enough water and other fluids to carry out its normal functions. If lost fluid remains unreplenished, you may suffer serious consequences.

Common causes of dehydration include intense bouts of diarrhea, vomiting, fever or excessive sweating. Inadequate intake of water during hot weather or exercise also may deplete your body's water stores. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk. Mild dehydration can cause symptoms such as weakness, dizziness and fatigue. Severe dehydration is a life-threatening medical emergency.

You can usually reverse mild to moderate dehydration by increasing your intake of fluids, but severe cases need immediate medical treatment. The safest approach is not to become dehydrated in the first place. You can do that by monitoring your fluid loss during hot weather, illness or exercise, and drinking enough liquids to replace what you lose.

Causes:
If you're an average adult, every day you lose more than 10 cups (close to 2.5 liters) of water simply by sweating, breathing and eliminating waste. You also lose electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body. Normally, you can replenish what you've lost through the foods and liquids you consume, even when you're active.

But when you eliminate more water and salts than you replace, dehydration results — your system literally dries out. Sometimes dehydration occurs for simple reasons: You don't drink enough because you're sick or busy, or because you lack access to potable water when you're traveling, hiking or camping.

* Diarrhea, vomiting- Severe, acute diarrhea, that is, diarrhea that comes on suddenly and violently — can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals. Children and infants are especially at risk. Worldwide, more than 1.5 million infants and children die of dehydration resulting from diarrhea every year — 300 to 500 of them in the United States. Most of these deaths occur in the first year of life.
* Fever- In general, the higher your fever, the more dehydrated you may become. If you have a fever in addition to diarrhea and vomiting, you lose even more fluids.
* Excessive sweating- You lose water when you sweat. If you engage in vigorous activity and don't replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose. But you can also become dehydrated in winter if you don't replace lost fluids. Preteens and teens who participate in sports may be especially susceptible, both because of their body weight, which is generally lower than that of adults, and because they may not be experienced enough to know the warning signs of dehydration.
* Increased urination- This is most often the result of undiagnosed or uncontrolled diabetes mellitus, a disease that affects the way your body uses blood sugar and that often causes increased thirst and more frequent urination. Another type of diabetes, diabetes insipidus, is also characterized by excessive thirst and urination, but in this case the cause is a hormonal disorder that makes your kidneys unable to conserve water. Certain medications — diuretics, antihistamines, blood pressure medications and some psychiatric drugs — as well as alcohol also can lead to dehydration, generally because they cause you to urinate or perspire more than normal.
* Burns- Doctors classify burns according to the depth of the injury and the extent of tissue damage. Third-degree burns are the most severe, penetrating all three layers of skin, and often destroying sweat glands, hair follicles and nerve endings. People with third-degree burns or extensive first- or second-degree burns experience profound fluid loss, and the resulting dehydration can be life-threatening.

Symptoms:
Mild to moderate dehydration is likely to cause:
Dry, sticky mouth, Sleepiness or tiredness — children are likely to be less active than usual, Thirst, Decreased urine output — fewer than six wet diapers a day for infants and eight hours or more without urination for older children and teens, Few or no tears when crying, Muscle weakness, Headache, Dizziness or lightheadedness.

Severe dehydration, a medical emergency, can cause:
Extreme thirst, Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults, Very dry mouth, skin and mucous membranes, Lack of sweating, Little or no urination — any urine that is produced will be dark yellow or amber, Sunken eyes, Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold, In infants, sunken fontanels — the soft spots on the top of a baby's head, Low blood pressure, Rapid heartbeat, Fever, In the most serious cases, delirium or unconsciousness.

Diagnosis:
Your doctor can often diagnose dehydration on the basis of physical signs and symptoms such as little or no urination, sunken eyes, and skin that lacks its normal elasticity and resilience when pinched. If you're dehydrated, you're also likely to have low blood pressure, especially when moving from a prone to a standing position, a faster than normal heart rate and reduced blood flow to your extremities.

To help confirm the diagnosis and pinpoint the degree of dehydration, you may have other tests, such as:
* Blood tests- These may be used to check your electrolytes, especially sodium and potassium; to look for signs of concentrated blood; and to evaluate how well your kidneys are working.
* Urinalysis- The color and clarity of your urine, the presence of carbon compounds (ketones) and your urine's specific gravity — that is, the mass of the urine as compared with equal amounts of distilled water — all help show whether you're dehydrated and to what degree. A high specific gravity, for example, indicates significant dehydration.

If it's not obvious why you're dehydrated, your doctor may order additional tests to check for diabetes and for liver or kidney problems.

Treatment:
The only effective treatment for dehydration is to replace lost fluids. The best approach to dehydration treatment depends on your age, the severity of your dehydration and its cause.

Treating dehydration in sick children
Your doctor can offer specific suggestions for treating dehydration in your child, but some general guidelines include the following:
Use an oral rehydration solution. Unless your doctor advises otherwise, use an oral rehydration solution such as Pedialyte for infants and children who have diarrhea, vomiting or fever. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose or another carbohydrate such as rice powder to enhance absorption in the intestinal tract. Oral rehydration products are readily available in most drugstores, and many pharmacies carry their own brands. Begin giving fluids early in the course of an illness instead of waiting until the situation becomes urgent.

In most developing countries, you can buy packets of a powdered oral rehydration solution, WHO-ORS, originally developed by the World Health Organization to treat diarrhea and dehydration in infants with cholera. Reconstitute the powder in water according to the directions on the package. Always boil the water first, remeasure the water, then add the powdered oral rehydration material.

Treating dehydration in sick adults
Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can improve their condition by drinking more water. Avoid coffee, tea and other beverages that contain caffeine, as they may temporarily increase dehydration. Fruit juices and sodas can make diarrhea worse.

Treating dehydration in athletes of all ages
For exercise-related dehydration, cool water is your best bet. Sports drinks containing electrolytes and a carbohydrate solution also may be helpful. There's no need for salt tablets — too much salt can lead to hypernatremic dehydration, a condition in which your body not only is short of water but also carries an excess of sodium.

Treating severe dehydration
Children and adults who are severely dehydrated should be treated by emergency personnel arriving in an ambulance or in a hospital emergency room, where they can receive salts and fluids through a vein (intravenously) rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do — something that's essential in life-threatening situations.

de Quervain syndrome

2008-04-10T00:25:00.000-07:00

de Quervain syndrome (also known as washerwoman's sprain, Radial styloid tenosynovitis, de Quervain disease, de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis or mother's wrist), is an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
It is name for named for Swiss surgeon Fritz de Quervain who first identified it in 1895. It should not be confused with "de Quervain's thyroiditis", another condition named for the same person.
Working in the garden, playing music, knitting, cooking and walking your pet can all be enjoyable activities, but if these activities cause pain in your wrist and hand, you may have a condition known as de Quervain's tenosynovitis.
In de Quervain's tenosynovitis, the sheath of the tendons on the thumb side of your wrist becomes inflamed or swollen, restricting the tendons' movement. The result with de Quervain's tenosynovitis is discomfort and pain every time you turn your wrist, grasp anything or make a fist.

Treatment for de Quervain's tenosynovitis may range from immobilizing your wrist and taking medications to surgery in more serious cases. If you start treatment early on, your symptoms of de Quervain's tenosynovitis should generally improve within four to six weeks.

Causes:

When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain's tenosynovitis, the tendons' slippery covering becomes inflamed, restricting movement of the tendons.

A common cause is chronic overuse of your wrist. For example, peeling carrots involves a repetitive motion, a bent wrist and the gripping of the peeler. If you peel carrots or potatoes day after day, hour after hour, this combination may be enough to irritate the sheath around the two tendons.

Other causes of de Quervain's tenosynovitis include:
* Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons.
* Inflammatory arthritis, such as rheumatoid arthritis.

Symptoms:

The main signs and symptoms of de Quervain's tenosynovitis are pain and swelling near the base of your thumb. The pain may appear suddenly or may increase over time. If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both.
Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

Symptoms of de Quervain's tenosynovitis include:
* Pain near the base of your thumb.
* Swelling near the base of your thumb.
* Numbness in the back of your thumb and index finger, caused by the swollen tendon rubbing on a nerve.
* A fluid-filled cyst in the same region as the swelling and pain.
* Difficulty moving your thumb and wrist when you're doing activities that involve grasping or pinching.
* A "sticking" or "stop-and-go" sensation in your thumb when trying to move it.
* A squeaking sound as the tendons try to move back and forth through the inflamed sheaths.

Diagnosis:

Your doctor may confirm a diagnosis of de Quervain's tenosynovitis by doing a Finkelstein test. In this simple test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considered positive.

If you feel pain about three inches up your forearm, you may have a condition called intersection syndrome. This is similar to de Quervain's tenosynovitis, but affects a different area of your wrist and requires different treatment.

Treatment:

To reduce pain and swelling, initial treatment of de Quervain's tenosynovitis may include:

* Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons.
* Avoiding repetitive thumb movements whenever possible.
* Avoiding pinching with your thumb when moving your wrist from side to side.
* Applying heat to or icing the affected area.
* Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve).

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. Treatment is generally successful if begun early on, though overuse injuries often recur if you have difficulty discontinuing the repetitive motions that caused the condition in the first place.

Making adjustments

Your medical team may include a physical therapist or occupational therapist who may monitor your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain and limit the irritation of the tendons.

In more serious cases

If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release pressure.

Dandruff

2008-04-10T00:15:00.000-07:00

Dandruff (also called scurf and historically termed Pityriasis capitis) is due to the excessive shedding of dead skin cells from the scalp. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and in fact quite common. Some people, however, either chronically or as a result of certain triggers, experience an unusually large amount of flaking, which can also be accompanied by redness and irritation. Most cases of dandruff can be easily treated with specialized shampoos. Dandruff is not an organism like lice; it is just dead skin that accumulates in the scalp.
Dandruff is unlikely to be the cause of hair loss. Excessive flaking can also be a symptom of seborrhoeic dermatitis, psoriasis, fungal infection or excoriation associated with infestation of head lice.
If dandruff is the only thing standing between you and a closet full of basic black, you're not alone. Many people have this chronic scalp disorder, which is marked by itching and excessive flaking of the scalp. Although dandruff isn't contagious and is rarely serious, it can be embarrassing and surprisingly persistent.
The good news is that dandruff can usually be controlled. Mild cases of dandruff may need nothing more than daily shampooing with a gentle cleanser. And stubborn flakes often respond to medicated shampoos. What's more, researchers have identified a yeast-like fungus that may cause or aggravate dandruff, a discovery that may lead to better treatments.

Causes:

At one time or another, dandruff causes have been attributed to dry skin, oily skin, shampooing too often or not often enough, a poor diet, stress, and the use of too many fancy styling products. Although some of these factors may exacerbate or contribute to scalp flaking, the real culprit may be a fat-eating, yeast-like fungus called malassezia, formerly known as pityrosporum.

Malassezia lives on the scalps of most healthy adults without causing problems. But sometimes it grows out of control, feeding on the oils secreted by your hair follicles and causing irritation that leads to increased cell turnover. The result is a large number of dead skin cells. As the cells fall off, they tend to clump together with oil from your hair and scalp, making them appear white, flaky and all too visible.

Exactly what causes an overgrowth of these organisms isn't known, although increased oil production; hormonal fluctuations; stress; illness; neurological disorders, such as Parkinson's disease; a suppressed immune system; infrequent shampooing and extra sensitivity to the malassezia fungus may contribute to the development of dandruff.

Seborrheic dermatitis

Flaking is a symptom of seborrheic dermatitis. Joseph Bark notes that "Redness and itching is actually seborrheic dermatitis, and it frequently occurs around the folds of the nose and the eyebrow areas, not just the scalp." Dry, thick, well-defined lesions consisting of large, silvery scales may be traced to the less common psoriasis of the scalp. Seasonal changes, stress, and immuno-suppression seem to affect seborrheic dermatitis.

Symptoms:

For most people, the signs and symptoms of dandruff are unmistakable: white, oily looking flakes of dead skin that dot your hair and shoulders and an itchy,
scaling scalp. But it's not quite that simple — many conditions cause excessive skin scaling, including:
* Dry skin- the kind you get in winter when the air is cold and rooms are overheated — is by far the most common cause of itchy, flaking skin. But flakes from dry skin are generally smaller and less oily than those caused by dandruff.
* Seborrheic dermatitis- This condition, a frequent cause of dandruff, is marked by red, greasy skin covered with flaky white or yellow scales. Seborrheic dermatitis affects not only your scalp but also other areas rich in oil glands, such as your eyebrows, the sides of your nose and the backs of your ears, your breastbone, your groin area, and sometimes your armpits.
* Psoriasis- This skin disorder causes an accumulation of dead skin cells that form thick silvery scales. Psoriasis commonly occurs on your knees, elbows and trunk, but it can also affect your scalp.
* Cradle cap- (seborrheic dermatitis of the scalp). This disorder, which causes a scaling, crusty scalp, is most common in newborns, but it can occur anytime during infancy. Although it can be alarming for parents, cradle cap isn't dangerous and usually clears up on its own by the time a baby is a year old.
* Contact dermatitis- Sometimes sensitivities to certain hair-care products or hair dyes can cause a red, itchy, scaling scalp.

Self-Care:

You can't prevent dandruff, but you can take steps to reduce your risk:
* Learn to manage stress- Stress affects your overall health, making you susceptible to a number of conditions and diseases. It can even help trigger dandruff or exacerbate existing symptoms.
* Shampoo often- If you tend to have an oily scalp, daily shampooing to remove the excess oil may help prevent dandruff.
* Cut back on styling products- Hair sprays, styling gels, mousses and hair waxes can all build up on your hair and scalp, making them oilier.
* Eat a healthy diet- A diet that provides enough zinc, B vitamins and essential fatty acid may help prevent dandruff.
* Get a little sun- Sunlight may be good for dandruff. But because exposure to ultraviolet light damages your skin and increases your risk of skin cancer, don't sunbathe. Instead, just spend a little time outdoors. And be sure to wear sunscreen on your face and body.

Treatment:

Dandruff is a chronic condition that can almost always be controlled, but dandruff treatment may take a little patience and persistence. In general, mild scaling can often be helped by daily cleansing with a gentle shampoo to reduce oiliness and cell buildup.

When regular shampoos fail, OTC dandruff shampoos may succeed. But dandruff shampoos aren't all alike, and you may need to experiment until you find one that works best for you. Dandruff shampoos are classified according to their active ingredient:

Zinc pyrithione shampoos (Selsun Salon, Head & Shoulders). These contain the antibacterial and antifungal agent zinc pyrithione, which has been shown to reduce the fungus that causes dandruff and seborrheic dermatitis.
Tar-based shampoos (Neutrogena T/Gel). Coal tar, a byproduct of the coal manufacturing process, helps conditions such as dandruff, seborrheic dermatitis and psoriasis by slowing cell turnover.
Shampoos containing salicylic acid (Ionil T). These "scalp scrubs" help eliminate scale, but they may leave your scalp dry, leading to more flaking. Using a conditioner after shampooing can help counter dryness.
Selenium sulfide shampoos (Selsun Blue). These shampoos help prevent cell turnover and may also reduce the number of malassezia. Because they can discolor blonde, gray or chemically colored hair, be sure to use them only as directed and to rinse well after shampooing.
Ketoconazole shampoos (Nizoral). The newest addition to the dandruff armamentarium, ketoconazole is a broad-spectrum antifungal agent that may work when other shampoos fail. It's available over-the-counter as well as by prescription.

Cystitis

2008-04-09T21:44:00.000-07:00

Cystitis is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by a bacterial infection, in which case it may be referred to as a urinary tract infection (UTI). A bladder infection can be painful and annoying, and can become a serious health problem if the infection spreads to your kidneys.

Less commonly, cystitis may occur as a reaction to certain drugs, radiation therapy or potential irritants, such as feminine hygiene spray, spermicidal jellies or long-term use of a catheter. Cystitis may also occur as a complication of another illness.

The usual treatment for bacterial cystitis is antibiotics. Other treatments are used for other types of cystitis.

Types:
There are several types of cystitis:

Bacterial cystitis, the most common type, which is most often caused by coliform bacteria being transferred from the bowel through the urethra into the bladder.

Interstitial cystitis (IC) is considered more of an injury to the bladder resulting in constant irritation and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown, though some suspect it may be autoimmune where the immune system attacks the bladder. However, there is hope. Several therapies are now available.

Eosinophilic cystitis, is a rare form of cystitis that is diagnosed via biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC is also unknown though it has been triggered in children by certain medications. Some consider it a form of interstitial cystitis.

Radiation cystitis, often occurs in patients undergoing radiation for the treatment of cancer.

Hemorrhagic cystitis.

Causes:
Your urinary system is composed of the kidneys, ureters, bladder and urethra. All play a role in removing waste from your body. Your kidneys — a pair of bean-shaped organs located toward the back of your upper abdomen — filter waste from your blood and adjust the body composition of many substances. Tubes called ureters carry urine from your kidneys to the bladder, where it's stored until it exits your body through the urethra.

Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria and becomes irritated and inflamed. It is very common.

The condition frequently affects sexually active women ages 20 to 50 but may also occur in those who are not sexually active or in young girls. Older adults are also at high risk for developing cystitis, with the incidence in the elderly being much higher than in younger people.

Cystitis is rare in males. Females are more prone to the development of cystitis because of their relatively shorter urethra—bacteria do not have to travel as far to enter the bladder—and because of the relatively short distance between the opening of the urethra and the anus. However it is not an exclusively female disease.

More than 85% of cases of cystitis are caused by Escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract. Sexual intercourse may increase the risk of cystitis because bacteria can be introduced into the bladder through the urethra during sexual activity. Once bacteria enter the bladder, they are normally removed through urination. When bacteria multiply faster than they are removed by urination, infection results.

Risks for cystitis include obstruction of the bladder or urethra with resultant stagnation of urine, insertion of instruments into the urinary tract (such as catheterization or cystoscopy), pregnancy, diabetes, and a history of analgesic nephropathy or reflux nephropathy.

The elderly of both sexes are at increased risk for developing cystitis due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia (BPH), prostatitis and urethral strictures. Also, lack of adequate fluids, bowel incontinence, immobility or decreased mobility and placement in a nursing home are situations which put people at increased risk for cystitis.

Noninfectious cystitis
Although bacterial infections are the most common cause of cystitis, a number of other noninfectious factors may cause the bladder to become inflamed. Some examples:
Interstitial cystitis- The cause of this chronic bladder inflammation, also called painful bladder syndrome, is unclear. Most cases are diagnosed in women. The condition can be difficult to diagnose and treat.
Drug-induced cystitis- Certain medications, particularly the chemotherapy drugs cyclophosphamide and ifosfamide, can cause inflammation of your bladder as the broken-down substances of the drugs exit your body.
Radiation cystitis- Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue.
Foreign-body cystitis- Long-term use of a catheter can predispose you to bacterial infections and to tissue damage, both of which can cause inflammation.
Chemical cystitis- Some people may be hypersensitive to chemicals contained in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder, causing inflammation.
Cystitis associated with other conditions- Cystitis may sometimes occur as a complication of other disorders, such as gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn's disease, diverticulitis, lupus and tuberculosis.

Symptoms:

Cystitis symptoms often include:

A strong, persistent urge to urinate, A burning sensation when urinating, Passing frequent, small amounts of urine, Blood in the urine (hematuria), Passing cloudy or strong-smelling urine, Discomfort in the pelvic area, A feeling of pressure in the lower abdomen, Low-grade fever, Pressure in the lower pelvis, Painful urination (dysuria), Need to urinate at night (nocturia, similar to prostate cancer or BPH), Blood in the urine (hematuria) (similar to a female's period or bladder cancer), Foul or strong urine odor, etc.

In young children, new episodes of bed-wetting (enuresis) also may be a sign of a UTI.

Diagnosis:
If you have symptoms of cystitis, talk to your doctor as soon as possible. In addition to discussing your signs and symptoms and your medical history, your doctor may order these tests, as well:

Urine analysis- If your doctor suspects you have a bladder infection, he or she may ask for a urine sample to determine whether bacteria, blood or pus is in your urine.
Cystoscopy- Inspection of your bladder with a cystoscope — a thin tube with a light and camera attached that can be inserted through the urethra into your bladder — may help with the diagnosis. Your doctor can also use the cystoscope to remove a small sample of tissue (biopsy) for analysis in the laboratory.
Imaging tests- Imaging tests usually aren't necessary but in some instances — especially when no evidence of infection is found — they may be helpful. Tests, such as X-ray or ultrasound, may help rule out other potential causes of bladder inflammation, such as a tumor or structural abnormality.

Treatment:
Antibiotics are used to control bacterial infection. It is vital that one finish an entire course of prescribed antibiotics. However, cystitis can also be treated with over-the-counter medicines, where self-treatment is appropriate.

Commonly used antibiotics include:
Nitrofurantoin, Trimethoprim-sulfamethoxazole, Amoxicillin, Cephalosporins, Ciprofloxacin or levofloxacin, Doxycycline, etc.

The choice of antibiotic should preferably be guided by the result of urine culture.

Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics control the bacterial infection. They may be required for long periods of time. Prophylactic low-dose antibiotics are sometimes recommended after acute symptoms have subsided.

Pyridium may be used to reduce the burning and urgency associated with cystitis. In addition, common substances that contain weak acids such as ascorbic acid or cranberry juice, act as weak buffers in the urine rendering it less acidic and thus reduce pain on urination. An effective, but old fashioned treatment (that seems to have been forgotten) is a salt water douche. Dissolve plenty of salt in warm water and bathe the affected region until symptoms subside.

Cystic fibrosis

2008-04-09T21:27:00.000-07:00

Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease that affects mainly the exocrine (mucus) glands of the lungs, liver, pancreas, and intestines, causing progressive disability due to multisystem failure.

Thick mucus production, as well as a less competent immune system, results in frequent lung infections. Diminished secretion of pancreatic enzymes is the main cause of poor growth, fatty diarrhea and deficiency in fat-soluble vitamins. Males can be infertile due to the condition congenital bilateral absence of the vas deferens. Often, symptoms of CF appear in infancy and childhood. Meconium ileus is a typical finding in newborn babies with CF.

Individuals with cystic fibrosis can be diagnosed prior to birth by genetic testing. Newborn screening tests are increasingly common and effective. The diagnosis of CF may be confirmed if high levels of salt are found during a sweat test, although some false positives may occur.

There is no cure for CF, and most individuals with cystic fibrosis die young: many in their 20s and 30s from lung failure. However, with the continuous introduction of many new treatments, the life expectancy of a person with CF is increasing. Lung transplantation is often necessary as CF worsens.

Cystic fibrosis is one of the most common life-shortening, childhood-onset inherited diseases. In the United States, 1 in 3900 children are born with CF. It is most common among Europeans and Ashkenazi Jews; one in twenty-two people of European descent are carriers of one gene for CF, making it the most common genetic disease in these populations. Ireland has the highest rate of CF carriers in the world (1 in 19).

CF is caused by a mutation in a gene called the cystic fibrosis transmembrane conductance regulator (CFTR). The product of this gene is a chloride ion channel important in creating sweat, digestive juices, and mucus. Although most people without CF have two working copies of the CFTR gene, only one is needed to prevent cystic fibrosis. CF develops when neither gene can produce a functional CFTR protein. Therefore, CF is considered an autosomal recessive disease.

Causes:
In cystic fibrosis, a defective gene alters a protein that regulates the normal movement of salt (sodium chloride) in and out of cells. This results in thick, sticky secretions in the respiratory and digestive tracts, as well as in the reproductive system. It also causes increased salt in sweat.

The affected gene, which is inherited from a child's parents, is a recessive gene. With recessive genes, children need to inherit two copies of the gene, one from each parent, in order to have the disease. If children inherit only one copy, they won't develop cystic fibrosis, but will be carriers and possibly pass the gene to their own children.

If two people who carry the defective gene conceive a child, there's a 25 percent chance the child will have cystic fibrosis, a 50 percent chance the child will be a carrier of the cystic fibrosis gene, and a 25 percent chance the child will neither have the disease nor be a carrier.

People who carry the cystic fibrosis gene are healthy and have no symptoms — they may be carriers and not know it. Although parents often blame themselves when a child is born with cystic fibrosis, it's important to remember that the causes of cystic fibrosis are not the result of anything a parent consciously does.

The role of fatty acids
Some experts believe that an imbalance of essential fatty acids may play a role in cystic fibrosis. People with cystic fibrosis appear to have excessively high levels of arachidonic acid and a deficiency of another fatty acid, docosahexaenoic acid.

Healthy people who carry one cystic fibrosis gene have fatty acid levels midway between those of people with cystic fibrosis and people with no genetic mutations for the disease. But the exact nature of the relationship between fatty acid levels and the gene defect that causes cystic fibrosis isn't clear.

Symptoms:
The specific signs and symptoms of cystic fibrosis can vary with the severity of the disease. For example, one child with cystic fibrosis may have respiratory problems but not digestive problems, while another child may have both. In addition, the signs and symptoms of cystic fibrosis may vary with age.

Signs and symptoms in newborns
In some newborns, the first sign may be a blockage of their intestines (meconium ileus). This occurs when meconium — tarry, greenish-black stools normally passed by an infant during the first day or two after birth — becomes so thick it can't move through the intestines. Other signs in newborns may include:

* Failure to grow.
* Bulky and greasy stools (steatorrhea).
* Frequent respiratory infections.

Signs and symptoms in children and young adults
Cystic fibrosis symptoms in children and young adults may include:

* Salty taste to the skin. People with cystic fibrosis tend to have higher than normal amounts of salt (sodium chloride) in their sweat. This may be one of the first signs parents notice because they can taste the salt when they kiss their child.
* Blockage in the bowels.
* Foul-smelling, greasy stools.
* Delayed growth.
* Thick sputum. It's easy for parents to overlook this sign because young children tend to swallow their sputum rather than cough it up.
* Coughing or wheezing.
* Frequent chest and sinus infections with recurring pneumonia or bronchitis.
* Protrusion of part of the rectum through the anus (rectal prolapse). This is often caused by stools that are difficult to pass or by frequent coughing.
* Enlargement or rounding (clubbing) of the fingertips and toes. Although clubbing eventually occurs in most people with cystic fibrosis, it also occurs in some people born with heart disease and other types of lung problems.

Cystic fibrosis may also be accompanied by:

* Growths (polyps) in the nasal passages.
* Cirrhosis of the liver due to inflammation or obstruction of the bile ducts.
* Displacement of one part of the intestine into another part of the intestine (intussusception) in children older than age 4.

Diagnosis:
Sweat test
The standard diagnostic test for cystic fibrosis is a sweat test, which measures the amount of sodium or chloride in a person's sweat. During the procedure, a small amount of an odorless sweat-producing chemical is applied to a small area on the arm or leg. An electrode attached to the area stimulates a very weak and painless electric current, causing a tingling or warm feeling. After several minutes, sweat is collected from the stimulated area and sent to a laboratory for analysis.

The sweat test is performed on two separate samples, which are usually taken on one occasion, to ensure that a false-positive or false-negative result hasn't occurred. A consistently high level of salt indicates cystic fibrosis. This test doesn't show whether someone has a mild or severe case of the disease, however, and it can't predict how well someone with cystic fibrosis will do.

In addition, the sweat test may not always be useful in newborns. That's because babies may not produce enough sweat for a reliable diagnosis in the first month of life. For this reason, doctors usually don't perform a sweat test until an infant is at least several months old.

Other tests
If your newborn has signs and symptoms of cystic fibrosis, your doctor may perform a genetic analysis of a blood sample to confirm the diagnosis. Tests may also help determine the extent and severity of cystic fibrosis. Among these are tests to measure how well the lungs, pancreas and liver are working.

Because cystic fibrosis is an inherited disease, your doctor may suggest testing the brothers and sisters of a child with cystic fibrosis, even if they show no signs or symptoms. Other family members, especially first cousins, also may want to be tested. In most cases family members can be screened with a sweat test, although in some cases genetic blood testing may be appropriate.

Treatment:
Many treatments exist for the symptoms and complications of cystic fibrosis. The main goal is to prevent infections, reduce the amount and thickness of secretions in the lungs, improve airflow, and maintain adequate calories and nutrition.

To accomplish these objectives, cystic fibrosis treatment may include:

Antibiotics- Newer antibiotics may more effectively fight the bacteria that cause lung infections in people with cystic fibrosis. Among these are aerosolized antibiotics that send medication directly into airways. One of the major drawbacks of long-term use of antibiotics is the development of bacteria that are resistant to drug therapy. In addition, using antibiotics over a long period of time can lead to fungal infections of the mouth, throat and respiratory tract.
Mucus-thinning drugs- When your white blood cells attack bacteria in your airways, DNA in your cells is released, making the mucus in your airways even thicker. The aerosolized drug dornase alfa (Pulmozyme) is an enzyme that fragments DNA, making mucus thinner and easier to cough up. Side effects of the drug may include airway irritation and sore throat.
Bronchodilators- Use of medications such as albuterol, which can be delivered by an inhaler or a nebulizer, may help keep open the bronchial tubes by clearing thick secretions.
Bronchial airway drainage- People with cystic fibrosis need a way to physically remove thick mucus from their lungs. This is often done by manually clapping with cupped hands on the front and back of the chest — a procedure that's best performed with the person's head over the edge of the bed so that gravity helps clear the secretions.

In some cases an electric chest clapper, known as a mechanical percussor, is used. An inflatable vest that vibrates at high frequency also can help people with cystic fibrosis cough up secretions. Many adults and children with pulmonary cystic fibrosis need to have bronchial airway drainage at least twice a day for 20 to 30 minutes. Older children and adults can learn to do this themselves, especially if they use mechanical aids, such as vests and percussors. Young children need the aid of parents, grandparents or older siblings.
Oral enzymes and better nutrition- Cystic fibrosis can cause you to become malnourished because the pancreatic enzymes needed for digestion don't reach your small intestine, preventing food from being absorbed. As a result, you may need many more calories than you otherwise would. Supplemental high-calorie nutrition, special fat-soluble vitamins and enteric-coated oral pancreatic enzymes can help you maintain or even gain weight.
Lung transplantation- Your doctor may suggest lung transplantation if you have severe breathing problems, life-threatening pulmonary complications or increasing resistance to antibiotics used to treat lung infections. Whether you're a good candidate for the procedure depends on a number of factors, including your overall health, certain lifestyle factors and the availability of donor organs. Because both lungs are affected by cystic fibrosis, both need to be replaced. If your chest isn't large enough to hold two adult donor lungs, your surgeon is likely to use two lower lobes contributed by two living donors. However it's performed, lung transplantation is a major operation and may lead to serious complications, especially post-surgical infections.
Pain relievers- Ibuprofen (Advil, Motrin, others) may slow lung deterioration in some children with cystic fibrosis.

Future treatments:
Major progress in cystic fibrosis research came in 1989, when researchers identified the genetic mutation that causes the disease. Since then scientists have been studying ways to insert copies of the normal gene into cells of the respiratory tract.

The challenge has been to find a reliable way to deliver the normal genetic material to affected cells that line the airways. Several methods have been developed as delivery systems, including using modified viruses, fat capsules (liposomes) and synthetic vectors. Clinical trials are under way to test the effectiveness of these delivery systems.

Other research is focusing on modifying the protein that the cystic fibrosis gene produces. This may help normalize the movement of salt and water in and out of the cells.

Cyanosis

2008-04-09T01:34:00.000-07:00

Cyanosis is a blue coloration of the skin and mucous membranes due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. It occurs when the oxygen saturation of arterial blood falls below 85-90% (1.5g/dl deoxyhemoglobin). The name is derived from the color cyan, the Greek word for blue.

Although human blood is always a shade of red (except in rare cases of hemoglobin-related disease), the optical properties of skin distort the dark red color of deoxygenated blood to make it appear blueish.

The elementary principle behind cyanosis is that deoxygenated hemoglobin is more prone to the optical bluish discoloration, and also produces vasoconstriction that makes it more evident. The scattering of color that produces the blue hue of veins and cyanosis is similar to the process that makes the sky and large bodies of water appear blue: some colors are refracted and absorbed more than others. During cyanosis, tissues are uncharacteristically low on oxygen, and therefore tissues that would normally be filled with bright oxygenated blood are instead filled with darker, deoxygenated blood. Darker blood is much more prone to the blue-shifting optical effects, and thus oxygen deficiency - hypoxia - leads to blue discoloration of the lips and other mucous membranes.

Types:
Cyanosis can occur in the fingers, including underneath the fingernails, as well as other extremities (called peripheral cyanosis), or in the lips and tongue (central cyanosis).

Central cyanosis is often due to a circulatory or ventilatory problem that leads to poorer blood oxygenation in the lungs or greater oxygen extraction due to slowing down of blood circulation in the skin's blood vessels.

Acute cyanosis can be a result of asphyxiation or choking, and is one of the surest signs that respiration is being blocked.

Peripheral cyanosis is the blue tint in fingers or extremities, due to inadequate circulation. The blood reaching the extremities is not oxygen rich and when viewed through the skin a combination of factors can lead to the appearance of a blue color. All factors contributing to central cyanosis can also cause peripheral symptoms to appear, however peripheral cyanosis can be observed without there being heart or lung failures. Small blood vessels may be restricted and can be treated by increasing the normal oxygenation level of the blood.

Causes:
Common causes of central cyanosis- Abnormal hemoglobin levels, Congenital heart disease, Heart failure, Heart valve disease, High altitude, Hypothermia, Hypoventilation, Lung disease, Myocardial infarction, Polycythaemia, Pulmonary embolism, COPD (Emphysema and Chronic Bronchitis), Asthma, Methemoglobinemia, Tetralogy of Fallot (heart defect).

Common causes of acute cyanosis- Choking, Inhaled foreign body, Cold exposure, Drug overdose, Shock, Asthma, Pneumothorax, Heart failure, Left ventricular failure.

Common causes of peripheral cyanosis- All common causes of central cyanosis, Arterial obstruction, Cold exposure (due to vasoconstriction), Raynaud's phenomenon (vasoconstriction), Reduced cardiac output (e.g. heart failure, hypovolaemia), Vasoconstriction, Venous obstruction (e.g. deep vein thrombosis).

Symptoms:
Adult respiratory distress syndrome, Asphyxia, Asthma, Blue baby, Bronchopulmonary dysplasia, Chemical pneumonia, Chronic Bronchitis, Chronic Obstructive Pulmonary Disease, Congenital heart defects, Dermatomyositis, Drowning, Emphysema, Epiglotitis, Erythromelalgia, Familial emphysema, Heart attack, Immune Thrombocytopenic Purpura, Kaposi's Sarcoma,
Melioidosis, Methahemoglobinemia, Mountain sickness, Necrotizing fasciitis, Neonatal Respiratory Distress Syndrome, Pneumoconiosis, Pneumonia, Primary pulmonary hypertension, Pulmonary edema, Pulmonary embolism, Raynaud's phenomenon, Sarcoidosis, Shaken Baby Syndrome, Shock, Whooping Cough.

Diagnosis:

Treatment:

Cushing's Syndrome

2008-04-09T01:08:00.000-07:00

Cushing's syndrome is a condition that occurs when your body is exposed to high levels of the hormone cortisol for a prolonged period of time. Sometimes called hypercortisolism, Cushing's syndrome can occur when your adrenal glands, located above your kidneys, make too much cortisol. It may also develop if you're taking high doses of cortisol-like medications (corticosteroids) for a prolonged period.

Too much cortisol can produce some of the hallmark signs of Cushing's syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. It can also result in high blood pressure, bone loss and, on occasion, diabetes.

The most common cause of Cushing's syndrome is the use of oral corticosteroid medication. By contrast, it's rare for the cause to be excess cortisol production by your body. The syndrome is named after Harvey Cushing, an American surgeon who first identified the condition in 1932.

Treatments for Cushing's syndrome are designed to return your body's cortisol production to normal. By normalizing or even markedly lowering cortisol levels, you'll experience noticeable improvements in your signs and symptoms. Left untreated, however, Cushing's syndrome can eventually lead to death.

Causes:
Your endocrine system consists of glands that produce hormones, which regulate processes throughout your body. These glands include the adrenal glands, pituitary gland, thyroid gland, parathyroid glands, pancreas, ovaries (in females) and testicles (in men).

Your adrenal glands produce a number of hormones, including cortisol. Cortisol plays a variety of roles in your body. For example, cortisol helps regulate your blood pressure and keeps your cardiovascular system functioning normally. It also helps your body respond to stress and regulates the way you convert (metabolize) proteins, carbohydrates and fats in your diet into usable energy. However, when the level of cortisol is too high in your body, you may develop Cushing's syndrome.

Cushing's syndrome can develop from a cause that originates outside of your body (Exogenous Cushing's syndrome). Taking corticosteroid medications in high doses over an extended period of time may result in Cushing's syndrome. These medications, such as prednisone, dexamethasone (Decadron) and methylprednisolone (Medrol), have the same effects as does the cortisol produced by your body. People can also develop Cushing's from injectable corticosteroids — for example, repeated injections for joint pain, bursitis and back pain. While certain inhaled steroid medicines (taken for asthma) and steroid skin creams (for skin disorders such as eczema) are in the same general category of drugs, they're generally not implicated in Cushing's syndrome unless taken in very high doses.

The condition may also be due to your body's own overproduction of cortisol (Endogenous Cushing's syndrome). This may occur from excess production by one or both adrenal glands, or overproduction of the adrenocorticotropic hormone (ACTH), which normally regulates cortisol production. In these cases, Cushing's syndrome may be related to:
* A pituitary gland tumor- A noncancerous (benign) tumor of the pituitary gland, located at the base of the brain, secretes an excess amount of ACTH, which in turn stimulates the adrenal glands to make more cortisol. When this form of the syndrome develops, it's called Cushing's disease. It occurs five times as often in women as in men and is the most common form of endogenous Cushing's syndrome.
* An ectopic ACTH-secreting tumor- Rarely, when a tumor develops in an organ that normally does not produce ACTH, the tumor will begin to secrete this hormone in excess, resulting in Cushing's syndrome. These tumors, which can be benign or cancerous (malignant), are usually found in the lung, pancreas, thyroid or thymus gland.
* A primary adrenal gland disease- In some people, the cause of Cushing's syndrome is excess cortisol secretion that doesn't depend on stimulation from ACTH and is associated with disorders of the adrenal glands. The most common of these disorders is a noncancerous tumor of the adrenal cortex, called an adrenal adenoma. Cancerous tumors of the adrenal cortex are rare, but they can cause Cushing's syndrome as well. Occasionally, benign, nodular enlargement of both adrenal glands can result in Cushing's syndrome.

Symptoms:
Common signs and symptoms of Cushing's syndrome include:
* Weight gain, particularly around your midsection and upper back
* Fatigue.
* Muscle weakness.
* Rounding of your face (moon face).
* Facial flushing.
* Fatty pad or hump between your shoulders (buffalo hump).
* Pink or purple stretch marks (striae) on the skin of your abdomen, thighs, breasts and arms.
* Thin and fragile skin that bruises easily.
* Slow healing of cuts, insect bites and infections.
* Depression, anxiety and irritability.
* Thicker or more visible body and facial hair (hirsutism).
* Acne.
* Irregular or absent menstrual periods in females.
* Erectile dysfunction in males.
* High blood pressure.

Diagnosis:
Cushing's syndrome can be difficult to diagnose, particularly endogenous Cushing's, because other conditions share the same signs and symptoms.

Your doctor will conduct a physical exam, looking for signs of Cushing's syndrome. He or she may suspect Cushing's syndrome if you have signs such as rounding of the face (moon face), a pad of fatty tissue at the shoulders and neck (buffalo hump), and thin skin with bruises and stretch marks. Your doctor may ask you about signs and symptoms such as fatigue, depression and weight change.

If you've been taking a corticosteroid medication long term, your doctor may suspect that you've developed Cushing's syndrome as a result of this drug. If you haven't been using a corticosteroid medication, these diagnostic tests may help pinpoint the cause:

Urine and blood tests- These tests measure hormone levels in your urine and blood and show whether your body is producing excessive cortisol. For the urine test, you may be asked to collect a sample of your urine over a 24-hour period. Both the urine and blood samples will be sent to a laboratory to be analyzed for cortisol levels.

Saliva test- Cortisol levels normally rise and fall throughout the day. In people without Cushing's syndrome, levels of cortisol drop significantly overnight. By analyzing cortisol levels from a small sample of saliva collected between 11 p.m. and midnight, doctors can see if cortisol levels are too high, indicating a diagnosis of Cushing's.

Imaging tests- Computerized tomography (CT) scans or magnetic resonance imaging (MRI) scans can provide images of your pituitary and adrenal glands to locate abnormalities, such as tumors.

As these tests help your doctor diagnose Cushing's syndrome, they may also rule out medical conditions with similar signs and symptoms. For example, polycystic ovary syndrome — a hormone disorder in women with enlarged ovaries — shares some of the same signs and symptoms as Cushing's has, such as excessive hair growth and irregular menstrual periods. Depression, eating disorders and alcoholism also can partially mimic Cushing's syndrome.

Treatment:
Treatments for Cushing's syndrome are designed to lower the high level of cortisol in your body. The best treatment for you depends on the cause of the syndrome. Treatment options include:

Reducing corticosteroid use- If the cause of Cushing's syndrome is long-term use of corticosteroid medications, your doctor may be able to keep your Cushing's signs and symptoms under control by reducing the dosage of the drug over a period of time, while still adequately managing your asthma, arthritis or other condition. For many of these medical problems, your doctor can prescribe noncorticosteroid drugs, which will allow him or her to reduce the dosage or eliminate the use of corticosteroids altogether.

Surgery- If the cause of Cushing's syndrome is a tumor, your doctor may recommend complete surgical removal. Pituitary tumors are typically removed by a neurosurgeon, who may perform the procedure through your nose. If a tumor is present in the adrenal glands, lung or pancreas, the surgeon can remove it through a standard operation or in some cases by using minimally invasive surgical techniques, with smaller incisions.

Radiation therapy- If the surgeon can't totally remove the pituitary tumor, he or she will usually prescribe radiation therapy to be used in conjunction with the operation. Additionally, radiation may be used for people who aren't suitable candidates for surgery. Radiation can be given in small doses over a six-week period, or by a technique called stereotactic radiosurgery or gamma-knife radiation.

Medical therapy- In some situations, when surgery and radiation don't produce a normalization of cortisol production, your doctor may advise medical therapy. Medications to control excessive production of cortisol include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone). Medical therapy is also sometimes used before surgery for people who are very sick. Doing so may improve their signs and symptoms and minimize their surgical risk.

In some cases, the tumor or its treatment will cause other hormones produced by the pituitary or adrenal gland to become deficient and your doctor will recommend hormone replacement medications.

Left untreated, Cushing's syndrome can lead to death. However, most often, treatments improve signs and symptoms and normalize cortisol levels.

Crohns Disease

2008-04-08T20:34:00.000-07:00

Crohn's disease, a type of inflammatory bowel disease (IBD), is a condition in which the lining of your digestive tract becomes inflamed, causing severe diarrhea and abdominal pain. The inflammation often spreads deep into the layers of affected tissue. Like ulcerative colitis, another common IBD, Crohn's disease can be both painful and debilitating and sometimes may lead to life-threatening complication.

While there's no known medical cure for Crohn's disease, therapies can greatly reduce the signs and symptoms of Crohn's disease and even bring about a long-term remission. With these therapies, many people afflicted with Crohn's disease are able to function normally in their everyday lives.

Causes:
The exact cause of Crohn's disease is unknown. However, genetic and environmental factors have been invoked in the pathogenesis of the disease. Research has indicated that Crohn's disease has a strong genetic link. The disease runs in families and those with a sibling with the disease are 30 times more likely to develop it than the normal population. Ethnic background is also a risk factor. Until very recently, whites and European Jews accounted for the vast majority of the cases in the United States, and in most industrialized countries, this demographic is still true.

Mutations in the CARD15 gene (also known as the NOD2 gene) are associated with Crohn's disease and with susceptibility to certain phenotypes of disease location and activity. In earlier studies, only two genes were linked to Crohn's, but scientists now believe there are over eight genes that show genetics play a crucial role in the disease.

It's possible that a virus or bacterium may cause Crohn's disease. When your immune system tries to fight off the invading microorganism, the digestive tract becomes inflamed. One microorganism that may be involved in the development of Crohn's is Mycobacterium avium subspecies paratuberculosis (MAP), a bacterium that causes intestinal disease in cattle. Researchers have found MAP in the blood and intestinal tissue of many people with Crohn's disease, but only rarely in people with ulcerative colitis.

There's no clear evidence that MAP causes Crohn's disease. Some researchers believe that a genetic susceptibility may trigger an abnormal response to the bacterium in some people. Currently, most investigators believe that some people with the disease develop it because of an abnormal immune response to bacteria that normally live in the intestine.

Symptoms:
Signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly, without warning. They include:

Diarrhea- The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. In mild cases, stools may simply be looser or more frequent than usual. But people with severe disease may have dozens of bowel movements a day, affecting both sleep and ordinary activities.
Abdominal pain and cramping- Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of intestinal tract contents through your digestive tract and may lead to pain and cramping. Mild Crohn's disease usually causes slight to moderate intestinal discomfort, but in more serious cases, the pain may be severe and occur with nausea and vomiting.
Blood in your stool- Food moving through your digestive tract can cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult blood). In severe disease, bleeding is often serious and ongoing.
Ulcers- Crohn's disease begins as small, scattered sores on the surface of the intestine. Eventually these sores may become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers in your mouth similar to canker sores.
Reduced appetite and weight loss- Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.
Fistula or abscess- Inflammation from Crohn's disease may tunnel through the wall of the bowel into adjacent organs, such as the bladder or vagina, creating an abnormal connection called a fistula. This can also lead to an abscess, a swollen, pus-filled sore. The fistula may also tunnel out through your skin. A common place for this type of fistula is in the area around the anus. When this occurs, it's called perianal fistula.

Diagnosis:
Blood tests- Your doctor may suggest blood tests to check for anemia — a condition in which there aren't enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection. Two tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but not everyone with Crohn's disease or ulcerative colitis has these antibodies.
Colonoscopy- This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis.
Flexible sigmoidoscopy- In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last 2 feet of your colon. The test usually takes just a few minutes. It's somewhat uncomfortable, and there's a slight risk of perforating the colon wall. It may also miss problems higher up in your colon or in your small intestine.
Barium enema- This diagnostic test allows your doctor to evaluate your large intestine with an X-ray. Before the test, barium, a contrast dye, is placed into your bowel in an enema form. Sometimes, air also is added. The barium fills and coats the lining of the bowel, creating a silhouette of your rectum, colon and a portion of your small intestine.
Small bowel X-ray- This test looks at the part of the small bowel that can't be seen by colonoscopy. After you drink barium, X-ray pictures are taken of your small intestine. The test can help locate areas of narrowing or inflammation in the small bowel that are seen in Crohn's disease.
Computerized tomography (CT)- Sometimes you may have a CT scan, a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel that can't be seen with other tests. Your doctor may order this scan to better understand the location and extent of your disease or to check for complications such as a partial blockages, abscesses or fistulas. Although not invasive, a CT scan exposes you to more radiation than a conventional X-ray does.

Capsule endoscopy- If you have signs and symptoms that suggest Crohn's disease but the usual diagnostic tests are negative, your doctor may perform capsule endoscopy. For this test you swallow a capsule that has a camera in it. The camera takes pictures, which are transmitted to a computer that you wear on your belt. The images are then downloaded, displayed on a monitor and checked for signs of Crohn's disease. Once it's made the trip through your digestive system, the camera exits your body painlessly in your stool.

Capsule endoscopy is generally very safe, but if you have a partial blockage in the bowel, there's a slight chance the capsule may become lodged in your intestine. Your doctor will try to minimize the chance of this by performing other diagnostic tests to look for a partial blockage before you have this procedure. If the camera does become lodged in the bowel, it may need to be surgically removed.

Treatment:
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

Sulfasalazine (Azulfidine)- Doctors have used this drug for many years to treat Crohn's disease. Although it can be effective in reducing symptoms of the disease, it has a number of side effects, including nausea, vomiting, heartburn and headache. Don't take this medication if you're allergic to sulfa medications.
Mesalamine (Asacol, Rowasa)- This medication tends to have fewer side effects than sulfasalazine has. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected.
Corticosteroids- Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.

Immune system suppressors are drugs which reduce inflammation, but they target your immune system rather than treating inflammation itself.
Azathioprine (Imuran) and mercaptopurine (Purinethol)- These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Although it can take up to three months for these medications to begin to work, they help reduce signs and symptoms of IBD in general and can heal fistulas from Crohn's disease in particular. If you're taking either of these medications, you'll need to follow up closely with your doctor and have your blood checked regularly to look for side effects.
Infliximab (Remicade)- This drug is specifically for adults and children with moderate to severe Crohn's disease who don't respond to or can't tolerate other treatments. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract and contributes to the formation of fistulas.
Methotrexate (Rheumatrex)- This drug, normally used to treat cancer, is sometimes used for people with Crohn's disease who don't respond well to other medications. It starts working in about eight to 10 weeks. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause allergic pneumonia.
Cyclosporine (Neoral, Sandimmune)- This potent drug, which is most often used to help heal Crohn's-related fistulas, is normally reserved for people who don't respond well to other medications. Cyclosporine begins working in one to two weeks — more quickly than less toxic drugs — but it has the potential for serious side effects, such as kidney and liver damage, high blood pressure, seizures, fatal infections and an increased risk of lymphoma.

Antibiotics can heal fistulas and abscesses in people with Crohn's disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and directly suppress the intestine's immune system, which can trigger symptoms. Frequently prescribed antibiotics include:
Metronidazole (Flagyl)- Once the most commonly used antibiotic for Crohn's disease, metronidazole can sometimes cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness. If these effects occur, stop the medication and call your doctor. Other side effects include nausea, a metallic taste in your mouth, headache, dizziness and loss of appetite. Avoid alcoholic beverages while taking this medication because a severe reaction may result.
Ciprofloxacin (Cipro)- This drug, which improves symptoms in some people with Crohn's disease, is now generally preferred to metronidazole. Ciprofloxacin may cause fainting, an irregular heartbeat, abdominal pain, diarrhea, fatigue and, rarely, tendon problems.

Coronary heart disease

2008-04-08T20:05:00.000-07:00

Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is the leading cause of death in the U.S. While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arise. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age.

Overview:
Atherosclerotic heart disease can be thought of as a wide spectrum of disease of the heart. At one end of the spectrum is the asymptomatic individual with atheromatous streaks within the walls of the coronary arteries (the arteries of the heart). These streaks represent the early stage of atherosclerotic heart disease and do not obstruct the flow of blood. A coronary angiogram performed during this stage of diseases may not show any evidence of coronary artery disease, because the lumen of the coronary artery has not decreased in calibre.

Atheromatous plaques that cause obstruction of less than 70 percent of the diameter of the vessel rarely cause symptoms of obstructive coronary artery disease. As the plaques grow in thickness and obstruct more than 70 percent of the diameter of the vessel, the individual develops symptoms of obstructive coronary artery disease. At this stage of the disease process, the patient can be said to have ischemic heart disease. The symptoms of ischemic heart disease are often first noted during times of increased workload of the heart. For instance, the first symptoms include exertional angina or decreased exercise tolerance.

As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary heart disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.

Causes:
Research suggests that coronary artery disease (CAD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:

* Smoking
* High amounts of certain fats and cholesterol in the blood
* High blood pressure
* High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack.

Symptoms:
There are often no typical symptoms as they are well known for coronary heart disease; Cardiac Syndrome X often is a diagnosis of exclusion. However, the following list may be helpful in diagnosing the disease:

* Chest pain or Angina, quite often at rest; the pain may spread to the left arm or the neck, back, throat, or jaw. There might be present a numbness (paresthesia) or a loss of feeling in the arms, shoulders, or wrists. Patients with female-pattern coronary artery disease often have chest pain after they exercise and a very variable duration of angina episodes.
* Coronary angiography demonstrates “normal” coronary arteries, i. e. no blockages or stenoses can be detected in the larger epicardial vessels.
* No inducible coronary artery spasm present during cardiac catheterization.
* Characteristic ischemic ECG changes during exercise testing.
* ST segment depression and angina in the absence of left ventricular wall motion abnormalities during pharmacological stress test.
* Reduction of platelet aggregation after exercise (aggregation time 10 seconds).
* Inconstant or partial response to sublingual nitrates.
* Absence of cardiac or systemic diseases potentially associated with microvascular dysfunction.
* Postmenopausal or menopausal status.
* Impaired quality of life.

The diagnosis of “Cardiac Syndrome W” - female-pattern coronary artery disease often is, as mentioned, an “exclusion” diagnosis. Therefore, usually the same tests are used as in any patient with the suspicion of coronary heart disease:

* Baseline ECG
* Exercise ECG – Stress test
* Exercise radioisotope test (nuclear stress test, myocardial scintigraphy).
* Echocardiography (including stress echocardiography).
* Coronary angiography.
* Intravascular ultrasound.
* MRI scan.

Diagnosis:
EKG (Electrocardiogram)- An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart. Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack.

Echocardiography- This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X Ray- A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.

Blood Tests- Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CAD.
Coronary Angiography and Cardiac Catheterization- Your doctor may ask you to have coronary angiography if other tests or factors show that you're likely to have CAD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries.
Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter.

Treatment:
Making lifestyle changes can often help prevent or treat CAD. For some people, these changes may be the only treatment needed:

* Follow a heart healthy eating plan to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy weight
* Increase your physical activity. Check with your doctor first to find out how much and what kinds of activity are safe for you.
* Lose weight, if you're overweight or obese.
* Quit smoking, if you smoke. Avoid exposure to secondhand smoke.
* Learn to cope with and reduce stress.

You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the different kinds of fat in prepared foods can be found on the Nutrition Facts label.

Foods high in soluble fiber also are part of a healthy eating plan. They help block the digestive track from absorbing cholesterol. These foods include:

* Whole grain cereals such as oatmeal and oat bran.
* Fruits such as apples, bananas, oranges, pears, and prunes.
* Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans.

A diet high in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

Fish are an important part of a heart healthy diet. They're a good source of omega-3 fatty acids, which may help protect the heart from blood clots and inflammation and reduce the risk for heart attack. Try to have about two fish meals every week. Fish high in omega-3 fats are salmon, tuna (canned or fresh), and mackerel.

You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-sodium and low-salt foods and "no added salt" foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.

Try to limit alcoholic drinks. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain. Men should have no more than two alcoholic drinks a day. Women should have no more than one alcoholic drink a day.

Regular physical activity can lower many CAD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your levels of HDL cholesterol (the "good" cholesterol that helps prevent CAD).

Therapeutic options for coronary heart disease today are based on three principles:

1. Medical treatment- drugs, e.g. nitroglycerin, beta-blockers, calcium antagonists, etc.
2. Coronary interventions as angioplasty and stent-implantation.
3. Coronary artery bypass grafting (CABG - coronary artery bypass surgery). Recent research efforts focus on new angiogenic treatment modalities (angiogenesis) and various (adult) stem cell therapies.

Convulsions

2008-04-08T19:53:00.000-07:00

Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly.

The term "convulsion" is often used interchangeably with "seizure," although there are many types of seizure, some of which have subtle or mild symptoms instead of convulsions. Seizures of all types are caused by disorganized and sudden electrical activity in the brain.

Causes:
Epilepsy, Alcohol use, Barbiturates, intoxication or withdrawal, Brain illness or injury, Brain tumor (rare), Choking, Drug abuse, Electric shock, Fever (particularly in young children),
Head injury, Heart disease, Heat illness, Malignant hypertension (very high blood pressure),
Meningitis, Poisoning, Stroke, Toxemia of pregnancy, Uremia related to kidney failure,
Venomous bites and stings, Withdrawal from benzodiazepines (such as Valium), Low blood sugar, etc.

Considerations:

Convulsions can be unsettling to watch. Despite their appearance, most seizures are relatively harmless. They usually last from 30 seconds to 2 minutes. However, if a seizure is prolonged, or if multiple seizures happen and the person doesn't awaken in between, this is a medical emergency.

If a person has recurring seizures, and there are no underlying causes that can be identified, that person is said to have epilepsy. Epilepsy can usually be controlled well with medication.

Pay attention to which arms or legs are shaking, whether there is any change in consciousness, whether there is loss of urine or stool, and whether the eyes deviate in any direction.

Symptoms:
Brief blackout followed by period of confusion, Sudden falling, Drooling or frothing at the mouth,
Grunting and snorting, Breathing stops temporarily, Uncontrollable muscle spasms with twitching and jerking limbs, Loss of bladder or bowel control, Eye movements, Teeth clenching, Unusual behavior like sudden anger, sudden laughter, or picking at one's clothing, The person may have warning symptoms prior to the attack, which may consist of fear or anxiety, nausea, visual symptoms, or vertigo.

First Aid:
1. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.
2. Cushion the person's head.
3. Loosen tight clothing, especially around the person's neck.
4. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
5. Look for a medical I.D. bracelet with seizure instructions.
6. Stay with the person until recovery or until you have professional medical help. Meanwhile, monitor the person's vital signs (pulse, rate of breathing).

In an infant or child, if the seizure occurs with a high fever, cool the child gradually with tepid water. You can give the child acetaminophen (Tylenol), especially if the child has had fever convulsions before. DO NOT immerse the child in a cold bath.

Do Not:
* DO NOT restrain the person.
* DO NOT place anything between the person's teeth during a seizure (including your fingers).
* DO NOT move the person unless he or she is in danger or near something hazardous.
* DO NOT try to make the person stop convulsing. He or she has no control over the seizure and is not aware of what is happening at the time.
* DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.

Constipation

2008-04-08T03:13:00.000-07:00

Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. It may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. The term obstipation is used for severe constipation that prevents passage of both stools and gas. Causes of constipation may be dietary, hormonal, anatomical, a side effect of medications (e.g. some painkillers), or an illness or disorder. Treatments consist of changes in dietary and exercise habits, the use of laxatives, and other medical interventions depending on the underlying cause.

Causes:
The main causes of constipation include:

* Hardening of the feces
Improper mastication (chewing) of food.
Insufficient intake of dietary fiber.
Dehydration from any cause or inadequate fluid intake.
Medication, e.g. diuretics and those containing iron, calcium, aluminum.
Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along.
Hypothyroidism (slow-acting thyroid gland).
Hypokalemia.
Injured anal sphincter (patulous anus).
Medications, such as loperamide, opioids (e.g. codeine & morphine) and certain tricyclic antidepressants.
* Severe illness due to other causes
Acute porphyria (a rare inherited condition).
Lead poisoning.
* Dyschezia (usually the result of suppressing defecation).
* Constriction, where part of the intestine or rectum is narrowed or blocked, not allowing feces to pass
Stenosis (Strictures).
Diverticula.
Tumors, either of the bowel or surrounding tissues.
Retained foreign body or a bezoar.
* Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings.
Functional constipation.
Constipation-predominant irritable bowel syndrome, characterized by a combination of constipation and abdominal discomfort and/or pain.
* Smoking cessation (nicotine has a laxative effect).
* Abdominal surgery, other types of surgery, childbirth.

Symptoms:
Following are the major constipation symptoms:

1. Difficulty in elimination of the hard faecal matter.
2. Cramping in a lower abdomen.
3. Mouth ulcer.
4. Bad breath.
5. Nausea.
6. Headache.
7. Coated tongue.
8. Dullness on skin.

Diagnosis:
The diagnosis is essentially made from the patient's description of the symptoms। Bowel movements that are difficult to pass, very firm, or made up of small rabbit-like pellets qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distention, abdominal pain, or a sense of incomplete emptying.

During physical examination, scybala (manually palpable lumps of stool) may be detected on palpation of the abdomen. Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not; if so, then suppositories or enemas may be considered. Otherwise, oral medication may be required. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present.

X-rays of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms।

Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation।

Treatment:
In people without medical problems, the main intervention is to increase the intake of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.

Lactulose, a non absorbable synthetic sugar that keeps sodium and water inside the intestinal lumen, relieves constipation. It can be used for months together. Among the other safe remedies, fiber supplements, lactitiol, sorbitol, milk of magnesia, lubricants etc. may be of value. Electrolyte imbalance e.g. hyponatremia may occur in some cases especially in diabetics.

In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation. The mechanism of the herbal, enema, and colonic irrigation treatments often include the breakdown of impacted and hardened fecal matter.

Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of melanosis coli.

Conjunctivitis

2008-04-03T03:13:00.000-07:00

Conjunctivitis, commonly called "Pink Eye" and "Red Eye" in the UK, and "Madras Eye" in India is an inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids), most commonly due to an allergic reaction or an infection (usually bacterial, or viral).

Pink eye may make you feel as if you've got something in one or both of your eyes that you just can't remove. When you wake up in the morning, your eyes may seem to be pasted shut from the discharge coming from your eyes. The whites of your eyes may begin to have a pink discoloration, and you may not see as clearly as you did before.
Inflammation causes small blood vessels in the conjunctiva to become more prominent, resulting in a pink or red cast to the whites of your eyes. Pink eye and red eye are terms commonly used to refer to all types of conjunctivitis. Though the inflammation of pink eye makes it an irritating condition, it rarely affects your sight. If you suspect pink eye, you can take steps to ease your discomfort. But because pink eye can be contagious, it should be diagnosed and treated early. This is especially important for preschool-age children, who commonly develop both viral and bacterial conjunctivitis.

Types:

Blepharoconjunctivitis is a combination of conjunctivitis with blepharitis (inflammation of the eyelids).
Keratoconjunctivitis is a combination of conjunctivitis and keratitis (corneal inflammation).
Episcleritis is an inflammatory condition that produces a similar appearance to conjunctivitis, but without discharge or tearing.

Causes:
Causes of pink eye include:

* Viruses.
* Bacteria.
* Allergies.
* A chemical splash in the eye.
* A foreign object in the eye.

Most cases of pink eye are caused by viruses. In newborns, pink eye may result from an incompletely opened tear duct.

Viral and bacterial conjunctivitis may affect one or both eyes. Viral conjunctivitis usually produces a watery or mucous discharge.
Bacterial conjunctivitis often produces a thicker, yellow-green discharge and may be associated with a respiratory infection or with a sore throat. Both viral and bacterial conjunctivitis are associated with colds. Both viral and bacterial types are very contagious. Adults and children alike can develop both of these types of pink eye. However, bacterial conjunctivitis is more common in children than it is in adults.

Allergic conjunctivitis affects both eyes and is a response to an allergy-causing substance such as pollen. In response to allergens, your body produces an antibody called immunoglobulin E (IgE). This antibody triggers special cells called mast cells in the mucous lining of your eyes and airways to release inflammatory substances, including histamines. Your body's release of histamine can produce a number of allergy symptoms, including red or pink eyes. If you have allergic conjunctivitis, you may experience intense itching, tearing and inflammation of the eyes — as well as itching, sneezing and watery nasal discharge. You may also experience swelling of the membrane (conjunctiva) that lines your eyelids and part of your eyeballs, resulting in what may look like clear blisters on the whites of your eyes.

Irritation from a chemical splash or foreign object in your eye is also associated with conjunctivitis. Discharge tends to be mucus, not pus. Sometimes, flushing and cleaning the eye to rid it of the chemical or object causes redness and irritation. Signs and symptoms usually clear up on their own within about a day.

Symptoms:
The most common signs and symptoms of pink eye include:

* Redness in one or both eyes
* Itchiness in one or both eyes
* Blurred vision and sensitivity to light
* A gritty feeling in one or both eyes
* A discharge in one or both eyes that forms a crust during the night
* Tearing

Acute allergic conjunctivitis is typically itchy. Sometimes distressingly so, and the patient often complains of some lid swelling. Chronic allergy often causes just itch or irritation, and often much frustration because the absence of redness or discharge can lead to accusations of hypochondria.
Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Its symptoms include watery discharge and variable itch. The infection usually begins with one eye, but may spread easily to the fellow eye.
Bacterial conjunctivitis due to the common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, grey or yellowish mucopurulent discharge that may cause the lids to stick together (matting), especially after sleeping.
Irritant or toxic conjunctivitis is irritable or painful when the infected eye is pointed far down or far up. Discharge and itch are usually absent. This is the only group in which severe pain may occur.

Diagnosis:
Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicroscopy, laboratory tests are often necessary if proof of aetiology is needed.
A purulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with Neisseria gonorrhoeae should be suspected if the discharge is particularly thick and copious.
A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy.
Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation.
Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of dry eye.
Other symptoms including pain, blurring of vision and photophobia should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula.

Treatment:
Conjunctivitis sometimes requires medical attention. The appropriate treatment depends on the cause of the problem. For the allergic type, cool water constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.
Your doctor may prescribe antibiotic eyedrops if the infection is bacterial, and the infection should clear within several days of starting treatment. Antibiotic eye ointment, in place of eyedrops, is sometimes prescribed for treating bacterial pink eye in children. An ointment is often easier to administer to an infant or young child than are eyedrops.

Congestive heart failure

2008-03-29T00:14:00.000-07:00

Congestive heart failure (CHF), congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood through the body. It is not to be confused with "cessation of heartbeat", which is known as asystole, or with cardiac arrest, which is the "cessation of normal cardiac function" with subsequent hemodynamic collapse leading to death.

Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.

The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

Causes:
Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can be present without knowing it:

Coronary artery disease and heart attack- Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart's pumping ability.

High blood pressure (hypertension)- Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
Faulty heart valves- The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.
Damage to the heart muscle (cardiomyopathy)- Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can't be found, it's referred to as idiopathic dilated cardiomyopathy.
Myocarditis- Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
Heart defects present at birth (congenital heart defects)- If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
Abnormal heart rhythms (heart arrhythmias)- Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
Other diseases- Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

Symptoms:

Heart failure typically develops slowly and is a chronic, long-term condition, although you may experience a sudden onset of symptoms, known as acute heart failure. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.

Some of the signs and symptoms for chronic and acute heart failure are:

Chronic heart failure- Fatigue and weakness, Rapid or irregular heartbeat, Shortness of breath (dyspnea) when you exert yourself or when you lie down, Reduced ability to exercise, Persistent cough or wheezing with white or pink blood-tinged phlegm, Swelling (edema) in your legs, ankles and feet, Swelling of your abdomen (ascites), Sudden weight gain from fluid retention, Lack of appetite and nausea, Difficulty concentrating or decreased alertness, etc.

Acute heart failure- Signs and symptoms similar to those of chronic heart failure but more severe, and start or worsen suddenly, Sudden fluid buildup, Rapid or irregular heartbeat with palpitations that may cause the heart to stop beating, Sudden, severe shortness of breath and coughing up pink, foamy mucus, Chest pain if caused by a heart attack, etc.

Diagnosis:
To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination.

Blood tests- Your doctor may take a sample of your blood to check your kidney and thyroid function and to look for indicators of other diseases that affect the heart. In addition, your doctor may check your blood for specific chemical markers of heart failure, such as a hormone called brain natriuretic peptide (BNP). Although first identified in the brain, BNP is secreted by the heart at high levels when it's injured or overworked.
Chest X-ray- X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
Electrocardiogram (ECG)- This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
Echocardiogram- An important test for diagnosing and monitoring heart failure is the echocardiogram. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can't fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping by measuring the percentage of blood pumped out of your heart's main pumping chamber (the left ventricle) with each heartbeat. This measurement is called the ejection fraction.
Ejection fraction- Your ejection fraction is measured during an echocardiogram. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 60 percent — meaning 60 percent of the blood that fills the ventricle is pumped out with each beat.
Other imaging tests- They may be used to measure ejection fraction, including cardiac catheterization, multiple gated acquisition (MUGA) scanning of the heart, magnetic resonance imaging (MRI) and computerized tomography (CT).

Treatment:
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one, two or more of these drugs. Several types of drugs have proved useful in the treatment of heart failure. They include:

Angiotensin-converting enzyme (ACE) inhibitors- These drugs help people with heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens or dilates blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).
Angiotensin II (A-II) receptor blockers (ARBs)- These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.
Digoxin (Lanoxin)- This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with the condition.
Beta blockers- This class of drug slows your heart rate and reduces blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines also reduce the risk of some abnormal heart rhythms.
Diuretics- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix).
Aldosterone antagonists- These drugs include spironolactone (Aldactone) and eplerenone (Inspra). They're primarily potassium-sparing diuretics, but they have additional properties that help the heart work better, may reverse scarring of the heart and may help people with severe heart failure live longer.

***A medication called BiDil is a single pill that combines hydralazine and isosorbide dinitrate — both of which dilate and relax the blood vessels. BiDil increases survival when added to standard therapy in black people with advanced heart failure.***

Surgery and medical devices:
Researchers continue to search for new and better ways to treat heart failure. Some treatments being studied and used in certain people include:

Implantable cardioverter-defibrillators (ICDs)- An ICD is a device implanted under the skin and attached to the heart with small wires. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, the ICD shocks it back into normal rhythm. Sometimes a biventricular pacemaker is combined with an ICD for people with severe heart failure.
Cardiac resynchronization therapy (CRT) or biventricular pacing- A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles), so that they pump in synchrony and in a more efficient, coordinated manner. As many as half the people with heart failure have abnormalities in their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart's limited energy and may cause heart failure to worsen. Sometimes a biventricular pacemaker is combined with an ICD for people at greatest risk of rhythm problems.
Heart pumps- These mechanical devices, called left ventricular assist devices (LVADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. LVADs are now being considered as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with end-stage heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.

Coeliac disease

2008-03-29T00:02:00.000-07:00

Coeliac disease, also spelled Celiac disease, is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. It is a digestive condition triggered by consumption of the protein gluten, which is found in bread, pasta, cookies, pizza crust and many other foods containing wheat, barley or rye. Oats may contain gluten as well. When a person with celiac disease eats foods containing gluten, an immune reaction occurs in the small intestine, resulting in damage to the surface of the small intestine and an inability to absorb certain nutrients from food.

Eventually, decreased absorption of nutrients (malabsorption) can cause vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment, which can lead to other illnesses. The decreased nutrient absorption that occurs in celiac disease is especially serious in children, who need proper nutrition to develop and grow.

No treatment can cure celiac disease. However, you can effectively manage celiac disease through changing your diet.

Causes:
Normally, your small intestine is lined with tiny, hair-like projections called villi. Resembling the deep pile of a plush carpet on a microscopic scale, villi work to absorb vitamins, minerals and other nutrients from the food you eat. Celiac disease results in damage to the villi. Without villi, the inner surface of the small intestine becomes less like a plush carpet and more like a tile floor, and your body is unable to absorb nutrients necessary for health and growth. Instead, nutrients such as fat, protein, vitamins and minerals are eliminated with your stool.

The exact cause of celiac disease is unknown, but it's often inherited. If someone in your immediate family has it, chances are 5 percent to 15 percent that you may as well. It can occur at any age, although problems don't appear until gluten is introduced into the diet.

Many times, for unclear reasons, the disease emerges after some form of trauma: an infection, a physical injury, the stress of pregnancy, severe stress or surgery.

Symptoms:
There are no typical signs and symptoms of celiac disease. Most people with the disease have general complaints, such as intermittent diarrhea, abdominal pain and bloating. Sometimes people with celiac disease may have no gastrointestinal symptoms at all. Celiac disease symptoms can also mimic those of other conditions, such as irritable bowel syndrome, gastric ulcers, Crohn's disease, parasite infections, anemia, skin disorders or a nervous condition.

Celiac disease may also present itself in less obvious ways, including irritability or depression, anemia, stomach upset, joint pain, muscle cramps, skin rash, mouth sores, dental and bone disorders (such as osteoporosis), and tingling in the legs and feet (neuropathy).

Some indications of malabsorption that may result from celiac disease include: Weight loss, Diarrhea, Abdominal cramps, gas and bloating, General weakness, Foul-smelling or grayish stools that may be fatty or oily, Stunted growth (in children), Osteoporosis, etc.

Diagnosis:
People with celiac disease carry higher than normal levels of certain antibodies (anti-gliadin, anti-endomysium and anti-tissue transglutaminase). Antibodies are specialized proteins that are part of your immune system and work to eliminate foreign substances in your body. In people with celiac disease, their immune systems may be recognizing gluten as a foreign substance and producing elevated levels of antibodies to get rid of it.

A blood test can detect high levels of these antibodies and is used to initially detect people who are most likely to have the disease and who may need further testing. To confirm the diagnosis, your doctor may need to microscopically examine a small portion of intestinal tissue to check for damage to the villi. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue.

A trial of a gluten-free diet also can confirm a diagnosis, but it's important that you not start such a diet before seeking a medical evaluation. Doing so may change the results of blood tests and biopsies so that they appear to be normal.

Treatment:
Celiac disease has no cure, but you can effectively manage the disease through changing your diet.

Once gluten is removed from your diet, inflammation in your small intestine will begin to subside, usually within several weeks. If your nutritional deficiencies are severe, you may need to take vitamin and mineral supplements recommended by your doctor or dietitian to help correct these deficiencies. Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people.

Improvements after starting a gluten-free diet may be especially dramatic in children. Not only do their physical symptoms improve, but also their behavior improves. In addition, their growth starts to pick up.

Your doctor may recommend that you meet with a dietitian who can instruct you on a gluten-free diet. There are still many basic foods allowed in a gluten-free diet. These include:

* Fresh meats, fish and poultry (not breaded or marinated).
* Most dairy products.
* Fruits.
* Vegetables.
* Rice.
* Potatoes.
* Gluten-free flours (rice, soy, corn, potato).

Most foods made from grains contain gluten. Avoid these foods unless they're labeled as gluten-free or made with corn, rice, soy or other gluten-free grain.

Chronic fatigue syndrome

2008-03-28T23:45:00.000-07:00

Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, variably debilitating disorder of uncertain cause/causes. It is a complicated disorder characterized by extreme fatigue that doesn't improve with bed rest and may worsen with physical or mental activity. Chronic fatigue syndrome may occur after an infection, such as a cold or viral illness. The onset can be during or shortly after a time of great stress, or chronic fatigue syndrome come on gradually without a clear starting point or obvious cause. Women are diagnosed with chronic fatigue syndrome far more often than men are. However, it's unclear whether chronic fatigue syndrome affects women more frequently or if women report it more often than men do. Treatment for chronic fatigue syndrome focuses on a combination of approaches to relieve signs and symptoms.

Causes:
Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike definite infections, it has no clear cause. Several possible causes have been proposed, including:

* Depression.
* Iron deficiency anemia.
* Low blood sugar (hypoglycemia).
* History of allergies.
* Virus infection, such as Epstein-Barr virus or human herpesvirus 6.
* Dysfunction in the immune system.
* Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands.
* Mild, chronic low blood pressure (hypotension).

The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood as in other autoimmune diseases, such as rheumatoid arthritis and lupus. Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system.

Symptoms:
Chronic fatigue syndrome is a flu-like condition that can drain your energy and, sometimes, last for years. People previously healthy and full of energy may experience a variety of signs and symptoms.
Primary- Loss of memory or concentration, Sore throat, Painful and mildly enlarged lymph nodes in your neck or armpits, Unexplained muscle soreness, Pain that moves from one joint to another without swelling or redness, Headache of a new type, pattern or severity, Sleep disturbance, Extreme exhaustion lasting more than 24 hours after physical or mental exercise, etc.
Additional signs and symptoms-Abdominal pain, Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise, Bloating, Chest pain, Chronic cough, Diarrhea, Dizziness, balance problems or fainting, Dry mouth, Earache, Irregular heartbeat, Jaw pain, Morning stiffness, Nausea, Chills and night sweats, Psychological problems, such as depression, irritability, anxiety disorders and panic attacks, Shortness of breath, Tingling sensations, Visual disturbances, such as blurring, sensitivity to light, eye pain and dry eyes, Weight loss or gain, etc.

Diagnosis:
A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms.

In general, doctors find it difficult to diagnose chronic fatigue syndrome because it has some of the same signs and symptoms as many other diseases. There's no diagnostic or laboratory procedure to confirm the presence of chronic fatigue syndrome.

Doctors exclude certain conditions before considering a diagnosis of chronic fatigue syndrome. These include:

* Having an active, identifiable medical condition that often results in fatigue, such as low levels of thyroid hormones (hypothyroidism) or sleep apnea.
* Using medicines that may cause fatigue.
* Having a relapse of a previously treated illness that can result in fatigue, such as cancer.
* Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness, such as schizophrenia or an eating disorder.
* Abusing alcohol or another substance.
* Being severely obese, as defined by a body mass index (BMI) of 45 or greater.

Over time, be alert to any new cues that might indicate that the problem is caused by something other than chronic fatigue syndrome. When other diseases or conditions are excluded, your doctor may then determine if your illness meets the CFS-specific criteria.

Treatment:
There's no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a combination of treatments, which may include:

Moderating daily activity- Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal should be to maintain a moderate level of daily activity and gently increase your stamina over time.
Cognitive behavior therapy- This treatment, often used in combination with graduated exercise, also has been found to improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health professional to identify negative beliefs and behaviors that might be delaying your recovery and replace them with healthy, positive ones.
Treatment of depression- If you're depressed, medications, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), may help. Antidepressants may also help improve sleep and relieve pain. Tricyclic antidepressants include amitriptyline (Limbitrol, a multi-ingredient drug that contains amitriptyline), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin).
Treatment of existing pain- Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), may be helpful to reduce pain and fever.
Treatment of allergy-like symptoms- Antihistamines, such as fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.
Treatment of low blood pressure (hypotension)- The drugs fludrocortisone (Florinef), atenolol (Tenormin) and midodrine (ProAmatine, Orvaten) may be useful for certain people with chronic fatigue syndrome.
Treatment for problems of the nervous system- Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.

Chromoblastomycosis

2008-03-28T05:48:00.000-07:00

Chromoblastomycosis is a long-term fungal infection of the skin and subcutaneous tissue (a chronic subcutaneous mycosis). The infection occurs most commonly in tropical or subtropical climates, often in rural areas. It can be caused by many different type of fungi which become implanted under the skin, often by thorns or splinters. Chromoblastomycosis spreads very slowly; it is rarely fatal and usually has a good prognosis, but it can be very difficult to cure. There are several treatment options, including medication and surgery.

Forms of the disease:

* cicatricial
* nodular
* plaque
* tumorous
* verrucous

Histopathology:
The skin lesions show a hyperkeratous pseudoepitheliomatous hyperplasia and keratolytic microabscesses in the epidermis. Dematiaceous hyphae and sclerotic bodies are found in the stratum corneum, with essentially only sclerotic bodies found in the areas of dermal inflammation. The sclerotic bodies are round, thick-walled, muriform, chestnut brown, and 5-12 µm in diameter. Brain abscesses are typically multilocular and well demarcated with thick walls. Irregular dematiaceous hyphae are seen in these abscesses.

Diagnosis:
The most informative test is to scrape the lesion and add potassium hydroxide (KOH), then examine under a microscope. (KOH scrapings are commonly used to examine fungal infections.) The pathognomonic finding is observing Medlar bodies, sclerotic cells. Scrapings from the lesion can also be cultured to identify the organism involved. Blood tests and imaging studies are not commonly used.

Treatment:
Chromoblastomycosis is very difficult to cure. There are two primary treatments of choice. Itraconazole, an antifungal azole, is given orally, with or without flucytosine (5-FC). Alternatively, cryosurgery with liquid nitrogen has also been shown to be effective. Other treatment options are the antifungal drug terbinafine, an experimental drug posaconazole (noxafil), and heat therapy. Antibiotics may be used to treat bacterial superinfections.

Chicken Pox

2008-03-27T22:15:00.000-07:00

Chickenpox is one of the five classical childhood exanthems or rashes, once a cause of significant morbidity and mortality, but now chiefly of historical importance—it was formerly one of the childhood infectious diseases caught by and survived by almost every child.

Chicken pox is a highly contagious viral infection caused by the varicella virus. The word chickenpox comes from the Old English word "gican" meaning "to itch" or from the Old French word "chiche-pois" for chickpea, a description of the size of the lesion.

Chickenpox has a 10-21 day incubation period and is highly contagious through physical contact two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox.

Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and those with a suppressed immune system being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the fetus.

Causes:

Chickenpox is a disease of childhood - 90% of cases occur in children aged 14 years and younger. Before widespread vaccination, the incidence of chicken pox in the United States approached the annual birth rate, averaging between 3.1 and 3.8 million cases per year. Chicken pox can occur at any time, but occurs most often in March, April, and May in temperate climates.
Chicken pox is acquired by direct contact with infected blister fluid or by inhalation of respiratory droplets. When a person with chicken pox coughs or sneezes, they expel tiny droplets that carry the varicella virus. A person who has never been exposed to chicken pox inhales these droplets and the virus enters the lungs, and then is carried through the bloodstream to the skin where it causes a rash. While the virus is in the bloodstream (before the rash begins) it causes typical viral symptoms like fever, fatigue, joint pains, headache, and swollen glands. These symptoms usually resolve by the time the rash develops.

Symptoms:
Symptoms of chicken pox include that:

* children sometimes have a prodrome of fever, malaise, headache, lack of appetite, and mild abdominal pain for 1 to 2 days.
* the rash typically appears first on a child's trunk, scalp, and face and consists of small, very itchy, flat red spots, which then turn into raised fluid filled vesicles, often described as looking like a 'dewdrop' that become umbilicated and cloudy and eventually crust over.
* the fever only lasts about 2 to 4 days.
* new 'crops' of the rash on the child's trunk and then arms and legs continue for about 4 days
* all of the lesions are crusted over about 6 to 7 days after the illness begins.
* the crusts then fall off in another 7 days, although it sometimes takes up to 20 days, usually without scarring.

Facts:
* The average child with chicken pox gets about 300 lesions.
* It is very typical or characteristic for children with chicken pox to have lesions in different stages at the same time, including the first flat red spots, the fluid filled vesicles, and the crusted vesicles.
* The fever with chicken pox usually ranges from 100 to 102 degrees Fahrenheit, but may be as high as 106 degrees in some cases.
* Children with chicken pox are contagious for 1 or 2 days before they develop a rash and until all of their vesicles have crusted.
* Chicken pox crusts that are scratched off or infected may lead to scars.
* Children who have chicken pox after having the chicken pox vaccine often have an atypical case, with much milder symptoms and fewer lesions.

Diagnosis:
Chicken pox is typically diagnosed clinically based on the history of viral symptoms and the characteristic appearance of the rash. However, sometimes chicken pox can be confused with herpes simplex, impetigo, insect bites, or scabies. Sometimes a viral culture can be performed to confirm the diagnosis, but it takes from 1 to 14 days to get the results.

Treatment:
Because chicken pox is usually a benign self-limited disease, treatment is typically aimed at treating symptoms and making the patient more comfortable. In some cases, the antiviral medication acyclovir may be used to treat chicken pox.

Patients with chicken pox typically have viral-type, prodromal symptoms such as headache, fever, fatigue, and muscle aches. These symptoms can be treated with acetaminophen (Tylenol) with doses determined by the weight of the patient.

Frequent baths are sometimes helpful to relieve itching. Adding finely-ground (colloidal) oatmeal such as Aveeno can help improve itching. Oatmeal baths can be prepared at home also by grinding or blending dry oatmeal into a fine powder and adding about 2 cups to the bath water. One-half to one cup of baking soda may also be added to bath water to reduce itching.

Over-the-counter and prescription antihistamines may be used to control severe itching. Diphenhydramine (Benadryl) is available over-the-counter and hydroxyzine (Atarax) is available by prescription. Both of these antihistamines cause drowsiness and may be helpful at night to help the patient sleep. The newer antihistamines such as loratadine (Claritin), certrizine (Zyrtec), and fexofenadine (Allegra) can be used to control itching but do not cause drowsiness.

Cataract

2008-03-27T21:43:00.000-07:00

A Cataract is a condition that develops in the lens of the eye. Cataracts are made from a protein that has altered from its natural state (denaturation), distorting and eventually prohibiting required light from entering into the retina, the part of the eye that receives light. Often cataracts cause no problems for many years but as the cataracts matures the cloudiness increases on the lens, the light reaching the retina decreases and significant sight loss and perhaps blindness can result.

Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated. Moreover, with time the cataract cortex liquefies to form a milky white fluid in a Morgagnian Cataract, and can cause severe inflammation if the lens capsule ruptures and leaks. Untreated, the cataract can cause phacomorphic glaucoma.

Classification:

The following is a classification of the various types of cataracts. This is not comprehensive and other unusual types may be noted.

Classified by etiology:
* Age-related cataracts
1) Immature Senile Cataract (IMSC) - partially opaque lens, disc view hazy
2) Mature Senile Cataract (MSC) - Completely opaque lens, no disc view
3) Hypermature Senile Cataract (HMSC)-Liquefied cortical matter: Morgagnian Cataract

* Congenital cataracts
1) Sutural cataract
2) Lamellar cataract
3) Zonular cataract
4) Total cataract

* Secondary cataracts
1) Drug-induced cataract (e.g. Corticosteroids)

* Traumatic cataracts
1) Blunt trauma (capsule usually intact)
2) Penetrating trauma (capsular rupture & leakage of lens material occurs)

Classified by location of opacity within lens structure:
* Anterior cortical cataracts
* Anterior polar cataracts
* Anterior subcapsular cataracts
* Nuclear cataracts
1) Grey
2) Yellow
3) Amber
4) Brown/Black

* Posterior cortical cataracts
* Posterior polar cataracts
* Posterior subcapsular cataracts (PSC)

Causes:
Cataracts develop from a variety of reasons, including long-term ultraviolet exposure, exposure to radiation, secondary effects of diseases such as diabetes, hypertension and advanced age; they are usually a result of denaturation of lens proteins. Genetic factors are often a cause of congenital cataracts and positive family history may also play a role in predisposing someone to cataracts at an earlier age, a phenomenon of "anticipation" in pre-senile cataracts. Cataracts may also be produced by eye injury or physical trauma. A study among Icelandair pilots showed commercial airline pilots as three times more likely to develop cataracts than people with non-flying jobs. This is thought to be caused by excessive exposure to radiation coming from outer space. Cataracts are also unusually common in persons exposed to infrared radiation, such as glassblowers who suffer from "exfoliation syndrome". Exposure to microwave radiation can cause cataracts.

Cataracts may be partial or complete, stationary or progressive, hard or soft.

Some drugs can induce cataract development, such as Corticosteroids and anti-hyperlipidemics like Ezetimibe.

Symptoms:

The most common symptom of cataracts is the noticeable blurring and worsening of vision. Other symptoms include the dimming and fading of colors, decreased night vision, problems with bright lights and sunshine, and in many cases, regular visits to the ophthalmologist for changes in glasses and contact lens prescriptions as vision worsens. Some patients report double vision in the affected eye although this symptom seems to decrease or disappear entirely as the cataracts grows.

If an individual's eyesight grows progressively worse, it is best to schedule a visit to an eye specialist as soon as possible. They will be able to assist with a diagnosis of the problem and available treatments if required.

Diagnosis:

In many cases, the diagnosis of a cataract is fairly simple. However, in the prenatal population, although diagnosis is possible it is a bit more difficult. Ultrasounds have proven an effective method to detect cataracts in unborn children. It is imperative that they be detected early if present as cataracts in babies can result in blindness for life if not treated properly and quickly soon after birth.
The most common way for an age-related cataracts to be diagnosed is during a routine eye exam.
During an eye exam, performed by an ophthalmologist or optometrist, there are several tests which may be administered to check for the presence of a cataracts.

* A visual acuity test will measure how well the individual can see while standing at various lengths from the cue card.
* A slip lamp exam uses a specialized microscope to increase the magnification of the eye. The specialist can then examine the eye in detail and up close.
* A tonometry test is a standard test which measures the fluid pressure inside the eye. The major finding in this test, if an increased pressure is detected, is the possibility of glaucoma.
* A dilated eye exam dilates the pupil. In this manner, the specialist is better able to view the lens to check for the present of a cataracts.

Treatment:
Natural-
* Limit consumption of lactose-containing foods (milk products). In animal studies, galactose, a component of lactose, has been shown to promote cataracts formation.
* A riboflavin deficiency has been implicated in cataracts development. Therefore, a supplemental dosage of riboflavin, 10-50 mg/day, may help treat or at least slow the progression of cataracts formation.
* Quercetin is recommended in a dosage of 500-1000 mg/day. WARNING: Quercetin may increase the possibility of birth defects in pregnant women and is not recommended during pregnancy.
* A supplemental dosage of 15-50 mg/day of zinc along with 2-3 mg/day of copper may help with cataracts.
* Taking Vitamin C, 1000 mg, two times a day may help to decrease damage caused by free radicals, in turn helping to treat cataracts.
* Supplementing the diet with Vitamin E at 400-800 IU/day plus selenium at 200-300 mcg/day has effectively cured cataracts in dogs.
* 200-600 mg/day of N-Acetylcysteine (NAC) along with zinc and copper may treat cataracts by working to destroy free radicals.

Surgery-
The most effective and common treatment is to surgically remove the cloudy lens. There are two types of surgery that can be used to remove cataracts: extra-capsular (extracapsular cataract extraction, or ECCE) and intra-capsular (intracapsular cataract extraction, or ICCE).

Extra-capsular (ECCE) surgery consists of removing the lens but leaving the majority of the lens capsule intact. High frequency sound waves (phacoemulsification) are sometimes used to break up the lens before extraction.

Intra-capsular (ICCE) surgery involves removing the entire lens of the eye, including the lens capsule, but it is rarely performed in modern practice. In either extra-capsular surgery or intra-capsular surgery, the cataractous lens is removed and replaced with a plastic lens (an intraocular lens implant) which stays in the eye permanently.

Carpal Tunnel Syndrome

2008-03-27T05:47:00.000-07:00

Carpal tunnel syndrome (CTS) or Median Neuropathy at the Wrist is a medical condition in which the median nerve is compressed at the wrist, leading to pain, paresthesias, and muscle weakness in the forearm and hand. A form of compressive neuropathy, CTS is more common in women than it is in men and, though it can occur at any age, has a peak incidence around age 42. The lifetime risk for CTS is around 10% of the adult population.

Most cases of CTS are idiopathic (without known cause). Repetitive activities are often blamed for the development of CTS along with several other possible causes. However, the correlation is often unclear.

It is a multi‐faceted problem and can therefore be challenging to treat. Still, there are a multitude of possible treatments: treating any possible underlying disease or condition, immobilizing braces, physiotherapy, massage therapy, medication, prioritizing hand activities, ergonomics, et cetera. Ultimately, carpal tunnel release surgery may be required in which outcomes are generally good.

The condition was first noted in medical literature in the early 1900s.

Causes:

The cause of carpal tunnel syndrome is pressure on the median nerve. The median nerve is a mixed nerve, meaning it has a sensory function and also provides nerve signals to move your muscles (motor function). The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger.

Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Causes might include anything from bone spurs to the most common cause, which is swelling or thickening of the lining and lubricating layer (synovium) of the tendons in your carpal tunnel.

The exact cause of the swelling usually isn't known, but a variety of conditions and factors can play a role:

* Other health conditions. Some examples include rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders and menopause — fluid retention due to pregnancy, or deposits of amyloid, an abnormal protein produced by cells in your bone marrow.
* Repetitive use or injury. Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, also can increase pressure within the carpal tunnel. Injury to your wrist can cause swelling that exerts pressure on the median nerve.
* Physical characteristics. It may be that your carpal tunnel is more narrow than average. Other less common causes include a generalized nerve problem or pressure on the median nerve at more than one location.

Symptoms:

Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm. Other common carpal tunnel syndrome symptoms include:

* Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This sensation often occurs while driving a vehicle or holding a phone or a newspaper or upon awakening. Many people "shake out" their hands to relieve their symptoms.
* Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on palm side of your forearm.
* A sense of weakness in your hands and a tendency to drop objects.
* A constant loss of feeling in some fingers. This can occur if the condition is advanced.

Diagnosis:

If you have signs and symptoms of carpal tunnel syndrome, your doctor may recommend the following diagnostic tests:

* Electromyogram- Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. This test can help determine if muscle damage has occurred.
* Nerve conduction study- In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.

Treatment:

Most people with carpal tunnel syndrome experience effective treatment with nonsurgical methods, including:

* Wrist splinting- A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely to help you if you've had only mild to moderate symptoms for less than a year.
* Nonsteroidal anti-inflammatory drugs- NSAIDs may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition. If no inflammatory condition is involved, NSAIDs are unlikely to help relieve your symptoms.
* Corticosteroids- Your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone, to relieve your pain. Corticosteroids decrease inflammation, thus relieving pressure on the median nerve. Oral corticosteroids aren't as effective as corticosteroid injections for treating carpal tunnel syndrome.

Candidiasis

2008-03-27T05:25:00.000-07:00

Candidiasis, commonly called yeast infection or thrush, is a fungal infection (mycosis) of any of the Candida species, of which Candida albicans is the most common. Candidiasis thereby encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases. Candida infections of the latter category are also referred to as candidemia and are usually confined to severely immunocompromised persons, such as cancer, transplant, and AIDS patients, whereas superficial infections of skin and mucosal membranes by Candida causing local inflammation and discomfort is common in many human populations. While clearly attributable to the presence of the opportunistic pathogens of the genus Candida, candidiasis describes a number of different disease syndromes that often differ in their causes and outcomes.

Causes:

Candida yeasts are usually present in most people, but uncontrolled multiplication resulting in disease symptoms is kept in check by other naturally occurring microorganisms, e.g., bacteria co-existing with the yeasts in the same locations, and by the human immune system.
A weakened or undeveloped immune system or metabolic illnesses, such as diabetes may predispose individuals to Candidiasis. Diseases or conditions linked to candidiasis include HIV/AIDS, mononucleosis, cancer treatments, steroids, stress and nutrient deficiency, among many others. Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida species. In extreme cases, these superficial infections of the skin or mucous membranes may enter into the bloodstream and cause systemic Candida infections.
Pregnancy, the use of oral contraceptives, engaging in vaginal sex immediately and without cleansing after anal sex and using lubricants containing glycerin have been found to be causally related to yeast infections.
Diet has been found to be the cause in some animals. Hormone Replacement Therapy and infertility treatments may also be predisposing factors.

Symptoms:

Symptoms include severe itching, burning, and soreness, irritation of the vagina and/or vulva, and a whitish or whitish-gray discharge, often with a curd-like appearance.
In men, symptoms include red patchy sores near the head of the penis or on the foreskin, severe itching and/or a burning sensation. Candidiasis of the penis can also have a white discharge, although uncommon. However, having no symptoms at all is common and usually, a more severe form of the symptoms may emerge later.

Diagnosis:

Medical professionals use two primary methods to diagnose yeast infections: microscopic examination, and culturing.

For the microscope method, a scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% potassium hydroxide (KOH) solution is then also placed on the slide. The KOH dissolves the skin cells but leaves the Candida untouched, so that when the slide is viewed under a microscope, the hyphae and pseudo spores of Candida are visible. Their presence in large numbers strongly suggests a yeast infection.

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then rubbed across a culture medium. The medium is incubated for several days, during which time colonies of yeast and/or bacteria develop. The characteristics of the colonies provide a presumptive diagnosis of the organism causing symptoms.

Treatment:
In clinical settings, candidiasis is commonly treated with antimycotics—the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole. For example, a one-time dose of fluconazole (as Diflucan 150-mg tablet taken orally) has been reported as being 90% effective in treating a vaginal yeast infection. This dose is only effective for vaginal yeast infections, and other types of yeast infections may require different treatments. In severe infections (generally in hospitalized patients), amphotericin B, caspofungin, or voriconazole may be used. Local treatment may include vaginal suppositories or medicated douches. Gentian violet can be used for breastfeeding thrush, but pediatrician William Sears recommends using it sparingly, since in large quantities it can cause mouth and throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals.

Cancer

2008-03-27T05:05:00.000-07:00

Cancer (malignant neoplasm) is a class of diseases in which a group of cells display the traits of uncontrolled growth (growth and division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not.

Cancer may affect people at all ages, even fetuses, but risk for the more common varieties tends to increase with age. Cancer causes about 13% of all deaths. According to the American Cancer Society, 7.6 million people died from cancer in the world during 2007. Apart from humans, forms of cancer may affect other animals and plants.

Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or infectious agents. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Complex interactions between carcinogens and the host genome may explain why only some develop cancer after exposure to a known carcinogen. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly being recognized as important.

Genetic abnormalities found in cancer typically affect two general classes of genes. Cancer-promoting oncogenes are often activated in cancer cells, giving those cells new properties, such as hyperactive growth and division, protection against programmed cell death, loss of respect for normal tissue boundaries, and the ability to become established in diverse tissue environments. Tumor suppressor genes are often inactivated in cancer cells, resulting in the loss of normal functions in those cells, such as accurate DNA replication, control over the cell cycle, orientation and adhesion within tissues, and interaction with protective cells of the immune system.

Cancer is usually classified according to the tissue from which the cancerous cells originate, as well as the normal cell type they most resemble. These are location and histology, respectively. A definitive diagnosis usually requires the histologic examination of a tissue biopsy specimen by a pathologist, although the initial indication of malignancy can be symptoms or radiographic imaging abnormalities. Most cancers can be treated and some cured, depending on the specific type, location, and stage. Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming more specific for different varieties of cancer. There has been significant progress in the development of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimize damage to normal cells. The prognosis of cancer patients is most influenced by the type of cancer, as well as the stage, or extent of the disease. In addition, histologic grading and the presence of specific molecular markers can also be useful in establishing prognosis, as well as in determining individual treatments.

Classification:
Male
prostate cancer (33%), lung cancer (13%), colorectal cancer (10%), bladder cancer (7%), cutaneous melanoma (5%), leukemia (4%), pancreatic cancer (5%).

Female
breast cancer (32%), lung cancer (27%), colorectal cancer (11%), endometrial cancer (6%), ovarian cancer (6%), non-Hodgkin lymphoma (4%), pancreatic cancer (6%).

Children

Leukemia is the most common infant malignancy (30%), followed by the central nervous system cancers and neuroblastoma. The remainder consists of Wilms' tumor, lymphomas, rhabdomyosarcoma, retinoblastoma, osteosarcoma and Ewing's sarcoma. Teratoma is the most common tumor in this age group, but most teratomas are surgically removed while still benign, hence not necessarily cancer.

Female and male infants have essentially the same overall cancer incidence rates, but white infants have substantially higher cancer rates than black infants for most cancer types. Relative survival for infants is very good for neuroblastoma, Wilms' tumor and retinoblastoma, and fairly good (80%) for leukemia, but not for most other types of cancer.

Symptoms:
Roughly, cancer symptoms can be divided into three groups:

* Local symptoms: unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and/or ulceration. Compression of surrounding tissues may cause symptoms such as jaundice (yellowing the eyes and skin).
* Symptoms of metastasis (spreading): enlarged lymph nodes, cough and hemoptysis, hepatomegaly (enlarged liver), bone pain, fracture of affected bones and neurological symptoms. Although advanced cancer may cause pain, it is often not the first symptom.
* Systemic symptoms: weight loss, poor appetite, fatigue and cachexia (wasting), excessive sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e. specific conditions that are due to an active cancer, such as thrombosis or hormonal changes.

Diagnosis:
A cancer may be suspected for a variety of reasons, but the definitive diagnosis of most malignancies must be confirmed by histological examination of the cancerous cells by a pathologist. Tissue can be obtained from a biopsy or surgery. Many biopsies (such as those of the skin, breast or liver) can be done in a doctor's office. Biopsies of other organs are performed under anesthesia and require surgery in an operating room.

The tissue diagnosis given by the pathologist indicates the type of cell that is proliferating, its histological grade and other features of the tumor. Together, this information is useful to evaluate the prognosis of this patient and to choose the best treatment. Cytogenetics and immunohistochemistry are other types of testing that the pathologist may perform on the tissue specimen. These tests may provide information about future behavior of the cancer (prognosis) and best treatment.

Treatment:

Cancer can be treated by surgery, chemotherapy, radiation therapy, immunotherapy, monoclonal antibody therapy or other methods. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient. A number of experimental cancer treatments are also under development.

Complete removal of the cancer without damage to the rest of the body is the goal of treatment. Sometimes this can be accomplished by surgery, but the propensity of cancers to invade adjacent tissue or to spread to distant sites by microscopic metastasis often limits its effectiveness. The effectiveness of chemotherapy is often limited by toxicity to other tissues in the body. Radiation can also cause damage to normal tissue.

Because "cancer" refers to a class of diseases, it is unlikely that there will ever be a single "cure for cancer" any more than there will be a single treatment for all infectious diseases.

For More Information visit http://www.cancer.gov/

Bursitis

2008-03-27T04:44:00.000-07:00

Bursitis is the inflammation of one or more bursae, or small sacs of synovial fluid, in the body. Bursae rest at the points where internal functionaries, like muscles and tendons, slide across bone. Healthy bursae create a smooth and almost frictionless gliding surface. With hundreds of them throughout the body they provide this surface for all motion, making movement normally painless. When bursitis takes hold, however, movement that relies on the inflamed bursa becomes rough and painful. Movement of tendons and muscles over the inflamed bursa causes it to become more inflamed, perpetuating the problem.

You have more than 150 bursae in your body. These small, fluid-filled sacs lubricate and cushion pressure points between your bones and the tendons and muscles near your joints. They help your joints move with ease. Bursitis occurs when a bursa becomes inflamed. When inflammation occurs, movement or pressure is painful.

Bursitis often affects the joints in your shoulders, elbows or hips. But you can also have bursitis by your knee, heel and the base of your big toe. Bursitis pain usually goes away within a few weeks or so with proper treatment, but recurrent flare-ups of bursitis are common.

Causes:

Bursitis is commonly caused by repetition of movement or excessive pressure. Elbows and knees are the most commonly affected because they are rested upon more than many parts of the body with bursae and they also get the most repetitive use. Inflammation of bursae can also be caused by other inflammatory conditions such as rheumatoid arthritis. Scoliosis can also be a cause of bursitis of the shoulders although this is rare. Shoulder bursitis is more commonly due to overuse of the shoulder joint and muscles.

The other main cause of bursitis is traumatic injury, which can cause swelling of the bursae. The swelling itself causes irritation because the sac will no longer fit in the small area between the bone and the functionary. When the bone begins to increase pressure on the bursa, bursitis ensues.

Symptoms:

If you have bursitis, you may notice:

* A dull ache or stiffness in the area around your elbow, hip, knee, shoulder, big toe or other joints.
* A worsening of pain with movement or pressure.
* An area that feels swollen or warm to the touch.
* Occasional skin redness in the area of the inflamed bursa.

Bursitis of the hip doesn't cause any visible swelling or skin redness because the bursae are located beneath some of your body's bulkiest muscles. In this type of bursitis, pain is primarily over the greater trochanter, a portion of your thighbone (femur) that juts out just below where the bone joins the hip.

Diagnosis:

Your doctor may have you undergo a physical examination and ask you about your recent activities. By feeling the painful joint and surrounding area, your doctor may be able to identify a specific area of tenderness.

If it appears that something else may be causing the discomfort, your physician may request an X-ray of the affected area. If bursitis is the cause, X-ray images can't positively establish the diagnosis, but they can help to exclude other causes of your discomfort.

Although you usually can trace bursitis to events of overuse or pressure, there may be no obvious cause. In the latter case, your doctor may want to perform additional screening to rule out other causes of joint inflammation and pain. This may include blood tests or an analysis of fluid from the inflamed bursa.

Treatment:

Bursitis treatment is usually simple and includes:

* Resting and immobilizing the affected area.
* Applying ice to reduce swelling.
* Taking Non Steroidal Anti-Inflammatory Drugs (NSAIDs) to relieve pain and to reduce the inflammation.

With simple self-care and home treatment, bursitis usually disappears within a couple of weeks.
Sometimes, your doctor may recommend physical therapy or exercises to strengthen the muscles in the area. Additionally, your doctor may inject a corticosteroid drug into the bursa to relieve inflammation. This treatment generally brings immediate relief and, in many cases, one injection is all you'll need.

If your bursitis is caused by an infection, you'll need to take antibiotics. Sometimes the bursa must be surgically drained, but only rarely is surgical removal of the affected bursa necessary.

Bulimia

2008-03-27T04:24:00.000-07:00

Bulimia nervosa, mostly known as Bulimia is an eating disorder in which the subject engages in recurrent binge eating followed by feelings of guilt, depression, and self-condemnation. The sufferer will then engage in compensatory behaviors to make up for the excessive eating, which are referred to as "purging". Purging can take the form of vomiting, fasting, the use of laxatives, enemas, diuretics or other medications, or overexercising.

Causes:

Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives. They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories.) After a length of time, the sufferer of bulimia will find that they no longer have control over their binging and purging. The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia.

There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, dance, cheerleading, acting and figure skating. Bulimia is more prevalent among Caucasians. In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduced cravings for fat and sugar.

Types:

There are two sub-types of bulimia nervosa: purging and non-purging.

Purging type is the more common type of bulimia, and involves any of self-induced vomiting, laxatives, diuretics, enemas, or Ipecac, to rapidly extricate the contents from their body.

Non-purging type occurs in only approximately 6%-8% of bulimia cases, as it is a less effective means of ridding the body of such a large number of calories. It involves doing excessive exercise or fasting after a binge, to counteract the large amount of calories previously ingested. This often occurs in purging-type bulimics, but is a secondary form of weight control.

Symptoms:

Some of the most common symptoms of bulimia are:
Eating uncontrollably, Purging, Strict dieting, Fasting, Vigorous exercise, Vomiting or abusing laxatives or diuretics in an attempt to lose weight, Vomiting blood, Using the bathroom frequently after meals, Preoccupation with body weight, Depression or mood swings, Feeling out of control, Swollen glands in neck and face, Heartburn, Bloating, Indigestion, Constipation, Irregular periods, Dental problems, Sore throat, Weakness, Exhaustion, Bloodshot eyes etc.

Diagnosis:

The criteria for diagnosing a patient with bulimia are:

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
* Eating, in a fixed period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
* A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
2. Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting, or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Treatment:
Standard bulimia nervosa treatments include medications (prescription drugs), various psychotherapies, nutrition therapy, other non-drug therapies and supportive or adjunct interventions such as yoga, art, massage, and movement therapy. Some novel treatments are currently under research, such as implantation of a device called a vagus nerve stimulator implanted at the base of the neck. This stimulator is currently in use to treat some forms of depression, and it is under research for treating obesity.
The most commonly used treatments—psychotherapy and medication—are delivered at various levels of inpatient and outpatient care, and in various settings depending on the severity of the illness and the treatment plan that has been developed for a particular patient.

Many types of prescription drugs have been used in treatment of bulimia nervosa, however, only one prescription drug (fluoxetine) actually has a labeled indication for bulimia nervosa.

Most prescription drug therapy used for treatment of the disorder is aimed at alleviating major depression, anxiety, or obsessive-compulsive disorder (OCD), which often co-exist with bulimia nervosa. Some prescription drug therapies are intended to make individuals feel full to try to prevent binge eating.

Buerger's disease

2008-03-26T13:34:00.000-07:00

Buerger's disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. It is strongly associated with use of tobacco products, primarily from smoking, but also from smokeless tobacco.

Buerger's disease is characterized by a combination of inflammation and clots in the blood vessels, which impairs blood flow. This eventually damages or destroys tissues and may lead to infection and gangrene. Buerger's disease usually begins in the hands and feet and may progress to affect larger areas of the limbs.

Buerger's disease is rare in the United States, but is more common in the Middle East and Far East. Buerger's disease most commonly affects men between ages 20 and 40, though it's becoming more common in women.

Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb may ultimately be necessary.

Causes:
Buerger's disease is caused by inflammation in the arteries and veins of the arms and legs. Inflammatory cells — and eventually blood clots — form in the vessels and block blood flow in and out of your hands and feet. Reduced blood flow means that the tissue in your hands and feet doesn't get adequate oxygen and nutrients needed to sustain it. This leads to the signs and symptoms of Buerger's disease, beginning with pain and weakness in your fingers and toes and advancing to other parts of your arms and legs. It isn't clear what triggers the inflammation and clots.

Symptoms:
Signs and symptoms of Buerger's disease include:

* Pain and weakness in your legs and feet or your arms and hands.
* Swelling in your feet and hands.
* Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon).
* Open sores on your fingers and toes.

Diagnosis:
No tests can definitely determine whether you have Buerger's disease. Instead, doctors order tests to narrow the diagnosis and rule out other more common conditions. These tests may include:

Blood tests-Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood clotting disorders and diabetes, along with other diseases and conditions.

The Allen's test-
Your doctor may conduct a simple test called the Allen's test to check blood flow through the arteries carrying blood to your hands. In the Allen's test, you make a tight fist, which forces the blood out of your hand. Your doctor alternately compresses the arteries at each side of your wrist to slow the flow of blood back into your hand. Next, you open your hand and your doctor releases the compression. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger's disease.

Arteriogram-An arteriogram, also called an angiogram, helps doctors see the condition of your arteries. Doctors inject dye into an artery and then take X-rays or other types of images. Images show any blockages in the artery. Your doctor may order arteriograms be performed on both of your arms and your legs — even if you don't have signs and symptoms of Buerger's disease in all of your limbs. Buerger's disease typically affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.

Treatment:
Quit using tobacco in any form-If you're diagnosed with Buerger's disease, you must stop using tobacco in order to stop progression of the disease. The inflammation stops when you quit using tobacco. Most people who quit tobacco won't have to face amputation of their fingers or toes in the future. Those who continue to use tobacco may worsen their Buerger's disease and need to have their affected fingers or toes removed.

It's hard to quit smoking. If you're like the majority of people who smoke, you've probably tried to quit in the past, but haven't been successful. Talk to your doctor about strategies to help you quit. Medications are available to ease your cravings. However, you won't be able to use nicotine replacement products, such as patches or gum, since the nicotine in these products also affects Buerger's disease.

Because it's imperative that you stop all tobacco use, your doctor may recommend more aggressive approaches to quitting. For instance, your doctor may periodically test your urine to make sure you aren't using tobacco. Another option is a residential smoking cessation program. In these programs, you stay at a treatment facility, sometimes a hospital, for a set number of days or weeks. During that time you participate in daily counseling sessions and other activities to help you deal with the cravings for cigarettes and to help you learn to live tobacco-free.

Other treatments-No treatments can cure Buerger's disease. Instead, your doctor may try various treatment approaches to reduce any signs and symptoms you have. Options include:

* Medications to improve blood flow or to dissolve blood clots.
* Surgery to cut the nerves in the affected area (surgical sympathectomy) to control pain.
* Amputation, if infection or gangrene occurs.

Brucellosis

2008-03-26T13:22:00.000-07:00

Brucellosis, also called undulant fever, undulating fever, or Malta fever, is a zoonosis (infectious disease transmitted from animals to humans) caused by bacteria of the genus Brucella. It is primarily a disease of domestic animals (goats, pigs, cattle, dogs, etc) and humans and has a worldwide distribution, mostly now in developing countries.

Causes:
The disease is transmitted either through contaminated or untreated milk (and its derivates) or through direct contact with infected animals, which may include dogs, pigs, camels and ruminants, primarily sheep, goats, cattle, bison. This also includes contact with their carcasses.
Brucellae, along with leptospira have the unique property of being able to penetrate through intact human skin, so infection by mere hand contact with infectious material is likely to occur.

Symptoms:
Brucellosis induces inconstant fevers, sweating, weakness, anemia, headaches, depression and muscular and bodily pain.

The symptoms are like those associated with many other febrile diseases, but with emphasis on muscular pain and sweating. The duration of the disease can vary from a few weeks to many months or even years. In first stage of the disease, septicaemia occurs and leads to the classic triad of undulant fevers, sweating (often with characteristic smell, likened to wet hay) and migratory arthralgia and myalgia.

Diagnosis:
Diagnosis of brucellosis relies on:

1. Demonstration of the agent: blood cultures in tryptose broth, bone marrow cultures. The growth of brucellae is extremely slow (they can take until 2 months to grow) and the culture poses a risk to laboratory personnel due to high infectivity of brucellae.
2. Demonstration of antibodies against the agent either with the classic Huddleson, Wright and/or Bengal Rose reactions, either with ELISA or the 2-mercaptoethanol assay for IgM antibodies associated with chronic disease
3. Histologic evidence of granulomatous hepatitis (hepatic biopsy)
4. Radiologic alterations in infected vertebrae : the Pedro Pons sign (preferential erosion of antero-superior corner of lumbar vertebrae) and marked osteophytosis are suspicious of brucellic spondylitis.

Treatment:
Antibiotics like tetracyclins, rifampicin and the aminoglycosides streptomycin and gentamicin are effective against Brucella bacteria. However, the use of more than one antibiotic is needed for several weeks, due to the fact that the bacteria incubates within cells.

The gold standard treatment for adults is daily intramuscular injections of streptomycin 1 g for 14 days and oral doxycycline 100 mg twice daily for 45 days. Gentamicin 5 mg/kg by intramuscular injection once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain. Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks.

Bronchitis

2008-03-26T13:11:00.000-07:00

Bronchitis is an inflammation of the large bronchi (medium-size airways) in the lungs. It can lead to pneumonia.

Acute bronchitis is usually caused by viruses or bacteria and may last several days or weeks. Acute bronchitis is characterized by cough and sputum (phlegm) production and symptoms related to the obstruction of the airways by the inflamed airways and the phlegm, such as shortness of breath and wheezing. Diagnosis is by clinical examination and sometimes microbiological examination of the phlegm. Treatment may be with antibiotics (if a bacterial infection is suspected), bronchodilators (to relieve breathlessness) and other treatments.

Chronic bronchitis is not necessarily caused by infection and is generally part of a syndrome called chronic obstructive pulmonary disease (COPD); it is defined clinically as a persistent cough that produces sputum (phlegm) and mucus, for at least three months in two consecutive years.

Causes:
bronchitis can be contagious. In about half of instances of acute bronchitis a bacterial or viral pathogen is identified. Typical viruses include respiratory syncytial virus, rhinovirus, influenza, and others.
Acute bronchitis can result from breathing irritating fumes, such as those of tobacco smoke or polluted air.

Symptoms:
Bronchitis may be indicated by an expectorating cough, shortness of breath (dyspnea) and wheezing. Occasionally chest pains, fever, and fatigue or malaise may also occur. Additionally, Bronchitis caused by Adenoviridae may cause systemic and gastrointestinal symptoms as well. However the coughs due to bronchitis can continue for up to three weeks or more even after all other symptoms have subsided.

Diagnosis:
A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi and prolonged expiration. Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.

A variety of tests may be performed in patients presenting with cough and shortness of breath:

* A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of pneumonia. Some conditions that predispose to bronchitis may be indicated by chest radiography.
* A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and culture showing that has pathogenic microorganisms such as Streptococcus species.
* A blood test would indicate inflammation (as indicated by a raised white blood cell count and elevated C-reactive protein).
* Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by irritation.
* Damage caused by irritation of the airways leads to inflammation and leads to neutrophils being present.
* Mucosal hypersecretion is promoted by a substance released by neutrophils.
* Further obstruction to the airways is caused by more goblet cells in the small airways. This is typical of chronic bronchitis.

Treatment:
Antibiotics-In most cases, acute bronchitis is caused by viruses, not bacteria and it will go away on its own without antibiotics. To treat acute bronchitis that appears to be caused by a bacterial infection, or as a precaution, antibiotics may be given. However, a meta-analysis found that antibiotics may reduce symptoms by one-half day.

Smoking cessation-To help the bronchial tree heal faster and not make bronchitis worse, smokers should cut back on the number of cigarettes smoked daily or quit smoking completely to allow their lungs to recover from the layer of tar that often builds up over time.

Antihistamines-Using over-the-counter antihistamines may be harmful in the self-treatment of bronchitis. An effect of antihistamines is to thicken mucus secretions. Expelling infected mucus via coughing can be beneficial in recovering from bronchitis. Expulsion of the mucus may be hindered if it is thickened. Antihistamines can help bacteria to persist and multiply in the lungs by increasing its residence time in a warm, moist environment of thickened mucus.

Bronchiolitis

2008-03-26T11:59:00.000-07:00

Bronchiolitis is an infection of the lungs airways. It most often occurs in young children, commonly between 3 and 6 months of age. About one in nine babies gets bronchiolitis in his or her first year of life, usually during the fall and winter months.

Bronchiolitis starts out with signs and symptoms similar to those of a common cold but then progresses to coughing and wheezing.

Although a child's bout of bronchiolitis may be scary, particularly for parents, signs and symptoms typically last for about a week and then go away. In the meantime, you can take a number of self-help measures to make your child more comfortable.

Causes:
Bronchiolitis occurs when an infectious agent — usually a virus — enters the respiratory system and makes its way to the bronchioles, causing them to become inflamed and swollen. As a result, mucus often collects in these airways, which can make it difficult for air to flow freely through your lungs.

In older children and adults, the resulting signs and symptoms are generally mild. But an infant's bronchioles are much narrower than are an adult's and are more easily blocked, leading to greater difficulty breathing.

The respiratory syncytial virus (RSV), a common virus, causes more than half of all childhood bronchiolitis cases. The rest are caused by infectious agents such as parainfluenza viruses, the influenza (flu) virus, some adenoviruses, Mycoplasma pneumoniae organisms or human metapneumovirus. Severe cases of bronchiolitis may reflect multiple infections, such as a combination of RSV and metapneumovirus.

Bronchiolitis is a contagious condition. You contract the infectious virus just like you would a cold or the flu — by inhaling airborne droplets of infected mucus or other respiratory secretions or by touching objects contaminated by these secretions and then touching your eyes, the inside of your nose or mouth.

Symptoms:
For the first two or three days, the signs and symptoms of bronchiolitis are similar to those of a common cold:

* Runny nose
* Stuffy nose
* Slight fever (may or may not occur)

After this, there may be two or three days of:

* Wheezing — breathing seems more difficult or noisy when breathing out
* Coughing — tends to be harsh, comes in fits and doesn't produce any phlegm
* Rapid or difficult breathing
* Rapid heartbeat

Severe bronchiolitis may cause your child to have difficulty breathing or develop bluish-looking skin (cyanosis) — a sign that he or she isn't getting enough oxygen. This requires emergency medical care.

Diagnosis:
Your doctor will likely listen to your child's lungs with a stethoscope to check for wheezing and prolonged breathing out (exhaling). These may indicate obstructed airflow in the bronchioles. The doctor may consider specific risk factors for bronchiolitis as well.

Sometimes other tests are recommended, including:

* Chest X-ray-In severe or uncertain cases, your doctor may request that a chest X-ray be taken to visually check for inflammation of the airways in the lungs and any signs of pneumonia. Your doctor may also check for the presence of a foreign object, such as a peanut or small piece of plastic, that your baby or toddler may have inhaled.
* Mucus sample test-In addition, your doctor may collect a sample of mucus from your child — using a nasal pharyngeal swab or a suction catheter that's gently inserted into the nose — to test for the virus that may be causing the bronchiolitis.

Treatment:
You can treat most cases of bronchiolitis at home with self-care steps. Because a virus is usually the cause of bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — aren't effective against it. If your child has an associated bacterial infection, such as pneumonia, your doctor may prescribe antibiotics for that.

In more severe cases, doctors may prescribe a bronchodilator, a medication to open up the airways in the lungs, such as albuterol or albuterol inhalers (Proventil, Ventolin, others). Inhaled antiviral drugs may also be used, although they may not always be as effective as desired.

Ribavirin is an antiviral drug which has a controversial role in treating RSV infection. There is no proven benefit but it is used sometimes for infants with pre-existing lung, heart or immune disease.

Bronchiectasis

2008-03-26T11:48:00.000-07:00

Bronchiectasis is a disease that causes localized, irreversible dilatation of part of the bronchial tree. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species or Bordetella pertussis.

Rene Theophile Hyacinthe Laënnec, the man who invented the stethoscope, used his creation to first discover bronchiectasis in 1819. The disease was researched in greater detail by Sir William Osler in the late 1800s; in fact, it is suspected that Osler actually died of complications from undiagnosed bronchiectasis.

Causes:
There are both congenital and acquired causes of bronchiectasis. Kartagener syndrome, which affects the mobility of cilia in the lungs, aids in the development of the disease. Another common genetic cause is cystic fibrosis, in which a small number of patients develop severe localized bronchiectasis. Young's syndrome, which is clinically similar to cystic fibrosis, is thought to significantly contribute to the development of bronchiectasis. This is due to the occurrence of chronic, sinopulmonary infections. Patients with alpha 1-antitrypsin deficiency have been found to be particularly susceptible to bronchiectasis, for unknown reasons. Other less-common congenital causes include primary immunodeficiencies, due to the weakened or nonexistent immune system response to severe, recurrent infections that commonly affect the lung.

Acquired bronchiectasis occurs more frequently, with one of the biggest causes being tuberculosis. Endobronchial tuberculosis commonly leads to bronchiectasis, either from bronchial stenosis or secondary traction from fibrosis. A especially common cause of the disease in children is Acquired Immune Deficiency Syndrome (AIDS), stemming from the human immunodeficiency virus. This disease predisposes patients to a variety of pulmonary ailments, such as pneumonia and other opportunistic infection. Bronchiectasis can sometimes be an unusual complication of inflammatory bowel disease, especially ulcerative colitis. It can occur in Crohn's disease as well, but does so less frequently. Bronchiectasis in this situation usually stems from various allergic responses to inhaled fungus spores. Recent evidence has shown an increased risk of bronchiectasis in patients with rheumatoid arthritis who smoke. One study stated a tenfold increased prevalence of the disease in this cohort. Still, it is unclear as to whether or not cigarette smoke is a specific primary cause of bronchiectasis.

Other acquired causes of bronchiectasis involving environmental exposures include respiratory infections, obstructions, inhalation and aspiration of ammonia and other toxic gases, pulmonary aspiration, alcoholism, heroin (drug use), and various allergies.

Diagnosis:
The diagnosis of bronchiectasis is based on the review of clinical history and characteristic patterns in high-resolution CT scan findings. Such patterns include "tree-in-bud" abnormalities and cysts with definable borders. In one small study, CT findings of bronchiectasis and multiple small nodules were reported to have a sensitivity of 80%, specificity of 87%, and accuracy of 80% for the detection of bronchiectasis. Bronchiectasis may also be diagnosed without CT scan confirmation if clinical history clearly demonstrates frequent, respiratory infections, as well confirmation of an underlying problem via blood work and sputum culture samples.

Treatment:
Treatment of bronchiectasis is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications. This includes the prolonged usage of antibiotics to prevent detrimental infections, as well as eliminating accumulated fluid with postural drainage and chest physiotherapy. Surgery may also be used to treat localized bronchiectasis, removing obstructions that could cause progression of the disease.

Inhaled steroid therapy that is consistently adhered to can reduce sputum production and decrease airway constriction over a period of time, and help prevent progression of bronchiectasis. One commonly used therapy is beclometasone dipropionate, which also used in asthma treatment. Use of inhalers such as albuterol (salbutamol), fluticasone (Flovent/Flixotide) and ipratropium (Atrovent) may help reduce likelihood of infection by clearing the airways and decreasing inflammation.

Mannitol dry inhalation powder, under the name Bronchitol, has been approved by the FDA for use in cystic fibrosis patients with or at risk for bronchiectasis. The original orphan drug indication approved in February 2005 allowed its use for the treatment of bronchiectasis. The original approval was based on the results of Phase II clinical studies showing the product to be safe, well-tolerated, and effective for stimulating mucus hydration/clearance, thereby improving quality of life in patients with chronic obstructive lung diseases like bronchiectasis. Long-term studies are underway as of 2007 to ensure the safety and effectiveness of the treatment.

Advair Diskus is also a commonly used inhaled corticosteroid which has in many cases been effective in clearing the airways, reducing sputum and reducing inflammation.

Brain Tumor

2008-03-26T11:35:00.000-07:00

A Brain Tumor is any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), 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 adults, although they can affect any part of the brain. In the United States in the year 2005, it was estimated that 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), which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths, and 20–25 percent of pediatric cancers. Ultimately, it is estimated that there are 13,000 deaths/year as a result of brain tumors.

Classification:
Most primary brain tumors originate from glia (gliomas) such as astrocytes (astrocytomas), oligodendrocytes (oligodendrogliomas), or ependymal cells (ependymoma). There are also mixed forms, with both an astrocytic and an oligodendroglial cell component. These are called mixed gliomas or oligoastrocytomas. Plus, mixed glio-neuronal tumors (tumors displaying a neuronal, as well as a glial component, e.g. gangliogliomas, disembryoplastic neuroepithelial tumors) and tumors originating from neuronal cells (e.g. gangliocytoma, central gangliocytoma) can also be encountered.

Other varieties of primary brain tumors include: primitive neuroectodermal tumors (PNET, e.g. medulloblastoma, medulloepithelioma, neuroblastoma, retinoblastoma, ependymoblastoma), tumors of the pineal parenchyma (e.g. pineocytoma, pineoblastoma), ependymal cell tumors, choroid plexus tumors, neuroepithelial tumors of uncertain origin (e.g. gliomatosis cerebri, astroblastoma), etc.

Secondary or metastatic brain tumors originate from malignant tumors (cancers) located primarily in other organs. Their incidence is higher than that of primary brain tumors. The most frequent types of metastatic brain tumors originate in the lung, skin (malignant melanoma), kidney (hypernephroma), breast (breast carcinoma), and colon (colon carcinoma). These tumor cells reach the brain via the blood-stream.

Some non-tumoral masses and lesions can mimic tumors of the central nervous system. These include tuberculosis of the brain, cerebral abscess (commonly in toxoplasmosis), and hamartomas (for example, in tuberous sclerosis and von Recklinghausen neurofibromatosis).

Diagnosis:
Although there is no specific clinical symptom or sign for brain tumours, 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, sudden intracranial hypertension (this may be due to bleeding within the tumour, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Imaging plays a central role in the diagnosis of brain tumours. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favour of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumours 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. 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 tumours. This is due to the fact that these tumours disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.

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

The definitive diagnosis of brain tumour can only be confirmed by histological examination of tumour tissue samples obtained either by means of brain biopsy or open surgery. The histologic examination is essential for determining the appropriate treatment and the correct prognosis.

Treatment and Prognosis:
Meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically, but the chances are less than 50%. In more difficult cases, Stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option.

Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases. However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors.

Patients with benign gliomas may survive for many years while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosis.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

A shunt operation is used not as a cure but to relieve the symptoms. The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

Research to treatment with the VSV-virus:
In 2008, Researchers of the Yale University, lead by Dr. Anthony van den Pol, have discovered that the Vesicular stomatitis virus, or VSV-virus, can infect and kill brain tumors, without affecting the other brain cells. The oncolytic properties of the virus, which normally applies to cancer cells, have shown to apply to brain tumors as well.

In the research, a human brain tumor was implanted into mice brains. The VSV-virus was injected via its tail and within 3 days all tumor cells were either killed or dying. On the 10,000 infected tumor cells, only one healthy brain cell was affected 'on accident'.

Research to virus-treatment like this has been some years old, but no other virusses has shown to be as efficient or specific as the VSV-virus. Future research will focus on the risks of this treatment, before it can be applied to humans.

Botulism

2008-03-26T11:09:00.000-07:00

Botulism is a rare, but serious paralytic illness caused by a toxin, botulin, that is produced by the bacteria Clostridium botulinum. Botulinic toxin is one of the most powerful known toxins: about one microgram is lethal to humans. It acts by blocking nerve function and leads to respiratory and musculoskeletal paralysis. There are three main kinds of botulism:

* Infant botulism is caused by swallowing the spores of the botulinum bacteria, which then grow inside of the infant's intestines and release toxin.
* Foodborne botulism is caused by eating foods that contain the rare botulinum toxin.
* Wound botulism is caused by a nerve toxin produced from a wound infected with Clostridium botulinum. This is the rarest type of botulism. It is very difficult to obtain it this way.

All forms of botulism can be lethal and are always considered medical emergencies. Foodborne botulism can be extremely dangerous as a public health risk because multiple persons can consume the poison from a single contaminated food source.

Symptoms:
Normal symptoms of Foodborne and Wound botulism, usually including dry mouth, double and/or blurred vision, difficulty swallowing, muscle weakness, drooping eyelids, difficult breathing, slurred speech, vomiting, urinary incontinence and sometimes diarrhea. These symptoms may continue to cause paralytic ileus with severe constipation, and will lead to body paralysis. The respiratory muscles are affected as well, which may cause death due to respiratory failure. These are all symptoms of the muscle paralysis caused by the bacterial toxin.

The mode of action of Infant botulism is through colonization by germinating spores in the gut of an infant. The first symptom is usually constipation, followed by generalized weakness, loss of head control and difficulty feeding. Like the other forms of botulism, the symptoms are caused by the absorption of botulinum toxin, and typically progress to a symmetric descending flaccid paralysis. Death is often the eventual outcome unless the infant receives artificial ventilation.

Diagnosis:
Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. However, these clues are often not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, cerebrospinal fluid examination, nerve conduction test (electromyography, or EMG), and an Edrophonium Chloride (Tensilon) test for myasthenia gravis. The most practical way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's serum or stool by injecting serum or stool extract into mice and looking for signs of botulism that can be blocked by specific antisera.

Treatment:
Infant botulism can be treated with human botulism immune globulin (BabyBIG), when available. Supply is extremely limited. This dramatically decreases the length of illness for most infants. Paradoxically, antibiotics (especially aminoglycosides or clindamycin) may cause dramatic acceleration of paralysis as the affected bacteria release toxin. Visual stimulation should be performed during the time the infant is paralyzed as well, in order to promote the normal development of visual pathways in the brain during this critical developmental period.

Furthermore each case of food-borne botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains.

There are two primary Botulinum Antitoxins available for treatment of Wound and Foodborne botulism. Trivalent (A,B,E) Botulinum Antitoxin is derived from equine sources utilizing whole antibodies (Fab & Fc portions). This antitoxin is available from the local health department via the CDC. The second antitoxin is heptavalent (A,B,C,D,E,F,G) Botulinum Antitoxin which is derived from "despeciated" equine IgG antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This is a less immunogenic antitoxin that is effective against all known strains of botulism where not contraindicated.

Blepharitis

2008-03-26T10:51:00.000-07:00

Blepharitis is inflammation of the eyelids. It is characterized by inflammation of the eyelid margins. Blepharitis usually causes redness of the eyes and itching and irritation of the eyelids in both eyes. Its appearance is often confused with conjunctivitis and due to its recurring nature it is the most common cause of "recurrent conjunctivitis" in older people. It is also often treated as "dry eye" by patients due to the gritty sensation it may give the eyes - although lubricating drops do little to improve the condition.

There are 3 forms of blepharitis (staphylococcal, seborrheic and MGD). All three forms of blepharitis are chronic in nature. Patients with staphylococcal blepharitis are relatively young (mean age 42 years) with a short history of ocular symptoms (mean 1.8 years). Patients with seborrheic blepharitis and MGD blepharitis are generally older and have a longer history of ocular symptoms.

Staphlycoccal blepharitis is a type of external eye inflammation. As with dandruff, it is usually asymptomatic until the disease progresses. As it progresses, the sufferer begins to notice a foreign body sensation, matting of the lashes, and burning. Usually, the primary care physician will prescribe topical antibiotics for staphylococcal blepharitis. Unfortunately this is not an effective treatment.

Seborrheic blepharitis, the most common type of blepharitis, is usually one part of the spectrum of seborrheic dermatitis seborrhea which involves the scalp, lashes, eyebrows, nasolabial folds and ears. Treatment is best accomplished by a dermatologist.

In Meibomian gland dysfunction (MGD) there are prominent blood vessels crossing the eyelid margin. In addition there is pouting or plugging of meibomian gland openings, and poor expressibility and/or turbidity of the oily meibomian secretions. Patients with MGD frequently are noted to have coexisting rosacea and seborrheic dermatitis (Rosacea's Red Face). Use of isotretinoin (Accutane), an oral medication for severe cystic acne, has also been implicated as a cause of blepharitis.

Treatment:
Blepharitis is a chronic disease for which there is no cure, and requires long-term treatment to keep it under control. Treatment consists of 2 phases (Acute phase and Maintenance phase). Acute phase treatment involves intensive therapy to rapidly bring the disease under control. In the maintenance phase the goal is to indefinitely continue the minimum amount of therapy that is necessary to keep the disease quiet. Herein we will not focus on the treatment of specific steroid responsive complications of blepharitis like marginal ulcers and phlyctenules, as they are less common and require specific diagnosis. We will focus on the treatments that help control the blepharitis process itself. Needless to say, controlling blepharitis itself, will reduce all the other blepharitis related complications.

Warm Compresses followed by Lid Scrubs is the most critical element of effective blepharitis control. This therapy removes the eyelid debris (which can be colonized by bacteria), reduces the bacterial load (mechanically as well as by lysis of bacteria due to detergent action of the soap in lid scrubbing) and stabilizes the tear film by releasing oily secretions from the meibomian glands, thus reducing tear evaporation (so the dry eye symptoms are also reduced).

Antibiotic treatment
The use of an ointment on the eyelid margin immediately after lid scrubbing may help to increase patient comfort. The choice here is usually Erythromycin eye ointment or Tobradex eye ointment (steroid-antibiotic combination). In addition, the antibiotics help to further reduce the bacterial load on the eyelids.
Oral tetracyclines (doxycycline or minocycline) for about 3 months can be used in recalcitrant Meibomian Gland Dysfunction (MGD) cases. Tetracycline antibiotics affect the meibomian gland secretions, inhibit bacterial lipases as well as reduce the eyelid bacterial load.

Anti-Inflammatory treatment
Castor oil has been used traditionally in folk medicine as an anti-inflammatory remedy for treatment of blepharitis. The main ingredient in Castor oil is ricinoleic acid. Castor oil could either increase or decrease eyelid inflammation depending upon whether it is used only once or is used several times for many days. Eyelid inflammation may increase initially after starting treatment but with repeated use over a week, the blepharitis inflammation will be reduced.

Antioxidant treatment
Eating more grapes may help blepharitis patients. The formation of oxidants like nitric oxide in the involved eyelid margin have been speculated to play a role in blepharitis. The substance, known as resveratrol is an anti-oxidant that is very effective against these nitrite type of oxidants. Grapes are particularly good sources of resveratrol. Resveratrol is found in the skin (not flesh) of grapes. Fresh grape skin contains about 50 to 100 micrograms of resveratrol per gram and red wine (also rich in resveratrol) contains about 1.5 to 3 milligrams per liter.