Aphasia and Apraxia

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Aneurysm

Definition

An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.

See also:

• Abdominal aortic aneurysm
• Cerebral aneurysm
• Thoracic aortic aneurysm

Causes

It is not clear exactly what causes aneurysms. Some aneurysms are present at birth (congenital). Defects in some of the parts of the artery wall may be responsible.

Common locations for aneurysms include:

• The major artery from the heart (the aorta)
• The brain (cerebral aneurysm)
• In the leg behind the knee popliteal artery aneurysm)
• Intestine (mesenteric artery aneurysm)
• An artery in the spleen (Splenic artery aneurysm)

High blood pressure and high cholesterol may raise your risk of certain types of aneurysms. High blood pressure is thought to play a role in abdominal aortic aneurysms. Atherosclerotic disease (cholesterol buildup in arteries) may also lead to the formation of some aneurysms.

Pregnancy is often linked to the formation and rupture of splenic artery aneurysms.

Symptoms

The symptoms depend on the location of the aneurysm. If the aneurysm occurs near the body's surface, pain and swelling with a throbbing mass is often seen.

Aneurysms within the body or brain often cause no symptoms.

If an aneurysm ruptures, low blood pressure, high heart rate, and lightheadedness may occur. The risk of death after a rupture is high.

Exams and Tests

The health care provider will perform a physical exam.

Tests used to diagnose an aneurysm include:

• CT scan
• Ultrasound

Treatment

Surgery is generally recommended. The type of surgery and when you need it depends on your symptoms and the size and type of aneurysm.

Some patients may have endovascular stent repair. A stent is a tiny tube used to prop open a vessel or reinforce it's wall. . This procedure can be done without a major cut, so you recover faster than you would with open surgery. Not all patients with aneurysms are candidates for stenting, however. See: Endovascular embolization

Outlook (Prognosis)

With successful surgical repair, the outlook is often excellent.

Possible Complications

The main complications of aneurysm include:

• Compression of nearby structures such as nerves, which may lead to weakness and numbness (most common with aneurysms that occur in the artery behind the knee)
• Infection, can lead to body-wide illness and rupture
• Rupture, which can cause massive bleeding that may lead to death

Massive bleeding is commonly seen with abdominal aortic aneurysms, mesenteric artery aneurysms, and splenic artery aneurysms.

Rupture of brain aneurysms can cause stroke, disability, and death. For more information, see: Cerebral aneurysm

When to Contact a Medical Professional

Call your health care provider for if you develop a lump on your body, whether or not it is painful and throbbing.

Prevention

Control of high blood pressure may help prevent some aneurysms. Following a healthy diet, getting regular exercise, and keeping your cholesterol at a healthy level may also help prevent aneurysms or their complications.

References

Isselbacher EM. Diseases of the aorta. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 78.

Zivin JA. Hemorrhagic cerebrovascular disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 432.

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 146.

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Congenital afibrinogenemia

Definition

Congenital afibrinogenemia is a rare, inherited blood disorder in which the blood does not clot normally. It occurs when you are missing or have a problem with a protein called fibrinogen, which is needed for the blood to clot.

Causes

This rare disease is caused by an abnormal gene that must be passed down from both parents. There may be either a lack of fibrinogen or a defect in the functioning of available fibrinogen. This condition can occur in both sexes. The main risk factor is a family history of bleeding disorders.

Symptoms

• Bruising
• Nosebleeds
• Excessive bleeding after injury or surgery
• Gastrointestinal bleeding
• Bleeding in joints
• Miscarriage

Exams and Tests

If the health care provider suspects a bleeding disorder, laboratory tests can determine the type and extent. This disorder usually shows up in childhood, often at birth.

Tests include:

• PTT
• Prothrombin time (PT)
• Clotting time
• Fibrinogen levels
• Thrombin time
• Reptilase time
• Bleeding time

All of these tests are abnormal in afibrinogenemia.

Treatment

Patients may receive the liquid portion of the blood (plasma) or a blood product containing concentrated fibrinogen (cryoprecipitate) through a vein (transfusion) to treat bleeding episodes or to prepare for surgery to treat other conditions. People with this condition should have the hepatitis B vaccine because transfusion increases the risk of hepatitis.

Outlook (Prognosis)

Excess bleeding is common with this condition. These episodes may be severe, or even fatal. Bleeding in the brain is a leading cause of death in patients with this disorder.

Possible Complications

• Bleeding from the umbilical cord
• Bleeding from the mucous membranes
• Gastrointestinal bleeding
• Intracranial bleeding
• Clotting with treatment
• Development of antibodies (inhibitors) to fibrinogen with treatment

When to Contact a Medical Professional

Call your health care provider or seek emergency care if you have excessive bleeding.

Tell your surgeon before you have surgery if you know or suspect you have a blood disorder.

Prevention

There is no known prevention. Couples who are thinking about having children may find genetic counseling helpful if at least one partner has this condition.

References

Hoffman R, Benz E, Shattil S, Furie B, Cohen H. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Churchill Livingstone, 2004.

Asselta R, Duga S, Tenchini ML. The molecular basis of quantitative fibrinogen disorders. J Thromb Haemost. October 2006;4:2115-2129.

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Adenoma

Adenoma (innocent hyperplasia of prostate gland, to be exact external glands of prostata) - hormonedependent disease at which there is a growth of a tela of prostate gland leading infringement of process urination.

Most often an adenoma diagnose for men older 50 years are more senior, therefore some experts consider the given disease by one of displays of a man's climax. Except for age changes there are some more the factors promoting occurrence of illness:
* hormonal infringements
* presence of other chronic diseases (an atherosclerosis etc.)
* a sedentary way of life
* the big increase in weight of a body
* the ecological factor

At an adenoma under action of testicular hormone (a man's sexual hormone) growth of cells of a ferruterous tela which adjacent direct to a wall of the urethra which are passing through prostate gland begins. Eventually proliferative the tela starts to press on urethra that leads to its narrowing. Than more time there is a disease, especially strong pressure appears on a urethra. Problems with urination begin:
* speeded up urination
* complicated and faltering urination
* a weak pressure of a uric jet
* incontience urine or a sharp delay wet
* erythrocyturia (blood in urine)

As the heaviest cases are considered a sharp delay wet and erythrocyturia. At long-standing current of illness prostate gland increases so, that ejecting a bladder becomes impossible. In such cases of patients urgent hospitalization is required. Occurrence of blood in urine specifies damage of veins of a bladder as a result of elevated pressure in it.
Depending on duration of current of disease and clinical displays allocate three stages of an adenoma. At initial stages symptoms of disease are expressed slightly, therefore the patient can not notice them at all. At the first initial stage the patient tests: frequent desires to urination, especially at night-time, time urination increases, a jet wet languid.

At transition of disease to the second stage it is observed: formation of residual urine, difficulty of outflow of urine from a bladder, faltering urination, sensation incomplete ejecting.
The further progress of illness leads to a delay or incontience of urine, internal constrictor loses the tone, can appear nethritic insufficiency.
Quite often the adenoma meshs with other diseases of urinogenital system (a cystitis, an urethritis, a pyelonephritis, urolithic illness, etc.), that is connected with infringement of process urination.
Treatment can be conservative and surgical. Selection of this or that method depends on weight of illness, availability of accompanying diseases, specific features of the patient.

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Prostatitis. Symptoms of a prostatitis. Treatment of a chronic prostatitis

The prostatitis - disease so complex and artful, that its treatment represents a greater problem for doctors of all world. However it at all does not mean, that the doctor anything helps sick of a prostatitis cannot, and to go to it it be no point. Not always there is a possibility completely to cure the patient of a prostatitis, but to eliminate symptoms of disease and to cause resistant long-term remission modern medicine in forces. And there duration of this period will already depend on the patient.

The prostatitis can suddenly develop, as sharp inflammatory disease with all corresponding semiology. In this case at the patient heat, a fever, a body temperature 38-39 With, sharp pains in perineum, a groin, for pubis, areas of back pass, painful urination and defecation will be marked.

Unfortunately, the medicine in general and urology in particular cannot boast of achievements in treatment of a syndrome which we name "prostatitis". The cancer of a prostata gland and innocent hyperplasia of prostate gland was intercepted with attention of the scientific, research centers and the pharmaceutical companies. And a prostatitis as " the poor relative " these diseases, remained long time outside of sphere of interests of the advanced medicine. Though all knew, that the echo the "dark horse" amazing prostate gland, and accordingly the attitude to a prostatitis as to "dark horse" was superficial, and sometimes - deformed.

The reasons for it was a little. Was considered, that the prostatitis does not bear direct threat for a life of the patient and, means, with this disease it is possible to adapt to live. Now the situation has cardinally changed, when to one of priorities of modern medicine became quality of a life. Last researches have shown, that the chronic prostatitis is one of frequent clinically and socially significant diseases. And mental health at a chronic prostatitis suffers not less, than at other heavy somatic diseases, that sharply reduces quality of a life of men. And it has served as serious stimulus for studying this problem.

Another very the cardinal error consist that many doctors have been convinced, and the some people till now consider, that the reason of all cases of a prostatitis is the chronic infection which is necessary for treating antibacterial preparations. Already absolutely the fact in evidence considers, that the chronic bacterial prostatitis is rather rare disease and makes only 10 % among all cases of a prostatitis.

One more serious problem are complexities in diagnostics of some forms of a prostatitis, and it is the reason of inadequate and ineffective treatment of such patients, that finally leads frustration both the patient, and the attending physician.

For example, men with urological masks of depression (urethral hypochondriacs) quite often became patients of urologists and many years were treated for a nonexistent prostatitis. It only aggravated opinion on complexity and hopelessness of treatment of a prostatitis. Other typical mistake was the far-fetched interrelation of a chronic prostatitis and erectile dysfunctions. Until recently, the mechanism fo erection has not been studied yet and methods of diagnostics and treatment of infringements erection are not standardized, the majority of the patients addressing to the urologist with AD, there passed inspection and treatment of a chronic prostatitis. In occasion of nonexistent disease of the patient accepted set of antibiotics, to it on a regular basis massed prostate gland and appointed various physiotherapeutic procedures. Thus the erection was not restored, and to the patient the label of "prostatics" that caused serious damage to mental health was attached.

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Pleurisy

Definition

Pleurisy is inflammation of the lining of the lungs that causes pain when you take a breath or cough.

Alternative Names

Pleuritis; Pleuritic chest pain

Causes

Pleurisy may develop when you have lung inflammation due to infections such as pneumonia or tuberculosis. It may also occur with:

• Asbestos-related disease
• Certain cancers
• Chest trauma
• Pulmonary embolus
• Rheumatic diseases

When you have pleurisy, the normally smooth lining of the lung (the pleura) become rough. They rub together with each breath, and may produce a rough, grating sound called a "friction rub." The health care professional can hear this sound with the stethoscope, or by placing an ear against the chest.

Symptoms

The main symptom of pleurisy is pain in the chest. Some people feel the pain in the shoulder.

Deep breathing, coughing, and chest movement makes the pain worse.

Pleurisy can cause fluid to collect inside the chest cavity. This can make breathing difficult and may cause the following symptoms:

• Coughing
• Cyanosis
• Shortness of breath
• Rapid breathing (tachypnea)

Exams and Tests

The doctor will use a stethoscope to listen to the lungs for abnormal sounds.

The health care provider may perform the following tests:

• CBC
• Thoracentesis
• Ultrasound of the chest
• X-ray of the chest

Treatment

The health care provider can remove fluid in the lungs by thoracentesis and check it for signs of infection.

Treatment depends on what is causing the pleurisy. Bacterial infections are treated with antibiotics. Some bacterial infections require a surgical procedure to drain all the infected fluid.

Viral infections normally run their course without medications. Patients often can control the pain of pleurisy with acetaminophen or anti-inflammatory drugs such as ibuprofen.

Outlook (Prognosis)

Recovery depends on what is causing the pleurisy.

Possible Complications

• Breathing difficulty
• Collapsed lung due to thoracentesis
• Complications from the original illness

When to Contact a Medical Professional

Call your health care provider if you have symptoms of pleurisy. If you have breathing difficulty or your skin turns blue, seek immediate medical care.

Prevention

Early treatment of bacterial respiratory infections can prevent pleurisy.

References

Marx J, et al. Rosens Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1005.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:497-498.

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General paresis

Definition

General paresis is an impairment of mental function caused by damage to the brain from untreated syphilis.

Causes

General paresis is one form of neurosyphilis. Today it is very rare.

The syphilis infection damages the nerves of the brain. This damage causes:

• Abnormal mental function including hallucinations and false ideas (delusions)
• Brief, sharp, "lightning" pains that occur with tabes dorsalis
• Decreased mental function
• Eye changes and abnormal pupil response
• Mood changes
• Overactive reflexes
• Personality changes
• Speech changes

General paresis usually begins about 15-20 years after the syphilis infection. Risks include syphilis infection and infection with other sexually transmitted diseases, such as gonorrhea (which may hide symptoms of syphilis infection).

Syphilis infections are passed through sexual contact with an infected person, but may also be transmitted by non-sexual contact.

Symptoms

• Decreased language ability (aphasia)
• Decreased motivation
• Impaired judgment
• Loss of ability to calculate
• Loss of long-term memory (long-past events)
• Loss of short-term memory (recent events)
• Muscle weakness (difficulty using legs, arms, or other parts of the body)
• Personality changes
  • Delusions, hallucinations
  • Irritability, anger
  • Inappropriate moods
  • No mood
• Seizures

Exams and Tests

Signs include:

• Change in the response of the pupil in the eye
• Inability to stand with the eyes closed (Romberg test)
• Loss of sense of vibration and position
• Muscle weakness
• Problems with walking (gait)
• Slowly worsening dementia, with loss of many brain functions

The doctor may do the following tests:

• Eye exam
• Muscle exam
• Nervous system (neurologic) exam

Blood tests to detect syphilis in the body include:

• FTA-ABS
• RPR
• VDRL

Tests of the nervous system may include:

• Cerebrospinal fluid (CSF)
• Head CT scan and MRI
• Nerve conduction tests

Treatment

The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics, such as doxycycline, to treat the infection. Treatment may continue until the infection has completely cleared.

Treating the infection will reduce new nerve damage, but it will not cure damage that has already occurred. A follow-up examination of the cerebrospinal fluid is needed to see whether the antibiotic therapy worked.

Treatment of symptoms is needed for existing nervous system damage. Emergency treatment of seizures may be needed. Anticonvulsants (such as phenytoin) can help control seizures.

Patients who are unable to care for themselves may need help with such activities as eating and dressing. Those with muscle weakness may need occupational therapy or physical therapy.

Outlook (Prognosis)

Without treatment, people can become disabled. People with late syphilis infections are more likely to get other infections and diseases.

Possible Complications

• Inability to care for yourself
• Inability to communicate or interact with others
• Injury due to seizures or falls

When to Contact a Medical Professional

Call your health care provider if you have symptoms of general paresis, especially if you know you've been infected with syphilis.

Go to the emergency room or call the local emergency number (such as 911) if you have seizures.

Prevention

Treating primary syphilis and secondary syphilis infections will prevent general paresis.

Practicing safe sex, such as limiting partners and using protection may reduce the risk of getting infected with syphilis. Avoid direct skin contact with patients who have secondary syphilis by wearing gloves.

References

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:404-406.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders;2003: 931-933.

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Parkinson's disease

Parkinson's disease (vorum tremens) is the chronic progressing disease of a brain for the first time was described in 1817 by J. Parkinson. Patients who has Parkinson's disease often suffer from involuntary trembling finitenesses (tremor), muscular rigidity, infringements of coordination and speech, and also experience difficulties with movement. These symptoms usually occurs after 60 years though cases of Parkinson's disease are known in the age of 50 years are more younger.

Parkinson's disease is a progressing disease, i.e. its symptoms and appearance eventually become aggravated and worsen. However, in spite of the fact that finally Parkinson's disease leads to physical inability and loss of capacity, disease progresses slowly, and even after statement of the diagnosis the majority of patients as early as long years can conduct a high-grade life.

Moreover, unlike other serious neurological diseases, Parkinson's disease gives in to treatment. Often resort to medicamentous treatment, or implant in a brain the special device stimulating brain activity. In extreme cases resort to surgical intervention - operations on a brain a method stereotaxis which essence consists in destruction of a small zone in subcrustal structures of a brain. Searches of effective means of treatment of Parkinson's disease now proceed.

Symptoms of Parkinson's disease

The first symptoms of Parkinson's disease is difficult to notice, as, for example, an immovability of hands at walking, an easy tremor in fingers of one hand or insignificant infringements of speech. Patients feel a devastation, a breakdown, depressions are subject or suffer from a sleeplessness. Besides habitual employment (a shower, shaving, cooking, etc.) require major efforts and borrow more time.

Other symptoms of Parkinson's disease

* Tremor. The tremor often begins with easy trembling hands or even separate fingers. Sometimes the tremor of hands is accompanied by the non-uniform movement of the big and average fingers reminding overrolling of invisible pills (so-called «a syndrome of driving of pills»). Sometimes there is also a tremor of the bottom finitenesses. These symptoms can be more expressed on one party of a body or be shown symmetrically and to be combined with other symptoms of defeat of nervous system. the Tremor is especially shown by infringements of coordination, sensitivity, when the patient is in a condition of stress. Though the tremor of finitenesses causes significant inconveniences, it does not lead to loss of capacity and disappears only when the patient sleeps. Many patients with Parkinson disease suffer only from an insignificant tremor.

* Slowness of movement (bradykinesia). In due course Parkinson's disease "acquires" new symptoms, among which slowness and awkwardness of movements, as well as infringement of coordination. Rigidity of muscles of legs can complicate movement, gait is broken. It especially annoyingly as complicates performance of the elementary actions.

* Rigidity of muscles. Often there is a rigidity of muscles of neck and finitenesses. In some cases rigidity even holds down movements and hurts.

* Loss of balance. Parkinson's disease, especially in a heavy condition, it is often accompanied by inability to keep balance. For many years this problem remains insignificant and does not cause discomfort.

* Loss of automatism of movements. Blinking, occurrence of a smile and flourish hands at walking - automatic actions of a normal organism which are carried out at a subconscious level and even besides our desire. At patients with Parkinson's disease this automatism of movements often vanishes, and and sometimes and disappears absolutely. In some cases on the person of patients expression of the steadfast and intense attention, a unblinking sight is fixed. At some patients, except for a mimicry, ability to gesticulation vanishes also.

* Infringement of an articulation. Many patients also suffer from infringement of speech - it can become slightly modulated, illegible. The voice loses intonations and becomes monotonous and silent. For older people it represents a special problem, as badly hearing elderly co-habitants can simply not hear them.

* Infringement of swallowing and salivation. This symptom appears at late stages of development of illness, but, with rare exception, patients with this symptom nevertheless are capable to accept food independently.

* Dementia. The insignificant percent of patients suffers from dementia - inability to think, understand and remember. This symptom also appears at recent stages of disease. Though dementia consider as display of Alzheimer's disease is more often, it can accompany and other serious diseases, including Parkinson's disease. In this case delay of thought processes and inability attests to the beginning of dementia to concentrate.

Reasons of occurrence of Parkinson's disease

For those 200 years that have passed from the moment of opening Parkinson's disease, scientists were possible to understand some aspects and processes of this most complicated disease.

Today it is known, that many symptoms and displays of Parkinson's disease develop owing to damage or destruction of the certain nervous terminations, located in black substance of a brain. In a normal condition these nervous cells develop dopamine. Function of dopamine consists in smooth transfer of impulses for maintenance of normal movements. At Parkinson's disease production of dopamine decreases, normal transfer of nervous impulses is broken and there are basic symptoms of Parkinson's disease.

During ageing all people lose some part developing of dopamine neutrons. But patients with Parkinson's disease lose more than half of the neutrons located in black substance. Though there is a degeneration and other cells of a brain, the cells developing of dopamine, are necessary for movement, therefore their loss is catastrophic. The reasons of damage or destruction of these cells till now is object of many researches. In opinion of scientists, Parkinson's disease can develop owing to an adverse combination of genetic and external factors. The certain medicines, illnesses and toxic substances also can create a clinical picture, characteristic for Parkinson's disease.

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Common Pain Killers Can Mask Signs of Prostate Cancer

Common painkillers taken on a regular basis, such as ibuprofen and aspirin, appear to lower a man's PSA level, the blood biomarker used by doctors to help gauge whether a man is at a risk of getting prostate cancer.

The authors of this new study, however, caution that men should not take the painkillers in an effort to prevent prostate cancer. An author on this study Eric A Singer M.D., M.A., a urology resident at the University of Rochester Medical Center, said, "We showed that men who regularly took certain medications like aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDS, had a lower serum PSA level.... But there's not enough data to say that men who took the medications were less likely to get prostate cancer. This was a limited study, and we do not know how many of those men actually got prostate cancer."

Singer and his team studind the records of approximately 1,319 men that were over the age of 40 who took part in the National Health and Nutrition Examination Survey between the years 2001 and 2002. Singer's team looked at the men's use of NSAIDs such as ibuprofen and aspirin, as well as acetaminophen, and they looked at their PSA levels. The level of a man's PSA, or prostate-specific antigen, is one of the numerous clues that doctors watch to gauge the risk a man has of getting prostate cancer.

The researchers found that men who did use NSAIDs on a regular basis had PSA levels that were about 10 percent lower than the men who did not use them. The team then made a similar observation with the pain killer acetaminophen, but the result was not statistically significant due to the lower number of men in the study that were taking that medication.

While it might be easily assumed that if you have lower PSA levels that this automatically translates to a low risk of getting prostate cancer, the authors stress that it is still too soon to draw that kind of conclusion. The corresponding author of the study Edwin van Wijngaarden, Ph.D., and the assistant professor in the Department of Community and Preventative Medicine states that while the results of this study are consistent with other research, and indicates that certain commonly used painkillers may reduce a man's risk of getting prostate cancer, the new findings are just preliminary and do not prove a link.

Singer stated that the PSA level of a man can be elevated for many reasons that are unrelated to cancer. For instance, while inflammation is a part of cancer, sometimes it may not be, and so it is possible that the lowered level of PSA reflects the reduction of inflammation without affecting a man's risk of getting prostatism. Also, another possibility is that a PSA level that this lowered by taking NSAIDs might artificially mask a man's risk of contracting prostate cancer. The pain medications could lower the PSA, but a man's risk might stay the exact same.

Singer says, "More than anything, these findings underscore the importance for doctors to know what medications their patients are on. For instance, there are medications commonly used to treat an enlarged prostate that can result in a decreased PSA, and most physicians know that. Doctors should also be asking about patients' use of NSAIDs such as aspirin and ibuprofen."

The data is said to show much interest, but it will take more research to determine how to interpret all the findings. In the meantime, these findings should not change men's behavior and prompt them to take these pain medications to try and prevent themselves from getting prostate cancer.

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Marijuana Use May Significantly Increase Risk of Testicular Cancer

According to the National Survey on Drug Use and Health, marijuana is the most widely used illicit drug in the U.S., with 95 million Americans age 12 and older having used the drug at least once, and three out of every four illegal drugs users reporting its use within the previous 30 days. Most users perceive marijuana as a natural herb thereby believing it to be harmless.

In truth, the habitual use of marijuana has been proven to cause concentration and thinking problems, deficits in mathematical skills and verbal expression, as well as selective impairments in memory retrieval processes. It can also lead to increased anxiety, panic attacks, depression, and other mental health problems. The long-term consequences of using marijuana include poor academic performance, poor job performance, cognitive deficits, and even lung damage.

New U.S. research has now added to the ever-growing list of dangers associated with the use of marijuana. The new study has shown that people who frequently use marijuana may be at more than double the risk of developing testicular cancer.

The study included 369 men from the Seattle-Puget Sound area who had been diagnosed with testicular cancer as well as 979 men without the disease. The study participants ranged in age from 18 to 44. Each participant was asked about his history of marijuana use. The findings revealed that current marijuana users were 70 percent more likely to develop a testicular malignancy than nonusers.

The risk was shown to be highest among those who had used marijuana for at 10 years or longer or began their usage before age 18 as well as those currently using it more than once a week. In addition, the study results suggested that a specific type of testicular cancer known as nonseminoma was linked to the drug’s use. Nonseminoma is a fast-progressing testicular malignancy that accounts for approximately 40 percent of all testicular cancer cases and most often develops in people between the ages of 20 and 35. The results of the analysis were published in the journal Cancer.

Research group member Stephen Schwartz, an epidemiologist and member of the Public Health Sciences Division at the Seattle's Fred Hutchinson Cancer Research Center said, “Our study is not the first to suggest that some aspect of a man's lifestyle or environment is a risk factor for testicular cancer, but it is the first that has looked at marijuana use.”

Although experts remain uncertain as to the causes of testicular cancer, known risk factors include a family history of the disease, undescended testes and abnormal testicular development. The link between marijuana use and the disease may be attributed to a disruption of the effects of a chemical that is naturally produced by the male reproductive system believed to have a protective effect against cancer.

Approximately 8,000 men within the U.S. are diagnosed with testicular cancer annually. According to the American Cancer Society, The disease has a five-year survival rate of about 96 percent as it usually responds well to treatment. However, some patients are not diagnosed until the disease is in its advanced stages. Performing regular testicular self-examinations can help to insure successful treatment by identifying growths that are still in the early stages.

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Salmonellosis, symptoms of the Salmonellosis. Treatment of the Salmonellosis.

The salmonellosis is the pluricausal infectious disease caused various serotypes of bacteria of sort Salmonella, is characterized by various clinical displays from asymptomatic carrier state up to heavy septic forms. In most cases of the salmonellosis proceeds with primary defeat of bodies of a digestive path (gastroenteritis, colitis). The activator of the Salmonellosis - greater group of salmonellas (family Enterobacteriaceae, sort Salmonella), numbering now more than 2200 serotypes.

Sources of the Salmonellosis are basically pets and the birds, however the certain value the person (plays also the patient, the carrier) as an additional source.

The basic way of infection at a salmonellosis - alimentary, caused by the use in food of products in which a plenty of salmonellas contains. Usually it is observed at wrong culinary processing. Treatment of a salmonellosis.
The incubatory period at a food way of infection with the Salmonellosis fluctuated from 6 h up to 3 days (more often 12-24). At nosocomial flashes when the contact-household way of transfer of an infection prevails, incubation a salmonellosis about 3-8 days are extended. Allocate following clinical forms of a salmonellosis:

- The gastrointestinal (localized), proceeding in stomachal, gastroenteritis, gastroenterocolitis and coloenteritis variants;
- The generalized form of a salmonellosis in the form of typhoid and septic variants;
- The diphtheriaphor: sharp, chronic and transient;
- The subclinical form of a salmonellosis;

Clinical forms of a salmonellosis differ and on weight of current.

The gastrointestinal form (a sharp gastritis, sharp gastroenteritis or gastroenterocolitis) - one of the most widespread forms of a salmonellosis (96-98 % of cases). Begins sharply, the body temperature (raises at heavy forms up to 39С and above), there is a general weakness, a headache, a fever, a nausea, vomiting, pains in epigastric and umbilical areas, frustration of a chair later joins. At some sick the salmonellosis in the beginning marks only a fever and attributes of the general intoxication, and changes from a gastroenteric path join a little bit later. They are Most expressed by the end of the first and for the second and third day from the beginning of disease by a salmonellosis. Expressiveness and duration of displays of a salmonellosis depend on weight.

At the easy form of a salmonellosis a body temperature subfebrile, vomiting unitary, a chair liquid aqueous up to 5 times day, duration of a diarrhea 1-3 days, loss of a liquid no more than 3 % of weight of a body. At the middle form of a salmonellosis the temperature raises up to 38-39оС, duration of a fever till 4 days, repeated vomiting, a chair up to 10 times day, duration of a diarrhea till 7 days; the tachycardia, downturn the AD are marked, can develop deaquation I-II degrees, loss of a liquid up to 6 % of weight of a body. Heavy current gastrointestinal forms of a salmonellosis is characterized by a high fever (above 39оС) which lasts 5 and more days, the expressed intoxication. Vomiting repeated, is observed within several days; the chair more than 10 times day, plentiful, aqueous, fetid, can be with an impurity of slime. The diarrhea proceeds till 7 days and more.

The increase in a liver and spleen is marked, is possible icteritiousness leather and sclera. The tachycardia, significant downturn the AD are observed cyanosis leather. Changes from kidneys come to light: oligohydruria, albuminuria, erythrocyte and cylinders in urine, the maintenance of residual nitrogen raises. Can develop sharp nephritic insufficiency. The water-salt exchange (deaquation II-III degrees) is broken, that is shown in dryness of a leather, blue disease, aphonia, spasmes. Losses of a liquid reach 7-10 % of weight of a body. In blood the level of hemoglobin and erythrocyte raises, is characteristic moderated leukocytosis with shift leukocytic formulas to the left.

The most frequent clinical variant at gastrointestinal a salmonellosis gastroenteritis. Destructive changes at a salmonellosis in a thick gut are registered only in 5-8 % of cases. Gastroenterology and colitis variants of a salmonellosis should be diagnosed only if in a clinical picture of disease displays colitis prevail and is available bacteriological or serologic acknowledgement of the diagnosis as these variants of a salmonellosis are rather similar on current to a sharp dysentery.

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Tuberous sclerosis

Definition

Tuberous sclerosis is a group of two genetic disorders that affect the skin, brain/nervous system, kidneys, and heart, and cause tumors to grow. The diseases are named after a tuber- or root-shaped growth in the brain.

Alternative Names

Adenoma sebaceum

Causes

Tuberous sclerosis is inherited. Changes (mutations) in two genes, TSC1 and TSC2, are responsible for the condition.

Only one parent needs to pass on the mutation for the child to get the disease. However, most cases are due to new mutations, so there usually is no family history of tuberous sclerosis.

This condition is one of a group of diseases called neuro-cutaneous syndromes. Both the skin and central nervous system (brain and spinal cord) are involved.

There are no known risk factors, other than having a parent with tuberous sclerosis. In that case, each child has a 50% chance of inheriting the disease.

Symptoms

Skin symptoms include:

• Caf-au-lait spots
• Red patches on the face containing many blood vessels (adenoma sebaceum)
• Raised patches of skin with an orange-peel texture (shagreen spots), often on the back
• White areas of skin that look like an ash leaf (ash leaf spots)

Brain symptoms include:

• Developmental delays
• Mental retardation
• Seizures

Other symptoms:

• Heart tumors (rhabdomyoma)
• Kidney tumors
• Pitted dental enamel
• Rough growths under or around the fingernails and toenails
• Rubbery non-cancerous tumors on or around the tongue

The symptoms of tuberous sclerosis vary from person to person. Some people have normal intelligence and no seizures. Others have severe retardation, serious tumors, or difficult-to-control seizures.

Exams and Tests

Signs may include:

• Abnormal heart rhythm (arrhythmia)
• Calcium deposits in the brain
• Non-cancerous "tubers" in the brain
• Rubbery growths on the tongue or gums
• Tumor-like growth (hamartoma) on the retina, pale patches in the eye
• Tumors

Tests may include:

• CT scan of the head
• MRI of the head
• Ultrasound of the kidney
• Ultraviolet light examination of the skin

DNA testing for either of the two genes that can cause this disease (TSC1 or TSC2) is available.

Regular ultrasound checks of the kidneys are an important screening tool, to make sure there is no tumor growth.

Treatment

There is no specific treatment for tuberous sclerosis. Because the disease can differ from person to person, treatment is based on the symptoms.

Medications are needed to control seizures, which is often difficult. Depending on the severity of the menal retardation, the child may need special education.

Small growths (adenoma sebaceum) on the face may be removed by laser treatment. These growths tend to come back, and repeat treatments will be necessary.

Rhabdomyomas commonly disappear after puberty, so surgery is usually not necessary.

Support Groups

For additional information and resources, contact the Tuberous Sclerosis Alliance at 800-225-6872.

Outlook (Prognosis)

Children with mild tuberous sclerosis usually do well. However, children with severe retardation or uncontrollable seizures usually do poorly. Occasionally when a severely affected child is born, the parents are examined, and one of them is found to have had a mild case of tuberous sclerosis that was not diagnosed.

The tumors in this disease tend to be non-cancerous (benign). However, some tumors (such as kidney or brain tumors) can become cancerous.

Possible Complications

• Brain tumors (astrocytoma)
• Heart tumors (rhabdomyoma)
• Severe mental retardation
• Uncontrollable seizures

When to Contact a Medical Professional

Call your health care provider if:

• Either side of your family has a history of tuberous sclerosis
• You notice symptoms of tuberous sclerosis in your child

Call a genetic specialist if your child is diagnosed with cardiac rhabdomyoma. Tuberous sclerosis is the leading cause of this tumor.

Prevention

Genetic counseling is recommended for prospective parents with a family history of tuberous sclerosis. Prenatal diagnosis is available for families with a known DNA mutation. However, tuberous sclerosis often appears as a new mutation, and these cases are not preventable.

References

Haslam RHA. Neurocutaneous Syndromes. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 596.

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Bunions

Definition

A bunion is when your big toe points toward the second toe. This causes a bump on the edge of your foot, at the joint of your big toe.

Alternative Names

Hallux valgus

Causes

Bunions occur more commonly in women and sometimes run in families. People born with abnormal bones in their feet are more likely to form a bunion. Wearing narrow-toed, high-heeled shoes may lead to a bunion. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe.

Symptoms

• Red, calloused skin along the foot at the base of the big toe
• A bony bump at this site
• Pain over the joint, aggravated by pressure from shoes
• Big toe turned toward the other toes

Exams and Tests

A doctor can usually diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot and, in some cases, arthritis.

Treatment

When a bunion first begins to develop, take good care of your feet and wear wide-toed shoes. This often solves the problem and prevents the need for any further treatment. It may help to wear felt or foam pads on the foot to protect the bunion, or devices to separate the first and second toes at night. These are available at drugstores. You can also try cutting a hole in a pair of old, comfortable shoes to wear around the house.

If the bunion gets worse -- resulting in severe deformity or pain -- surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are over 100 different surgical techniques that have been described to treat this condition.

Outlook (Prognosis)

The outlook depends on your age and activities, and the severity of the bunion. Teenagers may have more trouble treating a bunion than adults. Many adults do well by caring for the bunion when it first starts to develop, and wearing different shoes. Surgery reduces the pain in many, but not all, people with bunions.

Possible Complications

• Chronic foot pain
• Foot deformity
• Stiff foot
• Hallux varus (occurs with surgical over-correction, where the toe points away from the second toe)

When to Contact a Medical Professional

Call for an appointment with your doctor if the bunion:

• Continues to cause pain even after self care, such as wearing wide-toed shoes
• Prevents you from doing your usual activities
• Has any signs of infection (like redness or swelling), especially if you have diabetes

Prevention

Avoid compressing the toes of your foot with narrow, poor-fitting shoes.

References

Vanore JV. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1: Hallux valgus. J Foot Ankle Surg. 2003; 42(3): 112-123.

King DM. Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs. Foot Ankle Int. 2004; 25(4): 251-255.

Ferrari J, Higgins JP, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev. 2004.

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Donovanosis. Venereal granuloma

Except for the name «donovanosis» this venereal illness also refers to venereal granuloma, the fifth venereal illness, is simple granuloma or granulomatosis, tropical inguinal granuloma, granuloma ulcer genitals, inguinal granuloma. The name «granuloma» occurs from a latin word granulum – "kernel", and there was it of that the basic symptoms of venereal granuloma are really reminding grains papule – small pimples on genitals.

Speaking about classical venereal diseases, venereologists, as a rule, keep in mind five diseases. Two of them – a syphilis and a gonorrhoea – are widely widespread worldwide. Other three concern to type of rare infections in Russia, transferred by sexual contact. It is soft chancre («the third venereal illness»), inguinal megakaryoblastoma («the fourth venereal illness»), and, finally, venereal granuloma («the fifth venereal illness»).

In comparison with "counterparts", especially with a syphilis, donovanosis looks a harmless sore. However harmless venereal illnesses does not happen, and venereal granuloma is not exception. Complications granulomatosis if they are reached with business, can be more than serious and dangerous to human life.

Venereal granuloma is the chronic infection transferred, similarly to other venereal illnesses, first of all sexual by and slowly progressing in an organism of the infected person. Adults are ill venereal granuloma only, it is not transferred children.

The activator of venereal granuloma (donovanosis) owing to which illness has received this name, – bodies Donovan which refers to also Calymmatobacterium granulomatis or stick Aragan-Vianne. It is fine (1-2 microns) a bacterium bean-like or ovoid forms. At contact to patients, bacteria take root into a leather of genitals, perineum and other sites, causing disease.

In Russia cases venereal granuloma – a huge rarity as this illness is specific to the tropical countries with a warm and damp climate. Especially widely venereal granuloma it is widespread in Papua-new Guinea, Southern India, Southern Africa, the countries of Caribbean basin, in separate areas of Australia and Brazil. In America and in the Europe "brought in" cases venereal granuloma are registered only. There are scattered instances venereal granuloma and in Russia. Among our compatriots basically the people going in tropics on rest and interested persons to try of local "exotic" including in intimate relations catch.

Certainly, sick venereal granuloma the person can transfer an infection to the constant partner, but such cases – an even greater rarity, as venereal granuloma, on medical terminology, «rather less contagious». It means, that in difference, we shall tell from a gonorrhoea who is almost always transferred the healthy partner from the patient at the first not protected contact, venereal granuloma at sexual contact is transferred seldom enough.

According to statistics, the risk to catch venereal granuloma at the unitary not protected sexual contact to patients can change from 1 up to 50 %. Thus it is necessary to consider, that the damp climate and enough heat of an environment is necessary to a bacterium. Hence, arrived of tropics to Russia infected venereal granuloma "holidayer" is practically safe for constant partners, both at sexual attitudes, and at household contacts. And still it is better to not risk, because even 1 % of probable infection for one person can be quite enough.

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Cervical Cancer

Description An in-depth report on the causes, diagnosis, treatment, and prevention of cervical cancer.

Alternative Names Dysplasia; Human Papillomas Virus; Pap Smear

Treatment for Invasive Cervical Cancer Radiation therapy and surgery are about equally effective as a single option for treating very small cervical cancers in their earliest stages, with survival rates of up to 85% to 90% in appropriate patients. Factors influencing the choice between radiation therapy and surgery in women with invasive cancer include the patient's age and health and the extent of the disease. Both surgery and radiation therapy eliminate the possibility of having children in premenopausal women. Although treatments for cervical cancer have several potentially severe side effects, they are usually well-tolerated. Women undergoing any of these treatments should feel free to seek support groups and counseling, which can be as important for their outlook as medical therapies.

Surgery

In the early stages of cervical cancer, surgery is often the preferred primary treatment approach since it preserves normal sexual function. Surgery for invasive cancer is nearly always hysterectomy. Some patients desiring fertility who have early stage I cancer may be candidates for cervical cone biopsy.

Hysterectomy. A hysterectomy attempts to eliminate the cancerous tissue by removing the uterus. There are several variations of this operation, depending on the location of the tumor. In women of childbearing age, the ovaries can usually be left intact. Although a woman who has a hysterectomy but retains her ovaries cannot bear children, she will not go into premature menopause. (Studies indicate that leaving the ovaries intact is safe for most women and does not pose any greater risk for cervical cancer recurrence.)

A simple hysterectomy involves the removal of the uterus and the cervix, but leaves the parametrium (tissue surrounding the uterus) and vagina intact. Lymph nodes in the pelvis are not usually removed.

Click the icon to see an illustrated series detailing a hysterectomy.

A radical hysterectomy removes not only the uterus and the cervix but also the parametrium, the supporting ligaments, the upper vagina, and some or all of the local lymph nodes (a procedure called lymphadenectomy).

If the cancerous tumor recurs within the pelvis after primary treatment, a more extreme procedure may be performed called a pelvic exenteration, which combines radical hysterectomy with removal of the bladder and rectum. (In such cases, plastic surgery may be needed afterward to recreate an artificial vagina.) Patients undergoing this procedure are physically and psychologically screened in advance to determine whether it is an appropriate choice. The success rate for pelvic exenteration in halting the progression of the disease is approximately 25% to 45%.

Any form of hysterectomy is major surgery and requires at least a three to five day hospital stay. Although hysterectomy typically uses a wide abdominal incision, less invasive techniques that allow shorter recovery time may be possible for some women with early stage cancers if performed by experienced surgeons.

Side effects include difficulty emptying the bladder or bowels and a painful lower abdomen. Urinary tract infections are very common. Complications include fistulas (abnormal channels within the pelvis, which in this case are a result of surgery), bladder dysfunction, and cysts.

Normal activity, including intercourse, can be resumed in about four to eight weeks. Once the uterus is removed, menstruation will cease. If the ovaries are removed, the symptoms of menopause will begin. These symptoms are likely to be more severe in surgical menopause than in the course of a natural passage to menopause. Hormone replacement therapy should be considered. [For more information on hysterectomy see the Well-Connected Report #73, Fibroids: Uterineor Report #74, Endometriosis.]

Trachelectomy.An experimental procedure called trachelectomy is being investigated for preserving fertility in certain women in early stage cancer, but it is highly controversial and appropriate in only about 5% of cervical cancer patients. In the procedure, only the cancerous portion of the cervix is removed, while the uterus and the rest of the cervix are left intact. The cervix is closed with a suture.

Small, early studies suggest it may be effective for early stage 1 patients with no risk factors for aggressive cancer. In two small 1999 and 2000 studies, conception rates were between 27% and 37%, and survival rates after two years were over 95%. The procedure is primarily performed outside the US, and few American surgeons are skilled in this surgery at this time. Throughout the world, in fact, only about a few hundred of these procedures have been performed to date. Women should also realize that conception rates are still lower than normal. And even if they can get pregnant, there is a very high risk for miscarriage because the cervix is weakened. Larger and longer-term studies are needed to confirm its long-term safety.

Radiation

Radiation therapy is an alternative approach for early stage cervical cancer. Radiation with concurrent with cisplatin-based chemotherapy is now the standard treatment for locally advanced cervical cancer. Radiation therapy employs high-energy rays aimed at the body from an outside machine (external beam radiation) and radioactive materials placed inside the body against the cervix (intracavitary radiation).

• External beam radiation is given first and aimed at the lymph nodes along the pelvic wall. It usually involves a short period of direct-radiation five days a week for about six weeks in an outpatient setting.
• Intracavitary radiation (also called brachytherapy) follows and is designed to deliver high doses of radiation to the local tumor area. Radioactive material, typically cesium-137, is encapsulated in both gold and platinum. These capsules are inserted in a long stainless steel tube, called a tandem, which is inserted in the uterus and in small stainless steel cylinders, called colpostats, which are placed against the cervix as close to the cancerous cells as possible. Commonly, two or more radiation treatments are administered for about 35 hours each time. Radiation implants may also be inserted directly into the tumor using a needle.

In order to be effective, radiation therapy must be powerful enough to destroy the cancer cells' capacity to grow and divide. This means that normal cells are also affected, which may cause significant side effects. Fortunately, healthy cells usually recover quickly from the damage, whereas abnormal cells do not.

Advanced methods for targeting radiation more precisely are now available that limit the damage to healthy tissue. They include 3-D conformal radiation and intensity-modulated radiation therapy (IMRT):

• 3-D conformal techniques use computers and a three-dimensional image of the cervix to provide precise targeting of the tumor using multiple high-dose radiation beams.
• IMRT also uses 3-D techniques and employs very thin and precise beam at various intensities.

Side Effects. Side effects of radiation therapy include fatigue, redness or dryness in the treated area, diarrhea, frequent or uncomfortable urination, and vaginal dryness, itching, or burning. After treatment, side effects usually disappear.

Long-Term Complications. Complications include proctitis (inflammation of the rectum) and cystitis (inflammation of the bladder). Bowel obstruction is an uncommon complication. Radiation therapy may also cause vaginal scarring, sexual difficulties, and premature menopause in younger women. Occasionally an abnormal tunnel between the bladder and the vagina, known as a vesicovaginal fistula, will develop and may require surgery.

Click the icon to see an image of the female anatomy.

Investigative temporary silicone implants or a noninvasive device called the belly board may protect the small intestine during radiation therapy and help reduce complications.

Radiation itself may increase the risk for later development of cancer in the area surrounding the treated tissue. Although newer more precise radiotherapy approaches should reduce this risk, there is some concern that IMRT may double the incidence of secondary cancers over time compared to 3-D conformal techniques. This is of particular concern in younger patients.

Radiation and Hyperthermia. Investigators are studying hyperthermia (use of high heat often provided by ultrasound) in combinations with radiation therapy. This approach has shown some promise in achieving significant response rates in small studies. Comparison studies are important to determine if this approach would be as beneficial with radiation therapy as concurrent chemotherapy.

Chemotherapy

Chemotherapy employs cell-killing drugs, known as cytotoxic agents, to destroy widespread cancer cells that have spread from their point of origin (the primary tumor) and are, therefore, no longer treatable by surgery or radiation.

For many years, chemotherapy was only used with very advanced disease to reduce symptoms. Platinum-based chemotherapy agents (usually cisplatin) are now being used in many situations for cervical cancer including the following:

• In combination with radiation therapy to improve survival rates in certain women, including some with locally advanced cancer.
• In some women with locally advanced cancer to reduce tumors to the point where the cancer may be operable.
• When cancer has spread (metastasized), mostly to reduce symptoms such as pain.

Chemotherapy Agents Used.

• Platinum-Based Agents. One of the most active chemotherapeutic agents for cervical cancer is cisplatin, which enhances the effectiveness of radiation in the treatment of patients with more advanced disease stages. Cisplatin and carboplatin are known as platinum-based drugs. In general, platinum-based agents are the standard drugs used for this disease. Concurrent platinum-based agents and radiotherapy are important treatments for many later cancer stages. Even in treating metastatic disease, cisplatin used alone has been more helpful than even combinations of agents. There is some evidence that a combination of platinum plus paclitaxel with possibly other single agents may be more effective than platinum alone in the treatment of metastatic disease. Other platinum agents, such as nedaplatin, are under investigation.
• Drugs that Enhance Radiation. Some drugs being investigated appear to increase tumor response to radiation therapy, and so are known as radiation sensitizers or enhancers. Topotecan, a radioenhancer, for example, is showing some promise in early studies, although toxicity is high.
• Other Agents. Other drugs, mostly used in combinations, have also been investigated with some promise. They include with epirubicin, irinotecan, paclitaxel, bleomycin, mitomycin, vinorelbine, gemcitabine, and doxifluridine.

For cancer that has spread to other areas from its original source (metastatic disease), chemotherapy regimens may use single cytotoxic agents or several agents in combination.

Administration. Cytotoxic agents may be given orally or as injections. Treatment may be administered at a medical center, physician's office, or even a patient's home. Some patients receiving chemotherapy may need to remain in the hospital for several days so the effects of the drugs can be monitored. The drugs are often administered in cycles with a period of rest following a period of treatment in order to allow a recovery from the side effects.

Side Effects. Chemotherapy affects all fast-growing cells, including healthy ones, so some side effects are inevitable. Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment.

Common side effects include the following:

• Nausea and vomiting. Drugs known as serotonin antagonists, especially ondansetron (Zofran), can relieve these side effects in nearly all patients given moderate drugs and most patients who take more powerful drugs. In one study, a combination of dexamethasone (a corticosteroid) with ondansetron taken within 24 hours of chemotherapy achieved either a major or complete reduction in nausea and vomiting.
• Diarrhea.
• Temporary hair loss.
• Weight loss.
• Fatigue.
• Anemia.
• Depression.

Complications. Serious short- and long-term complications can also occur and may vary depending on the specific agents used. They include the following:

• Increased chance for infection from suppression of the immune system.
• Severe drops in white blood cells (neutropenia). Certain agents, such as taxanes, pose a higher risk for this than other chemotherapeutic drugs. White blood cell count may be improved with the addition of a drug called granulocyte colony-stimulating factor (either filgrastim and lenograstim).
• Liver and kidney damage.
• Abnormal blood clotting (thrombocytopenia).
• Allergic reaction, particularly to platinum-based agents. (A simple skin test in under investigation that may identify people with a potential allergic response.).
• Menstrual abnormalities are common and premature menopause occurs in about 30% of women, particularly in those over 40.
• Rarely, secondary cancers such as leukemia.
• Between a quarter and a third of women report problems in concentration, motor function, and memory, which may be long-term. This effect may be due to reductions in estrogen levels after treatments.

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Spasticity

Definition

Spasticity is stiff or rigid muscles with exaggerated, deep tendon reflexes (for example, a knee-jerk reflex). The condition can interfere with walking, movement, or speech.

See also: Muscle cramps

Alternative Names

Muscle stiffness

Considerations

Spasticity generally results from damage to the part of the brain that controls voluntary movement. It may also occur when you have damage to the nerves traveling from brain down to spinal cord.

Symptoms of spasticity include:

• Exaggerated deep tendon reflexes (the knee-jerk reflex)
• Scissoring (crossing of the legs as the tips of scissors would close)
• Repetitive jerky motions (clonus)
• Unusual posturing
• Carrying the shoulder, arm, wrist, and finger at an abnormal angle

Spasticity may also interfere with speech. Severe, long-term spasticity may lead to contracture of muscles, causing joints to be bent at a fixed position.

Causes

• Cerebral palsy
• Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
• Brain trauma
• Severe head injury
• Spinal cord injury
• Stroke
• Adrenoleukodystrophy
• Phenylketonuria
• Neurodegenerative illness
• Multiple sclerosis

This list is not all inclusive.

Home Care

Exercise, including muscle stretching, can help make your symptoms less severe.

When to Contact a Medical Professional

Contact your health care provider if:

• The spasticity worsens
• Contracture deformities appear to be developing
• Your condition gets worse

What to Expect at Your Office Visit

Your doctor will perform a physical exam and ask questions about your symptoms, including:

• When was it first noticed?
• How long has it lasted?
• Is it always present?
• How severe is it?
• What muscles are affected?
• What makes it better?
• What makes it worse?
• What other symptoms are also present?

Your doctor may refer you to a physical therapist. Physical therapy consists of variety of exercises, including muscle stretching and strengthening exercises. Physical therapy exercises can be taught to parents who may then help their child perform them at home.

Medicines for spasticity include baclofen, tizanidine, cyclobenzaprine, and benzodiazepines. In rare cases, a pump may be inserted into the spinal fluid to directly deliver medicine to the nervous system.

Botox injections may help relieve spasticity symptoms in some patients.

Sometimes, a person may need surgery to release the tendon or to cut the the nerve-muscle pathway.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 236, 247, 254.

Goldman L, Ausiello D. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa: WB Saunders; 2004:2324.

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Multiple Endocrine Neoplasia

- Diverse endocrine and metabolic infringements
- Symptoms are caused by infringements of secretion of one or several hormones
- Tumors often happen malignant
- The majority of tumors has a neuroectodermal origin
- Quite often syndromes of multiple endocrine neoplasia are accompanied of dysplasia of other organs and telas
- Both sporadic and family cases of multiple endocrine neoplasia are caused by genetic defects and inherited autosomal-dominant

The historical information:

- Communication between plural endocrine infringements and plural tumors of endocrine glands has been noticed by pathologists in the end of the last century. However modern representations about syndromes of multiple endocrine neoplasia have started to be formed in 50th years XX of a century. First Wermer has found out in several patients a combination of a hyperplasia of epithelial body, tumors of a hypophysis and tumors from insular cells and has suggested to name this syndrome plural endocrine adenomatosis (the modern name - multiple endocrine neoplasia type 1). A little bit later J. H. Sipple has described a syndrome including a medullar cancer of a thyroid gland and chromaffinoma. Today this syndrome can be named multiple endocrine neoplasia type 2a. Then R. N. Schimke has allocated a version of this syndrome, shown plural neuroma and other hereditary infringements (multiple endocrine neoplasia type 2b).

- Some hereditary syndromes, traditionally considered independent diseases, can be components of syndromes of multiple endocrine neoplasia. For example, the some endocrinologists consider Zollinger-Ellison syndrome as a component of multiple endocrine neoplasia type 1.

Genetics:

- All syndromes of multiple endocrine neoplasia are inherited autosomal-dominant and are characterized with high penetrance. In half of cases multiple endocrine neoplasia arises sporadically, i.e. is caused by again appeared mutation in sexual or somatic cells. The risk of disease at the child of the patient with sporadic multiple endocrine neoplasia makes 50 %. In families with multiple endocrine neoplasia the risk exceeds 75 %. Genealogic, cytogenetic and molecular-genetic researches have revealed the mutations underlying known types multiple endocrine neoplasia. These mutations can be found out by ПЦР with the subsequent hybridization about a site-specific oligonucleotides and to calculate individual and family risk of multiple endocrine neoplasia.

- Hypotheses. Tumors, characteristic for syndromes of multiple endocrine neoplasia, occur from cells of system APUD. According to the theory Pearse (1966), all cells of system APUD are derivatives of cells neuroectoderm (a nervous crest). Assume, that syndromes of multiple endocrine neoplasia are caused by mutations in cells of a nervous crest. These mutations are inherited by cells of endocrine glands and other cells of system APUD and lead to their tumoral transformation. In favour of this hypothesis existence of the so-called mixed types МЭН including hyperplasia of single cells of system APUD or tumours from such cells testifies. To mixed types of multiple endocrine neoplasia carry, for example, neurofibromatosis with attributes of multiple endocrine neoplasia types 1, 2а and 2b.

Against this hypothesis shows that fact, that at syndromes of multiple endocrine neoplasia quite often there are the new growths having an endodermal or a mesenchymal origin. It is not excluded, that the mutation causes transformation of cells only in one endocrine gland, and accompanying infringements have secondary character and are caused by hypersecretion of a hormone by cells of a primary tumour. It is known, for example, that at of multiple endocrine neoplasia type 1 hypersecretion of insulin by cells insulinoma causes hyperplasia of adenohypophysis.

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Etiology of Bacterial meningitis

The main activators of a bacterial meningitis is Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. All over the world they cause 75-80 % of cases of this disease, though a parity between these three activators in the different countries variously.

The meningitis caused Haemophilus influenzae, meets almost exclusively at children till 6 years. More than 90 % of Haemophilus influenzae's stock concern to type B; all of them encapsulated. To a meningitis precedes carrier state of microorganisms in a nasopharynx with their subsequent penetration into a blood-groove.

Neisseria meningitidis (meningococcus) usually causes a meningitis in children and young men. Epidemics usually caused by microorganisms are possible in serogroups A and B, less often in others serogroups. Neisseria meningitidis of serogroup B cause the majority of sporadic cases of a meningococcal meningitis. About 50 % of cases of a meningitis in the USA are caused by activators of this serogroup. Recently frequency of the infections caused Neisseria meningitidis serogroup B increases in Northern America, - first of all stocks which concern to clone ЕТ-15. These stocks cause flashes of disease with high fatality rate is more often. Stocks of serogroup Y cause a pneumonia. About 20 % of bacterial meningitises in the USA - meningococcal. One of the reasons of disease can be carrier state Neisseria meningitidis in a nasopharynx. The contributing factor - insufficiency of components of complement С5, С6, С7, С8 and, probably, С9 (membrane attack complex); thus the risk of the infections caused Neisseria spp., increases in 8000 times, however fatality rate decreases.

Activators of a bacterial meningitis at people 30 years are more senior more often happens Streptococcus pneumoniae (pneumococcus). In the age of 60 years a pneumococcus meningitis are more senior meets much more often, than at children. Streptococcus pneumoniae causes about 15 % of cases of a bacterial meningitis in the USA. At extramural contamination (from 1962 to 1988) has shown the analysis of 262 cases of a meningitis, that the most frequent activators were Streptococcus pneumoniae (37 %), Neisseria meningitidis (13 %) and Listeria monocytogenes (10 %). Ftality rate at a pneumococcus meningitis at adults remains high - 19-30 %.

The pneumococcus meningitis is usually complication of a pneumonia, an average otitis, mastoid disease, a sinusitis or infectious endocarditis. Contributing factors heavy pneumococcus infections - splenectomy, congenital asplenia or functional asplenism, erythroid myeloma, hypogammaglobulinemia, an alcoholism, a cirrhosis of a liver and Wiscott-Aldrich syndrome. Streptococcus pneumoniae - the most frequent activator of a meningism at crises of the basis of the skull, complicated by liquorrhea.

The meningitis caused Listeria monocytogenes, seldom meets in the USA, however fatality rate at it there is high. These microorganisms amaze newborns/elderly, the people, suffering with an alcoholism, a diabetes, malignant new growths, as well as adult population with the weakened immunity (for example, after transplantation of a kidney or at AIDS) is more often.

Encephalomeningitis, caused by Listeria monocytogenes, after transplantation of a kidney it is possible to reduce desease by means of preventive purpose trimethoprim/sulfamethoxazole. About in 30 % of cases circling disease at adults and in 50 % - at children do not find any contributing factors. Flashes of heavy circling disease are possible at the use in food of the infected milk, cheese or salad from crude cabbage, carrots and an onions.

The meningitis caused aerobic by gram-negative sticks, meets seldom. Exception newborns and make older people. So, at newborns the activator of a bacterial meningitis in 30-50 % of cases happens Escherichia coli. The meningitis after a craniocereberal trauma and neurosurgerical interventions, at older people, at an immunodeficiency, strongyloidosis or bacillemia can be caused Klebsiella spp., Escherichia coli and Pseudomonas aeruginosa. Prevalence of the meningitis caused by gram-negative sticks, is rather insignificant, but death rate remains high. Gram-negative sticks often happen activators of hospital infections, however frequency of the meningitis caused by these microorganisms at extramural contamination, recently increases - especially among the older people weakened, suffering an alcoholism and a diabetes.

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What can be a result of hepatitis?

Infection with a virus of a hepatitis, most probably leads to development of a hepatitis.

After infection there comes the incubatory period - time from penetration of a virus into blood before the first signs of disease (so - and developments of the certain changes in a liver). At a hepatitis A, B, C this period can be from 10-20 to 100-200 days and it depends on many factors. Development of a hepatitis passes a sharp phase - the first displays of an infection which can be appreciable and even heavy.

Then the recover could happens, when the virus leaves an organism and the condition of a liver comes to norm. Recover comes after all cases of a sharp hepatitis A and in most cases a of hepatitis B.If it will not occur, the chronic hepatitis develops.
The reasons on which there does not come recover after a sharp infection, usually carry to a condition of immune system. Unequivocally to tell, at whom there will come recover and at whom - is not present, it is impossible.

The chronic hepatitis develops at 5-10 % infected by a virus of a hepatitis B and at, at least, 60 % infected by a virus of a hepatitis C.

How the hepatitis can long proceed?

Sharp hepatitis usually come to the end with recover within 6 months. If the hepatitis proceeds longer than 6 months, speak about a chronic infection. Chronic hepatitis C and B have long-standing, long-term current. Even if thus long time is not observed displays of a hepatitis, the virus can be kept in a liver and continues. The risk of dangerous consequences of all this time is kept. At absence of displays of a hepatitis, but a constant tracking down of signs of a virus (markers of a virus hepatitis) speak about the chronic carrier. The carrier of a virus can become the reason of infection of other people. However carrying does not mean safety for the carrier.

What most dangerous consequences of a hepatitis?

The most dangerous consequence of a sharp hepatitis - development heavy fulminant forms of disease. It occurs seldom: nearby 1 % of cases of a hepatitis A and B in fulminant forms. The most dangerous consequences of a chronic hepatitis - development of a cirrhosis of a liver and a cancer (hepatocellular carcinoma). It occurs on a regular basis. The cirrhosis of a liver develops in 20% of cases of a chronic hepatitis B and in 5-20% of cases of hepatitis C. Virus hepatitis may cause the majority of cases of a cancer of a liver and serve as a principal cause of its change.

Whether can bring a hepatitis to ruin ill?
When it occurs?

The risk of a lethal outcome at sharp forms of a virus hepatitis is insignificant. It fulminant forms of a hepatitis B, as well as 0,1-2,1 % of cases of a hepatitis A with greater probability at adults. The risk of destruction from consequences of a chronic hepatitis makes 15-50 %. At development of a cirrhosis of a liver up to 50 % sick of a chronic hepatitis B and C perishes within 5 years. Outcomes of a chronic hepatitis In are included into number 10 of principal causes of death at men in developing countries (data the CART).

What hepatitis are more dangerous?

All a virus hepatitis are dangerous in their own way, one during the sharp period, others in connection with chronic current and risk of development of a cirrhosis of a liver.
No hepatitis can be disregarded.

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Health and Human Services Announces 5-Year Plan for Infection Prevention

The U.S. Department of Health and Human Services (HHS) has issued a statement setting up a five-year plan to prevent infections caused by the health care industry. Most of these infections can be avoided by implementing better procedures for in-care hospital treatment and surgical practices. Known as health care-associated infections, or HAIs, the plan outlines a variety of different areas that should be looked at as part of the prevention techniques for example, infections acquired from a surgical site.

In The Action Plan to Prevent Health Care-Associated Infections, is a compiled list of programs and agencies nationwide supported by the HHS who are collaborating to reduce the death toll from HAIs and to alleviate some of the cost involved in health care as a result of inaccurate treatments or procedures that can initiate HAIs. The Centers for Disease Control and Prevention’s (CDC) recent statistics from 2002 estimate about 1.7 million HAIs were reported throughout hospitals in the United States and were affiliated with over 99,000 deaths. The CDC also reports that HAIs are also estimated to be causing up to 20 billion dollars a year in the health industry.

A common infection found in hospitals, Methicillin-resistant Staphylococcus aureus (MRSA) is one that might have been on the news in the past year for the fight over whether or not a universal screening should be used on all patients. However, while screening for the infection may be costly, statistics show that MRSA infections since the year 2000 have more than tripled, partially due to HAIs.

By proposing a universal plan including state and local organizations, the HHS might have greater results by enabling everyone to work together toward the same uniformed goal.

HHS Secretary Mike Leavitt says in a statement, “This plan will serve as our roadmap on how the department addresses this important public health and patient safety issue….This collaborative interagency plan will help the nation build a safer, more affordable health care system.”

Accounting for 75 percent of the active HAIs, there are four types of infections to be aware of while staying in or visiting a hospital. The first category is surgical site infections (SSIs), followed by central line-associated bloodstream infections, pneumonia related to use of a ventilator, and urinary tract infections from catheter-insertions. MRSA comes in close behind on that list with a smaller number of infections contracted.

In order to control and eventually try to eradicate the occurrence of HAIs, the HHS came up with a five-point draft strategy for starting their plan. The first point is to establish a steering committee for HAI prevention to further a plan of action. Point two is to prioritize the science and research components among the 1,200 clinical practices in order to facilitate a widespread healthcare implementation. The third point is to investigate the policy options of the recommended practices and oversights in order to start a hospital-wide compliance assistance program. Point four is working towards a better consistency of HAI data by using a standard form of definitions. The fifth and final point to ensuring the plan’s progress is to continue to build on the principle of patient support and choice to come up with more motivation for healthcare providers and organizations to give the best care possible.

With HAIs as a leading cause of death in the United States, it makes sense that the HHS would make these specific infections a high priority for 2009. The five-year prevention plan largely relies on the cooperation of all healthcare organizations and an agreement on the guidelines associated with patient care and prevention of HAIs as a universal standard. Remember HAIs can occur in many different settings whether on the surgical floor of a hospital, within a typical outpatient procedure room, or in long-term facilities like assisted-living or rehabilitation centers.

HHS will update the plan after public response starts to come in and they will be holding meetings throughout the spring where the public can share their comments, concerns, and ideas for regulating implementation. With lives at stake and insurmountable debt a possibility for many people and organizations because of errors involved with spreading HAIs, the HHS seems to be starting the New Year with a great resolution.

For a complete medical description of The Action Plan to Prevent Health Care-Associated Infections from the Introduction to the Appendix, including the index of abbreviation codes to understand it all go to he Department of Health and Human Services website.

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National Brain Injury Month

March inevitably brings everyone closer to the arrival of spring and away from the dreariness of winter but our third month also hosts a widespread awareness of many disorders and conditions. Among them is National Brain Injury Month, the goal of which is to maintain awareness of brain deterioration and cases of sudden diagnosis across the nation.

In 2008, Capitol Hill hosted the “Brain Crane Project” at the Congressional Brain Injury Awareness Fair asking for patients or family members of someone who has suffered a brain injury to make a crane to display on Capitol Hill. Hundreds of colored cranes lined the exhibit increasing the participants’ awareness of these traumatic brain injuries (TBI) by sharing their personal stories with all of America. This year we look towards the future by saving children by focusing awareness on youth sports.

The theme for the Brain Injury Association of America’s (BIAA) 2009 awareness month is Sports and Concussions. The BIAA estimates that there are over 5.3 million Americans living with a disability caused by an injury to the brain and that the costs of such injuries maintained over a lifetime exceeded $60 billion according to the totals from the year 2000.

It has been said that a TBI occurs every 23 seconds and that almost 1.5 million Americans will endure one over the next year. The 2009 theme is focusing primarily on youth sports because many adolescents sustain concussions without realizing it and an untreated concussion is dangerous and can cause severe neurological damage. By bringing awareness to schools, after-school sports programs, and intramural leagues, the BIAA, as well as parents, teachers, and coaches, can only hope to prevent some of the traumatic brain injuries in children this year.

The Centers for Disease Control and Prevention (CDC) estimate that each year between 1.6 and 3.8 million concussions happen as a result of recreation and sports related incidents. As concussions are the most common type of injury to the brain during activity, one can occur after a severe blow or hit to the head.

Symptoms of a concussion can vary and may not appear for hours, days or weeks after the initial contact. Some concussions can happen when a direct hit to another body part causes the impact to go right to the brain. Signs of a concussion are usually any combination of the following: headache, nausea, dizziness or a problem standing or walking, blurred or double vision, general feelings of sluggishness, sensitivity to any noise or lights, a lingering groggy feeling, confusion, and trouble remembering things or focusing on one thing.

Doctors advise parents, teachers, supervisors, and coaches to never ignore a blow to the head. If there is a visible bump, take the victim out of the game or activity immediately and watch them for the symptoms of a concussion. If symptoms are visible take the player to see a doctor right away and only return to the game with consent from a health care provider.

Remember to remind your children/students to always tell an adult if he or she hits their head because a concussion is serious. Also remember to tell your child that the main myth about concussions is that people blackout or lose consciousness, however only in rare and very extreme cases does this actually happen.

The most common activities in which children ages 5 to 18 often receive concussions are: playground structure activities, bicycling, basketball, soccer, and football.

To learn more about the local events related to brain injury awareness in your area this month, look at the BIA-chartered website for your state.

For the month of March (and every month after) stay aware of traumatic brain injuries and teach your sports fanatics, rambunctious neighborhood kids, and professional athletes-in-training about the dangers and signs of a concussion while keeping them safe.

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Optic neuritis

Optic neuritis (optical neuritis, visual neuritis) is the sharp disease, shown an inflammation of an optic nerve. It often meets in a combination to the neurologic illnesses described demyeliniation. Demyeliniation is a loss of an external fatty layer of a nervous fibre which provides fast conductivity of a nervous impulse. More often neuritis an optic nerve it is combined with a multiple sclerosis - slowly progressing disease of the nervous system shown just this most demyeliniation. The inflammation of an optic nerve is frequent is a debut of a multiple sclerosis or precedes development of a multiple sclerosis for some years. Sometimes the reason of development neuritis an optic nerve remains to the unknown person.

The majority of patients with neuritis of an optic nerve test sharp deterioration of sight in a combination to a pain arising at movement by a sick eye. This disease is usually shown on one eye and can periodically give relapses, as for example often happens at a combination to a multiple sclerosis.

Attributes (symptoms)

Following symptoms of an optic nuritis do not meet in all cases, but they happen more often.

- Pain at movement by an eye (in 90 % of cases)
- Pain in an eye without movement
- Reduction of visual acuity
- Sight as in darkness
- The lowered perception of color
- Narrowing of a peripheral field of vision
- Blind spot in the center
- Fever
- Headache
- Nausea
- Decrease in sight after physical activities, baths, a hot shower or a bath (at rise of a body temperature)

Diagnostics

The doctor considers some factors at diagnostics an optic neuritis. Disease not always finds verification at survey of a disk of an optic nerve on eye day by means of ophthalmoscope. A pain at movement by an eye - the characteristic complaint for this disease. The doctor can check up reaction of pupils to light and appoint electrophysiological research of an optic nerve, research of fields of vision, colour perception and a computer tomography or a Magnetic resonance tomography of a brain.

Treatment

Treatment of this disease in overwhelming majority of cases is spent by purpose of steroid hormones and not steroid anti-inflammatory preparations in drops, ointments, tablets and injections. Also antibiotics are applied also. Very seldom resort to surgical operation at neuritis an optic nerve. It refers to decompression environments of an optic nerve and consists in its opening for pressure decrease in an optic nerve which at this disease is inevitably raised owing to an inflammatory hypostasis.

From long-term research of treatment an optic neuritis (Optic Neuritis Treatment Trial) doctors have learned, that purpose of steroid hormones in a vein (instead of in tablets) reduces risk of progress of a multiple sclerosis in the future. This find is of great importance, as at half of patients with neuritis an optic nerve in the future the multiple sclerosis develops. Though this treatment has the minimal influence on vision, it is important for the general health of the patient.

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