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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