The local effects of the tumour commonly cause headache and, less frequently, impairment of vision, particularly of the temporal ?eld of vision, as a result of pressure on the nerves to the eye. The tumour may damage the other pituitary cells giving rise to gonadal, thyroid or adrenocortical insu?ciency. The disease often becomes obvious in persons over about 45 years of age; they may also complain of excessive sweating, joint pains and lethargy. The diagnosis is con?rmed by measuring the level of growth hormone in the serum and by an X-ray of the skull which usually shows enlargement of the pituitary fossa.
Treatment The most e?ective treatment is surgically to remove the pituitary adenoma. This can usually be done through the nose and the sphenoid sinus, but large adenomas may need a full CRANIOTOMY. Surgery cures about 80 per cent of patients with a microadenoma and 40 per cent of those with a large lesion; the rate of recurrence is 5–10 per cent. For recurrences, or for patients un?t for surgery or who refuse it, a combination of irradiation and drugs may be helpful. Deep X-ray therapy to the pituitary fossa is less e?ective than surgery but may also be helpful, and recently more sophisticated X-ray techniques, such as gamma knife irradiation, have shown promise. Drugs – such as BROMOCRIPTINE, capergoline and quiangoline, which are dopamine agonists – lower growth-hormone levels in acromegaly and are particularly useful as an adjunct to radiotherapy. Drugs which inhibit growth-hormone release by competing for its receptors, octeotride and lanreotride, also have a place in treatment.
See www.niddk.nih.gov/health/endo/pubs/ acro/acro.htm
www.umm.edu/endocrin/acromegaly.htm... acromegaly
Habitat: The western Himalayas.
Ayurvedic: Rudanti, Rudravanti.Action: Depurative, bechic, blood purifier (used in skin diseases). Root powder and decoction also used as an adjunct in tuberculosis.
Dosage: Fruit—3-5 g powder. (CCRAS.)... astragalus candolleanusHin: Akasgaddah;
Mal: Kadamba, KollankovaTam: Akashagarudan, Gollankovai;Tel: Murudonda, NagadondaCorallocarpus is a prostrate or climbing herb distributed in Punjab, Sind, Gujarat, Deccan, Karnataka and Sri Lanka. It is monoecious with large root which is turnip-shaped and slender stem which is grooved, zigzag and glabrous. Tendrils are simple, slender and glabrous. Leaves are sub-orbicular in outline, light green above and pale beneath, deeply cordate at the base, angled or more or less deeply 3-5 lobed. Petiole is long and glabrous. Male flowers are small and arranged at the tip of a straight stiff glabrous peduncle. Calyx is slightly hairy, long and rounded at the base. Corolla is long and greenish yellow. Female flowers are usually solitary with short, stout and glabrous peduncles. Fruit is stalked, long, ellipsoid or ovoid. Seeds are pyriform, turgid, brown and with a whitish corded margin. It is prescribed in later stages of dysentery and old veneral complaints. For external use in chronic rheumatism, it is made into a liniment with cumin seed, onion and castor oil. It is used in case of snakebite where it is administered internally and applied to the bitten part. The root is given in syphilitic rheumatism and later stages of dysentery. The plant is bitter, sweet, alexipharmic and emetic. The root is said to possess alterative and laxative properties (Kirtikar and Basu, 1988). Root contains a bitter principle like Breyonin (Chopra et al, 1980).Agrotechnology: Cucurbits can be successfully grown during January-March and September- December. For the rainfed crop, sowing can also be started after the receipt of the first few showers.Pits of 60cm diameter and 30-45cm depth are to be taken at the desired spacing. Well rotten FYM or vegetable mixture is to be mixed with topsoil in the pit and seeds are to be sown at 4-5/pit. Unhealthy plants are to be removed after 2 weeks and retained 2-3 plants/pit. FYM is to be applied at 20-25t/ha as basal dose along with half dose of N (35kg/ha) and full dose of P (25kg) and K (25kg). The remaining dose of N (35kg) can be applied in 2 equal split doses at fortnightly intervals. During the initial stages of growth, irrigation is to be given at an interval of 3-4 days and at alternate days during flowering and fruiting periods. For trailing cucumber, pumpkin and melon, dried twigs are to be spread on the ground. Bitter gourd, bottle gourd, snake gourd and ash gourd are to be trailed on Pandals. Weeding and raking of the soil are to be conducted at the time of fertilizer application. Earthing up may be done during rainy season. The most dreaded pest of cucurbits is fruit flies which can be controlled by using fruit traps, covering the fruits with polythene, cloth or paper bags, removal and destruction of affected fruits and lastly spraying with Carbaryl or Malathion 0. 2% suspension containing sugar or jaggery at 10g/l at fortnightly intervals after fruit set initiation. During rainy season, downy mildew and mosaic diseases are severe in cucurbits. The former can be checked by spraying Mancozeb 0.2%. The spread of mosaic can be checked by controlling the vectors using Dimethoate or Phosphamidon 0.05% and destruction of affected plants and collateral hosts. Harvesting to be done at least 10 days after insecticide or fungicide application (KAU,1996).... cucurbitsCrohn’s disease is rare in the developing world, but in the western world the incidence is increasing and is now 6–7 per 100,000 population. Around 80,000 people in the UK have the disorder with more than 4,000 new cases occurring annually. Commonly Crohn’s disease starts in young adults, but a second incidence surge occurs in people over 70 years of age. Both genetic and environmental factors are implicated in the disease – for example, if one identical twin develops the disease, the second twin stands a high chance of being affected; and 10 per cent of sufferers have a close relative with in?ammatory bowel disease. Among environmental factors are low-residue, high-re?ned-sugar diets, and smoking.
Symptoms and signs of Crohn’s disease depend on the site affected but include abdominal pain, diarrhoea (sometimes bloody), ANOREXIA, weight loss, lethargy, malaise, ANAEMIA, and sore tongue and lips. An abdominal mass may be present. Complications can be severe, including life-threatening in?ammation of the colon (which may cause TOXAEMIA), perforation of the colon and the development of ?stulae between the bowel and other organs in the abdomen or pelvis. If Crohn’s disease persists for a decade or more there is an increased risk of the victim developing colon cancer. Extensive investigations are usually necessary to diagnose the disease; these include blood tests, bacteriological studies, ENDOSCOPY and biopsy, and barium X-ray examinations.
Treatment As with ulcerative colitis, treatment is aimed primarily at controlling symptoms. Physicians, surgeons, radiologists and dietitians usually adopt a team approach, while counsellors and patient support groups are valuable adjuncts in a disease that is typically lifelong. Drug treatment is aimed at settling the acute phase and preventing relapses. CORTICOSTEROIDS, given locally to the affected gut or orally, are used initially and the effects must be carefully monitored. If steroids do not work, the immunosuppressant agent AZATHIOPRINE should be considered. Antidiarrhoeal drugs may occasionally be helpful but should not be taken during an acute phase. The anti-in?ammatory drug SULFASALAZINE can be bene?cial in mild colitis. A new generation of genetically engineered anti-in?ammatory drugs is now available, and these selective immunosuppressants may prove of value in the treatment of Crohn’s disease.
Diet is important and professional guidance is advisable. Some patients respond to milk- or wheat-free diets, but the best course for most patients is to eat a well-balanced diet, avoiding items that the sufferer knows from experience are poorly tolerated. Of those patients with extensive disease, as many as 80 per cent may require surgery to alleviate symptoms: a section of affected gut may be removed or, as a lifesaving measure, a bowel perforation dealt with.
(See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP – Colitis; Crohn’s disease.)... crohn’s disease
Clinically, the lymphatic ?lariases characteristically cause ELEPHANTIASIS (lymphoedema); onchocerciasis gives rise to ophthalmic complications (river-blindness), rashes and subcutaneous nodules; loaiasis causes subcutaneous ‘Calabar swellings’ and subconjunctival involvement; and dracontiasis predisposes to secondary bacterial infections (usually involving the lower limbs). Diagnosis is by ?nding the relevant ?larial nematode, either in blood (day and night ?lms should be examined), or in one or other of the body ?uids. An EOSINOPHILIA is often present in peripheral blood. Serological diagnosis is also of value. In onchocerciasis, skin-snips and the Mazotti reaction are valuable adjuncts to diagnosis.
The mainstay of chemotherapy consists of diethylcarbamazine (aimed predominantly at the larval stage of the parasite). However, ivermectin (not available in the UK) is e?ective in onchocerciasis, and metronidazole or one of the benzimidazole compounds have limited value in dracontiasis. Suramin has been used to kill adult ?larial worms. Prevention consists of eradication of the relevant insect vector.... filariasis
using soft nylon or silk thread or tape.
Dental floss may be waxed or unwaxed.
Flossing should be carried out as an adjunct to toothbrushing.... flossing, dental
It is also the name given to the treatment of disease by the arti?cial production of FEVER. This can be achieved by various methods, such as radiation heat cabinets boosted with radio frequency (RF); immersion in a hot wax bath; heated suits or blankets; techniques using electromagnetic waves (e.g. RF, MICROWAVES); and ULTRASOUND of appropriate frequencies. Hyperthermia is sometimes of help as an adjunct to surgery, CHEMOTHERAPY, or RADIOTHERAPY in the treatment of cancer.... hyperthermia
Habitat: Native of South-east America; grown in Indian gardens.
English: Wild Passion Flower, Maypop.Action: Flowering and fruiting dried herb—mild sedative, hypnotic, tranquilizer, hypotensive, vasodilator, antispasmodic, anodyne, anti-inflammatory,
Key application: In nervous restlessness, irritability and difficulty in falling asleep. (German Commission E, ESCOP, The British Herbal Compendium, The British Herbal Pharmacopoeia, WHO.) The British Herbal Compendium also indicated it in neuralgia, dysmenorrhoea, and nervous tachycardia.The herb contains flavonoids (up to 2.5%), in particular C-glycosylflavones; cyanogenic glycoside, gynocardine.The alkaloid harman has been isolated, but the presence of harmine, har- maline, harmol and harmalol has been disputed. The alkaloid and flavonoids are reported to have sedative activity in animals. Apigenin exhibits antispasmodic and anti-inflammatory activity.Passion Flower was formerly approved as an OTC sedative in the USA, but it was taken off the market in 1978 because safety and effectiveness had not been proven. An animal study in 1977 suggested that apigenin binds to central benzodi-zepine receptors (possibly causing anxiolytic effects). (Natural Medicines Comprehensive Database, 2007.)The drug is used in homoeopathic medicine for epilepsy.The herb exhibits a motility-inhi- biting effect in animal experiments.Passion Flower, used as an adjunct to clonidine, was superior to clonidine for mental symptoms of opiate withdrawal. (Sharon M. Herr.)... passiflora incarnataHabitat: North-eastern India.
Siddha/Tamil: Odangod.Folk: Kazurati, Tirruli (Maharashtra), Atari-lataa, Kathapahaariaa, Lokhandi (Bengal).Action: Root bark—used for the treatment of respiratory troubles. Stem—febrifuge. Leaves—scorched and given to women during confinement. Powdered leaves and roots are applied to sores and wounds.
The roots contain dulcitol. The root bark contains an antibiotic principle, pristimerin (0.1%) which shows considered in vitro activity against several Gram-positive cocci, both haemolyt- ic and non-haemolytic. Pristimerin also inhibits in vitro growth of different strains of Mycobacterium tuberculosis. Clinical trials have shown that pristimerin is effective in the treatment of inflammatory conditions of the naso-pharyngeal mucosa resulting from common cold and influenzal infections. It is found useful as an adjunct to the common antibiotic therapy of respiratory inflammations of both bacterial and viral origin, and is reported to possess antitumour properties, but its high toxicity precludes its use as a cancero-static agent.... reissantia indicaConstituents: alkaloids, glycoproteins, polypeptides, flavonoids.
Action: tranquilliser, vasodilator – reducing blood pressure after an initial rise. Cardiac depressant. Used as an alternative to beta-blocking drugs when they produce sore eyes and skin rash. Stimulates the vagus nerve which slows the pulse. Contains acetylcholine. Diuretic. Immune enhancer. Anti-inflammatory. Uses. Arterial hypertension, insomnia, temporal arteritis, nervous excitability, hyperactivity, limb- twitching, epilepsy, (petit mal), chorea, tinnitus, rabies (Dr Laville). Benzodiazepine addiction – to assist withdrawal. Arteriosclerosis (with Horsetail). Headache, dizziness, fatigue.
Cancer: some success reported in isolated cases. Juice of the berries has been applied to external cancers since the time of the Druids. Present-day pharmacy: Iscador (Weleda), Viscotoxin. Pliny the Elder (AD 23-79) and Hippocrates record its use in epilepsy and for tumours. The berries may be prescribed by a medical practitioner only (UK). As an immune enhancer it is used as an adjunct to surgery and radiotherapy for patients for whom cytotoxic drugs are inappropriate because of adverse side-effects. Lymphocytes divide more readily by production of interferon.
Combinations: (1) with Skullcap and Valerian for nervous disorders (2) with Motherwort and Hawthorn for myocarditis (3) with Blue Cohosh for menstrual irregularity (4) with Hawthorn and Lime flowers for benign hypertension. Never combine with Gotu Kola. (Dr John Heinerman)
Preparations: Average dose: 2-6g, or equivalent. Thrice daily.
Tea: 1 heaped teaspoon to each cup cold water steeped 2 hours. Dose: half-1 cup.
Green Tincture. 4oz bruised freshly-gathered leaves in spring to 1 pint 45 per cent alcohol (Vodka, strong wine, etc). Macerate 8 days, shaking daily. Filter and bottle. Dose: 3-5 drops: (every 2 hours if an epileptic attack is suspected).
Powder, capsules: 300mg. 2 capsules thrice daily before meals. (Arkocaps)
Plenosol. (Madaus)
Liquid Extract (1:1): 8-10 drops.
Sale: pharmacy only. ... mistletoe
Transfusion of blood is a technique that has been used since the 17th century – although, until the 20th century, with a subsequent high mortality rate. It was only when incompatibility of BLOOD GROUPS was considered as a potential cause of this high mortality that routine blood-testing became standard practice. Since the National Blood Transfusion Service was started in the United Kingdom (in 1946), blood for transfusion has been collected from voluntary, unpaid donors: this is screened for infections such as SYPHILIS, HIV, HEPATITIS and nvCJD (see CREUTZFELDT-JAKOB DISEASE (CJD)), sorted by group, and stored in blood-banks throughout the country.
In the UK in 2004, the National Blood Authority – today’s transfusion service – announced that it would no longer accept donations from anyone who had received a blood transfusion since 1980 – because of the remote possibility that they might have been infected with the PRION which causes nvCJD.
A standard transfusion bottle has been developed, and whole blood may be stored at 2–6 °C for three weeks before use. Transfusions may then be given of whole blood, plasma, blood cells, or PLATELETS, as appropriate. Stored in the dried form at 4–21 °C, away from direct sunlight, human plasma is stable for ?ve years and is easily reconstituted by adding sterile distilled water.
The National Blood Authority prepares several components from each donated unit of blood: whole blood is rarely used in adults. This permits each product, whether plasma or various red-cell concentrates, to be stored under ideal conditions and used in appropriate clinical circumstances – say, to restore blood loss or to treat haemostatic disorders.
Transfusion of blood products can cause complications. Around 5 per cent of transfused patients suffer from a reaction; most are mild, but they can be severe and occasionally fatal. It can be di?cult to distinguish a transfusion reaction from symptoms of the condition being treated, but the safe course is to stop the transfusion and start appropriate investigation.
In the developed world, clinicians can expect to have access to high-quality blood products, with the responsibility of providing blood resting with a specially organised transfusion service. The cause of most fatal haemolytic transfusion reactions is a clerical error due to faulty labelling and/or failure to identify the recipient correctly. Hospitals should have a strict protocol to prevent such errors.
Arti?cial blood Transfusion with blood from donors is facing increasing problems. Demand is rising; suitable blood donors are becoming harder to attract; the processes of taking, storing and cross-matching donor blood are time-consuming and expensive; the shelf-life is six weeks; and the risk of adverse reactions or infection from transfused blood, although small, is always present. Arti?cial blood would largely overcome these drawbacks. Several companies in North America are now preparing this: one product uses puri?ed HAEMOGLOBIN from humans and another from cows. These provide oxygen-carrying capacity, are unlikely to be infectious and do not provoke immunological rejections. Yet another product, called Oxygene®, does not contain any animal or human blood products; it comprises salt water and a substance called per?ubron, the molecules of which store oxygen and absorb carbon dioxide more e?ectively than does haemoglobin. Within 24 hours of being transfused into a person’s bloodstream, per?ubron evaporates and is harmlessly breathed out by the recipient. Arti?cial blood is especially valuable in that it contains no unwanted proteins that can provoke adverse immunological reactions. Furthermore, it is disease-free, lasts for up to three years and is no more expensive than donor blood. It could well take the place of donor blood within a few years.
Autologous transfusion is the use of an individual’s own blood, provided in advance, for transfusion during or after a surgical operation. This is a valuable procedure for operations that may require large transfusions or where a person has a rare blood group. Its use has increased for several reasons:
fear of infection such as HIV and hepatitis.
shortages of donor blood and the rising cost of units of blood.
substantial reduction of risk of incompatible transfusions. In practice, blood transfusion in the UK is
remarkably safe, but there is always room for improvement. So, in the 1990s, a UK inquiry on the Serious Hazards of Transfusion (SHOT) was launched. It established (1998) that of 169 recently reported serious hazards following blood transfusion, 81 had involved a blood component being given to the wrong patient, while only eight were the result of viral or bacterial infections.
There are three ways to use a patient’s own blood in transfusion:
(1) predeposit autologous donation (PAD) – taking blood from a patient before operation and transfusing this blood back into the patient as required during and after operation.
(2) acute normovalaemic haemodilution (ANH) – diluting previously withdrawn blood and thus increasing the volume before transfusion.
(3) perioperative cell salvage (PCS) – the use of centrifugal cell separation on blood saved during an operation, particularly spinal surgery where blood loss may be considerable.
The government has urged NHS trusts to consider the introduction of PCS as a possible adjunct or alternative to banked-blood transfusion. In one centre (Nottingham), PCS has been used in the form of continuous autologous transfusion for several years with success.
Exchange transfusion is the method of treatment in severe cases of HAEMOLYTIC DISEASE OF THE NEWBORN. It consists of replacing the whole of the baby’s blood with Rh-negative blood of the correct blood group for the baby.... transfusion
Ultrasound is replacing ISOTOPE scanning in many situations, and also RADIOGRAPHY. Ultrasound of the liver can separate medical from surgical JAUNDICE in approximately 97 per cent of patients; it is very accurate in detecting and de?ning cystic lesions of the liver, but is less accurate with solid lesions – and yet will detect 85 per cent of secondary deposits (this is less than COMPUTED TOMOGRAPHY [CT] scanning). It is very accurate in detecting gall-stones (see GALL-BLADDER, DISEASES OF) and more accurate than the oral cholecystogram. It is useful as a screening test for pancreatic disease and can di?erentiate carcinoma of the pancreas from chronic pancreatitis with 85 per cent accuracy.
Ultrasound is the ?rst investigation indicated in patients presenting with renal failure, as it can quickly determine the size and shape of the kidney and whether there is any obstruction to the URETER. It is very sensitive to the presence of dilatation of the renal tract and will detect space-occupying lesions, di?erentiating cysts and tumours. It can detect also obstruction of the ureter due to renal stones by showing dilatations of the collecting system and the presence of the calculus. Adrenal (see ADRENAL GLANDS) tumours can be demonstrated by ultrasound, although it is less accurate than CT scanning.
The procedure is now the ?rst test for suspected aortic ANEURYSM and it can also show the presence of clot and delineate the true and false lumen. It is good at demonstrating subphrenic and subhepatic abscesses (see ABSCESS) and will show most intra-abdominal abscesses; CT scanning is however better for the retroperitoneal region. It has a major application in thyroid nodules as it can di?erentiate cystic from solid lesions and show the multiple lesions characteristic of the nodular GOITRE (see also THYROID GLAND, DISEASES OF). It cannot differentiate between a follicular adenoma and a carcinoma, as both these tumours are solid; nor can it demonstrate normal parathyroid glands. However, it can identify adenomas provided that they are more than 6 mm in diameter. Finally, ultrasound can di?erentiate masses in the SCROTUM into testicular and appendicular, and it can demonstrate impalpable testicular tumours. This is important as 15 per cent of testicular tumours metastasise whilst they are still impalpable.
Ultrasonic waves are one of the constituents in the shock treatment of certain types of gallstones and CALCULI in the urinary tract (see LITHOTRIPSY). They are also being used in the treatment of MENIÈRE’S DISEASE and of bruises and strains. In this ?eld of physiotherapy, ultrasonic therapy is proving of particular value in the treatment of acute injuries of soft tissue. If in such cases it is used immediately after the injury, or as soon as possible thereafter, prompt recovery is facilitated. For this reason it is being widely used in the treatment of sports injuries (see also SPORTS MEDICINE). The sound waves stimulate the healing process in damaged tissue.
Doppler ultrasound is a technique which shows the presence of vascular disease in the carotid and peripheral vessels, as it can detect the reduced blood ?ow through narrowed vessels.
Ultrasound in obstetrics Ultrasound has particular applications in obstetrics. A fetus can be seen with ultrasound from the seventh week of pregnancy, and the fetal heart can be demonstrated at this stage. Multiple pregnancy can also be diagnosed at this time by the demonstration of more than one gestation sac containing a viable fetus. A routine obstetric scan is usually performed between the 16th and 18th week of pregnancy when the fetus is easily demonstrated and most photogenic. The fetus can be measured to assess the gestational age, and the anatomy can also be checked. Intra-uterine growth retardation is much more reliably diagnosed by ultrasound than by clinical assessment. The site of the placenta can also be recorded and multiple pregnancies will be diagnosed at this stage. Fetal movements and even the heartbeat can be seen. A second scan is often done between the 32nd and 34th weeks to assess the position, size and growth rate of the baby. The resolution of equipment now available enables pre-natal diagnosis of a wide range of structural abnormalities to be diagnosed. SPINA BIFIDA, HYDROCEPHALUS and ANENCEPHALY are probably the most important, but other anomalies such as multicystic kidney, achondroplasia and certain congenital cardiac anomalies can also be identi?ed. Fetal gender can be determined from 20 weeks of gestation. Ultrasound is also useful as guidance for AMNIOCENTESIS.
In gynaecology, POLYCYSTIC OVARY SYNDROME can readily be detected as well as FIBROID and ovarian cysts. Ultrasound can monitor follicular growth when patients are being treated with infertility drugs. It is also useful in detecting ECTOPIC PREGNANCY. (See also PREGNANCY AND LABOUR.)... ultrasound
The most efficient way to lose weight is to eat 500–1,000 kcal (2,100–4,200 kJ) a day less than the body’s total energy requirements. Exercise also forms an extremely important part of a reducing regime, burning excess energy and improving muscle tone.
In most circumstances, drugs play little part in a weight loss programme.
However, sibutramine and orlistat may be useful adjuncts to a reducing diet and may be appropriate for some people with a high (see body mass index). Appetite suppressants related to amfetamines are not recommended.... weight reduction
Health Encyclopedia