see artificial insemination.
Not all sufferers from coeliac disease present with gastrointestinal symptoms: doctors, using screening techniques, have increasingly identi?ed large numbers of such people. This is important because researchers have recently discovered that untreated overt and silent coeliac disease increases the risk of sufferers developing osteoporosis (brittle bone disease – see BONE, DISORDERS OF) and cancer. The osteoporosis develops because the bowel fails to absorb the CALCIUM essential for normal bone growth. Because those with coeliac disease lack the enzyme LACTASE, which is essential for digesting milk, they avoid milk – a rich source of calcium.
The key treatment is a strict, lifelong diet free of gluten. As well as returning the bowel lining to normal, this diet results in a return to normal bone density. People with coeliac disease, or parents or guardians of affected children, can obtain help and guidance from the Coeliac Society of the United Kingdom. (See also MALABSORPTION SYNDROME; SPRUE.)... coeliac disease
Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.
Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.
Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.
A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.
Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production
– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).
Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.
Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.
Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.
Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).
Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;
(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.
Complications The risks of complications increase with duration of disease.
Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.
Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.
Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.
Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).
Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.
Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.
Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.
Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.
Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;
(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.
Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.
Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.
However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.
Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.
Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.
Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.
A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.
Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.... diabetes mellitus
Habitat: Waste places ; also seen growing wild in gardens.
Features ? Stem erect, smooth, channeled, covered with exuded glaucous matter. Leaves alternate, twice pinnate. Flowers in June, terminal umbels. Fruits very small, compressed oval, marked on back in three ridges, with three dark lines (oil cells) between. Taste is distinctive, but recalls caraway.The Indian Dill differs from our European variety in the essential oil contained in the seeds.Part used ? Dried ripe fruits.Action: Carminative, stomachic, diaphoretic.
The well-known and widely used Dillwater is a sound remedy for children's digestive disorders, particularly wind in stomach or bowels. Dose, 1 to 8 drachms. The oil is also given in 1 to 5 drop doses.... dillIt is characterised by excessive thirst and the passing of large volumes of urine which have a low speci?c gravity and contain no abnormal constituents. It is either due to a lack of the antidiuretic hormone normally produced by the HYPOTHALAMUS and stored in the posterior PITUITARY GLAND, or to a defect in the renal tubules which prevents them from responding to the antidiuretic hormone VASOPRESSIN. When the disorder is due to vasopressin insu?ciency, a primary or secondary tumour in the area of the pituitary stalk is responsible for one-third of cases. In another one-third of cases there is no apparent cause, and such IDIOPATHIC cases are sometimes familial. A further one-third of cases result from a variety of lesions including trauma, basal MENINGITIS and granulomatous lesions in the pituitary-stalk area. When the renal tubules fail to respond to vasopressin this is usually because of a genetic defect transmitted as a sex-linked recessive characteristic, and the disease is called nephrogenic diabetes insipidus. Metabolic abnormalities such as HYPERCALCAEMIA and potassium depletion render the renal tubule less sensitive to vasopressin, and certain drugs such as lithium and tetracycline may have a similar e?ect.
If the disease is due to a de?ciency of vasopressin, treatment should be with the analogue of vasopressin called desmopressin which is more potent than the natural hormone and has less pressor activity. It also has the advantage in that it is absorbed from the nasal mucosa and so does not need to be injected.
Nephrogenic diabetes insipidus cannot be treated with desmopressin. The urine volume can, however, usually be reduced by half by a thiazide diuretic (see THIAZIDES).... diabetes insipidus
Dialysis is available as either haemodialysis or peritoneal dialysis.
Haemodialysis Blood is removed from the circulation either through an arti?cial arteriovenous ?stula (junction) or a temporary or permanent internal catheter in the jugular vein (see CATHETERS). It then passes through an arti?cial kidney (‘dialyser’) to remove toxins (e.g. potassium and urea) by di?usion and excess salt and water by ultra?ltration from the blood into dialysis ?uid prepared in a ‘proportionator’ (often referred to as a ‘kidney machine’). Dialysers vary in design and performance but all work on the principle of a semi-permeable membrane separating blood from dialysis ?uid. Haemodialysis is undertaken two to three times a week for 4–6 hours a session.
Peritoneal dialysis uses the peritoneal lining (see PERITONEUM) as a semi-permeable membrane. Approximately 2 litres of sterile ?uid is run into the peritoneum through the permanent indwelling catheter; the ?uid is left for 3–4 hours; and the cycle is repeated 3–4 times per day. Most patients undertake continuous ambulatory peritoneal dialysis (CAPD), although a few use a machine overnight (continuous cycling peritoneal dialysis, CCPD) which allows greater clearance of toxins.
Disadvantages of haemodialysis include cardiovascular instability, HYPERTENSION, bone disease, ANAEMIA and development of periarticular AMYLOIDOSIS. Disadvantages of peritoneal dialysis include peritonitis, poor drainage of ?uid, and gradual loss of overall e?ciency as endogenous renal function declines. Haemodialysis is usually done in outpatient dialysis clinics by skilled nurses, but some patients can carry out the procedure at home. Both haemodialysis and peritoneal dialysis carry a relatively high morbidity and the ideal treatment for patients with end-stage renal failure is successful renal TRANSPLANTATION.... dialysis
The so-called ultra-short-wave diathermy (or short-wave diathermy, as it is usually referred to) has replaced the original long-wave diathermy, as it is produced consistently at a stable wave-length (11 metres) and is easier to apply. In recent years microwave diathermy has been developed, which has a still higher oscillating current (25,000 million cycles per second, compared with 500 million for short-wave diathermy).
When the current passes, a distinct sensation of increasing warmth is experienced and the temperature of the body gradually rises; the heart’s action becomes quicker; there is sweating with increased excretion of waste products. The general blood pressure is also distinctly lowered. The method is used in painful rheumatic conditions, both of muscles and joints.
By concentrating the current in a small electrode, the heating effects immediately below this are very much increased. The diathermy knife utilises this technique to coagulate bleeding vessels and cauterise abnormal tissue during surgery.... diathermy
Major diet-related health problems in prosperous communities tend to be the result of dietary excesses, whereas in underdeveloped, poor communities, problems associated with dietary de?ciencies predominate. Excessive intakes of dietary energy, saturated fats, sugar, salt and alcohol, together with an inadequate intake of dietary ?bre, have been linked to the high prevalence of OBESITY, cardiovascular disease, dental caries, HYPERTENSION, gall-stones (see GALL-BLADDER, DISEASES OF), non-insulindependent DIABETES MELLITUS and certain cancers (e.g. of the breast, endometrium, intestine and stomach) seen in developed nations. Health-promotion strategies in these countries generally advocate a reduction in the intake of fat, particularly saturated fat, and salt, the avoidance of excessive intakes of alcohol and simple sugars, an increased consumption of starch and ?bre and the avoidance of obesity by taking appropriate physical exercise. A maximum level of dietary cholesterol is sometimes speci?ed.
Undernutrition, including protein-energy malnutrition and speci?c vitamin and mineral de?ciencies, is an important cause of poor health in underdeveloped countries. Priorities here centre on ensuring that the diet provides enough nutrients to maintain health.
In healthy people, dietary requirements depend on age, sex and level of physical activity. Pregnancy and lactation further alter requirements. The presence of infections, fever, burns, fractures and surgery all increase dietary energy and protein requirements and can precipitate undernutrition in previously well-nourished people.
In addition to disease prevention, diet has a role in the treatment of certain clinical disorders, for example, obesity, diabetes mellitus, HYPERLIPIDAEMIA, inborn errors of metabolism, food intolerances and hepatic and renal diseases. Therapeutic diets increase or restrict the amount and/or change the type of fat, carbohydrate, protein, ?bre, vitamins, minerals and/or water in the diet according to clinical indications. Additionally, the consistency of the food eaten may need to be altered. A commercially available or ‘homemade’ liquid diet can be used to provide all or some of a patient’s nutritional needs if necessary. Although the enteral (by mouth) route is the preferred route for feeding and can be used for most patients, parenteral or intravenous feeding is occasionally required in a minority of patients whose gastrointestinal tract is unavailable or unreliable over a period of time.
A wide variety of weight-reducing diets are well publicised. People should adopt them with caution and, if in doubt, seek expert advice.... diet
Preventive By liaising with health education departments, schools and various groups in the community. They plan and provide nutrition education programmes including in-service training and the production of educational material in nutrition. They are encouraged to plan and participate in food surveys and research projects which involve the assessment of nutritional status.
Therapeutic Their role is to advise patients who require speci?c dietary therapy as all or part of their treatment. They teach patients in hospitals to manage their own dietary treatment, and ensure a supportive follow-up so that patients and their families can be seen to be coping with the diet. Therapeutic dietitians further advise catering departments on the adaptation of menus for individual diets and on the nutritional value of the food supplied to patients and sta?. They advise social-services departments so that meals-on-wheels provision has adequate nutritional value.
Industry The advice of dietitians is sought by industry in the production of product information literature, data sheets and professional leaflets for manufacturers of ordinary foods and specialist dietetic food. They give advice to the manufacturers on nutritional and dietetic requirements of their products.... dietetics
(2) A drug which usually acts by relaxing smooth muscle to increase the diameter of blood vessels, the bronchial tree, or other organs.
(3) An instrument used to increase the diameter of an ori?ce or organ, either to treat a stricture or to allow surgical access.... dilator
(2) Dissection of an artery involves tearing of the inner part of the wall, allowing blood to track through the media occluding the origins of smaller arteries and often leading to vessel rupture (see also ARTERIES).... dissection
has no connection with foot and mouth disease in cattle, deer, pigs and sheep.... hand, foot and mouth disease
Treatment In severely affected fetuses, a fetal blood transfusion may be required and/or the baby may be delivered early for further treatment. Mild cases may need observation only, or the reduction of jaundice by phototherapy alone (treatment with light, involving the use of sunlight, non-visible ULTRAVIOLET light, visible blue light, or LASER).
Whatever the case, the infant’s serum BILIRUBIN – the bilirubin present in the blood – and its HAEMOGLOBIN concentration are plotted regularly so that treatment can be given before levels likely to cause brain damage occur. Safe bilirubin concentrations depend on the maturity and age of the baby, so reference charts are used.
High bilirubin concentrations may be treated with phototherapy; extra ?uid is given to prevent dehydration and to improve bilirubin excretion by shortening the gut transit time. Severe jaundice and anaemia may require exchange TRANSFUSION by removing the baby’s blood (usually 10 millilitres at a time) and replacing it with rhesus-negative fresh bank blood. Haemolytic disease of the newborn secondary to rhesus incompatibility has become less common since the introduction of anti-D (Rho) immunoglobulin. This antibody should be given to all rhesus-negative women at any risk of a fetomaternal transfusion, to prevent them from mounting an antibody response. Anti-D is given routinely to rhesus-negative mothers after the birth of a rhesus-positive baby, but doctors should also give it after threatened abortions, antepartum haemorrhages, miscarriages, and terminations of pregnancy.
Occasionally haemolytic disease is caused by ABO incompatibility or that of rarer blood groups.... haemolytic disease of the newborn
Arteritis is a common complication and can result in the development of coronary artery aneurysms (see ANEURYSM) in up to 60 per cent of those affected. These aneurysms and even myocardial infarction (see HEART, DISEASES OF – Coronary thrombosis) are often detected after the second week of illness. The disease can be hard to diagnose as it mimics many childhood viral illnesses, especially in its early stages. The incidence in the UK is over 3 per 100,000 children under ?ve years of age.
Treatment Because of the danger of coronary artery disease, prompt treatment is important. This is with intravenous IMMUNOGLOBULINS and low-dose aspirin. To be e?ective, treatment must start in the ?rst week or so of the illness – a time when it is most di?cult to diagnose.... kawasaki disease
In the United Kingdom, the 1993 Education Act refers to ‘learning diffculties’: generalised (severe or moderate), or speci?c (e.g. DYSLEXIA, dyspraxia [or APRAXIA], language disorder). The 1991 Social Security (Disability Living Allowance) Regulations use the term ‘severely mentally impaired’ if a person suffers from a state of arrested development or incomplete physical development of the brain which results in severe impairment of intelligence and social functioning. This is distinct from the consequences of DEMENTIA. Though ‘mental handicap’ is widely used, ‘learning disability’ is preferred by the Department of Health.
There is a distinction between impairment (a biological de?cit), disability (the functional consequence) and handicap (the social consequence).
People with profound learning disability are usually unable to communicate adequately and may be seriously movement-impaired. They are totally dependent on others for care and mobility. Those with moderate disability may achieve basic functional literacy (recognition of name, common signs) and numeracy (some understanding of money) but most have a life-long dependency for aspects of self-care (some fastenings for clothes, preparation of meals, menstrual hygiene, shaving) and need supervision for outdoor mobility.
Children with moderate learning disability develop at between half and three-quarters of the normal rate, and reach the standard of an average child of 8–11 years. They become independent for self-care and public transport unless they have associated disabilities. Most are capable of supervised or sheltered employment. Living independently and raising a family may be possible.
Occurrence Profound learning disability affects about 1 in 1,000; severe learning disability 3 in 1,000; and moderate learning disability requiring special service, 1 per cent. With improved health care, survival of people with profound or severe learning disability is increasing.
Causation Many children with profound or severe learning disability have a diagnosable biological brain disorder. Forty per cent have a chromosome disorder – see CHROMOSOMES (three quarters of whom have DOWN’S (DOWN) SYNDROME); a further 15 per cent have other genetic causes, brain malformations or recognisable syndromes. About 10 per cent suffered brain damage during pregnancy (e.g. from CYTOMEGALOVIRUS (CMV) infection) or from lack of oxygen during labour or delivery. A similar proportion suffer postnatal brain damage from head injury – accidental or otherwise – near-miss cot death or drowning, cardiac arrest, brain infection (ENCEPHALITIS or MENINGITIS), or in association with severe seizure disorders.
Explanations for moderate learning disability include Fragile X or other chromosome abnormalities in a tenth, neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE), fetal alcohol syndrome and other causes of intra-uterine growth retardation. Genetic counselling should be considered for children with learning disability. Prenatal diagnosis is sometimes possible. In many children, especially those with mild or moderate disability, no known cause may be found.
Medical complications EPILEPSY affects 1 in 20 with moderate, 1 in 3 with severe and 2 in 3 with profound learning disability, although only 1 in 50 with Down’s syndrome is affected. One in 5 with severe or profound learning disability has CEREBRAL PALSY.
Psychological and psychiatric needs Over half of those with profound or severe – and many with moderate – learning disability show psychiatric or behavioural problems, especially in early years or adolescence. Symptoms may be atypical and hard to assess. Psychiatric disorders include autistic behaviour (see AUTISM) and SCHIZOPHRENIA. Emotional problems include anxiety, dependence and depression. Behavioural problems include tantrums, hyperactivity, self-injury, passivity, masturbation in public, and resistance to being shaved or helped with menstrual hygiene. There is greater vulnerability to abuse with its behavioural consequences.
Respite and care needs Respite care is arranged with link families for children or sta?ed family homes for adults where possible. Responsibility for care lies with social services departments which can advise also about bene?ts.
Education Special educational needs should be met in the least restrictive environment available to allow access to the national curriculum with appropriate modi?cation and support. For older children with learning disability, and for young children with severe or profound learning disability, this may be in a special day or boarding school. Other children can be provided for in mainstream schools with extra classroom support. The 1993 Education Act lays down stages of assessment and support up to a written statement of special educational needs with annual reviews.
Pupils with learning disability are entitled to remain at school until the age of 19, and most with severe or profound learning disability do so. Usually those with moderate learning disability move to further education after the age of 16.
Advice is available from the Mental Health Foundation, the British Institute of Learning Disabilities, MENCAP (Royal Society for Mentally Handicapped Children and Adults), and ENABLE (Scottish Society for the Mentally Handicapped).... learning disability
Symptoms: (acute) abdominal pain, muscle weakness, vomiting, low blood pressure due to dehydration, tiredness, mental confusion, loss of weight and appetite. Vomiting, dizzy spells. Increased dark pigmentation around genitals, nipples, palms and inside mouth. Persistent low blood pressure with occasional low blood sugar. Crisis is treated by increased salt intake. Research project revealed a craving for liquorice sweets in twenty five per cent of patients.
Herbs with an affinity for the adrenal glands: Parsley, Sarsaparilla, Wild Yam, Borage, Liquorice, Ginseng, Chaparral. Where steroid therapy is unavoidable, supplementation with Liquorice and Ginseng is believed to sustain function of the glands. Ginseng is supportive when glands are exhausted by prolonged stress. BHP (1983) recommends: Liquorice, Dandelion leaf.
Alternatives. Teas. Gotu Kola, Parsley, Liquorice root, Borage, Ginseng, Balm.
Tea formula. Combine equal parts: Balm and Gotu Kola. Preparation of teas and tea mixture: 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes; 1 cup 2 to 3 times daily.
Tablets/capsules. Ginseng, Seaweed and Sarsaparilla, Wild Yam, Liquorice. Dosage as on bottle. Formula. Combine: Gotu Kola 3; Sarsaparilla 2; Ginseng 1; Liquorice quarter. Doses. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 30-60 drops. Tinctures: 1-2 teaspoons 2 to 3 times daily.
Formula. Alternative. Tinctures 1:5. Echinacea 20ml; Yellow Dock 10ml; Barberry 10ml; Sarsaparilla 10ml; Liquorice (liquid extract) 5ml. Dose: 1-2 teaspoons thrice daily.
Supplementation. Cod liver oil. Extra salt. B-Vitamins. Folic acid. ... addison’s disease
The patient lives in an unreal world in which relatives have no sense of belonging. A loving gentle wife they once knew is no longer aware of their presence. Simple tasks, such as switching on an electrical appliance are fudged. There is distressing memory loss, inability to think and learn, speech disturbance – death of the mind. Damage by free radicals implicated.
Symptoms: Confusion, restlessness, tremor. Finally: loss of control of body functions and bone loss.
A striking similarity exists between the disease and aluminium toxicity. Aluminium causes the brain to become more permeable to that metal and other nerve-toxins. (Tulane University School of Medicine, New Orleans). High levels of aluminium are found concentrated in the neurofibrillary tangles of the brain in Alzheimer’s disease. Entry into the body is by processed foods, cookware, (pots and pans) and drugs (antacids).
“Reduction of aluminium levels from dietary and medicinal sources has led to a decline in the incidence of dementia.” (The Lancet, Nov 26, 1983).
“Those who smoke more than one packet of cigarettes a day are 4.5 times more likely to develop Alzheimer’s disease than non-smokers.” (Stuart Shalat, epidemiologist, Harvard University).
Researchers from the University of Washington, Seattle, USA, claim to have found a link between the disease and head injuries with damage to the blood/brain barrier.
Also said to be associated with Down’s syndrome, thyroid disease and immune dysfunction. Other contributory factors are believed to be exposure to mercury from dental amalgam fillings. Animal studies show Ginkgo to increase local blood flow of the brain and to improve peripheral circulation. Alternatives. Teas: Alfalfa, Agrimony, Lemon Balm, Basil, Chaparral, Ginkgo, Chamomile, Coriander (crushed seeds), Ginseng, Holy Thistle, Gotu Kola, Horsetail, Rosemary, Liquorice root (shredded), Red Clover flowers, Skullcap, Ladies Slipper.
Tea. Formula. Combine, equal parts: German Chamomile, Ginkgo, Lemon Balm. 1 heaped teaspoon to cup boiling water; infuse 5-15 minutes. 1 cup freely.
Decoction. Equal parts: Black Cohosh, Blue Flag root, Hawthorn berries. 1 teaspoon in each cupful water; bring to boil and simmer 20 minutes. Dose: half-1 cup thrice daily.
Powders. Formula. Hawthorn 1; Ginkgo 1; Ginger half; Fringe Tree half. Add pinch Cayenne pepper. 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Liquid extracts. Formula. Hawthorn 1; Ephedra half; Ginkgo 1. Dose: 30-60 drops, thrice daily, before meals.
Topical. Paint forehead and nape of neck with Tincture Arnica.
Diet: 2 day fluid-only fast once monthly for 6 months. Low fat, high fibre, lecithin. Lacto-vegetarian. Low salt.
Supplements. Vitamin B-complex, B6, B12, Folic acid, A, C, E, Zinc. Research has shown that elderly patients at high risk of developing dementia have lower levels of Vitamins A, E and the carotenes. Zinc and Vitamin B12 are both vital cofactors for brain enzymes.
Alzheimer’s Disease linked with zinc. Zinc is believed to halt cerebral damage. Senile plaques in the brain produce amyloid, damaging the blood-brain barrier. Toxic metals then cross into the brain, displacing zinc. This then produces abnormal tissue. (Alzheimer Disease and Associated Disorders, researchers, University of Geneva).
Japanese study. Combination of coenzyme Q10, Vitamin B6 and iron. Showed improved mental function. Abram Hoffer MD, PhD. Niacin 500mg tid, Vitamin C 500mg tid, Folic acid 5mg daily, Aspirin 300mg daily, Ginkgo herb 40mg daily. (International Journal of Alternative and Complementary Medicine, Feb 1994 p11)
Alzheimer’s Disease Society. 2nd Floor, Gordon House, 10 Greencoat Place, London SW1P 1PH, UK. Offers support to families and carers through membership. Practical help and information. Send SAE. ... alzheimer’s disease
Symptoms: malaise, bloody alternating diarrhoea and constipation; right side colicky abdominal pain worse after meals; flatulence, loss of weight and appetite. Intestinal obstruction can usually be palpated. Blood count. A blood count high in whites indicates an abscess – a serious condition which may require surgical repair during which segments of the gut may have to be removed. Malignant change rare. Differential diagnosis. Ulcerative colitis, appendicitis, appendix abscess, irritable bowel syndrome.
Cracks or ulcers at corners of the mouth may be a good marker of Crohn’s Disease.
Treatment. Select one of the following. Herbal treatment offers a safe alternative to steroids by inducing remission in acute exacerbation. Good responses have been observed from the anti-bacterials Wild Yam and Goldenseal. Fenugreek seeds are of special value. Comfrey (tissue regeneration). Irish Moss.
Teas: Chamomile, Comfrey leaves, Hops, Marshmallow leaves, Meadowsweet, Shepherd’s Purse (Dr A. Vogel), Lobelia. Silverweed and Cranesbill are excellent for internal bleeding; Poke root for intestinal ulceration.
Decoction. Fenugreek seeds: 2 teaspoons to large cup water simmered gently 10 minutes. 1 cup freely. The seeds also should be consumed.
Tablets/capsules. Wild Yam, Fenugreek, Ginger, Goldenseal, Lobelia, Slippery Elm.
Powders. Formula. Wild Yam 2; Meadowsweet 2; Goldenseal 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Liquid Extracts. (1) Formula. Wild Yam 1, Echinacea 2. 30-60 drops in water thrice daily. Or, (2) Formula: Turkey Rhubarb 2, Goldenseal 1, Caraway half. 20-30 drops in water thrice daily.
Tinctures. Formula. Bayberry 2, Goldenseal 1, Cardamoms 1. Dose: One to two 5ml teaspoons thrice daily.
Ispaghula seeds. 2-4 teaspoons thrice daily.
Tea Tree oil Suppositories. Insertion at night.
Diet. Bland, little fibre, Slippery Elm gruel. Irish Moss preparations. Increase fluid intake. Reject: broccoli, tomatoes, lima, Soya, Brussels sprouts, pinto beans, cocoa, chocolate, cow’s milk, peas, onions, turnips, radishes. Accept fish oils.
Addenbrookes Hospital, Cambridge. Reject foods containing wheat and all dairy produce.
Supplements. Vitamins A, B12, C, Calcium, Iron, Magnesium, Potassium, Zinc.
Study. In a study carried out by UK researchers (1993) food allergies were found to be the most common cause of the disease. Results suggested that dietary changes may be as effective as corticosteroids in easing symptoms. The most common allergens were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats, chocolate. An elemental diet with a formula of nutrients (E028, produced by Hospital Supplies, Liverpool) was used in trials. (The Lancet, 6.11.1993)
Notes. Crohn’s Disease is associated with Erythema nodosum, more frequently recognised in childhood. A frequent cause is cow’s milk intolerance. Smoking adds to the risk of Crohn’s disease.
In susceptible people, the food additives titanium dioxide and aluminosilicates may evoke a latent inflammatory response resulting in Crohn’s disease, ulcerative colitis or bowel cancer. These chemicals may be found in the intestinal lymphoid aggregations in gut mucosa. (Jonathan Powell, Gastro-intestinal Laboratory, St Thomas’s Hospital, London) (Titanium dioxide rarely occurs naturally but is added to confectionery, drinking water and anti-caking agents.) ... crohn’s disease
Symptoms: numbness, nerves may swell like iron rods. Infected nerves kill all sensation. In endemic areas, pins and needles in hands may call attention to it. A disease of nerves rather than skin. NOTIFIABLE DISEASE.
Many laymen and practitioners will never have seen a case. In the absence of modern medicine some good can be achieved by traditional remedies. Ancient Hindu and Chinese records refer to the use of Gotu Kola (internally and externally). Dr C.D. de Granpre? (1888) refers. (Martindale 27; p.441)
Oil of Chaulmoogra was used up to one hundred years ago before introduction of modern drugs. It fell into dis-use until discovered by a Director of Health in the Philippine Islands during World War I when he used it successfully in combination with camphor. In South America, where the disease is still active, Sarsaparilla has a long traditional reputation. Walnut oil is used as a dressing, in China. An anti- staphylococcal fraction has been isolated from the seeds of Psoralea corylifolia for use in leprosy. (Indian Journal of Pharmacy 26: 141, 1964)
Tea. Gotu Kola. Half a teaspoon to each cup boiling water; infuse 15 minutes. Drink freely. Stronger infusions may be used externally to cleanse ulceration.
Decoction. Combine: Sarsaparilla 1; Gotu Kola 1; Echinacea 2. Half an ounce to 1 pint water gently simmered 20 minutes. Dose: Half a cup 3 times daily.
Formula. Echinacea 2; Sarsaparilla 1; Gotu Kola 2. Dose. Powders 500mg. Liquid Extracts 3-5ml. Tinctures 5-10ml. Thrice daily.
Note: Antibody-positive cases of AIDS are vulnerable to leprosy, both diseases being caused by a similar bacterium.
To be treated by infectious diseases specialist. ... hansen’s disease
Symptoms. Hard rubbery glands are general, chiefly detected under the arm and groin. Enlarged nodes may compress nearby structures to produce nerve pains. Weight loss. Accumulation of fluid in lungs and abdomen. Obstruction of bile duct leads to jaundice. Patient may be prone to shingles. High fever heralds approaching fatality. Blood count, bone marrow aspiration and node biopsy confirm. Tubercula glands may simulate Hodgkin’s disease.
Some success reported by the use of the Periwinkle plant. (vinca rosea – Vinchristine) Wm Boericke, M.D. refers to Figwort as a powerful agent in Hodgkin’s disease.
Alternatives. Although there is no known cure, emphasis on the cortex of the adrenal gland may reduce skin irritation and pain in the later stages (Gotu Kola, Liquorice, Sarsaparilla). To arrest wasting and constitutional weakness: Echinacea. Anti-pruritics, alteratives and lymphatics are indicated.
Tea. Formula. Equal parts, Nettles, Gotu Kola, Red Clover. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 or more times daily.
Decoction. Formula. Equal parts – Yellow Dock, Queen’s Delight, Echinacea. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup 3 or more times daily.
Tablets/capsules. Poke root. Blue Flag root. Echinacea. Mistletoe.
Powders. Formula. Echinacea 2; Poke root 1; Bladderwrack 1. Dose: 500mg (two 00 capsules or one- third teaspoon) 3 or more times daily.
Tinctures. Mixture. Parts: Echinacea 2; Goldenseal quarter; Thuja quarter; Poke root half; Periwinkle 1. Dose: 1-2 teaspoons, 3 or more times daily. Where active inflammation is present – add Wild Yam 1. External. Castor oil packs to abdomen.
Treatment by a general medical practitioner or hospital specialist.
HOLISTIC MEDICINE. A school of thought which regards disease as a manifestation of an inner disturbance of the vital force, and not merely abnormality of certain groups of nerves, muscles, veins, or even the mind itself. Article 43 of Dr Samuel Hahnemann’s Organon of the Healing Art describes it:
“No organ, no tissue, no cell, no molecule is independent of the activities of the others but the life of each one of these elements is merged into the life of the whole. The unit of human life cannot be the organ, the tissue, the cell, the molecule, the atom, but the whole organism, the whole man.”
Holistic medicine relates disease to a patient’s personality, posture, diet, emotional life, and lifestyle. Treatment will be related to body, mind and spirit. It encourages a positive psychological response to the disease from which a patient suffers. For instance, its gentle approach to cancer embraces stress control, meditation, forms of visualisation and other life-enhancing skills.
Diet may be vegetarian, even vegan.... hodgkin’s disease
Supplementation. Vitamin B12.
HYDRAGOGUE. A herbal cathartic that causes watery evacuation and drastic purgation. White Bryony, American Mandrake. (Practitioner use only) ... hydatid disease
Etiology. Obscure; though cases may be traced to auto-toxaemia, Vitamin B deficiency, menstruation, malaria drugs (chloroquine).
Symptoms: dizziness, nausea, vomiting, tinnitus, sound distortions, heavy sweating, loss of hearing; usually in one ear only. Early diagnosis essential for effective treatment. This may mean reference to a department of otolaryngology or otoneurology.
Treatment. Antispasmodics. Nervines. Sometimes a timely diuretic reduces severity – Uva Ursi, Dandelion root, Wild Carrot.
Alternatives. Current European practice: Betony, German Chamomile, Passion flower, Hawthorn, Hops, Feverfew, White Willow.
Tea. Combine, equal parts: Valerian, Wild Carrot, Agrimony. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup every 2 hours during attack; thrice daily thereafter.
Decoction. Mistletoe: 2 teaspoons to each cup cold water steeped overnight. Bring to boil. Allow to cool. Half-1 cup, as above.
Tablets/capsules. Feverfew, Mistletoe, Prickly Ash.
Formula. Ginkgo 2; Dandelion 1; Black Cohosh 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.
Feverfew tincture. See: FEVERFEW.
Dr J. Christopher: inject into ears, at night, few drops oil of Garlic (or contents of Garlic capsule).
Cider vinegar. 2 teaspoons to glass water: as desired.
Aromatherapy. Inhalants: Eucalyptus or Rosemary oils.
Diet: gluten-free, low salt; good responses observed. High fibre. Avoid dairy products and chocolate. Vitamins: B-complex, B1; B2; B6; E; F. Brewer’s yeast, Niacin.
Minerals: Calcium. Magnesium. Phosphorus. Dolomite. ... meniere’s disease
Some authorities believe cause is vitamin and mineral deficiency – those which promote bone health being calcium and magnesium (dolomite). Supplementation helps cases but evidence confirms that some pet-owners are at risk – a virus from cats and dogs possibly responsible. The prime candidate is one exposed to canine distemper. Dogs are involved twice as much as cats. The virus is closely related to the measles virus in humans.
Symptoms. Limbs deformed, hot during inflammatory stage. Headaches. Dull aching pain in bones. Deafness from temporal bone involvement. Loss of bone rigidity. Bowing of legs.
Surgical procedures may be necessary. Appears to be a case for immunisation of dogs against distemper.
Alternatives. Black Cohosh, Boneset, Cramp bark, Bladderwrack, German Chamomile, Devil’s Claw, Helonias, Oat husks, Prickly Ash, Sage, Wild Yam.
Tea. Oats (mineral nutrient for wasting diseases) 2; Boneset (anti-inflammatory) 1; Valerian (mild analgesic) 1; Liquorice quarter. Mix. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.
Decoction. Cramp bark 1; White Willow 2. Mix. 4 heaped teaspoons to 1 pint (500ml) water gently simmered 20 minutes. Dose: half-1 cup thrice daily.
Tablets/capsules. Cramp bark, Devil’s Claw, Echinacea, Helonias, Prickly Ash, Wild Yam.
Formula. Devil’s Claw 1; Black Cohosh 1; Valerian 1; Liquorice quarter. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action enhanced when taken in cup of Fenugreek tea. Thrice daily. Every 2 hours acute cases.
Practitioner’s analgesic. Tincture Gelsemium: 10 drops in 100ml water. Dose: 1 teaspoon every 2 hours (inflammatory stage).
Topical. Comfrey root poultice.
Diet. High protein, low salt, low fat. Oily fish.
Supplements. Daily. Vitamin C (500mg); Vitamin D (1000mg); Calcium citrate (1 gram); Dolomite (1 gram); Beta-Carotene (7500iu). Kelp. ... paget’s disease
Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.
SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.
The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.
HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper
limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.
Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.
Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.
The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.
Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.
with plaster of Paris. If closed traction does not work, then open reduction of the fracture may
be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.
External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.
Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.
Complications of fractures are fairly common. In non-union, the fracture does not unite
– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.
Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.
Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:
subcapital where the neck joins the head of the femur.
intertrochanteric through the trochanter.
subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur
need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.
In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.
Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.
Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.
The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.
Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).
Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.
Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.
Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.
By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.
Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.
Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.
Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.
Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.
With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.
Further information is available from the National Osteoporosis Society.
Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.
If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.
For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.
Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.
EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.
MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.
OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.
OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of
Treatment Any major de?ciencies, such as thyroxin or insulin lack, should be corrected. The activity of the immune system should then be reduced. CORTICOSTEROIDS and, in more severe cases, strong immunosuppressant drugs – AZATHIOPRINE, CYCLOPHOSPHAMIDE or METHOTREXATE – should be administered. Treatment is di?cult because of the need to control the autoimmune condition without damaging the body’s ability to combat other diseases.... autoimmune disorders
The first symptom of coronary artery disease is frequently the chest pain of angina. Treatment is with drugs such as glyceryl trinitrate and other nitrate drugs, beta-blockers, calcium channel blockers, potassium channel activators, and vasodilator drugs. If drug treatment fails to relieve the symptoms, or there is extensive narrowing of the coronary
arteries, blood flow may be improved by balloon angioplasty or coronary artery bypass surgery.... coronary artery disease
The description ‘diaphragm’ is also used for the hemispherical rubber (‘dutch’) cap used in conjunction with a chemical spermicide as a contraceptive. It ?ts over the neck of the uterus (cervix) inside the vagina. (See CONTRACEPTION.)... diaphragm
Dislocations, like fractures (see BONE, DISORDERS OF), are divided into simple and compound, the bone in the latter case being forced through the skin. This seldom occurs, since the round head of the bone has not the same power to wound as the sharp end of a broken bone. Dislocations are also divided according to whether they are (1) congenital, i.e. present at birth in consequence of some malformation, or (2) acquired at a later period in consequence of injury, the great majority falling into the latter class. The reduction of a dislocated joint is a skilled procedure and should be done by an appropriately trained professional.... dislocations
The potential side-effects of diuretics are HYPOKALAEMIA, DEHYDRATION, and GOUT (in susceptible individuals).
Extra-renal mechanisms (a) Inhibiting release of antidiuretic hormone (e.g. water, alcohol); (b) increased renal blood ?ow (e.g. dopamine in renal doses).
Renal mechanisms (a) Osmotic diuretics act by ‘holding’ water in the renal tubules and preventing its reabsorption (e.g. mannitol); (b) loop diuretics prevent sodium, and therefore water, reabsorption (e.g. FRUSEMIDE); (c) drugs acting on the cortical segment of the Loop of Henle prevent sodium reabsorption, but are ‘weaker’ than loop diuretics (e.g. THIAZIDES); (d) drugs acting on the distal tubule prevent sodium reabsorption by retaining potassium
(e.g. spironalactone).... diuretics
Astigmatism (See ASTIGMATISM.)
Blepharitis A chronic in?ammation of the lid margins. SEBORRHOEA and staphylococcal infection are likely contributors. The eyes are typically intermittently red, sore and gritty over months or years. Treatment is di?cult and may fail. Measures to reduce debris on the lid margins, intermittent courses of topical antibiotics, steroids or systemic antibiotics may help the sufferer.
Blepharospasm Involuntary closure of the eye. This may accompany irritation but may also occur without an apparent cause. It may be severe enough to interfere with vision. Treatment involves removing the source of irritation, if present. Severe and persistent cases may respond to injection of Botulinum toxin into the orbicularis muscle.
Cataract A term used to describe any opacity in the lens of the eye, from the smallest spot to total opaqueness. The prevalence of cataracts is age-related: 65 per cent of individuals in their sixth decade have some degree of lens opacity, while all those over 80 are affected. Cataracts are the most important cause of blindness worldwide. Symptoms will depend on whether one or both eyes are affected, as well as the position and density of the cataract(s). If only one eye is developing a cataract, it may be some time before the person notices it, though reading may be affected. Some people with cataracts become shortsighted, which in older people may paradoxically ‘improve’ their ability to read. Bright light may worsen vision in those with cataracts.
The extent of visual impairment depends on the nature of the cataracts, and the ?rst symptoms noticed by patients include di?culty in recognising faces and in reading, while problems watching television or driving, especially at night, are pointers to the condition. Cataracts are common but are not the only cause of deteriorating vision. Patients with cataracts should be able to point to the position of a light and their pupillary reactions should be normal. If a bright light is shone on the eye, the lens may appear brown or, in advanced cataracts, white (see diagram).
While increasing age is the commonest cause of cataract in the UK, patients with DIABETES MELLITUS, UVEITIS and a history of injury to the eye can also develop the disorder. Prolonged STEROID treatment can result in cataracts. Children may develop cataracts, and in them the condition is much more serious as vision may be irreversibly impaired because development of the brain’s ability to interpret visual signals is hindered. This may happen even if the cataracts are removed, so early referral for treatment is essential. One of the physical signs which doctors look for when they suspect cataract in adults as well as in children is the ‘red re?ex’. This is observable when an ophthalmoscopic examination of the eye is made (see OPHTHALMOSCOPE). Identi?cation of this red re?ex (a re?ection of light from the red surface of the retina –see EYE) is a key diagnostic sign in children, especially young ones.
There is no e?ective medical treatment for established cataracts. Surgery is necessary and the decision when to operate depends mainly on how the cataract(s) affect(s) the patient’s vision. Nowadays, surgery can be done at any time with limited risk. Most patients with a vision of 6/18 – 6/10 is the minimum standard for driving – or worse in both eyes should
E
bene?t from surgery, though elderly people may tolerate visual acuity of 6/18 or worse, so surgery must be tailored to the individual’s needs. Younger people with a cataract will have more demanding visual requirements and so may opt for an ‘earlier’ operation. Most cataract surgery in Britain is now done under local anaesthetic and uses the ‘phaco-emulsi?cation’ method. A small hole is made in the anterior capsule of the lens after which the hard lens nucleus is liqui?ed ultrasonically. A replacement lens is inserted into the empty lens bag (see diagram). Patients usually return to their normal activities within a few days of the operation. A recent development under test in the USA for children requiring cataract operations is an intra-ocular ?exible implant whose magnifying power can be altered as a child develops, thus precluding the need for a series of corrective operations as happens now.
Chalazion A ?rm lump in the eyelid relating to a blocked meibomian gland, felt deep within the lid. Treatment is not always necessary; a proportion spontaneously resolve. There can be associated infection when the lid becomes red and painful requiring antibiotic treatment. If troublesome, the chalazion can be incised under local anaesthetic.
Conjunctivitis In?ammation of the conjunctiva (see EYE) which may affect one or both eyes. Typically the eye is red, itchy, sticky and gritty but is not usually painful. Redness is not always present. Conjunctivitis can occasionally be painful, particularly if there is an associated keratitis (see below) – for example, adenovirus infection, herpetic infection.
The cause can be infective (bacteria, viruses or CHLAMYDIA), chemical (e.g. acids, alkalis) or allergic (e.g. in hay fever). Conjunctivitis may also be caused by contact lenses, and preservatives or even the drugs in eye drops may cause conjunctival in?ammation. Conjunctivitis may addtionally occur in association with other illnesses – for example, upper-respiratory-tract infection, Stevens-Johnson syndrome (see ERYTHEMA – erythema multiforme) or REITER’S SYNDROME. The treatment depends on the cause. In many patients acute conjunctivitis is self-limiting.
Dacryocystitis In?ammation of the lacrimal sac. This may present acutely as a red, painful swelling between the nose and the lower lid. An abscess may form which points through the skin and which may need to be drained by incision. Systemic antibiotics may be necessary. Chronic dacryocystitis may occur with recurrent discharge from the openings of the tear ducts and recurrent swelling of the lacrimal sac. Obstruction of the tear duct is accompanied by watering of the eye. If the symptoms are troublesome, the patient’s tear passageways need to be surgically reconstructed.
Ectropion The lid margin is everted – usually the lower lid. Ectropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the skin of the lids such as happens with scarring or mechanical factors – for example, a tumour pulling the skin of the lower lid downwards. Ectropion tends to cause watering and an unsightly appearance. The treatment is surgical.
Entropion The lid margin is inverted – usually the lower lid. Entropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the inner surfaces of the lids due to scarring – for example, TRACHOMA or chemical burns. The inwardly directed lashes cause irritation and can abrade the cornea. The treatment is surgical.
Episcleritis In?ammation of the EPISCLERA. There is usually no apparent cause. The in?ammation may be di?use or localised and may affect one or both eyes. It sometimes recurs. The affected area is usually red and moderately painful. Episcleritis is generally not thought to be as painful as scleritis and does not lead to the same complications. Treatment is generally directed at improving the patient’s symptoms. The in?ammation may respond to NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) or topical CORTICOSTEROIDS.
Errors of refraction (Ametropia.) These will occur when the focusing power of the lens and cornea does not match the length of the eye, so that rays of light parallel to the visual axis are not focused at the fovea centralis (see EYE). There are three types of refractive error: HYPERMETROPIA or long-sightedness. The refractive power of the eye is too weak, or the eye is too short so that rays of light are brought to a focus at a point behind the retina. Longsighted people can see well in the distance but generally require glasses with convex lenses for reading. Uncorrected long sight can lead to headaches and intermittent blurring of vision following prolonged close work (i.e. eye strain). As a result of ageing, the eye becomes gradually long-sighted, resulting in many people needing reading glasses in later life: this normal process is known as presbyopia. A particular form of long-sightedness occurs after cataract extraction (see above). MYOPIA(Short sight or near sight.) Rays of light are brought to a focus in front of the retina because the refractive power of the eye is too great or the eye is too short. Short-sighted people can see close to but need spectacles with concave lenses in order to see in the distance. ASTIGMATISMThe refractive power of the eye is not the same in each meridian. Some rays of light may be focused in front of the retina while others are focused on or behind the retina. Astigmatism can accompany hypermetropia or myopia. It may be corrected by cylindrical lenses: these consist of a slice from the side of a cylinder (i.e. curved in one meridian and ?at in the meridian at right-angles to it).
Keratitis In?ammation of the cornea in response to a variety of insults – viral, bacterial, chemical, radiation, or mechanical trauma. Keratitis may be super?cial or involve the deeper layers, the latter being generally more serious. The eye is usually red, painful and photophobic. Treatment is directed at the cause.
Nystagmus Involuntary rhythmic oscillation of one or both eyes. There are several causes including nervous disorders, vestibular disorders, eye disorders and certain drugs including alcohol.
Ophthalmia In?ammation of the eye, especially the conjunctiva (see conjunctivitis, above). Ophthalmia neonatorum is a type of conjunctivitis that occurs in newborn babies. They catch the disease when passing through an infected birth canal during their mother’s labour (see PREGNANCY AND LABOUR). CHLAMYDIA and GONORRHOEA are the two most common infections. Treatment is e?ective with antibiotics: untreated, the infection may cause permanent eye damage.
Pinguecula A benign degenerative change in the connective tissue at the nasal or temporal limbus (see EYE). This is visible as a small, ?attened, yellow-white lump adjacent to the cornea.
Pterygium Overgrowth of the conjunctival tissues at the limbus on to the cornea (see EYE). This usually occurs on the nasal side and is associated with exposure to sunlight. The pterygium is surgically removed for cosmetic reasons or if it is thought to be advancing towards the visual axis.
Ptosis Drooping of the upper lid. May occur because of a defect in the muscles which raise the lid (levator complex), sometimes the result of ageing or trauma. Other causes include HORNER’S SYNDROME, third cranial nerve PALSY, MYASTHENIA GRAVIS, and DYSTROPHIA MYOTONICA. The cause needs to be determined and treated if possible. The treatment for a severely drooping lid is surgical, but other measures can be used to prop up the lid with varying success.
Retina, disorders of The retina can be damaged by disease that affects the retina alone, or by diseases affecting the whole body.
Retinopathy is a term used to denote an abnormality of the retina without specifying a cause. Some retinal disorders are discussed below. DIABETIC RETINOPATHY Retinal disease occurring in patients with DIABETES MELLITUS. It is the commonest cause of blind registration in Great Britain of people between the ages of 20 and 65. Diabetic retinopathy can be divided into several types. The two main causes of blindness are those that follow: ?rst, development of new blood vessels from the retina, with resultant complications and, second, those following ‘water logging’ (oedema) of the macula. Treatment is by maintaining rigid control of blood-sugar levels combined with laser treatment for certain forms of the disease – in particular to get rid of new blood vessels. HYPERTENSIVE RETINOPATHY Retinal disease secondary to the development of high blood pressure. Treatment involves control of the blood pressure (see HYPERTENSION). SICKLE CELL RETINOPATHY People with sickle cell disease (see under ANAEYIA) can develop a number of retinal problems including new blood vessels from the retina. RETINOPATHY OF PREMATURITY (ROP) Previously called retrolental ?broplasia (RLF), this is a disorder affecting low-birth-weight premature babies exposed to oxygen. Essentially, new blood vessels develop which cause extensive traction on the retina with resultant retinal detachment and poor vision. RETINAL ARTERY OCCLUSION; RETINAL VEIN OCCLUSION These result in damage to those areas of retina supplied by the affected blood vessel: the blood vessels become blocked. If the peripheral retina is damaged the patient may be completely symptom-free, although areas of blindness may be detected on examination of ?eld of vision. If the macula is involved, visual loss may be sudden, profound and permanent. There is no e?ective treatment once visual loss has occurred. SENILE MACULAR DEGENERATION (‘Senile’ indicates age of onset and has no bearing on mental state.) This is the leading cause of blindness in the elderly in the western world. The average age of onset is 65 years. Patients initially notice a disturbance of their vision which gradually progresses over months or years. They lose the ability to recognise ?ne detail; for example, they cannot read ?ne print, sew, or recognise people’s faces. They always retain the ability to recognise large objects such as doors and chairs, and are therefore able to get around and about reasonably well. There is no e?ective treatment in the majority of cases. RETINITIS PIGMENTOSAA group of rare, inherited diseases characterised by the development of night blindness and tunnel vision. Symptoms start in childhood and are progressive. Many patients retain good visual acuity, although their peripheral vision is limited. One of the characteristic ?ndings on examination is collections of pigment in the retina which have a characteristic shape and are therefore known as ‘bone spicules’. There is no e?ective treatment. RETINAL DETACHMENTusually occurs due to the development of a hole in the retina. Holes can occur as a result of degeneration of the retina, traction on the retina by the vitreous, or injury. Fluid from the vitreous passes through the hole causing a split within the retina; the inner part of the retina becomes detached from the outer part, the latter remaining in contact with the choroid. Detached retina loses its ability to detect light, with consequent impairment of vision. Retinal detachments are more common in the short-sighted, in the elderly or following cataract extraction. Symptoms include spots before the eyes (?oaters), ?ashing lights and a shadow over the eye with progressive loss of vision. Treatment by laser is very e?ective if caught early, at the stage when a hole has developed in the retina but before the retina has become detached. The edges of the hole can be ‘spot welded’ to the underlying choroid. Once a detachment has occurred, laser therapy cannot be used; the retina has to be repositioned. This is usually done by indenting the wall of the eye from the outside to meet the retina, then making the retina stick to the wall of the eye by inducing in?ammation in the wall (by freezing it). The outcome of surgery depends largely on the extent of the detachment and its duration. Complicated forms of detachment can occur due to diabetic eye disease, injury or tumour. Each requires a specialised form of treatment.
Scleritis In?ammation of the sclera (see EYE). This can be localised or di?use, can affect the anterior or the posterior sclera, and can affect one or both eyes. The affected eye is usually red and painful. Scleritis can lead to thinning and even perforation of the sclera, sometimes with little sign of in?ammation. Posterior scleritis in particular may cause impaired vision and require emergency treatment. There is often no apparent cause, but there are some associated conditions – for example, RHEUMATOID ARTHRITIS, GOUT, and an autoimmune disease affecting the nasal passages and lungs called Wegener’s granulomatosis. Treatment depends on severity but may involve NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), topical CORTICOSTEROIDS or systemic immunosuppressive drugs.
Stye Infection of a lash follicle. This presents as a painful small red lump at the lid margin. It often resolves spontaneously but may require antibiotic treatment if it persists or recurs.
Sub-conjunctival haemorrhage Haemorrhage between the conjunctiva and the underlying episclera. It is painless. There is usually no apparent cause and it resolves spontaneously.
Trichiasis Inward misdirection of the lashes. Trichiasis occurs due to in?ammation of or trauma to the lid margin. Treatment involves removal of the patient’s lashes. Regrowth may be prevented by electrolysis, by CRYOTHERAPY to the lid margin, or by surgery.
For the subject of arti?cial eyes, see under PROSTHESIS; also GLAUCOMA, SQUINT and UVEITIS.... eye, disorders of
Treatment includes the full gamut of neonatal intensive care, as well as speci?c therapy with PULMONARY SURFACTANT.... hyaline membrane disease
The disease is rare and tends to run in families. It occurs about 4 times more often in boys. Symptoms, which include constipation and bloating, usually develop in the first few weeks of life, but may become evident in infancy or early childhood. The child usually has a poor appetite and may fail to grow properly.
A barium X-ray examination can show the narrowed segment of the intestine.
A biopsy may be taken.
Treatment of Hirschsprung’s disease involves removing the narrowed segment and rejoining the normal intestine to the anus.... hirschsprung’s disease
The chorea usually affects the face, arms, and trunk, resulting in random grimaces and twitches, and clumsiness. Dementia takes the form of irritability, personality and behavioural changes, memory loss, and apathy.
At present, there is no cure for Huntington’s disease, and treatment is aimed at reducing symptoms with drugs.... huntington’s disease
Dominant genes A dominant characteristic is an e?ect which is produced whenever a gene or gene defect is present. If a disease is due to a dominant gene, those affected are heterozygous – that is, they only carry a fault in the gene on one of the pair of chromosomes concerned. A?ected people married to normal individuals transmit the gene directly to one-half of the children, although this is a random event just like tossing a coin. HUNTINGTON’S CHOREA is due to the inheritance of a dominant gene, as is neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE) and familial adenomatous POLYPOSIS of the COLON. ACHONDROPLASIA is an example of a disorder in which there is a high frequency of a new dominant mutation, for the majority of affected people have normal parents and siblings. However, the chances of the children of a parent with the condition being affected are one in two, as with any other dominant characteristic. Other diseases inherited as dominant characteristics include spherocytosis, haemorrhagic telangiectasia and adult polycystic kidney disease.
Recessive genes If a disease is due to a recessive gene, those affected must have the faulty gene on both copies of the chromosome pair (i.e. be homozygous). The possession of a single recessive gene does not result in overt disease, and the bearer usually carries this potentially unfavourable gene without knowing it. If that person marries another carrier of the same recessive gene, there is a one-in-four chance that their children will receive the gene in a double dose, and so have the disease. If an individual sufferer from a recessive disease marries an apparently normal person who is a heterozygous carrier of the same gene, one-half of the children will be affected and the other half will be carriers of the disease. The commonest of such recessive conditions in Britain is CYSTIC FIBROSIS, which affects about one child in 2,000. Approximately 5 per cent of the population carry a faulty copy of the gene. Most of the inborn errors of metabolism, such as PHENYLKETONURIA, GALACTOSAEMIA and congenital adrenal hyperplasia (see ADRENOGENITAL SYNDROME), are due to recessive genes.
There are characteristics which may be incompletely recessive – that is, neither completely dominant nor completely recessive – and the heterozygotus person, who bears the gene in a single dose, may have a slight defect whilst the homozygotus, with a double dose of the gene, has a severe illness. The sickle-cell trait is a result of the sickle-cell gene in single dose, and sickle-cell ANAEMIA is the consequence of a double dose.
Sex-linked genes If a condition is sex-linked, affected males are homozygous for the mutated gene as they carry it on their single X chromosome. The X chromosome carries many genes, while the Y chromosome bears few genes, if any, other than those determining masculinity. The genes on the X chromosome of the male are thus not matched by corresponding genes on the Y chromosome, so that there is no chance of the Y chromosome neutralising any recessive trait on the X chromosome. A recessive gene can therefore produce disease, since it will not be suppressed by the normal gene of the homologous chromosome. The same recessive gene on the X chromosome of the female will be suppressed by the normal gene on the other X chromosome. Such sex-linked conditions include HAEMOPHILIA, CHRISTMAS DISEASE, DUCHENNE MUSCULAR
DYSTROPHY (see also MUSCLES, DISORDERS OF – Myopathy) and nephrogenic DIABETES INSIPIDUS.
If the mother of an affected child has another male relative affected, she is a heterozygote carrier; half her sons will have the disease and half her daughters will be carriers. The sister of a haemophiliac thus has a 50 per cent chance of being a carrier. An affected male cannot transmit the gene to his son because the X chromosome of the son must come from the mother; all his daughters, however, will be carriers as the X chromosome for the father must be transmitted to all his daughters. Hence sex-linked recessive characteristics cannot be passed from father to son. Sporadic cases may be the result of a new mutation, in which case the mother is not the carrier and is not likely to have further affected children. It is probable that one-third of haemophiliacs arise as a result of fresh mutations, and these patients will be the ?rst in the families to be affected. Sometimes the carrier of a sex-linked recessive gene can be identi?ed. The sex-linked variety of retinitis pigmentosa (see EYE, DISORDERS OF) can often be detected by ophthalmoscopic examination.
A few rare disorders are due to dominant genes carried on the X chromosome. An example of such a condition is familial hypophosphataemia with vitamin-D-resistant RICKETS.
Polygenic inheritance In many inherited conditions, the disease is due to the combined action of several genes; the genetic element is then called multi-factorial or polygenic. In this situation there would be an increased incidence of the disease in the families concerned, but it will not follow the Mendelian (see MENDELISM; GENETIC CODE) ratio. The greater the number of independent genes involved in determining a certain disease, the more complicated will be the pattern of inheritance. Furthermore, many inherited disorders are the result of a combination of genetic and environmental in?uences. DIABETES MELLITUS is the most familiar of such multi-factorial inheritance. The predisposition to develop diabetes is an inherited characteristic, although the gene is not always able to express itself: this is called incomplete penetrance. Whether or not the individual with a genetic predisposition towards the disease actually develops diabetes will also depend on environmental factors. Diabetes is more common in the relatives of diabetic patients, and even more so amongst identical twins. Non-genetic factors which are important in precipitating overt disease are obesity, excessive intake of carbohydrate foods, and pregnancy.
SCHIZOPHRENIA is another example of the combined effects of genetic and environmental in?uences in precipitating disease. The risk of schizophrenia in a child, one of whose parents has the disease, is one in ten, but this ?gure is modi?ed by the early environment of the child.... genetic disorders
Laryngitis In?ammation of the mucous membrane of the larynx and vocal chords may be acute or chronic. The cause is usually an infection, most commonly viral, although it may be the result of secondary bacterial infection, voice abuse or irritation by gases or chemicals. ACUTE LARYNGITIS may accompany any form of upper-respiratory-tract infection. The main symptom is hoarseness and often pain in the throat. The voice becomes husky or it may be lost. Cough, breathing diffculties and sometimes stridor may occur. Acute airway obstruction is unusual following laryngitis but may occasionally occur in infants (see laryngotracheo-bronchitis, below).
Treatment Vapour inhalations may be soothing and reduce swelling. Usually all that is needed is rest and analgesics such as paracetamol. Rarely, airway intervention – either ENDOTRACHEAL INTUBATION or TRACHEOSTOMY – may be necessary if severe airway obstruction develops (see APPENDIX 1: BASIC FIRST AID). A?ected patients should rest their voice and avoid smoking.
Chronic laryngitis can result from repeated attacks of acute laryngitis; excessive use of the voice – loud and prolonged, singing or shouting; tumours, which may be benign or malignant; or secondary to diseases such as TUBERCULOSIS and SYPHILIS.
Benign tumours or small nodules, such as singer’s nodules, may be surgically removed by direct laryngoscopy under general anaesthetic; while cancer of the larynx may be treated either by RADIOTHERAPY or by SURGERY, depending on the extent of the disease. Hoarseness may be the only symptom of vocal-chord disturbance or of laryngeal cancer: any case which has lasted for six weeks should be referred for a specialist opinion.
Laryngectomy clubs are being established
A laryngoscopic view of the interior of the larynx.
throughout the country to support patients following laryngectomy. Speech therapists provide speech rehabilitation.... larynx, disorders of
There are also more than 200 identi?ed disorders described as inborn errors of metabolism. Some cause few problems; others are serious threats to an individual’s life. Individual disorders are, fortunately, rare – probably one child in 10,000 or 100,000; overall these inborn errors affect around one child in 1,000. Examples include GALACTOSAEMIA, PHENYLKETONURIA, porphyrias, TAY SACHS DISEASE and varieties of mucopolysaccharidosis, HOMOCYSTINURIA and hereditary fructose (a type of sugar) intolerance.... metabolic disorders
links to community pharmacies and social services.
access to NHS Direct information via the Internet and information points in public sites.
publication of a guide on health care for dispatch to callers.... nhs direct
Selenium 50mcg and Vitamin E 400iu are recommended by Jonathan Wright MD, for decreasing the pain of disease, decreasing over 3 months. (Health Update USA, June 1990) ... osgood schlatter disease
Treatment varies, depending (amongst other things) on the severity of the condition. In the acute phase, rest in bed is advisable, along with ANALGESICS. Later, exercise and physiotherapy are helpful, and in some cases manipulation of the spine brings relief by allowing the herniated, or prolapsed, disc to slip back into position. The injection of a local anaesthetic into the spine (epidural ANAESTHESIA) is yet another measure that often helps the more chronic cases. If those measures fail, surgery to remove the prolapsed disc may be necessary, but the patient’s condition should be carefully reviewed before surgery is considered since success is not certain. An alternative form of treatment is the injection into the disc of chymopapain, an ENZYME obtained from the paw-paw, which dissolves the disc.... prolapsed intervertebral disc
People who have an antisocial personality lack a sense of guilt and cannot tolerate frustration.
They may have problems with relationships and are frequently in trouble with the law.
Behaviour therapy, and various forms of psychotherapy, may help to improve integration.
In general, the effects of this disorder decrease with age.... antisocial personality disorder
Respiratory distress syndrome is a complication of SHOCK, systemic SEPSIS and viral respiratory infections. It was ?rst described in 1967, and – despite advances with assisted ventilation
– remains a serious disease with a mortality of more than 50 per cent. The maintenance of adequate circulating blood volume, peripheral PERFUSION, acid-base balance and arterial oxygenation is important, and assisted ventilation should be instituted early.
In newborns the mechanism is diferent, being provoked by an inability of the lungs to manufacture SURFACTANT.... respiratory distress syndrome
When it is compressed and cooled to -75ºC, carbon dioxide becomes solid dry ice, which is used in cryosurgery.... carbon dioxide
Meiosis produces egg (see ovum) and sperm cells that differ from their parent cells in that they have only half the normal number of chromosomes.... cell division
The disease may eventually cause a cerebrovascular accident, which commonly leads to a stroke.
Extensive narrowing of blood vessels throughout the brain can be a cause of dementia.... cerebrovascular disease
Dumbness is the inability to pronounce the sounds that make up words. DEAFNESS is the most important cause, being due to a congenital brain defect, or acquired brain disease, such as tertiary SYPHILIS. When hearing is normal or only mildly impaired, dumbness may be due to a structural defect such as tongue-tie or enlarged tonsils and adenoids, or to ine?cient voice control, resulting in lisping or lalling. Increased tension is a common cause of STAMMERING; speech disorders may occasionally be of psychological origin.
Normal speech may be lost in adulthood as a result of a STROKE or head injury. Excessive use of the voice may be an occupational hazard; and throat cancer may require a LARYNGECTOMY, with subsequent help in communication. Severe psychiatric disturbance may be accompanied by impaired social and communication skills. (See also VOICE AND SPEECH.)
Treatment The underlying cause of the problem should be diagnosed as early as possible; psychological and other specialist investigations should be carried out as required, and any physical defect should be repaired. People who are deaf and unable to speak should start training in lip-reading as soon as possible, and special educational methods aimed at acquiring a modulated voice should similarly be started in early childhood – provided by the local authority, and continued as required. Various types of speech therapy or PSYCHOTHERAPY may be appropriate, alone or in conjunction with other treatments, and often the ?nal result may be highly satisfying, with a good command of language and speech being obtained.
Help and advice may be obtained from AFASIC (Unlocking Speech and Language).... speech disorders
The term dilatation also refers to procedures for achieving such enlargement, as in dilatation and curettage.... dilatation
It is prescribed for people who request help for alcohol dependence.
Treatment is usually combined with a counselling programme.
Disulfiram slows down the clearance of alcohol in the body, causing flushing, headache, nausea, dizziness, and palpitations.
Symptoms may start within 10 minutes of drinking alcohol and can last for hours.
Occasionally, large amounts of alcohol taken during treatment can cause unconsciousness; a person taking the drug should carry a warning card.... disulfiram
It is treated by regular injections of the missing enzyme.... gaucher’s disease
The following diseases and conditions are treated under their separate dictionary entries: ANCYLOSTOMIASIS; BERIBERI; BLACKWATER FEVER; CHOLERA; DENGUE; DRACONTIASIS; DYSENTERY; ELEPHANTIASIS; FILARIASIS; HEAT STROKE; LEISHMANIASIS; LEPROSY; LIVER, DISEASES OF; MALARIA; ORIENTAL SORE; PLAGUE; PRICKLY HEAT; SCHISTOSOMIASIS; SLEEPING SICKNESS; STRONGYLOIDIASIS; SUNBURN; YAWS; YELLOW FEVER.... tropical diseases
(See anxiety; anxiety disorders.)... generalized anxiety disorder
GVH disease can usually be prevented by administration of immunosuppressant drugs. If the disease develops, it can be treated with corticosteroid drugs and immunosuppressant drugs such as ciclosporin In some cases, however, it can be difficult to control.... graft-versus-host disease
Many people suffered severe nerve damage and some died.... minamata disease
If a fragment has not completely separated from the bone, the joint may be immobilized in a plaster cast to allow reattachment. Loose bone or cartilage fragments in the knee are removed during arthroscopy. Disruption to the smoothness of the joint surface increases the risk of osteoarthritis.... osteochondritis dissecans
Symptoms. Intermittent claudication. Affected parts of the leg are much paler than others, the condition regressing to ulceration and possible gangrene. Inflammation of nerves, veins and arteries may lead to clot formation (thrombosis).
Treatment. Stop smoking. Vasodilator herbs.
Alternatives. Cayenne (minute doses), Bayberry, Lime flowers, Lobelia, Prickly Ash, Wahoo bark, Mistletoe, Skullcap, Cactus.
BHP (1983) recommends: Angelica root, Hawthorn berry, Wild Yam.
Decoction. Formula. Equal parts: Hawthorn, Mistletoe, Valerian. 2 teaspoons to two cups water gently simmered 10 minutes. Dose half-1 cup thrice daily, and when necessary.
Tablets/capsules. Alternatives. Prickly Ash 100mg. Hawthorn 200mg. Wild Yam 200mg. Dosage as on bottles.
Powders. Formula. Equal parts: Hawthorn, Wild Yam, Prickly Ash. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Tinctures. Formula. Equal parts: Bayberry, Hawthorn, Prickly Ash. Dose: 1-2 teaspoons thrice daily. Practitioner. Tincture Gelsemium BPC (1973). 0.3ml (5 drops) when necessary for relief of pain.
Diet. Low fat, low salt, high fibre.
Supplements. Daily. Vitamin E 1000-1500iu. Vitamin B-complex. Magnesium, Calcium.
Exercise. Physiotherapy exercise. From the sitting position raise legs to horizontal; rest for a few minutes. Lie down and raise legs to 45 degrees; rest for a few minutes. Reverse movements resting each time to equalise the circulation. (Brenda Cooke FNIMH) ... buerger’s disease
Common causes include natural disasters, violence, rape, torture, serious physical injury, and military combat.
Symptoms, which may develop many months after the event, include recurring memories or dreams of the event, a sense of personal isolation, and disturbed sleep and concentration.
There may be a deadening of feelings, or irritability and feelings of guilt, sometimes building up to depression.
Most people recover, in time, with emotional support and counselling.... post-traumatic stress disorder
Coronary thrombosis is more common in the West because of its preference for animal fats; whereas in the East fats usually take the form of vegetable oils – corn, sunflower seed, sesame, etc. Fatty deposits (atheroma) form in the wall of the coronary artery, obstructing blood-flow. Vessels narrowed by atheroma and by contact with calcium and other salts become hard and brittle (arterio-sclerosis) and are easily blocked. Robbed of oxygen and nutrients heart muscle dies and is replaced by inelastic fibrous (scar) tissue which robs the heart of its maximum performance.
Severe pain and collapse follow a blockage. Where only a small branch of the coronary arterial tree is affected recovery is possible. Cause of the pain is lack of oxygen (Vitamin E). Incidence is highest among women over 40 who smoke excessively and who take The Pill.
The first warning sign is breathlessness and anginal pain behind the breastbone which radiates to arms and neck. Sensation as if the chest is held in a vice. First-line agent to improve flow of blood – Cactus.
For cholesterol control target the liver. Coffee is a minor risk factor.
Measuring hair calcium levels is said to predict those at risk of coronary heart disease. Low hair concentrations may be linked with poor calcium metabolism, high aortic calcium build-up and the formation of plagues. (Dr Allan MacPherson, nutritionist, Scottish Agricultural College, Ayr, Scotland)
Evidence has been advanced that a diagonal ear lobe crease may be a predictor for coronary heart disease. (American Journal of Cardiology, Dec. 1992)
Tooth decay is linked to an increased risk of coronary heart disease and mortality, particularly in young men. (Dr Frank De Stefano, Marshfield Medical Research Foundation, Wisconsin, USA) Treatment. Urgency. Send for doctor or suitably qualified practitioner. Absolute bedrest for 3 weeks followed by 3 months convalescence. Thereafter: adapt lifestyle to slower tempo and avoid undue exertion. Stop smoking. Adequate exercise. Watch weight.
Cardiotonics: Motherwort, Hawthorn, Mistletoe, Rosemary. Ephedra, Lily of the Valley, Broom.
Cardiac vasodilators relax tension on the vessels by increasing capacity of the arteries to carry more blood. Others contain complex glycosides that stimulate or relax the heart at its work. Garlic is strongly recommended as a preventative of CHD.
Hawthorn, vasodilator and anti-hypertensive, is reputed to dissolve deposits in thickened and sclerotic arteries BHP (1983). It is believed to regulate the balance of lipids (body fats) one of which is cholesterol.
Serenity tea. Equal parts: Motherwort, Lemon Balm, Hawthorn leaves or flowers. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.
Decoction. Combine equal parts: Broom, Lily of the Valley, Hawthorn. 1-2 teaspoons to each cup water gently simmered 20 minutes. Half-1 cup freely.
Tablets/capsules. Hawthorn, Motherwort, Cactus, Mistletoe, Garlic.
Practitioner. Formula. Hawthorn 20ml; Lily of the Valley 10ml; Pulsatilla 5ml; Stone root 5ml; Barberry 5ml. Tincture Capsicum 1ml. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.
Prevention: Vitamin E – 400iu daily.
Diet. See: DIET – HEART AND CIRCULATION.
Supplements. Daily. Vitamin C, 2g. Vitamin E possesses anti-clotting properties, 400iu. Broad spectrum multivitamin and mineral including chromium, magnesium selenium, zinc, copper.
Acute condition. Strict bed-rest; regulate bowels; avoid excessive physical and mental exertion. Meditation and relaxation techniques dramatically reduce coronary risk. ... coronary heart disease
The cause is thought to be bacterial; affected tissues are found to contain macrophages (a type of scavenging cell) containing rod-shaped bacteria. Treatment is with antibiotic drugs for at least 1 year. Dietary supplements are used to correct nutritional deficiencies occurring as a result of malabsorption.... whipple’s disease
Alternatives. Treatment. Echinacea is the key remedy.
Others indicated: Red Clover flower, Blue Flag root, Horsetail, Poke root, Bladderwrack. May be taken singly, as available.
Tea: Combine Bladderwrack 2; Echinacea 2; Horsetail 1. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup thrice daily.
Tinctures. Combine: Bladderwrack 2; Echinacea 2; Horsetail 1. Dose: one to two 5ml teaspoons in water thrice daily.
Diet. Iodised salt. Avoid cabbage which contains a factor which depresses the thyroid gland. Supplementation. Vitamin A. B-complex. Kelp. ... hashimoto’s disease
Alternatives. To sustain.
Teas. Lime flowers, Motherwort, Buckwheat, Hawthorn.
Tablets/capsules. Hawthorn, Mistletoe, Motherwort.
Formula. Hawthorn 2; Lily of the Valley 1; Selenicereus grandiflorus 1. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water morning and evening. ... heart disease – congenital
Acute encephalitis, acute meningitis, acute poliomyelitis, anthrax, cholera, diphtheria, dysentery (amoebic and bacillary), food poisoning, infective jaundice, leprosy, leptospirosis, lassa fever, mumps, malaria, marburg disease, measles, German measles, ophthalmia neonatorum, paratyphoid fever, plague, rabies, relapsing fever, scarlet fever, smallpox, tetanus, tuberculosis, typhoid fever, typhus, viral haemorrhagic fever, whooping cough and yellow fever.
Six communicable diseases are internationally notifiable to the World Health Organisation: yellow fever, plague, cholera, smallpox, louse-borne relapsing fever, louse-borne typhus.
Notification has to be made to local and central Government authorities. Certain occupational diseases and all cases of cancer must be registered and notified.
It is required that the above diseases and certain others receive modern medical therapy in a hospital or treatment under the supervision of a qualified physician. Failure to conform may expose a practitioner, registered or unregistered, to a charge of negligence. ... notifiable diseases
The causes of are not fully understood, but the disorder often runs in families, which suggests that genetic factors may be involved. is not, as popularly believed, a result of poor parenting or abuse.
Symptoms develop in early childhood, usually between the ages of 3 and 7, and may include inability to finish tasks; short attention span; inability to concentrate in class; difficulty in following instructions; a tendency to talk excessively, frequently interrupting other people; difficulty in waiting or taking turns; inability to play quietly alone; and physical impulsiveness. Children with may have difficulty in forming friendships. Self-esteem is often low because an affected child is frequently scolded and criticized.
Treatment includes behaviour modification techniques, both at home and at school. In some children, avoidance of certain foods or food additives seems to reduce symptoms. In severe cases, stimulant drugs, usually methylphenidate, may be prescribed. Paradoxically, the use of stimulants in reduces hyperactivity and improves concentration. In general, the condition improves by adolescence but may be followed by antisocial behaviour and drug abuse or substance abuse.... attention deficit hyperactivity disorder
The most common type of motor neuron disease is amyotrophic lateral sclerosis ( or Lou Gehrig’s disease). It usually affects people over the age of 50 and is more common in men. Some cases run in families. Usually, symptoms start with weakness in the hands and arms or legs, and muscle wasting. There may be irregular muscle contractions, and muscle cramps or stiffness. All four extremities are soon affected.
Progressive muscular atrophy and progressive bulbar palsy both start with patterns of muscle weakness different from but usually develop into.There are 2 types of motor neuron disease that first appear in childhood or adolescence. In most cases, these conditions are inherited. Werdnig–Hoffman disease affects infants at birth or soon afterwards. In almost all cases, progressive muscle weakness leads to death within several years. Chronic spinal muscular atrophy begins in childhood or adolescence, causing progressive weakness but not always serious disability.
There are no specific tests for motor neuron disease. Diagnosis is based on careful clinical examination by a neurologist. Tests including EMG, muscle biopsy, blood tests, myelography, CT scanning, or MRI may be performed.
The disease typically goes on to affect the muscles involved in breathing and swallowing, leading to death within 2–4 years. However, about 10 per cent of sufferers survive for 10 years.
Nerve degeneration cannot be slowed down, but physiotherapy and the use of various aids may help to reduce disability. The drug riluzole is used to extend life (or the time until mechanical ventilation is required).... motor neuron disease
On exposure to cold, the digits turn white due to lack of blood. As sluggish blood flow returns, the digits become blue; when they are warmed and normal blood flow returns, they turn red. During an attack, there is often tingling, numbness, or a burning feeling in the affected fingers or toes. In rare cases, the artery walls gradually thicken, permanently reducing blood flow. Eventually painful ulceration or even gangrene may develop at the tips of the affected digits.
Diagnosis is made from the patient’s history. Treatment involves keeping the hands and feet as warm as possible. Vasodilator drugs or calcium channel blockers may be helpful in severe cases. (See also Raynaud’s phenomenon.)... raynaud’s disease
The disease is diagnosed by bloodclotting tests and measurement of blood levels of von Willebrand factor. Bleeding episodes can be prevented or controlled by desmopressin (a substance resembling ADH). Factor or concentrated von Willebrand factor may also be used to treat bleeding.... von willebrand’s disease
Various processes that can occur include in?ammation, ulceration, infection or tumour. Abdominal disease may be of rapid onset, described as acute, or more long-term when it is termed chronic.
An ‘acute abdomen’ is most commonly caused by peritonitis – in?ammation of the membrane that lines the abdomen. If any structure in the abdomen gets in?amed, peritonitis may result. Causes include injury, in?ammation of the Fallopian tubes (SALPINGITIS), and intestinal disorders such as APPENDICITIS, CROHN’S DISEASE, DIVERTICULITIS or a perforated PEPTIC ULCER. Disorders of the GALLBLADDER or URINARY TRACT may also result in acute abdominal pain.
General symptoms of abdominal disease include:
Pain This is usually ill-de?ned but can be very unpleasant, and is termed visceral pain. Pain is initially felt near the mid line of the abdomen. Generally, abdominal pain felt high up in the mid line originates from the stomach and duodenum. Pain that is felt around the umbilicus arises from the small intestine, appendix and ?rst part of the large bowel, and low mid-line pain comes from the rest of the large bowel. If the diseased organ secondarily in?ames or infects the lining of the abdominal wall – the PERITONEUM – peritonitis occurs and the pain becomes more de?ned and quite severe, with local tenderness over the site of the diseased organ itself. Hence the pain of appendicitis begins as a vague mid-line pain, and only later moves over to the right iliac fossa, when the in?amed appendix has caused localised peritonitis. PERFORATION of one of the hollow organs in the abdomen – for example, a ruptured appendix or a gastric or duodenal ulcer (see STOMACH, DISEASES OF) eroding the wall of the gut – usually causes peritonitis with resulting severe pain.
The character of the pain is also important. It may be constant, as occurs in in?ammatory diseases and infections, or colicky (intermittent) as in intestinal obstruction.
Swelling The commonest cause of abdominal swelling in women is pregnancy. In disease, swelling may be due to the accumulation of trapped intestinal contents within the bowel, the presence of free ?uid (ascites) within the abdomen, or enlargement of one or more of the abdominal organs due to benign causes or tumour.
Constipation is the infrequent or incomplete passage of FAECES; sometimes only ?atus can be passed and, rarely, no bowel movements occur (see main entry for CONSTIPATION). It is often associated with abdominal swelling. In intestinal obstruction, the onset of symptoms is usually rapid with complete constipation and severe, colicky pain. In chronic constipation, the symptoms occur more gradually.
Nausea and vomiting may be due to irritation of the stomach, or to intestinal obstruction when it may be particularly foul and persistent. There are also important non-abdominal causes, such as in response to severe pain or motion sickness.
Diarrhoea is most commonly due to simple and self-limiting infection, such as food poisoning, but may also indicate serious disease, especially if it is persistent or contains blood (see main entry for DIARRHOEA).
Jaundice is a yellow discoloration of the skin and eyes, and may be due to disease in the liver or bile ducts (see main entry for JAUNDICE).
Diagnosis and treatment Abdominal diseases are often di?cult to diagnose because of the multiplicity of the organs contained within the abdomen, their inconstant position and the vagueness of some of the symptoms. Correct diagnosis usually requires experience, often supplemented by specialised investigations such as ULTRASOUND. For this reason sufferers should obtain medical advice at an early stage, particularly if the symptoms are severe, persistent, recurrent, or resistant to simple remedies.... abdomen, diseases of
Habitat: Throughout India, especially common in Kumaon Hills and the Nilgiris, below an altitude of 1,200 m.
English: Peacocks tail.Ayurvedic: Mayurshikhaa, Madhu- chhadaa, Sahastrahi, Vahrishikhaa.Action: Styptic, antibacterial, antipyretic.
The stems and leaves contain rutin, a styptic active principle. Anthelmintic activity, attributed to the fern, was not observed in experiments on mice.Dosage: Root—3-5 g powder. (CCRAS.)... actiniopteris dichotomaThe exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.
The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.
Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)
– the hormone which provokes the adrenal cortex into action.
Symptoms The clinical symptoms appear slowly and depend upon the severity of the underlying disease process. The patient usually complains of appetite and weight loss, nausea, weakness and fatigue. The skin becomes pigmented due to the increased production of ACTH. Faintness, especially on standing, is due to postural HYPOTENSION secondary to aldosterone de?ciency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as DEPRESSION. Acute episodes – Addisonian crises – may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring. ANOREXIA, nausea and vomiting are common and the sufferer may feel cold.
Diagnosis This depends on demonstrating impaired serum levels of cortisol and inability of these levels to rise after an injection of ACTH.
Treatment consists in replacement of the de?cient hormones. HYDROCORTISONE tablets are commonly used; some patients also require the salt-retaining hormone, ?udrocortisone. Treatment enables them to lead a completely normal life and to enjoy a normal life expectancy. Before surgery, or if the patient is pregnant and unable to take tablets, injectable hydrocortisone may be needed. Rarely, treated patients may have a crisis, perhaps because they have not been taking their medication or have been vomiting it. Emergency resuscitation is needed with ?uids, salt and sugar. Because of this, all patients should carry a card detailing their condition and necessary management. Treatment of any complicating infections such as tuberculosis is essential. Sometimes DIABETES MELLITUS coexists with Addison’s disease and must be treated.
Secondary adrenal insu?ciency may occur in panhypopituitarism (see PITUITARY GLAND), in patients treated with CORTICOSTEROIDS or after such patients have stopped treatment.... addison’s disease
Habitat: Assam, West Bengal, Bihar, Orissa, Andhra Pradesh and Tamil Nadu; often cultivated in Indian gardens.
Ayurvedic: Madhumaalati.Action: Antiseptic; anodyne (an ingredient in massage oils for paraplegia, neuralgia, sciatica); also anthelmintic and emetic.
The leaves contain quercetin, kaem- pferol and phenolic acids. Shoot tips and flower buds contain tannin.Aganosma calycina A. DC. is also equated with Madhumaalati.... aganosma dichotomaTRANQUILLISERS can help control di?cult behaviour and sleeplessness but should be used with care. Recently drugs such as DONEPEZIL and RIVASTIGMINE, which retard the breakdown of ACETYLCHOLINE, may check
– but not cure – this distressing condition. About 40 per cent of those with DEMENTIA improve.
Research is in progress to transplant healthy nerve cells (developed from stem cells) into the brain tissue of patients with Alzheimer’s disease with the aim of improving brain function.
The rising proportion of elderly people in the population is resulting in a rising incidence of Alzheimer’s, which is rare before the age of 60 but increases steadily thereafter so that 30 per cent of people over the age of 84 are affected.... alzheimer’s disease
Habitat: Distributed in the Mediterranean region, extending to Central Asia and India.
Ayurvedic: Brahmadandi (Tri- cholepis glaberrima DC. of the same family is also equated with Brahmadandi.)Unani: Baadaavard.Action: Deobstruent, aperient, febrifuge, nervine (used in debility), antiseptic (used in leucoderma).... amberboa divaricata
Measuring the partial pressure of the gas by taking blood for blood gas estimation provides information on the adequacy of breathing. A high partial pressure may indicate impending or actual respiratory failure.... carbon dioxide (co2)
Atherosclerosis is due to the deposition of CHOLESTEROL into the walls of arteries. The process starts in childhood with the development of fatty streaks lining the arteries. In adulthood these progress, scarring and calcifying to form irregular narrowings within the arteries and eventually leading to blockage of the vessel. The consequence of the narrowing or blockage depends on which vessels are involved
– diseased cerebral vessels cause strokes; coronary vessels cause angina and heart attacks; renal vessels cause renal failure; and peripheral arteries cause limb ischaemia (localised bloodlessness).
Risk factors predisposing individuals to atherosclerosis include age, male gender, raised plasma cholesterol concentration, high blood pressure, smoking, a family history of atherosclerosis, diabetes and obesity.
Arteritis occurs in a variety of conditions that produce in?ammation in the arteries. Examples include syphilis – now rare in Britain
– which produces in?ammation of the aorta with subsequent dilatation (aneurysm formation) and risk of rupture; giant cell arteritis (temporal arteritis), a condition usually affecting the elderly, which involves the cranial arteries and leads to headache, tenderness over the temporal arteries and the risk of sudden blindness; Takayasu’s syndrome, predominantly affecting young females, which involves the aortic arch and its major branches, leading to the absence of pulse in affected vessels; and polyarteritis nodosa, a condition causing multiple small nodules to form on the smaller arteries. General symptoms such as fever, malaise, weakness, anorexia and weight loss are accompanied by local manifestations of ischaemia (bloodlessness) in di?erent parts of the body.... arteries, diseases of
Habitat: Throughout India as a weed.
English: Horse-purslane, Hogweed.Ayurvedic: Rakta-punarnavaa, Punarnavaa, Katthilla, Shophaghni, Shothaghni. Varshaabhu (also equated with Trianthema portu- lacastrum Linn., which exhibits anti-inflammatory, antipyretic and analgesic activity).Unani: Itsit, Bishkhaparaa.Siddha/Tamil: Mookkirattai.Folk: Gadaha-purnaa.Action: Diuretic, anti-inflammatory, antiarthritic, spasmolytic, antibacterial (used for inflammatory renal diseases, nephrotic syndrome, in cases of ascites resulting from early cirrhosis of liver and chronic peritonitis, dropsy associated with chronic Bright's diseases, for serum uric acid levels). Root—anticon- vulsant, analgesic, expectorant, CNS depressant, laxative, diuretic, abortifacient.
Key application: As diuretic, hepatoprotective. (Indian Herbal Pharmacopoeia.)B. repanda, synonym B. chinensis Linn., roots exhibited antihepatotox- ic activity against carbon tetrachloride galactosamine-and paracetamol- induced intoxication in rats. Powdered root gave encouraging results in spermatorrhoea and leucorrhoea.The chloroform and methanolic extracts of the roots and aerial parts of B. diffusa also exhibited antihepatotox- ic activity against carbon tetrachloride- induced intoxication in rats.Punarnavaa is official in IP as a diuretic. The diuretic action of the drug is attributed to the presence of xanthone, beta-ecdysone. Flavonoid, arbinofura- noside, present in the drug, was found to lower serum uric acid in experimental animals, as also in humans.Punarnavaa has been reported to increase serum protein level and reduce urinary protein extraction in clinical trials in patients suffering with nephrotic syndrome. The activity is attributed to the presence of rotenoids in various parts of the plant.An antifibrinolytic agent, punar- navoside, has been found to stop IUCD-induced bleeding in monkeys. The drug contains quinolizidine alkaloids.Dosage: Whole plant—20-30 g for decoction (API Vol. I); root—1-3 g powder; 10-20 ml fresh juice. (API Vol. III.)... boerhavia diffusaThey include branchial cyst and branchial fistula.
A branchial cyst is a soft swelling, containing a pus-like or clear fluid, that appears on the side of the neck in early adulthood.
Treatment is by surgical removal.
A branchial fistula occurs between the back of the throat and the external surface of the neck, where it appears as a small hole, usually noted at birth.
A hole in the neck that does not extend to the back of the throat is a branchial cleft sinus.
A branchial fistula or cleft sinus may discharge mucus or pus and may be removed surgically.... branchial disorders
Infection, usually from contact with cat’s faeces, is not generally serious but has serious consequences if a woman is infected during pregnancy.
Cat faeces may also carry eggs of the cat roundworm, a possible cause of toxocariasis.
Rarely, a larva from an ingested roundworm egg migrates to and lodges in an eye, causing deterioration of vision or even blindness.
Children who have been playing in sand or soil contaminated by cat faeces are most commonly affected.
Other cat-related disorders in humans include tinea (ringworm), fungal infections of the skin, bites from cat fleas, and allergic reactions to dander that may cause asthma or urticaria.
Diseases from cats can be avoided by good hygiene, veterinary care for animals that are ill, and regular worming and flea treatment of cats.... cats, diseases from
The most common cervical infections are sexually transmitted, such as gonorrhoea, chlamydial infections, and trichomoniasis.
Viral infections of the cervix include those due to the human papilloma virus and the herpes simplex virus (see warts, genital; herpes, genital).
Polyps are noncancerous growths on the cervix.
Cancerous growths (see cervix, cancer of) are preceded by changes in the surface cells (cervical dysplasias), which can be detected by a cervical smear test.... cervix, disorders of
Probability-based computer systems store information on thousands of cases of different disorders detailing exact type, location, duration, symptoms, medical history, and diagnosis.
A patient’s symptoms and medical history can be entered into a computer, which then compares the details with existing data and produces a list of the most likely diagnoses.
Such technology is not currently in common use in hospitals, but is of value for people isolated from medical services, such as oil-rig crews.
Computers programmed to interpret visual data, such as abnormal cells, have potential use in certain types of blood test and cervical smear tests.
Computers are also used in investigative procedures such as CT scanning and MRI.... computer-aided diagnosis
conductive deafness Deafness caused by faulty conduction of sound from the outer to the inner ear.... conduct disorders
It causes a bronze skin coloration, and sufferers often develop diabetes mellitus.... diabetes, bronze
(See also contraception, barrier methods.)... diaphragm, contraceptive
and plays an important role in breathing. There are openings in the diaphragm for the oesophagus and major nerves and blood vessels. To inhale, the diaphragm’s muscle fibres contract, pulling the whole diaphragm downwards and drawing air into the lungs. (See also breathing.)... diaphragm muscle
Symptoms are similar for all variants. Progressive dementia and myoclonus (sudden muscular contractions) occur; muscular coordination diminishes; the intellect and personality deteriorate; and blindness may develop. As the disease progresses, speech is lost and the body becomes rigid. There is no treatment and death usually occurs within 2–3 years.... creutzfeldt–jakob disease
Gestational diabetes is usually detected in the second half of pregnancy.
The mother does not produce enough insulin to keep blood glucose levels normal.
True gestational diabetes disappears with the delivery of the baby but is associated with an increased risk of developing type 2 diabetes in later life.... diabetic pregnancy
Overconsumption of alcohol can lead to various alcohol-related disorders. A high salt intake predisposes a person towards hypertension. Some components of the diet protect against disease. For example, fibre protects against diverticular disease, chronic constipation, and haemorrhoids.
Many people’s diets contain too few natural vitamins. Pregnant women need high intakes of folic acid to reduce the risk of neural tube defects.
Although many illnesses are commonly ascribed to food allergy, it is only rarely that a definite link is proved. (See also nutritional disorders).... diet and disease
Food and the products of digestion are moved from the throat to the rectum by peristalsis (waves of muscular contractions of the intestinal wall).
Food is broken down into simpler substances before being absorbed into the bloodstream.Physical breakdown is performed by the teeth, which cut and chew, and the stomach, which churns the food. The chemical breakdown of food is performed by the action of enzymes, acids, and salts.
Carbohydrates are broken down into simple sugars. Proteins are broken down into polypeptides, peptides, and amino acids. Fats are broken down into glycerol, glycerides, and fatty acids.
In the mouth, saliva lubricates food and contains enzymes that begin to break down carbohydrates. The tongue moulds food into balls (called boli) for easy swallowing. The food then passes into the pharynx. From here, it is pushed into the oesophagus and squeezed down into the stomach, where it is mixed with hydrochloric acid and pepsin. Produced by the stomach lining, these substances help break down proteins. When the food has been converted to a semi-liquid consistency, it passes into the duodenum where bile salts and acids (produced by the liver) help to break down fats. Digestive juices released by the pancreas into the duodenum contain enzymes that further break down food. Breakdown ends in the small intestine, carried out by enzymes produced by glands in the intestinal lining. Nutrients are absorbed in the small intestine. The residue enters the large intestine, where water is absorbed. Undigested matter is expelled via the rectum and anus as faeces.... digestive system
They are used to treat heart conditions, most commonly atrial fibrillation.
Those most frequently used are digitoxin and digoxin.... digitalis drugs
Tumours All masses cause varying combinations of headache and vomiting – symptoms of raised pressure within the inexpansible bony box formed by the skull; general or localised epileptic ?ts; weakness of limbs or disordered speech; and varied mental changes. Tumours may be primary, arising in the brain, or secondary deposits from tumours arising in the lung, breast or other organs. Some brain tumours are benign and curable by surgery: examples include meningiomas and pituitary tumours. The symptoms depend on the size and situation of the mass. Abscesses or blood clots (see HAEMATOMA) on the surface or within the brain may resemble tumours; some are removable. Gliomas ( see GLIOMA) are primary malignant tumours arising in the glial tissue (see GLIA) which despite surgery, chemotherapy and radiotherapy usually have a bad prognosis, though some astrocytomas and oligodendronogliomas are of low-grade malignancy. A promising line of research in the US (in the animal-testing stage in 2000) suggests that the ability of stem cells from normal brain tissue to ‘home in’ on gliomal cells can be turned to advantage. The stem cells were chemically manipulated to carry a poisonous compound (5-?uorouracil) to the gliomal cells and kill them, without damaging normal cells. Around 80 per cent of the cancerous cells in the experiments were destroyed in this way.
Clinical examination and brain scanning (CT, or COMPUTED TOMOGRAPHY; magnetic resonance imaging (MRI) and functional MRI) are safe, accurate methods of demonstrating the tumour, its size, position and treatability.
Strokes When a blood vessel, usually an artery, is blocked by a clot, thrombus or embolism, the local area of the brain fed by that artery is damaged (see STROKE). The resulting infarct (softening) causes a stroke. The cells die and a patch of brain tissue shrinks. The obstruction in the blood vessel may be in a small artery in the brain, or in a larger artery in the neck. Aspirin and other anti-clotting drugs reduce recurrent attacks, and a small number of people bene?t if a narrowed neck artery is cleaned out by an operation – endarterectomy. Similar symptoms develop abruptly if a blood vessel bursts, causing a cerebral haemorrhage. The symptoms of a stroke are sudden weakness or paralysis of the arm and leg of the opposite side to the damaged area of brain (HEMIPARESIS), and sometimes loss of half of the ?eld of vision to one side (HEMIANOPIA). The speech area is in the left side of the brain controlling language in right-handed people. In 60 per cent of lefthanders the speech area is on the left side, and in 40 per cent on the right side. If the speech area is damaged, diffculties both in understanding words, and in saying them, develops (see DYSPHASIA).
Degenerations (atrophy) For reasons often unknown, various groups of nerve cells degenerate prematurely. The illness resulting is determined by which groups of nerve cells are affected. If those in the deep basal ganglia are affected, a movement disorder occurs, such as Parkinson’s disease, hereditary Huntington’s chorea, or, in children with birth defects of the brain, athetosis and dystonias. Modern drugs, such as DOPAMINE drugs in PARKINSONISM, and other treatments can improve the symptoms and reduce the disabilities of some of these diseases.
Drugs and injury Alcohol in excess, the abuse of many sedative drugs and arti?cial brain stimulants – such as cocaine, LSD and heroin (see DEPENDENCE) – can damage the brain; the effects can be reversible in early cases. Severe head injury can cause localised or di?use brain damage (see HEAD INJURY).
Cerebral palsy Damage to the brain in children can occur in the uterus during pregnancy, or can result from rare hereditary and genetic diseases, or can occur during labour and delivery. Severe neurological illness in the early months of life can also cause this condition in which sti? spastic limbs, movement disorders and speech defects are common. Some of these children are learning-disabled.
Dementias In older people a di?use loss of cells, mainly at the front of the brain, causes ALZHEIMER’S DISEASE – the main feature being loss of memory, attention and reasoned judgement (dementia). This affects about 5 per cent of the over-80s, but is not simply due to ageing processes. Most patients require routine tests and brain scanning to indicate other, treatable causes of dementia.
Response to current treatments is poor, but promising lines of treatment are under development. Like Parkinsonism, Alzheimer’s disease progresses slowly over many years. It is uncommon for these diseases to run in families. Multiple strokes can cause dementia, as can some organic disorders such as cirrhosis of the liver.
Infections in the brain are uncommon. Viruses such as measles, mumps, herpes, human immunode?ciency virus and enteroviruses may cause ENCEPHALITIS – a di?use in?ammation (see also AIDS/HIV).
Bacteria or viruses may infect the membrane covering the brain, causing MENINGITIS. Viral meningitis is normally a mild, self-limiting infection lasting only a few days; however, bacterial meningitis – caused by meningococcal groups B and C, pneumococcus, and (now rarely) haemophilus – is a life-threatening condition. Antibiotics have allowed a cure or good control of symptoms in most cases of meningitis, but early diagnosis is essential. Severe headaches, fever, vomiting and increasing sleepiness are the principal symptoms which demand urgent advice from the doctor, and usually admission to hospital. Group B meningococcus is the commonest of the bacterial infections, but Group C causes more deaths. A vaccine against the latter has been developed and has reduced the incidence of cases by 75 per cent.
If infection spreads from an unusually serious sinusitis or from a chronically infected middle ear, or from a penetrating injury of the skull, an abscess may slowly develop. Brain abscesses cause insidious drowsiness, headaches, and at a late stage, weakness of the limbs or loss of speech; a high temperature is seldom present. Early diagnosis, con?rmed by brain scanning, is followed by antibiotics and surgery in hospital, but the outcome is good in only half of affected patients.
Cerebral oedema Swelling of the brain can occur after injury, due to engorgement of blood vessels or an increase in the volume of the extravascular brain tissue due to abnormal uptake of water by the damaged grey (neurons) matter and white (nerve ?bres) matter. This latter phenomenon is called cerebral oedema and can seriously affect the functioning of the brain. It is a particularly dangerous complication following injury because sometimes an unconscious person whose brain is damaged may seem to be recovering after a few hours, only to have a major relapse. This may be the result of a slow haemorrhage from damaged blood vessels raising intracranial pressure, or because of oedema of the brain tissue in the area surrounding the injury. Such a development is potentially lethal and requires urgent specialist treatment to alleviate the rising intracranial pressure: osmotic agents (see OSMOSIS) such as mannitol or frusemide are given intravenously to remove the excess water from the brain and to lower intracranial pressure, buying time for de?nitive investigation of the cranial damage.... brain, diseases of
Benign disease is much more common than cancer, particularly in young women, and includes acute in?ammation of the breast (mastitis); abscess formation; and benign breast lumps, which may be ?broadenosis – di?use lumpiness also called chronic mastitis or ?brocystic disease – in which one or more ?uid-?lled sacs (cysts) develop.
Women who are breast feeding are particularly prone to mastitis, as infection may enter the breast via the nipple. The process may be arrested before a breast abscess forms by prompt treatment with antibiotics. Non-bacterial in?ammation may result from mammary duct ectasia (dilatation), in which abnormal or
blocked ducts may over?ow. Initial treatments should be with antibiotics, but if an abscess does form it should be surgically drained.
Duct ectasia, with or without local mastitis, is the usual benign cause of various nipple complaints, with common symptoms being nipple retraction, discharge and skin change.
Breast lumps form the chief potential danger and may be either solid or cystic. Simple examination may fail to distinguish the two types, but aspiration of a benign cyst usually results in its disappearance. If the ?uid is bloodstained, or if a lump still remains, malignancy is possible, and all solid lumps need histological (tissue examination) or cytological (cell examination) assessment. As well as having their medical and family history taken, any women with a breast lump should undergo triple assessment: a combination of clinical examination, imaging
– mammography for the over-35s and ultrasonagraphy for the under-35s – and ?ne-needle aspiration. The medical history should include details of any previous lumps, family history (up to 10 per cent of breast cancer in western countries is due to genetic disposition), pain, nipple discharge, change in size related to menstrual cycle and parous state, and any drugs being taken by the patient. Breasts should be inspected with the arms up and down, noting position, size, consistency, mobility, ?xity, and local lymphadenopathy (glandular swelling). Nipples should be examined for the presence of inversion or discharge. Skin involvement (peau d’orange) should be noted, and, in particular, how long changes have been present. Fine-needle aspiration and cytological examination of the ?uid are essential with ULTRASOUND, MAMMOGRAPHY and possible BIOPSY being considered, depending on the patient’s age and the extent of clinical suspicion that cancer may be present.
The commonest solid benign lump is a ?broadenoma, particularly in women of childbearing age, and is a painless, mobile lump. If small, it is usually safe to leave it alone, provided that the patient is warned to seek medical advice if its size or character changes or if the lump becomes painful. Fibroadenosis (di?use lumpiness often in the upper, outer quadrant) is a common (benign) lump. Others include periductal mastitis, fat NECROSIS, GALACTOCELE, ABSCESS, and non-breast-tissue lumps – for example, a LIPOMA (fatty tissue) or SEBACEOUS CYST. A woman with breast discharge should have a mammograph, ductograph, or total duct excision until the cause of any underlying duct ectasia is known. Appropriate treatment should then be given.
Malignant disease most commonly – but not exclusively – occurs in post-menopausal women, classically presenting as a slowly growing, painless, ?rm lump. A bloodstained nipple discharge or eczematous skin change may also be suggestive of cancer.
The most commonly used classi?cation of invasive cancers has split them into two types, ductal and lobular, but this is no longer suitable. There are also weaknesses in the tumour node metastases (TNM) system and the International Union Against Cancer (UICC) classi?cation.
The TNM system – which classi?es the lump by size, ?xity and presence of affected axillary glands and wider metastatic spread – is best combined with a pathological classi?cation, when assessing the seriousness of a possibly cancerous lump. Risk factors for cancer include nulliparity (see NULLIPARA), ?rst pregnancy over the age of 30 years, early MENARCHE, late MENOPAUSE and positive family history. The danger should be considered in women who are not breast feeding or with previous breast cancer, and must be carefully excluded if the woman is taking any contraceptive steroids or is on hormone-replacement therapy (see under MENOPAUSE).
Screening programmes involving mammography are well established, the aim being to detect more tumours at an early and curable stage. Pick-up rate is ?ve per 1,000 healthy women over 50 years. Yearly two-view mammograms could reduce mortality by 40 per cent but may cause alarm because there are ten false positive mammograms for each true positive result. In premenopausal women, breasts are denser, making mammograms harder to interpret, and screening appears not to save lives. About a quarter of women with a palpable breast lump turn out to have cancer.
Treatment This remains controversial, and all options should be carefully discussed with the patient and, where appropriate, with her partner. Locally contained disease may be treated by local excision of the lump, but sampling of the glands of the armpit of the same side should be performed to check for additional spread of the disease, and hence the need for CHEMOTHERAPY or RADIOTHERAPY. Depending on the extent of spread, simple mastectomy or modi?ed radical mastectomy (which removes the lymph nodes draining the breast) may be required. Follow-up chemotherapy, for example, with TAMOXIFEN (an oestrogen antagonist), much improves survival (it saves 12 lives over 100 women treated), though it may occasionally cause endometrial carcinoma. Analysis in the mid-1990s of large-scale international studies of breast-cancer treatments showed wide variations in their e?ectiveness. As a result the NHS has encouraged hospitals to set up breast-treatment teams containing all the relevant health professional experts and to use those treatments shown to be most e?ective.
As well as the physical treatments provided, women with suspected or proven breast cancer should be o?ered psychological support because up to 30 per cent of affected women develop an anxiety state or depressive illness within a year of diagnosis. Problems over body image and sexual diffculties occur in and around one-quarter of patients. Breast conservation and reconstructive surgery can improve the physical effects of mastectomy, and women should be advised on the prostheses and specially designed brassieres that are available. Specialist nurses and self-help groups are invaluable in supporting affected women and their partners with the problems caused by breast cancer and its treatment. Breast Cancer Care, British Association of Cancer United Patients (BACUP), Cancerlink, and Cancer Relief Macmillan Fund are among voluntary organisations providing support.... breasts, diseases of
Habitat: Bengal, Assam and Andamans up to 1,000 m.
English: Teri Pods.Ayurvedic: Vaakeri.Siddha/Tamil: Nunigatcha.Action: Root—astringent and antipyretic, used in phthisis and scrofulous affections.
The roots gave a phenolic compound vakerin, identical with bergenin. The ethanol-water extract of roots inhibits the growth of Mycobacterium tuberculosis.The pods contain 28% tannin (without seeds, more than 54%). The bark contains 28% tannin (without seeds, more than 54%). The tannin is pure gallo-tannin and gallic acid.Dosage: Root—3-5 g powder. (CCRAS.)... caesalpinia digynyChronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.
The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.
Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.
Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:
RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).
marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.
loss of weight.
CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.
bounding pulse with changes in heart rhythm.
OEDEMA of the legs and arms.
decreasing mobility.
Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.
Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.
Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.
Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.
Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)
Abnormal prion proteins accumulate in the brain and the spinal cord, damaging neurones (see NEURON(E)) and producing small cavities. Diagnosis can be made by tonsil (see TONSILS) biopsy, although work is under way to develop a diagnostic blood test. Abnormal prion proteins are unusually resistant to inactivation by chemicals, heat, X-RAYS or ULTRAVIOLET RAYS (UVR). They are resistant to cellular degradation and can convert normal prion proteins into abnormal forms. Human prion diseases, along with scrapie in sheep and BSE in cattle, belong to a group of disorders known as transmissible spongiform encephalopathies. Abnormal prion proteins can transfer from one animal species to another, and variant CJD has occurred as a result of consumption of meat from cattle infected with BSE.
From 1995 to 1999, a scienti?c study of tonsils and appendixes removed at operation suggested that the prevalence of prion carriage may be as high as 120 per million. It is not known what percentage of these might go on to develop disease.
One precaution is that, since 2003, all surgical instruments used in brain biopsies have had to be quarantined and disposable instruments are now used in tonsillectomy.
Measures have also been introduced to reduce the risk of transmission of CJD from transfusion of blood products.
In the past, CJD has also been acquired from intramuscular injections of human cadaveric pituitary-derived growth hormone and corneal transplantation.
The most common form of CJD remains the sporadic variety, although the eventual incidence of variant CJD may not be known for many years.... creutzfeldt-jakob disease (cjd)
When a death occurs at sea, the captain of the ship has authority to permit burial at sea. If, however, there are any doubts about cause of death, the captain may decide to preserve the body and refer the case to the relevant authorities at the next port of call.
Embalming is still used occasionally. The process consists in removing the internal organs through small openings, and ?lling the body cavities with various aromatics of antiseptic power – the skin being swathed in bandages or otherwise protected from the action of the air. Bodies are also preserved by injecting the blood vessels with strong antiseptics such as perchloride of mercury.
Cremation or incineration of the body is now the commonest method of disposal of the dead in the UK, where land for burials is increasingly scarce; today it accounts for around 75 per cent of disposals. The process of incineration takes 1–2 hours. Something in the range of 2·3 to 3·2 kg (5–7 lbs) of ash result from the combustion of the body, and there is no admixture with that from the fuel.
Cremation of a body means that it is almost impossible to conduct any meaningful forensic tests should any subsequent doubts be raised about the cause of death. So, before cremation can take place, two doctors have to sign the cremation forms. The ?rst is usually the doctor who was caring for the patient at the time of death – an important exception being cases of sudden death, when the coroner holds an inquest into the cause and authorises the necessary approval for cremation. In 1999, fewer than 3,500 deaths were certi?ed following a post-mortem, out of a total number of deaths in England and Wales of more than 556,000. When the coroner is not involved, the second doctor must have been quali?ed for ?ve years; he or she must be unconnected with the patient’s care and not linked professionally with the ?rst doctor. (For example, if the ?rst doctor is a general practitioner – as in the majority of cases they are – the second doctor should be from another practice.) Before signing the cremation certi?cate the second doctor must conduct an external examination of the dead person and discuss the circumstances of death with the ?rst doctor.
The two cremation forms are then inspected by crematorium medical referees who must be satis?ed that the cause of death has de?nitely been ascertained. The present death and cremation certi?cation system has been in place in the UK for many years – the legislative framework for cremation was set up in 1902 – and death certi?cation procedures were last reviewed by the government-appointed Brodrick committee in 1971, with no fundamental changes proposed. The case of Harold Shipman, a general practitioner convicted of murdering more than 15 patients, and suspected of murdering many more, has revealed serious weaknesses in the certi?cation system. A comprehensive review of the present procedures was in place at the time of writing (2004).... dead, disposal of the
Habitat: Kashmir; commonly grown in gardens, especially on the hills.
English: Carnation, Clove Pink.Action: Flowers—diaphoretic, alexiteric, cardiac tonic. whole plant—vermifuge. Juice of plant antiviral.
Leaves contain glucoproteins.A related species, Dicentra anatoli- cus Boiss, found in the Western Himalayas, is used as an antiperiodic in intermittent fevers.... dianthus carophyllusFor a more profuse abundant sweating Sudorifics are employed: Red Sage, Boneset, Ginger, Angelica root, Virginia Snakeroot, Cayenne, Crawley root. ... diaphoretics
Life is our most precious gift. But at some point that gift might be at risk. It is at such time that food and drink may contribute to our sense of well-being.
Rapidly accumulating evidence links cancer to a growing public awareness of the role of diet. Also, involvement of supplements in cancer prevention are a fruitful area of research.
Vital food enzymes are not destroyed in cooking when a large proportion of food is eaten raw. All food should be free from additives.
A high fat intake is a risk factor in cancer of the ovary, womb and prostate gland. It also affects the bowel flora, changing bile acid metabolism and the concentration of carcinogenic bile acid metabolites. Obesity significantly increases risk of cancer.
Epidemiological studies in man show that people with low Vitamin A levels are more susceptible to lung cancer. Cancer risk is increased by low levels of Vitamin A, particularly Beta Carotene, Vitamin E and Selenium.
Antioxidants control the activity of free-radicals that destroy body cells, and source foods containing them are therefore of value in cancer prevention. Most cancers generate a high degree of toxicity and this is where antioxidants, particularly Vitamin C are indicated. A deficiency of Vitamin C has been associated with cancer of the oesophagus, stomach, lungs and breast. This vitamin is known to increase life expectancy in terminally ill patients and is a mild analgesic for pain. Vitamin B6 may be of value for nausea.
Vitamins and minerals of value: Vitamins A, B6, C, E, Calcium, Chromium, Magnesium, Molybdenum, Selenium, Zinc.
Stimulants should be avoided: cocoa, alcohol, sugar, coffee (including decaffeinated). Tea should not be too strong as it inhibits absorption of iron. Choice should be over a wide range of foods, to eat less fat and more wholegrain cereals and raw fresh fruit and vegetables. ... diet - cancer
“A good and proper diet in disease is worth a hundred medicines and no amount of medication can do good to a patient who does not observe a strict regimen of diet.” (Charaka Samhita 300AD)
A healthy diet helps maintain the immune system, builds up reserves and hastens recovery from illness.
A good general diet includes foods low in fat, salt and high in fibre. All white sugar and white sugar products (chocolates, sweets, etc) should be replaced with natural sugars (honey, dates, figs, molasses, raisins etc). It should contain plenty of raw fresh fruit and vegetables; best prepared in a juice-press.
Vegetables should be conservatively cooked in very little water with little salt in a covered vessel. At least one mixed raw vegetable salad should be taken daily. Bread can be replaced by jacket potato, Soya- bean flour products or ripe bananas. Puddings, pastry and suety meals should be avoided.
Lean meat should be restricted to two or three parts a week with liberal inclusion of oily fish. Tofu, a Soya bean product, is an excellent alternative to meat. Three or four eggs, only, should be taken weekly.
Dairy produce (milk, butter, cream) contain cholesterol which thickens the blood, blocks arteries and increases resistance against the heart and major blood vessels, and should be taken sparingly.
Accept: Garlic, Onions, Lecithin, Muesli or Oatmeal porridge for breakfast or at other times during the day, yoghurt, honey.
Reject: fried foods, biscuits, confectionery.
Salt: replace with powdered Garlic, Celery or Kelp.
Alcohol: replace with fresh fruit or raw vegetable juices. Coffee is a risk factor raising cholesterol concentration; Dandelion coffee, Rutin or any one of many herbal teas available offer alternatives.
Avoid over-eating and meals when tired. Foods should be well masticated without liquid drinks; dry- feed. Plenty of liquid drinks, water etc should be taken between meals.
Supplements: Vitamin C 200mg, Vitamin E 200iu, morning and evening. Evening Primrose oil. Efamol produce a combined Evening Primrose and Fish oil capsule.
Dietary fibre can prevent certain colonic diseases. Treatment of disease by diet is preferred to drugs because it has the advantage of being free from side-effects. ... diet - general
Accept: rice, cornflour, honey, salad vegetables, all fruits, preserves. ... diet - low protein
Habitat: The Himalayas from Kumaon to Khasia Hills. Cultivated in Indian gardens.
English: Squirrel Corn. (A related species, Corydalis cucullaria, known as Turkey Pea, occurs in Canada and the USA.)Action: Diuretic, alterative, anti- scrofula. Used for torpid and sluggish conditions, menstrual disorders and diseases due to vitiated blood. Also employed as a sedative for the relief of paralysis agitans and other muscular tremors.
A large number of physiologically active isoquinoline alkaloids have been isolated from the tubers of many species of Dicentra, but the use of Corydalis is not linked with the alkaloids they contain, only bulbocapnine, present in the tubers, exhibits therapeutic activity. It produces catalepsy in mammals and possesses sympathetic as well as parasympathetic central effects.It has been employed for the relief of paralysis agitans and other muscular tremors, vesticular nystagmus and similar conditions.The root contains protopine, cory- deline, bulbocapnine, cancentrine, de- hydrocancentrines A and B. Bicucul- line (an isoquinoline alkaloid) isolated from the tuber of Dicentra cucullaria, is a centrally-acting, spasmogenic antagonist of GABA.... dicentra canadensisDDT has thus had a wide use in medicine, public health, veterinary medicine, horticulture, and agriculture. Unfortunately, the indiscriminate use of DDT is potentially hazardous, and its use is now restricted or banned in several countries, including the United Kingdom.
The danger of DDT is that it enters the biological food chain with the result that animals at the end of the food chain such as birds or predators may build up lethal concentrations of the substance in their tissues.
In any case, an increasing number of species of insects were becoming resistant to DDT. Fortunately, newer insecticides have been introduced which are toxic to DDT-resistant insects, but there are doubts whether this supply of new insecticides can be maintained as insects develop resistance to them.... dichlorodiphenyl trichloroethane
Habitat: Native to Africa and Asia, found in north-western and southern India.
Folk: Navananji (Maharashtra), Vajradanti (Punjab).Action: Febrifuge (used in febrile attacks after childbirth. Applied locally to putrescent wounds.
In Indian medicine, Vajradanti, equated with Potentilla arbuscula D. Don and its related species (Rosaceae), is used topically for strengthening gums and teeth.... dicoma tomentosaHabitat: The temperate Himalayas from Nepal to Bhutan and Khasi Hills.
Folk: BasakAction: Febrifuge, antipyretic, antiparasitic (used for malarial fever). Dried roots, known as Chang Shan, dried leafy tops, known as Shu Chi, in Chinese medicine, are used for malarial fever. Dried roots (Chang Shan) contain the alkaloid dichroine A and B, dichrin A and B.
The active principle febrifugine compared to quinine was estimated to be 16 to 64 times more efficacious against Plasmodium gallinaceum in chicks, about 100 times against Plasmodium lophurae in ducks also against Plasmodium relictum in canaries. The aqueous extract of the plant inhibited the infecting rate of the parasite Plasmodium berghei up to 10 days and increased the mean survival time to twice that of untreated control at 2.5 g/kg dose.Clinical trials with febrifugine indicated that the drug given in four oral doses totalling 2-5 mg/day reduces the parasite count.... dichroa febrifugaHabitat: Northwestern and Central India, Maharashtra, from North Karnataka southwards.
Ayurvedic: Virataru, Vellantaru, Viravrksha.Siddha/Tamil: Vidathalai.Folk: Varatuli, Khairi.Action: Root—astringent and diuretic; used in renal affections, urinary calculi, also in rheumatism. Tender shoots—applied externally for ophthalmia.
The plant foliage contain tannin— 2.40, 5.60 and 4.40 mg/100 g during February, June and November respectively. Roots afforded n-octacosanol, beta-amyrin, friedelan-3-one, friede- lan-3-beta-olandbeta-sitosterol. Flowers contain cyanidin and quercetin.Dosage: Root, bark—50-100 ml decoction. (CCRAS.)... dichrostachys cinereaHabitat: Western Himalayas from Kashmir to Kunawar, common in Pangi.
English: Gas Plant, Dittany, Burning Bush.Action: Root bark—used in nervous diseases, hysteria, intermittent fevers, urinogenital disorders, and amenorrhoea; a decoction for scabies and other skin affections. Toxic.
Dittany stimulates the muscles of the uterus, while its effect on the gastro-intestinal tract is antispasmod- ic, it relaxes the gut. (The plant is used in Greek folk medicine as anti- spasmodic.) The herb contains furo- quinoline alkaloids (including dictam- nine), furococumarins, limonoids, and flavonoids (including rutin).Volatile oil contains estragol, anet- hole, and a toxic alkaloid dictamnine. Flowers yield 0.05% essential oil containing methylchavicol and anethole. Leaves yield 0.15% essential oil.... dictamnus albusHabitat: Sub-tropical Himalaya from Himachal Pradesh to Aruna- chal Pradesh at 500-2,500 m.
Ayurvedic: Kshudra-Paashaana- bheda, Shilaa-valkaa, Shilaa- pushpa.Action: Leaf—antilithic. Used for stones in kidney and bladder.
The leaves contain a number of chal- cones, quinochalcones and flavanones. Pediflavone has also been isolated from young leaves.... didymocarpus pedicellataHabitat: Throughout the plains of India, as a weed in cultivated fields.
Ayurvedic: Katthinjara, Kunanjara.Siddha/Tamil: Thoyya-keerai.Folk: Lat-mahuriaa, Lahsuvaa.Action: Astringent, antibilious. Laxative in large doses. Flowers and seeds—diuretic; given for urinary discharges.
The plant contains alpha-and beta- spinasterol.... digera muricataHabitat: Native to Europe. Now cultivated mainly in Kashmir (Yarikhah), also occurs wild.
English: Grecian Foxglove.Ayurvedic: Hritpatri, Tilapushpi (non-classical). (Yellow var.)Action: See D. purpurea.
Earlier, the herb was used to treat ulcers, boils, abscesses, headaches and paralysis. William Withering, an 18th century English country doctor, explored the plant's hidden properties. His work led to the production of digoxin, a life-saving medicine.Safety of the herb cannot be established due to variable amounts of cardiac glycosides. The powder is toxic at 520 mg.... digitalis lanataHabitat: Native to West Europe. Cultivated in Tangmarg and Kishtawar in Kashmir, Darjeeling and the Nilgiris.
English: Digitalis, Foxglove.Ayurvedic: Hritpatri, Tilapushpi (non-classical). (Purple var.)Action: Main source of digoxin for the pharmaceutical industry. Digitalis glycosides increase the force of contraction of heart without increasing the oxygen consumption and slow the heart rate when auricular fibrillation is present. To be used only under strict medical supervision.
Not used as a herbal drug.... digitalis purpureaHabitat: The Himalayan terai from Punjab to Assam, and South India and the Andamans.
Folk: Dillenia. Agai (Bihar), Agachi (Maharashtra).Action: See D. indica.
The bark contains 6% tannin.... dillenia pentagynaDillys, Dylis, Dyllis, Dil, Dill, Dilly... dilys
Dimitee, Dimitey, Dimitie, Dimitea, Dimiteah, Dimiti... dimity
Habitat: The Himalayas from Nepal to Bhutan; north Bengal, Bihar, Orissa and Madhya Pradesh.
English: Elephant Apple.Ayurvedic: Bhavya.Folk: Uva, Chaaltaa.Action: Fruit—laxative, carminative, bechic, febrifuge, antispasmodic (used for abdominal pains). Bark and leaves—astringent.
The sepals contain (on dry weight basis): tannin 0.37, glucose 2.92 and malic acid 0.51%. The bark and leaves contain about 10% and 9% tannin (on dry weight basis) respectively.The fruit yielded a polysaccharide, arabingalactan.The leaves yielded cycloartenone, n-hentriacontanol, betulin, betulinic acid and beta-sitosterol. The bark gave iso-rhamnetin, naringenin, quercetin derivatives and kaempferol.... dillenia indicaDina, Dinora, Dinorah, Dyna, Dynah, Dena, Denna, Dene, Deneen, Denia, Denica... dinah
Dionysea, Dionisa, Dionysa, Dionis, Dionysie, Dionyza, Dionyzia... dionysia
Habitat: Native to East Asia; cultivated in Assam, Vadodara, Tamil Nadu, Bengal and Madhya Pradesh.
English: Wild Yam, Greater Yam, Asiatic Yam.Ayurvedic: Kaashthaaluka. Aaluka (var.). Aalukas (yams) of Ayurvedic texts, belong to Dioscorea spp.Siddha/Tamil: Perumvalli kizhangu.Folk: Kathaalu.Action: Even the best among the cultivated yams causes irritation in the throat or a feeling of discomfort when eaten raw. Wild yams—cholagogue, antispasmodic, anti-inflammatory, antirheumatic, diuretic. Also used for painful periods, cramps and muscle tension.
Key application: Dioscorea villosa L., Wild Yam—as spasmolytic, anti-inflammatory. (The British Herbal Pharmacopoeia.)The edible tubers of Dioscorea alata are purple-coloured and contain an- thocyanins, cyanidin and peonidin- 3-gentiobioside acylated with sinapic acid. The tubers contain surcose, while leaves contain large quantities of D- fructose, D-glucose and the polyols, 2-deoxyribitol, 6-deoxysorbitol and glycerol.Mouldy yams are reported to contain a compound ipomeanol which is being tested against human lung cancer. (J. Am Med Assoc, 1994,15, 23.)Diosgenin obtained from Dioscorea species was used in the first commercial production of oral contraceptives, topical hormones, systemic corticos- teroids, androgens, estrogens, pro- gestogens and other sex hormones.The chemical transformation of di- osgenin to estrogen, progesterone or any other steroidal compound does not occur in human body. Topically applied Wild Yam does not appear to cause changes in serum FSH, estradi- ol or progesterone. (Natural Medicines Comprehensive Database, 2007.)Diosgenin, combined with the drug clofibrate, caused a greater decrease in LDL than either substance alone in rats. (Sharon M. Herr.)... dioscorea alataHabitat: Wet regions of the Himalayas from Central Nepal, eastwards to northern Bengal, Assam and Chittagong.
Ayurvedic: Kaasaalu, Kasaalu.Folk: Koshakanda (Bengal).Action: See D. alata.... dioscorea anguina
Habitat: Throughout tropical India, at 1,500-2,100 m.
English: Patoto Yam, Bulb-bearing Yam, Air Potato, Dog Yam.Ayurvedic: Vaaraahi, Vaaraahikan- da, Grshti, Banaaalu, Suraalu, Raktaalu. Substitute for Vriddhi.Unani: Baraahikand.Siddha/Tamil: Kodi-kilangu, Pannu-kilangu.Action: Dried and pounded tubers are used as an application for swellings, boils and ulcers; roasted tubers are used in dysentery, piles, venereal sores. Leaf—febrifuge.
The raw tubers are bitter due to the presence of furanoid norditerpenes (they lose their bitterness on roasting and are then eaten). The wild tubers contain nearly 83% starch and possess hunger-suppressing property. They contain certain poisonous alkaloids.The rhizomes afforded D-sorbitol, furanoid norditerpenes—diosbulbins A-D, 2,4,6,7-tetrahydroxy-9,10-dihy- drophenanthrene and 2,4,5,6,-tetra- hydroxyphenanthrene, diosgenin, lucein, neoxanthine, violaxanthin, zeax- anthin, auroxanthin and cyrptoxan- thin.... dioscorea bulbiferaAction: Tubers—used for ulcer, to kill worms in wounds. Plant parts— used in whitlow, sores, boils.
The tubers contain 81.45-81.8 carbohydrates, 7.20-9.12% albuminoids. The toxic principle is dioscorine which is distributed throughout the plant.... dioscorea daemonaHabitat: Assam, Bengal, Bihar, Orissa and Andaman and Nicobar Islands.
Ayurvedic: Shankhaaluka.Action: Tubers contain 77.7978.23% carbohydrates, 9.73-10.13% albuninoids.... dioscorea glabra
Habitat: The Western Ghats, Sikkim, Assam, Orissa and Bengal.
Ayurvedic: Vaaraahi (var.).Folk: Naagar-kanda (Bihar).Action: Tubers contain 85.50% carbohydrates, 8.30% albuminoids.... dioscorea hamiltonii
Habitat: The Himalaya from Kashmir to Arunachal Pradesh and in Assam at 450-3,100 m.
Ayurvedic: Vaaraahikanda (var.), Grishti.Folk: Gun, Kris (Punjab).Action: Tuber—antipthiriac. Leaf— febrifuge. The rhizomes are a rich source of diogenin and its glycoside. Steroidal saponins have also been isolated. Diogenin is used in the preparation of various steroidal drugs.
Synonym: D. hispada Dennst. D. hirsuta Dennst.
Family: Dioscoreaceae.Habitat: Sikkim, the Himalayas, Khasi Hills.... dioscorea deltoidea
Habitat: Madhya Pradesh, Uttar Pradesh, Orissa, Bengal, Assam and the Andamans.
English: Lesser Yam, Karen Potato.Ayurvedic: Madhvaaluka.Siddha/Tamil: Musilam, Valli kilangu, Siruvalli Kilangu.Folk: Suthani.Action: Tubers are starchy and free from dioscorine, contain 71.29% carbohydrates, 10.82% albuminoids.... dioscorea esculenta
Habitat: South India; throughout the hills of Deccan.
Ayurvedic: Amlikaakanda (controversial synonym).Siddha: Kavala-kodi, Venilai Valli.Folk: Aambaalio Kanda (Gujarat).Action: Used externally for reducing swellings.... dioscorea oppositifolia
Habitat: Native to tropical Asia; distributed throughout India.
Ayurvedic: Vaaraahikanda (var., dry pieces are sold as Vidaarikanda).Folk: Kaantaalu.Action: Tubers contain 71.0780.77% carbohydrates, 8.68-15.93% albuminoids. Tubers are used to disperse swellings.... dioscorea pentaphylla
Habitat: The Himalaya from Nepal to Bhutan, up to 1,500 m, also in Naga Hills.
Ayurvedic: Neelaalu.Action: Tuber—antiphthiriac.
The rhizomes are used as a hair wash for killing lice. They contain diogenin (on dry basis) 2.5%. Also obtained are steroidal sapogenins, sito- sterol glucoside, prazerigenin-A gluco- side, prazerigenin-A bioside and 9,10- dihydrophenanthrenes.... dioscorea prazeriHabitat: Orissa and South India.
English: Ebony Persimmon, Malabar Ebony, Ceylon Ebony.Ayurvedic: Tinduka.Unani: Aaabnuus.Siddha/Tamil: Acha-Thumbi.Action: Plant—astringent, attenuant, lithontriptic.
The heartwood contains 2 beta- naphthalhydes, 2 naphthoic acid derivatives; ceryl alcohol, betulin, alpha- amyrin, ursolic acid, baurenol and stigmasterol. The leaves contain ur- solic acid, alpha-amyrin, betulin and lupeol.... diospyros ebenumHabitat: Throughout India in shady wet places and near streams.
English: Gaub Persimmon, Riber EbonyAyurvedic: Tinduka, Tinduki, Sphu- urjaka, Kaalaskandha, Asitkaaraka. Nilasaara.Unani: Tendu.Siddha/Tamil: Tumbika, Kattatti.Action: Fruit and stem bark— astringent. Infusion of fruits—used as gargle in aphthae and sore throat. Fruit juice—used as application for wounds and ulcers. Oil of seeds— given in diarrhoea and dysentery Ether extract of fruit—antibacterial. Bark—astringent and styptic, used in menorrhagia, diarrhoea, dysentery and intermittent fevers.
A paste is applied to boils and tumours. The ethyl acetate extract showed antistress and anti-ulcerogenic activity. It also prevented hepatotoxi- city and leucocytosis in experimental animals.The bark contains betulinic acid, myricyl alcohol, triterpenoids and sa- ponin. The leaves gave beta-sitosterol, betulin and oleanolic acid. Fruit pulp and seeds contain lupeol, betulin, gallic acid, betulinic acid, hexacosane, hex- acosanol, sitosterol, beta-D-glucoside of sitosterol and a triterpene ketone.Stem bark—antiprotozoal, antiviral, hypoglycaemic, semen-coagulant. Stems yielded nonadecan-7-ol-one.Dosage: Bark—50-100 ml decoction. (CCRAS.)... diospyros embryopterisHabitat: Native to China; now grown in Himachal Pradesh, Kumaon, the Nilgiris and West Bengal for edible fruits.
English: Japanese Persimmon.Ayurvedic: Tinduka (var.).Action: Hypotensive, hepatopro- tective, antidote to poisons and bacterial toxins. Calyx and peduncle of fruit—used in the treatment of cough and dyspnoea. Roasted seeds—used as a substitute for coffee.
The fruit, in addition to sugars, glucose, fructose, ascorbic acid, citric acid, contains (% of fresh weight) 0.20-1.41 tannins, 0.21-10.07 total pectins, 0.67 pentosans and 0.16-0.25 polyphenols. The fruit also contains 2.4 mg/100 g carotenoids; carotene expressed as vitamin A 2200-2600 IU. The carote- noids identified in the pulp include cryptoxanthine, zeaxanthin, antherax- anthin, lycopene and beta-carotene. (Many carotenoids originally present in the fruit decompose during ripening.The fruit pulp is an antidote to bacterial toxins and is used in the preparation of a vaccine for pertussis.Condensed tannins from the fruits effectively inhibited 2-nitrofluorene mutagen.The immature leaves contain a ster- oidal saponin, lignin and phenolic compounds. Eugenol and dihydroac- tinidiolide are reported from fresh leaves.The leaves are reported to exhibit hepatoprotective activity. Leaves also contain hypotensive principles. Astra- galin and isoquercitrin have been isolated from leaves.... diospyros kakiHabitat: Madhya Pradesh, Maharashtra, Orissa, Bihar, Uttar Pradesh and West Peninsula.
English: Coromandel Ebony, Persimmon.Ayurvedic: Tinduka (var.), Dirgha- patrakaa.Siddha/Tamil: Karum Dumbi, Thumbi, Beedi-elai.Action: Leaves—carminative, laxative, diuretic, styptic. Bark— astringent. Used in dyspepsia and diarrhoea. Unripe fruit— carminative and astringent. Ripe fruit—antibilious. Dried flowers— used in anaemia, inflammation of spleen, also in leucorrhoea. Leaf and dried flower—used in dyspepsia and diarrhoea, topically in scabies. Aerial parts—hypotensive.
Half-ripe fruit contains 23, ripe fruit 15 and bark 19% tannin.The bark and sapwood extracts yield beta-sitosterol, lupeol, betulin and be- tulinic acid. Leaves contain hentria- contane, hentriacontanol, alpha-amy- rin, baurenol, ursolic, oleanolic and be- tulinic acids.... diospyros melanoxylonHabitat: Throughout the greater part of India.
English: Mountain persimmon.Ayurvedic: Visha-tinduka, Kaaka- tinduka.Siddha/Tamil: Vakkanai, Vakkanatan.Folk: Timru.Action: Various plant parts are used in fever, puerperal fever, neuralgia, pleurisy, pneumonia, menorrhagia, dysurea. Fruits are applied externally to boils.
Bark extract—anti-inflammatory, antipyretic and analgesic. Leaves and seeds—antibacterial.Diospyrin occurs in the bark and wood. Leaves contain hentriacon- tane, hentriacontanol, beta-sitosterol, alpha-and beta-amyrin, lupeol, taraxe- rol and ursolic acid.Alcoholic extract of the plant showed CNS depressant and spasmolytic activity and also produced bradycardia and hypertension.... diospyros montanaHabitat: Sub-Himalayan tract from Ravi to Nepal, also in Rajasthan, Madhya Pradesh, Bihar and Orrisa.
English: Nepal Ebony Persimmon.Ayurvedic: Viralaa, Tinduka (var.).Siddha/Tamil: Tumbi.Action: Astringent, anti- inflammatory, styptic. Various plant parts are used for dry cough, bronchitis, pleurisy, pneumonia, dysuria, fistula, tumours, bleeding gums, haemorrhagic conditions.
The leaves and stems gave beta- sitosterol, lupeol, betulin, betulinic and oleanolic acids.Unsaponifiable matter of seeds showed CNS depressant activity.... diospyros tomentosaHabitat: The Andamans.
English: Gurjun.Ayurvedic: Ashwakarna, Garjan, Shveta-Garjan, Jarandruma.Action: Decoction of the bark is prescribed in rheumatism. Oil— applied to ulcerated wounds. Balsam—applied externally in gonorrhoea.
Dipterocarpus resin gave sesquiter- penoids. The essential oil contains 2 sesquiterpenoids of eudesmane series.... dipterocarpus alatusHabitat: The Andamans and Assam.
English: Common Gurjun tree, Wood Oil tree.Ayurvedic: Ajakarna, Chhaagakar- na, Ashwakarna.Siddha/Tamil: Enney, Saara.Folk: Gurjan.Action: Oleo-resin (known as Gurjan Oil or Gurjan Balsam)— stimulant to genitourinary system, diuretic, spasmolytic; used externally on ulcers, ringworm and other cutaneous affections. Bark—a decoction is prescribed rheumatism.
Essential oil from oleo-resin contained humulene, beta-caryophyllene, a bicyclic sesquiterpene hydrocarbon and a sesquiterpene alcohol.The twig bark contains 9% tannin and 7.3% soluble non-tans.Dosage: Oil—3-5 ml. (CCRAS.)... dipterocarpus turbinatusLung trauma or contusion
Inhalation of toxic gases or smoke
ASPIRATION of gastric contents
Near-drowning... direct insult
Social services are provided by local-authority social-services departments. They include: practical help in the home (usually through home helps or aids to daily living); assistance in taking advantage of available educational facilities; help with adaptations to the disabled person’s house; provision of meals (‘Meals on Wheels’ or luncheon centres); and help in obtaining a telephone. Many of these facilities will involve the disabled person in some expense, but full details can be obtained from the local social-services department which will, if necessary, send a social worker to discuss the matter in the disabled person’s home. Owing to lack of funds and sta?, many local-authority social-services departments are unable to provide the full range of services.
Aids to daily living There is now a wide range of aids for the disabled. Full details and addresses of local o?ces can be obtained from: Disabled Living Foundation and British Red Cross.
Aids to mobility and transport Some car manufacturers make specially equipped or adapted cars, and some have o?cial systems for discounts. Details can be obtained from local dealers. Help can also be obtained from Motability, which provides advice.... disabled persons
Dyscordia, Diskordia, Dyskordia... discordia
Nutritional Profile Energy value (calories per serving): Moderate to high Protein: None Fat: None Saturated fat: None Cholesterol: None Carbohydrates: None (except for cordials which contain added sugar) Fiber: None Sodium: Low Major vitamin contribution: None Major mineral contribution: Phosphorus
About the Nutrients in This Food Spirits are the clear liquids produced by distilling the fermented sugars of grains, fruit, or vegetables. The yeasts that metabolize these sugars and convert them into alcohol stop growing when the concentration of alcohol rises above 12–15 percent. In the United States, the proof of an alcoholic beverage is defined as twice its alcohol content by volume: a beverage with 20 percent alcohol by volume is 40 proof. This is high enough for most wines, but not high enough for most whiskies, gins, vodkas, rums, brandies, and tequilas. To reach the concentra- tion of alcohol required in these beverages, the fermented sugars are heated and distilled. Ethyl alcohol (the alcohol in beer, wine, and spirits) boils at a lower temperature than water. When the fermented sugars are heated, the ethyl alcohol escapes from the distillation vat and condenses in tubes leading from the vat to a collection vessel. The clear liquid that collects in this vessel is called distilled spirits or, more technically, grain neutral spirits. Gins, whiskies, cordials, and many vodkas are made with spirits American whiskeys (which include bourbon, rye, and distilled from grains. blended whiskeys) and Canadian, Irish, and Scotch whiskies are all made from spirits aged in wood barrels. They get their flavor from the grains and their color from the barrels. (Some whiskies are also colored with caramel.) Vodka is made from spirits distilled and filtered to remove all flavor. By law, vodkas made in America must be made with spirits distilled from grains. Imported vodkas may be made with spirits distilled either from grains or potatoes and may contain additional flavoring agents such as citric acid or pepper. Aquavit, for example, is essentially vodka flavored with caraway seeds. Gin is a clear spirit flavored with an infusion of juniper berries and other herbs (botanicals). Cordials (also called liqueurs) and schnapps are flavored spirits; most are sweetened with added sugar. Some cordials contain cream. Rum is made with spirits distilled from sugar cane (molasses). Tequila is made with spirits distilled from the blue agave plant. Brandies are made with spirits distilled from fruit. (Arma- gnac and cognac are distilled from fermented grapes, calvados and applejack from fermented apples, kirsch from fermented cherries, slivovitz from fermented plums.) Unless they contain added sugar or cream, spirits have no nutrients other than alcohol. Unlike food, which has to be metabolized before your body can use it for energy, alcohol can be absorbed into the blood-stream directly from the gastrointestinal tract. Ethyl alcohol provides 7 calories per gram.
The Most Nutritious Way to Serve This Food The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits, and “moderate drinking” as two drinks a day for a man, one drink a day for a woman.
Diets That May Restrict or Exclude This Food Bland diet Lactose-free diet (cream cordials made with cream or milk) Low-purine (antigout) diet
Buying This Food Look for: Tightly sealed bottles stored out of direct sunlight, whose energy might disrupt the structure of molecules in the beverage and alter its flavor. Choose spirits sold only by licensed dealers. Products sold in these stores are manufac- tured under the strict supervision of the federal government.
Storing This Food Store sealed or opened bottles of spirits in a cool, dark cabinet.
Preparing This Food All spirits except unflavored vodkas contain volatile molecules that give the beverage its characteristic taste and smell. Warming the liquid excites these molecules and intensifies the flavor and aroma, which is the reason we serve brandy in a round glass with a narrower top that captures the aromatic molecules as they rise toward the air when we warm the glass by holding it in our hands. Whiskies, too, though traditionally served with ice in America, will have a more intense flavor and aroma if served at room temperature.
What Happens When You Cook This Food The heat of cooking evaporates the alcohol in spirits but leaves the flavoring intact. Like other alcoholic beverages, spirits should be added to a recipe near the end of the cooking time to preserve the flavor while cooking away any alcohol bite. Alcohol is an acid. If you cook it in an aluminum or iron pot, it will combine with metal ions to form dark compounds that discolor the pot and the food you are cooking. Any recipe made with spirits should be prepared in an enameled, glass, or stainless-steel pot.
Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low density lipoproteins (LDLs), the protein and fat particles that carry cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carry cholesterol out of the body. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moderate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How alcohol prevents stroke is still unknown, but it is clear that moderate use is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, reduce their risk of stroke. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcoholic beverages dilate the tiny blood vessels just under the skin, bringing blood up to the surface. That’s why moderate amounts of alcoholic beverages (0.2–1 gram per kilogram of body weight, or two ounces of whiskey for a 150-pound adult) temporarily warm the drinker. But the warm blood that flows up to the surface of the skin will cool down there, making you even colder when it circulates back into the center of your body. Then an alcohol flush will make you perspire, so you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.
Adverse Effects Associated with This Food Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, learning disabilities, and mental retarda- tion—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who drink three to four drinks a day or five drinks on any one occasion while pregnant. To date there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while preg- nant, but two studies at Columbia University have suggested that as few as two drinks a week while pregnant may raise a woman’s risk of miscarriage. (One drink is 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and distilled spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the A merican Cancer Societ y’s warn ing that men and women who consume more than t wo drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuses depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use every day to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tis- sues. Although individuals vary widely in their capacity to metabolize alcohol, an adult of average size can metabolize the alcohol in four ounces (120 ml) whiskey in approximately five to six hours. If he or she drinks more than that, the amount of alcohol in the body will exceed the available supply of ADH. The surplus, unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, the drinker will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining uric acid, which is irritating. The level of lactic acid in the body will increase, making him or her feel tired and out of sorts; the acid-base balance will be out of kilter; the blood vessels in the head will swell and throb; and the stomach, its lining irritated by the alcohol, will ache. The ultimate result is a hangover whose symptoms will disappear only when enough time has passed to allow the body to marshal the ADH needed to metabolize the extra alcohol in the person’s blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. Migraine headache. Some alcoholic beverages contain chemicals that inhibit PST, an enzyme that breaks down certain alcohols in spirits so that they can be eliminated from the body. If they are not broken down by PST, these alcohols will build up in the bloodstream and may trigger a migraine headache. Gin and vodka appear to be the distilled spirits least likely to trigger headaches, brandy the most likely.
Food/Drug Interactions Acetaminophen (Tylenol, etc.). FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetaminophen combination may cause liver failure. Anti-alcohol abuse drugs (disulfiram [Antabuse]). Taken concurrently with alcohol, the anti- alcoholism drug disulfiram can cause flushing, nausea, a drop in blood pressure, breathing difficulty, and confusion. The severity of the symptoms, which may var y among individu- als, generally depends on the amount of alcohol consumed and the amount of disulfiram in the body. Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners), intensif ying the effect of the drugs and increasing the risk of side effects such as spontane- ous nosebleeds. Antidepressants. Alcohol may strengthen the sedative effects of antidepressants. Aspirin, ibuprofen, ketoprofen, naproxen and nonsteroidal anti-inflammatory drugs. Like alco- hol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Com- bining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antide- pressants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol intensifies the sedative effects of these medications and, depending on the dose, may cause drowsiness, sedation, respiratory depression, coma, or death. MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of natural enzymes that break down tyramine, a substance formed naturally when proteins are metabolized. Tyramine is a pressor amine, a chemical that constricts blood vessel and raises blood pressure. If you eat a food that contains tyramine while you are taking an M AO inhibitor, the pressor amine cannot be eliminated from your body and the result may be a hypertensive crisis (sustained elevated blood pressure). Brandy, a distilled spirit made from wine (which is fermented) contains tyramine. All other distilled spirits may be excluded from your diet when you are taking an M AO inhibitor because the spirits and the drug, which are both sedatives, may be hazard- ous in combination.... distilled spirits
Dixi, Dixy, Dixey, Dixee, Dixea, Dixeah... dixie
Examination of the ear includes inspection of the external ear. An auriscope is used to examine the external ear canal and the ear drum. If a more detailed inspection is required, a microscope may be used to improve illumination and magni?cation.
Tuning-fork or Rinne tests are performed to identify the presence of DEAFNESS. The examiner tests whether the vibrating fork is audible at the meatus, and then the foot of the fork is placed on the mastoid bone of the ear to discover at which of the two sites the patient can hear the vibrations for the longest time. This can help to di?erentiate between conductive and nerve deafness.
Hearing tests are carried out to determine the level of hearing. An audiometer is used to deliver a series of short tones of varying frequency to the ear, either through a pair of headphones or via a sound transducer applied directly to the skull. The intensity of the sound is gradually reduced until it is no longer heard and this represents the threshold of hearing, at that frequency, through air and bone respectively. It may be necessary to play a masking noise into the opposite ear to prevent that ear from hearing the tones, enabling each ear to be tested independently.
General symptoms The following are some of the chief symptoms of ear disease: DEAFNESS (see DEAFNESS). EARACHE is most commonly due to acute in?ammation of the middle ear. Perceived pain in this region may be referred from other areas, such as the earache commonly experienced after tonsillectomy (removal of the TONSILS) or that caused by carious teeth (see TEETH, DISORDERS OF). The treatment will depend on the underlying cause. TINNITUS or ringing in the ear often accompanies deafness, but is sometimes the only symptom of ear disease. Even normal people sometimes experience tinnitus, particularly if put in soundproofed surroundings. It may be described as hissing, buzzing, the sound of the sea, or of bells. The intensity of the tinnitis usually ?uctuates, sometimes disappearing altogether. It may occur in almost any form of ear disease, but is particularly troublesome in nerve deafness due to ageing and in noise-induced deafness. The symptom seems to originate in the brain’s subcortical regions, high in the central nervous system. It may be a symptom of general diseases such as ANAEMIA, high blood pressure and arterial disease, in which cases it is often synchronous with the pulse, and may also be caused by drugs such as QUININE, salicylates (SALICYLIC ACID and its salts, for example, ASPIRIN) and certain ANTIBIOTICS. Treatment of any underlying ear disorder or systemic disease, including DEPRESSION, may reduce or even cure the tinnitis, but unfortunately in many cases the noises persist. Management involves psychological techniques and initially an explanation of the mechanism and reassurance that tinnitus does not signify brain disease, or an impending STROKE, may help the person. Tinnitus maskers – which look like hearing aids – have long been used with a suitably pitched sound helping to ‘mask’ the condition.
Diseases of the external ear
WAX (cerumen) is produced by specialised glands in the outer part of the ear canal only. Impacted wax within the ear canal can cause deafness, tinnitis and sometimes disturbance of balance. Wax can sometimes be softened with olive oil, 5-per-cent bicarbonate of soda or commercially prepared drops, and it will gradually liquefy and ‘remove itself’. If this is ineffective, syringing by a doctor or nurse will usually remove the wax but sometimes it is necessary for a specialist (otologist) to remove it manually with instruments. Syringing should not be done if perforation of the tympanic membrane (eardrum) is suspected. FOREIGN BODIES such as peas, beads or buttons may be found in the external ear canal, especially in children who have usually introduced them themselves. Live insects may also be trapped in the external canal causing intense irritation and noise, and in such cases spirit drops are ?rst instilled into the ear to kill the insect. Except in foreign bodies of vegetable origin, where swelling and pain may occur, syringing may be used to remove some foreign bodies, but often removal by a specialist using suitable instrumentation and an operating microscope is required. In children, a general anaesthetic may be needed. ACUTE OTITIS EXTERNA may be a di?use in?ammation or a boil (furuncle) occurring in the outer ear canal. The pinna is usually tender on movement (unlike acute otitis media – see below) and a discharge may be present. Initially treatment should be local, using magnesium sulphate paste or glycerine and 10-per-cent ichthaminol. Topical antibiotic drops can be used and sometimes antibiotics by mouth are necessary, especially if infection is acute. Clotrimazole drops are a useful antifungal treatment. Analgesics and locally applied warmth should relieve the pain.
CHRONIC OTITIS EXTERNA producing pain and discharge, can be caused by eczema, seborrhoeic DERMATITIS or PSORIASIS. Hair lotions and cosmetic preparations may trigger local allergic reactions in the external ear, and the chronic disorder may be the result of swimming or use of dirty towels. Careful cleaning of the ear by an ENT (Ear, Nose & Throat) surgeon and topical antibiotic or antifungal agents – along with removal of any precipitating cause – are the usual treatments. TUMOURS of the ear can arise in the skin of the auricle, often as a result of exposure to sunlight, and can be benign or malignant. Within the ear canal itself, the commonest tumours are benign outgrowths from the surrounding bone, said to occur in swimmers as a result of repeated exposure to cold water. Polyps may result from chronic infection of the ear canal and drum, particularly in the presence of a perforation. These polyps are soft and may be large enough to ?ll the ear canal, but may shrink considerably after treatment of the associated infection.
Diseases of the middle ear
OTITIS MEDIA or infection of the middle ear, usually occurs as a result of infection spreading up the Eustachian tubes from the nose, throat or sinuses. It may follow a cold, tonsillitis or sinusitis, and may also be caused by swimming and diving where water and infected secretions are forced up the Eustachian tube into the middle ear. Primarily it is a disease of children, with as many as 1.5 million cases occurring in Britain every year. Pain may be intense and throbbing or sharp in character. The condition is accompanied by deafness, fever and often TINNITUS.
In infants, crying may be the only sign that something is wrong – though this is usually accompanied by some localising manifestation such as rubbing or pulling at the ear. Examination of the ear usually reveals redness, and sometimes bulging, of the ear drum. In the early stages there is no discharge, but in the later stages there may be a discharge from perforation of the ear drum as a result of the pressure created in the middle ear by the accumulated pus. This is usually accompanied by an immediate reduction in pain.
Treatment consists of the immediate administration of an antibiotic, usually one of the penicillins (e.g. amoxicillin). In the majority of cases no further treatment is required, but if this does not quickly bring relief then it may be necessary to perform a myringotomy, or incision of the ear drum, to drain pus from the middle ear. When otitis media is treated immediately with su?cient dosage of the appropriate antibiotic, the chances of any permanent damage to the ear or to hearing are reduced to a negligible degree, as is the risk of any complications such as mastoiditis (discussed later in this section). CHRONIC OTITIS MEDIA WITH EFFUSION or glue ear, is the most common in?ammatory condition of the middle ear in children, to the extent that one in four children in the UK entering school has had an episode of ‘glue ear’. It is characterised by a persistent sticky ?uid in the middle ear (hence the name); this causes a conductive-type deafness. It may be associated with enlarged adenoids (see NOSE, DISORDERS OF) which impair the function of the Eustachian tube. If the hearing impairment is persistent and causes problems, drainage of the ?uid, along with antibiotic treatment, may be needed – possibly in conjunction with removal of the adenoids. The insertion of grommets (ventilation tubes) was for a time standard treatment, but while hearing is often restored, there may be no long-term gain and even a risk of damage to the tympanic membrane, so the operation is less popular than it was a decade or so ago. MASTOIDITIS is a serious complication of in?ammation of the middle ear, the incidence of which has been dramatically reduced by the introduction of antibiotics. In?ammation in this cavity usually arises by direct spread of acute or chronic in?ammation from the middle ear. The signs of this condition include swelling and tenderness of the skin behind the ear, redness and swelling inside the ear, pain in the side of the head, high fever, and a discharge from the ear. The management of this condition in the ?rst instance is with antibiotics, usually given intravenously; however, if the condition fails to improve, surgical treatment is necessary. This involves draining any pus from the middle ear and mastoid, and removing diseased lining and bone from the mastoid.
Diseases of the inner ear
MENIÈRE’S DISEASE is a common idiopathic disorder of ENDOLYMPH control in the semicircular canals (see EAR), characterised by the triad of episodic VERTIGO with deafness and tinnitus. The cause is unknown and usually one ear only is affected at ?rst, but eventually the opposite ear is affected in approximately 50 per cent of cases. The onset of dizziness is often sudden and lasts for up to 24 hours. The hearing loss is temporary in the early stages, but with each attack there may be a progressive nerve deafness. Nausea and vomiting often occur. Treatment during the attacks includes rest and drugs to control sickness. Vasodilator drugs such as betahistine hydrochloride may be helpful. Surgical treatment is sometimes required if crippling attacks of dizziness persist despite these measures. OTOSCLEROSIS A disorder of the middle ear that results in progressive deafness. Often running in families, otosclerosis affects about one person in 200; it customarily occurs early in adult life. An overgrowth of bone ?xes the stapes (the innermost bone of the middle ear) and stops sound vibrations from being transmitted to the inner ear. The result is conductive deafness. The disorder usually affects both ears. Those affected tend to talk quietly and deafness increases over a 10–15 year period. Tinnitus often occurs, and occasionally vertigo.
Abnormal hearing tests point to the diagnosis; the deafness may be partially overcome with a hearing aid but surgery is eventually needed. This involves replacing the stapes bone with a synthetic substitute (stapedectomy). (See also OTIC BAROTRAUMA.)... ear, diseases of
Treatment As the disease can be neither prevented nor cured, treatment is supportive, with strict anti-infection procedures essential as human-to-human transmission can occur via skin and mucous-membrane contacts. Incubation period is 5–10 days. Fever with MYALGIA and headache occur initially, often accompanied by abdominal and chest symptoms. Haemorrhagic symptoms soon develop and the victim either starts to improve in the second week or develops multi-organ failure and lapses into a coma. Mortality ranges from 25 to 90 per cent.... ebola virus disease
Gender is determined by a combination of genetic and environmental factors, in which the in?uence of family upbringing is an important factor. When physical sexual characteristics are ambiguous, the child’s gender identity can usually be established if the child is reared as being clearly male or female. Should, however, the child be confused about its sexual identity, the uncertainty may continue into adult life. Transsexuals generally experience con?icts of identity in childhood, and such problems usually occur by the age of two years. In this type of identity disorder, which occurs in one in 30,000 male births and one in 100,000 female births, the person believes that he or she is the victim of a biological accident, trapped in a body different from what is felt to be his or her true sex.
Treatment is di?cult: psychotherapy and hormone treatment may help, but some affected individuals want surgery to change their body’s sexual organs to match their innately felt sexual gender. The decision to seek a physical sex change raises major social problems for individuals, and ethical problems for their doctors. Surgery, which is not always successful in the long term, requires careful assessment, discussion and planning. It is important to preclude mental illness; results in homosexual men who have undergone surgery are not usually satisfactory. Advice and information may be obtained from Gender Identity Consultancy Services.... gender identity disorders
Arrhythmias An abnormal rate or rhythm of the heartbeat. The reason is a disturbance in the electrical impulses within the heart. Sometimes a person may have an occasional irregular heartbeat: this is called an ECTOPIC beat (or an extrasystole) and does not necessarily mean that an abnormality exists. There are two main types of arrhythmia: bradycardias, where the rate is slow – fewer than 60 beats a minute and sometimes so slow and unpredictable (heartblock) as to cause blackouts or heart failure; and tachycardia, where the rate is fast – more than 100 beats a minute. A common cause of arrhythmia is coronary artery disease, when vessels carrying blood to the heart are narrowed by fatty deposits (ATHEROMA), thus reducing the blood supply and damaging the heart tissue. This condition often causes myocardial infarction after which arrhythmias are quite common and may need correcting by DEFIBRILLATION (application of a short electric shock to the heart). Some tachycardias result from a defect in the electrical conduction system of the heart that is commonly congenital. Various drugs can be used to treat arrhythmias (see ANTIARRHYTHMIC DRUGS). If attacks constantly recur, the arrhythmia may be corrected by electrical removal of dead or diseased tissue that is the cause of the disorder. Heartblock is most e?ectively treated with an arti?cial CARDIAC PACEMAKER, a battery-activated control unit implanted in the chest.
Cardiomyopathy Any disease of the heart muscle that results in weakening of its contractions. The consequence is a fall in the e?ciency of the circulation of blood through the lungs and remainder of the body structures. The myopathy may be due to infection, disordered metabolism, nutritional excess or de?ciency, toxic agents, autoimmune processes, degeneration, or inheritance. Often, however, the cause is not identi?ed. Cardiomyopathies are less common than other types of heart diseases, and the incidence of di?erent types of myopathy (see below) is not known because patients or doctors are sometimes unaware of the presence of the condition.
The three recognised groups of cardiomyopathies are hypertrophic, dilated and restrictive.
•Hypertrophic myopathy, a familial condition, is characterised by great enlargement of the muscle of the heart ventricles. This reduces the muscle’s e?ciency, the ventricles fail to relax properly and do not ?ll suf?ciently during DIASTOLE.
In the dilated type of cardiomyopathy, both ventricles overdilate, impairing the e?ciency of contraction and causing congestion of the lungs.
In the restrictive variety, proper ?lling of the ventricles does not occur because the muscle walls are less elastic than normal. The result is raised pressure in the two atria (upper cavities) of the heart: these dilate and develop FIBRILLATION. Diagnosis can be di?cult and treatment is symptomatic, with a poor prognosis. In suitable patients, heart TRANSPLANTATION may be considered. Disorders of the heart muscle may also be
caused by poisoning – for example, heavy consumption of alcohol. Symptoms include tiredness, palpitations (quicker and sometimes irregular heartbeat), chest pain, di?culty in breathing, and swelling of the legs and hands due to accumulation of ?uid (OEDEMA). The heart is enlarged (as shown on chest X-ray) and ECHOCARDIOGRAPHY shows thickening of the heart muscle. A BIOPSY of heart muscle will show abnormalities in the cells of the heart muscle.
Where the cause of cardiomyopathy is unknown, as is the case with most patients, treatment is symptomatic using DIURETICS to control heart failure and drugs such as DIGOXIN to return the heart rhythm to normal. Patients should stop drinking alcohol. If, as often happens, the patient’s condition slowly deteriorates, heart transplantation should be considered.
Congenital heart disease accounts for 1–2 per cent of all cases of organic heart disease. It may be genetically determined and so inherited; present at birth for no obvious reason; or, in rare cases, related to RUBELLA in the mother. The most common forms are holes in the heart (atrial septal defect, ventricular septal defect – see SEPTAL DEFECT), a patent DUCTUS ARTERIOSUS, and COARCTATION OF THE AORTA. Many complex forms also exist and can be diagnosed in the womb by fetal echocardiography which can lead to elective termination of pregnancy. Surgery to correct many of these abnormalities is feasible, even for the most severe abnormalities, but may only be palliative giving rise to major diffculties of management as the children become older. Heart transplantation is now increasingly employed for the uncorrectable lesions.
Coronary artery disease Also known as ischaemic heart disease, this is a common cause of symptoms and death in the adult population. It may present for the ?rst time as sudden death, but more usually causes ANGINA PECTORIS, myocardial infarction (heart attack) or heart failure. It can also lead to a disturbance of heart rhythm. Factors associated with an increased risk of developing coronary artery disease include diabetes, cigarette smoking, high blood pressure, obesity, and a raised concentration of cholesterol in the blood. Older males are most affected.
Coronary thrombosis or acute myocardial infarction is the acute, dramatic manifestation of coronary-artery ischaemic heart disease – one of the major killing diseases of western civilisation. In 1999, ischaemic heart disease was responsible for about 115,000 deaths in England and Wales, compared with 153,000 deaths in 1988. In 1999 more than 55,600 people died of coronary thrombosis. The underlying cause is disease of the coronary arteries which carry the blood supply to the heart muscle (or myocardium). This results in narrowing of the arteries until ?nally they are unable to transport su?cient blood for the myocardium to function e?ciently. One of three things may happen. If the narrowing of the coronary arteries occurs gradually, then the individual concerned will develop either angina pectoris or signs of a failing heart: irregular rhythm, breathlessness, CYANOSIS and oedema.
If the narrowing occurs suddenly or leads to complete blockage (occlusion) of a major branch of one of the coronary arteries, then the victim collapses with acute pain and distress. This is the condition commonly referred to as a coronary thrombosis because it is usually due to the affected artery suddenly becoming completely blocked by THROMBOSIS. More correctly, it should be described as coronary occlusion, because the ?nal occluding factor need not necessarily be thrombosis.
Causes The precise cause is not known, but a wide range of factors play a part in inducing coronary artery disease. Heredity is an important factor. The condition is more common in men than in women; it is also more common in those in sedentary occupations than in those who lead a more physically active life, and more likely to occur in those with high blood pressure than in those with normal blood pressure (see HYPERTENSION). Obesity is a contributory factor. The disease is more common among smokers than non-smokers; it is also often associated with a high level of CHOLESTEROL in the blood, which in turn has been linked with an excessive consumption of animal, as opposed to vegetable, fats. In this connection the important factors seem to be the saturated fatty acids (low-density and very low-density lipoproteins [LDLs and VLDLs] – see CHOLESTEROL) of animal fats which would appear to be more likely to lead to a high level of cholesterol in the blood than the unsaturated fatty acids of vegetable fats. As more research on the subject is carried out, the arguments continue about the relative in?uence of the di?erent factors. (For advice on prevention of the disease, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)
Symptoms The presenting symptom is the sudden onset, often at rest, of acute, agonising pain in the front of the chest. This rapidly radiates all over the front of the chest and often down over the abdomen. The pain is frequently accompanied by nausea and vomiting, so that suspicion may be aroused of some acute abdominal condition such as biliary colic (see GALLBLADDER, DISEASES OF) or a perforated PEPTIC ULCER. The victim soon goes into SHOCK, with a pale, cold, sweating skin, rapid pulse and dif?culty in breathing. There is usually some rise in temperature.
Treatment is immediate relief of the pain by injections of diamorphine. Thrombolytic drugs should be given as soon as possible (‘rapid door to needle time’) and ARRHYTHMIA corrected. OXYGEN is essential and oral ASPIRIN is valuable. Treatment within the ?rst hour makes a great di?erence to recovery. Subsequent treatment includes the continued administration of drugs to relieve the pain; the administration of ANTIARRHYTHMIC DRUGS that may be necessary to deal with the heart failure that commonly develops, and the irregular action of the heart that quite often develops; and the continued administration of oxygen. Patients are usually admitted to coronary care units, where they receive constant supervision. Such units maintain an emergency, skilled, round-the-clock sta? of doctors and nurses, as well as all the necessary resuscitation facilities that may be required.
The outcome varies considerably. The ?rst (golden) hour is when the patient is at greatest risk of death: if he or she is treated, then there is a 50 per cent reduction in mortality compared with waiting until hospital admission. As each day passes the prognosis improves with a ?rst coronary thrombosis, provided that the patient does not have a high blood pressure and is not overweight. Following recovery, there should be a gradual return to work, care being taken to avoid any increase in weight, unnecessary stress and strain, and to observe moderation in all things. Smoking must stop. In uncomplicated cases patients get up and about as soon as possible, most being in hospital for a week to ten days and back at work in three months or sooner.
Valvular heart disease primarily affects the mitral and aortic valves which can become narrowed (stenosis) or leaking (incompetence). Pulmonary valve problems are usually congenital (stenosis) and the tricuspid valve is sometimes involved when rheumatic heart disease primarily affects the mitral or aortic valves. RHEUMATIC FEVER, usually in childhood, remains a common cause of chronic valvular heart disease causing stenosis, incompetence or both of the aortic and mitral valves, but each valve has other separate causes for malfunction.
Aortic valve disease is more common with increasing age. When the valve is narrowed, the heart hypertrophies and may later fail. Symptoms of angina or breathlessness are common and dizziness or blackouts (syncope) also occur. Replacing the valve is a very e?ective treatment, even with advancing age. Aortic stenosis may be caused by degeneration (senile calci?c), by the inheritance of two valvular leaflets instead of the usual three (bicuspid valve), or by rheumatic fever. Aortic incompetence again leads to hypertrophy, but dilatation is more common as blood leaks back into the ventricle. Breathlessness is the more common complaint. The causes are the same as stenosis but also include in?ammatory conditions such as SYPHILIS or ANKYLOSING SPONDYLITIS and other disorders of connective tissue. The valve may also leak if the aorta dilates, stretching the valve ring as with HYPERTENSION, aortic ANEURYSM and MARFAN’S SYNDROME – an inherited disorder of connective tissue that causes heart defects. Infection (endocarditis) can worsen acutely or chronically destroy the valve and sometimes lead to abnormal outgrowths on the valve (vegetations) which may break free and cause devastating damage such as a stroke or blocked circulation to the bowel or leg.
Mitral valve disease leading to stenosis is rheumatic in origin. Mitral incompetence may be rheumatic but in the absence of stenosis can be due to ISCHAEMIA, INFARCTION, in?ammation, infection and a congenital weakness (prolapse). The valve may also leak if stretched by a dilating ventricle (functional incompetence). Infection (endocarditis) may affect the valve in a similar way to aortic disease. Mitral symptoms are predominantly breathlessness which may lead to wheezing or waking at night breathless and needing to sit up or stand for relief. They are made worse when the heart rhythm changes (atrial ?brillation) which is frequent as the disease becomes more severe. This leads to a loss of e?ciency of up to 25 per cent and a predisposition to clot formation as blood stagnates rather than leaves the heart e?ciently. Mitral incompetence may remain mild and be of no trouble for many years, but infection must be guarded against (endocarditis prophylaxis).
Endocarditis is an infection of the heart which may acutely destroy a valve or may lead to chronic destruction. Bacteria settle usually on a mild lesion. Antibiotics taken at vulnerable times can prevent this (antibiotic prophylaxis) – for example, before tooth extraction. If established, lengthy intravenous antibiotic therapy is needed and surgery is often necessary. The mortality is 30 per cent but may be higher if the infection settles on a replaced valve (prosthetic endocarditis). Complications include heart failure, shock, embolisation (generation of small clots in the blood), and cerebral (mental) confusion.
PERICARDITIS is an in?ammation of the sac covering the outside of the heart. The sac becomes roughened and pain occurs as the heart and sac rub together. This is heard by stethoscope as a scratching noise (pericardial rub). Fever is often present and a virus the main cause. It may also occur with rheumatic fever, kidney failure, TUBERCULOSIS or from an adjacent lung problem such as PNEUMONIA or cancer. The in?ammation may cause ?uid to accumulate between the sac and the heart (e?usion) which may compress the heart causing a fall in blood pressure, a weak pulse and circulatory failure (tamponade). This can be relieved by aspirating the ?uid. The treatment is then directed at the underlying cause.... heart, diseases of
K
Diagram of glomerulus (Malpighian corpuscle).
Fortunately the body has two kidneys and, as most people can survive on one, there is a good ‘functional reserve’ of kidney tissue.
Symptoms Many patients with kidney disorders do not have any symptoms, even when the condition is quite advanced. However,
others experience loin pain associated with obstruction (renal colic) or due to infection; fevers; swelling (oedema), usually of the legs but occasionally including the face and arms; blood in the urine (haematuria); and excess quantities of urine (polyuria), including at night (nocturia), due to failure of normal mechanisms in the kidney for concentrating urine. Patients with chronic renal failure often have very di?use symptoms including nausea and vomiting, tiredness due to ANAEMIA, shortness of breath, skin irritation, pins and needles (paraesthesia) due to damage of the peripheral nerves (peripheral neuropathy), and eventually (rarely seen nowadays) clouding of consciousness and death.
Signs of kidney disease include loin tenderness, enlarged kidneys, signs of ?uid retention, high blood pressure and, in patients with end-stage renal failure, pallor, pigmentation and a variety of neurological signs including absent re?exes, reduced sensation, and a coarse ?apping tremor (asterixis) due to severe disturbance of the body’s normal metabolism.
Renal failure Serious kidney disease may lead to impairment or failure of the kidney’s ability to ?lter waste products from the blood and excrete them in the urine – a process that controls the body’s water and salt balance and helps to maintain a stable blood pressure. Failure of this process causes URAEMIA – an increase in urea and other metabolic waste products – as well as other metabolic upsets in the blood and tissues, all of which produce varying symptoms. Failure can be sudden or develop more slowly (chronic). In the former, function usually returns to normal once the underlying cause has been treated. Chronic failure, however, usually irreparably reduces or stops normal function.
Acute failure commonly results from physiological shock following a bad injury or major illness. Serious bleeding or burns can reduce blood volume and pressure to the point where blood-supply to the kidney is greatly reduced. Acute myocardial infarction (see HEART, DISEASES OF) or pancreatitis (see PANCREAS, DISORDERS OF) may produce a similar result. A mismatched blood transfusion can produce acute failure. Obstruction to the urine-?ow by a stone (calculus) in the urinary tract, a bladder tumour or an enlarged prostate can also cause acute renal failure, as can glomerulonephritis (see below) and the haemolytic-uraemia syndrome.
HYPERTENSION, DIABETES MELLITUS, polycystic kidney disease (see below) or AMYLOIDOSIS are among conditions that cause chronic renal failure. Others include stone, tumour, prostatic enlargement and overuse of analgesic drugs. Chronic failure may eventually lead to end-stage renal failure, a life-threatening situation that will need DIALYSIS or a renal transplant (see TRANSPLANTATION).
Familial renal disorders include autosomal dominant inherited polycystic kidney disease and sex-linked familial nephropathy. Polycystic kidney disease is an important cause of renal failure in the UK. Patients, usually aged 30–50, present with HAEMATURIA, loin or abdominal discomfort or, rarely, urinary-tract infection, hypertension and enlarged kidneys. Diagnosis is based on ultrasound examination of the abdomen. Complications include renal failure, hepatic cysts and, rarely, SUBARACHNOID HAEMORRHAGE. No speci?c treatment is available. Familial nephropathy occurs more often in boys than in girls and commonly presents as Alport’s syndrome (familial nephritis with nerve DEAFNESS) with PROTEINURIA, haematuria, progressing to renal failure and deafness. The cause of the disease lies in an absence of a speci?c ANTIGEN in a part of the glomerulus. The treatment is conservative, with most patients eventually requiring dialysis or transplantation.
Acute glomerulonephritis is an immune-complex disorder due to entrapment within glomerular capillaries of ANTIGEN (usually derived from B haemolytic streptococci – see STREPTOCOCCUS) antibody complexes initiating an acute in?ammatory response (see IMMUNITY). The disease affects children and young adults, and classically presents with a sore throat followed two weeks later by a fall in urine output (oliguria), haematuria, hypertension and mildly abnormal renal function. The disease is self-limiting with 90 per cent of patients spontaneously recovering. Treatment consists of control of blood pressure, reduced ?uid and salt intake, and occasional DIURETICS and ANTIBIOTICS.
Chronic glomerulonephritis is also due to immunological renal problems and is also classi?ed by taking a renal biopsy. It may be subdivided into various histological varieties as determined by renal biospy. Proteinuria of various degrees is present in all these conditions but the clinical presentations vary, as do their treatments. Some resolve spontaneously; others are treated with steroids or even the cytotoxic drug CYCLOPHOSPHAMIDE or the immunosuppressant cyclosporin. Prognoses are generally satisfactory but some patients may require renal dialysis or kidney transplantation – an operation with a good success rate.
Hydronephrosis A chronic disease in which the kidney becomes greatly distended with ?uid. It is caused by obstruction to the ?ow of urine at the pelvi-ureteric junction (see KIDNEYS – Structure). If the ureter is obstructed, the ureter proximal to the obstruction will dilate and pressure will be transmitted back to the kidney to cause hydronephrosis. Obstruction may occur at the bladder neck or in the urethra itself. Enlargement of the prostate is a common cause of bladder-neck obstruction; this would give rise to hypertrophy of the bladder muscle and both dilatation of the ureter and hydronephrosis. If the obstruction is not relieved, progressive destruction of renal tissue will occur. As a result of the stagnation of the urine, infection is probable and CYSTITIS and PYELONEPHRITIS may occur.
Impaired blood supply may be the outcome of diabetes mellitus and physiological shock, which lowers the blood pressure, also affecting the blood supply. The result can be acute tubular necrosis. POLYARTERITIS NODOSA and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) may damage the large blood vessels in the kidney. Treatment is of the underlying condition.
Infection of the kidney is called pyelonephritis, a key predisposing factor being obstruction of urine ?ow through the urinary tract. This causes stagnation and provides a fertile ground for bacterial growth. Acute pyelonephritis is more common in women, especially during pregnancy when bladder infection (CYSTITIS) spreads up the ureters to the kidney. Symptoms are fever, malaise and backache. Antibiotics and high ?uid intake are the most e?ective treatment. Chronic pyelonephritis may start in childhood as a result of congenital deformities that permit urine to ?ow up from the bladder to the kidney (re?ux). Persistent re?ux leads to recurrent infections causing permanent damage to the kidney. Specialist investigations are usually required as possible complications include hypertension and kidney failure.
Tumours of the kidney are fortunately rare. Non-malignant ones commonly do not cause symptoms, and even malignant tumours (renal cell carcinoma) may be asymptomatic for many years. As soon as symptoms appear – haematuria, back pain, nausea, malaise, sometimes secondary growths in the lungs, bones or liver, and weight loss – urgent treatment including surgery, radiotherapy and chemotherapy is necessary. This cancer occurs mostly in adults over 40 and has a hereditary element. The prognosis is not good unless diagnosed early. In young children a rare cancer called nephroblastoma (Wilm’s tumour) can occur; treatment is with surgery, radiotherapy and chemotherapy. It may grow to a substantial size before being diagnosed.
Cystinuria is an inherited metabolic defect in the renal tubular reabsorption of cystine, ornithine, lysine and arginine. Cystine precipitates in an alkaline urine to form cystine stones. Triple phosphate stones are associated with infection and may develop into a very large branching calculi (staghorn calculi). Stones present as renal or ureteric pain, or as an infection. Treatment has undergone considerable change with the introduction of MINIMALLY INVASIVE SURGERY (MIS) and the destruction of stone by sound waves (LITHOTRIPSY).... kidneys, diseases of
– the corpus callosum. Other clefts or ?ssures (sulci) make deep impressions, dividing the cerebrum into lobes. The lobes of the cerebrum are the frontal lobe in the forehead region, the parietal lobe on the side and upper part of the brain, the occipital lobe to the back, and the temporal lobe lying just above the region of the ear. The outer 3 mm of the cerebrum is called the cortex, which consists of grey matter with the nerve cells arranged in six layers. This region is concerned with conscious thought, sensation and movement, operating in a similar manner to the more primitive areas of the brain except that incoming information is subject to much greater analysis.
Numbers of shallower infoldings of the surface, called furrows or sulci, separate raised areas called convolutions or gyri. In the deeper part, the white matter consists of nerve ?bres connecting di?erent parts of the surface and passing down to the lower parts of the brain. Among the white matter lie several rounded masses of grey matter, the lentiform and caudate nuclei. In the centre of each cerebral hemisphere is an irregular cavity, the lateral ventricle, each of which communicates with that on the other side and behind with the third ventricle through a small opening, the inter-ventricular foramen, or foramen of Monro.
BASAL NUCLEI Two large masses of grey matter embedded in the base of the cerebral hemispheres in humans, but forming the chief part of the brain in many animals. Between these masses lies the third ventricle, from which the infundibulum, a funnel-shaped process, projects downwards into the pituitary body, and above lies the PINEAL GLAND. This region includes the important HYPOTHALAMUS.
MID-BRAIN or mesencephalon: a stalk about 20 mm long connecting the cerebrum with the hind-brain. Down its centre lies a tube, the cerebral aqueduct, or aqueduct of Sylvius, connecting the third and fourth ventricles. Above this aqueduct lie the corpora quadrigemina, and beneath it are the crura cerebri, strong bands of white matter in which important nerve ?bres pass downwards from the cerebrum. The pineal gland is sited on the upper part of the midbrain.
PONS A mass of nerve ?bres, some of which run crosswise and others are the continuation of the crura cerebri downwards.
CEREBELLUM This lies towards the back, underneath the occipital lobes of the cerebrum.
MEDULLA OBLONGATA The lowest part of the brain, in structure resembling the spinal cord, with white matter on the surface and grey matter in its interior. This is continuous through the large opening in the skull, the foramen magnum, with the spinal cord. Between the medulla, pons, and cerebellum lies the fourth ventricle of the brain.
Structure The grey matter consists mainly of billions of neurones (see NEURON(E)) in which all the activities of the brain begin. These cells vary considerably in size and shape in di?erent parts of the brain, though all give o? a number of processes, some of which form nerve ?bres. The cells in the cortex of the cerebral hemispheres, for example, are very numerous, being set in layers ?ve or six deep. In shape these cells are pyramidal, giving o? processes from the apex, from the centre of the base, and from various projections elsewhere on the cell. The grey matter is everywhere penetrated by a rich supply of blood vessels, and the nerve cells and blood vessels are supported in a ?ne network of ?bres known as neuroglia.
The white matter consists of nerve ?bres, each of which is attached, at one end, to a cell in the grey matter, while at the other end it splits up into a tree-like structure around another cell in another part of the grey matter in the brain or spinal cord. The ?bres have insulating sheaths of a fatty material which, in the mass, gives the white matter its colour; they convey messages from one part of the brain to the other (association ?bres), or, grouped into bundles, leave the brain as nerves, or pass down into the spinal cord where they end near, and exert a control upon, cells from which in turn spring the nerves to the body.
Both grey and white matter are bound together by a network of cells called GLIA which make up 60 per cent of the brain’s weight. These have traditionally been seen as simple structures whose main function was to glue the constituents of the brain together. Recent research, however, suggests that glia are vital for growing synapses between the neurons as they trigger these cells to communicate with each other. So they probably participate in the task of laying down memories, for which synapses are an essential key. The research points to the likelihood that glial cells are as complex as neurons, functioning biochemically in a similar way. Glial cells also absorb potassium pumped out by active neurons and prevent levels of GLUTAMATE – the most common chemical messenger in the brain – from becoming too high.
The general arrangement of ?bres can be best understood by describing the course of a motor nerve-?bre. Arising in a cell on the surface in front of the central sulcus, such a ?bre passes inwards towards the centre of the cerebral hemisphere, the collected mass of ?bres as they lie between the lentiform nucleus and optic thalamus being known as the internal capsule. Hence the ?bre passes down through the crus cerebri, giving o? various small connecting ?bres as it passes downwards. After passing through the pons it reaches the medulla, and at this point crosses to the opposite side (decussation of the pyramids). Entering the spinal cord, it passes downwards to end ?nally in a series of branches (arborisation) which meet and touch (synapse) similar branches from one or more of the cells in the grey matter of the cord (see SPINAL CORD).
BLOOD VESSELS Four vessels carry blood to the brain: two internal carotid arteries in front, and two vertebral arteries behind. These communicate to form a circle (circle of Willis) inside the skull, so that if one is blocked, the others, by dilating, take its place. The chief branch of the internal carotid artery on each side is the middle cerebral, and this gives o? a small but very important branch which pierces the base of the brain and supplies the region of the internal capsule with blood. The chief importance of this vessel lies in the fact that the blood in it is under especially high pressure, owing to its close connection with the carotid artery, so that haemorrhage from it is liable to occur and thus give rise to stroke. Two veins, the internal cerebral veins, bring the blood away from the interior of the brain, but most of the small veins come to the surface and open into large venous sinuses, which run in grooves in the skull, and ?nally pass their blood into the internal jugular vein that accompanies the carotid artery on each side of the neck.
MEMBRANES The brain is separated from the skull by three membranes: the dura mater, a thick ?brous membrane; the arachnoid mater, a more delicate structure; and the pia mater, adhering to the surface of the brain and containing the blood vessels which nourish it. Between each pair is a space containing ?uid on which the brain ?oats as on a water-bed. The ?uid beneath the arachnoid membrane mixes with that inside the ventricles through a small opening in the fourth ventricle, called the median aperture, or foramen of Magendie.
These ?uid arrangements have a great in?uence in preserving the brain from injury.... divisions
Anorexia nervosa Often called the slimmer’s disease, this is a syndrome characterised by the loss of at least a quarter of a person’s normal body weight; by fear of normal weight; and, in women, by AMENORRHOEA. An individual’s body image may be distorted so that the sufferer cannot judge real weight and wants to diet even when already very thin.
Anorexia nervosa usually begins in adolescence, affecting about 1–2 per cent of teenagers and college students at any time. It is 20 times more common among women than men. Up to 10 per cent of sufferers’ sisters also have the syndrome. Anorexia may be linked with episodes of bulimia (see below).
The symptoms result from secretive self-starvation, usually with excessive exercise, self-induced vomiting, and misuse of laxatives. An anorexic (or anorectic) person may wear layers of baggy clothes to keep warm and to hide the ?gure. Starvation can cause serious problems such as ANAEMIA, low blood pressure, slow heart rate, swollen ankles, and osteoporosis. Sudden death from heart ARRHYTHMIA may occur, particularly if the sufferer misuses DIURETICS to lose weight and also depletes the body’s level of potassium.
There is probably no single cause of anorexia nervosa. Social pressure to be thin seems to be an important factor and has increased over the past 20–30 years, along with the incidence of the syndrome. Psychological theories include fear of adulthood and fear of losing parents’ attention.
Treatment should start with the general practitioner who should ?rst rule out other illnesses causing similar signs and symptoms. These include DEPRESSION and disorders of the bowel, PITUITARY GLAND, THYROID GLAND, and OVARIES.
If the diagnosis is clearly anorexia nervosa, the general practitioner may refer the sufferer to a psychiatrist or psychologist. Moderately ill sufferers can be treated by COGNITIVE BEHAVIOUR THERAPY. A simple form of this is to agree targets for daily calorie intake and for acceptable body weight. The sufferer and the therapist (the general practitioner or a member of the psychiatric team) then monitor progress towards both targets by keeping a diary of food intake and measuring weight regularly. Counselling or more intensely personal PSYCHOTHERAPY may help too. Severe life-threatening complications will need urgent medical treatment in hospital, including rehydration and feeding using a nasogastric tube or an intravenous drip.
About half of anorectic sufferers recover fully within four years, a quarter improve, and a quarter remain severely underweight with (in the case of women) menstrual abnormalities. Recovery after ten years is rare and about 3 per cent die within that period, half of them by suicide.
Bulimia nervosa is a syndrome characterised by binge eating, self-induced vomiting and laxative misuse, and fear of fatness. There is some overlap between anorexia nervosa and bulimia but, unlike the former, bulimia may start at any age from adolescence to 40 and is probably more directly linked with ordinary dieting. Bulimic sufferers say that, although they feel depressed and guilty after binges, the ‘buzz’ and relief after vomiting and purging are addictive. They often respond well to cognitive behaviour therapy.
Bulimia nervosa does not necessarily cause weight loss because the binges – for example of a loaf of bread, a packet of cereal, and several cans of cold baked beans at one sitting – are cancelled out by purging, by self-induced vomiting and by brief episodes of starvation. The full syndrome has been found in about 1 per cent of women but mild forms may be much more common. In one survey of female college students, 13 per cent admitted to having had bulimic symptoms.
Bulimia nervosa rarely leads to serious physical illness or death. However, repeated vomiting can cause oesophageal burns, salivary gland infections, small tears in the stomach, and occasionally dehydration and chemical imbalances in the blood. Inducing vomiting using ?ngers may produce two tell-tale signs – bite marks on the knuckles and rotten, pitted teeth.
Those suffering from this condition may obtain advice from the Eating Disorders Association.... eating disorders
The traditional remedy is to wind the worm from the skin on to a small stick. Once the worm is out, the condition usually clears up. The drugs tiabendazole and niridazole are given to reduce inflammation, antibiotics are given to control secondary infection, and the patient is immunized against tetanus.... guinea worm disease
In general, genetic factors do not play a large part in causing heart disorders, however they do contribute to the hyperlipidaemias that predispose a person to atherosclerosis and coronary artery disease. Structural abnormalities in the heart are among the most common birth defects (see heart disease, congenital).
Infections after birth may result in endocarditis or myocarditis. Tumours arising from the heart tissues are rare. They include noncancerous myxomas and cancerous sarcomas.
The heart muscle may become thin and flabby from lack of protein and calories. Thiamine (vitamin B1) deficiency, common in alcoholics, causes beriberi with congestive heart failure. Alcohol poisoning over many years may cause a type of cardiomyopathy. Obesity is an important factor in heart disease, probably through its effect on other risk factors, such as hypertension, diabetes, and cholesterol.
The coronary arteries may become narrowed due to atherosclerosis, depriving areas of heart muscle of oxygen. The result may be angina pectoris or, eventually, a myocardial infarction.
Some drugs, such as the anticancer drug doxorubicin, tricyclic antidepressants, and even drugs used to treat heart disease, may disturb the heartbeat or damage the heart muscle.
Many common and serious heart disorders may be a complication of an underlying condition, such as cardiomyopathy or a congenital defect. Such disorders include cardiac arrhythmia, some cases of heart block, and heart failure. Cor pulmonale is a failure of the right side of the heart as a consequence of lung disease.... heart, disorders of
The mechanisms by which the body loses unwanted heat are controlled by the hypothalamus in the brain. When blood temperature rises, the hypothalamus sends out nerve impulses to stimulate the sweat glands and dilate blood vessels in the skin, which cools the body down. However, excessive sweating may result in an imbalance of salts and fluids in the body, which may lead to heat cramps or heat exhaustion. When the hypothalamus is disrupted (for example, by a fever), the body may overheat, leading to heatstroke. Excessive external heat may cause prickly heat.
Most heat disorders can be prevented by gradual acclimatization to hot conditions and taking salt tablets or solution.
A light diet and frequent cool baths or showers may also help.
Alcohol and strenuous exercise should be avoided.... heat disorders
A dislocated jaw is usually due either to a blow or to yawning.
There is pain in front of the ear on the affected side or sides, and the jaw projects forwards.
The mouth cannot be fully closed, making eating and speaking difficult.
Dislocation tends to recur.
Surgery may be carried out to stabilize the joint but is often unsuccessful.... jaw, dislocated
The first symptoms include headache, muscular and abdominal pain, diarrhoea, and a dry cough.
Over the next few days, pneumonia develops, resulting in a high fever, shaking chills, coughing up of thick sputum (phlegm), drowsiness, and sometimes delirium.
Treatment is with the antibiotic drug erythromycin.... legionnaires’ disease
Congenital or inherited deficiencies can occur in either of the 2 prongs of the adaptive immune system: humoral or cellular. Deficiencies of the humoral system include hypogammaglobulinaemia and agammaglobulinaemia. The former may cause few or no symptoms, depending on the severity of the deficiency, but agammaglobulinaemia can be fatal if not treated with immunoglobulin. Congenital deficiencies of T-lymphocytes may lead to problems such as persistent and widespread candidiasis (thrush). A combined deficiency of both humoral and cellular components of the immune system, called severe combined immunodeficiency (SCID), is usually fatal in the 1st year of life unless treatment can be given by bone marrow transplant.
Acquired immunodeficiency may be due either to disease processes (such as infection with HIV, which leads to AIDS) or damage to the immune system as a result of its suppression by drugs. Severe malnutrition and many cancers can also cause immunodeficiency. Mild immunodeficiency arises through a natural decline in immune defences with age.... immunodeficiency disorders
A number of serious diseases are spread by biting insects.
These include malaria and filariasis (transmitted by mosquitoes), sleeping sickness (tsetse flies), leishmaniasis (sandflies), epidemic typhus (lice), and plague (rat fleas).
Mosquitoes, sandflies, and ticks can also spread illnesses such as yellow fever, dengue, Lyme disease, and some types of viral encephalitis.
Organisms picked up when an insect ingests blood from an infected animal or person are able to survive or multiply in the insect.
Later, the organisms are either injected into a new human host via the insect’s saliva or deposited in the faeces at or near the site of the bite.
Most insect-borne diseases are confined to the tropics and subtropics, although tick-borne Lyme disease occurs in some parts of the.
The avoidance of insect-borne disease is largely a matter of keeping flies off food, discouraging insect bites by the use of suitable clothing and insect repellents, and, in parts of the world where malaria is present, the use of mosquito nets and screens, pesticides, and antimalarial tablets.... insects and disease
Structural abnormalities may be present from birth (congenital) or may develop later. They cause blockage of the intestine (see intestine, blockage of) and include atresia, stenosis, and volvulus. In newborns, meconium (fetal intestinal contents) may block the intestine.
Generalized inflammation of the intestine may result from viral or bacterial infections or from noninfectious causes, as in ulcerative colitis and Crohn’s disease. Gastroenteritis is the term commonly applied to inflammation of the stomach and intestines. Infection encompasses food poisoning, traveller’s diarrhoea, typhoid fever, cholera, amoebiasis, and giardiasis. Intestinal worm infestations include roundworms and tapeworms. Sometimes inflammation is localized, such as in appendicitis and diverticular disease.
Tumours of the small intestine are rare, but noncancerous growths, lymphomas, and carcinoid tumours (causing carcinoid syndrome) occur. Tumours of the large intestine are common (see colon, cancer of; rectum, cancer of). Some forms of familial polyposis may progress to cancer. Impaired blood supply (ischaemia) to the intestine may occur as a result of partial or complete obstruction of the arteries in the abdominal wall (from diseases such as atherosclerosis) or from the blood vessels being compressed or trapped, as in intussusception or hernias. Loss of blood supply may cause gangrene.
Other disorders that affect the intestine include peptic ulcers, diverticulosis, malabsorption, coeliac disease, and irritable bowel syndrome.... intestine, disorders of
The most common lipid disorders are the hyperlipidaemias, which are characterized by high levels of lipids in the blood and can cause atherosclerosis and pancreatitis.
There are also some very rare lipid disorders due solely to heredity, such as Tay–Sachs disease.... lipid disorders
Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.
Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.
Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of
Habitat: Tropical India in moist regions.
English: Milky Yam.Ayurvedic: Kshira-vidaari, Kshir- valli, Payasvini, Swaadukandaa, Ikshukandaa, Gajavaajipriyaa, Kan- dapalaasha, Bhuumikuushmaanda.Siddha: Paalmudukkan kizhangu.Folk: Bilaaikanda. Bhuin Kakhaaru (Orissa).Action: Cholagogue, galactagogue, alterative, demulcent, purgative. Resin from root—uses similar to Jalap. Flour of raw rhizome is given in enlargement of liver and spleen, also for menorrhagia, debility and fat accumulation.
Rhizomes gave taraxerol acetate and beta-sitosterol. Fresh leaves contain 6.3 mg/100 g of carotene.Vidaari is equated with Pueraria tuberosa DC. (Fabaceae). Dry pieces of Dioscorea pentaphylla Linn. are sold as Vidaari Kanda.Dosage: Tuber—3-6 g powder. (CCRAS.)... ipomoea digitata[catlist id=11 numberposts=100 pagination=yes instance=2 orderby=title order=asc]
... medical dictionaryCramp Painful spasm of a muscle usually caused by excessive and prolonged contraction of the muscle ?bres. Cramps are common, especially among sportsmen and women, normally lasting a short time. The condition usually occurs during or immediately following exercise as a result of a build-up of LACTIC ACID and other chemical by-products in the muscles
– caused by the muscular e?orts. Cramps may occur more frequently, especially at night, in people with poor circulation, when the blood is unable to remove the lactic acid from the muscles quickly enough.
Repetitive movements such as writing (writer’s cramp) or operating a keyboard can cause cramp. Resting muscles may suffer cramp if a person sits or lies in an awkward position which limits local blood supply to them. Profuse sweating as a result of fever or hot weather can also cause cramp in resting muscle, because the victim has lost sodium salts in the sweat; this disturbs the biochemical balance in muscle tissue.
Treatment is to massage and stretch the affected muscle – for example, cramp in the calf muscle may be relieved by pulling the toes on the affected leg towards the knee. Persistent night cramps sometimes respond to treatment with a drug containing CALCIUM or QUININE. If cramp persists for an hour or more, the person should seek medical advice, as there may be a serious cause such as a blood clot impeding the blood supply to the area affected.
Dystrophy See myopathy below.
In?ammation (myositis) of various types may occur. As the result of injury, an ABSCESS may develop, although wounds affecting muscle generally heal well. A growth due to SYPHILIS, known as a gumma, sometimes forms a hard, almost painless swelling in a muscle. Rheumatism is a vague term traditionally used to de?ne intermittent and often migratory discomfort, sti?ness or pain in muscles and joints with no obvious cause. The most common form of myositis is the result of immunological damage as a result of autoimmune disease. Because it affects many muscles it is called POLYMYOSITIS.
Myasthenia (see MYASTHENIA GRAVIS) is muscle weakness due to a defect of neuromuscular conduction.
Myopathy is a term applied to an acquired or developmental defect in certain muscles. It is not a neurological disease, and should be distinguished from neuropathic conditions (see NEUROPATHY) such as MOTOR NEURONE DISEASE (MND), which tend to affect the distal limb muscles. The main subdivisions are genetically determined, congenital, metabolic, drug-induced, and myopathy (often in?ammatory) secondary to a distant carcinoma. Progressive muscular dystrophy is characterised by symmetrical wasting and weakness, the muscle ?bres being largely replaced by fatty and ?brous tissue, with no sensory loss. Inheritance may take several forms, thus affecting the sex and age of victims.
The commonest type is DUCHENNE MUSCULAR DYSTROPHY, which is inherited as a sex-linked disorder. It nearly always occurs in boys.
Symptoms There are three chief types of myopathy. The commonest, known as pseudohypertrophic muscular dystrophy, affects particularly the upper part of the lower limbs of children. The muscles of the buttocks, thighs and calves seem excessively well developed, but nevertheless the child is clumsy, weak on his legs, and has di?culty in picking himself up when he falls. In another form of the disease, which begins a little later, as a rule at about the age of 14, the muscles of the upper arm are ?rst affected, and those of the spine and lower limbs become weak later on. In a third type, which begins at about this age, the muscles of the face, along with certain of the shoulder and upper arm muscles, show the ?rst signs of wasting. All the forms have this in common: that the affected muscles grow weaker until their power to contract is quite lost. In the ?rst form, the patients seldom reach the age of 20, falling victims to some disease which, to ordinary people, would not be serious. In the other forms the wasting, after progressing to a certain extent, often remains stationary for the rest of life. Myopathy may also be acquired when it is the result of disease such as thyrotoxicosis (see under THYROID GLAND, DISEASES OF), osteomalacia (see under BONE, DISORDERS OF) and CUSHING’S DISEASE, and the myopathy resolves when the primary disease is treated.
Treatment Some myopathies may be the result of in?ammation or arise from an endocrine or metabolic abnormality. Treatment of these is the treatment of the cause, with supportive physiotherapy and any necessary physical aids while the patient is recovering. Treatment for the hereditary myopathies is supportive since, at present, there is no cure – although developments in gene research raise the possibility of future treatment. Physiotherapy, physical aids, counselling and support groups may all be helpful in caring for these patients.
The education and management of these children raise many diffculties. Much help in dealing with these problems can be obtained from Muscular Dystrophy Campaign.
Myositis ossi?cans, or deposition of bone in muscles, may be congenital or acquired. The congenital form, which is rare, ?rst manifests itself as painful swellings in the muscles. These gradually harden and extend until the child is encased in a rigid sheet. There is no e?ective treatment and the outcome is fatal.
The acquired form is a result of a direct blow on muscle, most commonly on the front of the thigh. The condition should be suspected whenever there is severe pain and swelling following a direct blow over muscle. The diagnosis is con?rmed by hardening of the swelling. Treatment consists of short-wave DIATHERMY with gentle active movements. Recovery is usually complete.
Pain, quite apart from any in?ammation or injury, may be experienced on exertion. This type of pain, known as MYALGIA, tends to occur in un?t individuals and is relieved by rest and physiotherapy.
Parasites sometimes lodge in the muscles, the most common being Trichinella spiralis, producing the disease known as TRICHINOSIS (trichiniasis).
Rupture of a muscle may occur, without any external wound, as the result of a spasmodic e?ort. It may tear the muscle right across – as sometimes happens to the feeble plantaris muscle in running and leaping – or part of the muscle may be driven through its ?brous envelope, forming a HERNIA of the muscle. The severe pain experienced in many cases of LUMBAGO is due to tearing of one of the muscles in the back. These conditions are usually relieved by rest and massage. Partial muscle tears, such as occur in sport, require more energetic treatment: in the early stages this consists of the application of an ice or cold-water pack, ?rm compression, elevation of the affected limb, rest for a day or so and then gradual mobilisation (see SPORTS MEDICINE).
Tumours occur occasionally, the most common being ?broid, fatty, and sarcomatous growths.
Wasting of muscles sometimes occurs as a symptom of disease in other organs: for example, damage to the nervous system, as in poliomyelitis or in the disease known as progressive muscular atrophy. (See PARALYSIS.)... muscles, disorders of
Several diseases and conditions are treated under separate headings. (See APPENDICITIS; CHOLERA; COLITIS; CONSTIPATION; CROHN’S DISEASE; DIARRHOEA; DYSENTERY; ENTERIC FEVER; HAEMORRHOIDS; HERNIA; INFLAMMATORY BOWEL DISEASE (IBD); ILEITIS; INTUSSUSCEPTION; IRRITABLE BOWEL SYNDROME (IBS); PERITONITIS; RECTUM, DISEASES OF; ULCERATIVE COLITIS.)
In?ammation of the outer surface is called peritonitis, a serious disease. That of the inner surface is known generally as enteritis, in?ammation of special parts receiving the names of colitis, appendicitis, irritable bowel syndrome (IBS) and in?ammatory bowel disease (IBD). Enteritis may form the chief symptom of certain infective diseases: for example in typhoid fever (see ENTERIC FEVER), cholera and dysentery. It may be acute, although not connected with any de?nite organism, when, if severe, it is a very serious condition, particularly in young children. Or it may be chronic, especially as the result of dysentery, and then constitutes a less serious if very troublesome complaint.
Perforation of the bowel may take place as the result either of injury or of disease. Stabs and other wounds which penetrate the abdomen may damage the bowel, and severe blows or crushes may tear it without any external wound. Ulceration, as in typhoid fever, or, more rarely, in TUBERCULOSIS, may cause an opening in the bowel-wall also. Again, when the bowel is greatly distended above an obstruction, faecal material may accumulate and produce ulcers, which rupture with the ordinary movements of the bowels. Whatever the cause, the symptoms are much the same.
Symptoms The contents of the bowel pass out through the perforation into the peritoneal cavity, and set up a general peritonitis. In consequence, the abdomen is painful, and after a few hours becomes extremely tender to the touch. The abdomen swells, particularly in its upper part, owing to gas having passed also into the cavity. Fever and vomiting develop and the person passes into a state of circulatory collapse or SHOCK. Such a condition may be fatal if not properly treated.
Treatment All food should be withheld and the patient given intravenous ?uids to resuscitate them and then to maintain their hydration and electrolyte balance. An operation is urgently necessary, the abdomen being opened in the middle line, the perforated portion of bowel found, the perforation stitched up, and appropriate antibiotics given.
Obstruction means a stoppage to the passage down the intestine of partially digested food. Obstruction may be acute, when it comes on suddenly with intense symptoms; or it may be chronic, when the obstructing cause gradually increases and the bowel becomes slowly more narrow until it closes altogether; or subacute, when obstruction comes and goes until it ends in an acute attack. In chronic cases the symptoms are milder in degree and more prolonged.
Causes Obstruction may be due to causes outside the bowel altogether, for example, the pressure of tumours in neighbouring organs, the twisting around the bowel of bands produced by former peritonitis, or even the twisting of a coil of intestine around itself so as to cause a kink in its wall. Chronic causes of the obstruction may exist in the wall of the bowel itself: for example, a tumour, or the contracting scar of an old ulcer. The condition of INTUSSUSCEPTION, where part of the bowel passes inside of the part beneath it, in the same way as one turns the ?nger of a glove outside in, causes obstruction and other symptoms. Bowel within a hernia may become obstructed when the hernia strangulates. Finally some body, such as a concretion, or the stone of some large fruit, or even a mass of hardened faeces, may become jammed within the bowel and stop up its passage.
Symptoms There are four chief symptoms: pain, vomiting, constipation and swelling of the abdomen.
Treatment As a rule the surgeon opens the abdomen, ?nds the obstruction and relieves it or if possible removes it altogether. It may be necessary to form a COLOSTOMY or ILEOSTOMY as a temporary or permanent measure in severe cases.
Tumours are rare in the small intestine and usually benign. They are relatively common in the large intestine and are usually cancerous. The most common site is the rectum. Cancer of the intestine is a disease of older people; it is the second most common cancer (after breast cancer) in women in the United Kingdom, and the third most common (after lung and prostate) in men. Around 25,000 cases of cancer of the large intestine occur in the UK annually, about 65 per cent of which are in the colon. A history of altered bowel habit, in the form of increasing constipation or diarrhoea, or an alternation of these, or of bleeding from the anus, in a middle-aged person is an indication for taking medical advice. If the condition is cancer, then the sooner it is investigated and treated, the better the result.... intestine, diseases of
Occupational health includes both mental and physical health. It is about compliance with health-and-safety-at-work legislation (and common law duties) and about best practice in providing work environments that reduce risks to health and safety to lowest practicable levels. It includes workers’ ?tness to work, as well as the management of the work environment to accommodate people with disabilities, and procedures to facilitate the return to work of those absent with long-term illness. Occupational health incorporates several professional groups, including occupational physicians, occupational health nurses, occupational hygienists, ergonomists, disability managers, workplace counsellors, health-and-safety practitioners, and workplace physiotherapists.
In the UK, two key statutes provide a framework for occupational health: the Health and Safety at Work, etc. Act 1974 (HSW Act); and the Disability Discrimination Act 1995 (DDA). The HSW Act states that employers have a duty to protect the health, safety and welfare of their employees and to conduct their business in a way that does not expose others to risks to their health and safety. Employees and self-employed people also have duties under the Act. Modern health-and-safety legislation focuses on assessing and controlling risk rather than prescribing speci?c actions in di?erent industrial settings. Various regulations made under the HSW Act, such as the Control of Substances Hazardous to Health Regulations, the Manual Handling Operations Regulations and the Noise at Work Regulations, set out duties with regard to di?erent risks, but apply to all employers and follow the general principles of risk assessment and control. Risks should be controlled principally by removing or reducing the hazard at source (for example, by substituting chemicals with safer alternatives, replacing noisy machinery, or automating tasks to avoid heavy lifting). Personal protective equipment, such as gloves and ear defenders, should be seen as a last line of defence after other control measures have been put in place.
The employment provisions of the DDA require employers to avoid discriminatory practice towards disabled people and to make reasonable adjustments to working arrangements where a disabled person is placed at a substantial disadvantage to a non-disabled person. Although the DDA does not require employers to provide access to rehabilitation services – even for those injured or made ill at work – occupational-health practitioners may become involved in programmes to help people get back to work after injury or long-term illness, and many businesses see the retention of valuable sta? as an attractive alternative to medical retirement or dismissal on health grounds.
Although a major part of occupational-health practice is concerned with statutory compliance, the workplace is also an important venue for health promotion. Many working people rarely see their general practitioner and, even when they do, there is little time to discuss wider health issues. Occupational-health advisers can ?ll in this gap by providing, for example, workplace initiatives on stopping smoking, cardiovascular health, diet and self-examination for breast and testicular cancers. Such initiatives are encouraged because of the perceived bene?ts to sta?, to the employing organisation and to the wider public-health agenda. Occupational psychologists recognise the need for the working population to achieve a ‘work-life balance’ and the promotion of this is an increasing part of occupational health strategies.
The law requires employers to consult with their sta? on health-and-safety matters. However, there is also a growing understanding that successful occupational-health management involves workers directly in the identi?cation of risks and in developing solutions in the workplace. Trade unions play an active role in promoting occupational health through local and national campaigns and by training and advising elected workplace safety representatives.
Occupational medicine The branch of medicine that deals with the control, prevention, diagnosis, treatment and management of ill-health and injuries caused or made worse by work, and with ensuring that workers are ?t for the work they do.
Occupational medicine includes: statutory surveillance of workers’ exposure to hazardous agents; advice to employers and employees on eliminating or reducing risks to health and safety at work; diagnosis and treatment/management of occupational illness; advice on adapting the working environment to suit the worker, particularly those with disabilities or long-term health problems; and advice on the return to work and, if necessary, rehabilitation of workers absent through illness. Occupational physicians may play a wider role in monitoring the health of workplace populations and in advising employers on controlling health hazards where ill-health trends are observed. They may also conduct epidemiological research (see EPIDEMIOLOGY) on workplace diseases.
Because of the occupational physician’s dual role as adviser to both employer and employee, he or she is required to be particularly diligent with regards to the individual worker’s medical CONFIDENTIALITY. Occupational physicians need to recognise in any given situation the context they are working in, and to make sure that all parties are aware of this.
Occupational medicine is a medical discipline and thus is only part of the broader ?eld of occupational health. Although there are some speci?c clinical duties associated with occupational medicine, such as diagnosis of occupational disease and medical screening, occupational physicians are frequently part of a multidisciplinary team that might include, for example, occupational-health nurses, healthand-safety advisers, ergonomists, counsellors and hygienists. Occupational physicians are medical practitioners with a post-registration quali?cation in occupational medicine. They will have completed a period of supervised in-post training. In the UK, the Faculty of Occupational Medicine of the Royal College of Physicians has three categories of membership, depending on quali?cations and experience: associateship (AFOM); membership (MFOM); and fellowship (FFOM).
Occupational diseases Occupational diseases are illnesses that are caused or made worse by work. In their widest sense, they include physical and mental ill-health conditions.
In diagnosing an occupational disease, the clinician will need to examine not just the signs and symptoms of ill-health, but also the occupational history of the patient. This is important not only in discovering the cause, or causes, of the disease (work may be one of a number of factors), but also in making recommendations on how the work should be modi?ed to prevent a recurrence – or, if necessary, in deciding whether or not the worker is able to return to that type of work. The occupational history will help in deciding whether or not other workers are also at risk of developing the condition. It will include information on:
the nature of the work.
how the tasks are performed in practice.
the likelihood of exposure to hazardous agents (physical, chemical, biological and psychosocial).
what control measures are in place and the extent to which these are adhered to.
previous occupational and non-occupational exposures.
whether or not others have reported similar symptoms in relation to the work. Some conditions – certain skin conditions,
for example – may show a close relationship to work, with symptoms appearing directly only after exposure to particular agents or possibly disappearing at weekends or with time away from work. Others, however, may be chronic and can have serious long-term implications for a person’s future health and employment.
Statistical information on the prevalence of occupational disease in the UK comes from a variety of sources, including o?cial ?gures from the Industrial Injuries Scheme (see below) and statutory reporting of occupational disease (also below). Neither of these o?cial schemes provides a representative picture, because the former is restricted to certain prescribed conditions and occupations, and the latter suffers from gross under-reporting. More useful are data from the various schemes that make up the Occupational Diseases Intelligence Network (ODIN) and from the Labour Force Survey (LFS). ODIN data is generated by the systematic reporting of work-related conditions by clinicians and includes several schemes. Under one scheme, more than 80 per cent of all reported diseases by occupational-health physicians fall into just six of the 42 clinical disease categories: upper-limb disorders; anxiety, depression and stress disorders; contact DERMATITIS; lower-back problems; hearing loss (see DEAFNESS); and ASTHMA. Information from the LFS yields a similar pattern in terms of disease frequency. Its most recent survey found that over 2 million people believed that, in the previous 12 months, they had suffered from an illness caused or made worse by work and that
19.5 million working days were lost as a result. The ten most frequently reported disease categories were:
stress and mental ill-health (see MENTAL ILLNESS): 515,000 cases.
back injuries: 508,000.
upper-limb and neck disorders: 375,000.
lower respiratory disease: 202,000.
deafness, TINNITUS or other ear conditions: 170,000.
lower-limb musculoskeletal conditions: 100,000.
skin disease: 66,000.
headache or ‘eyestrain’: 50,000.
traumatic injury (includes wounds and fractures from violent attacks at work): 34,000.
vibration white ?nger (hand-arm vibration syndrome): 36,000. A person who develops a chronic occu
pational disease may be able to sue his or her employer for damages if it can be shown that the employer was negligent in failing to take reasonable care of its employees, or had failed to provide a system of work that would have prevented harmful exposure to a known health hazard. There have been numerous successful claims (either awarded in court, or settled out of court) for damages for back and other musculoskeletal injuries, hand-arm vibration syndrome, noise-induced deafness, asthma, dermatitis, MESOTHELIOMA and ASBESTOSIS. Employers’ liability (workers’ compensation) insurers are predicting that the biggest future rise in damages claims will be for stress-related illness. In a recent study, funded by the Health and Safety Executive, about 20 per cent of all workers – more than 5 million people in the UK – claimed to be ‘very’ or ‘extremely’ stressed at work – a statistic that is likely to have a major impact on the long-term health of the working population.
While victims of occupational disease have the right to sue their employers for damages, many countries also operate a system of no-fault compensation for the victims of prescribed occupational diseases. In the UK, more than 60 diseases are prescribed under the Industrial Injuries Scheme and a person will automatically be entitled to state compensation for disability connected to one of these conditions, provided that he or she works in one of the occupations for which they are prescribed. The following short list gives an indication of the types of diseases and occupations prescribed under the scheme:
CARPAL TUNNEL SYNDROME connected to the use of hand-held vibrating tools.
hearing loss from (amongst others) use of pneumatic percussive tools and chainsaws, working in the vicinity of textile manufacturing or woodworking machines, and work in ships’ engine rooms.
LEPTOSPIROSIS – infection with Leptospira (various listed occupations).
viral HEPATITIS from contact with human blood, blood products or other sources of viral hepatitis.
LEAD POISONING, from any occupation causing exposure to fumes, dust and vapour from lead or lead products.
asthma caused by exposure to, among other listed substances, isocyanates, curing agents, solder ?ux fumes and insects reared for research.
mesothelioma from exposure to asbestos.
In the UK, employers and the self-employed have a duty to report all occupational injuries (if the employee is o? work for three days or more as a result), diseases or dangerous incidents to the relevant enforcing authority (the Health and Safety Executive or local-authority environmental-health department) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). Despite this statutory duty, comparatively few diseases are reported so that ?gures generated from RIDDOR reports do not give a useful indication of the scale of occupational diseases in the UK. The statutory reporting of injuries is much better, presumably because of the clear and acute relationship between a workplace accident and the resultant injury. More than 160,000 injuries are reported under RIDDOR every year compared with just 2,500 or so occupational diseases, a gross underestimate of the true ?gure.
There are no precise ?gures for the number of people who die prematurely because of work-related ill-health, and it would be impossible to gauge the exact contribution that work has on, for example, cardiovascular disease and cancers where the causes are multifactorial. The toll would, however, dwarf the number of deaths caused by accidents at work. Around 250 people are killed by accidents at work in the UK each year – mesothelioma, from exposure to asbestos at work, alone kills more than 1,300 people annually.
The following is a sample list of occupational diseases, with brief descriptions of their aetiologies.
Inhaled materials
PNEUMOCONIOSIS covers a group of diseases which cause ?brotic lung disease following the inhalation of dust. Around 250–300 new cases receive bene?t each year – mostly due to coal dust with or without silica contamination. SILICOSIS is the more severe disease. The contraction in the size of the coal-mining industry as well as improved dust suppression in the mines have diminished the importance of this disease, whereas asbestos-related diseases now exceed 1,000 per year. Asbestos ?bres cause a restrictive lung disease but also are responsible for certain malignant conditions such as pleural and peritoneal mesothelioma and lung cancer. The lung-cancer risk is exacerbated by cigarette-smoking.
Even though the use of asbestos is virtually banned in the UK, many workers remain at risk of exposure because of the vast quantities present in buildings (much of which is not listed in building plans). Carpenters, electricians, plumbers, builders and demolition workers are all liable to exposure from work that disturbs existing asbestos. OCCUPATIONAL ASTHMA is of increasing importance – not only because of the recognition of new allergic agents (see ALLERGY), but also in the number of reported cases. The following eight substances are most frequently linked to occupational asthma (key occupations in brackets): isocyanates (spray painters, electrical processors); ?our and grain (bakers and farmers); wood dust (wood workers); glutaraldehyde (nurses, darkroom technicians); solder/colophony (welders, electronic assembly workers); laboratory animals (technicians, scientists); resins and glues (metal and electrical workers, construction, chemical processors); and latex (nurses, auxiliaries, laboratory technicians).
The disease develops after a short, symptomless period of exposure; symptoms are temporally related to work exposures and relieved by absences from work. Removal of the worker from exposure does not necessarily lead to complete cessation of symptoms. For many agents, there is no relationship with a previous history of ATOPY. Occupational asthma accounts for about 10 per cent of all asthma cases. DERMATITIS The risk of dermatitis caused by an allergic or irritant reaction to substances used or handled at work is present in a wide variety of jobs. About three-quarters of cases are irritant contact dermatitis due to such agents as acids, alkalis and solvents. Allergic contact dermatitis is a more speci?c response by susceptible individuals to a range of allergens (see ALLERGEN). The main occupational contact allergens include chromates, nickel, epoxy resins, rubber additives, germicidal agents, dyes, topical anaesthetics and antibiotics as well as certain plants and woods. Latex gloves are a particular cause of occupational dermatitis among health-care and laboratory sta? and have resulted in many workers being forced to leave their profession through ill-health. (See also SKIN, DISEASES OF.)
Musculoskeletal disorders Musculoskeletal injuries are by far the most common conditions related to work (see LFS ?gures, above) and the biggest cause of disability. Although not all work-related, musculoskeletal disorders account for 36.5 per cent of all disabilities among working-age people (compared with less than 4 per cent for sight and hearing impairment). Back pain (all causes – see BACKACHE) has been estimated to cause more than 50 million days lost every year in sickness absence and costs the UK economy up to £5 billion annually as a result of incapacity or disability. Back pain is a particular problem in the health-care sector because of the risk of injury from lifting and moving patients. While the emphasis should be on preventing injuries from occurring, it is now well established that the best way to manage most lower-back injuries is to encourage the patient to continue as normally as possible and to remain at work, or to return as soon as possible even if the patient has some residual back pain. Those who remain o? work on long-term sick leave are far less likely ever to return to work.
Aside from back injuries, there are a whole range of conditions affecting the upper limbs, neck and lower limbs. Some have clear aetiologies and clinical signs, while others are less well de?ned and have multiple causation. Some conditions, such as carpal tunnel syndrome, are prescribed diseases in certain occupations; however, they are not always caused by work (pregnant and older women are more likely to report carpal tunnel syndrome irrespective of work) and clinicians need to be careful when assigning work as the cause without ?rst considering the evidence. Other conditions may be revealed or made worse by work – such as OSTEOARTHRITIS in the hand. Much attention has focused on injuries caused by repeated movement, excessive force, and awkward postures and these include tenosynovitis (in?ammation of a tendon) and epicondylitis. The greatest controversy surrounds upper-limb disorders that do not present obvious tissue or nerve damage but nevertheless give signi?cant pain and discomfort to the individual. These are sometimes referred to as ‘repetitive strain injury’ or ‘di?use RSI’. The diagnosis of such conditions is controversial, making it di?cult for sufferers to pursue claims for compensation through the courts. Psychosocial factors, such as high demands of the job, lack of control and poor social support at work, have been implicated in the development of many upper-limb disorders, and in prevention and management it is important to deal with the psychological as well as the physical risk factors. Occupations known to be at particular risk of work-related upper-limb disorders include poultry processors, packers, electronic assembly workers, data processors, supermarket check-out operators and telephonists. These jobs often contain a number of the relevant exposures of dynamic load, static load, a full or excessive range of movements and awkward postures. (See UPPER LIMB DISORDERS.)
Physical agents A number of physical agents cause occupational ill-health of which the most important is occupational deafness. Workplace noise exposures in excess of 85 decibels for a working day are likely to cause damage to hearing which is initially restricted to the vital frequencies associated with speech – around 3–4 kHz. Protection from such noise is imperative as hearing aids do nothing to ameliorate the neural damage once it has occurred.
Hand-arm vibration syndrome is a disorder of the vascular and/or neural endings in the hands leading to episodic blanching (‘white ?nger’) and numbness which is exacerbated by low temperature. The condition, which is caused by vibrating tools such as chain saws and pneumatic hammers, is akin to RAYNAUD’S DISEASE and can be disabling.
Decompression sickness is caused by a rapid change in ambient pressure and is a disease associated with deep-sea divers, tunnel workers and high-?ying aviators. Apart from the direct effects of pressure change such as ruptured tympanic membrane or sinus pain, the more serious damage is indirectly due to nitrogen bubbles appearing in the blood and blocking small vessels. Central and peripheral nervous-system damage and bone necrosis are the most dangerous sequelae.
Radiation Non-ionising radiation from lasers or microwaves can cause severe localised heating leading to tissue damage of which cataracts (see under EYE, DISORDERS OF) are a particular variety. Ionising radiation from radioactive sources can cause similar acute tissue damage to the eyes as well as cell damage to rapidly dividing cells in the gut and bone marrow. Longer-term effects include genetic damage and various malignant disorders of which LEUKAEMIA and aplastic ANAEMIA are notable. Particular radioactive isotopes may destroy or induce malignant change in target organs, for example, 131I (thyroid), 90Sr (bone). Outdoor workers may also be at risk of sunburn and skin cancers. OTHER OCCUPATIONAL CANCERS Occupation is directly responsible for about 5 per cent of all cancers and contributes to a further 5 per cent. Apart from the cancers caused by asbestos and ionising radiation, a number of other occupational exposures can cause human cancer. The International Agency for Research on Cancer regularly reviews the evidence for carcinogenicity of compounds and industrial processes, and its published list of carcinogens is widely accepted as the current state of knowledge. More than 50 agents and processes are listed as class 1 carcinogens. Important occupational carcinogens include asbestos (mesothelioma, lung cancer); polynuclear aromatic hydrocarbons such as mineral oils, soots, tars (skin and lung cancer); the aromatic amines in dyestu?s (bladder cancer); certain hexavalent chromates, arsenic and nickel re?ning (lung cancer); wood and leather dust (nasal sinus cancer); benzene (leukaemia); and vinyl chloride monomer (angiosarcoma of the liver). It has been estimated that elimination of all known occupational carcinogens, if possible, would lead to an annual saving of 5,000 premature deaths in Britain.
Infections Two broad categories of job carry an occupational risk. These are workers in contact with animals (farmers, veterinary surgeons and slaughtermen) and those in contact with human sources of infection (health-care sta? and sewage workers).
Occupational infections include various zoonoses (pathogens transmissible from animals to humans), such as ANTHRAX, Borrelia burgdorferi (LYME DISEASE), bovine TUBERCULOSIS, BRUCELLOSIS, Chlamydia psittaci, leptospirosis, ORF virus, Q fever, RINGWORM and Streptococcus suis. Human pathogens that may be transmissible at work include tuberculosis, and blood-borne pathogens such as viral hepatitis (B and C) and HIV (see AIDS/HIV). Health-care workers at risk of exposure to infected blood and body ?uids should be immunised against hapatitis B.
Poisoning The incidence of occupational poisonings has diminished with the substitution of noxious chemicals with safer alternatives, and with the advent of improved containment. However, poisonings owing to accidents at work are still reported, sometimes with fatal consequences. Workers involved in the application of pesticides are particularly at risk if safe procedures are not followed or if equipment is faulty. Exposure to organophosphate pesticides, for example, can lead to breathing diffculties, vomiting, diarrhoea and abdominal cramps, and to other neurological effects including confusion and dizziness. Severe poisonings can lead to death. Exposure can be through ingestion, inhalation and dermal (skin) contact.
Stress and mental health Stress is an adverse reaction to excessive pressures or demands and, in occupational-health terms, is di?erent from the motivational impact often associated with challenging work (some refer to this as ‘positive stress’). Stress at work is often linked to increasing demands on workers, although coping can often prevent the development of stress. The causes of occupational stress are multivariate and encompass job characteristics (e.g. long or unsocial working hours, high work demands, imbalance between e?ort and reward, poorly managed organisational change, lack of control over work, poor social support at work, fear of redundancy and bullying), as well as individual factors (such as personality type, personal circumstances, coping strategies, and availability of psychosocial support outside work). Stress may in?uence behaviours such as smoking, alcohol consumption, sleep and diet, which may in turn affect people’s health. Stress may also have direct effects on the immune system (see IMMUNITY) and lead to a decline in health. Stress may also alter the course and response to treatment of conditions such as cardiovascular disease. As well as these general effects of stress, speci?c types of disorder may be observed.
Exposure to extremely traumatic incidents at work – such as dealing with a major accident involving multiple loss of life and serious injury
(e.g. paramedics at the scene of an explosion or rail crash) – may result in a chronic condition known as post-traumatic stress disorder (PTSD). PTSD is an abnormal psychological reaction to a traumatic event and is characterised by extreme psychological discomfort, such as anxiety or panic when reminded of the causative event; sufferers may be plagued with uncontrollable memories and can feel as if they are going through the trauma again. PTSD is a clinically de?ned condition in terms of its symptoms and causes and should not be used to include normal short-term reactions to trauma.... occupational health, medicine and diseases
BURSITIS, TENDINITIS and non-speci?c back pain (see BACKACHE).
Osteoarthritis (OA) rarely starts before 40, but by the age of 80 affects 80 per cent of the population. There are structural and functional changes in the articular cartilage, as well as changes in the collagenous matrix of tendons and ligaments. OA is not purely ‘wear and tear’; various sub-groups have a genetic component. Early OA may be precipitated by localised alteration in anatomy, such as a fracture or infection of a joint. Reactive new bone growth typically occurs, causing sclerosis (hardening) beneath the joint, and osteophytes – outgrowths of bone – are characteristic at the margins of the joint. The most common sites are the ?rst metatarsal (great toe), spinal facet joints, the knee, the base of the thumb and the terminal ?nger joints (Heberden’s nodes).
OA has a slow but variable course, with periods of pain and low-grade in?ammation. Acute in?ammation, common in the knee, may result from release of pyrophosphate crystals, causing pseudo-gout.
Urate gout results from crystallisation of URIC ACID in joints, against a background of hyperuricaemia. This high concentration of uric acid in the blood may result from genetic and environmental factors, such as excess dietary purines, alcohol or diuretic drugs.
In?ammatory arthritis is less common than OA, but potentially much more serious. Several types exist, including: SPONDYLARTHRITIS This affects younger men, chie?y involving spinal and leg joints. This may lead to in?ammation and eventual ossi?cation of the enthesis – that is, where the ligaments and tendons are inserted into the bone around joints. This may be associated with disorders in other parts of the body: skin in?ammation (PSORIASIS), bowel and genito-urinary in?ammation, sometimes resulting in infection of the organs (such as dysentery). The syndromes most clearly delineated are ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF), psoriatic or colitic spondylitis, and REITER’S SYNDROME. The diagnosis is made clinically and radiologically; no association has been found with autoantibodies (see AUTOANTIBODY). A particularly clear gene locus, HLA B27, has been identi?ed in ankylosing spondylitis. Psoriasis can be associated with a characteristic peripheral arthritis.
Systemic autoimmune rheumatic diseases (see AUTOIMMUNE DISORDERS). RHEUMATOID ARTHRITIS (RA) – see also main entry. The most common of these diseases. Acute in?ammation causes lymphoid synovitis, leading to erosion of the cartilage, associated joints and soft tissues. Fibrosis follows, causing deformity. Autoantibodies are common, particularly Rheumatoid Factor. A common complication of RA is Sjögren’s syndrome, when in?ammation of the mucosal glands may result in a dry mouth and eyes. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and various overlap syndromes occur, such as systemic sclerosis and dermatomyositis. Autoantibodies against nuclear proteins such as DNA lead to deposits of immune complexes and VASCULITIS in various tissues, such as kidney, brain, skin and lungs. This may lead to various symptoms, and sometimes even to organ failure.
Infective arthritis includes: SEPTIC ARTHRITIS An uncommon but potentially fatal disease if not diagnosed and treated early with approriate antibiotics. Common causes are TUBERCLE bacilli and staphylococci (see STAPHYLOCOCCUS). Particularly at risk are the elderly and the immunologically vulnerable, such as those under treatment for cancer, or on CORTICOSTEROIDS or IMMUNOSUPPRESSANT drugs. RHEUMATIC FEVER Now rare in western countries. Resulting from an immunological reaction to a streptococcal infection, it is characterised by migratory arthritis, rash and cardiac involvement.
Other infections which may be associated with arthritis include rubella (German measles), parvovirus and LYME DISEASE.
Treatment Septic arthritis is the only type that can be cured using antibiotics, while the principles of treatment for the others are similar: to reduce risk factors (such as hyperuricaemia); to suppress in?ammation; to improve function with physiotherapy; and, in the event of joint failure, to perform surgical arthroplasty. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) include aspirin, paracetamol and many recently developed ones, such as the proprionic acid derivatives IBUPROFEN and naproxen, along with other drugs that have similar properties such as PIROXICAM. They all carry a risk of toxicity, such as renal dysfunction, or gastrointestinal irritation with haemorrhage. Stronger suppression of in?ammation requires corticosteroids and CYTOTOXIC drugs such as azathioprine or cyclophosphamide. Recent research promises more speci?c and less toxic anti-in?ammatory drugs, such as the monoclonal antibodies like in?iximab. An important treatment for some osteoarthritic joints is surgical replacement of the joints.... joints, diseases of
Habitat: The Himalayas from Kashmir to Sikkim, in the alpine region at altitudes of3,000-6,000 m.
Folk: Chohahak, Amlu (Punjab). Kailaashi (Kashmir).Action: Refrigerant, antiscorbutic.... oxyria digyna
Treatment Acute vertigo symptoms can sometimes be alleviated with drugs such as CYCLIZINE HYDROCHLORIDE and NICOTINIC ACID, but the disorder is notoriously di?cult to treat and no certain cure is available. Surgical decompression of the ?uid in the ear’s balancing mechanism may relieve vertigo and prevent the disease from worsening. The vestibular nerve to the ear can also be cut to relieve vertigo while preserving hearing.... menière’s disease
A localised (focal) form of liver disease in all tropical/subtropical countries results from invasive Entamoeba histolytica infection (amoebic liver ‘abscess’); serology and imaging techniques assist in diagnosis. Hydatidosis also causes localised liver disease; one or more cysts usually involve the right lobe of the liver. Serological tests and imaging techniques are of value in diagnosis. Whilst surgery formerly constituted the sole method of management, prolonged courses of albendazole and/or praziquantel have now been shown to be e?ective; however, surgical intervention is still required in some cases.
Hepato-biliary disease is also a problem in many tropical/subtropical countries. In southeast Asia, Clonorchis sinensis and Opisthorchis viverini infections cause chronic biliary-tract infection, complicated by adenocarcinoma of the biliary system. Praziquantel is e?ective chemotherapy before advanced disease ensues. Fasciola hepatica (the liver ?uke) is a further hepato-biliary helminthic infection; treatment is with bithionol or triclabendazole, praziquantel being relatively ine?ective.... liver disease in the tropics
In?ammation of the liver, or HEPATITIS, may occur as part of a generalised infection or may be a localised condition. Infectious hepatitis, which is the result of infection with a virus, is one of the most common forms. Many di?erent viruses can cause hepatitis, including that responsible for glandular fever (see MONONUCLEOSIS). Certain spirochaetes may also be the cause, particularly that responsible for LEPTOSPIROSIS, as can many drugs. Hepatitis may also occur if there is obstruction of the BILE DUCT, as by a gall-stone.
Cirrhosis of the liver A disorder caused by chronic damage to liver cells. The liver develops areas of ?brosis or scarring; in response, the remaining normal liver cells increase and form regeneration nodules. Those islands of normality, however, suffer from inadequate blood supply, thus adversely affecting liver function. Alcohol is the most common cause of cirrhosis in the United Kingdom and the USA, and the incidence of the disorder among women in the UK has recently risen sharply as a consequence of greater consumption of alcohol by young women in the latter decades of the 20th century. In Africa and many parts of Asia, infection with hepatitis B virus is a common cause. Certain drugs – for example, PARACETAMOL – may damage the liver if taken in excess. Unusual causes of cirrhosis include defects of the bile ducts, HAEMOCHROMATOSIS (raised iron absorption from the gut), CYSTIC FIBROSIS, cardiac cirrhosis (the result of heart failure causing circulatory congestion in the liver), and WILSON’S DISEASE (raised copper absorption).
Symptoms Some people with cirrhosis have no signs or symptoms and the disease may be diagnosed at a routine medical examination. Others may develop jaundice, OEDEMA (including ascites – ?uid in the abdomen), fever, confusion, HAEMATEMESIS (vomiting blood), loss of appetite and lethargy. On examination, cirrhotic patients often have an enlarged liver and/ or SPLEEN, and HYPERTENSION. Liver function tests, cholangiography (X-ray examination of the bile ducts) and biopsy of liver tissue will help to reach a diagnosis.
Treatment Nothing can be done to repair a cirrhosed organ, but the cause, if known, must be removed and further advance of the process thus prevented. In the case of the liver, a high-protein, high-carbohydrate, low-fat diet is given, supplemented by liver extract and vitamins B and K. The consumption of alcohol should be banned. In patients with liver failure and a poor prognosis, liver TRANSPLANTATION is worthwhile but only after careful consideration.
Abscess of the liver When an ABSCESS develops in the liver, it is usually a result of amoebic DYSENTERY, appearing sometimes late in the disease – even after the diarrhoea is cured (see below). It may also follow upon in?ammation of the liver due to other causes. In the case of an amoebic abscess, treatment consists of oral metronidazole.
Acute hepatic necrosis is a destructive and often fatal disease of the liver which is very rare. It may be due to chemical poisons, such as carbontetrachloride, chloroform, phosphorus and industrial solvents derived from benzene. It may also be the cause of death in cases of poisoning with fungi. Very occasionally, it may be a complication of acute infectious hepatitis.
Cancer of the liver is not uncommon, although it is rare for the disease to begin in the liver – the involvement of this organ being usually secondary to disease situated somewhere in the stomach or bowels. Cancer originating in the liver is more common in Asia and Africa. It usually arises in a ?brotic (or cirrhotic) liver and in carriers of the hepatitis B virus. There is great emaciation, which increases as the disease progresses. The liver is much enlarged, and its margin and surface are rough, being studded with hard cancer masses of varying size, which can often be felt through the abdominal wall. Pain may be present. Jaundice and oedema often appear.... liver, diseases of
Habitat: Throughout India, up to 1,500 m in the Himalaya.
English: Small Bitter Gourd, Bur Cucumber.Ayurvedic: Karkotikaa, Karkotikaa- vandhyaa, Karkotaka, Karkota.Siddha/Tamil: Tholoo-pavai, Paluppakai, Kaattupaagala.Folk: Jangali Karelaa, Ban-Karelaa, Bhat-Karelaa, Dhar-Karelaa.Action: Tuberous root—astringent, febrifuge, antiseptic, anthelmintic, spermicidal. Used in bleeding piles, urinary affections; smeared over body in high fever with delirium (as a sedative). A paste, prepared with the root of male plant, is applied externally for pain in the breast.
The root extract exhibited significant anti-allergic activity comparable with standard drugs used against allergy and bronchial asthma (in experimental animals).... momordica dioicaAcute gastritis is an in?ammatory reaction of the gastric mucosa to various precipitating factors, ranging from physical and chemical injury to infections. Acute gastritis (especially of the antral mucosas) may well represent a reaction to infection by a bacterium called Helicobacter pylori. The in?ammatory changes usually go after appropriate antibiotic treatment for the H. pylori infection. Acute and chronic in?ammation occurs in response to chemical damage of the gastric mucosa. For example, REFLUX of duodenal contents may predispose to in?ammatory acute and chronic gastritis. Similarly, multiple small erosions or single or multiple ulcers have resulted from consumption of chemicals, especialy aspirin and antirheumatic NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS).
Acute gastritis may cause anorexia, nausea, upper abdominal pain and, if erosive, haemorrhage. Treatment involves removal of the o?ending cause.
Chronic gastritis Accumulation of cells called round cells in the gastric mucosal characterises chronic gastritis. Most patients with chronic gastritis have no symptoms, and treatment of H. pylori infection usually cures the condition.
Atrophic gastritis A few patients with chronic gastritis may develop atrophic gastritis. With or without in?ammatory change, this disorder is common in western countries. The incidence increases with age, and more than 50 per cent of people over 50 may have it. A more complete and uniform type of ATROPHY, called ‘gastric atrophy’, characterises a familial disease called PERNICIOUS ANAEMIA. The cause of the latter disease is not known but it may be an autoimmune disorder.
Since atrophy of the corpus mucosa results in loss of acid- and pepsin-secreting cells, gastric secretion is reduced or absent. Patients with pernicious anaemia or severe atrophic gastritis of the corpus mucosa may secrete too little intrinsic factor for absorption of vitamin B12 and so can develop severe neurological disease (subacute combined degeneration of the spinal cord).
Patients with atrophic gastritis often have bacterial colonisation of the upper alimentary tract, with increased concentration of nitrite and carcinogenic N-nitroso compounds. These, coupled with excess growth of mucosal cells, may be linked to cancer. In chronic corpus gastritis, the risk of gastric cancer is about 3–4 times that of the general population.
Postgastrectomy mucosa The mucosa of the gastric remnant after surgical removal of the distal part of the stomach is usually in?amed and atrophic, and is also premalignant, with the risk of gastric cancer being very much greater than for patients with duodenal ulcer who have not had surgery.
Stress gastritis Acute stress gastritis develops, sometimes within hours, in individuals who have undergone severe physical trauma, BURNS (Curling ulcers), severe SEPSIS or major diseases such as heart attacks, strokes, intracranial trauma or operations (Cushing’s ulcers). The disorder presents with multiple super?cial erosions or ulcers of the gastric mucosa, with HAEMATEMESIS and MELAENA and sometimes with perforation when the acute ulcers erode through the stomach wall. Treatment involves inhibition of gastric secretion with intravenous infusion of an H2-receptorantagonist drug such as RANITIDINE or FAMOTIDINE, so that the gastric contents remain at a near neutral pH. Despite treatment, a few patients continue to bleed and may then require radical gastric surgery.
Gastric ulcer Gastric ulcers were common in young women during the 19th century, markedly fell in frequency in many western countries during the ?rst half of the 20th century, but remained common in coastal northern Norway, Japan, in young Australian women, and in some Andean populations. During the latter half of this century, gastric ulcers have again become more frequent in the West, with a peak incidence between 55 and 65 years.
The cause is not known. The two factors most strongly associated with the development of duodenal ulcers – gastric-acid production and gastric infection with H. pylori bacteria – are not nearly as strongly associated with gastric ulcers. The latter occur with increased frequency in individuals who take aspirin or NSAIDs. In healthy individuals who take NSAIDs, as many as 6 per cent develop a gastric ulcer during the ?rst week of treatment, while in patients with rheumatoid arthritis who are being treated long term with drugs, gastric ulcers occur in 20–40 per cent. The cause is inhibition of the enzyme cyclo-oxygenase, which in turn inhibits the production of repair-promoting PROSTAGLANDINS.
Gastric ulcers occur especially on the lesser curve of the stomach. The ulcers may erode through the whole thickness of the gastric wall, perforating into the peritoneal cavity or penetrating into liver, pancreas or colon.
Gastric ulcers usually present with a history of epigastric pain of less than one year. The pain tends to be associated with anorexia and may be aggravated by food, although patients with ‘prepyloric’ ulcers may obtain relief from eating or taking antacid preparations. Patients with gastric ulcers also complain of nausea and vomiting, and lose weight.
The principal complications of gastric ulcer are haemorrhage from arterial erosion, or perforation into the peritoneal cavity resulting in PERITONITIS, abscess or ?stula.
Aproximately one in two gastric ulcers heal ‘spontaneously’ in 2–3 months; however, up to 80 per cent of the patients relapse within 12 months. Repeated recurrence and rehealing results in scar tissue around the ulcer; this may cause a circumferential narrowing – a condition called ‘hour-glass stomach’.
The diagnosis of gastric ulcer is con?rmed by ENDOSCOPY. All patients with gastric ulcers should have multiple biopsies (see BIOPSY) to exclude the presence of malignant cells. Even after healing, gastric ulcers should be endoscopically monitored for a year.
Treatment of gastric ulcers is relatively simple: a course of one of the H2 RECEPTOR ANTAGONISTS heals gastric ulcers in 3 months. In patients who relapse, long-term inde?nite treatment with an H2 receptor antagonist such as ranitidine may be necessary since the ulcers tend to recur. Recently it has been claimed that gastric ulcers can be healed with a combination of a bismuth salt or a gastric secretory inhibitor
for example, one of the PROTON PUMP INHIBITORS such as omeprazole or lansoprazole
together with two antibiotics such as AMOXYCILLIN and METRONIDAZOLE. The long-term outcome of such treatment is not known. Partial gastrectomy, which used to be a regular treatment for gastric ulcers, is now much more rarely done unless the ulcer(s) contain precancerous cells.
Cancer of the stomach Cancer of the stomach is common and dangerous and, worldwide, accounts for approximately one in six of all deaths from cancer. There are marked geographical di?erences in frequency, with a very high incidence in Japan and low incidence in the USA. In the United Kingdom around 33 cases per 100,000 population are diagnosed annually. Studies have shown that environmental factors, rather than hereditary ones, are mainly responsible for the development of gastric cancer. Diet, including highly salted, pickled and smoked foods, and high concentrations of nitrate in food and drinking water, may well be responsible for the environmental effects.
Most gastric ulcers arise in abnormal gastric mucosa. The three mucosal disorders which especially predispose to gastric cancer include pernicious anaemia, postgastrectomy mucosa, and atrophic gastritis (see above). Around 90 per cent of gastric cancers have the microscopic appearance of abnormal mucosal cells (and are called ‘adenocarcinomas’). Most of the remainder look like endocrine cells of lymphoid tissue, although tumours with mixed microscopic appearance are common.
Early gastric cancer may be symptomless and, in countries like Japan with a high frequency of the disease, is often diagnosed during routine screening of the population. In more advanced cancers, upper abdominal pain, loss of appetite and loss of weight occur. Many present with obstructive symptoms, such as vomiting (when the pylorus is obstructed) or di?culty with swallowing. METASTASIS is obvious in up to two-thirds of patients and its presence contraindicates surgical cure. The diagnosis is made by endoscopic examination of the stomach and biopsy of abnormal-looking areas of mucosa. Treatment is surgical, often with additional chemotherapy and radiotherapy.... stomach, diseases of
In?ammation of the lungs is generally known as PNEUMONIA, when it is due to infection; as ALVEOLITIS when the in?ammation is immunological; and as PNEUMONITIS when it is due to physical or chemical agents.
Abscess of the lung consists of a collection of PUS within the lung tissue. Causes include inadequate treatment of pneumonia, inhalation of vomit, obstruction of the bronchial tubes by tumours and foreign bodies, pulmonary emboli (see EMBOLISM) and septic emboli. The patient becomes generally unwell with cough and fever. BRONCHOSCOPY is frequently performed to detect any obstruction to the bronchi. Treatment is with a prolonged course of antibiotics. Rarely, surgery is necessary.
Pulmonary oedema is the accumulation of ?uid in the pulmonary tissues and air spaces. This may be caused by cardiac disease (heart failure or disease of heart valves – see below, and HEART, DISEASES OF) or by an increase in the permeability of the pulmonary capillaries allowing leakage of ?uid into the lung tissue (see ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)).
Heart failure (left ventricular failure) can be caused by a weakness in the pumping action of the HEART leading to an increase in back pressure which forces ?uid out of the blood vessels into the lung tissue. Causes include heart attacks and HYPERTENSION (high blood pressure). Narrowed or leaking heart valves hinder the ?ow of blood through the heart; again, this produces an increase in back pressure which raises the capillary pressure in the pulmonary vessels and causes ?ooding of ?uid into the interstitial spaces and alveoli. Accumulation of ?uid in lung tissue produces breathlessness. Treatments include DIURETICS and other drugs to aid the pumping action of the heart. Surgical valve replacement may help when heart failure is due to valvular heart disease.
Acute respiratory distress syndrome Formerly known as adult respiratory distress syndrome (ARDS), this produces pulmonary congestion because of leakage of ?uid through pulmonary capillaries. It complicates a variety of illnesses such as sepsis, trauma, aspiration of gastric contents and di?use pneumonia. Treatment involves treating the cause and supporting the patient by providing oxygen.
Collapse of the lung may occur due to blockage of a bronchial tube by tumour, foreign body or a plug of mucus which may occur in bronchitis or pneumonia. Air beyond the blockage is absorbed into the circulation, causing the affected area of lung to collapse. Collapse may also occur when air is allowed into the pleural space – the space between the lining of the lung and the lining of the inside of the chest wall. This is called a pneumothorax and may occur following trauma, or spontaneously
– for example, when there is a rupture of a subpleural air pocket (such as a cyst) allowing a communication between the airways and the pleural space. Lung collapse by compression may occur when ?uid collects in the pleural space (pleural e?usion): when this ?uid is blood, it is known as a haemothorax; if it is due to pus it is known as an empyema. Collections of air, blood, pus or other ?uid can be removed from the pleural space by insertion of a chest drain, thus allowing the lung to re-expand.
Tumours of the lung are the most common cause of cancer in men and, along with breast cancer, are a major cause of cancer in women. Several types of lung cancer occur, the most common being squamous cell carcinoma, small- (or oat-) cell carcinoma, adenocarcinoma, and large-cell carcinoma. All but the adenocarcinoma have a strong link with smoking. Each type has a di?erent pattern of growth and responds di?erently to treatment. More than 30,000 men and women die of cancer of the trachea, bronchus and lung annually in England and Wales.
The most common presenting symptom is cough; others include haemoptisis (coughing up blood), breathlessness, chest pain, wheezing and weight loss. As well as spreading locally in the lung – the rate of spread varies – lung cancer commonly spawns secondary growths in the liver, bones or brain. Diagnosis is con?rmed by X-rays and bronchoscopy with biopsy.
Treatment Treatment for the two main categories of lung cancer – small-cell and nonsmall-cell cancer – is di?erent. Surgery is the only curative treatment for the latter and should be considered in all cases, even though fewer than half undergoing surgery will survive ?ve years. In those patients unsuitable for surgery, radical RADIOTHERAPY should be considered. For other patients the aim should be the control of symptoms and the maintenance of quality of life, with palliative radiotherapy one of the options.
Small-cell lung cancer progresses rapidly, and untreated patients survive for only a few months. Because the disease is often widespread by the time of diagnosis, surgery is rarely an option. All patients should be considered for CHEMOTHERAPY which improves symptoms and prolongs survival.
Wounds of the lung may cause damage to the lung and, by admitting air into the pleural cavity, cause the lung to collapse with air in the pleural space (pneumothorax). This may require the insertion of a chest drain to remove the air from the pleural space and allow the lung to re-expand. The lung may be wounded by the end of a fractured rib or by some sharp object such as a knife pushed between the ribs.... lungs, diseases of
Rarely, the UTERUS may be completely absent as a result of abnormal development. In such patients secondary sexual development is normal but MENSTRUATION is absent (primary amennorhoea). The chromosomal make-up of the patient must be checked (see CHROMOSOMES; GENES): in a few cases the genotype is male (testicular feminisation syndrome). No treatment is available, although the woman should be counselled.
The uterus develops as two halves which fuse together. If the fusion is incomplete, a uterine SEPTUM results. Such patients with a double uterus (uterus didelphys) may have fertility problems which can be corrected by surgical removal of the uterine septum. Very rarely there may be two uteri with a double vagina.
The uterus of most women points forwards (anteversion) and bends forwards (ante?exion). However, about 25 per cent of women have a uterus which is pointed backwards (retroversion) and bent backwards (retro?exion). This is a normal variant and very rarely gives rise to any problems. If it does, the attitude of the uterus can be corrected by an operation called a ventrosuspension.
Endometritis The lining of the uterine cavity is called the ENDOMETRIUM. It is this layer that is partially shed cyclically in women of reproductive age giving rise to menstruation. Infection of the endometrium is called endometritis and usually occurs after a pregnancy or in association with the use of an intrauterine contraceptive device (IUCD – see CONTRACEPTION). The symptoms are usually of pain, bleeding and a fever. Treatment is with antibiotics. Unless the FALLOPIAN TUBES are involved and damaged, subsequent fertility is unaffected. Very rarely, the infection is caused by TUBERCULOSIS. Tuberculous endometritis may destroy the endometrium causing permanent amenorrhoea and sterility.
Menstrual disorders are common. Heavy periods (menorrhagia) are often caused by ?broids (see below) or adenomyosis (see below) or by anovulatory cycles. Anovulatory cycles result in the endometrium being subjected to unopposed oestrogen stimulation and occasionally undergoing hyperplasia. Treatment is with cyclical progestogens (see PROGESTOGEN) initially. If this form of treatment fails, endoscopic surgery to remove the endometrium may be successful. The endometrium may be removed using LASER (endometrial laser ablation) or electrocautery (transcervical resection of endometrium). Hysterectomy (see below) will cure the problem if endoscopic surgery fails. Adenomyosis is a condition in which endometrial tissue is found in the muscle layer (myometrium) of the uterus. It usually presents as heavy and painful periods, and occasionally pain during intercourse. Hysterectomy is usually required.
Oligomenorhoea (scanty or infrequent periods) may be caused by a variety of conditions including thyroid disease (see THYROID GLAND, DISEASES OF). It is most commonly associated with usage of the combined oral contraceptive pill. Once serious causes have been eliminated, the patient should be reassured. No treatment is necessary unless conception is desired, in which case the patient may require induction of ovulation.
Primary amenorrhoea means that the patient has never had a period. She should be investigated, although usually it is only due to an inexplicable delay in the onset of periods (delayed menarche) and not to any serious condition. Secondary amenorrhoea is the cessation of periods after menstruation has started. The most common cause is pregnancy. It may be also caused by endocrinological or hormonal problems, tuberculous endometritis, emotional problems and severe weight loss. The treatment of amenorrhoea depends on the cause.
Dysmenorrhoea, or painful periods, is the most common disorder; in most cases the cause is unknown, although the disorder may be due to excessive production of PROSTAGLANDINS.
Irregular menstruation (variations from the woman’s normal menstrual pattern or changes in the duration of bleeding or the amount) can be the result of a disturbance in the balance of OESTROGENS and PROGESTERONE hormone which between them regulate the cycle. For some time after the MENARCHE or before the MENOPAUSE, menstruation may be irregular. If irregularity occurs in a woman whose periods are normally regular, it may be due to unsuspected pregnancy, early miscarriage or to disorders in the uterus, OVARIES or pelvic cavity. The woman should seek medical advice.
Fibroids (leiomyomata) are benign tumours arising from the smooth muscle layer (myometrium) of the uterus. They are found in 80 per cent of women but only a small percentage give rise to any problems and may then require treatment. They may cause heavy periods and occasionally pain. Sometimes they present as a mass arising from the pelvis with pressure symptoms from the bladder or rectum. Although they can be shrunk medically using gonadorelin analogues, which raise the plasma concentrations of LUTEINISING HORMONE and FOLLICLE-STIMULATING HORMONE, this is not a long-term solution. In any case, ?broids only require treatment if they are large or enlarging, or if they cause symptoms. Treatment is either myomectomy (surgical removal) if fertility is to be retained, or a hysterectomy.
Uterine cancers tend to present after the age of 40 with abnormal bleeding (intermenstrual or postmenopausal bleeding). They are usually endometrial carcinomas. Eighty per cent present with early (Stage I) disease. Patients with operable cancers should be treated with total abdominal hysterectomy and bilateral excision of the ovaries and Fallopian tubes. Post-operative RADIOTHERAPY is usually given to those patients with adverse prognostic factors. Pre-operative radiotherapy is still given by some centres, although this practice is now regarded as outdated. PROGESTOGEN treatment may be extremely e?ective in cases of recurrence, but its value remains unproven when used as adjuvant treatment. In 2003 in England and Wales, more than 2,353 women died of uterine cancer.
Disorders of the cervix The cervix (neck of the womb) may produce an excessive discharge due to the presence of a cervical ectopy or ectropion. In both instances columnar epithelium – the layer of secreting cells – which usually lines the cervical canal is exposed on its surface. Asymptomatic patients do not require treatment. If treatment is required, cryocautery – local freezing of tissue – is usually e?ective.
Cervical smears are taken and examined in the laboratory to detect abnormal cells shed from the cervix. Its main purpose is to detect cervical intraepithelial neoplasia (CIN) – the presence of malignant cells in the surface tissue lining the cervix – since up to 40 per cent of women with this condition will develop cervical cancer if the CIN is left untreated. Women with abnormal smears should undergo colposcopy, a painless investigation using a low-powered microscope to inspect the cervix. If CIN is found, treatment consists of simply removing the area of abnormal skin, either using a diathermy loop or laser instrument.
Unfortunately, cervical cancer remains the most common of gynaecological cancers. The most common type is squamous cell carcinoma and around 4,000 new cases (all types) are diagnosed in England and Wales every year. As many as 50 per cent of the women affected may die from the disease within ?ve years. Cervical cancer is staged clinically in four bands according to how far it has extended, and treatment is determined by this staging. Stage I involves only the mucosal lining of the cervix and cone BIOPSY may be the best treatment in young women wanting children. In Stage IV the disease has spread beyond the cervix, uterus and pelvis to the URINARY BLADDER or RECTUM. For most women, radiotherapy or radical Wertheim’s hysterectomy – the latter being preferable for younger women – is the treatment of choice if the cancer is diagnosed early, both resulting in survival rates of ?ve years in 80 per cent of patients. Wertheim’s hysterectomy is a major operation in which the uterus, cervix, upper third of vagina and the tissue surrounding the cervix are removed together with the LYMPH NODES draining the area. The ovaries may be retained if desired. Patients with cervical cancer are treated by radiotherapy, either because they present too late for surgery or because the surgical skill to perform a radical hysterectomy is not available. These operations are best performed by gynaecological oncologists who are gynaecological surgeons specialising in the treatment of gynaecological tumours. The role of CHEMOTHERAPY in cervical and uterine cancer is still being evaluated.
Prolapse of the uterus is a disorder in which the organ drops from its normal situation down into the vagina. First-degree prolapse is a slight displacement of the uterus, second-degree a partial displacement and third-degree when the uterus can be seen outside the VULVA. It may be accompanied by a CYSTOCOELE (the bladder bulges into the front wall of the vagina), urethrocoele (the urethra bulges into the vagina) and rectocoele (the rectal wall bulges into the rear wall of the vagina). Prolapse most commonly occurs in middle-aged women who have had children, but the condition is much less common now than in the past when prenatal and obstetric care was poor, women had more pregnancies and their general health was poor. Treatment is with pelvic exercises, surgical repair of the vagina or hysterectomy. If the woman does not want or is not ?t for surgery, an internal support called a pessary can be ?tted – and changed periodically.
Vertical section of female reproductive tract (viewed from front) showing sites of common gynaecological disorders.
Hysterectomy Many serious conditions of the uterus have traditionally been treated by hysterectomy, or removal of the uterus. It remains a common surgical operation in the UK, but is being superseded in the treatment of some conditions, such as persistent MENORRHAGIA, with endometrial ablation – removal of the lining of the uterus using minimally invasive techniques, usually using an ENDOSCOPE and laser. Hysterectomy is done to treat ?broids, cancer of the uterus and cervix, menorrhagia, ENDOMETRIOSIS and sometimes for severely prolapsed uterus. Total hysterectomy is the usual type of operation: it involves the removal of the uterus and cervix and sometimes the ovaries. After hysterectomy a woman no longer menstruates and cannot become pregnant. If the ovaries have been removed as well and the woman had not reached the menopause, hormone replacement therapy (HRT – see MENOPAUSE) should be considered. Counselling helps the woman to recover from the operation which can be an emotionally challenging event for many.... uterus, diseases of
Thrush is characterised by the presence of white patches on the mucous membrane which bleeds if the patch is gently removed. It is caused by the growth of a parasitic mould known as Candida albicans. Antifungal agents usually suppress the growth of candida. Candidal in?ltration of the mucosa is often found in cancerous lesions.
Leukoplakia literally means a white patch. In the mouth it is often due to an area of thickened cells from the horny layer of the epithelium. It appears as a white patch of varying density and is often grooved by dense ?ssures. There are many causes, most of them of minor importance. It may be associated with smoking, SYPHILIS, chronic SEPSIS or trauma from a sharp tooth. Cancer must be excluded.
Stomatitis (in?ammation of the mouth) arises from the same causes as in?ammation elsewhere, but among the main causes are the cutting of teeth in children, sharp or broken teeth, excess alcohol, tobacco smoking and general ill-health. The mucous membrane becomes red, swollen and tender and ulcers may appear. Treatment consists mainly of preventing secondary infection supervening before the stomatitis has resolved. Antiseptic mouthwashes are usually su?cient.
Gingivitis (see TEETH, DISEASES OF) is in?ammation of the gum where it touches the tooth. It is caused by poor oral hygiene and is often associated with the production of calculus or tartar on the teeth. If it is neglected it will proceed to periodontal disease.
Ulcers of the mouth These are usually small and arise from a variety of causes. Aphthous ulcers are the most common; they last about ten days and usually heal without scarring. They may be associated with STRESS or DYSPEPSIA. There is no ideal treatment.
Herpetic ulcers (see HERPES SIMPLEX) are similar but usually there are many ulcers and the patient appears feverish and unwell. This condition is more common in children.
Calculus (a) Salivary: a calculus (stone) may develop in one of the major salivary-gland ducts. This may result in a blockage which will cause the gland to swell and be painful. It usually swells before a meal and then slowly subsides. The stone may be passed but often has to be removed in a minor operation. If the gland behind the calculus becomes infected, then an ABSCESS forms and, if this persists, the removal of the gland may be indicated. (b) Dental, also called TARTAR: this is a calci?ed material which adheres to the teeth; it often starts as the soft debris found on teeth which have not been well cleaned and is called plaque. If not removed, it will gradually destroy the periodontal membrane and result in the loss of the tooth. (See TEETH, DISORDERS OF.)
Ranula This is a cyst-like swelling found in the ?oor of the mouth. It is often caused by mild trauma to the salivary glands with the result that saliva collects in the cyst instead of discharging into the mouth. Surgery may be required.
Mumps is an acute infective disorder of the major salivary glands. It causes painful enlargement of the glands which lasts for about two weeks. (See also main entry for MUMPS.)
Tumours may occur in all parts of the mouth, and may be BENIGN or MALIGNANT. Benign tumours are common and may follow mild trauma or be an exaggerated response to irritation. Polyps are found in the cheeks and on the tongue and become a nuisance as they may be bitten frequently. They are easily excised.
A MUCOCOELE is found mainly in the lower lip.
An exostosis or bone outgrowth is often found in the mid line of the palate and on the inside of the mandible (bone of the lower jaw). This only requires removal if it becomes unduly large or pointed and easily ulcerated.
Malignant tumours within the mouth are often large before they are noticed, whereas those on the lips are usually seen early and are more easily treated. The cancer may arise from any of the tissues found in the mouth including epithelium, bone, salivary tissue and tooth-forming tissue remnants. Oral cancers represent about 5 per cent of all reported malignancies, and in England and Wales around 3,300 people are diagnosed annually as having cancer of the mouth and PHARYNX.
Cancer of the mouth is less common below the age of 40 years and is more common in men. It is often associated with chronic irritation from a broken tooth or ill-?tting denture. It is also more common in those who smoke and those who chew betel leaves. Leukoplakia (see above) may be a precursor of cancer. Spread of the cancer is by way of the lymph nodes in the neck. Early treatment by surgery, radiotherapy or chemotherapy will often be e?ective, except for the posterior of the tongue where the prognosis is very poor. Although surgery may be extensive and potentially mutilating, recent advances in repairing defects and grafting tissues from elsewhere have made treatment more acceptable to the patient.... mouth, diseases of
PSORIASIS is a common cause of disease of the nail plate, as are eczema (see DERMATITIS) and fungal infection (see FUNGAL AND YEAST INFECTIONS). Deformity of the nail may point to systemic disease, as in CLUBBING, or the spoon-shaped concave nails (koilonychia) of severe iron de?ciency. Acute toxic illnesses may temporarily disturb nail growth causing horizontal ridges (Beau’s lines) which grow out slowly.
Onycholysis is separation of the nail plate from its bed. It may be due to psoriasis of the nail bed and trauma, or may occur spontaneously. Gross thickening of nails is common in the toes, caused by psoriasis or fungal infection.... nails, diseases of
The symptoms depend upon the site of the infection. General symptoms such as fever, weight loss and night sweats are common. In the most common form of pulmonary tuberculosis, cough and blood-stained sputum (haemoptysis) are common symptoms.
The route of infection is most often by inhalation, although it can be by ingestion of products such as infected milk. The results of contact depend upon the extent of the exposure and the susceptibility of the individual. Around 30 per cent of those closely exposed to the organism will be infected, but most will contain the infection with no signi?cant clinical illness and only a minority will go on to develop clinical disease. Around 5 per cent of those infected will develop post-primary disease over the next two or three years. The rest are at risk of reactivation of the disease later, particularly if their resistance is reduced by associated disease, poor nutrition or immunosuppression. In developed countries around 5 per cent of those infected will reactivate their healed tuberculosis into a clinical problem.
Immunosuppressed patients such as those infected with HIV are at much greater risk of developing clinical tuberculosis on primary contact or from reactivation. This is a particular problem in many developing countries, where there is a high incidence of both HIV and tuberculosis.
Diagnosis This depends upon identi?cation of mycobacteria on direct staining of sputum or other secretions or tissue, and upon culture of the organism. Culture takes 4–6 weeks but is necessary for di?erentiation from other non-tuberculous mycobacteria and for drug-sensitivity testing. Newer techniques involving DNA ampli?cation by polymerase chain reaction (PCR) can detect small numbers of organisms and help with earlier diagnosis.
Treatment This can be preventative or curative. Important elements of prevention are adequate nutrition and social conditions, BCG vaccination (see IMMUNISATION), an adequate public-health programme for contact tracing, and chemoprophylaxis. Radiological screening with mass miniature radiography is no longer used.
Vaccination with an attenuated organism (BCG – Bacillus Calmette Guerin) is used in the United Kingdom and some other countries at 12–13 years, or earlier in high-risk groups. Some studies show 80 per cent protection against tuberculosis for ten years after vaccination.
Cases of open tuberculosis need to be identi?ed; their close contacts should be reviewed for evidence of disease. Adequate antibiotic chemotherapy removes the infective risk after around two weeks of treatment. Chemoprophylaxis – the use of antituberculous therapy in those without clinical disease – may be used in contacts who develop a strong reaction on tuberculin skin testing or those at high risk because of associated disease.
The major principles of antibiotic chemotherapy for tuberculosis are that a combination of drugs needs to be used, and that treatment needs to be continued for a prolonged period – usually six months. Use of single agents or interrupted courses leads to the development of drug resistance. Serious outbreaks of multiply resistant Mycobacterium tuberculosis have been seen mainly in AIDS units, where patients have greater susceptibility to the disease, but also in developing countries where maintenance of appropriate antibacterial therapy for six months or more can be di?cult.
Streptomycin was the ?rst useful agent identi?ed in 1944. The four drugs used most often now are RIFAMPICIN, ISONIAZID, PYRAZINAMIDE and ETHAMBUTOL. Three to four agents are used for the ?rst two months; then, when sensitivities are known and clinical response observed, two drugs, most often rifampicin and isoniazid, are continued for the rest of the course. Treatment is taken daily, although thrice-weekly, directly observed therapy is used when there is doubt about the patient’s compliance. All the antituberculous agents have a range of adverse effects that need to be monitored during treatment. Provided that the treatment is prescribed and taken appropriately, response to treatment is very good with cure of disease and very low relapse rates.... nature of the disease tuberculosis has
Acute in?ammation is generally the result of a viral infection (see COLD, COMMON) affecting the mucous membrane and paranasal sinuses (see SINUSITIS); less commonly it results from the inhalation of irritant gases. Boils may develop just inside the entrance to the nose, causing pain; these are potentially troublesome as infection can spread to the sinuses. HAY FEVER is one distressing form of acute rhinitis.
Malformations are of various kinds. Racial and familial variations in the external nose occur and may be a reason for RHINOPLASTY. Di?erences in the size and shape of the nose occur, often forming the starting point for chronic in?ammation of the nose, perennial rhinitis (all the year round), hay fever, or ASTHMA. More commonly, obstruction results from nasal polyps or adenoids, leading to inhalation through the mouth. Adenoids are an overgrowth of glandular tissue at the back of the throat, into which the nose opens. Polyps are growths of soft jelly-like character: they arise from chronic in?ammation associated with allergic rhinitis, chronic sinusitis, asthma, and aspirin abuse. Large polyps can cause erosion of the nasal bones and should be surgically removed.
Bleeding (see HAEMORRHAGE).
Foreign bodies At ?rst these may not cause any symptoms, but in time they can cause obstruction of the affected nostril with a foul-smelling bloody discharge. The problem is common with small children who tend to push small objects into their noses. Foreign bodies require removal, sometimes in hospital. Anyone attempting to remove a foreign body should take care not to push it further into the nose.
Loss of sense of smell, or anosmia, may be temporary or permanent. Temporary anosmia is caused by conditions of the nose which are reversible, whereas permanent
anosmia is caused by conditions which destroy the OLFACTORY NERVES. Temporary conditions are those such as the common cold, or other in?ammatory conditions of the nasal mucosa or the presence of nasal polyps (see above). Permanent anosmia may follow in?uenzal NEURITIS or it may also follow injuries to the brain and fractures of the skull involving the olfactory nerves.
Injury to nose The commonest injury is a fracture of the nasal bones or displacement of the cartilage that forms the bridge of the nose. The nasal SEPTUM may also be displaced sideways by a lateral blow. Sporting activities, especially boxing and rugby football, are commonly a cause of nasal injury. If a fracture is suspected, or if there is substantial tissue swelling, an X-ray examination is necessary. Resetting a damaged bone should be done either immediately, before swelling makes surgery di?cult, or ten days or so later when the swelling has subsided. Results are usually good, ensuring a clear airway as well as a restored pro?le. It is not unusual for the cheek-bone to sustain a depressed fracture at the same time as the nose is broken. Careful assessment and prompt surgery are called for. (For more information on fractures, see under BONE, DISORDERS OF).
Rhinitis In?ammation of the MUCOUS MEMBRANE lining the nose. Symptoms include nasal discharge and obstruction, sneezing and sometimes pain in the sinuses. There are several types of rhinitis:
•Allergic – due to allergy to dust, pollen or other airborne particles. Also called hay fever, allergic rhinitis causes a runny nose, sneezing and local congestion. It affects up to 10 per cent of the population and is more common in people suffering from other allergic disorders such as asthma or eczema (see DERMATITIS). Skin tests help to identify the causative ALLERGEN which the sufferer can then try to avoid, although in the case of pollen this is di?cult. Decongestant drugs, ANTIHISTAMINE DRUGS, and CORTICOSTEROIDS may help, as can SODIUM CROMOGLYCATE inhaled regularly during the pollen season. A desensitisation course to a particular allergen sometimes provides long-term relief.
Atrophic rhinitis is caused by a deterioration in the nasal mucous membrane as a result of chronic bacterial infection, nasal surgery or AGEING. Symptoms include persistent nasal infection and discharge and loss of sense of smell. ANTIBIOTICS and, in some cases, OESTROGENS alleviate the symptoms.
Hypertrophic rhinitis results from repeated nasal infection, and is characterised by thickened nasal membranes and congestion of the nasal veins. Removal of thickened mucosa may help severe cases.
Vasomotor rhinitis occurs when the mucosa becomes oversensitive to stimuli such as pollutants, temperature changes or certain foods or medicines. It may occur as a result of emotional disturbances and is common in pregnancy.
Viral rhinitis occurs as a result of infection by the common cold virus; treatment is symptomatic. Sinusitis is sometimes a complication.... nose, disorders of
Habitat: Throughout plains of India, ascending up to 1,200 m in Kumaon.
Folk: Samraapani (Gujarat), Dupatiyaa.Action: Herb—used for the treatment of dysentery. Root— given to induce sleep.
The herb, collected at the flowering stage from Mumbai, contained silica 3.87, calcium 1.02, magnesium 1.00, potassium 0.53, phosphorus 0.18%; iodine content 0.026-00.049 ppm (dry- matter basis).... zornia diphylla1st degree. Goat’s Rue, Fenugreek Seeds, Garlic, Jambul.
2nd degree. Damiana, Nettles, Pipsissewa, Olive leaves, Karela, White Horehound, Sweet Sumach, Mountain Grape, Fennel. ... anti-diabetics
Noti?able diseases in the UK (For more information on a speci?c disease, refer to the separate dictionary entry.) Acute encephalitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Ebola virus disease Food poisoning Lassa fever Leprosy (reported to Chief Medical O?cer at the Department of Health) Leptospirosis Malaria Marburg disease Measles Meningitis Meningococcal septicaemia (without meningitis) Mumps Ophthalmia neonatorum Paratyphoid fever Plague Rabies Relapsing fever Rubella Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Viral haemorrhagic fever (including Lassa fever) Viral hepatitis Whooping cough Yellow fever
Reporting AIDS is voluntary (and in con?dence) to the Director, Communicable Diseases Surveillance Centre (PHLS).... notifiable diseases
A still more serious and frequent cause of oesophageal stricture is that due to cancer, which may occur at any part, but is most common at the lower end, near the entrance into the stomach. The chief symptoms of this condition are increasing di?culty in swallowing, increasing debility, together with enlargement of the glands in the neck. The condition usually occurs in middle age or beyond and around 5,000 people are diagnosed with such cancer every year in the United Kingdom. In many cases treatment can only be palliative, but recent advances in surgery are producing promising results. In some cases treatment with irradiation or anti-cancer drugs produces relief, if not cure. In those in whom neither operation nor radiation can be performed, life may be prolonged and freedom from pain obtained by ?uid food which is either swallowed or passed down a tube. In cases of achalasia (see above), the passage of a special bougie down the oesophagus to dilate the sphincter may be e?ective.
Strictures of the oesophagus may also be produced by the pressure of tumours or aneurysms within the cavity of the chest but external to the gullet.
Finally, di?culty in swallowing sometimes occurs in certain serious nervous diseases from paralysis affecting the nerves supplying the muscular coats of the PHARYNX, which thus loses its propulsive power (bulbar paralysis).
Foreign bodies which lodge in the respiratory part of the throat – i.e. at the entrance to, or in the cavity of, the larynx – set up immediate symptoms of CHOKING. Those which lodge in the gullet, on the contrary, do not usually set up any immediately serious symptoms, although their presence causes considerable discomfort. Medical attention is usually required.... oesophagus, diseases of
Habitat: Native of Mexico; well- acclimatized throughout India.
English: Prickly Pear, Slipper Thorn.Ayurvedic: Naagaphani, Kanthaari.Unani: Naagphani.Siddha/Tamil: Sappathikalli, Nagathali.Action: Leaves—applied as poultice to allay inflammation and heat. Fruit—baked and given in whooping cough.
Dried or fresh flowers of cactus (opuntia series)—astringent and haemostatic. An infusion is given in irritable bowel, mucous colitis, and prostatitis. Ash of the aerial portion, mixed with sugar candy, is given for 21 days for birth control in tribal areas of Andhra Pradesh.The Plant is recommended for growing in high pollution zones for abating sulphur dioxide pollution.Pods contain a polysaccharide, ar- binogalactan. Betanin has been isolated from ripe fruits. Flowers contain the glycosides of isorhamnetin and quer- cetin, with smal amounts of the free flavonols.... opuntia dilleniiSymptoms: inflammation of the lung and high temperature with dry cough.
Tea: Equal parts; Elderflowers (to reduce temperature). Comfrey leaves (cough), Thyme (antibiotic), Peppermint (to assist breathing). 2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup freely. Alternative: Combine Tinctures: Pleurisy root 2; Lobelia 1; Ginger half. One or two 5ml teaspoons in water 3-4 times daily. ... damp hay disease
As the Vegan diet is deficient in Vitamin B12 which may lead to anaemia, supplements are available. Some Vegan products have this vitamin added.
Their rule is to combine legumes with other cereals, seeds or nuts at the same meal. The combination is claimed to be equal to one animal based. ... diet - vegan
Failure of OVULATION is the cause of INFERTILITY in around a third of couples seeking help with conception. It may also lead to menstrual problems (see MENSTRUATION), such as an irregular menstrual cycle or MENORRHAGIA. An uncommon cause of failure of ovulation is POLYCYSTIC OVARY SYNDROME, often associated with acne, hirsutism, and obesity. Treatment depends on the symptoms. Early ovarian failure is the cause of premature MENOPAUSE. Treatment consists of hormone replacement therapy using a combination of oestrogen and progestogen.
Ovarian cysts (for example, follicular cysts) result from ovulation. They may be symptomless but sometimes cause abdominal pain, pain during intercourse or disturbances in menstruation. Twisting or rupture can cause severe pain, pyrexia (fever) and nausea, and explorative surgery – endoscopic laparotomy – may be needed to establish a diagnosis (symptoms of ECTOPIC PREGNANCY are similar). The ovary may have to be removed. Simple cysts often disappear of their own accord but a large cyst can cause pressure on surrounding structures and therefore should be surgically removed.
In young women the most common benign tumour is a dermoid cyst, while in older women, ?broma (see under UTERUS, DISEASES OF) is more common. All benign tumours should be removed surgically in order to be sure they are not malignant.
Malignant tumours may be primary (arising in the ovary) or secondary (metastases from a cancer developing in another organ). Treatment depends upon the site and type of the primary tumour.
Around 5,000 women a year are diagnosed as having ovarian cancer in England and Wales. Unfortunately it is not readily detected in its early stages; around 85 per cent of women do not see a doctor until after the tumour has spread. Early tumours present with symptoms similar to benign tumours, while late ones present with abdominal distension, pain and vague gastrointestinal symptoms. The disease is most common in menopausal women. Earlier diagnosis and treatment can be achieved by ULTRASOUND screening. Treatment is surgical, aimed at totally removing the tumour mass. Nowadays RADIOTHERAPY is only used for palliation. CHEMOTHERAPY is often given to patients with ovarian metastases, or who have residual disease after surgery. The most active cytotoxic agent is the taxane, PACLITAXEL – especially when it is combined with cisplatin.... ovaries, diseases of
(e.g. etidronate). Those with the disease can obtain help and advice from the National Association for the Relief of Paget’s Disease.... paget’s disease of bone
Pancreatic cancer The incidence of pancreatic cancer is rising: around 7,000 cases are now diagnosed annually in the UK, accounting for 1–2 per cent of all malignancies. There is an established association with heavy cigarette-smoking, and the cancer is twice as common in patients with diabetes mellitus as compared with the general population. Cancer of the pancreas is hard to diagnose; by the time symptoms occur the tumour may be di?cult to treat surgically – with PALLIATIVE bypass surgery the only procedure.
Chronic pancreatitis may be painless; it leads to pancreatic failure causing MALABSORPTION SYNDROME and diabetes mellitus, and the pancreas becomes calci?ed with shadowing on X-RAYS. The malabsorption is treated by a low-fat diet with pancreatic enzyme supplements; the diabetes with insulin; and pain is treated appropriately. Surgery may be required.
Acute pancreatitis An uncommon disease of the pancreas which may start gradually or suddenly, usually accompanied by severe abdominal pain which often radiates through to the back. Biliary tract disease and alcohol account for 80 per cent of patients admitted with acute pancreatitis, while other causes include drugs (see AZATHIOPRINE and DIURETICS) and infections such as MUMPS. Patients are acutely ill with TACHYCARDIA, fever and low blood pressure; many go into SHOCK. The condition may be mistaken for a perforated PEPTIC ULCER, except that in acute pancreatitis the blood concentration of AMYLASE is raised. The main complication is the formation of a PSEUDOCYST. Treatment includes intravenous feeding, ANTICHOLINERGIC drugs and ANALGESICS. Regular measurements of blood GLUCOSE, CALCIUM, amylase and blood gases are required. Abdominal ULTRASOUND may identify gall-stones (see under GALL-BLADDER, DISEASES OF). If the patient deteriorates, he or she should be admitted for intensive care as haemorrhagic pancreatic necrosis may be developing. LAPAROTOMY and DEBRIDEMENT may be called for. Mortality is 5–10%.... pancreas, disorders of
Symptomatic relief. Rutin, Hawthorn, Echinacea. Vitamin E: 200iu daily. ... fabry’s disease
The infection may be silent – with no obvious symptoms – or symptoms may be troublesome, for example, vaginal discharge and sometimes a palpable mass in the lower abdomen. If a LAPAROSCOPY is done – usually by endoscopic examination – overt evidence of PID is found in around 65 per cent of suspected cases.
PID may be confused with APPENDICITIS, ECTOPIC PREGNANCY – and PID is a common cause of such pregnancies – ovarian cyst (see OVARIES, DISEASES OF) and in?ammatory disorders of the intestines. Treatment is with a combination of ANTIBIOTICS that are active against the likely pathogens, accompanied by ANALGESICS. Patients may become seriously ill and require hospital care, where surgery is sometimes required if conservative management is unsuccessful. All women who have PID should be screened for sexually transmitted disease and, if this is present, should be referred with their partner(s) to a genito-urinary medicine clinic. Up to 20 per cent of women who have PID become infertile, and there is a seven-to ten-fold greater risk of an ectopic pregnancy occurring.... pelvic inflammatory disease(pid)
Symptoms: loss of weight, wasting illness, skin abscesses.
Treatment. Tea: Aniseed 1; Senna leaf 1; Nettles 2. 2 teaspoons to each cup boiling water; infuse 10-15 minutes in covered vessel. 1 cup thrice daily. Add to each dose: 30 drops Tincture Echinacea. ... goat disease
Habitat: Indian gardens.
English: Country Gooseberry.Ayurvedic: Lavali-phala, Lowani Hariphala.Siddha/Tamil: Aranelli.Action: Fruit—astringent, tonic to liver; improves appetite, useful in biliousness, constipation, vomiting, bronchitis. Roots and seed— cathartic. The juice of the root bark produces headache and severe abdominal pain.
The root bark contains 18% tannin, saponin, gallic acid and a crystalline substance (probably lupeol). The bark contains beta-amyrin and phyllanthol.The fruit is sour; contains acidity (as acetic acid) 1.70%.... phyllanthus distichusHabitat: Native to West Indies and tropical America; grown in Indian gardens; in Bengal, Bihar, Orissa and Bangalore.
English: Allspice tree, Jamaica Pepper tree, Pimento tree.Action: Berry oil and leaf oil— carminative and stimulant. The oil contains chiefly eugenol (65-80%), responsible for the herb's effect on the digestive system and its pain relief properties; also for anaesthetic effect when crushed berries are applied topically.... pimenta dioica
DIABETES INSIPIDUS, a condition characterised by the passing of a large volume of URINE every day, is due to lack of the antidiuretic hormone (see VASOPRESSIN). Enhanced production of the ADRENOCORTICOTROPHIC HORMONE (ACTH) leads to CUSHING’S SYNDROME. Excessive production of PROLACTIN by micro or macro adenomas (benign tumours) leads to hyperprolactinaemia and consequent AMENORRHOEA and GALACTORRHOEA. Some adenomas do not produce any hormone but cause effects by damaging the pituitary cells and inhibiting their hormone production.
The most sensitive cells to extrinsic pressure are the gonadotrophin-producing cells and the growth-hormone producing cells, so that if the tumour occurs in childhood, growth hormone will be suppressed and growth will slow. Gonadotrophin hormone suppression will prevent the development of puberty and, if the tumour occurs after puberty, will result in amenorrhoea in the female and lack of LIBIDO in both sexes. The thyroid-stimulating hormone cells are the next to suffer and the pressure effects on these cells will result in hypothyroidism (see under THYROID GLAND, DISEASES OF).
Fortunately the ACTH-producing cells are the most resistant to extrinsic pressure and this is teleologically sound as ACTH is the one pituitary hormone that is essential to life. However, these cells can suffer damage from intracellular tumours, and adrenocortical insu?ciency is not uncommon.
Information about these disorders may be obtained from the Pituitary Foundation.... pituitary-linked disorders
Treatment. See: HEART – LEFT VENTRICULAR FAILURE. ... mitral disease
ULTRASOUND scanning is probably the most widely used diagnostic tool in obstetric practice. It can detect structural abnormalities such as SPINA BIFIDA and CLEFT PALATE and even cardiac and renal problems. A series of scans can assess whether the baby is growing at a normal rate; ultrasound may also be used to assist with other diagnostic tests (e.g. AMNIOCENTESIS – see below).
Tests on the mother’s blood can also diagnose fetal abnormalities. Alphafetoprotein (AFP) is produced by babies and ‘leaks’ into the AMNIOTIC FLUID and is absorbed by the mother. In spina bi?da and other neural-tube defects there is increased leakage of AFP, and a blood test at 16 weeks’ gestation can detect a raised level which suggests the presence of these abnormalities.
The triple test, also performed at 16 weeks, measures AFP and two hormones – HUMAN CHORIONIC GONADOTROPHIN and unconjugated OESTRADIOL – and is used in diagnosing DOWN’S (DOWN) SYNDROME.
Amniocentesis involves inserting a needle through the mother’s abdominal wall into the uterus to remove a sample of amniotic ?uid at 16–18 weeks. Examination of the ?uid and the cells it contains is used in the diagnosis of Down’s syndrome and other inherited disorders. The test carries a small risk of miscarriage.
Chorionic villus sampling may be used to diagnose various inherited conditions. A small amount of tissue from the developing PLACENTA is removed for analysis: this test has the advantages of having a lower incidence of miscarriage than amniocentesis and is carried out at an earlier stage (9–13 weeks).
Analysis of a blood sample removed from the umbilical cord (cordocentesis) may diagnose infections in the uterus, blood disorders or inherited conditions.
Direct observation of the fetus via a viewing instrument called a fetoscope is also used diagnostically and will detect structural abnormalities.
Most tests have a recognised incidence of false positive and negative results and are therefore usually cross-checked with another test. Counselling of the parents about prenatal tests is important. This allows them to make an informed choice which may not necessarily involve terminating the pregnancy if an abnormality is found. (See PREGNANCY AND LABOUR.)... prenatal screening or diagnosis
Reflex anal dilatation, in which the anus dilates in response to local contact, may occur in certain anal disorders or after repeated anal penetration.... anal dilatation
Prostatitis This can be either acute or chronic. Acute prostatitis is caused by a bacterial infection, while chronic prostatitis may follow on from an acute attack, arise insidiously, or be non-bacterial in origin.
Symptoms Typically the patient has pain in the PERINEUM, groins, or supra pubic region, and pain on EJACULATION. He may also have urinary frequency, and urgency.
Treatment Acute and chronic prostatitis are treated with a prolonged course of antibiotics. Patients with chronic prostatitis may also require anti-in?ammatory drugs, and antidepressants.
Prostatic enlargement This is the result of benign prostatic hyperplasia (BPH), causing enlargement of the prostate. The exact cause of this enlargement is unknown, but it affects 50 per cent of men between 40 and 59 years and 95 per cent of men over 70 years.
Symptoms These are urinary hesitancy, poor urinary stream, terminal dribbling, frequency and urgency of urination and the need to pass urine at night (nocturia). The diagnosis is made from the patient’s history; a digital examination of the prostate gland via the rectum to assess enlargement; and analysis of the urinary ?ow rate.
Treatment This can be with tablets, which either shrink the prostate – an anti-androgen drug such as ?nasteride – or relax the urinary sphincter muscle during urination. For more severe symptoms the prostate can be removed surgically, by transurethral resection of prostate (TURP), using either electrocautery or laser energy. A new treatment is the use of microwaves to heat up and shrink the enlarged gland.
Cancer Cancer of the prostate is the fourth most common cause of death from cancer in northern European males: more than 10,000 cases are diagnosed every year in the UK and the incidence is rising by 3 per cent annually.
Little is known about the cause, but the majority of prostate cancers require the male hormones, androgens, to grow.
Symptoms These are similar to those resulting from benign prostatic hypertrophy (see above). Spread of the cancer to bones can cause pain. The use of a blood test measuring the amount of an ANTIGEN, PROSTATE SPECIFIC ANTIGEN (PSA), can be helpful in making the diagnosis – as can an ULTRASOUND scan of the prostate.
Treatment This could be surgical, with removal of the prostate (either via an abdominal incision, total prostatectomy, or transurethrally), or could be by radiotherapy. In more advanced cancers, treatment with anti-androgen drugs, such as cyprotexone acetate or certain oestrogens, is used to inhibit the growth of the cancer.... prostate gland, diseases of
Symptoms The condition is most commonly con?ned to the occurrence of ‘dead ?ngers’ – the ?ngers (or the toes, ears, or nose) becoming white, numb, and waxy-looking. This condition may last for some minutes, or may not pass o? for several hours, or even for a day or two.
Treatment People who are subject to these attacks should be careful in winter to protect the feet and hands from cold, and should always use warm water when washing the hands. In addition, the whole body should be kept warm, as spasm of the arterioles in the feet and hands may be induced by chilling of the body. Su?erers should not smoke. VASODILATORS are helpful, especially the calcium antagonists. In all patients who do not respond to such medical treatment, surgery should be considered in the form of sympathectomy: i.e. cutting of the sympathetic nerves to the affected part. This results in dilatation of the arterioles and hence an improved blood supply. This operation is more successful in the case of the feet than in the case of the hands.... raynaud’s disease
However, calling a condition psychosomatic implies something more – the primacy of the psyche over the soma. Going back to the in?uential theories and practice of PSYCHOANALYSIS as expounded from the 1930s, many diseases have been proposed as the result of psychological factors.These have included PEPTIC ULCER, ULCERATIVE COLITIS, ASTHMA, PSORIASIS and others. In this view, much physical disorder is due to repressed or excessive emotions. Likewise it is also argued that whereas some people express psychological distress via psychological symptoms (such as anxiety, depression and so on), others develop physical symptoms instead – and that they are also at greater risk of physical disease.
The trouble with this view is that medical advances repeatedly show that it goes too far. Stress certainly causes physical symptoms – for example, DYSPEPSIA – but the belief that it caused peptic ulcers vanished with the discovery of the true cause: colonisation of the stomach by the bacterium, Helicobacter pylori. Of course, stress and social adversity affect the risk of many diseases. For example, the incidence of heart disease among UK government employees (civil servants) has been shown to be in?uenced by their social class and their degree of job satisfaction. But we do not know how this works. Some argue that social adversity and stress in?uence how the heart functions (‘He died of a broken heart’). Stress can also affect IMMUNITY but it cannot cause AIDS/HIV and we do not know if there is a link running from stress to abnormal immune function to actual illness.
We can say that psychological factors provoke physical symptoms, and often even explain how this can happen. For example, when you are anxious you produce more epinephrine (adrenaline), which gives rise to chest pain, ‘butter?ies in the stomach’ and PALPITATION. These symptoms are not ‘all in the mind’, even if the trigger is a psychological one. People who are depressed are more likely to experience nearly every physical symptom there is, but especially pain and fatigue. Taken as a whole, psychologically induced symptoms are an enormous burden on the NHS and probably responsible for more doctor visits and sickness absence than any other single cause. Also we can be con?dent that social adversity and stress powerfully in?uence the outcome of many illnesses; likewise, a vast range of unhealthy activities and behaviours such as smoking, excessive alcohol intake, excessive eating, and so on. But we must be careful not to assume that our emotions directly cause our illnesses.... psychosomatic diseases
Safe use of medicines All medicines can have unwanted effects (‘side-effects’ or, more strictly, adverse effects) that are unpleasant and sometimes harmful. It is best not to take any medicine, prescribed or otherwise, unless there is a clear reason for doing so; the possible adverse effects of treatment, and the risk of their occurring, have to be set against any likely bene?t. Remember too that one treatment can affect another already being taken. Many adverse events depend upon the recommended dose being exceeded. Some people – for example, those with allergies (see ALLERGY) to a particular group of drugs, or those with kidney or liver disease – are more likely to suffer adverse effects than otherwise healthy people.
When an individual begins a course of treatment, he or she should take it as instructed. With ANTIBIOTICS treatments especially, it is important to take the whole course of tablets prescribed, because brief exposure of bacteria to an antibiotic can make them resistant to treatment. Most drugs can be stopped at once, but some treatments can cause unpleasant, and occasionally dangerous, symptoms if stopped abruptly. Sleeping tablets, anti-EPILEPSY treatment, and medicines used to treat ANGINA PECTORIS are among the agents which can cause such ‘withdrawal symptoms’. CORTICOSTEROIDS are a particularly important group of medicines in this respect, because prolonged courses of treatment with high doses can suppress the ability of the body to respond to severe stresses (such as surgical operations) for many months or even years.... safe disposal of unwanted medicines
The parasites live in the bloodstream and can affect the heart, intestines, and nervous system.
Symptoms include swelling of the lymph nodes and fever.
Long-term complications include damage to the heart.
The drug nifurtimox kills the parasites in the blood but has unpleasant side effects.... chagas’ disease
Imperforate anus, or absence of the anus, may occur in newly born children, and the condition is relieved by operation.
Itching at the anal opening is common and can be troublesome. It may be due to slight abrasions, to piles, to the presence of threadworms (see ENTEROBIASIS), and/or to anal sex. The anal area should be bathed once or twice a day; clothing should be loose and smooth. Local application of soothing preparations containing mild astringents (bismuth subgallate, zinc oxide and hamamelis) and CORTICOSTEROIDS may provide symptomatic relief. Proprietary preparations contain lubricants, VASOCONSTRICTORS and mild ANTISEPTICS.
Pain on defaecation is commonly caused by a small ulcer or ?ssure, or by an engorged haemorrhoid (pile). Haemorrhoids may also cause an aching pain in the rectum. (See also PROCTALGIA.)
Abscess in the cellular tissue at the side of the rectum – known from its position as an ischio-rectal abscess – is fairly common and may produce a ?stula. Treatment is by ANTIBIOTICS and, if necessary, surgery to drain the abscess.
Prolapse or protrusion of the rectum is sometimes found in children, usually between the ages of six months and two years. This is generally a temporary disorder. Straining at defaecation by adults can cause the lining of the rectum to protrude outside the anus, resulting in discomfort, discharge and bleeding. Treatment of the underlying constipation is essential as well as local symptomatic measures (see above). Haemorrhoids sometimes prolapse. If a return to normal bowel habits with the production of soft faeces fails to restore the rectum to normal, surgery to remove the haemorrhoids may be necessary. If prolapse of the rectum recurs, despite a return to normal bowel habits, surgery may be required to rectify it.
Tumours of small size situated on the skin near the opening of the bowel, and consisting of nodules, tags of skin, or cauli?ower-like excrescences, are common, and may give rise to pain, itching and watery discharges. These are easily removed if necessary. Polypi (see POLYPUS) occasionally develop within the rectum, and may give rise to no pain, although they may cause frequent discharges of blood. Like polypi elsewhere, they may often be removed by a minor operation. (See also POLYPOSIS.)
Cancer of the rectum and colon is the commonest malignancy in the gastrointestinal tract: around 17,000 people a year die from these conditions in the United Kingdom. Rectal cancer is more common in men than in women; colonic cancer is more common in women. Rectal cancer is a disease of later life, seldom affecting young people, and its appearance is generally insidious. The tumour begins commonly in the mucous membrane, its structure resembling that of the glands with which the membrane is furnished, and it quickly in?ltrates the other coats of the intestine and then invades neighbouring organs. Secondary growths in most cases occur soon in the lymphatic glands within the abdomen and in the liver. The symptoms appear gradually and consist of diarrhoea, alternating with attacks of constipation, and, later on, discharges of blood or blood-stained ?uid from the bowels, together with weight loss and weakness. A growth can be well advanced before it causes much disturbance. Treatment is surgical and usually this consists of removal of the whole of the rectum and the distal two-thirds of the sigmoid colon, and the establishment of a COLOSTOMY. Depending upon the extent of the tumour, approximately 50 per cent of the patients who have this operation are alive and well after ?ve years. In some cases in which the growth occurs in the upper part of the rectum, it is now possible to remove the growth and preserve the anus so that the patient is saved the discomfort of having a colostomy. RADIOTHERAPY and CHEMOTHERAPY may also be necessary.... rectum, diseases of
Parasomnias These include medical disorders such as ASTHMA, ANGINA PECTORIS or EPILEPSY which are made worse by sleep, and a range of behavioural alterations which are usually related to a speci?c sleep stage or to a change from one state of sleep to another. Sleepwalking, night terrors, and nightmares are examples.
Insomnia Insomnia is de?ned as a di?culty in initiating or maintaining sleep. It affects around 15 per cent of the population at any one time, and is often due to a poor pre-sleep routine (e.g. taking excessive stimulants such as ca?eine); unsatisfactory sleep due to poor environments such as an uncomfortable bed or a cold or noisy bedroom; anxiety and/or depression; or occasionally to a physical problem – for example, pain – or a medical disorder associated with sleep such as obstructive SLEEP APNOEAS or periodic limb movements.
Excessive daytime sleepiness This is usually due to sleep deprivation caused either by inadequate duration of sleep, or by poor quality of sleep. The individual’s lifestyle is often a cause and modi?cation of this may relieve the problem. Other common causes of excessive daytime sleepiness are depression, obstructive sleep apnoeas, periodic limb movements, excessive alcohol or other drug intake, and, less commonly, NARCOLEPSY.... sleep, disorders of
The incidence of STDs rose sharply during World War II but the advent of PENICILLIN and subsequent antibiotics meant that syphilis and gonorrhoea could be treated e?ectively. The arrival of oral contraception and more tolerant public attitudes to sexual activities resulted in an increase in the incidence of sexually transmitted infections. The diagnosis of NONSPECIFIC URETHRITIS (NSU), once given to many patients whose symptoms were not due to the traditional recognised infections, was in the 1970s realised to be wrong, as the condition was proved to be the result of infection by chlamydia.
Most STDs are treatable, but herpes is an infection that could become chronic, while hepatitis B and, of course, AIDS/HIV are potentially fatal – although treatment of HIV is now proving more e?ective. As well as the treatment and subsequent monitoring of patients with STDs, one of the important functions of clinics has been the tracing, treatment and follow-up of sexual contacts of infected individuals, a procedure that is conducted con?dentially.
Apart from AIDS/HIV, the incidence of STDs fell during the 1980s; however in some countries the agents causing syphilis and gonorrhoea began to develop resistance to antibiotics, which showed the continued importance of practising safe sex – in particular by restricting the number of sexual partners and ensuring the regular use of condoms. In the United Kingdom the rates per million of the male population infected by syphilis rose from 8.8 in 1991 to 9.7 in 1999; in females the ?gures were 4.0 to 4.5, respectively. For gonorrhoea, the ?gures for men were 399.4 in 1991 and 385 in 1999, with women also showing a reduction, from
216.5 to 171.3. In 1991, 552.6 per million of men had chlamydia, a ?gure which rose to
829.5 in 1999; for women in the same period the incidence also rose, from 622.5 to 1,077.1 per million. For genital herpes simplex virus, the infection rate for men fell from 236.6 per million to 227.7, whereas the ?gures for women showed a rise, 258.5 to 357. The incidence of AIDS/HIV is given under the relevant entry. (These ?gures are based on information in United Kingdom Health Statistics, 2001 edition, UKHSI, published by the O?ce of National Statistics.)... sexually transmitted diseases (stds)
Others appear under their appropriate alphabetical headings: ACNE; ALBINISM; ALOPECIA; ALOPECIA AREATA; APHTHOUS ULCER; BASAL CELL CARCINOMA; BOILS (FURUNCULOSIS); BOWEN’S DISEASE; CALLOSITIES; CANDIDA; CHEILOSIS; CHEIRAPOMPHOLYX; DANDRUFF; DERMATOFIBROMA; DERMATOMYOSITIS; DERMATOPHYTES; DERMOGRAPHISM; ECTHYMA; ERYSIPELAS; ERYTHEMA; ERYTHRASMA; ERYTHRODERMA; ESCHAR; EXANTHEM; FUNGAL AND YEAST INFECTIONS; HAND, FOOT AND MOUTH DISEASE; HERPES GENITALIS; HERPES SIMPLEX; HERPES ZOSTER; IMPETIGO; INTERTRIGO; KELOID; KERATOSIS; LARVA MIGRANS; LICHEN; LUPUS; MADURA FOOT; MELANOMA; MILIARIA; MOLLUSCUM CONTAGIOSUM; MOLE; MYCOSIS FUNGOIDES; NAEVUS; ORF; PEDICULOSIS; PEMPHIGUS; PHOTOCHEMOTHERAPY; PHOTODERMATOSES; PITYRIASIS; PORPHYRIAS; PRURITUS; PSORIASIS; RINGWORM; ROSACEA; SARCOIDOSIS; SCABIES; SCLERODERMA; URTICARIA; VITILIGO; WARTS; XANTHOMATA.
Skin cancer Primary cancer is common and chronic exposure to ultraviolet light is the most important cause. BASAL CELL CARCINOMA is the most common form; squamous cell carcinoma is less common and presents as a growing, usually painless nodule which may ulcerate. Squamous cancer may spread to regional lymph glands and metastasise, unlike basal cell cancer. Occupational exposure to chemical carcinogens may cause squamous carcinoma – for example, cancer from pitch warts or the scrotal carcinoma of chimney sweeps exposed to coal dust in earlier centuries. Squamous carcinoma of the lip is associated with clay-pipe smoking.
Cancer may arise from the population of melanocytes of the skin (see MELANOCYTE; MELANOMA).
Apart from these three most frequent forms of skin cancer, various forms of cancer can arise from cells of the dermis, of which LYMPHOMA is the most important (see also MYCOSIS FUNGOIDES).
Lastly, secondary deposits from internal cancer, particularly from the breast, may metastasise to the skin.
Dermatitis and eczema These are broadly synonymous, and the terms are frequently interchangeable. Eczema is a pattern of in?ammation with many potential causes. Dermatitis is commonly used to suggest an eczema caused by external factors; it is a common pattern of in?ammation of the skin characterised by redness and swelling, vesiculation (see VESICLE), and scaling with intense itching and often exudation (weeping). Fissuring, thickening (licheni?cation – see LICHEN) and secondary bacterial infection may follow. Dermatitis can affect any part of the body. It may be genetically detemined or due to other ‘internal’ factors, such as venous HYPERTENSION in a leg, or stress. Often it is ‘external’ in origin – due to strong irritants or chemical allergens. (See also ALLERGY; ALLERGEN.) ATOPIC DERMATITIS is genetic in origin and usually begins in infancy. It may persist for years, and ASTHMA, allergic RHINITIS and conjunctivitis (see under EYE, DISORDERS OF) – ‘hay fever’ – may be associated. Atopic children tend to have multiple allergies, especially to inhaled allergens such as house-dust mite, cat and dog dander and pollens. Allergy to foods is less common but potentially more dangerous, especially if to nuts, when it can cause acute URTICARIA or even ANAPHYLAXIS. Atopic subjects are particularly prone to persistent and multiple verrucae (see WARTS) and mollusca (see MOLLUSCUM CONTAGIOSUM) and to severe HERPES SIMPLEX infections. (See also ATOPY.)
EXFOLIATE DERMATITIS (PITYRIASIS RUBRA)
Generalised exfoliation and scaling of the skin, commonly with ERYTHEMA. Drugs may cause it, or the disorder may be linked with other skin diseases such as benign dermatoses and lupus erythematosus (see under LUPUS). SUMMER POMPHOLYX is an acute vesicular eczema of the palms and soles recurring every summer. Inhaled allergens are a frequent cause. VENOUS (STASIS) DERMATITIS begins on a lower calf, often in association with PURPURA, swelling and sometimes ulceration. Chronic venous hypertension in the leg, consequent on valvular incompetence in the deep leg veins owing to previous deep vein thrombosis (see VEINS, DISEASES OF), is the usual cause. NEURODERMATITIS A pattern of well-de?ned plaques of licheni?ed eczema particularly seen on the neck, ulnar forearms or sides of the calves in subjects under emotional stress. IRRITANT CONTACT DERMATITIS Most often seen in an industrial setting (occupational dermatitis), it is due to damage by strong chemicals such as cutting oils, cement, detergents and solvents. In almost all cases the hands are most severely affected. ALLERGIC CONTACT DERMATITIS, in contrast, can affect any part of the body depending on the cause – for example, the face (cosmetics), hands (plants, occupational allergens) or soles (rubber boots). Particularly common allergens include metals (nickel and chromate), rubber addititives, and adhesives (epoxy resins).
Treatment Avoidance of irritants and contact allergens, liberal use of EMOLLIENTS, and topical application of corticosteroid creams and ointments (see CORTICOSTEROIDS) are central.... skin, diseases of
Fibrous covering disclosing agents Dyes that make the plaque deposits on teeth more visible so that they can be seen and removed. discoid lupus erythematosus A form of the chronic autoimmune disorder lupus erythematosus.... disc, intervertebral
This is usually performed consciously to obtain emotional relief in a manner that will not cause harm to oneself or to another person.
Some psychotherapists believe that displacement is an unconscious defence mechanism, which prevents disturbing feelings from entering consciousness.... displacement activity
Kyphosis is a backward curvature of the spine causing a hump back. It may be postural and reversible in obese people and tall adolescent girls who stoop, but it may also be ?xed. Scheuermann’s disease is the term applied to adolescent kyphosis. It is more common in girls. Senile kyphosis occurs in elderly people who probably have osteoporosis (bone weakening) and vertebral collapse.
Disc degeneration is a normal consequence of AGEING. The disc loses its resiliance and becomes unable to withstand pressure. Rupture (prolapse) of the disc may occur with physical stress. The disc between the fourth and ?fth lumbar vertebrae is most commonly involved. The jelly-like central nucleus pulposus is usually pushed out backwards, forcing the annulus ?brosus to put pressure on the nerves as they leave the spinal canal. (See PROLAPSED INTERVERTEBRAL DISC.)
Ankylosing spondylitis is an arthritic disorder of the spine in young adults, mostly men. It is a familial condition which starts with lumbar pain and sti?ness which progresses to involve the whole spine. The discs and ligaments are replaced by ?brous tissue, making the spine rigid. Treatment is physiotherapy and anti-in?ammatory drugs to try to keep the spine supple for as long as possible.
A National Association for Ankylosing Spondylitis has been formed which is open to those with the disease, their families, friends and doctors.
Spondylosis is a term which covers disc degeneration and joint degeneration in the back. OSTEOARTHRITIS is usually implicated. Pain is commonly felt in the neck and lumbar regions and in these areas the joints may become unstable. This may put pressure on the nerves leaving the spinal canal, and in the lumbar region, pain is generally felt in the distribution of the sciatic nerve – down the back of the leg. In the neck the pain may be felt down the arm. Treatment is physiotherapy; often a neck collar or lumbar support helps. Rarely surgery is needed to remove the pressure from the nerves.
Spondylolisthesis means that the spine is shifted forward. This is nearly always in the lower lumbar region and may be familial, or due to degeneration in the joints. Pressure may be put on the cauda equina. The usual complaint is of pain after exercise. Treatment is bed rest in a bad attack with surgery indicated only if there are worrying signs of cord compression.
Spinal stenosis is due to a narrowing of the spinal canal which means that the nerves become squashed together. This causes numbness with pins and needles (paraesthia) in the legs. COMPUTED TOMOGRAPHY and nuclear magnetic resonance imaging scans can show the amount of cord compression. If improving posture does not help, surgical decompression may be needed.
Whiplash injuries occur to the neck, usually as the result of a car accident when the head and neck are thrown backwards and then forwards rapidly. This causes pain and sti?ness in the neck; the arm and shoulder may feel numb. Often a support collar relieves the pain but recovery commonly takes between 18 months to three years.
Transection of the cord occurs usually as a result of trauma when the vertebral column protecting the spinal cord is fractured and becomes unstable. The cord may be concussed or it may have become sheared by the trauma and not recover (transected). Spinal concussion usually recovers after 12 hours. If the cord is transected the patient remains paralysed. (See PARALYSIS.)... spine and spinal cord, diseases and injuries of
Types of dissociative disorder include hysterical amnesia (see hysteria), fugue, depersonalization, and multiple personality.
(See also conversion disorder.)... dissociative disorders
Habitat: Western Ghats at low elevations.
English: Eve's Apple, Forbidden Fruit.Siddha/Tamil: Kandalaippalai, Kattalari-palai.Folk: Tengari (Var.).Action: Seed, leaves, bark— purgative. Latex—cathartic.
The fruit gave the alkaloid, coronaridine. Root bark gave alkaloids— heyneanine and voacristine hydrox- yindolenine. The petroleum ether-ex- tractable alkaloids of the fruit showed CNS depressant and hypotensive activities.Tabernaemontana heyneana Wall., synonym, Ervatamia heyneana Cooke is also equated with Tengari of Indian medicine.The wood and stembark yielded indole alkaloids; ursolic acid, beta-amy- rin andbeta-amyrin acetate. A number of alkaloids showed cytotoxic activity. (Phytochemistry, 19,1980.)... tabernaemontana dichotomaHabitat: Throughout in river beds and near sea-coasts in Tamil Nadu.
Ayurvedic: Maachikaa (related species).Siddha/Tamil: Nirumari.Folk: Jhaau. Galls—Maayin.Action: Twigs and galls—astringent. Tannin content—leaves 8%, twig- bark 10%, galls 50%.
The leaves gave tamarixetin, kaemp- feride, quercetiin and D-mannitol. Aerial parts contain trans-2-hydroxy- methoxycinnamic acid and isorham- netin. Hexane extract gave hentriacon- tan-7-ol.The flavones (tamaridone and tama- done) have also been isolated from ethanolic extract, along with hexaco- syl-p-coumarate, gardenin, nevaden- sin and apigenin. Gardenin B exhibited antiviral and anti-invasive activity against solid tumours.... tamarix dioicaHydrocoele is a collection of ?uid distending one or both sides of the scrotum with ?uid. Treatment is by withdrawal of the ?uid using a sterile syringe and aspiration needle.
Hypogonadism Reduced activity of the testes or ovaries (male and female gonads). The result is impaired development of the secondary sexual characteristics (growth of the genitals, breast and adult hair distribution). The cause may be hereditary or the result of a disorder of the PITUITARY GLAND which produces GONADOTROPHINS that stimulate development of the testes and ovaries.
Varicocoele is distension of the veins of the spermatic cord, especially on the left side, the causes being similar to varicose veins elsewhere (see VEINS, DISEASES OF). The chief symptom is a painful dragging sensation in the testicle, especially after exertion. Wearing a support provides relief; rarely, an operation may be advisable. Low sperm-count may accompany a varicocele, in which case surgical removal may be advisable.
Orchitis or acute in?ammation may arise from CYSTITIS, stone in the bladder, and in?ammation in the urinary organs, especially GONORRHOEA. It may also follow MUMPS. Intense pain, swelling and redness occur; treatment consists of rest, support of the scrotum, analgesics as appropriate, and the administration of antibiotics if a de?nitive microorganism can be identi?ed. In some patients the condition may develop and form an ABSCESS.
Torsion or twisting of the spermatic cord is relatively common in adolescents. About half the cases occur in the early hours of the morning during sleep. Typically felt as pain of varying severity in the lower abdomen or scrotum, the testis becomes hard and swollen. Treatment consists of immediate undoing of the torsion by manipulation. If done within a few hours, no harm should ensue; however, this should be followed within six hours by surgical operation to ensure that the torsion has been relieved and to ?x the testes. Late surgical attention may result in ATROPHY of the testis.
Tuberculosis may occur in the testicle, especially when the bladder is already affected. Causing little pain, the infection is often far advanced before attracting attention. The condition generally responds well to treatment with a combination of antituberculous drugs (see also main entry for TUBERCULOSIS).
Tumours of the testes occur in around 600 males annually in the United Kingdom, and are the second most common form of malignant growth in young males. There are two types: SEMINOMA and TERATOMA. When adequately treated the survival rate for the former is 95 per cent, while that for the latter is 50 per cent.
Injuries A severe blow may lead to SHOCK and symptoms of collapse, usually relieved by rest in bed; however, a HAEMATOMA may develop.... testicle, diseases of
Ankyloglossia or tongue-tie is a rare disorder in which the frenum or band connecting the lower surface of the tongue to the ?oor of the mouth is so short or tight that the tongue cannot be protruded. Surgery can remedy the defect. It is easy to overdiagnose and is not a common cause of di?culty in feeding at birth or speech defects in infancy.
Gross enlargement of the tongue can make speech indistinct or make swallowing and even breathing di?cult. This is known as macroglossia and may be such that the tongue is constantly protruded from the mouth. The cause may be CONGENITAL, as in severe cases of DOWN’S (DOWN) SYNDROME, or it may occur as a result of ACROMEGALY or be due to abnormal deposits as in AMYLOIDOSIS.
A marked tremor of the tongue when protruded may be seen in various neurological diseases, but may be caused by alcoholism.
After a STROKE involving the motor nerve centre, the control of one side of the tongue musculature will be lost. This will result in the protruded tongue pointing to the side of the body which is paralysed. The sense of taste on one side of the tongue may also be lost in some diseases of the brain and facial nerve.
The presence of fur on the tongue may be obvious and distressing. This is due to thickening of the super?cial layers of the tongue which may appear like hairs which trap food debris and become discoloured. Furring is common during fever and as a result of mouth-breathing and smoking.
In some conditions the tongue may appear dry, red and raw (GLOSSITIS). An in?amed beefy tongue is characteristic of pellagra, a disease caused by de?ciency of NICOTINIC ACID in the diet. A magenta-coloured tongue may be seen when there is a lack of RIBOFLAVIN.
Ulcers of the tongue are similar to those elsewhere in the mouth. The most common are aphthous ulcers which are small, red and painful and last for about ten days. They are associated with stress, mild trauma (such as from jagged teeth), and occasionally with folic acid and vitamin B12 de?ciency. Ulcers of the tongue are sometimes found in patients with chronic bowel disease.... tongue, disorders of
Growth in an abnormal direction may be due to injury to the lid or, more commonly, to infection.
Severe blepharitis may destroy the roots of the lashes.
Trachoma, an infection in which the lid is distorted by scarring, may lead to trichiasis.
With age, the lashes become finer and fewer.... eyelashes, disorders of
Habitat: Warmer regions of India, particularly in Uttar Pradesh. Bihar, West Bengal and Assam.
English: Patol, Pointed Gourd.Ayurvedic: Patola, Kulaka, Raa- jiphala, Karkashchhada, Karkasha, Bijagarbha.Unani: Parwal.Siddha: Kommu Patolia.Action: Aerial parts—hypogly- caemic. Fruits—juice of unripe fruits used in spermatorrhoea. Leaves—febrifuge; prescribed as a diet in enlargement of liver and spleen; piles and fistula. Root— cathartic, febrifuge.
The fruits contain free amino acids, nicotinic acid, riboflavin, vitamin C, thiamine, 5-hydroxytryptamine. Mature plant and root gave cucurbita-5, 24-dienol. Colocynthin, trichosan- thin, hentriacontane have been isolated from the root.Fatty acids from the seeds comprise elaeostearic, linoleic, oleic and saturated acids.The whole fruit and pulp produced significant hypocholesterolaemic, hy- potriglyceridaemic and hyper-phos- pholipidaemic effects in normal and midly diabetic human subjects.Extracts of seeds exhibit haemagglu- nating activity.Dosage: Leaf—10-2 ml juice. (CCRAS.)... trichosanthes dioicaThere is no apparent cause for a factitious disorder other than a wish for attention.
The most common disorder of this type, Munchausen’s syndrome, is characterized by physical symptoms.
In a second form, Ganser’s syndrome, there are psychological symptoms.
These disorders differ from malingering, in which the person claims to be ill for a particular purpose, such as obtaining time off work.... factitious disorders
(See also fibroadenosis).... fibrocystic disease
(See diabetic pregnancy.)... gestational diabetes
Urethritis is in?ammation of the urethra from infection.
Causes The sexually transmitted disease GONORRHOEA affects the urethra, mainly in men, and causes severe in?ammation and urethritis. Non-speci?c urethritis (NSU) is an in?ammation of the urethra caused by one of many di?erent micro-organisms including BACTERIA, YEAST and CHLAMYDIA.
Symptoms The classic signs and symptoms are a urethral discharge associated with urethral pain, particularly on micturition (passing urine), and DYSURIA.
Treatment This involves taking urethral swabs, culturing the causative organism and treating it with the appropriate antibiotic. The complications of urethritis include stricture formation.
Stricture This is an abrupt narrowing of the urethra at one or more places. Strictures can be a result of trauma or infection or a congenital abnormality from birth. Rarely, tumours can cause strictures.
Symptoms The usual presenting complaint is one of a slow urinary stream. Other symptoms include hesitancy of micturition, variable stream and terminal dribbling. Measurement of the urine ?ow rate may help in the diagnosis, but often strictures are detected during cystoscopy (see CYSTOSCOPE).
Treatment The traditional treatment was the periodic dilation of the strictures with ‘sounds’
– solid metal rods passed into the urethra. However, a more permanent solution is achieved by cutting the stricture with an endoscopic knife (optical urethrotomy). For more complicated long or multiple strictures, an open operation (urethroplasty) is required.... urethra, diseases of and injury to
Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).
Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.
Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.
Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.
Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.
Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).
Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.
Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.
Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of
Symptoms. Vulva or penis swollen and itching. Neuritis of the eye with possible ensuing blindness. A specific disease unrelated to herpes simplex which it resembles. There is no evidence that it is venereal. Basic pathology is inflammation of the veins, arteries and capillaries (Nettles). Thrombosis is possible (Hawthorn).
Treatment. Tea. (1) Nettles. Or (2): place half an ounce Burdock root in 1 pint water; simmer gently 20 minutes: Add 1oz Nettles. Allow to steep for further 15 minutes. Dose: 1 cup thrice daily.
Tablets/capsules. Kelp, Echinacea, Blue Flag.
Tinctures. Combine Echinacea 2; Goldenseal three-quarters; Myrrh quarter. Dose: 1-2 teaspoons in water thrice daily.
Practitioner. Tincture Colchicum BP 1973.
Topical. Bathe with dilute cider vinegar. Cold tea. Garlic ointment. Tea Tree oil diluted many times. Houseleek.
Eyedrops. Goldenseal eyedrops.
Diet. Avoid hot peppery foods, fried foods.
Low-salt. Regular raw food days.
Supplementation. Vitamin E: 500-1000iu daily. Vitamin B-complex. Calcium and Magnesium. Avoid: scented soap, talcum powder, wool (alternatives: cotton briefs, open gusset tights). Information: Bechet’s Syndrome Society, 3 Belgrave Street, Haxby Road, York Y03 7YY. ... bechet’s disease
Species causing disorders include the scabies mite, which burrows in human skin causing intense itching; the housedust mite, which can cause asthma when inhaled in dust; and chiggers (American harvest mites), which are found in thick grass and cause an itchy rash when they bite. Mites in grain or fruit may cause skin irritation, sometimes known as grocers’ or bakers’ itch.Certain mites transmit diseases, particularly scrub typhus and rickettsial pox.... mites and disease
Bleeding from the nose (see nosebleed) is usually caused by injury or a foreign body in the nose.
A discharge of cerebrospinal fluid from the nose may follow a fracture at the base of the skull.... nasal discharge
The operation is commonly part of the treatment of cancer of the tongue, tonsils, or other structures in the mouth and throat.... neck dissection, radical
Habitat: North-western Himalaya from Kashmir to Simla at 2,4003,600 m.
English: Stinging Nettle.Ayurvedic: Vrishchhiyaa-shaaka (related species).Unani: Anjuraa.Folk: Shisuun (Kumaon).Action: Plant—diuretic, astringent, antihaemorrhagic; eliminates uric acid from the body, detoxifies the blood. Externally, astringent and haemostatic.
Used internally for the treatment of nephritis, haemoptysis and other haemorrhages.Key application: Above ground parts—as a supportive therapy for rheumatic ailments (internally and externally). Internally, in irrigation therapy for inflammatory diseases of the lower urinary tract and prevention and treatment of kidney gravel. (German Commission E, ESCOP, The British Herbal Compendium, The British Herbal Pharmacopoeia.) Root—in symptomatic treatment of micturition disorders (dysuria, pol- lakiuria, nocturia, urine retention) in benign prostatic hyperplasia at stages I and II. (German Commission E, ESCOP, WHO, The British Herbal Pharmacopoeia.)Clinical experiments have confirmed the utility of the herb as a haemostatic in uterine haemorrhage and bleeding from nose. The herb is also used in sciatica, rheumatism and palsy. The treatment for paralysis comprises slapping the patient with a bundle of twigs. Alcoholic extract of Russian sp. is used in the cholecystitis and habitual constipation.The root exhibits an antiprolifera- tive effect on prostatic epithelial and stromal cells. It may also lessen the effects of androgenic hormones by competitively blocking acess to human sex hormone binding globulin. (Planta Med, 63, 1997; ibid, 66, 2000. Also, ESCOP monograph; Altern Complem Ther, 1998; Simon Mills; Natural Medicines Comprehensive Database, 2007.)In Europe, the juice of the leaves or roots, mixed with honey or sugar, was prescribed forbronchial asthma. In the USA, a freeze-dried preparation of the herb (300 mg gelatin capsules) has been found to improve condition of allergic rhinitis patients. The powdered seeds were considered a cure for goitre. (M. Grieve.)The urticating properties of the hairs are attributed to the presence of acetyl- choline, histamine and 5-hydroxytryp- tamine (5-HT). A histamine-liberating enzyme is also present.Acetylcholine is present in the leaves, rootlets, rhizomes and cortex in the ascending order of concentration. Histamine is not present in the underground parts of the plant. Its concentration in the leaves is about four times than that in the stem-cortex. Betaine and choline are present in the leaves.The leaves gave flavonoids (including rutin), sterols, carotenoids, vitamins (including C, B group, K), minerals, plant phenolic acids. The coumarin scopoletin has been isolated from the flowers and the root.A polysaccharide fraction obtained from aqueous extract showed anti- inflammatory activity in carrageenan- induced rat paw oedema and lymphocyte transformation test. A lectin was found to stimulate proliferation of human lymphocytes. (Planta Med, 55, 1989.)The leaf and root is contraindicat- ed in kidney disease and pregnancy. 5-hydroxytryptamine is a uterotropic constituent. (Francis Brinker.)... urtica dioicaComfrey decoction. 1 heaped teaspoon to cup water gently simmered 5 minutes; strain when cold; 1 cup – to which is added 20 drops Tincture Calendula (Marigold), thrice daily. Fenugreek seeds may be used as an alternative to Comfrey.
Alternative:– Mixture: equal parts liquid extracts: Comfrey, Marigold, St John’s Wort. One teaspoon in water or honey thrice daily.
Tablets/capsules. Fenugreek, St John’s Wort.
Topical. Comfrey, Fenugreek or Horsetail poultice.
Supplements. Vitamin A, C, E. Dolomite, Zinc.
Supportive. Exposure of site to sunlight.
Comfrey. The potential benefit of Comfrey root outweighs possible risk for bone disorders. ... bone disorders
The best known of these neurocutaneous disorders is neurofibromatosis, in which there are brown patches on the skin and numerous fibrous nodules on the skin and nerves. Another example is tuberous sclerosis, which is characterized by small skin-coloured swellings over the cheeks and nose, mental deficiency, and epilepsy.... neurocutaneous disorders
Typically, a child shows hostile, argumentative behaviour that includes loss of temper, defiance of rules, and swearing.
To some extent such behaviour is common in adolescence, but when law-breaking or violence occur the condition is deemed to be pathological.... oppositional defiant disorder
Varicose veins are dilated tortuous veins occurring in about 15 per cent of adults – women more than men. They most commonly occur in the legs but may also occur in the anal canal (HAEMORRHOIDS) and in the oesophagus (due to liver disease).
Normally blood ?ows from the subcutaneous tissues to the super?cial veins which drain via perforating veins into the deep veins of the leg. This ?ow, back towards the heart, is aided by valves within the veins. When these valves fail, increased pressure is exerted on the blood vessels leading to dilatations known as varicose veins.
Treatment is needed to prevent complications such as ulceration and bleeding, or for
cosmetic purposes. Treatment alternatives include injection with sclerosing agents to obliterate the lumen of the veins (sclerotherapy), or surgery; in the elderly or un?t, an elastic stocking may su?ce. One operation is the Trendelenburg operation in which the saphenous vein is disconnected from the femoral vein and individual varicose veins are avulsed. (See also VASCULITIS.)
Thrombosis Thrombosis occurs when blood, which is normally a liquid, clots within the vein to form a semisolid thrombus (clot). This occurs through a combination of reduced blood ?ow and hypercoagulability (a reduced threshold for clotting). The most common site for this to occur is in the deep veins of the leg, where it is known as a deep-vein thrombosis (DVT).
Predisposing factors include immobility (leading to reduced blood ?ow), such as during long journeys (e.g. plane ?ights) where there is little opportunity to stretch one’s legs; surgery (leading to temporary post-operative immobility and hypercoagulability of blood); oestrogen administration (low-dose oestrogen oral contraceptives carry a very low relative risk); and several medical illnesses such as heart failure, stroke and malignancy.
Deep-vein thrombosis presents as a tender, warm, red swelling of the calf. Diagnosis may be con?rmed by venogram (an X-ray taken following injection of contrast medium into the foot veins) or by ultrasound scanning looking for ?ow within the veins.
Prevention is important. This is why patients are mobilised and/or given leg exercises very soon after an operation, even major surgery. People should avoid sitting for long periods, particularly if the edge of the seat is hard, thus impeding venous return from the legs. Car drivers should stop regularly on a long journey and walk around; airline travellers should, where possible, walk round the aisle(s) and also exercise and massage their leg muscles, as well as drinking ample non-alcoholic ?uids.
Diagnosis and treatment are important because there is a risk that the clotted blood within the vein becomes dislodged and travels up the venous system to become lodged in the pulmonary arteries. This is known as PULMONARY EMBOLISM.
Treatment is directed at thinning the blood with ANTICOAGULANTS, initially with heparin and subsequently with WARFARIN for a period of time while the clot resolves.
Blocked super?cial veins are described as super?cial thrombophlebitis, which produces in?ammation over the vein. It responds to antiin?ammatory analgesics. Occasionally heparin and ANTIBIOTICS are required to treat associated thrombosis and infection.... veins, diseases of
Abscess, Alzheimer’s Disease, anoxia (oxygen starvation), coma, concussion, haemorrhage, Down’s syndrome, epilepsy, tumour, hydrocephalus (water on the brain), meningitis, multiple sclerosis, stroke (rupture of blood vessel), spina bifida, syphilis (general paralysis of the insane), sleepy sickness.
Poor circulation through the brain due to hardening of the arteries: Ginkgo, Ginseng. Ginseng stimulates the hypothalmic/pituitary axis of the brain and favourably influences its relationship with the adrenal glands.
Congestion of the brain – Cowslip (Boerwicke). Irritability of brain and spine – Hops. Oats. Inflammation of the brain (encephalitis) as in viral infection, poliomyelitis, rabies, sleepy sickness, etc: Echinacea, Passion flower, Skullcap and Lobelia. Gelsemium acts as a powerful relaxant in the hands of a practitioner: Tincture BPC (1973): dose 0.3ml.
Brain storm from hysteria, locomotor ataxia, etc – Liquid Extract Lobelia: 5ml teaspoon in water when necessary (Dr Jentzsch, 1915, Ellingwood) Supplement with Zinc, Vitamins C and E.
Blood clot, thrombosis: Yarrow. Neurasthenia: Oats, Basil, Hops.
Brain fag and jet-lag: Chamomile, Skullcap, Oats, Ginseng, Ginkgo.
Tumour may be present years before manifesting: Goldenseal.
Mental state: depression, anxiety, schizophrenia.
Tea. Formula. Skullcap, Gotu Kola and German Chamomile; equal parts. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Strain. 1 cup thrice daily.
Unspecified tensive state. Formula. Tinctures. Hops 1; Passion flower 2; Valerian 2. Dose: 2 teaspoons thrice daily until diagnosis is concluded.
Unspecified torpor. Formula. Tinctures. Ginseng 1; Kola 1; Capsicum quarter. 2 teaspoons in water thrice daily until diagnosis is concluded.
Brain weakness in the elderly: Ginkgo. See: ALZHEIMER’S DISEASE.
Fluid on the brain: see HYDROCEPHALUS.
Abscess of the brain: see ABSCESS.
Brain restoratives. Black Haw, True Unicorn root, Galangal, Oats, Oatstraw, False Unicorn root, Kola, Hops. Vitamin B6. Magnesium.
Cerebral thrombosis. See entry.
Note: Cold water may help victims to survive: rapid loss of body heat protects the brain. (Child Health Department, University of Wales)
Treatment by or in liaison with general medical practitioner or hospital specialist. ... brain disorders
When the discharge is yellow, indicating pus, an infection is suspected which may develop into an abscess. Herbal treatment can be effective but if, after a week, the condition has not improved surgical exploration may be necessary to remove the affected duct.
Alternatives. Clivers, Goldenseal, Fenugreek, Marigold, Poke root, Queen’s Delight, Wild Indigo. Taken as tea, powder, liquid extract or decoction.
Tea. Formula. Equal parts: Red Clover, Clivers, Gotu Kola. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup thrice daily.
Powders. Formula. Wild Indigo 1; Echinacea 2; Poke root 1. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Tinctures. Formula. Echinacea 2; Goldenseal 1; Poke root 1. Dose: 30-60 drops thrice daily.
Topical – for sore nipples. Wheatgerm oil, Evening Primrose oil. Lotions: Goldenseal, Marigold, distilled extract of Witch Hazel. Nipples to be washed before a child is again put to the breast. Cracked nipples: Comfrey – pulp from fresh plant, or equal parts powder and milk as a paste.
Minerals: magnesium, zinc. ... breasts, nipples, discharge
The disease resembles eczema and can cause itching and a burning feeling.
A non-healing sore may develop.
Without treatment, the tumour may spread into the breast.
Diagnosis is made with a biopsy.... paget’s disease of the nipple
The disease is a type of osteochondritis juvenilis, thought to be due to disrupted blood supply to the bone.
The condition is most common in boys aged 5–10, and usually affects 1 hip.
Symptoms include pain in the thigh and groin, and a limp on the affected side.
Diagnosis is made with X-rays.
Treatment may be rest for a few weeks, followed by splinting of the hip, or surgery.
The disease usually clears up by itself within 3 years, but the hip may be permanently deformed.... perthes’ disease
Acute toxic nephritis is possible in the convalescent stage of scarlet and other infectious fevers, even influenza. Causes are legion, including septic conditions in the ear, nose, throat, tonsils, teeth or elsewhere. Resistance to other infections will be low because of accumulation of toxins awaiting elimination. When protein escapes from the body through faulty kidneys general health suffers.
This condition should be treated by or in liaison with a qualified medical practitioner.
Treatment. Bedrest essential, with electric blanket or hot water bottle. Attention to bowels; a timely laxative also assists elimination of excessive fluid. Diuretics. Diaphoretics. Abundant drinks of bottled water or herb teas (3-5 pints daily). Alkaline drinks have a healing effect upon the kidneys. Juniper is never given for active inflammation.
Useful teas. Buchu, Cornsilk, Couchgrass, Clivers, Bearberry, Elderflowers, Marshmallow, Mullein, Marigold flowers, Wild Carrot, Yarrow.
Greece: traditional tea: equal parts, Agrimony, Bearberry, Couchgrass, Pellitory.
Powders. Equal parts: Dandelion, Cornsilk, Mullein. Dose: 750mg (three 00 capsules or half teaspoon) every 2 hours. In water or cup of Cornsilk tea.
Tinctures. Equal parts: Buchu, Elderflowers, Yarrow. Mix. Dose: 1-2 teaspoons in water or cup of Cornsilk tea, every two hours.
Topical. Hot poultices to small of the back; flannel or other suitable material saturated with an infusion of Elderflowers, Goldenrod, Horsetail or Yarrow. Herbal treatment offers a supportive role. ... bright’s disease (acute)
The immune system is the body’s internal defence armoury which protects from sickness and disease. White blood cells are influenced by the thymus gland and bone marrow to become “T” lymphocytes or “B” lymphocytes which absorb and destroy bacteria. There are times when these powerful defence components inflame and attack healthy tissue, giving rise to auto immune disease which may manifest as one of the numerous anaemic, rheumatic or nervous disorders, even cancer.
A watchful eye should be kept on any sub-acute, non-specific inflammation going on quietly over a long period – a certain indication of immune-inadequacy. It would appear that some unknown body intelligence operates behind the performance of the immune system; emotional and physic stresses such as divorce or job dissatisfaction can lead to a run-down of body defences. Some psychiatrists believe it to be a self-produced phenomenon due to an unresolved sense of guilt or a dislike of self. When this happens, bacterial, virus or fungus infections may invade and spread with little effective opposition. People who are happy at their home and work usually enjoy a robust immune system.
An overactive immune system may develop arthritis with painful joint inflammation, especially with a background of a fat-rich diet. A link between silicone implants and auto-immune disease is suspected.
“There is increasing evidence,” writes Dr D. Addy, Consulting Pediatrician, “that fevers may enhance the defence mechanism against infection.” (See: FEVER) “There is also increasing evidence of a weakening of the immune system through suppression of fevers by modern drugs. In this way, aspirin and other powerful anti-inflammatories may be responsible for feeble immune response.”
White cell stimulators: Liquorice, Ginseng (Siberian), Goldenseal, Echinacea. These increase ability of white blood cells to attack bacteria and invading cells. Chinese medicine: Ginseng (men), Chinese Angelica (women).
Treatment. To strengthen body defences. Garlic, Borage, Comfrey, Agrimony, Balm, Chamomile (German), Echinacea, Horsetail, Liquorice, Lapacho, Sage, Wild Yam, Wild Indigo, Poke root, Thuja. Shiitake Mushroom. Reishi Mushroom, Chlorella..
Tea. Combine, equal parts, St John’s Wort, Borage, Chamomile (German). 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.
Powders. Combine, Echinacea 4; Comfrey root 2; Wild Yam 1. 500mg (two 00 capsules, or one-third teaspoon) thrice daily.
Tinctures. Combine, Echinacea 4; Poke root 1; Thuja 1. 1-2 teaspoons in water thrice daily.
Tincture: Tincture Myrrh BPC 1973: 5-10 drops in water, morning and evening.
Decoctions. Horse-radish. Fenugreek seeds.
Bio-strath. Yeast-based herbal tonic. Exerts a positive influence on the immune system by rapid and marked increase in white blood cells.
Diet. Foods rich in essential fatty acids: nuts, seeds, beans, pulses, Evening Primrose oil, Cod Liver oil flavoured with mint or lemon. High protein: eggs, fish. (Low protein – acute stage). Foods rich in selenium. Yoghurt, cider vinegar, pineapple juice. Sugar has an immune suppressing effect.
Supplements. To rebuild immune system. Vitamins A, B5, B6, C, D, E. Zinc is required to produce histamine which is a vasodilator. Combination: zinc, selenium and GLA. Iron. Calcium.
Aromatherapy. Lavender oil: massage or baths.
Note: An alleged link exists between silicone implants and auto-immune disease. A new study reveals evidence that women with silicone breast implants who breast-feed their children put them at risk of developing systemic sclerosis. (JAMA Jan 19 1994) ... auto immune disease
A constant fear is the onset of uraemia caused by accumulation in the blood of waste by-products of protein digestion, therefore the patient should reject meat in favour of fish. Eggs and dairy products taken in strict moderation.
Where urea accumulates in the circulation ‘sustaining’ diuretics are indicated; these favour excretion of solids without forcing the discharge of more urine: including Shepherd’s Purse, Gravel root, or Uva Ursi when an astringent diuretic is needed for a show of blood in the urine. According to the case, other agents in common practice: Dandelion root, Yarrow, Hawthorn, Marigold, Stone root, Hydrangea. Parsley Piert, Buchu, Hawthorn, Golden Rod.
The patient will feel the cold intensely and always be tired. Warm clothing and ample rest are essential. Heart symptoms require treatment with Lily of the Valley or Broom.
This condition should be treated by or in liaison with a qualified medical practitioner.
Treatment. As kidney damage would be established, treatment would be palliative; efforts being to relieve strain and obtain maximum efficiency. There may be days of total bed-rest, raw foods and quiet. Consumption of fluids may not be as abundant as formerly. Soothing herb teas promote well-being and facilitate elimination. Oil of Juniper is avoided.
Efforts should be made to promote a rapid absorption – to restore the balance between the circulation and the lymphatics. For this purpose Mullein is effective. A few grains of Cayenne or drops of Tincture Capsicum enhances action.
Indicated. Antimicrobials, urinary antiseptics, diuretics, anti-hypertensives. For septic conditions add Echinacea.
Of Therapeutic Value. Alfalfa, Broom, Buchu, Couchgrass, Cornsilk, Dandelion, Lime flowers, Marigold, Mullein, Marshmallow, Parsley Piert, Periwinkle (major), Wild Carrot, Water Melon seed tea. Tea. Combine equal parts: Couchgrass, Dandelion, Mullein. 2 teaspoons to each cup boiling water. Infuse 5-15 minutes. 1 cup freely.
Powders. Combine equal parts: Stone root, Hydrangea, Hawthorn. Dose: 500mg (two 00 capsules or one-third teaspoon) 3 or more times daily in water or cup Cornsilk tea. A few grains Cayenne enhances action. Formula. Buchu 2; Mullein 2; Echinacea 1; Senna leaves half. Mix. Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or cup Cornsilk tea 3 or more times daily. 2-3 drops Tincture Capsicum to each dose enhances action.
Diffusive stimulant for the lymphatic vessels. Onion milk is an effective potassium-conserving diuretic and diaphoretic. Onions are simmered gently in milk for 2 hours and drunk when thirsty or as desired – a welcome alternative to water. May be eaten uncooked.
Diet. Salt-free, low fat, high protein. Spring water. Raw goat’s milk, potassium broth. Fish oils. Avoid eggs and dairy products. No alcohol.
Supplements. Vitamins A, B-complex, C plus bioflavonoids, B6, D, E, Magnesium, Lecithin. Herbal treatment offers a supportive role. ... bright’s disease (chronic)
Alternatives. Cramp bark, Cayenne, Chamomile, Guaiacum, Hops, Meadowsweet, Celery, Prickly Ash, Valerian, Wild Lettuce, Wild Yam. Mistletoe (F. Hyde). White Willow.
Tea. Equal parts: German Chamomile, Hops, Meadowsweet. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes; 1 cup 3 or more times daily.
Tablets/capsules. Chamomile, Mistletoe, Prickly Ash, Ligvites, Wild Yam, Valerian, Kelp.
Alternative formulae:– Powders. Prickly Ash 1; Valerian 1; Cramp bark half; Guaiacum quarter. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Liquid Extracts. White Willow 2; Prickly Ash 1; Celery seeds half; Liquorice quarter; Tincture Capsicum quarter. Mix. 30-60 drops thrice daily.
Tinctures. White Willow 2; Prickly Ash 1; Valerian 1; Meadowsweet 1; Tincture Capsicum quarter. Mix. 2 teaspoons thrice daily.
Topical. Comfrey poultices (Maria Treben). “Three oils.”
Diet. Lacto-vegetarian. Dandelion coffee. Oily fish.
General. Straight knee brace for rigid support. ... charcot’s disease
Most hazards stem from the pressure increase with depth.
Conditions treated include burst lung and decompression sickness.... scuba-diving medicine
Acne is common in adolescents and is partly related to the action of androgen hormones.
Inflammation of the skin occurs in dermatitis, eczema, and skin allergy.
The skin is also vulnerable to injuries such as burns, cuts, and bites (see bites, animal; insect bites).... skin, disorders of the
Other causes requiring specific treatment are: thickening and narrowing of blood vessels, diabetes, Buerger’s disease, Raynaud’s disease (spasm of the arterioles and veins), arteritis. See appropriate entries.
As a protection against these diseases Garlic becomes increasingly popular. Control of blood fats through diet and exercise necessary.
Alternatives. Cayenne, Ginger, Hawthorn berries, Horseradish, Mustard, Prickly Ash bark, Buckwheat, Dandelion, Lime flowers, Mistletoe, Rosemary, Yarrow, Ginkgo.
Tea: Lime flowers, Hawthorn berries, Yarrow. Equal parts. Mix. Ginger, quarter part (or pinch of Red Pepper). Mix. 1-2 teaspoons to each cup water. Bring to boil. Remove vessel when boiling point is reached. Dose: 1 cup 2-3 times daily.
Tablets or capsules: Prickly Ash, Hawthorn, Mistletoe, Ginkgo.
Formula. Hawthorn 2; Yarrow 2; Prickly Ash 1; Ginger quarter. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures 2 teaspoons 2-3 times daily.
Practitioner. Liquid extracts: Hawthorn 2; Lily of the Valley 2; Prickly Ash 1; Tincture Capsicum (one- tenth part). Dose: 30-60 drops in water or honey, 2-3 times daily.
Diet and Supplements. See: DIET – HEART AND CIRCULATION. ... circulatory disorders
Specific learning disabilities include dyslexia and dyscalculia, where there is a problem with mathematics.... specific learning disability
Essential fatty acids have an important role in the function of the nervous system, being closely related to the fatty (myelin) sheath and cell membranes. Disturbance in their metabolism may result in nerve disorder. Thus, vegetable oils of Soya, corn, safflower and sunflower should replace animal fats and dairy products.
Symptoms. Numb, prickling, tickling sensation on the skin, paralysis, incoordination, physical weakness and visual complaints.
Treatment. Indeterminate diagnosis.
Tablets/capsules. Prickly Ash, Black Cohosh, Ginseng, Ginkgo.
Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Black Cohosh, Prickly Ash, Ginseng. Doses. Powders: two 00 capsules or one-third teaspoon, (500mg). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water, honey or fruit juice.
Evening Primrose oil capsules or tablets: two 500mg thrice daily.
Aromatherapy. Rosemary spinal rub: 6 drops Oil Rosemary in 2 teaspoons Almond oil.
Diet. High protein, low fat, oily fish or 2 teaspoons Cod Liver oil daily. Gluten-free diet. Cholesterol- free – avoid milk, meat fat and dairy products. Avoid coffee and other caffeine stimulants. Dandelion coffee.
Supplements. B-complex, B3, B6, B12, C, E. Dolomite, Manganese, Zinc. ... demyelinating diseases
Episodes of diarrhoea range in severity and are due to gastroenteritis.
Attention to hygiene, drinking bottled water, and avoiding ice in drinks can prevent a large proportion of episodes.... traveller’s diarrhoea
Intrinsic stains, within the tooth’s substance, are permanent. Causes include death of the pulp or the removal of the pulp during root-canal treatment and the use of the antibiotic tetracycline in children. Mottling of the tooth enamel occurs if excessive amounts of fluoride are taken during development of the enamel (see fluorosis). Hepatitis during infancy may cause discoloration of the primary teeth. The teeth of children with congenital malformation of the bile ducts may be similarly affected.
Many stains can be covered or diminished with cosmetic dental procedures.... discoloured teeth
Symptoms improve with time and analgesic drugs. However, in severe cases, surgical techniques, such as decompression of the spinal canal or removal of the protruding material and repair of the disc, may be necessary.... disc prolapse
Types of diuretic drug differ markedly in their speed and mode of action. Thiazide diuretics cause a moderate increase in urine production. Loop diuretics are fast-acting, powerful drugs. They are often used as an emergency treatment for heart failure. Potassium-sparing diuretics are used along with thiazide and loop diuretics, both of which may cause the body to lose too much potassium. Carbonic anhydrase inhibitors block the action of the enzyme carbonic anhydrase, which affects the amount of bicarbonate ions in the blood; these drugs increase urine output moderately but are effective only for short periods of time. Osmotic diuretics are used to maintain urine output following serious injury or major surgery.
Diuretic drugs may cause chemical imbalances in the blood.
Hypokalaemia (low blood levels of potassium) is usually treated with potassium supplements or potassium-sparing diuretic drugs.
A diet rich in potassium may be helpful.
Some diuretics raise the blood level of uric acid, increasing the risk of gout.
Certain diuretics increase the blood glucose level, which can cause or worsen diabetes mellitus.... diuretic drugs
Bites from dog fleas are an occasional nuisance. Ticks and mites from dogs, including a canine version of the scabies mite, are other common problems. The fungi that cause tinea infections in dogs can be caught by humans.
Some people become allergic to animal dander (tiny scales from fur or skin). They may, for example, have asthma or urticaria when a dog is in the house. (See also zoonoses.)... dogs, diseases from
(See also gingivitis, acute ulcerative.)... vincent’s disease
Foods containing gluten include: many breakfast cereals, shredded wheat, wheat germ flakes, white and wholemeal bread, cakes, puddings, biscuits, porridge, rye and wheat crispbreads, crumbled fish and meat, semolina, baked beans, macaroni, baby foods, soups in packets and tins, chocolate, cocoa, spaghetti, muesli, custard, sausages, batter, beer, instant coffee, bedtime drinks and all kinds of pasta.
Natural gluten-free foods include maize, peas, millet, Soya, lima beans, rice. Brown rice is the basic cereal food: cornflakes, puffed rice, rice cereals. Millet flakes, sago, tapioca. These may be prepared in skimmed milk. Gluten-free flours and bread. The potato comes into its own in the gluten-free kitchen, especially for thickening soups and casseroles.
One school of medical thought associates certain nerve dyscrasies with nutritional deficiencies, the gluten-free diet being advised for cases of multiple sclerosis, myasthenia gravis, poliomyelitis, syringomyelia, motor neurone disease.
Book. Gluten-Free cooking Recipes for Coeliacs and Others, by Rita Greer. ... diet - gluten-free
1. Starches and sugars are not eaten with protein and acid fruit. Acid fruits should be eaten with protein meals.
2. Sugars, proteins, fats and starches are eaten only in small quantities. Vegetables, salads and fruits should form 80 per cent of the diet – all these are necessary to maintain the alkaline reserve.
3. All refined sugars and starches are avoided.
Example: potatoes or bread are not eaten with meat or fish. Sugar or honey are not used on acid fruits.
Sugar and honey are only compatible with starch fruits such as bananas. There are, however, certain foods that are compatible with all meals: mushrooms, oils, butter, cream, raisins, nuts, milk, egg yolks (the white is one of the most acid foods known).
Dr Hay advised against eating refined or processed foods – white sugar, white flour, etc, and against eating one kind of meal within four hours of a meal of the same kind.
Book: “Food Combining for Health”, by Doris Grant and Jean Joice. (Thorsons)
The Hay Diet has proved beneficial for Crohn’s disease, Colitis, Indigestion, Migraine, Raynaud’s disease, Irritable Bowel Syndrome, Heart disease, Allergies and certain other disturbances. ... diet - the hay diet
Unsaturated fatty acids, as in vegetable oils, should replace animal fats (saturated fatty acids) that increase deposits of cholesterol on the inner coat of arteries and encourage hardening. Vegetable oils contain lecithin – a homogeniser which thins and separates the cholesterol, sweeping it along through the bloodstream and preventing deposits to form on walls of the arteries.
A study on the European population has shown a strong link between oily fish consumption and a reduced risk of heart disease. Populations that eat a lot of fish, such as Greenland Eskimos (about 400g a day) and Japanese fishermen (about 200g a day) have low rates of heart disease.
Another study, by the Leiden University of the Netherlands, has found that men who ate more than 30g of fish per day were less than half as likely to die from coronary heart disease as those who ate no fish. A diet high in fish lowers plasma cholesterol, triglyceride and very low density lipoprotein levels and is of value in the treatment of hyperlipidaemia (abnormally high concentration of fats in the blood).
Indicated: Magnesium-containing foods, lecithin, Evening Primrose oil for gamma linoleic acid which is converted into prostaglandin E1 in the body and helps reduce high blood pressure and prevents platelet clumping. Coffee carries a risk factor and should be taken sparingly – alternatives: herbal teas Rutin, Lime flowers and others as available in bulk or tea-bags. Green grapes.
Supplements, daily: Vitamin C 1g; Vitamin E 400iu; Magnesium 300mg – 450mg for pregnant women and nursing mothers. Iodine. Chromium, Selenium. Garlic tablets/capsules – 2-3 at night.
Flora margarine is high in essential polyunsaturated fats – made from sunflower seed oil. Hay diet: good results reported. ... diet - heart and circulation
Marked floppiness and paralysis occur during the first few months, and affected children rarely survive beyond age 3.
There is no cure for the disease. Treatment aims to keep the affected infant as comfortable as possible.... werdnig–hoffmann disease
Fibre-deficient foods lead to poor elimination of body wastes and constipation, disposing the colon to a toxic state. This induces depression, a coated tongue and tiredness during the day. Such foods bring about a change in the balance of bowel bacterial flora, and form gas which may cause pouches of diverticulitis to develop. One of its less obvious effects is to enhance the risk of tooth and gum disease. Soon calcium is expelled by the urine and the intake of magnesium reduced, thus favouring the development of stone.
All plant material; leaves, stalks, seeds etc contain fibre. High-fibre foods include: whole grains, wholemeal bread, wholemeal flour (100 per cent extraction rate), crispbreads, biscuits (digestive, bran, oatmeal or coconut), raw green salad materials, potatoes boiled in their jackets, breakfast cereals (porridge, muesli, All-Bran, Shredded Wheat), brown rice, bran (2 teaspoons thrice daily; increase if necessary), fresh or dried fruit once or twice daily. ... diet - high fibre
Reject: canned foods (except fruit), packet mixes, all bought cooked meats – sausages, bacon, ham. Cakes containing baking soda, chocolate, toffee, treacle, bought biscuits, kippers and other smoked fish, yeast extracts, chutneys, sauces, excessively salted cheeses, butter and margarine.
Accept: rice, pasta, cereals, home-made cottage cheese, eggs (3 per week), all meats, chicken, poultry, whitefish, shellfish, herring, salmon, unsalted bread, butter, margarine, vegetable oils, restricted milk and cream, all vegetables and fruits, fruit juices, brown sugar, wines.
Excess salt leads to retention of fluid in body tissues and adds to work the heart will perform. ... diet - low salt
The average macrobiotic diet is made up approximately of the proportions: whole grains 45 per cent; vegetables 25 per cent; beans, legumes and seeds 10 per cent; nuts 5 per cent; fruit 5 per cent; seaweeds 5 per cent; poultry 2.5 per cent; fish 2.5 per cent.
Whole grains: wheat, barley, rye, oats, brown rice, buckwheat, millet, corn. Vegetables: green leaves and roots – grown organically. Beans, legumes and seeds: all beans, aduki, lentils, chickpeas. Seeds: sesame, sunflower, etc. Seaweeds: hiziki, wakama, dulse, Carragheen moss, kelp. Very low sugar. Moderate fats and oils. ... diet - macrobiotic
Accept. Goat’s milk, yoghurt, eggs – twice weekly. The high potassium and low salt content of bananas help reduce itching. Lecithin. Oily fish. Purslane is a non-fish source of EPA and suitable for the vegetarian approach. Cottage cheese. Pumpkin seeds as a source of zinc. Dandelion coffee. Artichoke: such as Schoenenberger plant juice. Salad dressing: emulsify 1 teaspoon Cider vinegar to each 2 teaspoons safflower seed oil.
Reject: Fried and greasy foods, pastries, chocolates, sweets, ice cream, spicy foods, seasoning, sausage meats, white flour products, white sugar products, alcoholic drinks, meat from the pig (ham, pork, bacon), peppers, horseradish, condiments. Powdered kelp in place of salt, powdered garlic or celery.
Foods known to contain artificial colours and preservatives. All soft drinks, except those made at home from fresh fruits or raw vegetables; coffee, strong tea, oranges. Cola drinks, chocolate, milk, cream, cheese, whey.
Supplement. Beta carotene.
Study. A flare-up can be caused by nuts, jams, fruits, artificially coloured or flavoured foods. (British Journal of Dermatology, 110, 457, (1984)) ... diet - skin disorders
Eat plenty of fresh fruit and raw vegetables for vitamins and minerals as well as for fibre. As a substitute for mayonnaise use low-fat plain yoghurt. Vegetable fats should replace animal fats: instead of butter – margarine from Sunflower or Safflower oils.
Carbohydrates. At liberty: porridge, muesli, wholemeal bread and wholegrain products, pasta, potatoes, beans, peas, brown rice. These are high in fibre and low in fat. Processed foods should be avoided and those with natural goodness preferred, except for All-Bran which is rich in iron.
Protein. Meat should be taken in small quantities only – turkey, poultry, steamed fish, replace red with grilled lean white meats. Chicken is the most versatile, least expensive and most nutritious of meats. Cottage cheese is low in calories. Food should not be fried but grilled, roasted or baked.
Fluids. Juices, or drinks made with skimmed milk, herb teas. Dandelion coffee. In place of alcohol – carrot, tomato and other fresh vegetable juices.
Reject. Fried foods, white and brown sugar products, honey, sweets, contectionery, jams, biscuits, chocolates, canned fruits, thick soups. Frankfurters, beefburgers, hamburgers, everything from the pig: bacon, ham, pork, lard. Avoid between-meal snacks but chew a carrot or piece of other raw vegetable or fresh fruit.
There is increasing support for a well-balanced vegetarian diet for weight reduction as it contains no animal fats. Protein is preferred from such foods as beans, pulses, nuts, eggs; and calcium from cottage cheese and milk. The Hay Diet also has been found to be frequently effective. ... diet - slimming
Treatment: Once a patient is established on any of the digitalis (Foxglove) drugs it is very difficult to discontinue. Smaller doses are advised in the process of weaning to Lily of the Valley (Convallaria majalis) which has a digitalis-like effect by reversing heart rhythm disorders.
Dosage: dried leaves 60-200mg or by infusion. Liquid Extract, 0.6 to 2ml. Tincture, 0.5 to 1ml. Thrice daily.
Treatment by general medical practitioner or qualified phytotherapist. ... digoxin intoxication
Prominent cyst formations have been reduced, even eliminated by Poke root, internally and externally, though surgery is sometimes indicated. Diuretics influence the kidneys to expel more body fluids and are sometimes helpful to reduce size. Cold water packs may be applied to the affected area two or more times daily, as practical.
Alternatives. Tea. Formula. Equal parts: Ground Ivy, Clivers, Horsetail. One heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup morning and evening.
Poke root. Tablets, powders. Tincture. 5-10 drops in water 3 times daily.
Evening Primrose oil. Two 500mg capsules, 3 times daily. Trials carried out by departments of Surgery at the University of Wales and the University of Dundee found Evening Primrose oil effective and safe. Poultice. Poke root. Horsetail.
Diet. As salt favours retention of fluid in cystic tissue it should be restricted.
Supplements. Daily. Beta carotene; B-complex; B6, Vitamin C 1g; Zinc. Vitamin E contra-indicated.
Treatment by or in liaison with a general medical practitioner. ... fibrocystic breast disease (fbd)
It seems that this common bacteria, in some unknown way, receives a booster by taking on viral DNA. Lungs, liver and stomach may be attacked, while red blood cells are disrupted and their haemoglobin released. Among other conditions caused by streptococcus is the bright red rash of scarlet fever, sinusitis, meningitis and rheumatic fever. Flesh-eater disease may take just twenty hours to kill a man (“galloping gangrene”).
Symptoms. High temperature – body hot, hands and feet freezing cold. ‘Strep’ sore throat (pharyngitis). Bright red skin rash. Pains in arms and legs as if straining a muscle.
Treatment. The disease is resistant to penicillin. Frequent hot lemon drinks well-laced with honey. Tinctures. Echinacea 2; Goldenseal 1; Myrrh half. Dose: 10-20 drops in dessertspoon water or honey, hourly, acute cases.
Treatment by or in liaison with medical practitioner or infectious diseases specialist. ... flesh-eating disease
Symptoms: diarrhoea, abdominal swelling and pain, irritability, inability to gain weight, neuritis, ulcers on tongue and mouth, low blood pressure, debility, lactase-deficiency. Breast-feeding stops coeliac disease.
Alternatives. Tea. Mix, equal parts: Raspberry leaves, Agrimony, Lemon Balm. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup freely.
Tablets/capsules. Goldenseal, Slippery Elm. Calamus. Fenugreek seeds, Papaya. Wild Yam.
Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Sarsaparilla, Wild Yam, Stone root. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons. In water, banana mash or honey, thrice daily.
Papaya (papain) digests wheat gluten and assists recovery. Half-1g with meals.
Aloe Vera juice. Promotes improved bowel motility, increases stool specific gravity, and reduces indication of protein putrefaction, flatulence and bloating after meals. (J. Bland PhD. JAM June 1985, p.11)
Topical. Warm hip baths of Lemon Balm, Chamomile, etc. (Alfred Vogel)
Diet. Gluten-free. Rice. Unpasteurised yoghurt. Buttermilk. Sweet acidophilus milk. Raw carrot juice. Bananas mashed with a little Slippery Elm or dried milk powder, carob bean powder and Soya milk. Supplementation. Vitamins A, B-complex, B6, B12, Folic acid, C, D, E, K (Alfalfa tea). Calcium, Iron and Magnesium orotates. ... gluten-sensitive disease
Treatment. Purpose of medication is to stimulate flow of bile and support the liver.
Arthur Hyde, MNIMH recommends a selection from the following according to individual case: Balmony, Barberry, Dandelion, Goldenseal, Hops, Ladyslipper, Mistletoe, Passion flower, Stone root. Tinctures. Formula. Marigold 2; Barberry 2; Ginkgo 1. Dose: 2 drops in feed, or in water, thrice daily. Infants 3-5 years: 10 drops.
To be treated by or in liaison with a qualified medical practitioner. ... haemolytic disease of infants
Onset: 2-10 days.
Sources of infection: water-cooling and air-conditioning plants, Aerosols.
Usually attacks those with existing lung weakness. Those with low natural resistance and smokers are most at risk. Epidemic or single cases. Diagnosis confirmed by Haematological laboratory.
Symptoms. High body temperature (above 39°C). Rigor. Shivering. Diarrhoea. Dry cough. Bleeding from stomach and intestines. Mental confusion. Chest pains, shortness of breath, occasional diarrhoea. Differential diagnosis. Glandular fever. Other forms of pneumonia.
Indicated: anti-microbials and expectorants.
Treatment. Formula. Pleurisy root 2; Echinacea root 2; Grindelia quarter. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Every 3 hours. Take together with:–
Fenugreek tea. 2 heaped teaspoons seeds to each cup water simmered gently 10 minutes. Drink freely 1 cup. Seeds should be swallowed.
Enema. Strong Yarrow tea enema to control bowel bleeding. ... legionnaire’s disease
A genetic defect causes congenital adrenal hyperplasia, in which the adrenal cortex is unable to make sufficient hydrocortisone and aldosterone, and androgens are produced in excess. In adrenal failure, there is also deficient production of hormones by the adrenal cortex; if due to disease of the adrenal glands, it is called Addison’s disease. Adrenal tumours are rare and generally lead to excess hormone production.
In many cases, disturbed activity of the adrenal glands is caused, not by disease of the glands themselves, but by an increase or decrease in the blood level of hormones that influence the action of the adrenal glands. For example, hydrocortisone production by the adrenal cortex is controlled by ACTH, which is secreted by the pituitary gland. Pituitary disorders can disrupt production of hydrocortisone.... adrenal gland disorders
High alcohol consumption increases the risk of cancers of the mouth, tongue, pharynx (throat), larynx (voice box), and oesophagus, especially if combined with smoking. Incidence of liver cancer, as well as the liver diseases alcoholic hepatitis and cirrhosis, is higher among alcoholics. High alcohol consumption increases the risk of cardiomyopathy, hypertension, and stroke. Alcohol irritates the digestive tract and may cause gastritis. Heavy drinking in pregnancy increases the risk of miscarriage and fetal alcohol syndrome. Alcoholics are more likely to suffer from anxiety and depression and to develop dementia.
Many alcoholics have a poor diet and are prone to diseases caused by nutritional deficiency, particularly of thiamine (see vitamin B complex). Severe thiamine deficiency, called beriberi, disturbs nerve function, causing cramps, numbness, and weakness in the legs and hands. Its effects on the brain can cause confusion, disturbances of speech and gait, and eventual coma (see Wernicke– Korsakoff syndrome). Severe thiamine deficiency can also cause heart failure.
A prolonged high level of alcohol in the blood and tissues can disturb body chemistry, resulting in hypoglycaemia (reduced glucose in the blood) and hyperlipidaemia (increased fat in the blood).
These may damage the heart, liver, blood vessels, and brain; irreversible damage may cause premature death.... alcohol-related disorders
Added to the above are:– muscular rigidity, loss of reflexes, drooling – escape of saliva from the mouth. Muscles of the face are stiff giving a fixed expression, the back presents a bowed posture. The skin is excessively greasy and the patient is unable to express emotional feelings. Loss of blinking. Pin- rolling movement of thumb and forefinger.
Causes: degeneration of groups of nerve cells deep within the brain which causes a lack of neurotransmitting chemical, dopamine. Chemicals such as sulphur used by agriculture, drugs and the food industry are suspected. Researchers have found an increase in the disease in patients born during influenza pandemics.
Treatment. While cure is not possible, a patient may be better able to combat the condition with the help of agents that strengthen the brain and nervous system.
Tea. Equal parts: Valerian, Passion flower, Mistletoe. 1 heaped teaspoon to each cup water; bring to boil; simmer 1 minute; dose: half-1 cup 2-3 times daily.
Gotu Kola tea. (CNS stimulant).
Tablets/capsules. Black Cohosh, Cramp bark, Ginseng, Prickly Ash, Valerian.
Formula. Ginkgo 2; Black Cohosh 1; Motherwort 2; Ginger 1. Mix. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-3 teaspoons in water or honey. Fava Bean Tea.
Case report. Two patients unresponsive to Levodopa treatment reported improvement following meals of fresh broad beans. (Vicia faba) The beans contain levodopa in large amounts. (Parkinson Disease Update Vol 8, No 66, p186, Medical Publications, PO Box 24622-H, Philadelphia, USA) See also: BROAD BEANS. L-DOPA.
Nacuna Pruriens. Appropriate. Essential active constituent: L-dopa. (Medicinal plants and Traditional Medicine in Africa, by Abayomi Sofowora, Pub: John Wiley)
Practitioner. To reduce tremor: Tincture Hyoscyamus BP. To reduce spasm: Tincture Belladonna BP. To arrest drooling: Tincture Stramonium BP.
Diet. It is known that people who work in manganese factories in Chile may develop Parkinson’s disease after the age of 30. Progress of the disease is arrested on leaving the factory. Two items of diet highest in manganese are wheat and liver which should be avoided, carbohydrates in place of wheat taking the form of rice and potatoes.
Supplements. Daily: B-complex, B2, B6, niacin. C 200mg to reduce side-effects of Levodopa. Vitamin E 400iu to possibly reduce rigidity, tremors and loss of balance.
Treatment of severe nerve conditions should be supervised by neurologists and practitioners whose training prepares them to recognise serious illness and to integrate herbal and supplementary intervention safely into the treatment plan.
Antioxidants. Evidence has been advanced showing how nutritional antioxidants, high doses of Vitamin C and E, can retard onset of the disease, delaying the use of Levodopa for an average of 2 and a half years. (Fahn S., High Dose Alpha-tocopherol and ascorbate in Early Parkinson’s Disease – Annals of Neurology, 32-S pp128-132 1992)
For support and advice: The Parkinson’s Disease Society, 22 Upper Woburn Place, London WC1H 0RA, UK. Send SAE. ... parkinson’s disease
Rarely, the anus may fail to develop normally and surgical treatment is needed (see anus, imperforate).
In anal stenosis, the anus is too narrow to allow the passage of faeces.
Anal fissures originate from tears in the lining of the anus, usually as a result of straining to pass faeces.
Cancer of the skin around the anus is rare (see anus, cancer of).
Haemorrhoids are enlarged blood vessels under the anal lining.
An anal fistula is an abnormal channel connecting the anal canal with the skin surrounding the anus.
Itching of the anus is common and may be due to haemorrhoids or other disorders such as threadworm infestation.... anus, disorders of
In generalized anxiety disorder, there is persistent tension and apprehension that has no specific focus or cause, together with physical or psychological symptoms that disrupt normal activity. Panic disorders are characterized by sudden attacks of extreme, unreasonable anxiety. Phobias are irrational fears, such as the fear of open spaces or spiders, that lead to avoidance of certain situations or objects.
Counselling, psychotherapy, and group or individual cognitive–behaviour therapy are used to treat anxiety disorders.
Antianxiety drugs (especially benzodiazepine drugs) may be used for shortterm treatment but are addictive.... anxiety disorders
Atherosclerosis, in which fat deposits build up on artery walls, is the most common arterial disease.
It can involve arteries throughout the body, including the brain (see cerebrovascular disease), heart (see coronary artery disease), and legs (see peripheral vascular disease).
Atherosclerosis is the main type of arteriosclerosis, a group of disorders that cause thickening and loss of elasticity of artery walls.
Hypertension is another common cause of thickening and narrowing of arteries, and it increases the risk of a stroke or kidney failure.
Arteritis is inflammation of artery walls that causes narrowing and sometimes blockage.
Aneurysm is ballooning of an artery wall caused by the pressure of blood flowing through a weakened area.
Thrombosis occurs when a blood clot forms in a blood vessel, causing obstruction of the blood flow.
Blockage of an artery by a fragment of blood clot or other material travelling in the circulation is called an embolism.
Raynaud’s disease is a disorder involving intermittent spasm of small arteries in the hands and feet, usually due to cold.... arteries, disorders of
In asbestosis, widespread fine scarring occurs in the lungs. The disease causes breathlessness and a dry cough, eventually leading to severe disability and death. It develops mostly in industrial workers who have been heavily exposed to asbestos. The period from initial exposure to development of the disease is usually at least 20 years. Diagnosis is by chest X-ray. Asbestosis increases the risk of lung cancer.
Mesothelioma is a cancerous tumour of the pleura (the membrane surrounding the lungs) or the peritoneum (the membrane lining the abdominal cavity). In the pleura, mesotheliomas cause pain and breathlessness; in the peritoneum they cause enlargement of the abdomen and intestinal obstruction. The condition cannot be treated and usually leads to death within 1 or 2 years. The average interval between initial exposure to asbestos and death is 20–30 years. Mesothelioma affects people who have worked with blue or brown asbestos.
In diffuse pleural thickening, the outer and inner layers of the pleura become thickened, and excess fluid may accumulate in the cavity between them.
This combination restricts the ability of the lungs to expand, resulting in shortness of breath.
The condition may develop even after short exposure to asbestos.... asbestos-related diseases
Disturbed bladder control can also result from nerve degeneration in conditions such as diabetes mellitus, multiple sclerosis, or dementia. An unstable or irritable bladder is a common condition and is sometimes associated with a urinary tract infection or prolapse of the uterus. Tension or anxiety can cause frequent urination. In children, delayed bladder control (see enuresis) most often results from delayed maturation of the nervous system.... bladder, disorders of
Coagulation disorders are usually due a deficiency of or abnormality in the enzymes (coagulation factors) involved in blood clotting. Defects may be congenital or acquired later in life. The
main congenital coagulation defects are von Willebrand’s disease, haemophilia, and Christmas disease.
Acquired defects of coagulation factors may develop at any age due to severe liver disease, digestive system disorders that prevent the absorption of vitamin K (needed to make certain coagulation factors), or the use of anticoagulant drugs. Disseminated intravascular coagulation (DIC) is an acquired disorder that is both complex and serious. It may be the result of underlying infection or cancer. In this condition, platelets accumulate and clots form within small blood vessels; coagulation factors are used up faster than they can be replaced, and severe bleeding may result.
Coagulation disorders are treated by replacement of the missing factor, factors extracted from fresh blood, or fresh frozen plasma. Genetically engineered factors may be used. Anticoagulants are sometimes used to suppress excess clotting activity in.
Thrombocytopenia, which results from insufficient platelets in the blood, produces surface bleeding into the skin and gums and multiple small bruises. Platelet defects may be inherited, associated with the use of certain drugs (including aspirin), or a complication of certain bone marrow disorders such as myeloid leukaemia. Treatment consists of platelet transfusions. Rarely, abnormal bleeding is caused by a bloodvessel defect or scurvy. Elderly people and patients on long-term courses of corticosteroid drugs may suffer mild abnormal bruising due to loss of skin support to the smallest blood vessels.
Treatment is rarely required.... bleeding disorders
Reduced oxygen supply may occur at birth, causing cerebral palsy. Later in life, cerebral hypoxia can result from choking or from arrest of breathing and heartbeat. From middle age onwards, cerebrovascular disease is the most important cause of brain disorder. If an artery within the brain becomes blocked or ruptures, leading to haemorrhage, the result is a stroke. The brain may also be damaged by a blow to the head see head injury).
Infection within the brain (encephalitis) may be due to viral infection. Infection of the membranes surrounding the brain (meningitis) is generally due to bacterial infection. Creutzfeldt–Jakob disease is a rare, fatal brain disease associated with an infective agent called a prion which, in some cases, has been linked with (bovine spongiform encephalopathy), a disease in cattle.
Multiple sclerosis is a progressive disease of the brain and spinal cord. Degenerative brain diseases include Alzheimer’s disease and Parkinson’s disease. Emotional or behavioural disorders are generally described as psychiatric illnesses; but the distinction between neurological and psychiatric disorders is now much less clear.... brain, disorders of
EAR estimated average requirement: the amount of energy or a nutrient that will meet the needs of 50% of the population.
RDA recommended daily amount: the average amount of a nutrient that should be provided per head of a group of people if the needs of practically all members of the group are to be met.
LRNI lowest recommended nutrient intake: the amount of a nutrient that provides only 2.5% of the population with their requirements.
RNI reference nutrient intake: the amount that is sufficient for almost 97.5% of individuals in a population. It is the term usually used when expressing dietary requirements.
safe level: used when there is insufficient data to determine the RNI, set as the average requirement plus 20%.
RI reference intake: a guide to how many calories and nutrients an average person can consume each day for a healthy balanced diet. This is used in labelling information for energy, protein, carbohydrate, sugars, fat, saturated fat, fibre, and salt.... dietary reference values
Infection is the most common cause of ear disorders; it may occur in the ear canal, leading to otitis externa, or affect the middle ear, causing otitis media. This can lead to perforation of the eardrum (see eardrum, perforated). Persistent glue ear, often due to infection, is the most common cause of childhood hearing difficulties. Viral infection of the inner ear may cause labyrinthitis.
Cauliflower ear is the result of one large or several small injuries to the pinna. Perforation of the eardrum can result from poking objects into the ear or loud noise. Prolonged exposure to loud noise can cause tinnitus and/or deafness. Pressure changes associated with flying or scuba diving can also cause minor damage (see barotrauma).Tumours of the ear are rare. Acoustic neuroma is a noncancerous tumour of the acoustic nerve that may press on structures in the ear to cause deafness, tinnitus, and problems with balance.
In cholesteatoma, skin cells and debris collect in the middle ear. Obstruction of the ear canal is most often the result of earwax, although in small children, an object may have been pushed into the ear (see ear, foreign body in).
In otosclerosis, a hereditary condition, a bone in the middle ear becomes fixed, causing deafness. Meniérè’s disease is an uncommon condition in which deafness, vertigo, and tinnitus result from the accumulation of fluid in the inner ear. Deafness in many elderly people is due to presbyacusis, in which hair cells in the cochlea deteriorate.
Certain drugs, such as aminoglycoside drugs and some diuretic drugs, can damage ear function.... ear, disorders of
In premature ejaculation, emission of semen occurs before or almost immediately following penetration. Premature ejaculation is the most common sexual problem in men, and is often due to over-stimulation or anxiety about sexual performance. If the problem occurs frequently, sexual counselling and techniques for delaying ejaculation may help (see sex therapy).
Inhibited ejaculation is a rare condition in which erection is normal, or even prolonged, but ejaculation is abnormally delayed or fails to occur. The problem may be psychological in origin, in which case counselling may help, or it may be a complication of a disorder such as diabetes mellitus or alcohol dependence. In some cases, inhibited ejaculation occurs as a side effect of particular drugs, such as some antihypertensive and antidepressant drugs.
In retrograde ejaculation, the valve at the base of the bladder, which normally closes during ejaculation, stays open. As a result, ejaculate is forced back into the bladder. Retrograde ejaculation may occur as a result of a neurological disease, after surgery on the bladder or prostatectomy. There is no treatment, but intercourse with a full bladder can sometimes result in normal ejaculation. (See also azoospermia; psychosexual dysfunction; sexual problems.)... ejaculation, disorders of
Fetal distress may cause the baby’s heart-rate to slow or to fail to show normal variability, which can be recorded on a cardiotocograph (see fetal heart monitoring). Acidosis (high acidity in the body), which can be detected in a sample of blood taken from the scalp, indicates that the oxygen supply to the fetus is inadequate. Signs of meconium in the amniotic fluid can also be an indication of fetal distress.
Fetal distress sometimes occurs as a temporary episode, but, if acidosis is severe, the distressed fetus may need to be delivered promptly by caesarean section, forceps delivery, or vacuum extraction. (See also childbirth.)... fetal distress
Learning difficulties may be either general or specific.
In general learning difficulties, all aspects of mental and physical functioning may be affected.
Depending on the severity of the problem, a child with general learning difficulties may need to be educated in a special school.
Specific learning difficulties include dyslexia, dyscalculia (the inability to solve mathematical problems), and dysgraphia (writing disorders).
Causes of learning difficulties include deafness, speech disorders, and disorders of vision, as well as genetic and chromosomal problems.... learning difficulties
The longer consumption goes on, the more severe the damage.
The initial effect is the formation of fat globules between liver cells, a condition called fatty liver.
This is followed by alcoholic hepatitis, and damage then progresses to cirrhosis.
Alcohol-related liver disease increases the risk of developing liver cancer.
Liver function tests show a characteristic pattern of abnormalities, and liver biopsy may be needed to assess the severity of damage.
There is no particular treatment, but abstinence from alcohol prevents further damage.
Treatment for alcohol dependence may be required.... liver disease, alcoholic
cystic fibrosis. The lungs can also be affected by allergic disorders. The most important of these is asthma. Another such disorder is allergic alveolitis, which is usually a reaction to dust of plant or animal origin. Irritation of the airways, usually by tobacco-smoking, can cause diseases characterized by damage to lung tissue and narrowing of the airways (see pulmonary disease, chronic obstructive). The lungs can also be affected by cancerous tumours; lung cancer is one of the most common cancers. Noncancerous lung tumours are uncommon.
Injury to a lung, usually resulting from penetration of the chest wall, can cause the lung to collapse (see pneumothorax; haemothorax). Damage to the interior of the lungs can be caused by inhalation of toxic substances (see asbestosis; silicosis). Blood supply to the lungs may be reduced by pulmonary embolism.
Lung disorders can be investigated in various ways, such as chest X-ray, bronchoscopy, and pulmonary function tests.... lung, disorders of
Dysmenorrhoea (painful periods) is the most common type of menstrual disorder. Other types of menstrual disorder are amenorrhoea (absence of menstruation), polymenorrhoea (too frequent menstruation), oligomenorrhoea (infrequent periods or scanty blood loss), and menorrhagia (excessive bleeding).
Some women have extreme variations in the length of menstrual cycles or menstrual periods, or in the amount of blood lost (see menstruation, irregular).... menstruation, disorders of
A diet deficient in carbohydrates is almost inevitably also deficient in protein, leading to the development of protein–calorie malnutrition. Such malnutrition is most often seen as a result of severe poverty and famine (see kwashiorkor; marasmus).
Deficiency of specific nutrients is commonly associated with a disorder of the digestive system, such as coeliac disease, Crohn’s disease, or pernicious anaemia (see anaemia, megaloblastic).
Inadequate intake of protein and calories may also occur in people who excessively restrict their diet to lose weight (see anorexia nervosa), hold mistaken beliefs about diet and health (see food fad), or suffer from a loss of interest in food associated with alcohol dependence or drug dependence.Obesity results from taking in more energy from the diet than is used up by the body. Nutritional disorders may also result from an excessive intake of minerals and vitamins. An excessive intake of saturated fat is thought to be a contributory factor in coronary artery disease and in some forms of cancer.
Naturally occurring toxins can interfere with the digestion, absorption, and/or utilization of nutrients, or can cause specific disorders due to their toxic effects: for example, the ergot fungus found on rye can cause ergotism.... nutritional disorders
The disorder usually starts in adolescence. Genetic factors, an obsessive personality, or a tendency to neurotic symptoms may contribute. Some types of brain damage, especially in encephalitis, can cause obsessional symptoms. Many sufferers respond well to behaviour therapy, which may be combined with antidepressant drugs, but symptoms may recur under stress.... obsessive–compulsive disorder
Pneumoconiosis is fibrosis of the lung due to inhalation of industrial dusts, such as coal. Asbestosis is associated with asbestos in industry. Allergic alveolitis is caused by organic dusts (see farmer’s lung).
Industrial chemicals can damage the lungs if inhaled, or other major organs if they enter the bloodstream via the lungs or skin. Examples include fumes of cadmium, beryllium, lead, and benzene. Carbon tetrachloride and vinyl chloride are causes of liver disease. Many of these compounds can cause kidney damage. Work-related skin disorders include contact dermatitis and squamous cell carcinoma. Rare infectious diseases that are more common in certain jobs include brucellosis and Q fever (from livestock), psittacosis (from birds), and leptospirosis (from sewage). People who work with blood or blood products are at increased risk of viral hepatitis (see hepatitis, viral) and AIDS, as are healthcare professionals. The nuclear industry and some healthcare professions use measures to reduce the danger from radiation hazards. Other occupational disorders include writer’s cramp, carpal tunnel syndrome, singer’s nodes, Raynaud’s phenomenon, deafness, and cataracts.... occupational disease and injury
Infections of the oesophagus are rare but may occur in immunosuppressed patients. The most common are herpes simplex and candidiasis (thrush). Oesophagitis is usually due to reflux of stomach contents, causing heartburn. Corrosive oesophagitis can occur as a result of swallowing caustic chemicals. Both may cause an oesophageal stricture.
Congenital defects include oesophageal atresia, which requires surgery soon after birth. Tumours of the oesophagus are quite common; about 90 per cent are cancerous (see oesophagus, cancer of). Injury to the oesophagus is most commonly caused by a tear or rupture due to severe vomiting and retching. (See also swallowing difficulty.)... oesophagus, disorders of
Specific types of personality disorders are divided into 3 groups but there is often overlap. The 1st group is characterized by eccentric behaviour. Paranoid people show suspiciousness and mistrust of others, schizoid people are cold emotionally, and schizotypal personalities have behaviour oddities similar to those of schizophrenia, but less severe.In the 2nd group, behaviour tends to be dramatic. Histrionic people are excitable and constantly crave stimulation, narcissists have an exaggerated sense of their own importance (see narcissism), and people with antisocial personality disorder fail to conform to accepted social standards of behaviour.
People in the 3rd group show anxiety and fear. Dependent personalities lack the self-confidence to function independently (see dependence). Those with compulsive personalities are rigid in their habits (see obsessive–compulsive disorder), and passive-aggressive people resist demands from others.
Treatment is usually counselling, psychotherapy, and behaviour therapy.... personality disorders
Rat-bite fever is a rare infection transmitted directly by a rat bite. There are 2 types of this infection, caused by different bacteria. The symptoms include inflammation at the site of the bite and in nearby lymph nodes and vessels, bouts of fever, a rash, and, in one type, painful joint inflammation. Treatment for both types is with antibiotic drugs.
Rabies virus can be transmitted by the bites of infected rats. Lassa fever, also a viral disease, may be contracted from the urine of rats in West Africa. Rats also carry the viral infection lymphocytic chorio-meningitis, as well as the bacterial infection tularaemia.... rats, diseases from
Diagnosis is by X-rays. The head of the humerus is repositioned in the joint socket. The shoulder is then immobilized in a sling for about 3 weeks.
Complications of shoulder dislocation include damage to nerves, causing temporary weakness and numbness in the shoulder; damage to an artery in the upper arm, causing pain and discoloration of the arm and hand; and damage to muscles that support the shoulder.... shoulder, dislocation of
A genetic disorder may impair the thyroid’s ability to secrete hormones and goitre may result. Thyroid infection is uncommon and leads to thyroiditis. Viral infection can cause extreme pain and temporary hyperthyroidism. Hormonal changes during puberty or pregnancy may cause a degree of goitre temporarily. Hyperthyroidism due to excessive production of by the pituitary gland is rare but can occur as a result of a pituitary tumour.
Because iodine is necessary for the production of thyroid hormone, its deficiency may lead to goitre. Severe iodine deficiency in children may cause myxoedema. (See also thyroid cancer.)
thyroid hormones The 3 hormones produced by the thyroid gland are thyroxine (T4) and triiodothyronine (T3), which regulate metabolism, and calcitonin, which helps to regulate calcium levels in the body.... thyroid gland, disorders of
In the , the only disease known to be transmitted to humans by ticks is Lyme disease. Others transmitted in various parts of the world include relapsing fever, Rocky Mountain spotted fever, Q fever, tularaemia, and certain types of viral encephalitis. The prolonged bite of certain female ticks can cause tick paralysis, in which a toxin in the tick saliva affects the nerves that control movement. In extreme cases, this can be fatal.... ticks and disease
Discharge may be abnormal if it is excessive, offensive-smelling, yellow or green, or if it causes itching. Abnormal discharge often accompanies vaginitis, and may be the result of infection, as in
candidiasis or trichomoniasis, or may be due to a foreign body, such as a forgotten tampon, in the vagina.... vaginal discharge
BI-RADS (Breast Imaging Reporting and Data System) a standardized system of terminology, report organization, assessment, and classification for mammography and ultrasound or MRI of the breast. BI-RADS reporting enables radiologists to communicate results to the referring physician clearly and consistently, with a final assessment and specific management recommendations.
The success of BI-RADS has inspired several other systems of the same kind: TI-RADS (Thyroid Imaging Reporting and Data System); LI-RADS (Liver Imaging Reporting and Data System); and PI-RADS (Prostate Imaging Reporting and Data System).... bipolar affective disorder
/// ... generalized anxiety disorder questionnaire
HIV (human immunodeficiency virus) a *retrovirus responsible for *AIDS. There are two varieties, HIV-1 and HIV-2; the latter is most common in Africa. See also HTLV.... histrionic personality disorder
The standard international classification for statistical, administrative, and epidemiological purposes, as supplied by the World Health Organization
The WHO framework for measuring health and disability in individuals and populations... international classification of diseases
Isosorbide dinitrate is converted in the body to the active form of the drug, isosorbide mononitrate, which is available as a preventative oral treatment for angina.... isosorbide dinitrate
ology combining form. see -logy.... ollier’s disease
Autosomal dominant polycystic kidney disease (ADPKD) affects between 1 in 400 and 1 in 1000 individuals and is one of the most common hereditary diseases. Two types have been defined. ADPKD 1 is the commonest and responsible for about 85% of cases. It is due to a mutation in the PKD1 gene on chromosome 16, which encodes polycystin 1, an *ion-channel-regulating protein. ADPKD2 is due to a mutation in the PKD2 gene on chromosome 4, which encodes the protein polycystin 2, a calcium-release channel. ADPKD2 tends to be a milder disease with later presentation.
ADPKD is a multisystem disorder that is also associated with cyst formation in other organs (particularly the liver), cardiovascular disorders, and colonic diverticular disease. Renal disease presents in early adult life with haematuria, loin pain, urinary tract infection, hypertension, renal stone disease, or the finding of a mass in the abdomen. Other cases are identified by family contact tracing; the findings of a few cysts on renal ultrasonography in a young adult with a family history of ADPKD is highly suggestive of the disease. Renal disease is progressive and about 50% of patients will have reached end-stage by the time they enter their seventh decade. The progress of the renal failure can be slowed by good blood pressure control. In the UK, patients with ADPKD are responsible for 5–10% of the total on renal replacement therapy.
There are a number of separate rare autosomal dominant conditions other than ADPKD1 and ADPKD 2 that can present with polycystic kidneys. These include *von Hippel-Lindau disease and *tuberous sclerosis.... polycystic disease of the kidneys
respiratory distress syndrome (RDS; hyaline membrane disease) the condition of a newborn infant in which the lungs are imperfectly expanded. Initial inflation and normal expansion of the lungs requires the presence of a substance (*surfactant) that reduces the surface tension of the air sacs (alveoli) and prevents collapse of the small airways. Without surfactant the airways collapse, leading to inefficient and ‘stiff’ lungs. The condition is most common and serious among preterm infants, in whom surfactant may be deficient. It lasts 5–10 days, with worsening on days 2–3. Breathing is rapid, laboured, and shallow, and microscopic examinations of lung tissue in fatal cases has revealed the presence of *hyalin material in the collapsed air sacs. The condition is treated by careful nursing, intravenous fluids, and oxygen, with or without positive-pressure ventilation (see noninvasive ventilation). Early surfactant replacement therapy has been shown to reduce the severity of RDS and when given prophylactically it has been demonstrated to improve clinical outcome. See also adult respiratory distress syndrome.... respiratory distress
The carrier condition (sickle-cell trait) occurs when the defective gene is inherited from only one parent. It generally causes no symptoms but confers some protection from malaria, which accounts for the high frequency of the gene in malarious areas. If a general anaesthetic is to be given to a patient with this condition, the anaesthetist should be alerted.... sickle-cell disease
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