Remission Health Dictionary

The procedure by which malignant or defective bone marrow in a patient is replaced with normal bone marrow. Sometimes the patient’s own marrow is used (when the disease is in remission); after storage using tissue-freezing technique (cryopreservation) it is reinfused into the patient once the diseased marrow has been treated (autologous transplant). More commonly, a transplant uses marrow from a donor whose tissue has been matched for compatibility. The recipient’s marrow is destroyed with CYTOTOXIC drugs before transfusion. The recipient is initially nursed in an isolated environment to reduce the risk of infection.

Disorders that can be helped or even cured include certain types of LEUKAEMIA and many inherited disorders of the immune system (see IMMUNITY).... bone marrow transplant

A progressive disease of the central nervous system in which patches of myelin in the brain and spinal cord are destroyed. Multiple sclerosis (or ) is an autoimmune disorder, in which the immune system attacks the myelin sheath that covers some nerves in the brain and spinal cord. Affected nerves cannot conduct nerve impulses, so functions such as movement and sensation may be lost. Any area of the body can be affected. Symptoms range from numbness and tingling to paralysis and incontinence.

Attacks of symptoms are followed by a variable period of remission, in which dramatic improvements may be made.

Women are more likely to develop than men, and there may be a genetic factor, as the disease sometimes runs in families. There may also be an environmental factor, as is more common in temperate zones than in the tropics.

Symptoms usually develop early in adulthood. Spinal cord damage may cause tingling, numbness, weakness in the extremities, spasticity, paralysis, and incontinence. Damage to white matter (myelinated nerves) in the brain may cause fatigue, vertigo, clumsiness, muscle weakness, slurred speech, blurred vision, numbness, weakness, or facial pain.

Attacks may last several months. After a variable remission period, a relapse occurs, which may be precipitated by injury, infection, or stress. Some people have mild relapses and long periods of remission, with few permanent effects. Some people become gradually more disabled from the first attack. A few suffer gross disability within the 1st year.

There is no single diagnostic test, but MRI may show damage to white matter in the brain. Evoked response tests on the eyes also provide strong evidence.

There is no specific treatment.

Some people claim that dietary modifications such as sunflower or evening primrose oils are beneficial.

In some cases, interferon beta can extend the time between attacks and reduce the rate of decline.... multiple sclerosis

(L.) G. Don.

Synonym: Vinca rosea L. Lochnera rosea (L.) Reichub.

Family: Apocynaceae.

Habitat: Commonly grown in Indian gardens.

English: Madagascar Periwinkle (Vinca major L. Pich. and Vinca minor Linn. are known as Greater Periwinkle and Lesser Periwinkle respectively).

Folk: Sadaabahaar, Nayantaaraa, Nityakalyaani.

Action: The cytotoxic dimeric alkaloids, present in Madagascar Periwinkle, Catharanthus roseus L. Don, Vincea rosea L., and used for the treatment of certain type of cancer, have not been found in V. major.

Catharanthus roseus (Madagascar Periwinkle) : cytostatic, anti-neoplas- tic, slows down growth of cells by su- pressing immune response. Vinblas- tine and Vincristine are said to prolong remission of leukaemia to more than five years. These chemotherapeutic agents are toxic to the nervous system. Vinblastine is also used for breast cancer and Hodgkin's disease.

Vinca major L. Pich. (Greater Periwinkle): astringent, anti-haemorrha- gic; used for menorrhagia and leu- corrhoea. Contains indole alkaloids including reserpinine and serpentine; tannins.

Vinca minor Linn. (Lesser Periwinkle): astringent; circulatory stimulant. Leaves—stomachic and bitter. Root— hypotensive. Used for gastric catarrh, chronic dyspepsia, flatulence; also for headache, dizziness, behaviours disorders. A homoeopathic tincture is given for internal haemorrhages.... catharanthus roseus

A disease or imbalance of long, slow duration, showing little overall change and characterized by periods of remission interspersed with acute episodes. The opposite of acute.... chronic

An drug used mainly to induce remission of acute myeloblastic LEUKAEMIA. A potent suppressant of myeloblasts, its use requires monitoring by a HAEMATOLOGIST. (See CYTOTOXIC.)... cytarabine

Also known as Tourette’s syndrome, this is a hereditary condition of severe and multiple tics (see TIC) of motor or vocal origin. It usually starts in childhood and becomes chronic (with remissions). With a prevalance of one in 2,000, a dominant gene (see GENES) with variable expression may be responsible. The disorder is associated with explosive vocal tics and grunts, occasionally obscene (see COPROLALIA). The patient may also involuntarily repeat the words or imitate the actions of others (see PALILALIA). HALOPERIDOL, pimozide (an oral antipsychotic drug similar to CHLORPROMAZINE hydrochloride) and clonidine are among drugs that may help to control this distressing, but fortunately rare, disorder.... gilles de la tourette’s syndrome

A drug widely used in the PROPHYLAXIS treatment of certain forms of MENTAL ILLNESS. The drug should be given only on specialist advice. The major indication for its use is acute MANIA; it induces improvement or remission in over 70 per cent of such patients. In addition, it is e?ective in the treatment of manic-depressive patients (see MANIC DEPRESSION), preventing both the manic and the depressive episodes. There is also evidence that it lessens aggression in prisoners who behave antisocially and in patients with learning diffculties who mutilate themselves and have temper tantrums.

Because of its possible toxic effects – including kidney damage – lithium must only be administered under medical supervision and with monitoring of the blood levels, as the gap between therapeutic and toxic concentrations is narrow. Due to the risk of its damaging the unborn child, it should not be prescribed, unless absolutely necessary, during pregnancy – particularly not in the ?rst three months. Mothers should not take it while breast feeding, as it is excreted in the milk in high concentrations. The drug should not be taken with DIURETICS.... lithium carbonate

An aminosalicylate drug used for the treatment of mild to moderate ULCERATIVE COLITIS and the maintenance of remission. It should be used with caution by pregnant women.... mesalazine

An adjective describing symptoms or diseases that recur. For example, palindromic rheumatoid arthritis is a condition in which symptoms wax and wane with periods of complete remission.... palindromic

The term applied to the form of fever in which, during remissions (see REMISSION), the temperature falls, but not to normal.... remittent fever

The recurrence of a disease after an apparent recovery, or the return of symptoms after a remission.... relapse

pl. n. drugs containing 5-aminosalicylic acid, used to treat ulcerative colitis (and to maintain patients in remission from it) and Crohn’s disease affecting the colon. They include *sulfasalazine, *olsalazine, and mesalazine.... aminosalicylates

combining form denoting 1. lysis; dissolution. 2. remission of symptoms.... lysis

Get a taste of South America by drinking pau d’arco tea. It has a pleasant, earthy taste, astringent and just a bit bitter. Find out more about its health benefits and side effects! About Pau D’Arco Tea Pau D’Arco tea uses the inner bark of the Pink Ipê tree, also known as Pink Lapacho. The tree can be found in many South American countries. The Pink Lapacho is a large tree which can grow up to 30m tall. Usually, the trunk represents a third of that height, while the rest is used by the tree’s branches. The bark is dark brown, tough and hard to peel, and its branches spring up with opposite and petiolate leaves, and large, tubular-shaped pink flowers which bloom between July and September. How to make Pau D’Arco Tea To enjoy some pau d’arco tea, add 3 tablespoons to a pot containing 1 liter of water and bring it to boiling point. Once it reaches boiling point, lower the heat to medium-low and leave it like this for about 20 minutes. Once that’s done, strain the tea and pour it into cups. Pau d’arco tea can be served both hot and cold. If you want to, you can sweeten it with honey, stevia or fruit juice. Pau D’Arco Tea Benefits The inner bark of the Pink Lapacho tea has important active constituents, such as lapachol, lapachone and isolapachone, as well as various flavonoids and tannins. They are transferred to the pau d’arco tea; this way, the beverage helps us stay healthy. Pau d’arco tea plays an important role in the help against cancer. Cancer patients who have consumed this tea have shown progress, from alleviation of chemotherapy symptoms to complete remission of the cancerous tumors. Pau d’arco tea is also useful in the treatment of other diseases, such as diabetes, fibromyalgia, and lupus. Drinking pau d’arco tea can help if you’ve got a cold or the flu. It is also useful as a remedy for smoker’s cough, and acts as an expectorant, stimulating coughing in order to get rid of mucus. It was also discovered that pau d’arco tea increases the production of red blood cells. Although researches are still being made in this area, it is recommended in the treatment for leukemia, anemia and other blood disorders. Pau d’arco tea is also useful in fighting fungi. It is used to treat yeast infection and candida, due to its antifungal nature. It can help in the treatment for stomach ulcers, tuberculosis, pneumonia, and dysentery. It also protects you against tropical diseases (malaria, schistosomiasis). Pau D’Arco Tea Side Effects Pau d’arco tea may act like a blood thinner. Don’t drink this tea at least two weeks before a surgery, otherwise it might increase the risk of bleeding both during and after the surgery, and can decrease the blood clotting speed. You also shouldn’t drink pau d’arco tea if you’ve got a bleeding disorder (hemophilia) or if you’re taking anticoagulants. If you’re taking any medication, talk to your doctor first before drinking pau d’arco tea. It may interfere with various medications, for example aspirin, enoxaparin, warfarin, and dalteparin. It is also recommended that you not drink pau d’arco tea if you’re pregnant or breastfeeding. During pregnancy, it can lead to child defects or even death of the baby. It can also affect the baby during breastfeeding. Be careful with the amount of pau d’arco tea you drink a day. The maximum amount of tea you can drink a day is 1 liter. If you drink more, it might lead to nausea, vomiting or bleeding (in which case you should consult a doctor). Other symptoms include headaches, dizziness and diarrhea. Pau d’arco tea has lots of important health benefits, but it also has a few side effects which you should remember. If you make sure it’s safe to drink this tea, you can enjoy it with no worries!... drink pau d’arco tea from south america

A serious disorder in which the chief symptoms are muscular weakness and a special tendency for fatigue to come on rapidly when e?orts are made. The prevalence is around 1 in 30,000. Two-thirds of the patients are women, in whom it develops in early adult life. In men it tends to develop later in life.

It is a classical example of an autoimmune disease (see AUTOIMMUNITY). The body develops ANTIBODIES which interfere with the working of the nerve endings in muscle that are acted on by ACETYLCHOLINE. It is acetylcholine that transmits the nerve impulses to muscles: if this transmission cannot be e?ected, as in myasthenia gravis, then the muscles are unable to contract. Not only the voluntary muscles, but those connected with the acts of swallowing, breathing, and the like, become progressively weaker. Rest and avoidance of undue exertion are necessary, and regular doses of neostigmine bromide, or pyridostigmine, at intervals enable the muscles to be used and in some cases have a curative e?ect. These drugs act by inhibiting the action of cholinesterase – an ENZYME produced in the body which destroys any excess of acetylcholine. In this way they increase the amount of available acetylcholine which compensates for the deleterious e?ect of antibodies on the nerve endings.

The THYMUS GLAND plays the major part in the cause of myasthenia gravis, possibly by being the source of the original acetylcholine receptors to which the antibodies are being formed. Thymectomy (removal of the thymus) is often used in the management of patients with myasthenia gravis. The incidence of remission following thymectomy increases with the number of years after the operation. Complete remission or substantial improvement can be expected in 80 per cent of patients.

The other important aspect in the management of patients with myasthenia gravis is IMMUNOSUPPRESSION. Drugs are now available that suppress antibody production and so reduce the concentration of antibodies to the acetylcholine receptor. The problem is that they not only suppress abnormal antibody production, but also suppress normal antibody production. The main groups of immunosuppressive drugs used in myasthenia gravis are the CORTICOSTEROIDS and AZATHIOPRINE. Improvement following steroids may take several weeks and an initial deterioration is often found during the ?rst week or ten days of treatment. Azathioprine is also e?ective in producing clinical improvement and reducing the antibodies to acetylcholine receptors. These effects occur more slowly than with steroids, and the mean time for an azathioprine remission is nine months.

The Myasthenia Gravis Association, which provides advice and help to sufferers, was created and is supported by myasthenics, their families and friends.... myasthenia gravis

In?ammation of the LIVER which damages liver cells and may ultimately kill them. Acute injury of the liver is usually followed by complete recovery, but prolonged in?ammation after injury may result in FIBROSIS and CIRRHOSIS. Excluding trauma, hepatitis has several causes:

Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.

Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.

WILSON’S DISEASE.

Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).

Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.

Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.

Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.

Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.

•Hepatitis A virus (HAV) is an ENTEROVIRUS

which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.

Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.

Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.

Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.

Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic

viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.

As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.

Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around

0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).

Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:

Parenteral drug abusers.

Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.

Men who have sex with men.

Patients undergoing regular haemodialysis.

Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis

Drugs used to quieten disturbed patients, whether this is the result of brain damage, MANIA, DELIRIUM, agitated DEPRESSION or an acute behavioural disturbance. They relieve the ?orid PSYCHOTIC symptoms such as hallucinations and thought-disorder in SCHIZOPHRENIA and prevent relapse of this disorder when it is in remission.

Most of these drugs act by blocking DOPAMINE receptors. As a result they can give rise to the extrapyramidal effects of PARKINSONISM and may also cause HYPERPROLACTINAEMIA.

Troublesome side-effects may require control by ANTICHOLINERGIC drugs. The main antipsychotic drugs are: (i) chlorpromazine, methotrimeprazine and promazine, characterised by pronounced sedative effects and a moderate anticholinergic and extrapyramidal e?ect; (ii) pericyazine, pipothiazine and thioridazine, which have moderate sedative effects and marked anticholinergic effects, but less extrapyramidal effects than the other groups; (iii) ?uphenazine, perphenazine, prochlorperazine, sulpiride and tri?uoperazine, which have fewer sedative effects and fewer anticholinergic effects, but more pronounced extrapyramidal effects.... neuroleptics

Also known as plasmapheresis. The removal of the circulating PLASMA from the patient. It is done by removing blood from a patient and returning the red cells with a plasma expander. The plasma exchange is carried out through an in-dwelling CANNULA in the femoral vein, and the red cells and plasma are separated by a hemonetics separator. Usually a sequence of three or four sessions is undertaken, at each of which 2–3 litres of plasma are removed. The lost plasma can either be replaced by human serum albumin (see ALBUMINS) or a plasma expander.

In autoimmune disorders, disease is due to damage wrought by circulating ANTIBODIES or sensitised lymphocytes (see LYMPHOCYTE). If the disease is due to circulating humoral antibodies, removal of these antibodies from the body should theoretically relieve the disorder. This is the principle on which plasma exchange was used in the management of autoimmune diseases due to circulating antibodies. Such disorders include Goodpasture’s syndrome, SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and MYASTHENIA GRAVIS. One of the problems in the use of plasma exchange in the treatment of such diseases is that the body responds to the removal of an antibody from the circulation by enhanced production of that antibody by the immune system. It is therefore necessary to suppress this homeostatic response with cytotoxic drugs such as AZATHIOPRINE. Nevertheless, remissions can be achieved in autoimmune diseases due to circulating antibodies by the process of plasma exchange.... plasma exchange

Given three months to live, Jason Winters, terminal cancer patient, was suffering from infiltrating squamous cell carcinoma wrapped round his carotid artery. Refusing major surgery, he travelled the world in search of native remedies. He was able to contact people who put him on the track of Wild Violet leaves, Red Clover flowers (Trifolium pratense) and leaves of the Chaparral bush (Larrea divaricata). The story of how he infused them, together with a well- known spice, is dramatically recorded in his book “Killing Cancer”. After a spectacular recovery, remission has lasted for over 15 years and others have benefited from his experience.

Treatment by oncologist. ... cancer – squamous cell carcinoma

The presence of tissue normally found on the walls of the womb in an abnormal site, i.e. endometrial tissue implants may appear in the pelvic cavity where they multiply causing obstruction or retrograde tissue change. Scars and adhesions may form between womb and bowel. An ovary may be affected by a tissue thread passing through a Fallopian tube as an aftermath of menstruation. The condition may disappear at pregnancy or menopause. Such fibrous adhesions prevent proper conception and fertility.

Symptoms. Sharp stabbing pains are worse by intercourse. Pain radiates down the back; worse two weeks before menstruation. Incidence has increased since introduction of the vaginal tampon. Enlarged ‘boggy’ uterus. Menstrual irregularity and pain. Diagnosis confirmed by laparoscopy.

Treatment. Official treatment is by Danol hormone therapy which induces a state of artificial pregnancy. Shrinkage and remission of symptoms follow as long as medication is continued. Where the condition has not regressed too far, a number of phyto-pharmaceuticals may bring a measure of relief. These are believed to reduce levels of gonadotrophins and ovarian steroids and abolish cyclical hormonal changes. They are best administered by a qualified herbal practitioner: (MNIMH). Prescriptions vary according to the requirements of each individual case and are modified to meet changed symptoms and progress.

Formula.

Tr Zingiber fort BP (1973) 5 Tr Xanthoxylum 1:5 BHP (1983) 20 L.E. Glycyrrhiza BP (1973) 10 Tr Phytolacca 1:10 BPC (1923) 5 Tr Chamaelirium 1:5 BHP (1983) 50

Aq ad 250ml

Sig 5-10ml (3i) tds aq cal pc.

For pain episodes: pelvic antispasmodics – say Anemone: 10-20 drops (tincture) prn. Extra Ginger, pelvic stimulant, may be taken once or twice daily between meals. Chamomile tea: 1-2 cups daily to maintain endocrine balance.

Formula. Mrs Janet Hicks, FNIMH. Blue Flag root 30ml; Burdock root 20ml; Hawthorn berries 20ml; Pulsatilla herb 40ml; Vervain 50ml; Dandelion root 30ml; Ginger 10ml. Dose: 5ml in water, thrice daily. (Medical Herbalist, Alresford, Nr Winchester, UK)

Formula. Mrs Brenda Cooke, FNIMH. Helonias, Wild Yam, Vervain, Black Haw, Parsley Piert, Marigold, Butternut, aa 15. Goldenseal 10, Ginger 2.5. 5mls tds., pc. (Medical Herbalist, Mansfield, Notts, UK)

Topical. Castor oil packs to low abdomen, twice weekly.

Note: Vigorous exercise appears to reduce the risk of women developing the condition.

Danazol drug rash. Echinacea. Chickweed cream. ... endometriosis

A chronic in?ammation of the synovial lining (see SYNOVIAL MEMBRANE) of several joints, tendon sheaths or bursae which is not due to SEPSIS or a reaction to URIC ACID crystals. It is distinguished from other patterns of in?ammatory arthritis by the symmetrical involvement of a large number of peripheral joints; by the common blood-?nding of rheumatoid factor antibody; by the presence of bony erosions around joints; and, in a few, by the presence of subcutaneous nodules with necrobiotic (decaying) centres.

Causes There is a major immunogenetic predisposition to rheumatoid arthritis in people carrying the HLA-DR4 antigen (see HLA SYSTEM). Other minor immunogenetic factors have also been implicated. In addition, there is a degree of familial clustering which suggests other unidenti?ed genetic factors. Genetic factors cannot alone explain aetiology, and environmental and chance factors must be important, but these have yet to be identi?ed.

Epidemiology Rheumatoid arthritis more commonly occurs in women from the age of 30 onwards, the sex ratio being approximately 4:1. Typical rheumatoid arthritis may occur in adolescence, but in childhood chronic SYNOVITIS usually takes one of a number of di?erent patterns, classi?ed under juvenile chronic arthritis.

Pathology The primary lesion is an in?ammation of the synovial membrane of joints. The synovial ?uid becomes diluted with in?ammatory exudate: if this persists for months it leads to progressive destruction of articular CARTILAGE and BONE. Cartilage is replaced by in?ammatory tissue known as pannus; a similar tissue invades bone to form erosions. Synovitis also affects tendon sheaths, and may lead to adhesion ?brosis or attrition and rupture of tendons. Subcutaneous and other bursae may be involved. Necrobiotic nodules also occur at sites outside synovium, including the subcutaneous tissues, the lungs, the pericardium and the pleura.

Clinical features Rheumatoid arthritis varies from the very mild to the severely disabling. Many mild cases probably go undiagnosed. At least 50 per cent of patients continue to lead a reasonably normal life; around 25 per cent are signi?cantly disabled in terms of work and leisure activities; and a minority become markedly disabled and are limited in their independence. There is often an early acute phase, followed by substantial remission, but in other patients gradual step-wise deterioration may occur, with progressive involvement of an increasing number of joints.

The diagnosis of rheumatoid arthritis is largely based on clinical symptoms and signs. Approximately 70 per cent of patients have rheumatoid factor ANTIBODIES in the SERUM but, because of the large number of false positives and false negatives, this test has very little value in clinical practice. It may be a useful pointer to a worse prognosis in early cases if the level is high. X-RAYS may help in diagnosing early cases and are particularly helpful when considering surgery or possible complications such as pathological fracture. Patients commonly develop ANAEMIA, which may be partly due to gastrointestinal blood loss from antiin?ammatory drug treatment (see below).

Treatment involves physical, pharmacological, and surgical measures, together with psychological and social support tailored to the individual patient’s needs. Regular activity should be maintained. Resting of certain joints such as the wrist with splints may be helpful at night or to assist prolonged manual activities. Sound footwear is important. Early use of antirheumatic drugs reduces long-term disability. Drug treatment includes simple ANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and slow-acting drugs including GOLD SALTS (in the form of SODIUM AUROTHIOMALATE), PENICILLAMINE, SULFASALAZINE, METHOTREXATE and AZATHIOPRINE.

The non-steroidal agents are largely e?ective in reducing pain and early-morning sti?ness, and have no e?ect on the chronic in?ammatory process. It is important, especially in the elderly, to explain to patients the adverse effects of NSAIDs, the dosage of which can be cut by prescribing paracetamol at the same time. Combinations of anti-rheumatic drugs seem better than single agents. The slow-acting drugs take approximately three months to act but have a more global e?ect on chronic in?ammation, with a greater reduction in swelling and an associated fall in erythrocyte sedimentation rate (ESR) and rise in the level of HAEMOGLOBIN. Local CORTICOSTEROIDS are useful, given into individual joints. Systemic corticosteroids carry serious problems if continued long term, but may be useful under special circumstances. Much research is currently going on into the use of tumour necrosis factor antagonists such as INFLIXIMAB and etanercept, but their precise role remains uncertain.... rheumatoid arthritis

An overall title for a group of psychiatric disorders typ?ed by disturbances in thinking, behaviour and emotional response. Despite its inaccurate colloquial description as ‘split personality’, schizophrenia should not be confused with MULTIPLE PERSONALITY DISORDER. The illness is disabling, running a protracted course that usually results in ill-health and, often, personality change. Schizophrenia is really a collection of symptoms and signs, but there is no speci?c diagnostic test for it. Similarity in the early stages to other mental disorders, such as MANIC DEPRESSION, means that the diagnosis may not be con?rmed until its response to treatment and its outcome can be assessed and other diseases excluded.

Causes There is an inherited element: parents, children or siblings of schizophrenic sufferers have a one in ten chance of developing the disorder; a twin has a 50 per cent chance if the other twin has schizophrenia. Some BRAIN disorders such as temporal lobe EPILEPSY, tumours and ENCEPHALITIS seem to be linked with schizophrenia. Certain drugs – for example, AMPHETAMINES – can precipitate schizophrenia and DOPAMINE-blocking drugs often relieve schizophrenic symptoms. Stress may worsen schizophrenia and recreational drugs may trigger an attack.

Symptoms These usually develop gradually until the individual’s behaviour becomes so distrubing or debilitating that work, relationships and basic activities such as eating and sleeping are interrupted. The patient may have disturbed perception with auditory HALLUCINATIONS, illogical thought-processes and DELUSIONS; low-key emotions (‘?at affect’); a sense of being invaded or controlled by outside forces; a lack of INSIGHT and inability to acknowledge reality; lethargy and/or agitation; a disrespect for personal appearance and hygiene; and a tendency to act strangely. Violence is rare although some sufferers commit violent acts which they believe their ‘inner voices’ have commanded.

Relatives and friends may try to cope with the affected person at home, but as severe episodes may last several months and require regular administration of powerful drugs – patients are not always good at taking their medication

– hospital admission may be necessary.

Treatment So far there is no cure for schizophrenia. Since the 1950s, however, a group of drugs called antipsychotics – also described as NEUROLEPTICS or major tranquillisers – have relieved ?orid symptoms such as thought disorder, hallucinations and delusions as well as preventing relapses, thus allowing many people to leave psychiatric hospitals and live more independently outside. Only some of these drugs have a tranquillising e?ect, but their sedative properties can calm patients with an acute attack. CHLORPROMAZINE is one such drug and is commonly used when treatment starts or to deal with an emergency. Halperidol, tri?uoperazine and pimozide are other drugs in the group; these have less sedative effects so are useful in treating those whose prominent symptoms are apathy and lethargy.

The antipsychotics’ mode of action is by blocking the activity of DOPAMINE, the chemical messenger in the brain that is faulty in schizophrenia. The drugs quicken the onset and prolong the remission of the disorder, and it is very important that patients take them inde?nitely. This is easier to ensure when a patient is in hospital or in a stable domestic environment.

CLOZAPINE – a newer, atypical antipsychotic drug – is used for treating schizophrenic patients unresponsive to, or intolerant of, conventional antipsychotics. It may cause AGRANULOCYTOSIS and use is con?ned to patients registered with the Clorazil (the drug’s registered name) Patient Monitoring Service. Amisulpride, olanzapine, quetiapine, risperidone, sertindole and zotepine are other antipsychotic drugs described as ‘atypical’ by the British National Formulary; they may be better tolerated than other antipsychotics, and their varying properties mean that they can be targeted at patients with a particular grouping of symptoms. They should, however, be used with caution.

The welcome long-term shift of mentally ill patients from large hospitals to community care (often in small units) has, because of a lack of resources, led to some schizophrenic patients not being properly supervised with the result that they fail to take their medication regularly. This leads to a recurrence of symptoms and there have been occasional episodes of such patients in community care becoming a danger to themselves and to the public.

The antipsychotic drugs are powerful agents and have a range of potentially troubling side-effects. These include blurred vision, constipation, dizziness, dry mouth, limb restlessness, shaking, sti?ness, weight gain, and in the long term, TARDIVE DYSKINESIA (abnormal movements and walking) which affects about 20 per cent of those under treatment. Some drugs can be given by long-term depot injection: these include compounds of ?upenthixol, zuclopenthixol and haloperidol.

Prognosis About 25 per cent of sufferers recover fully from their ?rst attack. Another 25 per cent are disabled by chronic schizophrenia, never recover and are unable to live independently. The remainder are between these extremes. There is a high risk of suicide.... schizophrenia

Inflammation of the vermiform appendix – a small worm-like offshoot from the gut at the junction of the colon and small intestine, in the low right fossa of the abdomen. Blockage leads to stasis and infection. Pain starts from the centre of the abdomen and moves down towards the low right groin focusing on a sensitive spot known as McBurney’s point (midway between the naval and the right groin). Possible history of constipation.

Symptoms. Attack may be sudden, with acute low right abdominal pain. Lost appetite. Vomiting occurs usually only once. Nausea. Temperature slightly raised (102°). Muscles rigid and boardlike. The sufferer tries to find relief by lying on his back with right leg drawn up. Rapid heartbeat.

May lapse into abscess, perforation or peritonitis. If neglected, gangrene is a possibility, therefore a modern hospital is the safest place. In any case surgical excision may be necessary to prevent a burst when pus would discharge into the surrounding cavity causing peritonitis.

Differential diagnosis. Inflammation of the right ovary, gall bladder or kidney, ileitis, diverticulitis, perforated peptic ulcer.

Skin temperature aids diagnosis. Application of Feverscan thermometer detects local skin temperature over the right iliac fossa and records at least 1°C warmer than that on the left.

An added aid to diagnosis is the facial expression which predominantly conveys an aura of malaise with an obvious upward curving of the upper lip. This is not a wince or grimace but a slower reaction, and occurs on gentle pressure over the appendix. Rectal tenderness may indicate peritonitis.

A practitioner’s prescription would be raised according to the individual requirements of each case; some calling for support of nervous system (Skullcap, Lady’s Slipper) or for the heart (Hawthorn, Motherwort), etc.

To be treated by or in liaison with a qualified medical practitioner.

Treatment. Acute stage – immediate hospitalisation.

Tea. Formula. For non-acute stage: equal parts – German Chamomile, Yarrow, Black Horehound. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup thrice daily.

Tea: children. Agrimony.

Tablets/capsules. (non-acute stage), Goldenseal, Blue Flag root, Calamus, Cranesbill, Wild Yam. Juice: Aloe Vera.

Chinese medicine. Fenugreek seeds: 2 teaspoons to each cup water simmer 5 minutes. 1 cup thrice daily, consuming the seeds.

Powders. Formula. Echinacea 2; Myrrh half; Wild Yam half; trace of Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily. Every 2 hours for acute cases.

Tinctures. Formula. Echinacea 2; Wild Yam half; Elderflowers 1; few drops Tincture Capsicum (cayenne). Dose: 1-2 teaspoons in water or herb tea thrice daily or every 2 hours for acute cases.

Finlay Ellingwood MD. Equal parts, Liquid Extract Bryonia and Echinacea. Dose: 20 drops in water, hourly. For prevention of sepsis and pus formation.

Eric F.W. Powell, MNIMH. 1 teaspoon Tincture Echinacea; 10 drops Tincture Myrrh; 2 drops Tincture

Capsicum; in wineglassful hot water. Each wineglass taken in sips; dose repeated hourly until pain eases; then less frequently.

Frank Roberts, MNIMH. Liquid extracts: Equal parts, Wild Yam, Echinacea, Lobelia. Mix. 30-60 drops in wineglassful water, sipped 4 times daily.

John Cooper MD, Waldron, Arkansas, USA. 20 grains Epsom’s salts in hot water every 2 hours until pain ceases, then continue half that quantity. To control pain: Tincture Belladonna, 8 drops in water, when necessary.

Enema. Large enemas are not indicated. Warm strong infusion of German Chamomile proves helpful (50 flowers to 1 pint boiling water). Inject with 1 tablespoon warm olive oil.

Topical. Castor oil packs. Chamomile, Catnep, or Linseed poultices. In France, cases of acute appendicitis are treated with Tea Tree oil by abdominal massage as an alternative to surgery; good results reported.

Diet. No solid food taken as long as raised temperature persists. Herb tea and fruit-juice fast.

Remission of fever or after surgery: Slippery Elm gruel. Convalescent stage requires extra protein to make good muscle wastage and loss of weight. Low fibre.

Supplements. Daily. Beta-carotene 300,000iu. Vitamin C 2-3g. Vitamin E 400-800iu. Child: quarter of adult dose.

Acute stage: until the doctor comes. Do not eat or drink, take laxatives or painkillers. Go to bed. Hot water bottle to ease pain. ... appendicitis

La grippe. An acute contagious viral infection. There are three distinct antigenic types, A, B and C. Droplet infection. Incubation period 48 hours.

Symptoms: chill, shivering, headache, sore throat, weakness, tiredness, dry cough, aching muscles and joints, body temperature rise, fever. Virus tends to change, producing new strains.

Influenza lowers the body’s resistance to infection. For stomach influenza, see: GASTROENTERITIS. Effects of influenza may last for years.

Treatment. (Historical) One of the most virulent strains of history was during the outbreak after World War I. The American Eclectic School of physicians treated successfully with: 5 drops Liquid Extract Lobelia, 5 drops Liquid Extract Gelsemium, and 10 drops Liquid Extract Bryonia. Distilled water to 4oz. 1 teaspoon 4-5 times daily.

Bedrest. Drink plenty of fluids (herb teas, fruit juices). Hot bath at bedtime.

Alternatives. Teas. Elderflowers and Peppermint, Yarrow, Boneset, Pleurisy root.

Tablets/capsules. Lobelia, Cinnamon.

Potter’s Peerless Composition Essence.

Powders. Cinnamon, with pinch of Cayenne.

Dose: 500mg (two 00 capsules or one-third teaspoon) every 2 hours.

Formula. Lobelia 2; Pleurisy root 1; Peppermint quarter; Valerian half. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Acute cases: every 2 hours in hot water. On remission of temperature: thrice daily.

Nurse Ethel Wells, FNIMH. Half an ounce each: Elderflowers, Yarrow, White Horehound, Peppermint, Boneset. Infuse 2 tablespoons in 1 pint boiling water in a clean teapot. Drink teacupful at bedtime and the remainder, cold, in teacupful doses the following day.

Inhalant. Aromatherapy: 5 drops each, Niaouli, Pine and Eucalyptus oils in bowl of hot water; inhale steam with head covered. See also: FRIAR’S BALSAM. 4 drops Peppermint oil in bath.

Diet. 3-day fast, where possible, with herb teas and fruit juices.

Supplements. Daily. Vitamin A 7,500iu. Vitamin C 3g. ... influenza

Chronic inflammation and ulceration of the gut, especially the terminal ileum from changes in the gut blood vessels. Commences with ulceration which deepens, becomes fibrotic and leads to stricture. Defective immune system. Resistance low. May be associated with eye conditions and Vitamin B12 deficiency.

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

Auto-immune disease – antibody to DNA. Non-tubercula. Two kinds: (1) discoid lupus erythematosus (DLE) and (2) systemic lupus erythematosus (SLE). DLE occurs mostly in middle-aged women, but SLE in young women. Activity may be followed by period of remission. The condition may evolve into rheumatic disease.

Symptoms (SLE): Loss of appetite, fever. Weight loss, weakness. Thickened scaly red patches on face (butterfly rash). May invade scalp and cause loss of hair. Sunlight worsens. Anaemia. Joint pains. Enlarged spleen. Heart disorders. Kidney weakness, with protein in the urine. Symptoms worse on exposure to sunlight. Low white blood cell count. Many patients may also present with Raynaud’s phenomenon while some women with silicone breast implants may develop lupus.

Treatment. Anti-virals. Alteratives. Anti-inflammatories, anticoagulants. Alternatives. Teas: Lime flowers, Gotu Kola, Ginkgo, Aloe Vera, Boneset.

Decoctions: Burdock. Queen’s Delight. Helonias.

Tablets/capsules. Echinacea. Blue Flag root. Wild Yam. Ginkgo.

Formula. Dandelion 1; Black Haw 1; Wild Yam half; Poke root half. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Topical. Sunlight barrier creams: Aloe Vera, Comfrey. Horsetail poultice. Garlic ointment. Castor oil packs.

Diet. See: DIET – SKIN DISORDERS.

Supplements. Calcium pantothenate, Vitamin A, Vitamin E, Selenium.

Note: The disorder is frequently misdiagnosed as rheumatoid arthritis, multiple sclerosis or ME. Lupus antibodies have been linked with premature heart disease in women and transient strokes. ... lupus erythematosus

Greek word ‘white blood’. (Leukosis) Acute myeloid and lymphoblastic. Cancer of the white blood cells of two main types; myeloid, involving the polymorph type and lymphatic involving lymphocytes. Each type may take acute or chronic form, the acute being more serious. The disease is not an infection.

Causes: exposure to chemicals, X-rays or radioactive material. Genetic factors are believed to predispose. The condition may be acute or chronic and may follow chemotherapy.

Remissions are known to have been induced by a preparation from the Periwinkle plant (Vinca rosea) now re-classified as Catharanthus roseus.

“Smokers suffer a significantly increased risk of developing acute myelocytic leukaemia.” (“Cancer”: 1987 vol 60, pp141-144)

Acute Leukaemia. Rapid onset with fatality within weeks or months. Fever. Proliferation of white cells in the bone marrow which are released and blood-borne to the liver, spleen and lymphatics. There may be bleeding from kidneys, mouth, bowel and beneath the skin. (Shepherd’s Purse, Yarrow) The acute form is known also as acute lymphoblastic or acute myeloblastic leukaemia. May be mis-diagnosed as tuberculosis.

Chronic Leukaemia. Gradual onset. Breathlessness from enlargement of the spleen. Swelling of glands under arms, in neck and groin. Loss of weight, appetite, strength, facial colour and body heat. Anaemia, spontaneous bleeding and a variety of skin conditions. Diarrhoea. Low grade fever.

No cure is known, but encouraging results in orthodox medicine promise the disease may be controlled, after the manner of diabetes by insulin. Successful results in such control are reported by Dr Hartwell, National Cancer Institute, Maryland, USA, with an alkaloid related to Autumn Primrose (Colchicum officinale). Vinchristine, a preparation from Periwinkle is now well-established in routine treatment. Red Clover, also, is cytotoxic to many mammalian cells. Vitamin C (present in many herbs and fruits) inhibits growth of non-lymphoblastic leukaemia cells. Good responses have been observed by Dr Ferenczi, Hungary, by the use of raw beet root juice.

Also treated with success by Dr Hartland (above) has been lymphocytic leukaemia in children which he treated with a preparation from Periwinkle.

Choice of agents depends largely upon the clinical experience of the practitioner and ease of administration. Addition of a nerve restorative (Oats, Kola, Black Cohosh or Helonias) may improve sense of well-being. To support the heart and circulatory system with cardiotonics (Hawthorn, Motherwort, Lily of the Valley) suggests sound therapy.

Herbal treatment may favourably influence haemoglobin levels and possibly arrest proliferation of leukaemic cells and reduce size of the spleen. It would be directed towards the (a) lymphatic system (Poke root), (b) spleen (Tamarinds), (c) bone marrow (Yellow Dock), and (d) liver (Blue Flag root).

An older generation of herbalists prescribed Blue Flag root, Yellow Dock, Poke root, Thuja and Echinacea, adding other agents according to indications of the particular case.

Tea. Formula. Equal parts: Red Clover, Gotu Kola, Plantain. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes. 1 cup thrice daily.

New Jersey tea (ceanothus). 1 teaspoon to each cup boiling water. Half-1 cup thrice daily.

Periwinkle tea (Vinca rosea). 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Decoction. Formula. Equal parts: Echinacea, Yellow Dock, Blue Flag root. 1 teaspoon to each cup water gently simmered 20 minutes. 1 cup before meals thrice daily.

Formula. Red Clover 2; Yellow Dock 1; Dandelion root 1; Thuja quarter; Poke root quarter; Ginger quarter. Dose: Liquid Extract: 1 teaspoon. Tinctures: 1-2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Vinchristine. Dosage as prescribed. In combination with other medicines.

Wheatgrass. Juice of fresh Wheatgrass grown as sprouts and passed through a juicer. Rich in minerals. One or more glasses daily.

Beetroot juice. Rich in minerals. Contains traces of rare rabidium and caesium, believed to contribute to anti-malignancy effect. (Studies by Dr A. Ferenczi, Nobel Prize-winner, published 1961)

Diet: Dandelion coffee.

Supplements. B-complex, B12, Folic acid, Vitamin C 2g morning and evening, Calcium ascorbate 2g morning and evening. Copper, Iron, Selenium, Zinc.

Childhood Leukaemia. Research has linked the disease with fluorescent lighting. “Fluorescent tubes emit blue light (400mm wavelength). Light penetrates the skin and produces free radicals. Free radicals damage a child’s DNA. Damaged DNA causes leukaemia to develop. The type and intensity of lighting in maternity wards should be changed. This could be prevented by fitting cheap plastic filters to fluorescent lights in maternity wards.” (Peter Cox, in “Here’s Health”, on the work of Dr Shmuel Ben-Sasson, The Hubert Humphrey Centre of Experimental Medicine and Cancer Research, Jerusalem)

Treatment by hospital specialist. ... leukaemia

A rare disorder in which granulomas (nodular collections of abnormal cells), associated with areas of chronic tissue inflammation due to vasculitis, develop in the nasal passages, lungs, and kidneys. It is thought that the condition is an autoimmune disorder (in which the body’s natural defences attack its own tissues). Principal symptoms include a bloody nasal discharge, coughing (which sometimes produces bloodstained sputum), breathing difficulty, chest pain, and blood in the urine. There may also be loss of appetite, weight loss, weakness, fatigue, and joint pains.

Treatment is with immunosuppressant drugs, such as cyclophosphamide or azathioprine, combined with corticosteroids to alleviate symptoms and attempt to bring about a remission.

With prompt treatment, most people recover completely within about a year, although kidney failure occasionally develops.

Without treatment, complications may occur, including perforation of the nasal septum, causing deformity of the nose; inflammation of the eyes; a rash, nodules, or ulcers on the skin; and damage to the heart muscle, which may be fatal.... wegener’s granulomatosis

(ECT) a treatment for severe depression and occasionally for *puerperal psychosis, catatonia, and *mania. A convulsion is produced by passing an electric current through the brain; this is thought to induce stimulation, and is modified by giving a *muscle relaxant drug and an *anaesthetic, so that in fact only a few muscle twitches are produced. The procedure can temporarily cause confusion and headache, which almost always pass off within a few hours. Patients often complain of memory problems during treatment, which normally subside when the treatment has ended. These side-effects are reduced by unilateral treatment, in which the current is passed only through the non-dominant hemisphere of the brain. A course of ECT usually entails between 6 and 10 treatments; sometimes up to 16 treatments are given to achieve remission of depression. ECT is effective in about 50% of patients in whom no other antidepressant treatment was successful, and NICE guidelines suggest it should be used in such cases. However, the beneficial effect on mood does not always last. Occasionally maintenance ECT (usually involving one treatment every 2–4 weeks) is given to avoid relapse after a completed course of ECT. Under the Mental Health Act 1983 (as amended 2007), special legal provision applies to ECT.... electroconvulsive therapy