Bruxism

Definition

Bruxism is when you clench (tightly hold your top and bottom teeth together) or grind (slide your teeth back and forth over each other) your teeth.

Alternative Names

Teeth grinding and clenching

Causes

People can clench and grind without being aware of it during both the day and night, although sleep-related bruxism is often the bigger problem because it is harder to control.

The cause of bruxism is not completely agreed upon, but daily stress may be the trigger in many people. Some people probably clench their teeth and never feel symptoms. Whether or not bruxism causes pain and other problems may be a complicated mix of factors:

• How much stress you are under
• How long and tightly you clench and grind
• Whether your teeth are misaligned
• Your posture
• Your ability to relax
• Your diet
• Your sleeping habits

Each person is probably different.

Symptoms

Clenching the teeth puts pressure on the muscles, tissues, and other structures around your jaw. The symptoms can cause temporomandibular joint problems (TMJ).

Grinding can wear down your teeth. Grinding can be noisy enough at night to bother sleeping partners.

Symptoms include:

• Anxiety, stress, and tension
• Depression
• Earache (partly because the structures of the temporomandibular joint are very close to the ear canal, and partly because you can perceive pain in a different location than its source (referred pain))
• Eating disorders
• Headache
• Insomnia
• Sore or painful jaw

Exams and Tests

An examination can rule out other disorders that may cause similar jaw pain or ear pain, including:

• Dental disorders
• Ear disorders such as ear infections
• Problems with the temporomandibular joint (TMJ)

You may have a history of significant stress and tension.

Treatment

The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.

To help relieve pain, there are many self-care steps you can take at home. For example:

• Apply ice or wet heat to sore jaw muscles. Either can have a beneficial effect.
• Avoid eating hard foods like nuts, candies, steak.
• Drink plenty of water every day.
• Get plenty of sleep.
• Learn physical therapy stretching exercises to help restore a normal balance to the action of the muscles and joints on each side of the head.
• Massage the muscles of the neck, shoulders, and face. Search carefully for small, painful nodules called trigger points that can cause pain throughout the head and face.
• Relax your face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
• Try to reduce your daily stress and learn relaxation techniques.

To prevent damage to the teeth, mouth guards or appliances (splints) have been used since the 1930s to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching.

A splint may also help reduce clenching, but some people find that it makes their clenching worse. In others, the symptoms go away as long as they use the splint, but pain returns when they stop or the splint loses its effectiveness over time.

There are many different types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If one type doesn't work, another may.

For example, a splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated, under the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.

As a next phase after splint therapy, orthodontic adjustment of the bite pattern may help some people. Surgery should be considered a last resort.

Finally, there have been many approaches to try to help people unlearn their clenching behaviors. These are more successful for daytime clenching, since nighttime clenching cannot be consciously stopped.

In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.

Outlook (Prognosis)

Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.

Possible Complications

• Depression
• Eating disorders
• Insomnia
• Increased dental or TMJ problems

Nightly grinding can awaken roommates and sleeping partners.

When to Contact a Medical Professional

See a TMJ specialist immediately if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Therefore, see a TMJ specialist for a full evaluation if self-care measures do not help within several weeks.

Grinding and clenching does not fall clearly into one medical discipline, and TMJ specialists have a variety of treatment approaches. For a massage-based approach, look for a massage therapist trained in trigger point therapy, neuromuscular therapy, or clinical massage, particularly for TMJ disorders.

Dentists who specialize in evaluating and treating TMJ disorders will typically take x-rays and prescribe a mouth guard. Surgery is now considered a last resort by most TMJ experts.

Prevention

Stress reduction and anxiety management may reduce bruxism in people prone to the condition.

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Solder

Definition

Solder is used to connect electric wires or other metal parts together. Solder poisoning occurs when someone swallows solder in large amounts. It can also cause burns to the skin.

Poisonous Ingredient

• Antimony
• Bismuth
• Cadmium
• Copper
• Ethylene glycol
• Lead
• Mild acids
• Silver
• Tin
• Zinc

Where Found

• Solder

Note: This list may not include all sources of solder.

Symptoms

Symptoms for lead:

• Bladder and kidneys
  • Kidney damage
• Eyes, ears, nose, mouth, and throat
  • Metallic taste
  • Vision problems
  • Yellow eyes (jaundice)
• Gastrointestinal
  • Abdominal pain
  • Constipation
  • Diarrhea
  • Excessive thirst
  • Loss of appetite
  • Vomiting
  • Weight loss
• Heart and blood
  • Collapse
  • Convulsions
  • High blood pressure
  • Low blood pressure
• Muscles and joints
  • Paralysis
  • Muscle aches
  • Fatigue
  • Weakness
  • Joint pain
• Nervous system
  • Coma
  • Confusion
  • Excitability
  • Hallucinations
  • Headache
  • Irritability
  • Lack of desire to do anything
  • Sleeping difficulty
  • Tremor
  • Twitching
  • Uncoordinated movements
• Skin
  • Pale skin
  • Yellow skin

Symptoms for tin and zinc chloride:

• Bladder and kidneys
  • Decreased urine output
  • No urine output
• Eyes, ears, nose, mouth, and throat
  • Burns in mouth and throat
  • Yellow eyes (jaundice)
• Gastrointestinal
  • Diarrhea
  • Vomiting
• Skin
  • Yellow skin

Symptoms for ethylene glycol:

• Disturbance in the acid balance of the blood (can lead to failure of many organs)
• Kidney failure

Symptoms for cadmium:

• Kidney damage
• Reduced brain function or intelligence
• Reduced lung function
• Softening of the bones and kidney failure (itai-itai disease)

Symptoms for bismuth:

• Diarrhea
• Eye irritation
• Gingivitis
• Kidney damage
• Metallic taste
• Skin irritation

Symptoms for silver:

• Greyish-black staining of the skin and mucus membranes (argyria)
• Silver deposits in the eyes (argyrosis)

Symptoms for antimony:

• Chemical burns
• Depression
• Dizziness
• Eczema
• Headache
• Irritation of mucus membranes
• Stomach problems

Symptoms for copper:

• Fever

Home Care

Seek immediate medical help. Do NOT make a person throw up unless told to do so by Poison Control or a health care professional.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

Before Calling Emergency

Determine the following information:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

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Nephrotic syndrome

Definition

Nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5 grams per day), low blood protein levels, high cholesterol levels, and swelling. The urine may also contain fat, which can be seen under the microscope.

Alternative Names

Nephrosis

Causes

Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the basement membrane of the glomerulus. This immediately causes abnormal excretion of protein in the urine.

The most common cause in children is minimal change disease, while membranous glomerulonephritis is the most common cause in adults.

This condition can also occur as a result of infection, use of certain drugs, cancer, genetic disorders, immune disorders, or diseases that affect multiple body systems including diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis.

It can accompany kidney disorders such as glomerulonephritis, focal and segmental glomerulosclerosis, and mesangiocapillary glomerulonephritis.

Nephrotic syndrome can affect all age groups. In children, it is most common from age 2 to 6. This disorder occurs slightly more often in males than females.

Symptoms

• Swelling (edema )
  • general
  • around the eyes
  • in the extremities, especially the feet and ankles
• Swollen abdomen
• Facial swelling
• Foamy appearance of the urine
• Weight gain (unintentional) from fluid retention
• Poor appetite
• High blood pressure

Exams and Tests

Physical examination can detect some symptoms. Other symptoms and signs of causative disorders can also be found with examination.

Urinalysis reveals large amounts of urine protein. Fats are often also present in the urine.

Tests to rule out various causes may include the following:

• Glucose tolerance test
• Antinuclear antibody
• Rheumatoid factor
• Cryoglobulins
• Complement levels
• Hepatitis B and C antibodies
• VDRL serology
• Serum protein electrophoresis
• Kidney biopsy

This disease may also alter the results of the following tests:

• Urinary casts
• Triglyceride
• Protein electrophoresis - urine
• Serum iron
• Cholesterol
• Albumin

Treatment

The goals of treatment are to relieve symptoms, prevent complications and delay progressive kidney damage. Treatment of the causative disorder is necessary to control nephrotic syndrome. Treatment may be required for life.

Corticosteroid, immunosuppressive, antihypertensive, and diuretic medications may help control symptoms. Antibiotics may be needed to control infections. Angiotensin converting enzyme (ACE) inhibitors may significantly reduce the degree of protein loss in the urine and are therefore frequently prescribed for treatment of nephrotic syndrome.

If hypertension occurs, it must be treated vigorously. Treatment of high blood cholesterol and triglyceride levels is also recommended to reduce the risk of atherosclerosis. Dietary limitation of cholesterol and saturated fats may be of little benefit, as the high levels which accompany this condition seem to be the result of overproduction by the liver rather than from excessive fat intake. Medications to reduce cholesterol and triglycerides may be recommended.

High-protein diets are of debatable value. In many patients, reducing the amount of protein in the diet produces a decrease in urine protein. In most cases, a moderate-protein diet (1 gram of protein per kilogram of body weight per day) is usually recommended. Sodium (salt) may be restricted to help control swelling. Vitamin D may need to be replaced if nephrotic syndrome is chronic and unresponsive to therapy.

Blood thinners may be required to treat or prevent clot formation.

Outlook (Prognosis)

The outcome varies; the syndrome may be acute and short-term or chronic and unresponsive to therapy. The cause and development of complications also affects the outcome.

Possible Complications

• Atherosclerosis and related heart diseases
• Renal vein thrombosis
• Acute renal failure
• Chronic renal failure
• Infections, including pneumococcal pneumonia
• Malnutrition
• Fluid overload, congestive heart failure, pulmonary edema

When to Contact a Medical Professional

Call your health care provider if symptoms which may indicate nephrotic syndrome occur.

Call your health care provider if nephrotic syndrome persists or if new symptoms develop, including severe headache, fever, sores on the skin, cough, discomfort with urination, or decreased urine output.

Go to the emergency room or call the local emergency number (such as 911) if convulsions occur.

Prevention

Treatment of causative disorders may prevent development of nephrotic syndrome.

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

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

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

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

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

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

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

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

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Syphilitic myelopathy

Definition

Syphilitic myelopathy is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.

Alternative Names

Tabes dorsalis

Causes

Syphilitic myelopathy is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted, infectious disease. For information on the disease, see: Syphilis.

The condition called tabes dorsalis includes syphilitic myelopathy and additional symptoms of nerve damage.

The infection damages the tissue of the spinal cord and peripheral nervous tissue. This causes decreased muscle function (myelopathy), including progressive weakness of the legs, arms, and other areas. Loss of function may eventually result in paralysis.

Coordination difficulties contribute to problems walking. There are often changes in sensation, including painful paresthesia (abnormal sensations), which are also referred to as "lightning pains."

In syphilitic myelopathy, the muscle problems are accompanied by other symptoms characteristic of nervous system damage caused by syphilis. These include vision changes, stroke, and psychiatric illness.

Syphilitic myelopathy is now very rare because syphilis is usually treated early in the disease or as a result of screening blood tests that identify the disease in its latent (silent) form. Such blood tests are performed, for example, on individuals who donate blood and during pregnancy.

Symptoms

• Abnormal sensations, often called "lightning pains"
• Difficulty walking
• Loss of coordination
• Loss of reflexes
• Muscle weakness
• Wide-based gait (the person walks with the legs far apart)

Exams and Tests

Physical examination may suggest myelopathy. Decreased or absent reflexes may be present due to nerve damage.

Tests may include the following:

• Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases
• Serum VDRL or serum RPR (used as a screening test for syphilis infection -- if positive, one of the following will be required to confirm the diagnosis):
  • FTA-ABS
  • MHA-TP
• CSF (cerebrospinal fluid) examination
  • abnormal results indicating chronic meningitis
  • a positive neurosyphilis test (CSF VDRL test)

Treatment

The goals of treatment are to cure the infection and to reduce progression of the disorder. Treatment of the infection reduces new nerve damage and may reduce symptoms but does not cure existing nerve damage.

For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may undergo desensitization to penicillin so that they can be safely treated with it.

Treatment of symptoms is required for existing neurologic damage. Assistance or supervision may be needed if the person is unable to perform self-care activities (eating, dressing, etc.). Rehabilitation, physical therapy, occupational therapy, or other interventions may be appropriate for people with muscle weakness.

Analgesics may be required to control pain. These may include over-the-counter medications such as aspirin (oral salicylates) or acetaminophen for mild pain but narcotics may be required. Anti-epilepsy drugs such as carbamazepine may have a role in the treatment of lightning pains.

Outlook (Prognosis)

Progressive disability is possible if the disorder is left untreated.

Possible Complications

• Complications of late-stage syphilis infection, which may include:
  • Inflammation of the aorta (aortitis) with aortic aneurysm
  • Disease of the heart valves
  • Destructive changes in bones, skin, and other organs
• Complications of neurosyphilis, including dementia, strokes, eye disease
• Difficulty with walking and balance

When to Contact a Medical Professional

Call your health care provider if loss of coordination, loss of muscle strength, or loss of sensation occurs.

Prevention

Adequate treatment and follow-up of primary syphilis infections reduces the risk of developing syphilitic myelopathy.

If you are sexually active, practice safe sex and always use a condom.

All pregnant women should be screen for syphilis.

References

Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med. 2004;2:362-365.

Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

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Osteitis fibrosa

Definition

Osteitis fibrosa is a complication of hyperparathyroidism in which the bones turn soft and become deformed.

Alternative Names

Osteitis fibrosa cystica

Causes

The parathyroid glands are four glands in the neck that help control calcium use and removal by the body. They do this by producing parathyroid hormone, or PTH. PTH helps control calcium, phosphorus, and vitamin D levels within the blood and bone.

Too much parathyroid hormone (hyperparathyroidism) can lead to increased bone break down, which can cause bones to turn soft.

Rarely, parathyroid cancer may cause osteitis fibrosa.

Before 1950, about half of people diagnosed with hyperparathyroidism had osteitis fibrosa. Now it is uncommon, because patients with hyperparathyroidism are diagnosed earlier, before bone softening has occurred.

People with severe hyperparathyroidism have a higher risk for developing osteitis fibrosa.

Symptoms

Osteitis fibrosa may cause bone pain or tenderness. There may be fractures (breaks) in the arms, legs, or spine, or other bone problems.

Hyperparathyroidism may cause kidney stones, kidney problems, nausea, constipation, fatigue, and weakness.

Exams and Tests

Blood tests show a high level of calcium, parathyroid hormone, and alkaline phosphatase (a bone chemical). Phosphorus may be low.

X-rays may show thin bones, fractures, bowing, and cysts. Teeth x-rays may also be abnormal.

A bone x-ray may be done. People with hyperparathyroidism are more likely to have osteopenia (thin bones) or osteoporosis (very thin bones) than to have full-blown osteitis fibrosa.

Treatment

Most of the bone problems of osteitis fibrosa are usually reversible with surgery.

Most patients with hyperparathyroidism have no symptoms, and many can be followed with blood tests and bone measurements. Others may need surgery to remove the abnormal parathyroid gland(s).

If surgery is not possible, drugs can sometimes be used to lower calcium levels.

Possible Complications

The complications of osteitis fibrosa include bone fractures, pain, and deformities. There may be other problems due to hyperparathyroidism such as kidney stones and kidney failure.

When to Contact a Medical Professional

Call your health care provider if you have bone pain, tenderness, or symptoms of hyperparathyroidism.

Prevention

Today, routine blood tests performed during a medical check up or for another health problem usually detect high calcium levels before severe damage is done.

References

Wysolmerski JJ. Insogna KL. The Parathyroid Glands, Hypercalcemia, and Hypocalcemia. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 266.

Bringhurst FR, Demay MB, Kronenberg HM. Disorders of Mineral Metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 27.

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Tumors of a brain at children

Tumors of the central nervous system win first place on frequency among solid malignant tumours at children, making 20 % of all oncological desease in children's age. These tumors occurs frequency 2-2,8 on 100000 children's population, taking the second place among the reasons of death of children with an oncological pathology. Children of preschool age fall ill more often: the peak of desease is necessary for 2-7 years. Though the parameter lethality from these tumours till now exceeds lethality's parameters at many malignant processes at children, modern therapeutic approaches and advanced achievements in the diagnostic opportunities, allowing early to diagnose a tumour and precisely to plan treatment, allow to cure a lot of children.

Etiology of this group of tumors now it is unknown, though there are data about predisposition of patients for example, with neurofibromatosis, to occurrence at them glioma a brain. Communication of occurrence neurogliocytoma at children with a syndrome basocellular nevus (defeat of a skin, anomaly of a skeleton, a leather, brushes, feet and anomalies of central nervous system) is known. The raised desease of tumors of a brain is marked at children with a congenital immunodeficiency, at children with ataxia-venous lake.

Often tumor of a brain arises as the second tumor at children, suffering sharp leukosis, a hepatocellular cancer, adrenocortical tumors. All these data attest to availability of some contributory causes for progress of malignant tumours of a brain, to decipher which and to define their influence on the forecast it is necessary in the future.

Classification of tumors of a brain at children.

According to the international classification the CART (1990, the second edition) biological behaviour of tumours central nervous system it is defined (in addition to presence of histologic features of a differentiation) so-called, a degree malignity or anaplasia: from I (good-quality) up to IV (malignant). To tumors low degrees of malignity belong to tumor I-II of a degree (Low grade), to a high degree of malignity
- III-IV degrees (High grade).

The histologic structure of tumours of a brain at children significantly differs from those at adults. Meningiomas, neurilemmomas, tumors of a hypophysis and metastasises from other bodies which rather often amaze brain of adult patients, very seldom meet at children's age. At children of 70 % of tumours make gliomas.

The first classification of tumors of a brain has been offered in 20th years of our century Bailey and Cushing. This classification is based on histogenesis fabrics of a brain and the subsequent classifications have all in to the basis this principle.

The tumors of a brain diagnosed for children of the first years of a life, have the central arrangement, i.e. amaze more often the third ventricle, hypothalamus, chiasm optic nerves, an average brain, the bridge, a cerebellum and the fourth ventricle. In spite of the fact that the volume of substance of a brain of a back cranial pole makes only the tenth part from all volume of a brain, more than half of all malignant tumors of a brain at children is more senior than 1 year make tumors of a back cranial pole. It mainly - neurogliocytoma, cerebellar astrocytoma, gliomas of a trunk of a brain and ependymoma the fourth ventricle,.

Clinical picture.

Generally speaking, any tumor of a brain has malignant behaviour irrespective of it the histologic nature as its growth occurs in the limited volume, and irrespective of the histologic nature of a tumour the clinical picture of all tumours of a brain is defined, mainly, localization of tumoral growth, age and a preclinical level of development of the sick child.

Central nervous system neoplasms can cause neurologic frustration by direct infiltration or prelum normal structures, or mediated, causing of obstruction neurolymph ways.

The factor defining dominating symptoms at children by tumours of a brain, the raised intracranial pressure is, in consequence of that there is a classical triad - a morning headache, vomiting and drowsiness. Heavy, anticipate the headache seldom arises at children, but it is especially important to pay attention to this complaint. Spasmes - the second symptom on frequency after a headache, especially at children with suprasternal tumors. Approximately at a quarter of such patients of a spasm are the first demonstration of a tumour. Sometimes these children aspire to incline a head in one party. Involving in process of a cerebellum can cause ataxia, nystagmus and others cerebellar frustration.

Diagnostic.

Besides routine clinical inspections, including survey of the oculist, to such children should be necessarily lead CT and MRT with contrast substance head and a spinal cord. Especially at localization of a tumor in back to pole MRT it is extremely informative, as this method has greater resolution. These researches with success have replaced intrusive procedures - arterial angiography or air ventriculography.

Histologic verification of a tumor is necessary, but is at times complicated because of the technical difficulties connected with localization of a tumour, involving in process the vitally-important structures. Now with gradual ocurrence in practice of neurosurgeons of a new hi-tech method of operative intervention - stereotactic surgeries begins possible to make biopsy tumors practically any localization. Sometimes in communication with substantial growth of intracranial pressure by a first step operation of shunting is, that considerably improves the neurologic status of the patient.

Cerebrospinal research will give a-brain liquid the information about possible extracratonal distribution of malignant process. In rare cases of distribution of a tumor for central nervous system limits (for example, at presence neurogliocytoma) carrying out of additional diagnostic actions, such as x-ray of a thorax, ultrasonic of a belly cavity, myelogram is necessary.

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Multiple Endocrine Neoplasia

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

The historical information:

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

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

Genetics:

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

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

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

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Multiple Endocrine Neoplasia

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

The historical information:

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

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

Genetics:

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

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

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

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Subarachnoid hemorrhage

Definition

Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space.

Alternative Names

Hemorrhage - subarachnoid

Causes

Subarachnoid hemorrhage can be caused by:

• Bleeding from an arteriovenous malformation (AVM)
• Bleeding disorder
• Cerebral aneurysm rupture
• Head injury
• Unknown cause (idiopathic)
• Use of blood thinners

Injury-related subarachnoid hemorrhage is often seen in the elderly who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.

Subarachnoid hemorrhage due to rupture of a cerebral aneurysm occurs in approximately 10-15 out of 10,000 people. However, some studies suggest that number may be slightly lower. Subarachnoid hemorrhage due to rupture of a cerebral aneurysm is most common in persons age 20 to 60. It is slightly more common in women than men.

Risks include:

• Aneurysms in other blood vessels
• Disorders associated with aneurysm or weakened blood vessels
• Fibromuscular dysplasia (FMD) and other connective tissue disorders
• High blood pressure
• History of polycystic kidney disease
• Smoking

A strong family history of aneurysms may also increase your risk.

Symptoms

The main symptom is a severe headache that starts suddenly and is often worse near the back of the head. Patients often describe it as the "worst headache ever" and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head.

Other symptoms:

• Decreased consciousness and alertness
• Difficulty or loss of movement or feeling
• Mood and personality changes, including confusion and irritability
• Muscle aches (especially neck pain and shoulder pain)
• Nausea and vomiting
• Photophobia (light bothers or hurts the eyes)
• Seizure
• Stiff neck
• Vision problems, including double vision, blind spots, or temporary vision loss in one eye

Additional symptoms that may be associated with this disease:

• Eyelid drooping
• Eyes, pupils different size
• Opisthotonos (not very common)
• Seizures

Exams and Tests

A physical exam may show a stiff neck due to irritated meninges, the tissues that cover the brain. Except those in a deep coma, persons with a subarachnoid hemorrhage may resist neck movement.

A neurological exam may show signs of decreased nerve and brain function (focal neurologic deficit).

An eye exam may show signs of bleeding in the brain. Decreased eye movements can be a sign of damage to the cranial nerves. In milder cases, no problems may be seen on an eye exam.

If your doctor thinks you may have a subarachnoid hemorrhage, a head CT scan (without dye contrast) should be immediately done. In some cases, the scan may be normal, especially if there has only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap) must be performed. Patients with SAH will have blood in their spinal fluid.

Cerebral angiography of blood vessels of the brain may show small aneurysms or other vascular problems. This test can pinpoint the exact location of the bleed and can tell if there are blood vessel spasms.

Transcranial doppler ultrasound is used to look at blood flow through the skull. It can also detect blood vessel spasms and may be used to guide treatment.

Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are occasionally used to diagnose a stroke or tumor.

Treatment

The goals of treatment are to save your life, repair the cause of bleeding, relieve symptoms, and prevent complications.

If the hemorrhage is due to an injury, surgery is done only to remove large collections of blood or to relieve pressure on the brain.

If the hemorrhage is due to the rupture of an aneurysm, surgery is needed to repair the aneurym. If the patient is critically ill, surgery may have to wait until the person is more stable. Surgery may involve a craniotomy and aneurysm clipping, which closes the aneurysm, or endovascular coiling, a procedure in which coils are placed within the aneurysm to prevent further bleeding.

If no aneurysm is found, the person should be closely watched by a health care team and may need repeated imaging tests.

Treatment for coma or decreased alertness status may be needed. This may include special positioning, life support, and methods to protect the airway. A draining tube may be placed into the brain to relieve pressure.

If the person is conscious, strict bed rest may be advised. The person will be told to avoid activites that can increase pressure inside the head. Such activities include bending over, straining, and suddenly changing position. The doctor may prescribe stool softeners or laxatives to prevent straining during bowel movements.

Blood pressure will be strictly controlled. This requires medicines given through an IV line. The medicine often requires frequent adjustments. A medicine called calcium channel blocker is used to prevent blood vessel spams.

Pain killers and anti-anxiety medications may be used to relieve headache and reduce intracranial pressure. Phenytoin or other medications may be used to prevent or treat seizures.

Outlook (Prognosis)

How well a patient with SAH does depends on a number of different factors, including the location and extent of the bleeding, as well as any complications. Older age and more severe symptoms from the beginning are associated with a poorer prognosis.

Complete recovery can occur after treatment, but death may occur in some cases with or without treatment.

Possible Complications

Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is significantly worsened.

Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.

Other complications include:

• Stroke
• Seizures
• Medication side effects
• Complications of surgery

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) you have symptoms of a subarachnoid hemorrhage.

Prevention

Identification and successful treatment of an aneurysm would prevent subarachnoid hemorrhage.

References

Kirmani JF, Alkawi A, Ahmed S, et al.Endovascular treatment of subarachnoid hemorrhage. Neurol Res. 2005;27 Suppl 1:103-7.

Edlow JA. Diagnosis of subarachnoid hemorrhage. Neurocrit Care. 2005;2(2):99-109.

Bird S. Failure to diagnose: subarachnoid haemorrhage. Aust Fam Physician. 2005 Aug;34(8):682-3.

Marx J. Rosens Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:2362-2363.

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Optic neuritis

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

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

Attributes (symptoms)

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

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

Diagnostics

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

Treatment

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

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

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Etiology of Bacterial meningitis

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

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

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

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

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

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

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

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

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Parkinson's disease

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

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

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

Symptoms of Parkinson's disease

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

Other symptoms of Parkinson's disease

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

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

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

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

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

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

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

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

Reasons of occurrence of Parkinson's disease

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

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

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

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Brain edema

Brain edema - the pathological condition, described accumulation of a liquid in a fabric of a brain and intracranial hypertensia clinically shown by a syndrome.

There are 4 basic kinds of brain edema:

- cellulotoxic
- vasogenic
- interstitial
- osmotic.

They differ by etiology, time of development, localization and methods of preventive maintenance and treatment

Cellulotoxic edema appears because of swelling glia, neurocyte and endotheliocyte and begins in some minutes after damage of a brain, for example hypoxia. As a result of decrease in a metabolism activity Na+, K+-AT phases a cellular membrane is broken. Sodium collects in a cell, and on a gradient of osmotic pressure in a cell water starts to act. Cellulotoxic edema is localized basically in grey substance of a brain.

Vasogenic edema is the most frequent version of a hypostasis of a brain. It develops because of increase of permeability of capillaries. Through a wall of capillaries in extracellular space there are fibers, and after them - water. vasogenic edema is localized basically in white substance of a brain.

Interstitial edema develops at a hydrocephaly because of difficulty of outflow pressure inside ventricle of a brain raises. Under the action of this pressure there is a strengthened filtration of water and low-molecular substances in the fabric of a brain surrounding ventricles.

The ischemia of a brain leads all over again to cellulotoxic, and then - to vasogenic edema. Thus, the pathophysiological picture is so usual that some people suggest to use the term "an ischemic edema". In the first minutes of an ischemia develops cellulotoxic edema mentioning mainly astrocytes which are located around of capillaries. If blood supply is quickly restored, these changes happen to be backwards. Otherwise because of swelling of astrocytes and endothelial cells the gleam of capillaries is narrowed so, even after restoration of blood supply blood can not act in capillaries. It aggravates an ischemia and necrosis.

In a phase vasogenic edema permeability of a wall of capillaries raises. It is shown, that it occurs cause of pinocytosis increases and as a result of infringement of dense contacts between cells of endothelium. After restoration of a blood-groove permeability of blood-brain barrier increases even more. As well as at other forms of vasogenic edema.

Simultaneously with cellulotoxic and vasogenic edema necrosis develops. Glia and neurocyte in a greater degree are subject of necrosis in comparison with endothelium. In process of their destruction in intercellular substance of a brain osmotically active substances that leads to an even greater output of water from capillaries collect.

The ischemic hypostasis reaches a maximum on 2-4-е day after a heart attack and decreases by the end of the second week. Further in the field of necrosis inflammatory reaction, including phagocytosis develops. Within several day or weeks necrotic weights resolve, and the hypostasis disappears. Believe, that the hypostasis can cause an ischemia and by that to increase a zone of a heart attack.

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Pneumonia

It is considered pneumonia to be artful illness. At a seeming simplicity of process (a bacterial inflammation of a fabric of a lung) it is rather diverse in the displays. Frequently the pneumonia is shown in such a manner that to suspect a pathology from lungs not too simply. Such feature of this illness is connected by that a huge role play age and conditions in which the pneumonia develops. The activators (bacteria) causing a pneumonia at the baby, the ill house, and at the elderly person who has ill during stay in hospital, essentially different, accordingly both displays, and treatment, and the forecast at these patients cardinally differ.

In most cases it is necessary to collide with a pneumonia which is complication SARS or with a pneumonia which begins at once, without any previous colds.

In this case the circle of microbes which doctors cause a pneumonia, and is known, selecting an antibiotic for treatment, are guided by this list of potentially possible activators. Necessity to consider what microbe has caused an inflammation, is dictated to what not all antibiotics act on all microbes. The choice of an antibiotic depends on that, how much concrete bacterium is sensitive to action of an antibacterial preparation.

The pneumonia is characterized, as was already spoken, varied symptoms.

Sudden rise of temperature up to 40 degrees, accompanied all over again dry cough, extremely bad state of health, a short wind (that is any physical activity, even minimal, causes the speeded up heavy breath). Thus there can be pains in the breasts amplifying at cough and deep breath. The pain can give to a stomach or is simple the stomach can hurt only. At a deep breath the fit of coughing is possible. Sometimes there is a reddening one cheek (from that side where the pain is marked). All this conforms so-called croupous to a pneumonia at which the inflammation covers the most part of a lung. Not all from the described symptoms are present necessarily, but the temperature, cough and sharp weakness meet practically constantly.

Illness begins as usual SARS: a cold, cough, temperature. After a while the temperature falls, and then again raises and does not decrease any more. It too a variant of current of a pneumonia.

The temperature does not rise above 38 degrees, but keeps almost constantly at this level, is accompanied by cough, weakness. It also can be a pneumonia.

At children criteria which should guard concerning possible presence of a pneumonia, the following are: duration of temperature above 38 degrees within three and more days; a short wind (the speeded up breath); sharp slackness, drowsiness.

The final diagnosis can be put only on the basis of x-ray of a thorax.

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What is the arthritis? Symptoms of an arthritis, development and national methods of treatment

Whence the arthritis undertakes? It is no wonder: we work for wear, all the day long sitting in a chair, we transfer colds on legs, we wear clothing not on a season, and we read only in books about a healthy way of life. Naturally, it strikes serious blow on our joints, and, after some time, the arthritis can develop.
The reasons of occurrence of an arthritis set also could be a trauma, excessive physical activity. The arthritis can develop as well with diseases of nervous system or infringement of a metabolism. To occurrence of an arthritis assist not only hereditary pathologies of bones and joints, but also excess weight, smoking. The arthritis can be consequence of surgical intervention on joints.
Irrespective of the reasons of occurrence of an arthritis, the metabolism in joints, intraarticulate a cartilage getting thin that leads to its inflammation, puffiness, deformations and development of arthrosis is broken.

Symptoms of an arthritis are well familiar: a frequent pain and a swelling of joints, constraint in movements, especially in the mornings. Subsequently – weakness, fast fatigue, aching periodic pains, a sleeplessness and, from time to time, rise in temperature.

Listen to yourself. If you have suddenly noticed, that in the mornings fingers of hands not such flexible as it is usual, and, in due course, to develop them there is all longer and longer; then joints start to ache a bit is an arthritis! And, if an arthritis to not start to treat, through any time the form of joints, that already – display arthrosis starts to vary. If you have found out first attributes of an arthritis – do not pull, do not wait! Go to visit doctor immediately.
Medicamentous treatment of an arthritis, physiotherapeutic procedures, medical gymnastics slow down destruction of a cartilage, and will allow you to keep long time mobility of joints and will relieve of painful sensations

Various diseases of joints now suffers about 70 % of adults. The more we become senior, the more strongly threat of diseases, more difficultly they are treated by that. The arthritis in most cases starts to be shown in 40-50 years. And it is more dangerous also because, that can cause complications on heart.

The national recipes, helping to remove a painful syndrome at an periarthritis
- The Indian doctors, being based on thousand-year experience, have found out, that eaten 2-3 crude garlic in day will help to support your joints in a mobile condition and will protect them from puffiness, and you – from painful sensations.

- For clarification and preventive maintenance of an arthritis by good means are juicy mixes, especially in the mornings because at this time juices are well acquired by an organism. The most useful mixes:
1. Carrots, a beet, a cucumber in a proportion 10:3:3 accordingly.
2. Carrots, cabbage, leaves of salad in a proportion 8:4:4 accordingly.
3. Carrots, spinach in a proportion 10:6 accordingly.
To drink such mixes it is necessary daily within a month.

- If at night from a pain strongly reduces hands, take woolen gloves, wet them in a solution of table salt at the rate of: 1 spoon of salt on 1 glass of water. Put gloves on for about half an hour, wring out, dry and put on night. Since morning grease hands with a cream that the leather has not suffered.

- At a pain in joints it is good to apply radio procedures:
1.5 drops of a pine oil, 3 drops a lavender oil, 3 drops of a lemon oil, 1 spoon of an olive oil.
2.5 drops of a lemon oil, 4 drops of an eucalyptus oil, 4 drops of a lavender oil, 1 spoon of a grapes oil.

Components of the chosen structure to mix and rub massage movements in a sick joint. Then to tie a soft woolen fabric and to provide to a joint rest.

Do not forget to do daily gymnastics for the prevention and treatments of an arthritis, but it is obligatory after consultation of the doctor because some exercises can be counter-indicative to you!

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Generic Cardiovascular Drugs Are Just as Effective As Brand Name Varieties

Brand name or generic? That is the question frequently asked by consumers, doctor, and insurers alike. Which is better? Is there really a difference? At least in the case of drugs used for the treatment of heart disease, there is apparently no difference. According to researchers, all brand name and FDA-approved generic cardiovascular drugs are created equal.

Aaron Kesselheim, MD, JD, MPH, of Brigham and Women's Hospital in Boston is the lead author of the new study, which has just been published in The Journal of the American Medical Association. Kesselheim and colleagues analyzed combined data from 47 studies of generic and brand name cardiovascular drugs published between January 1984 and August 2008. Regarding the results of the analysis, Kesselheim stated, “We found no evidence that brand-name drugs are any better in terms of clinical outcomes than generic drugs.”

The study covered beta-blockers, diuretics, calcium-channel blockers, statins, antiplatelet agents, ACE inhibitors, alpha-blockers, anti-arrhythmic agents, and warfarin. The analysis performed by the researchers focused on clinical outcomes for patients in the collection of study data regarding heart rate, blood pressure illness, and death. Brand-name drugs were not found to offer any advantage for patients' clinical outcomes in those studies.

Ironically, the research team also reviewed 43 editorials and commentaries published during the same period of time as the studies and discovered that 53 percent of them voiced negative views on substituting generic drugs. The reasons for the lack of support of generic drugs were not clear although the researchers noted that concerns may rose from subjective experiences as well as from financial connections to drug companies. The authors wrote, “To limit unfounded distrust of generic medications, popular media and scientific journals could choose to be more selective about publishing perspective pieces based on anecdotal evidence of diminished clinical efficacy or greater risk of adverse effects with generic medications.”

Regarding the study, in a statement issued by The Pharmaceutical Research and Manufacturers of America (PhRMA), an industry group for U.S. pharmaceutical and biotechnology companies, Senior Vice President Ken Johnson said, “PhRMA has always supported patients receiving the medicines that are best for them, including both brand-name medicines and generic drugs.” He also acknowledged, “Without today's brand-name drugs to legally copy, there would be no generic drug industry. Worse yet, there would be little hope of finding new treatments and cures for a wide range of debilitating, and often deadly, diseases.”

Pharmaceutical companies retain exclusive rights to market a drug they develop for a certain number of years after approval by the FDA. After this time, other drug developers may sell chemically equivalent generic versions. The active ingredient always remains the same, however the inert binders and fillers as well as color and shape may vary from manufacturer to manufacturer.

The greatest advantage in the use of generic medications is that they have substantially less cost. According to Kesselheim, “Brand-name drugs for cardiovascular disease can be as much as a few dollars a pill, whereas generic drugs might be as little as a few cents a pill.”

About 66 percent of the total prescriptions in the United States are for generic drugs, yet they account for less than 15 percent of the money spent on prescription drugs, as indicated by the Generic Pharmaceutical Association industry group.

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What is epilepsy?

Epilepsy is a condition when post convulsive attacks are repeated. However, the diagnosis of epilepsy is set up only in case if the person have had at least two attacks and if no any other illness causing attacks is proved. Epilepsy is not infectious and is not mental disease.

How often it occurs?

This illness is observed approximately at 7 of 1000 children in the age of under 16 years; and at 1 from 200 of adults.

When it occurs?

Attacks often occurs at newborns and children with diseases of a heat. It does not mean, that at the child will develop in the subsequent epilepsy.

Epilepsy can develop at any person at any age, but begins at children and teenagers is more often: at 75 % of people with the epilepsy the diagnosis is put in the age under 20 years. At more recent age the reason of occurrence of epilepsy can become craniocereberal traumas, insults, tumors of a brain. The number of such cases of epilepsy sharply increases among people older 60 years.

What are the reasons of occurrence?

There is no unified reason of occurrence of epilepsy. The majority of forms of epilepsy is not inherited, but can occur a little bit more often in some families. About 40 % of patients with epilepsy have close relatives with this disease. There is a set of various types of post convulsive attacks with a various degree of weight. The attack which begins from one certain site of a brain, refers to fractional or focal. If the attack covers at once all brain from the beginning it is generalized. Some attacks can begin from one site, and then extend on all brain and become generalized. Organic infringements of a structure of a brain (a tumor, scars from traumas, an insult) detect at people with fractional by attacks is more often. In 70 % of cases the reason of epilepsy is unknown.

The most popular reasons of occurrence are:

- A craniocereberal trauma
- An insult
- Tumors of a brain
- Lack of oxygen and blood supply at a birth
- Infringements of a structure of a brain
- A meningitis, virus and parasitic diseases, an abscess of a brain
- Hereditary factors

What are necessary inspections?

To set the correct diagnosis, the doctor in details finds out all symptoms of an attack, sequence of their development, frequency and their stereotype. As illnesses of the patient and its relatives for revealing disease which can cause development of an attack are studied all.

The further inspection depends on of this type attack, age of the patient, results of the analysis of its case record and clinical survey. Often statement of the diagnosis is helped by the description of an attack the witness of its progress (the person who has transferred an attack, as a rule, of it does not remember).

In addition to clinical survey it is necessarily to check the electroencephalography. This painless procedure represents record of bio electric activity of a brain. Carrying out of a resonant tomography or a computer tomography.

What are consequences?

People with epilepsy often collide that their attacks strongly frighten associates. Children cannot participate in some sports and other kinds of activity, schoolmates can avoid them. Despite of correct selection anti epileptic therapies occurrence of hyperactive behavior and difficulties in training is possible.

Restriction of some kinds of activity, for example, driving of the car, can lower mood, cause alarm. Treatment of people with heavy uncontrollable forms of epilepsies should include discussion of social, emotional and personal changes which can accompany with disease.

How it is treated?

Modern treatment completely prevents progress of attacks, and patients with the epilepsy can conduct a normal way of life. Objective of treatment is full elimination of attacks with the minimal by-effects.

Now the most widespread way of prevention of development of attacks is daily reception antiepileptic preparations there is a wide range of them. Some of them operate only at the certain types of epilepsy. By-effects in case of their occurrence absolutely differently proceed at various patients. In this connection very important precisely to follow instructions of the attending physician. With the epilepsy medical consultation up to and during pregnancy is necessary for women. At pregnancy it is not necessary to interrupt sharply reception anti epileptic medicines at all.

If medicinal treatment does not allow to supervise attacks, probably to remove the damaged site of a brain surgical by. To define, whether it is necessary to be treated in a similar way, the inspection including record of an attack with use of video and electroencephalography of the equipment is necessary highly specially.

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Papilloma

The papilloma (an infection of papilloma) has been known to gynecologists for a long time. It is described by doctors of the Ancient Greece under the name condyloma. Papillomas name also as interlabial verrugas. In the end of 60th of 19th century when there were methodical opportunities of studying of a virus infection, from interlabial verrugas viruses have been allocated. The structure had them much in common with virus particles of vulgar verrugas of skin. Later specific subtypes of viruses of papilloma have been allocated at woman with condylomas of genital tracts.

Contagion of papillomas occurs only by genital tracks. Papillomas amaze basically the young women leading an active sexual life with different partners. Last years growth of viruses of papilloma infections is noted. Distinguish papillomas in the form of peaked condylomas, flat and inverting condylomas.

The virus of papilloma can be transferred through direct contact between external covers of the infected and not infected person. Defeat of a mucous coat by papilloma of genitals results from sexual contact. Peaked condylomas is frequent, at 65-70 % of ill people, reveal at inspection at both sexual partners. Quite often papillomas are combined with other venereal diseases. Probably intra-uterine contamination of a papilloma virus, and as at passage through patrimonial ways. Besides the reason of occurrence of papilloma newborns can have an infection a papilloma a virus through blood, milk, clothes, etc.

Papillomas (peaked condylomas) have exophytic growth, settle down mainly in the field of greater and small genital lips, less often in a vagina and on a cervix uteri. Growth of condylomas at an external aperture of a urethra and around of back passage is sometimes observed.

Papillomas (peaked condylomas) usually happen plural, that has served as an occasion for definition by their term condylomatosis. Peaked condylomas act above a surface of a skin and mucous coat, have a thin petiole, less often — the wide basis. Their consistence soft or firm. At plentiful growth of condylomas remind a structure of a cauliflower. Condylomas of a skin of external genitals have the albesent or brownish color, developing on mucous coat — light pink or reddish painting.

Microscopically papillomas consist of epithelial tissue (multilayered flat) and osculant stroma in which pass vessels. Superficial cells of epithelial tissue of condyloma usually have character as cornific.

Papilloma - removal and preventive maintenance.

Papillomas can be eliminated the different ways: by cold spell, by high-frequency coagulation or by laser. Thus it is necessary to remember that even removal of papillomas does not guarantee the patient against their repeated formation. The virus of papilloma of the person is a virus disease and the person remains the carrier of a virus within several years. Therefore by way of preventive maintenance against occurrence of papillomas it is necessary to take care os all organism as a whole.

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HealthNews Dozen: Top 12 Fitness Trends for the New Year

Health and fitness are part of any plan for life improvement. And there is no better time to dedicate oneself to a healthier lifestyle than upon the start of a new year. It is typically the number one resolution of people in America: to get healthy, which may include a more appropriate diet, more daily exercise, and/or a gym routine.

But New Year’s resolutions may last only a few weeks. That is why health professionals take many more factors into considerations when predicting the actual trends for the new year. Not only do they look at the past and current years and the course of health and fitness throughout, but they are familiar enough with where the industry is going as 2008 comes to an end to predict what 2009 may hold.

For the third year running, the American College of Sports Medicine (ACSM) has conducted its annual survey of 1,540 certified health and fitness professionals across six continents to predict what the industry may seen in the coming year. The survey provided 35 choices of possible trends to choose from, and the most popular were ranked and published in the November/December issue of ACSM’s Health and Fitness Journal. The report was authored by the survey’s lead author, Walter Thompson, PhD, FACSM, FAACVPR, and Regent’s Professor at Georgia State University.

For the second straight year, it was voted that the health and fitness industry will see more educated and experienced fitness professionals. As the field becomes more competitive and the public grows more concerned over the credentials of those who hold their health in their hands, not to mention stricter regulations being put into place, more professionals are working toward certification and accreditation. Not only should that be more comforting to those seeking health and fitness guidance, but it heightens the level of education among those who want to train and teach.

Also for the second year in a row, obesity rates with regard to children came in as the runner-up, signifying a growing concern among professionals the general public alike that youngsters are not eating properly and getting enough exercise. Over the past decade, children have become more sedentary, as video games, computers, cell phones, and the like involve little to no physical activity. By stressing fitness in schools and encouraging children to play outdoor games, become involved in sports, and even exercise in formal classes or at a gym, it might reverse the trend of the next generation as more obese than any in history.

Personal training ranked third, again for a second year, which shows that people seem to be taking fitness more seriously than ever. Instead of people relying on self-discipline or self-education about health issues, hiring someone to motivate, teach, and encourage exercise and positive eating habits is becoming more common.

Other items that made it into the top twenty were, in order from 13th to 20th, were wellness coaching for health-related behavioral changes, worker incentive programs, outcome measurements to monitor progress, spinning or indoor cycling, physician referrals to health and fitness facilities, exercise for weight loss, group personal training, and reaching new markets, such as people who have never participated in the health and fitness community before.

Author Thompson noted, “When predictions become consistent, we view it as an opportunity for education and action. These developing themes will help health and fitness professionals give the best possible service to the public, and also help the public understand the quality of service they should be receiving as clients.”

While the reported trends should not have a tremendous effect on one’s personal goals for 2009, they do show which way the industry is going and what be more readily available--like personal training--than in the past. Whatever one’s New Year’s resolutions may be, if health and fitness are on the list in some fashion, that desire to make it happen is all anyone in the industry can ask for.

By www.healthnews.com

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