Factors and the conditions causing irritation of a dental pulp

The irritation of a pulp of a tooth can arise owing to caries of a teeth, as a result of preparation of a tooth and carious cavities, under influence a filler material, owing to penetration of microorganisms at not tight seal, at an exposure dentin.

Caries of a tooth serves as a principal cause of changes in a pulp and its inflammations. Already at initial damage dentin fibrilloblasts react adjournment secondary and formation of a layer scleroid dentin (adjournment of salts of calcium on walls of dentinal canaliculus) down to full occlusion of dentinal canaliculus. These processes should be considered as display of protective mechanisms of a pulp on action of a cue.

At processing of a caries and destruction of enamel of a bacterium get in dentin, however the inflammation of a pulp does not arise. It is established, that first signs of an inflammation come, when carious the cavity is separated from a pulp by a layer of 1,1 mm [Reeves R., Stanley H. R., 1996], i.e. the pulp practically is not infected up to an instant of penetration of microorganisms in secondary dentin [Massler, Pawlak J., 1977].

Preparation of a cavity without use of a water spray leads to its damage. Thus probability of damage of the in direct proportion area of preparation and depth of damage. Thus, preparation of a tooth under vinirs or artificial crownwork without due cooling serves a serious risk factor for a pulp.

Filler materials. There are the numerous data specifying irritating influence various of filler materials. From cements the most expressed adverse action renders silicate though specify, that it is shown at formation of a clearance between edge of enamel and dentin as microorganisms nestle close in dentin [Brannstrom, 1979].

Composites also are considered as irritating materials. First of all, toxicity of composites of the first generation was marked. Materials let out now as specify numerous supervision, render insignificant influence on a pulp.

During many years use of bondings was studied at sealing. It is proved, that improvement of a compounding bondings has allowed to achieve favorable reaction of a pulp to used composites.

Regional permeability as considers a number of researchers, is a principal cause of irritation of a dental pulp after sealing. The leading part thus belongs to microorganisms. With the purpose of the prevention of the specified changes in a pulp it is recommended to spend padding fabrics of a tooth and use bonding systems.

The exposure of dentin can occur after loss of a seal, as a result of deleting fabrics, at erosion, etc., that is accompanied by sensitivity action of irritating factors. Sensitivity can arise also at an exposure cervical dentin because canaliculus of dentin become opened.

The sheeting (direct) provides:

1) clarification of a surface of a pulp;

2) drying of a cavity;

3) imposing on the naked pulp of medical paste;

4) a seal from zinc oxide eugenic acid cement;

5) imposing of a constant seal.

Most widely used materials for protection of a pulp contain all calcium hydroxide. As a result of it above a site of an exposure it is postponed secondary dentin, forming the dentin bridge. Consider, that formation of a barrier occurs not due to the calcium containing in a material, closing a pulp.

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Dermatitis

Dermatitis is an inflammatory process arising in integuments. Its reason can become various physical or chemical factors of an environment. The degree of influence of the harmful agent sometimes depends on individual sensitivity of an organism, in this case it is a question of the allergic nature of disease. It takes place both at external contact with cue, and after its hit inside of an organism. Depending on it, distinguish contact forms of illness and toxicoderma.

Ordinary contact reactions result from hit on a leather of caustic chemical substances, for example, acids or alkalis. Depth and the area of defeat thus neatly depends on concentration, area and time of influence of the negative factor. At long-standing contact to small dozes of toxin pathological process gets chronic character, and at lots — immediately there is a sharp reaction. It is accompanied by reddening of a leather, formation of bubbles, a suppuration, occurrence of hypostases, pains, burnings and an itch.

As a rule, its reason are solar burns, significant differences of temperatures, toxic substances of a vegetative or animal origin, cosmetic and perfumery means, medicinal creams and ointments. As most often meeting form sharp dermatits the attrition and the water callouses formed on a leather owing to mechanical friction serves. Usually on palms of hands it is observed after heavy physical work, and on stops — as a result of long carrying close footwear. At people with excess weight quite often attritions arise on a body between folds of a leather.

For chronic process bluish painting of integuments, occurrence of cracks, a thickening of a horn layer and a peeling is characteristic. The reason of similar reactions can become various fungoid, bacterial or virus infections, strong diaphoresis, especially in a combination to synthetic clothes. To cause the allergic form of disease some foodstuff are capable. At children such condition has received the name of a diathesis. More often it is connected with the use in food of dairy products, citron, nuts, eggs.

Constant stay in a condition of stress provokes occurrence or strengthening of negative symptoms of dermatitis. It is necessary to comply with caution to people with a dry leather, especially in cold and windy weather. During this period for protection of the open sites of an integument it is necessary to use special creams. For preventive maintenance of disease it is necessary to adhere strictly to the safety precautions at the reference with dangerous substances on work and houses, in time to eliminate activators of infections, with caution to approach to use of medical products.

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Hernias at children: inguinal, umbilical, a hernia of a white line of a stomach. Symptoms. Methods of treatment.

Hernia is an outwandering bodies from a cavity in norm them borrowed through properly existing or pathologically generated aperture with conservation of an integrity of envelopes, their covering, or availability of conditions for this purpose.
Let's consider a hernia of a forward belly wall of a stomach. It is the most widespread surgical pathologies at children. An original cause of progress of hernias - defect of progress of a belly wall. However there are some features which we shall consider separately.

Umbilical hernia. For 4-5 day after a birth of the child the umbilical cord disappears. The umbilical ring consists of two parts. The bottom part where pass umbilical arteries and a uric channel, are well reduced and form a dense cicatricial fabric. In the top part there passes a umbilical vein. Its walls thin, have no muscular environment, are badly reduced in the further. Quite often at weak peritoneal band and patent to a umbilical vein the umbilical hernia is formed. Except for it the major factor promoting occurrence of this pathology, frequent increase of intrabelly pressure is. It can be caused, for example, frequent we cry the child.
The aperture in the top part of a umbilical ring can be wide, and not trouble the child. But in case of small defect with firm edges concern of the child probably. As a rule, a umbilical hernia always can be reduced. The restrained umbilical hernia to meet in an adult practice more often. However we quite often should operate children with unreducible hernias (when hernial contents are attached to an internal wall of a leather of a forward belly wall by solderings).

Experience of out-patient supervision of children with the umbilical hernias diagnosed at early age, allows to tell with confidence, that to 5-7 years age often there comes self-healing. Liquidation of a hernia is assisted with strengthening a belly wall. It certainly massage, laying of children on a tummy, gymnastics. Surgical treatment it is begun not earlier than 5 years age. Properly and accurately lead operation, allows to eliminate a hernia with good cosmetic effect. As a rule, relapses does not happen.

Hernia of "a white line" stomach (anteperitoneal adipoma). If to lead a line between omphalus and ensiform shoot of a brest is and there is "a white line" stomach. At a direct muscle of the stomach, shaping given area, is from 3-6 tendinous crosspieces. In seat of intersection of these crosspieces and "a white line" stomach sometimes there are small defects. In them it is often stuck out anteperitoneal fat. If they settle down in immediate proximity from a umbilical ring, them name paraumbilical (periomphalic) hernias. Unfortunately, these hernias are not inclined to spontaneous closing. Treatment only operative, similar to operation at a umbilical hernia.

An inguinal hernia. Very frequent surgical disease at children. As a rule, all hernias at children of early age congenital. What reasons of occurrence of this pathology? It is a lot of opinions in this occasion at children's surgeons. It and weakness of a forward belly wall and feature of a structure inguinal areas and nonclosure vaginal a shoot abdominal membrane and a heredity. We shall try under the order, on an example of an congenital inguinal at the boy.
About from 6-th month of intra-uterine progress of the boy orchis fall from a belly cavity in marsupium on inguinal to the channel. Therefore these hernias name slanting. For presentation present itself, that on a tube (vaginal to a shoot abdominal membrane) as on the lift, orchis, conducted by the lowering mechanism from a belly cavity goes down in marsupium. Then under the plan there is a closing a pipe (vaginal shoot abdominal membrane) and by that the termination of the message between belly completely and marsupium. If it does not occur, at increase of intrabelly pressure in the nonclosure vaginal shoot of abdominal membrane leaves contents of a belly cavity. It is an inguinal hernia.
What for to an organism to strain and stretch a stomach when there is an opportunity to dump a superfluous pressure in "hernial contents". And frequently the child grows and … increases hernial bulge. Treatment of the given pathology only operative. Technically to carry out it at the child easier is more senior 1 year. However quite often operation is shown to the child at once at statement of the diagnosis. To wait dangerously. Occurrence of terrible complication - infringement inguinal hernias is possible. Hernial bulge in inguinal areas earlier that arising disappearing suddenly became firm, the child has begun to worry and has begun to cry, there was a vomiting, refusal of meal. At touch up to firm "bulla" in a groin to the child it is very painfull!!!
Most likely, there was an infringement inguinal hernias. To not give food, not give water and it is urgent to bring the child to the hospital. Muscles of a stomach have restrained contents of a hernial bag. It can be a site of a gut, a bladder or ootheca at girls. If urgently to not help the child after a while the site, deprived blood supplies, can be sphacelous, i.e. become lifeless. In that case treatment very heavy and long. In my practice there were 2 cases, hernial contents at the restrained hernia were a site of a blind gut with again changed an appendicular shoot. It was necessary to lead simultaneously with celotomy.

Believe, it is better to not lead up to infringement. To operate the child with a hernia it is necessary healthy, with good analyses and in the daytime. And it is possible only at scheduled operation. Every year in our branch, about to 500 children with the given pathology, scheduled operative interventions are spent. Operations last about 15-20 minutes, pass under a mask narcosis and the control of skilled anaesthesiologists. And here, after the small period of rehabilitation - your child is completely healthy. We have made all in time and properly.

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Pain Medications May Not Help Protect Against Dementia

Many of the elderly in America suffer from the degenerative disease known as Alzheimer’s. Previous research suggested the elderly who want to avoid Alzheimer’s disease might want to try taking daily doses of certain painkillers such as naproxen and ibuprofen, but new information is suggesting that this might not be the best idea.

Dr. Eric B. Larson, the executive director of the Group Health Center for Health Studies in Seattle, said, “If people are thinking, ‘Should I take these to prevent dementia?’, the answer based on our study would be no.” However, he also stated that the people who already take the medications known as non-steroidal anti-inflammatory drugs or NSAIDs for pain should not stop using them based on this information.


Previous studies conducted have shown that the medications, which also include aspirin—which wasn’t included in the new study—seem to have the power to help prevent Alzheimer’s disease in some cases, although the drugs do not seem to help the people who have already been diagnosed with the disease or those who have developed it quickly.

The relationship between the NSAIDs and Alzheimer’s disease appears to be much more complex that was previously believed, the authors stated. The finding of this new study appear in the April 22nd online issue of Neurology.

In this study, the team in Seattle examined the medical records of more than 2,700 people that were age 65 and above. Approximately 90 percent of the patients were Caucasian and members of a Washington state medical insurance group as early as the year 1977. The researchers checked that patients use of NSAIDs and found that 351 of them were heavy users, defined as being prescribed at least 500 daily does over a period of two years, when they were enrolled in this study. Another 107 patients started using the NSAIDs more heavily later on. The medications in question are naproxen (Aleve), ibuprofen (Advil) and many others.

The people that used these medications extensively were 66 percent more likely to develop dementia compared to those who didn’t, according to the statistics, which were adjusted to account for the number of the participants that had certain medical conditions, among other factors. The medications themselves may not be the main problem, instead, Larson suggests that they could be a sign of more chronic medical issues. He said, “They heavy users [of painkillers] had more diabetes, more arthritis, more signs of heart failure. It’s very likely that what you’re seeing is people using these medications because they’re becoming to fail in their life.”

Dr. Steven Vlad, who is an epidemiology and rheumatology researcher at the Boston University School of Medicine, said that the new findings are very much contrary to what many other studies have found, but it is still uncertain how to fit them into previous research. As for the big picture, he stated, “the practical, day-to-day utility of this study is small. We just don’t know enough yet.”

He also said that he agrees with Larson that people should not take the medications purely to help prevent Alzheimer’s disease, especially since the drugs pose the risks of bleeding, kidney disease, and gastrointestinal ulcers. The biggest issue at this point is that we still don’t know how to balance the potential benefits of these medications against the known risks, Vlad said.

The next question is, What to do? Larson said that the best strategies to help prevent dementia are still the usual suspects which include regular exercise, not smoking and getting control of blood pressure. He said, “These things are really common sense. Even in late life, they probably do benefit your brain from the standpoint of health.”

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Alcohol and Cognition

Alcohol Alert from the NIAAA

Research shows that alcohol adversely affects the brain. When health professionals encounter patients who are having cognitive difficulties, such as impaired memory or reasoning ability, alcohol use may be the cause of the problem. When treating patients who have abused alcohol, it may be of value to attempt to identify the level of any impairment and to modify the treatment accordingly.

Some researchers have investigated whether or not there is measurable alcohol-related cognitive impairment among nonalcoholic social drinkers. Their findings suggest a dose-response relationship between alcohol consumption and diminished scores on certain neuropsychological tests (e.g., Parker & Noble 1977; Parker et al. 1983). Statistically significant decreases in test performance have been found for people whose self-reported alcohol consumption was in the range of what was considered social drinking.

This is not to say these people were clinically impaired, only that they exhibited certain performance deficits that correlated with alcohol consumption. It is important to note that similar correlations from other studies have not been found to be consistently significant. For example, the results of one general population study (Bergman et al. 1983) showed no correlation between self-reported alcohol consumption and neuropsychological test scores; other findings (Emmerson et al. 1988) failed to show a simple dose-response relationship.

In a recent review of such studies, Parsons (1986) concluded that data on the relationship of cognitive impairment to amount of alcohol consumed by social drinkers are inconclusive.

Brains of Alcoholics

Alcoholics in treatment present a different picture. Although most alcoholics entering treatment do not have decreased overall intelligence scores, approximately 45 to 70 percent of these patients have specific deficits in problem solving, abstract thinking, concept shifting, psychomotor performance, and difficult memory tasks (Parsons & Leber 1981; Eckardt & Martin 1986; Tabakoff & Petersen 1988). Such deficits usually are not apparent without neuropsychological testing.

In addition, structural changes in the brains of alcoholics have been reported (Ron 1979; Wilkinson 1987), as well as reduced cerebral blood flow (Ishikawa et al. 1986) and altered electrical activity (Porjesz & Begleiter 1981), but there is not yet any clear evidence implicating these changes as the cause of observed cognitive deficits.

For the most severe alcoholics, serious organic cerebral impairment is a common complication, occurring in about 10 percent of patients (Horvath 1975). The diverse signs of severe brain dysfunction that persist after cessation of alcohol consumption have been conceptualized in terms of two organic mental disorders: alcohol amnestic disorder (memory disorder) and dementia associated with alcoholism (Lishman 1981; American Psychiatric Association 1987).

Recently however, it has been recognized that these two disorders are not mutually exclusive and that some features of each often coexist in the same patient (Martin & Eckardt 1985). Alcohol amnestic disorder, commonly called Korsakoff's psychosis or Wernicke-Korsakoff syndrome, is characterized by short-term memory, impairments and behavioral changes that occur without clouding of consciousness or general loss of intellectual abilities. Dementia associated with alcoholism consists of global loss of intellectual abilities with an impairment in memory function, together with disturbance(s) of abstract thinking, judgment, other higher cortical functions, or personality change without a clouding of consciousness.

Toxic Effects of Alcohol

It has been suggested that subcortical lesions due to nutritional (thi amine) deficiency are characteristic of Korsakoff's, whereas alcoholic dementia is associated more with cortical changes (Victor & Laureno 1978). There is some evidence that a genetic abnormality may predispose some people to Korsakoff's in the presence of excessive alcohol use and malnutrition (Blass & Gibson 1977; Mukherjee et aI. 1987).

Tarter and Edwards (1986) summarize evidence suggesting that neuropsychological impairment in alcoholics may occur for a number of reasons. The toxic effects of alcohol on the brain may cause impairment directly. In addition, some alcoholics may exhibit impairment as an indirect result of alcohol abuse, e.g., they may have experienced a craniocerebral trauma, they may be eating poorly and suffering nutritional deficits (such as thiamine or niacin deficiencies), or they may have cognitive impairments associated with liver disease.

Some alcoholics may have been cognitively impaired before they began drinking. There is some evidence that persons in groups considered to be at risk for alcoholism (e.g., children of alcoholics) are less adept at certain learning tests and visual-spatial integration than are persons in groups not deemed at risk for alcoholism; this area of research is still under active investigation.

Some researchers have observed that cognitive deficits in some alcoholics resemble those seen in normal elderly persons, leading to speculation that alcohol's effect on cognition may be explained as premature aging (Tarter 8 Edwards 1986). However, it is more likely that such deficits are independent of any deficits associated with normal aging (Grant et al. 1984; Cutting 1988).

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Colitis - a problem of intestines

Very often at people the wrong opinion concerning such disease as colitis is created. They assume, that colitis is a gripe. However, this incorrect assumption. The word colitis has occurred from the Greek word "kolon" which is translated as a large gut. Actually colitis is an inflammatory disease of a mucous membrane of thick intestines.

Colitis in sharp forms pass very violently, but during too time it is very fast. Chronic colitis in turn proceed very long and languidly. Sharp colitis are very often accompanied by an inflammation of thin guts and a stomach. The medicine knows some types of colitis. Among them: ulcer, infectious, ischemic, medicinal, radiating and some other types of colitis. Ulcer colitis it is accompanied by occurrence of chancres in paries of intestines. At ischemic prick blood badly reaches intestines.

There is a big number of the reasons of occurrence colitis. It can be intestinal infections, an infection in a bilious bubble or a pancreas, long application of antibiotics, infringement of blood supply of a gut. If to speak about a wrong feed it also influences formation of colitis. More often this abusing flour and animal food, also a spicy food and alcohol. If at you a dysbacteriosis of intestines, worms, a bad heredity or a food allergy, quite probably, that you become "hostage" of colitis. One more very frequent factor of occurrence of colitis is the wrong mode of day, a frequent mental or physical overstrain.

The basis of any colitis includes damage of a mucous membrane of a gut. If colitis is caused by an intestinal infection then disease passes with rough influence on an organism. During the moment of disease various bacteria and parasites get on a mucous membrane of a gut and start it to damage. During this moment in a gut of the patient there is an inflammatory process. Because of it the wall of a gut swells. The gut cannot normally function any more. The wrong operating mode causes desires on defecation, a diarrhea and painful sensations in a stomach. At the patient at prick constantly the temperature raises.

First attributes of colitis are a pain in the field of a stomach and a unstable chair. Rumbling and a swelling of a stomach can disturb the patient. In a dung there can be a slime or blood. The person with colitis feels slackness, weakness. The given disease proceeds more often, approximately, some weeks.

If happens you got a colitis, it is necessary for you to address necessarily to the gastroenterologist. Only him can put you the correct diagnosis. Also you should hand over the analysis кала and to pass some researches on various devices.

Treatment of any kind of colitis requires a special diet. All other treatment is appointed depending on the reasons of disease. If at you has appeared colitis because of an intestinal infection then to you will necessarily appoint antibiotics. In case of if you became the owner of this disease because of application of a plenty of medicines then all medical products are canceled.

Medicinal therapy, physiotherapy, psychotherapy – all this methods of treatment colitis. Sanatorium treatment of this disease very well helps.

Colitis, as well as all other diseases, requires duly treatment. For this reason leave all businesses on then and engage for the beginning in the health. Visiting of the gastroenterologist will help you to get rid from colitis and to feel far more confidently and better.

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Uterine Fibroids and Hysterectomy

Description An in-depth report on the causes, diagnosis, treatment, and prevention of uterine fibroids

Alternative Names Endometrial Ablation; Hysterectomy; Laparoscopy; Myomectomy; Uterine Fibroids

Other Procedures In order to operate on the uterus, the surgeon may choose to reach the area through a wide abdominal incision (laparotomy) or using less invasive measures with the use of endoscopy. The decision usually is based on the severity of the case. It should be noted that research on treatments for uterine fibroids is very scanty and even physicians may not have the best data needed to make an optimal decision for their patient. Women should discuss all options very carefully and be sure that their surgeons have had experience with any procedure they choose. Laparotomy. Laparotomy is the standard abdominal surgical procedure. It is invasive and usually requires a wide abdominal horizontal incision right above the pubic bone, the so-called bikini incision. Endoscopy. Endoscopic techniques used for uterine disorders are hysteroscopy and laparoscopy. Endoscopic techniques are used increasingly to replace conventional surgical techniques for many disorders. A common factor in all endoscopic procedures is the use of a fiberoptic scope and tubes, tiny camera lenses, and minuscule surgical instruments. Any incisions used are very small, Band-Aid size.

• Operative Hysteroscopy. In this procedure, the cervix is dilated, which requires either a local or general anesthetic. A device called a hysteroscopy is inserted up through the vagina and cervix into the uterine cavity. It contains tiny surgical instruments as well as a mini-camera and light source to view images of the uterus, which are transmitted to a video monitor. This approach is becoming increasingly common. Complication rates include excessive fluid absorption, infection, and uterine perforation.
• Laparoscopy. This procedure employs two or more small incisions, one at the navel, and one or more in the lower abdomen. Carbon dioxide gas is injected into the abdomen, distending it and pushing the bowel away. A laparoscope is inserted through the navel incision and a probe is inserted through a second incision above the pubic hairline. The probe allows the physician to directly view the abdominal cavity, including the outer walls of the uterus, fallopian tubes, and ovaries. The physician manipulates surgical instruments that are passed through additional small abdominal incisions, using the image of the uterus on the video monitor as the guide.

Preoperative Hormone Treatment

GnRH agonists, usually depo-Lupron or Synarel, are often used for about two to three months before many uterine surgical procedures.

There are a number of benefits:

• May reduce the volume of fibroids by 40% to 60%, in some cases to the extent that a less invasive procedure may be performed.
• May reduce the risk of bleeding.
• May shorten operating time.
• May reduce postoperative symptoms for many patients.

Treatments may not be useful, however, for small fibroids, which may shrink to the point that they are no longer visible at the time of surgery. Since fibroids regrow after treatment, the problem would recur.

There has also been some question whether these drugs provide any additional advantages for myomectomies that use conventional surgical techniques. Ultrasound may be useful in helping to detect fibroids most likely to benefit from GnRH agonists before such a procedure.

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What Are Osteophytes?

Question: What Are Osteophytes?

What are osteophytes? What causes osteophytes to develop? Can they develop at any joint or are they more common for specific joints or specific types of arthritis? How are osteophytes diagnosed and treated?

Answer:

What Are Osteophytes?

Osteophytes which are protrusions of bone and cartilage are very common and develop in areas of a degenerating joint. They are associated with the most common type of arthritis, osteoarthritis. Osteophytes typically develop as a reparative response by the remaining cartilage.

Osteoarthritis Screening Quiz

Osteoarthritis - Test Your Knowledge

The Cause of Knee Pain: Step-by-Step

Developing Osteophytes

Osteophytes may also develop from the tissue that lines the bone or joint and occur in any number of locations.

Marginal osteophytes develop at the periphery or margins of all joints.

Central osteophytes are most prominent in the hip and knee.

Diagnosing Osteophytes

Osteophytes can be diagnosed by clinical exam as with the PIP (proximal interphalangeal joint), DIP (distal interphalangeal joint) and first CMC joints (carpometacarpal joint) of the hand or by radiographs (x-rays). If you did radiographs on everyone over 50 years of age, most would show some osteophytes. Yet, most people with osteophytes are asymptomatic.

Hand Anatomy (Illustration from ASSH)

Treatment of Osteophytes

If symptomatic, treatment of osteophytes includes:

physical therapy

NSAIDs (nonsteroidal anti-inflammatory drugs)

analgesics (painkillers)

supplements

surgery (an option in severe cases)

Related Resources - Osteophytes

What is Degenerative Arthritis?

Osteoarthritis - Fast Facts

Guide to Osteoarthritis

Rheumatoid Arthritis or Osteoarthritis: Which is it?

Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is a must-have for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book.

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Nerve conduction velocity

Definition

Nerve conduction velocity (NCV) is a test of the speed of signals through a nerve.

Alternative Names

NCV

How the Test is Performed

Patches called surface electrodes, similar to those used for ECG, are placed on the skin over the nerve at various locations. Each patch gives off a very mild electrical impulse, which stimulates the nerve.

The nerve's resulting electrical activity is recorded by the other electrodes. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to determine the speed of the nerve signals.

Electromyography is often done at the same time as this test.

How to Prepare for the Test

Normal body temperature must be maintained (low body temperature slows nerve conduction).

Tell your doctor if you have a cardiac defibrillator or pacemaker, as precautions may need to be taken.

How the Test Will Feel

The impulse may feel like an electric shock. Depending on how strong the stimulus is, you will feel it to varying degrees, and it may be uncomfortable you. You should feel no pain once the test is finished.

Often the nerve conduction test is followed by electromyography (EMG) which involves needles being placed into the muscle and you contracting that muscle. This can be uncomfortable during the test, and you may feel muscle soreness at the site of the needles afterwards as well.

Why the Test is Performed

This test is used to diagnose nerve damage or destruction. Occasionally, the test may be used to evaluate diseases of nerve or muscle, including myopathy, Lambert-Eaton syndrome, or myasthenia gravis.

Normal Results

NCV is related to the diameter of the nerve and the normal degree of myelination (the presence of a myelin sheath on the axon) of the nerve. Newborn infants have values that are approximately half that of adults, and adult values are normally reached by age 3 - 4.

What Abnormal Results Mean

Most often, abnormal results are due to some sort of nerve damage or destruction, including:

• Axonopathy
• Conduction block (the impulse is blocked somewhere along the nerve pathway)
• Demyelination

The nerve damage or destruction may be due to many different conditions, including:

• Alcoholic neuropathy
• Diabetic neuropathy
• Nerve effects of uremia (from kidney failure)
• Traumatic injury to a nerve
• Guillain-Barre syndrome
• Diphtheria
• Carpal tunnel syndrome
• Brachial plexopathy
• Charcot-Marie-Tooth disease (hereditary)
• Chronic inflammatory polyneuropathy
• Common peroneal nerve dysfunction
• Distal median nerve dysfunction
• Femoral nerve dysfunction
• Friedreich's ataxia
• General paresis
• Mononeuritis multiplex
• Primary amyloid
• Radial nerve dysfunction
• Sciatic nerve dysfunction
• Secondary systemic amyloid
• Sensorimotor polyneuropathy
• Tibial nerve dysfunction
• Ulnar nerve dysfunction

Any peripheral neuropathy can cause abnormal results, as can damage to the spinal cord and disk herniation (herniated nucleus pulposus) with nerve root compression.

Risks

There are essentially no risks.

Considerations

A NCV test shows the condition of the best surviving nerve fibers and may remain normal in some cases. A normal NCV test result can occur in some persons with significant nerve disease.

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Walking abnormalities

Definition

Walking abnormalities are unusual and uncontrollable walk patterns, usuallycaused by diseases or injuries to the legs, feet, brain, spine, or inner ear.

Alternative Names

Gait abnormalities

Considerations

The pattern of how a person walks is called their gait. Many different types ofwalking abnormalities are produced unconsciously. Most, but not all, are due to some physical condition.

Somewalking abnormalities are so characteristic that they have been given descriptive names:

• Propulsive gait -- a stooped, rigid posture, with the head and neck bent forward
• Scissors gait -- legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement
• Spastic gait -- a stiff, foot-dragging walk caused by one-sided, long-term, muscle contraction
• Steppage gait -- foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking
• Waddling gait -- a distinctive duck-like walk that may appear in childhood or later in life

Abnormal gait may be caused by diseases in many different areas of the body. For example:

• Vestibular disorders (the inner ear is responsible for maintaining balance, and damage results in vertigo)
• Central nervous system disorders of the brain that cause muscular problems resulting in gait disturbance such as multiple sclerosis and cerebral palsy)
• Spinal cord abnormalities (disease, trauma, degeneration)
• Peripheral nerve diseases (nerves from the spinal cord to the muscles may be damaged by disease or trauma and result in gait abnormalities)
• Degenerative muscle diseases (muscular dystrophy, myotonic dystrophy, myositis)
• Neurodegenerative illnesses (Parkinson's disease)
• Skeletal abnormalities and disease
• Arthritis
• Foot conditions (plantar warts, bunions, ingrown toenails, pressure ulcers)
• Toxic reactions (alcohol, drugs, allergens)

Causes

ABNORMAL GAIT IN GENERAL

• Trauma
• Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin ulcer, swelling, spasms)
• Chondromalacia patellae
• Fracture
• Hemophilia
• Immunization (soreness in the leg or buttocks)
• Legs that are different lengths
• Myositis
• Tight or uncomfortable shoes
• Shin splints
• Infection
• Tendonitis
• Torsion of the testis
• Conversion disorder (a psychological disorder)

CAUSES OF SPECIFIC GAITS

• Propulsive gait:
  • Carbon monoxide poisoning
  • Manganese poisoning
  • Parkinson's disease
  • Drugs including phenothiazines, haloperidol, thiothixene, loxapine, metoclopramide, and metyrosine (usually drug effects are temporary)
• Scissors gait:
  • Cerebrovascular accident (stroke)
  • Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)
  • Liver failure
  • Multiple sclerosis
  • Pernicious anemia
  • Spinal cord trauma
  • Spinal cord tumor
  • Syphilitic meningomyelitis
  • Syringomyelia
  • Cerebral palsy
• Spastic gait:
  • Brain abscess
  • Brain tumor
  • Cerebrovascular accident (stroke)
  • Head trauma
  • Multiple sclerosis
• Steppage gait:
  • Guillain-Barre syndrome
  • Herniated lumbar disk
  • Multiple sclerosis
  • Peroneal muscle atrophy
  • Peroneal nerve trauma
  • Poliomyelitis
  • Polyneuropathy
  • Spinal cord trauma
• Waddling gait:
  • Congenital hip dysplasia
  • Muscular dystrophy
  • Spinal muscle atrophy

Home Care

Treatment of the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals.

For an abnormal gait that occurs with conversion disorder, psychiatric counseling as well as comfort and love from family members is strongly recommended.

For a propulsive gait:

• Encourage the person to be as self-reliant and independent as possible.
• Allow plenty of time for daily activities, especially walking. People with this problem are susceptible to falls because of poor balance and an unconscious effort to always catch up.
• Provide walking assistance for safety reasons, especially on uneven ground.
• Consult a physical therapist about exercise therapy and walking retraining.

For a scissors gait:

• Loss of skin sensation is often associated with scissors gait, so skin care should be provided in order to avoid skin breakdown and ulcers.
• Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate.

For a spastic gait:

• Both active and passive exercises are encouraged.
• Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate.
• A cane or a walker is recommended for those with poor balance.

For a steppage gait:

• Adequate rest is encouraged. Fatigue can often cause an affected person to stub his toe and fall.
• Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate.

For a waddling gait, follow the prescribed therapy.

When to Contact a Medical Professional

If there is any sign of uncontrollable and unexplained gait abnormalities, call your health care provider.

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Drowsiness

Definition

Drowsiness refers to feeling abnormally sleepy during the day -- often with a strong tendency to actually fall asleep in inappropriate situations or at inappropriate times.

Alternative Names

Sleepiness - during the day; Hypersomnia; Somnolence

Considerations

Excessive daytime sleepiness (without a known cause) suggests the presence of a significant sleep disorder and is different from fatigue. Although depression, anxiety, stress, and boredom can contribute to excessive sleepiness, these conditions more typically cause fatigue and apathy.

Causes

• Having to work excessive hours or varying shifts (nights, weekends)
• Medications (tranquilizers, sleeping pills, antihistamines)
• Medical conditions (such as hypothyroidism, hypercalcemia, and hyponatremia/hypernatremia)
• Self-imposed short sleep time
• Sleep disorders (such as sleep apnea syndrome and narcolepsy)

Home Care

You can relieve drowsiness by treating the cause of the problem. For drowsiness due to depression, anxiety, boredom, or stress, try to solve problems without professional help first.

For drowsiness due to medications, talk to your health care provider about switching medications or discontinuing them. DO NOT CHANGE MEDICATIONS WITHOUT FIRST CONSULTING YOUR HEALTH CARE PROVIDER.

For drowsiness due to obesity and hypoventilation (reduced breathing), weight loss is recommended, and you should consult your health care provider.

Your health care provider can treat hypothyroidism, hypercalcemia, and hypo/hypernatremia.

For drowsiness due to narcolepsy, your doctor may prescribe stimulants (such as Ritalin).

For drowsiness due to other causes, seek medical help.

Consider buying a carbon monoxide monitor to check that the air in your home or apartment does not contain excessive levels of carbon monoxide.

When to Contact a Medical Professional

Contact your health care provider if:

• You think the cause of your drowsiness is from any of the above conditions.

What to Expect at Your Office Visit

The doctor will examine you to determine the cause of your drowsiness. Your sleep patterns will be investigated, and you'll have a psychological profile taken.

You may be asked the following medical history questions about your drowsiness:

• Sleep pattern
  • How well do you sleep?
  • How much do you sleep?
  • Do you snore?
  • Do you have episodes in which you do not breathe during sleep (sleep apnea)?
  • Do you fall asleep during the day when you are not intending to nap (such as when watching TV or reading)?
    • If so, do you awake feeling refreshed?
    • How often does this happen?
• Emotional state
  • Are you depressed?
  • Are you anxious or feeling stressed?
  • Are you bored?
• Other
  • What medications do you take?
  • What have you done to try to relieve the drowsiness?
  • How well did it work?
  • What other symptoms do you have?

Diagnostic tests that may be performed include:

• Blood tests (such as a CBC and blood differential, electrolytes, and thyroid hormone levels)
• CT scan of the head
• EEG
• Sleep studies
• Urine tests (such as a urinalysis)

After seeing your health care provider:

If your health care provider made a diagnosis related to drowsiness, you may want to note that diagnosis in your personal medical record.

References

Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29:1415-1419.

Schwartz JR, Roth T. Shift work sleep disorder: burden of illness and approaches to management. Drugs. 2006;66:2357-2370.

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Diagnostics and treatment of tinea

A tinea represents a fungoid infection which can amaze set of parts of a body of the person. Below we shall designate sites of a body on which can appear dermatosis.
The-part of a head covered by hair.
- A smooth leather of a trunk.
- Nails.
- Stops of legs.
- Inguinal area.
- A skin of the face on which the vegetation settles down.

The given infection is widely widespread. If in time to undertake elimination of illness and to observe all doctor's instructions such effective treatment will give the favorable forecast. But can be and so, that at the started illness the chronic form tinea develops.
Infection tinea occurs at direct contact to the sick person, or through the polluted subjects. Among these subjects there can be a footwear, towels or mats in bathroom. The activator of disease tinea is the fungus.

Treatment of illness individually, depends on the form of its display. At disease of tinea it is necessary to address to the doctor. In fact depending on the form of disease of defeat of a leather differ on appearance and duration of existence of illness.

From a tinea of a hair parts of a head basically suffer children, and is characterized by occurrence small, one step at a time extending papules on a head, as well as a peeling, loss of hair on the amazed sites. Also on seat of papule can be formed inflamed, furuncular-like units.
At disease of a tinea of a smooth skin, papules extend on any sites of a skin, there are flat formations, dry, covered by scaly crust or damp, covered by crusts. Depending on a degree of their increase, the centers of spots are cleared, giving a classical picture of a leather in the form of circles.

A tinea nails begins with tips of one or more nails on legs or hands. In the second case disease is shown far less often, than in the first. Illness leads to a gradual thickening of nails, variation of their color, a curvature. Under them the substance formed from of died cells accumulates. As a result, the nail can be completely destroyed.
A tinea stop causes finely lamellar peeling of a skin, occurrence of bubbles between fingers. In heavy cases the infection can lead to inflammatory process of all the stops, described a strong itch and a pain at walking.

A tinea of an inguinal areas it is characterized by occurrence red, with precise borders, spots in an inguinal areas. The designated spots can extend on buttocks, internal surfaces of a hips and external genitals.
At diagnostics of a tinea, it is carried out scrape from the amazed sites of a leather. The received material investigate by means of a microscope.
A tinea, as a rule, it is treated by preparations for external application. Local treatment proceeds within two weeks after disappearance of symptoms. Also, at treatment of a tinea use the open damp bandages.

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Illnesses of the spinal cord

Illnesses of a spinal cord often lead to irreversible neurologic infringements and to proof and expressed invalidization. Insignificant on the sizes the pathological centers cause occurrence of pamplegia, paraplegia and infringements of sensitivity from top to bottom from the center as through the small area of cross-section section of a spinal cord pass practically all axifugal impellent and eisodic sensitive spending ways. Many illnesses, especially accompanied a compression of a spinal cord from the outside, carry inversive character in this connection sharp defeats of a spinal cord should be carried to the most critical urgent conditions in neurology.

The spinal cord has a segmentary structure and innervate finitenesses and a trunk. 31 pairs spinal nerves that does anatomic diagnostics concerning simple depart from it. To define localization of pathological process in a spinal cord allow border of frustration of sensitivity, paraplegia and other typical syndromes. Therefore at diseases of a spinal cord careful inspection of the patient with application of additional laboratory tests, including a nuclear magnetic resonance, computer tomography, myelography and research somatosensory the caused potentials is required. Owing to ease in carrying out and the best resolution computer tomography and the nuclear magnetic resonance supersede standard myelography. Especially valuable information on internal structure of a spinal cord gives a nuclear magnetic resonance.

Parity of an anatomic structure of a spine column and spinal cord with clinical symptoms

The universal organization of a longitudinal axis spinal cord by a somatic principle allows to identify easily reasonably the syndromes caused by defeat of a spinal cord and spinal nerves. Longitudinal localization of the pathological center establish on the uppermost border of sensitive and impellent dysfunction. In the mean time the parity between bodies of spondyles (or their superficial reference points, awned shoots) and the segments of a spinal cord located under them complicates anatomic interpretation of symptoms of diseases of a spinal cord. Syndromes of defeat of a spinal cord describe according to the involved segment, instead of a being next to spondyle.
During embryonal progresses the spinal cord grows more slowly a spine column so the spinal cord comes to an end behind of a body of the first lumbar spondyle, and its radices accept more steep descending direction to reach innervate them structures of finitenesses or internal bodies. The useful rule consists in that. That is radices (except for CVIII) leave rachial the channel through apertures above bodies of spondyles appropriating them, whereas chest and lumbar radix — under the same spondyles. The top cervical segments lay behind of bodies of spondyles with same numbers, bottom cervical — on one segment above a spondyle appropriating them, top chest — on two segments above, and bottom chest — on three. Lumbar and sacral segments of a spinal cord [(the last shape a brain cone (conusmedullaris)] are localized behind of spondyles ThIX—li. To specify propagation various extramedullary processes, especially at spondylosis, important carefully to measuresagittal diameters of the rachial channel. In norm at cervical and chest levels these parameters make 16—22 mm; at a level of spondyles li-liii-nearby 15—23 mm and below — 16—27 mm.

Clinical syndromes of diseases of a spinal cord

As the basic clinical symptoms of defeat of a spinal cord serve loss of sensitivity the border which are passing on a horizontal circle on a trunk, i.e. «A level of frustration of sensitivity», and weakness in finitenesses, innervate descending corticospinal fibres. Infringements of sensitivity, especially paresthesia, can appear in stops (or one stop) and to extend upwards, originally making impression about polyneuropathy before the constant border of frustration of sensitivity will be established. The pathological centers leading a break corticospinal and bulbospinal of ways at same level of a spinal cord, cause paraplegia or pamplegia, accompanied increase of a muscular tone and deep tendinous reflexes, and also the symptom of Babynskiy.
At detailed survey usually find out segmentary infringements, for example a strip of changes of sensitivity top level conducting touch frustration (a hyperalgesia or a hyperpathia), and also a hypotonia, an atrophy and the isolated loss deep tendinous reflexes. A level conducting frustration of sensitivity and segmentary semiology approximately specify localization cross-section affect. As an exact localizing attribute the pain felt on an average line of a back, especially at a chest level serves, the pain in interscapular areas can appear the first symptom of a compression of a spinal cord. Radicular pains points on primary localization of the spinal defeat located more lateralis. At involving the bottom department of a spinal cord — a brain cone of a pain are often marked in the bottom part of a back.

At an early stage of sharp cross-section defeat in finitenesses the hypotonia, instead of spasticity because of a so-called spinal shock can be marked. The given condition can be kept about several weeks, and it is erroneous it sometimes accept for extensive segmentary defeat, but later reflexes become high. At the sharp cross-section defeats especially caused by a heart attack, to a paralysis often precede short clonic or myoclonic movements in finitenesses. Other important symptom of cross-section defeat of the spinal cord, requiring close attention, especially at a combination with spasticity and availability of a level of sensitive frustration, vegetative dysfunction, first of all a delay serves wet.

Significant efforts are undertaken for clinical differentiation intramedullary (inside of a spinal cord) and extramedullary compression defeats, but the majority of rules are approximate and do not allow to differentiate one from others reliably. To the attributes testifying in favour of extramedullary of pathological processes, concern radicular pains; a syndrome half spinal affcets Brown-Sekar; symptoms of defeat peripheral effector neuron within the limits of one-two segments, often asymmetric; early attributes of involving of corticospinal ways; essential decrease in sensitivity in sacral segments.
On the other hand, hardly focalized the burning pains, the dissociated loss of painful sensitivity safety of sarcous-articulate sensitivity, conservation of sensitivity in the field of perineum, sacral the segments, late arising and less expressed the pyramidal semiology, normal or slightly changed structure SMZH are usually characteristic for intramedullary defeats. «Untact sacral segments» means safety of perception of painful and temperature irritations in sacral dermatome, it is usual with SIIInoSV. With rostral zones above a level of frustration of sensitivity. As a rule, it is an authentic sign the intramedullary defeats, accompanied involving of the most internal fibres spinothalamic ways, but not mentioning the most external fibres providing touch innervation sacral dermatome.

Browm-Sekar syndrome designate aggregate of symptoms half cross-section defeat of the spinal cord, shown homolateral monocles hemiplegia with loss of muscular-articulate and vibrating (deep) sensitivity a combination with contralateral loss of painful and temperature (superficial) sensitivity. The top border of frustration of painful and temperature sensitivity quite often define on 1—2 segments below a site of damage of a spinal cord as spinothalamic ways after formation synapse in a back horn pass fibres in opposite lateral funicle, rising upwards. If there are segmentary infringements in the form of radicular pains, muscular atrophies, fading tendinous reflexes they usually happen unilateral.

The pathological centers limited by the central part of a spinal cord or mentioning in basic it, mainly amaze neurocyte of grey substance and segmentary conductors, decussate at the given level. The most widespread processes such are a bruise at a spinal trauma, myelosyringosis, tumours and vascular defeats in pool of a forward spinal artery. At involving a cervical department of a spinal cord the syndrome of the central spinal defeat is accompanied by weakness of the hand significantly more expressed in comparison with weakness of a leg, and the dissociated frustration of sensitivity (analgesia, i.e loss of painful sensitivity distribution in the form of a cape on shoulders and the bottom part of a neck, without anesthesia, i.e. losses of tactile sensations, and at safety of vibrating sensitivity).

The defeats localized in the field of body C or below, squeeze the spinal nerves which are a part of a horse tail, and cause languid asymmetric paraparesis with areflexia to which dysfunction of a bladder and an intestines, as a rule, accompanies. Distribution of sensitive frustration reminds outlines of a saddle, reaches level L and corresponds to zones innervation radicular, entering in a horse tail. Achilles and knee reflexes are lowered or are absent. Pains, irradiate in perineum or a hip are often marked. At pathological processes in the field of a cone of a spinal cord of a pain are expressed more poorly, than at defeats a horse tail, and frustration of functions of an intestines and a bladder arise earlier; die away only Achilles reflexes. Compression processes can simultaneously grasp as a horse tail, and a cone and to cause the combined syndrome of defeat peripheral effector neuron with some hyperreflection and symptom of Babinskiy.

The classical syndrome of the big occipital aperture is characterized by weakness of muscles of a humeral belt and a hand after which there is a weakness homolateral legs and, finally, contralateral hands. Volumetric processes of the given localization sometimes give a suboccipital pain extending on a neck and shoulders. Other certificate of a high cervical level of defeat syndrome of Gorner which is not observed at availability of variations below segment TII serves. Some illnesses can cause sudden «insult-like» myelopathy without previous symptoms. To their number concern a epidural haemorrhage, hemorrhachis, a heart attack of a spinal cord, an incomplete dislocation of spondyles.

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Epilepsy. Guidance for patients.

Epilepsy - one of the most widespread diseases of nervous system which cause of the prominent features represents a serious medical and social problem. Among the children's population frequency of epilepsy makes 0,75-1 %, from them of 65 % can live practically without attacks provided that they pass appropriating medical examination and receive appropriate treatment. Epilepsy - disease of the brain, described attacks of infringements of impellent, sensitive, vegetative or cogitative functions. Thus during between attacks the patient can be absolutely normal, nothing differing from other people. It is important to note, that the individual attack yet is not an epilepsy. Only repeated attacks - the basis for an establishment of the diagnosis of epilepsy. At epilepsy attacks also should be spontaneous, i.e. nothing to be provoked; they appear always unexpectedly. The attacks arising at temperature (pyretic spasmes), a fright, at a capture of blood, as a rule, have no attitude to epilepsy.

The reasons of occurrence of an epilepsy depend on age. At children of younger age the most frequent causal factor got epilepsy is oxygen starvation during pregnancy (hypoxia), as well as congenital developmental anomalies of a brain, intra-uterine infections (a toxoplasmosis, a cytomegaly, a roetheln, a herpes, etc.); less often - a patrimonial trauma. There are also forms of epilepsy with hereditary predisposition (for example, youthful myoclonic epilepsy). At these forms the risk of a birth of the sick child if one of parents is sick of epilepsy, is low and makes no more than 8 %. Extremely seldom there are progressing hereditary forms of epilepsy, mainly, in families with close relatives marriage or in the certain ethnic groups (for example, among a Finno-Ugrian population). In these families the risk of a birth of the sick child can be very high and reach 50 %.

Thus, allocate a "symptomatic" epilepsy (when it is possible to find out structural defect of a brain), an autopathic epilepsy (when there is a hereditary predisposition and structural changes in a brain are absent) and a cryptogenic epilepsy (when the reason of disease to reveal it is not possible).

Allocate nidal (franctional, focal, local) attacks, at which spasmes or original sensations (for example, numbness) in the certain parts of a body can be observed; most often - on behalf of or finitenesses, especially in hands. Nidal attacks can be shown also by short attacks of visual, acoustical, olfactory or flavouring hallucinations; short-term sensation of a pain or discomfort in a stomach; inflow of ideas with impossibility to concentrate; sensation «already seen» or «never seen»; attacks of unmotivated fear. The consciousness at these attacks is usually kept (simple fractional attacks), and the patient in details describes the sensations.
Deenergizing consciousness without falling and spasmes (complex fractional attacks) is possible. Thus the patient continues automated to carry out the interrupted action. During this moment can meet automatisms: chewing, stroking bodies, rub palms and so forth thus is made impression, that the person is simply absorbed by the activity. Duration of franctional attacks usually no more than 30 sec. After complex of fractional attacks short-term confusion of consciousness, drowsiness are possible.

Generalized attacks happen convulsive and non-convulsive (absenses). Generalized convulsive tonic-clonic attacks - the most serious, shocking, frightening parents and attacks surrounding type, nearby not the heaviest. Sometimes in some hours or even days up to an attack patients test some phenomena named by harbingers: the general discomfort, alarm, aggression, irritability, a sleeplessness, sweaty, the feeling of heat or a cold, etc. If directly ahead of an attack of the patient feels aura (discomfort in a stomach, visual sensations, unreality surrounding and so forth), and then loses consciousness and falls in spasmes such attack refers to again-generalized.
During aura some patients have time to secure themselves, having called to the aid associates or having reached up to a bed. At primarily-generalized convulsive attacks of the patient does not feel aura; these attacks are especially dangerous the suddenness. Favourite time of their occurrence - the period soon after awakening patients. In the beginning of an attack (a tonic phase) there is a pressure of muscles and shrill shout is often observed. During this phase probably biting language. Short-term respiratory standstill with the subsequent occurrence of cyanosis develops. The clonic phase of an attack further develops: there are rhythmical twitchings muscles, is usual with involving all finitenesses. In the end of clonic phases it is often observed incontience of urine. Spasmes usually stop spontaneously in some minutes (2-5 mins). Then the post attack period comes, described drowsiness, confusion of consciousness, a headache and approach of a dream.

Non-convulsive generalized epilepsy attacks called by absense. They arise almost exclusively at children's age and an early youth. The child suddenly fades (deenergizing of consciousness) and steadfastly looks in one point; the sight seems absent. Attacks proceed all some 5-20 seconds and often remain not noticed. These attacks are very sensitive to hyperventilation - are provoked by the deep forced breath during 2-3 minutes

Allocate also myoclonic attacks: involuntary reduction of muscles of all body or its parts, for example, hands or a head, thus the patient can reject aside subject matters being hands. These attacks quite often arise in the morning, especially if the patient has not slept. The consciousness at them is kept. Atopic attacks are characterized by sudden full loss of a muscular tone owing to what the patient sharply falls. Convulsive reductions are absent. Children of the first year of a life have a special type of heavy attacks - infantile spasms. The given attacks proceed serially in the form of nods, folding of a trunk, bending of hands and legs. Children with this type of attacks usually lag behind in impellent and mental progress.

Exist about 40 various forms of epilepsy and different types of attacks. The doctor should lead indispensable inspection and precisely diagnose the form of epilepsy and character of attacks. Thus for each form there is certain an antiepileptic preparation and the programme of treatment.

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Nevus pigmentary, dysplastic, blue, boundary, removal of nevus

Pigmentary nevus - a good-quality congestion of pigmentary cells on a skin. Pigmentary nevus it is seldom possible to meet at babies; they start to be shown in the childhood, and especially much they appear in youthes, and with the years number of pigmentary nevuses one step at a time decreases. The type of pigmentary nevuses can be various - they can be flat or acting above a surface of a leather, the smooth or covered hair. It is necessarily necessary for adult people to pay attention to variation of their form, color or appearance as it can be one of initial symptoms developing malignant melanoma.

Dysplastic nevuses is pigment spots of the complex form and with not sharp borders, slightly rise above a level of a skin, painting varies them from red-brown up to dark-brown on a pink background.

Dysplastic nevuses for the first time have drawn to itself attention the unusual type and the raised frequency in some families (are transferred by right of succession). As a rule, dysplastic nevuses is larger than ordinary birthmarks, reaching 5–12 mm in diameter.

Boundary pigmentary nevus. Develops in the field of dermo-epidermal joints and it is characterized raised melanocyte by activity. Clinically it looks like flat is dark-brown or black papule in diameter up to 1 sm, with a smooth dry surface is more often. The important differential-diagnostic sign boundary pigmentary nevus is the total absence on it of hair. Boundary nevus can sometimes look a spot roundish or wrong outlines with equal wavy edges. Favourite localization at boundary nevus is not present. It can settle down on a leather of the person, a neck, a trunk. According to the literature, pigmentary nevuses on a skin of a palm, soles, genitals almost always are boundary. Boundary nevus is congenital is more often, however can appear in the first years of a life or even after puberty.

Blue (dark blue) nevus represents sharply limited from a surrounding skin papule is dark-dark blue or bluish color, roundish outlines, densely-elastic consistence with a smooth hairless surface. It is characterized by massive congestions of melanin in deep layers of derma, that causes its blue color. The size of papule no more than 0,5 sm though in the literature individual supervision huge blue nevus are described, reaching several centimeters in diameter. Settles down blue nevus more often on the person, finitenesses, buttocks. Localization in an oral cavity is possible. Blue nevus meets at representatives of Asian people is more often. Congenital it never happens and appears mainly after puberty. Progress of melanosis on seat blue nevus is observed seldom, but such cases are described, as has induced it to carry to danger of melanoma.

Huge pigmentary nevus - always congenital. It increases in sizes in process of growth of the child, reaching the big size (from a palm and it is more) and borrows sometimes the most part of a trunk, a neck and other areas. Usually on a significant extent a surface of nevus is torous, warty, with deep cracks on a skin. Often there are sites trichauxis (hair nevus). Color variate from grayish up to black, often non-uniform on various sites of nevus. Malignization of huge pigmentary nevus according to various authors occurs in 1,8 % up to 10 % of cases.

Papillomatous nevus is characterized rough, torous by a surface. It is often localized on hair parts of a head, but happens and on any other site of an integument. The sizes more often greater, up to several centimeters, outlines are wrong, color variates from color of a normal skin up to brownish, less often - is dark-brown or even black. Similar fibroepithelial papilloma quite often happens it is penetrated by hair.

Removal of nevuses

Any pigmentary new growths of a skin require attention and vigilance.

Their treatment consists in radical (within the limits of not changed leather) removal by a method surgical ablation (stages are presented on illustrations in the bottom of page). Use modern noninvasive sutural and rules of aesthetic surgery allows to achieve materials undistinguished postoperative cicatrical tissue.

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Bronchiolitis

Etiology

Many diseases have bronchiolitis like clinical displays, vast majority from them virus ethiology. A respiratory-syncytial virus (RS) consider as the most frequent reason bronchiolitis. It is established, that from 40 up to 75 % of children acts in hospital with the diagnosis bronchiolitis, caused this virus. Other activators can be rhinovirus, a virus parainfluenza (type 3), adenovirus (type 3, 7 and 21), a virus of a flu and, occasionally, a virus of an epidemic parotitis. Though in children of advanced age Mycoplasma pneumoniae usually causes disease of the bottom respiratory ways, but at chest age it seldom causes bronchiolitis.

Epidemiology

Using widely widespread clinical term «the whistling child at a respiratory infection», Henderson and co-author. Have noted, that the highest frequency of disease was at children of the first year of a life: 11,4 cases on 100 children in a year. On the second to year of a life frequency decreased to 6 cases on 100 children in a year. In Houston frequency РС bronchiolitis, demanding hospitalization, in families with a low social level made 5 cases on 100 chest babies in a year. About 80 % of the hospitalized children 6 months Therefore authors were more younger have come to conclusion: the the child is more younger, the more hard at it disease proceeds and is more often hospitalization is required.

Babies with heavy forms bronchiolitis have a low level of the antibodies transferred from mother. From the hospitalized children with the proved Óß-infection at 18-20 % can arise apnoea to which contribute prematurity and early age of the child. Other group of high risk for occurrence of the Óß-infection is made by patients with VPS. At the general lethality 1-2 % in this group at the Óß-infection it reaches 37 %.

Epidemic of the Óß-virus develops annually in the winter while frequency contamination viruses parainfluenza decreases a little. The disease caused by the Óß-virus, is very infectious, if in collective there is a patient, as a rule, all contact children (98 %) fall ill. Transfer of the Óß-virus to family as is significant. Reasonably to be ill to one member of family that 46 % of the others were infected.

Frequency of hospital infections is high. During flash of the Óß-infection of 45 % of tentatively not infected hospitalized children were ill with this infection. The risk of disease raised with an increase of duration of hospitalization. Probably, its basic source in hospital is the medical personnel which distributed a virus, catching through the secrets allocated by infected patients. Infection occured approximately in 42 %.

Clinical aspects

Usually the baby catches from the senior children or adults with an infection of respiratory ways.

Diagnosis: bronchiolitis

Cough, cold, ptarmus are the first symptoms of disease. In the subsequent at patients on a background of irritability respiratory frustration with polypnea, participation in breath of auxiliary muscles, dry rattles progress. There can be an insignificant fever. The appreciable short wind causes difficulty of the certificate sucking. Physical survey reveals signs of sharp inflammatory disease of respiratory ways: polypnea, cyanosis, inflating of wings of a nose and impaction compliant seats of a chest wall. Lungs emphysematous, the edge of a liver can act on some fingers from under a costal arch. At lungs auscultation - dry diffuse and damp rattles, lengthening of an exhalation.

Indispensable laboratory researches at the patient with heavy bronchiolitis include: the roentgenogram of a thorax; the clinical analysis of blood; research of arterial gases of blood; virologic definition of the Óß-virus and antibodies to it; crop of blood on microflora if it is impossible to exclude a bacterial pneumonia.

Radiological inspection of the child with sharp bronchiolitis shows availability sharp emphysema lungs at the majority of patients. At half of children define peribronchial sealings. Leukocytosis usually is absent. RS the virus can be identified by reaction of linkage complement or indirect immunofluorescence antibodies in film, taken with a mucous membrane of a nose.

For diagnostics of respiratory insufficiency at bronchiolitis it is necessary to investigate arterial gases of blood. On the basis of a series from 32 patients the Hall and co-authors have established, that average saturation by oxygen of hemoglobin has made 87 %. Hypoxemia persistence, proceeding 3-7 weels, even on a background of clinical improvement of a condition.

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Basal ganglia of endbrain and movement

Basal ganglia are located in the basis of a endbrain and represent the important subcrustal connecting link between associative areas of a cerebral cortex and impellent areas of a cerebral cortex. Following structures are concern to basal ganglia: a striped kernel of basal ganglia consisting caudate nucleus of basal ganglia and shells of basal ganglia, a pale sphere of basal ganglia subdivided on internal and external departments, a black substance of basal ganglia and a subthalamic kernel of basal ganglia. In structure of basal ganglia often include also a fencing and less often - amygdala.

Infringements of movements are caused by defeat of basal kernels - the anatomically isolated group of pair subcrustal structures.

Basal kernels facilitate movements started by a bark and suppress extra accompanying movements. Striatum receives the somatotopic organized projections almost from all zones of a bark. These projections are organized in the form of parallel ways which begin from frontal areas, postcentral (somatotopic) areas, precentral (motor) areas and parietotemporal-occipital areas.

Neurocytes of striatum send fibres to the structures shaping the main axifugal way of basal kernels - to a mesh part of a black substance and a medial pale sphere.

Thus, at braking neurocytes a mesh part of a black substance and a medial pale sphere exciting influence thalamus on a bark amplifies - as promotes simplification of movement started by a bark.

On the contrary, at excitation neurocytes a mesh part of a black substance and a medial pale sphere exciting influence thalamus on a bark suppresses - that leads to braking of unnecessary movement.

On a spinal cord basal kernels have no direct output. The direct way from striatum to a mesh part of a black substance and a medial pale sphere is formed brake by fibres. Their function consists in strengthening exciting influence of kernels thalamus on those departments of a motor bark which are responsible for the necessary movement. The indirect way is organized more difficultly. Its function consists in suppression of exciting influence thalamus on other departments of a motor bark.

Thus, if activation of a direct way from striatum strengthens excitation of a motor bark activation of an indirect way - weakens.

Activity of these two ways is adjusted with the compact part of a black substance sending to striatum dopaminergic fibres. These fibres raise direct a axifugal way to striatum (through neurocytes with D1-receptors) and brake - indirect (through neurocytes with D2-receptors). Striatum sends also brake gamma-aminobutyric acid fibres to a compact part of a black substance, forming that with it a negative feedback. Finally, activity of striatum modulate it cholinergic inserted neurocytes - antagonists dopaminergic neurocytes.

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Arterial hypertensia and atherosclerosis

The atherosclerosis is a scourge of 20-th century. One of factors of its progress is the arterial hypertensia. At an atherosclerosis infringement of balance of lipids in blood that is shown in increase of a level of lipoproteins low density and lowering of a level of lipoproteins high density is marked. It leads to formation on walls of vessels so-called atheromatous plaque which will consist of some salts of calcium, fibres of fibrin and cholesterol. And it, in turn, conducts to narrowing a gleam of vessels, and most seriously it concerns to vessels of heart (coronary arteries) as causes an ischemic heart disease and a heart attack of a myocardium, and to vessels of a brain that is shown in the form of infringements of blood circulation of a brain and insults.

Displays of an atherosclerosis

The atherosclerosis usually externally is not shown in any way until narrowing of vessels will not reach that degree when blood circulation in bodies and fabrics is broken seriously. For example, it can be a pain behind a brest, connected with physical activity, and sometimes and in rest, a pain in finitenesses which also are connected with narrowing arteries.

Heart attack of a myocardium

The heart attack of a myocardium is a condition at which in a cardiac musle – a myocardium – there is a sharp infringement of blood circulation as a result of full corking a gleam of one of coronary arteries atheromatous plaque or a blood clot (that happens less often). At absence of blood circulation during certain time in a fabric of a myocardium comes necrosis which already happens irreversible. In the subsequent this necrosis is replaced with a cicatricial tela.

Diagnostics of an atherosclerosis

Usually the atherosclerosis comes to light only when the conditions caused by it are marked: a stenocardia, a heart attack of a myocardium, an insult, infringements of blood circulation in finitenesses. Diagnostics of an atherosclerosis is based on following methods of research:

* The electrocardiogram. It is a method based on registration of electric activity of heart. As we already spoke, in heart there is a spending system on which passes an electric impulse from unit where it is formed up to other muscles. These potentials reflect work of heart. At the certain pathology, on an electrocardiogram those or other attributes are marked. It especially concerns anisorhythmia, the ischemic phenomena which are characteristic for a heart attack of a myocardium.
* The bicycle ergometry. This method also is based on an electrocardiogram, but carried out under the certain load when the patient receives physical activity on a velosimulator. Owing to such load the demand of heart for blood supply amplifies, and there is visible an availability of infringements of a blood-groove in heart.
* The coronary arteriography. It is radiological methods of diagnostics at which into coronary vessels it is entered thin long catheter which usually enter through a humeral or femoral artery. After achievement by catheter coronary arteries, in them it is entered opaque medium. After that the x-ray picture which helps to reveal sites of narrowing of arteries atheromatous plaque is done.
* The echocardiography (ultrasonic of heart). This method allows to reveal structural variations from heart, for example, a thickening of ventricular walls, that speaks about their hypertrophy. It is one of signs of an arterial hypertensia.
* The computer tomography. It is a radiological method which allows to receive level-by-level cuts of fabrics of heart.
* The magnetic resonance imaging procedure. The given method also allows to receive level-by-level cuts of fabrics, and especially vessels as it is very sensitive. It not a x-ray method in which electromagnetic waves in strong by a magnet a field are applied.

Treatment of an atherosclerosis

Treatment of an atherosclerosis includes, first of all, variation of a diet, physical exercises, as well as preparations for reduction of a level of cholesterol in blood. To surgical methods concern first of all balloon angioplasty when into a gleam narrowed plaque a vessel it is entered thin long catheter with inflated cartridge on the end then the gleam of an artery extends, and stent when in a gleam of an artery it is established so-called stent, playing a part of a skeleton for a vessel. In some cases other interventions, for example, shunting are spent also.

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Sarcoma

Sarcoma of soft parts – extensive group of the malignant new growths occurring from primitive embryonic mesoderm (an average germinal leaf). Primary mesenchyma, a part of mesoderm, gives rise to various variants of the connecting fabric which are a part of sinews, bands, muscles, etc. From them and formation of a sarcoma is possible. However some sarcomas have ectodermal and epithelial origin, characteristic for a cancer.

The majority of cases of a sarcoma arises spontaneously, i.e. without the visible reasons, however to risk factors of the given disease carry chemical carcinogens, an ionizing radiation, a burden heredity.

The sarcoma of soft parts can meet at any age, but meets at people white color of a skin after 40 years (middle age ill - 50 years) more often. Other essential laws it is not revealed.

The sarcoma of soft parts meets reasonably seldom, frequency about 1 case on 1 million person in a year or about 6000 cases in a year in absolute expression among all population of the Earth. Death rate from a sarcoma rather high: about half of the patients who have ill a sarcoma, dies.

The most frequent place of development of a sarcoma – the bottom finitenesses. The above, the less often sarcoma is. If on the bottom finitenesses the sarcoma meets approximately in 40 % of cases, in the field of a head and a neck only in 5 %.

Besides usual characteristics of a tumor (the histological structure, the size, availability of the nearest and remote metastasizes) can be divided sarcomas on a degree malignity:

* the Low degree of malignity. Here carry such characteristics of a sarcoma, as a high differentiation of cells and small mitotic their activity, small quantity of actually tumoral cells and a plenty stromas in a sarcoma, small quantity of vessels and a small number of the centers necrosis.
* the High degree of malignity. Here carry opposite characteristics of a sarcoma, as a high differentiation of cells and small mitotic their activity, small quantity of actually tumoral cells and a plenty stromas in a sarcoma, small quantity of vessels and a small number of the centers necrosis.

On a degree of malignity define the forecast of disease, so also probability of success of treatment.

Examples of sarcomas of soft parts are:

* alveolar sarcoma of soft parts;
* angiosarcoma;
* malignant perithelial endothelioma;
* malignant mesenchymoma;
* malignant fibrous histiocytoma;
* malignant neurilemmoma;
* leiomyosarcoma;
* lipoblastoma;
* rhabdomyoblastoma;
* synovial sarcoma;
* fibrosarcoma;
* epithelioid sarcoma.

Usually the sarcoma is characterized by slow growth and painlessness during enough long time, therefore revealing is long an existing and causeless swelling (palpated formation on finitenesses, in a stomach and other parts of a body) should guard and force is urgent to address to the doctor for specification of the diagnosis. The most frequent metastasises of a sarcoma are observed in lungs, less often – in regional lymph nodes.

Diagnostics of a sarcoma is spent by survey by the expert, application of means of medical visualization, biopsy with the subsequent research of a fabric of a tumor and some other additional methods.

From all means of medical visualization (ultrasonic research, a x-ray computer tomography, a magnetic resonance tomography) consider as the most informative MRT though in each specific case the choice of a method of diagnostics should be spent individually.

Tumors biopsy can be excisional (through a cut), and also paracentetic. Opened (excisional) biopsy has advantage in case of the specified specification of already available plan of treatment.

Treatment of a sarcoma of soft fabrics mainly surgical. If radical operation is impossible, as additional methods the chemotherapy and-or beam therapy of a sarcoma are used. Unfortunately, their efficiency while is low, and in case of a tracking down of metastasises the probability of treatment endeavors to zero.

To the factors improving the forecast of disease, carry time of doubling of a tumor more than 20 days, an recurrence-free interval more than year, quantity of units less than 4. Radical removal of a tumor and metastasises in lungs is capable to give 5-years survival rate approximately 20 % to patients. The basic problem remains recurring diseases. The lowest risk of relapse – for tumors of the bottom finitenesses (less than 25 %), the highest – for extraperitoneal spaces (about 75 %).

To the factors improving survival rate, carry: age less than 50 years; a low degree malignity sarcomas; a pain in the field of a tumor; the small sizes of a tumor and its arrangement on finitenesses; absence of metastasises.

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Leukemia

The leukemia or leukosis is a whole group of tumors which is characterized uncontrolled proliferation and a different degree of a differentiation hematogenic cells. Leukemic cells thus are descendants, clones of one of mutate cells.

The reason of a leukemia, as a rule, are chromosomal aberrations, i.e. variations in structure of chromosomes as a result of various processes of restructuring of their structure: trans location, deletion, inversions, fragmentation.

According to traditional classification, all leukemia share on sharp and chronic. Such division is connected with various capacity of the given tumors to a differentiation proliferating cells. In case of sharp leukosis the differentiation practically is absent, in blood the huge quantity unripe, nonfunctional blast cells that leads to oppression normal hematosis all fragments collects. The specified signs come to light in blood more than in 80 % of cases. Chronic leukosis (leukemia) gives a population of the differentiated cells, is usual granulocytic, one step at a time replacing normal cells of peripheral blood.

Sharp leukemia can be divided on lymphoblastic and myeloblastosis.

* Sharp lymphoblastic leukosis develops from predecessors B-achroacyte (about 75 % cases) more often.
* Sharp myeloblastosis leukosis (the sharp myeloid leukemia) often refers to «nonlymphoid leukemia» to emphasize its variety and difference from Sharp lymphoblastic leukosis since blasts thus can have a granulocytic origin. Sharp 'nonlymphoid leukosis' histological is classified by the letter of M with figures from 0 up to 7, for example, М7 is a sharp megacaryoblast leukemia.

The diagnosis of a leukemia is put on set of researches of blood, and a bone brain. At diagnostics the clinical picture, and cytogenetics, morphology and immunology revealed blasts has not crucial importance. On parameters revealed at it will depend not only statement of the final diagnosis, but also the forecast, treatment and an outcome of disease.

The forecast at leukemia in whole is more favorable at children's age (1-9 years), as well as depends on a type of a pathology, a type of cells and terms of revealing of disease.

The basis of treatment leukosis is made with chemotherapy. Treatment today legal that is why each type of a pathology and its separate features matter for a choice of the report of treatment. At sharp leukosis treatment is based on poly chemotherapy. Its efficiency above at sharp lympholeukosis reaches 95 %. At sharp myeloleukemia efficiency of chemotherapy exceeds 80 %, but reasonably is often accompanied by complications, and 5-years remission is observed only at 40 % of patients, while relapses at Sharp lymphoblastic leukosis – more a unusual occurrence.

As a whole therapy of leukosis should be spent in specialized branch, with an opportunity of application of the most modern and effective treatment that guarantees both a high probability of full remission, and full of recover after all complex of medical actions.

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