Bronchiectasis

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Adenoma

Adenoma (innocent hyperplasia of prostate gland, to be exact external glands of prostata) - hormonedependent disease at which there is a growth of a tela of prostate gland leading infringement of process urination.

Most often an adenoma diagnose for men older 50 years are more senior, therefore some experts consider the given disease by one of displays of a man's climax. Except for age changes there are some more the factors promoting occurrence of illness:
* hormonal infringements
* presence of other chronic diseases (an atherosclerosis etc.)
* a sedentary way of life
* the big increase in weight of a body
* the ecological factor

At an adenoma under action of testicular hormone (a man's sexual hormone) growth of cells of a ferruterous tela which adjacent direct to a wall of the urethra which are passing through prostate gland begins. Eventually proliferative the tela starts to press on urethra that leads to its narrowing. Than more time there is a disease, especially strong pressure appears on a urethra. Problems with urination begin:
* speeded up urination
* complicated and faltering urination
* a weak pressure of a uric jet
* incontience urine or a sharp delay wet
* erythrocyturia (blood in urine)

As the heaviest cases are considered a sharp delay wet and erythrocyturia. At long-standing current of illness prostate gland increases so, that ejecting a bladder becomes impossible. In such cases of patients urgent hospitalization is required. Occurrence of blood in urine specifies damage of veins of a bladder as a result of elevated pressure in it.
Depending on duration of current of disease and clinical displays allocate three stages of an adenoma. At initial stages symptoms of disease are expressed slightly, therefore the patient can not notice them at all. At the first initial stage the patient tests: frequent desires to urination, especially at night-time, time urination increases, a jet wet languid.

At transition of disease to the second stage it is observed: formation of residual urine, difficulty of outflow of urine from a bladder, faltering urination, sensation incomplete ejecting.
The further progress of illness leads to a delay or incontience of urine, internal constrictor loses the tone, can appear nethritic insufficiency.
Quite often the adenoma meshs with other diseases of urinogenital system (a cystitis, an urethritis, a pyelonephritis, urolithic illness, etc.), that is connected with infringement of process urination.
Treatment can be conservative and surgical. Selection of this or that method depends on weight of illness, availability of accompanying diseases, specific features of the patient.

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Doctors Find Live Worm in Patient's Eye - Analysis

Comments: Bizarre as it may seem, the preceding photos are authentic, though the same cannot be said of the accompanying narrative, which is an utter fabrication.

There is no way to determine who assembled the collage, but I did manage to locate the source of the individual images, an article entitled "Anterior Orbital Myiasis Caused by Human Botfly," published in the July 2000 number of the Archives of Ophthalmology, a journal of the American Medical Association.

"Myiasis" is the medical term for a maggot (fly larva) infestation of a living body. In this case, the patient was a 5-year-old boy treated by U.S. Air Force surgeons in a rural area of the Republic of Honduras. "The respiratory pore of a late-stage larva of the human botfly (Dermatobia hominis) was located in the anterior orbit," says the article abstract. "The larva was gently removed under general anesthesia through a small incision in the conjunctiva." The patient was apparently none the worse for wear in the aftermath.

Of botflies and blowflies

It would appear that the article itself was not consulted when this email tale was composed. Neither "bad dust" nor excessive eye rubbing were cited as causes of the infestation in the 5-year-old patient. According to entomologists, the human botfly lays its eggs on the bodies of other insects (such as mosquitoes), which then transfer the eggs to animal or human hosts by direct contact. When a botfly egg hatches, the larva burrows into the host's skin head-first and begins feeding.

This nasty creature is found mainly in Central and South America, but there are other species of flies known to responsible for cases of myiasis in North America, mainly blowflies. According to an epidemiological study conducted in 2000, most instances of myiasis acquired in the United States are the result of blowflies laying their eggs in pre-existing wounds.

None of which is quite as terrifying as the claim that any one of us could end up with a worm in our eye simply by being exposed to too much dust, which helps explain why the true facts of the case aren't circulating with the photos. In folklore, the story's the thing - accuracy takes a back seat to emotional impact, or, as folklorist Jan Harold Brunvand succinctly puts it, "The truth never stands in the way of a good story."

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Mucinous (Colloid) Carcinoma of the Breast

Overview of Mucinous Carcinoma of the Breast:

Mucinous (colloid) carcinoma is a rare type of invasive breast cancer that is formed when cancer cells within your breast produce mucous. This mucous contains breast cancer cells that are easily distinguished from normal cells under a microscope. Together, the mucous and cancer cells form a jelly-like tumor. Most mucinous carcinomas of the breast are estrogen-receptor positive and HER2/neu negative. This type of breast cancer rarely spreads to your lymph nodes.

Mucinous Carcinoma of the Breast is an Uncommon Diagnosis:

Mucinous carcinoma of the breast is a rare type of invasive breast cancer, diagnosed in less than 3% of all women diagnosed with breast cancer. It is not a mucinous disorder called "mucocele-like tumor (MLT)," which is often associated with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS). Making a distinction between a diagnosis of a mucinous carcinoma and a mucocele-like tumor is difficult and usually requires a biopsy and careful pathological examination.

Also Known As:

colloid carcinoma

Signs and Symptoms of Mucinous Carcinoma:

A gelatinous tumor of mucinous carcinoma of the breast will feel like a slightly bumpy water balloon, similar to harmless fluid-filled cysts. Smaller tumors may be too little to detect with your fingers, but larger tumors may press on surrounding breast tissue and cause it to feel tender. During your regular breast self-exam, if you feel an area that won't compress like the rest of your breast tissue, get it checked out by a health professional.

Tests Used to Diagnose Mucinous Carcinoma:

• Mammogram – A mucinous carcinoma of the breast will often appear on a mammogram as a mass with distinct borders, having a bumpy shape. These can sometimes look like benign masses on a mammogram.
• Breast ultrasound – A little less than half of all mucinous carcinomas will be seen on a breast ultrasound, and the smaller tumors tend to hide within fatty tissue.
• Open surgical biopsy – A tissue sample is taken and tested for specific characteristics in the lab.

Your Prognosis for Mucinous Carcinoma:

Mucinous carcinoma of the breast usually appears in older women (ages 48 to 82) and is a medium- to- low-grade slow-growing type of breast cancer. Since it is not aggressive, your outlook, or prognosis if you are diagnosed with this type of breast cancer, is better than most other invasive breast cancers. A study done in western Australia found that, in most cases of mucinous carcinoma, the cancer did not spread to the lymph nodes nor metastasize to other parts of the body.

Treatments for Mucinous Carcinoma:

Mucinous carcinoma should be treated to get rid of the cancer and to prevent it from returning (recurrence). Treatments may include:

• Lumpectomy (surgery to remove the tumor and a margin of the surrounding tissue)
• Mastectomy (surgery to remove all of the breast tissue)
• Radiation
• Hormone Therapy (for hormone-sensitive cancers)

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Rash - child under 2 years

Definition

A rash is a change in the color or texture of the skin. A skin rash can be flat, bumpy, scaly, red, skin-colored, or slightly lighter or darker than skin color.

Alternative Names

Baby rash; Diaper rash; Miliaria; Prickly heat

Considerations

Most bumps and blotches on a newborn baby are harmless and clear up by themselves.

By far the most common skin problem in infants is diaper rash. Diaper rash is an irritation of the skin caused by dampness, urine, or feces. Most babies who wear diapers will have some type of diaper rash.

However, there are other skin disorders that can cause rashes. These are usually not serious unless accompanied by other symptoms.

Causes

• Diaper rash (rash in the diaper area) is a skin irritation caused by prolonged dampness and the interaction of urine and feces with the skin.
• Yeast diaper rash is caused by a type of yeast called candida, which also causes thrush in the mouth. The rash looks different from a regular diaper rash. It is very red, and there are usually small red bumps on the outer edges of the rash. This rash requires treatment with medication.
• Heat rash or prickly heat is caused by the blockage of the pores that lead to the sweat glands. It is most common in very young children but can occur at any age, particularly in hot and humid weather. An infant does not sweat. The sweat is held within the skin and forms little red bumps or occasionally small blisters.
• Erythema toxicum can cause flat red splotches (usually with a white, pimple-like bump in the middle) that appear in up to half of all babies. This rash rarely appears after 5 days of age, is usually gone in 7 - 14 days, and is nothing to worry about.
• Baby acne is caused by exposure to the mother's hormones. Red bumps, sometimes with white dots in the center, may be seen on a newborn's face. Acne usually occurs between 2 and 4 weeks of age, but may appear up to 4 months after birth and can last for 12 - 18 months.
• Cradle cap (seborrheic dermatitis) causes greasy, scaling, crusty patches on the scalp that appear in a baby's first 3 months. It usually goes away by itself, but some cases may require treatment with medication.
• Hives are red welts that appear to move around on the body. For example, if you drew a circle to mark one of the welts, a few hours later that circle would not have a welt in it, but there would be welts on other parts of the body. They differ in size and shape. Hives may last for a few weeks. The cause is uncertain.
• Eczema is a condition of the skin in which areas are dry, scaly, red (or darker than normal skin color), and itchy. When it goes on for a long time the areas become thickened. It is often associated with asthma and allergies, although it can often occur without either of these. Eczema often runs in families.

Home Care

DIAPER RASHES

Keep the skin dry. Change wet diapers as quickly as possible. Allow the baby's skin to air dry as long as is practical. Launder cloth diapers in mild soap and rinse well. Avoid using plastic pants. Avoid irritating wipes (especially those containing alcohol) when cleaning the infant.

Ointments or creams may help reduce friction and protect the baby's skin from irritation. Powders such as cornstarch or talc should be used cautiously, as they can be inhaled by the infant and may cause lung injury.

If your baby has a yeast diaper rash, the doctor will prescribe a cream to treat it.

OTHER RASHES

Heat rash or prickly heat is best treated by providing a cooler and less humid environment for the child.

Powders are unlikely to help treat heat rash and should be stored out of reach of the infant to prevent accidental inhalation. Avoid ointments and creams because they tend to keep the skin warmer and block the pores.

Erythema toxicum is normal in newborn babies and will go away on its own in a few days. You do not need to do anything for it.

White or clear milia/miliaria will go away on their own. You do not need to do anything for it.

For hives, talk with your doctor to try to find the cause. Some specific causes require prescription medication. Antihistamine medications may help stop the itching.

BABY ACNE

Normal washing is usually all that is necessary to treat baby acne. Use plain water or mild baby soap and only bathe your baby every 2-3 days. Avoid acne medicines used by adolescents and adults.

CRADLE CAP

For cradle cap, wash the hair or scalp with water or a mild baby shampoo. Use a brush to remove the flakes of dry skin. If this cannot be removed easily, apply an oil to the scalp to soften it. Cradle cap usually disappears by 18 months. If it does not disappear, it becomes infected, or if it is resistant to treatments, consult your doctor.

ECZEMA

For skin problems caused by eczema, the keys to reducing rash are to reduce scratching and keep the skin moisturized.

• Keep the baby's fingernails short and consider putting soft gloves on the child at night to minimize scratching.
• Drying soaps and anything that has caused irritation in the past (including foods) should be avoided.
• Apply a moisturizing cream or ointment immediately after baths to avoid drying.
• Hot or long baths, or bubble baths, may be more drying and should be avoided.
• Loose, cotton clothing will help absorb perspiration.
• Consult a doctor if these measures do not control the eczema, (your child may need prescription medicines) or if the skin begins to appear infected.

While the majority of children with eczema will outgrow it, many will have sensitive skin as adults.

When to Contact a Medical Professional

Call your child's health care provider if your child has:

• A fever or other unexplained symptoms associated with the rash
• Any areas that look wet, oozing, or red, which are signs of infection
• A rash that extends beyond the diaper area
• A rash that is worse in the skin creases
• A rash, spots, blister, or discoloration and is younger than 3 months
• Blisters
• No improvement after 3 days of home treatment
• Significant scratching

What to Expect at Your Office Visit

The health care provider will perform a physical examination. The baby's skin will be thoroughly examined to determine the extent and type of the rash. Bring a list of all the products used on the child's skin.

You may be asked questions such as:

• When did the rash start?
  • Did it begin suddenly (within hours) or slowly and gradually?
  • Did symptoms begin at birth or in infancy? What age?
  • Did symptoms begin after a fever occurred and was relieved?
  • Did the rash occur after skin injury, bathing, or exposure to sunlight or cold?
• What does the rash look like?
  • Are there pinpoint red spots?
  • Does it look like small red areas or blisters?
  • Does it look like bruises?
  • Does it look like hives (red welts that come and go on different parts of the body and are very itchy)?
  • Does the skin look dry and tough?
  • Is the rash scaling or crusting?
• Where on the body does the rash occur?
  • Is the rash spreading to other areas?
• What other symptoms are also present?
• What type of soaps and detergents do you use?
• Do you put anything on the skin (creams, lotions, oils, perfumes)?
• Is your child taking any medications? How long has the child taken them?
• Has your child recently eaten any new foods?
• Has your child been in contact with grasses/weeds/trees recently?
• Has your child recently been sick?
• Does your child or anyone in your family have allergies?
• Do any skin problems run in your family?

Tests are seldom required but may include the following:

• Allergy skin tests
• Blood studies (such as CBC, blood differential)
• Microscopic examination of a sample of the affected skin

Depending on the cause of the rash, antihistamines may be recommended to decrease itching. Antibiotics may be prescribed if there is a bacterial infection.

The doctor may prescribe a cream for diaper rash caused by yeast. If the rash is severe and not caused by yeast, a corticosteroid cream may be recommended.

For eczema, the doctor may prescribe ointments or cortisone drugs to decrease inflammation.

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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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Dementia

Definition

Dementia is a loss of brain function that occurs with certain diseases.

Alternative Names

Chronic brain syndrome; Lewy body dementia; DLB; Vascular dementia

Causes

The two major causes of non-reversible (degenerative) dementia are:

• Alzheimer's disease
• Loss of brain function due to a series of small strokes (vascular dementia)

The two conditions often occur together.

Dementia with Lewy bodies (DLB) is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain.

The structures and symptoms of DLB are similar to those of Alzheimer's disease, but it is not clear whether DLB is a form of Alzheimer's or a separate disease. There is no cure for DLB or Alzheimer's.

Conditions that damage blood vessels or nerve structures of the brain can also lead to dementia.

Treatable causes of dementia include:

• Brain tumors
• Dementia due to metabolic causes
• Infections
• Low vitamin B12 levels
• Normal pressure hydrocephalus
• Thyroid conditions

Dementia usually occurs in older age. It is rare in people under age 60. The risk for dementia increases as a person gets older.

Symptoms

Problems may involve language, memory, perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually first appears as forgetfulness.

Symptoms include:

• Changed feeling (sensation) or perception
• Changed sleep patterns
  • Change in sleep-wake cycle
  • Insomnia
  • Need for increased sleep
• Decrease in problem-solving skills and judgment
• Disorientation
  • Confused about people, places, or times
  • Unable to pick up cues from the environment
• Disorders of problem-solving or learning
  • Trouble making calculations
  • Unable to learn
  • Unable to think abstractly
  • Unable to think in general terms
• Impaired recognition (agnosia)
  • Trouble recognizing familiar objects or people
  • Trouble recognizing things through the senses
• Lack of or poor language ability (aphasia)
  • Unable to form words
  • Unable to name objects
  • Unable to read or write
  • Unable to repeat a phrase
  • Unable to speak (without muscle paralysis)
  • Unable to understand speech
  • Have impaired language skills
  • Repeat phrases
  • Speak poorly (enunciation)
  • Use slang or the wrong words
• Memory problems
  • Unable to remember new things (short-term memory problems)
  • Unable to remember the past (long-term memory problems)
• Motor system problems
  • Gait changes
  • Impaired skilled motor function (apraxia)
    • Unable to copy geometric figures
    • Unable to copy hand positions
    • Unable to dress self
  • Inappropriate movements
  • Other motor system problems
• Seeing or hearing things that aren't there (hallucinations) and having false ideas (delusions)
• Severe confusion
• Personality changes
  • Anxiety
  • Decreased ability to care for oneself
  • Decreased interest in daily living activities
  • Depression
  • Inappropriate mood or behavior
  • Irritability
  • No mood (flat affect)
  • Not flexible
  • Only concerned with self (self-centered)
  • Poor temper control
  • Unable to function or interact in social or personal situations
  • Unable to keep a job
  • Unable to make decisions
  • Withdrawal from social interaction
• Unable to be spontaneous
• Unable to concentrate

Other symptoms that may occur with dementia:

• Incontinence
• Swallowing problems

Exams and Tests

The following tests and procedures may be done:

• B12 level
• Blood ammonia levels
• Blood chemistry (chem-20)
• Blood gas analysis
• Cerebrospinal fluid (CSF) analysis
• Drug or alcohol levels (toxicology screen)
• Electroencephalograph (EEG)
• Glucose test
• Head CT
• Liver function tests
• Mental status test
• MRI of head
• Serum calcium
• Serum electrolytes
• Thyroid function tests
• Thyroid stimulating hormone level
• Urinalysis

Treatment

The goal of treatment is to control the symptoms of dementia. Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.

Stopping or changing medications that make confusion worse may improve brain function. Medicines that contribute to confusion include:

• Anticholinergics
• Central nervous system depressants
• Cimetidine
• Lidocaine
• Painkillers (analgesics)

Treating conditions that can lead to confusion can often greatly improve mental functioning. Such conditions include:

• Anemia
• Decreased oxygen (hypoxia)
• Depression
• Heart failure
• Infections
• Nutritional disorders
• Thyroid disorders

Medications may be needed to control behavior problems. Possible medications include:

• Antipsychotics
• Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) for Alzheimer's-type dementia
• Dopamine blockers (haloperidol, risperdal, olanzapine, clozapine)
• Mood stabilizers (fluoxetine, imipramine, citalopram)
• Serotonin-affecting drugs (trazodone, buspirone)
• Stimulants (methylphenidate)

A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.

Psychotherapy or group therapy usually does not help because it may cause more confusion.

LONG-TERM TREATMENT:

A person with dementia may need monitoring and help at home or in an institution. Possible options include:

• Adult day care
• Boarding homes
• Convalescent homes
• In-home care

Family members can get help caring for the person with dementia from:

• Adult protective services
• Community resources
• Homemakers
• Visiting nurses or aides
• Volunteer services

In some communities, support groups may be available (see elder care - support group). Family counseling can help family members cope with home care.

Other tips for reducing disorientation:

• Have familiar objects and people around
• Keep lights on at night
• Provide environmental and other cues with reality orientation
• Reward appropriate behaviors and ignore inappropriate ones to control unacceptable or dangerous behaviors
• Stick to a simple activity schedule

Advance directives, power of attorney, and other legal actions may make it easier to decide about the care of the person with dementia. Seek legal advice early in the course of the disorder, before the person with dementia is unable to make such decisions.

Outlook (Prognosis)

Dementia usually gets worse and often decreases quality of life and lifespan.

Possible Complications

Complications depend on the cause of the dementia, but may include the following:

• Abuse by an overstressed caregiver
• Increased infections anywhere in the body
• Loss of ability to function or care for self
• Loss of ability to interact
• Reduced life span
• Side effects of medications used to treat the disorder

When to Contact a Medical Professional

• Call your health care provider if dementia develops or a sudden change in mental status occurs.
• Call your health care provider if the condition of a person with dementia gets worse.
• Call your health care provider if you are unable to care for a person with dementia at home.

Prevention

Most causes of dementia are not preventable.

You can reduce the risk of vascular dementia, which is caused by a series of small strokes, by quitting smoking and controlling high blood pressure and diabetes. Eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia.

References

Alva G. Alzheimer disease and other dementias. Clin Geriatr Med. 2003; 19(4): 763-76.

American Academy of Neurology. About Dementia. Neurology. 2004; 63(10); E20.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:283-286.

Goetz, CG. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders; 2007.

Farlow MR, Cummings JL. Effective pharmacologic management of Alzheimer's disease. Am J Med, 2007;120:388-397.

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Bezoar

Definition

A bezoar is a ball of swallowed foreign material (usually hair or fiber) that collects in the stomach and fails to pass through the intestines.

Alternative Names

Trichobezoar; Hairball

Causes

Chewing on or eating hair or fuzzy materials (or indigestible materials such as plastic bags) can lead to the formation of a bezoar. The rate is very low and the risk is greater among mentally retarded or emotionally disturbed children. Generally bezoars are mostly seen in females aged 10 to 19.

Symptoms

• Indigestion
• Stomach upset or distress
• Nausea
• Vomiting
• Diarrhea
• Pain
• Gastric ulcers

Exams and Tests

The child may have a lump in the abdomen that can be felt by the health care provider. A barium swallow x-ray will show the mass in the stomach, sometimes a scope is used (endoscopy) to directly view the bezoar.

Treatment

The bezoar may need to be surgically removed (especially trichobezoars which tend to be large). Sometimes small bezoars can be removed through a scope placed through the mouth and into the stomach (similar to an EGD procedure). Then, follow the prevention measures described.

Outlook (Prognosis)

Full recovery is expected.

Possible Complications

Persistent vomiting can lead to dehydration.

When to Contact a Medical Professional

Call your health care provider if you suspect your child has a bezoar.

Prevention

If your child has had a hair bezoar in the past, trim the child's hair short so he or she cannot put the ends in the mouth. Keep indigestible materials away from a child that has a tendency to put items in the mouth.

Be sure to remove the child's access to fuzzy or fiber-filled materials.

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Retroperitoneal fibrosis

Definition

Retroperitoneal fibrosis is a disorder in which the tubes that carry urine from the kidneys to the bladder are blocked by a fibrous mass in the back of the abdomen.

Alternative Names

Idiopathic retroperitoneal fibrosis; Ormond's disease

Causes

Retroperitoneal fibrosis is a rare disorder caused by an excess of fibrous tissue in the areajust behind the stomach. Doctors don't know why these masses form. It is most common in people aged 40 - 60, and men are twice as likely to develop them as women.

The disorder may cause chronic unilateral obstructive uropathy or chronic bilateral obstructive uropathy, which result when the fibrous mass blocks the ureters.The symptoms are caused by the obstruction of the ureters, the tubes that carry urine from the kidneys to the bladder.

Symptoms

Early symptoms:

• Dull pain in the abdomen that increases with time
• Swelling of one leg
• Decreased circulation in the legs leading to pain and discoloration
• Severe abdominal pain with hemorrhage due to ischemic bowel

Later symptoms:

• Decreased urine output
• Total lack of urine (anuria)
• Nausea, vomiting, changes in thinking caused by kidney failure and the resulting build-up of toxic chemicals in the blood.

Exams and Tests

• Serum BUN and creatinine showing elevated levels
• Kidney ultrasound showing hydronephrosis (distention of the kidney pelvis because of fluid accumulation) and a mass
• Excretory urography showing compression and deviation of the ureters
• Abdominal CT scan (the best test to reveal the retroperitoneal mass)
• MRI (compareswell to the CT scan)
• Biopsy showingeither retroperitoneal fibrosisor a cancerous tumor

Treatment

Powerful anti-inflammatory medicines called corticosteroids are tried first. Some doctors also use a drug called tamoxifen to treat this condition.

If corticosteroid treatment doesn't work, a biopsy should be done to confirm the diagnosis. If confirmed, other medicines to suppress the immune system are usually prescribed.

When medicine does not work, surgery and stents (draining tubes) are needed.

Outlook (Prognosis)

Prognosis depends on the extent of the fibrosis and the amount of damage to the kidneys. The kidney damage may be temporary or permanent.

Possible Complications

• Chronic bilateral obstructive uropathy
• Chronic unilateral obstructive uropathy
• Chronic renal failure

When to Contact a Medical Professional

Call your health care provider if you experience lower abdomen or flank pain, particularly with decreased urine volume.

Prevention

If possible, avoid prolonged use of medications which contain methysergide, which has been shown to cause retroperitoneal fibrosis.

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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 urination 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 prostatic diseases 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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Donovanosis. Venereal granuloma

Except for the name «donovanosis» this venereal illness also refers to venereal granuloma, the fifth venereal illness, is simple granuloma or granulomatosis, tropical inguinal granuloma, granuloma ulcer genitals, inguinal granuloma. The name «granuloma» occurs from a latin word granulum – "kernel", and there was it of that the basic symptoms of venereal granuloma are really reminding grains papule – small pimples on genitals.

Speaking about classical venereal diseases, venereologists, as a rule, keep in mind five diseases. Two of them – a syphilis and a gonorrhoea – are widely widespread worldwide. Other three concern to type of rare infections in Russia, transferred by sexual contact. It is soft chancre («the third venereal illness»), inguinal megakaryoblastoma («the fourth venereal illness»), and, finally, venereal granuloma («the fifth venereal illness»).

In comparison with "counterparts", especially with a syphilis, donovanosis looks a harmless sore. However harmless venereal illnesses does not happen, and venereal granuloma is not exception. Complications granulomatosis if they are reached with business, can be more than serious and dangerous to human life.

Venereal granuloma is the chronic infection transferred, similarly to other venereal illnesses, first of all sexual by and slowly progressing in an organism of the infected person. Adults are ill venereal granuloma only, it is not transferred children.

The activator of venereal granuloma (donovanosis) owing to which illness has received this name, – bodies Donovan which refers to also Calymmatobacterium granulomatis or stick Aragan-Vianne. It is fine (1-2 microns) a bacterium bean-like or ovoid forms. At contact to patients, bacteria take root into a leather of genitals, perineum and other sites, causing disease.

In Russia cases venereal granuloma – a huge rarity as this illness is specific to the tropical countries with a warm and damp climate. Especially widely venereal granuloma it is widespread in Papua-new Guinea, Southern India, Southern Africa, the countries of Caribbean basin, in separate areas of Australia and Brazil. In America and in the Europe "brought in" cases venereal granuloma are registered only. There are scattered instances venereal granuloma and in Russia. Among our compatriots basically the people going in tropics on rest and interested persons to try of local "exotic" including in intimate relations catch.

Certainly, sick venereal granuloma the person can transfer an infection to the constant partner, but such cases – an even greater rarity, as venereal granuloma, on medical terminology, «rather less contagious». It means, that in difference, we shall tell from a gonorrhoea who is almost always transferred the healthy partner from the patient at the first not protected contact, venereal granuloma at sexual contact is transferred seldom enough.

According to statistics, the risk to catch venereal granuloma at the unitary not protected sexual contact to patients can change from 1 up to 50 %. Thus it is necessary to consider, that the damp climate and enough heat of an environment is necessary to a bacterium. Hence, arrived of tropics to Russia infected venereal granuloma "holidayer" is practically safe for constant partners, both at sexual attitudes, and at household contacts. And still it is better to not risk, because even 1 % of probable infection for one person can be quite enough.

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Salmonellosis, symptoms of the Salmonellosis. Treatment of the Salmonellosis.

The salmonellosis is the pluricausal infectious disease caused various serotypes of bacteria of sort Salmonella, is characterized by various clinical displays from asymptomatic carrier state up to heavy septic forms. In most cases of the salmonellosis proceeds with primary defeat of bodies of a digestive path (gastroenteritis, colitis). The activator of the Salmonellosis - greater group of salmonellas (family Enterobacteriaceae, sort Salmonella), numbering now more than 2200 serotypes.

Sources of the Salmonellosis are basically pets and the birds, however the certain value the person (plays also the patient, the carrier) as an additional source.

The basic way of infection at a salmonellosis - alimentary, caused by the use in food of products in which a plenty of salmonellas contains. Usually it is observed at wrong culinary processing. Treatment of a salmonellosis.

The incubatory period at a food way of infection with the Salmonellosis fluctuated from 6 h up to 3 days (more often 12-24). At nosocomial flashes when the contact-household way of transfer of an infection prevails, incubation a salmonellosis about 3-8 days are extended. Allocate following clinical forms of a salmonellosis:

- The gastrointestinal (localized), proceeding in stomachal, gastroenteritis, gastroenterocolitis and coloenteritis variants;
- The generalized form of a salmonellosis in the form of typhoid and septic variants;
- The diphtheriaphor: sharp, chronic and transient;
- The subclinical form of a salmonellosis;

Clinical forms of a salmonellosis differ and on weight of current.

The gastrointestinal form (a sharp gastritis, sharp gastroenteritis or gastroenterocolitis) - one of the most widespread forms of a salmonellosis (96-98 % of cases). Begins sharply, the body temperature (raises at heavy forms up to 39С and above), there is a general weakness, a headache, a fever, a nausea, vomiting, pains in epigastric and umbilical areas, frustration of a chair later joins. At some sick the salmonellosis in the beginning marks only a fever and attributes of the general intoxication, and changes from a gastroenteric path join a little bit later. They are Most expressed by the end of the first and for the second and third day from the beginning of disease by a salmonellosis. Expressiveness and duration of displays of a salmonellosis depend on weight.

At the easy form of a salmonellosis a body temperature subfebrile, vomiting unitary, a chair liquid aqueous up to 5 times day, duration of a diarrhea 1-3 days, loss of a liquid no more than 3 % of weight of a body. At the middle form of a salmonellosis the temperature raises up to 38-39оС, duration of a fever till 4 days, repeated vomiting, a chair up to 10 times day, duration of a diarrhea till 7 days; the tachycardia, downturn the AD are marked, can develop deaquation I-II degrees, loss of a liquid up to 6 % of weight of a body. Heavy current gastrointestinal forms of a salmonellosis is characterized by a high fever (above 39оС) which lasts 5 and more days, the expressed intoxication. Vomiting repeated, is observed within several days; the chair more than 10 times day, plentiful, aqueous, fetid, can be with an impurity of slime. The diarrhea proceeds till 7 days and more.

The increase in a liver and spleen is marked, is possible icteritiousness leather and sclera. The tachycardia, significant downturn the AD are observed cyanosis leather. Changes from kidneys come to light: oligohydruria, albuminuria, erythrocyte and cylinders in urine, the maintenance of residual nitrogen raises. Can develop sharp nephritic insufficiency. The water-salt exchange (deaquation II-III degrees) is broken, that is shown in dryness of a leather, blue disease, aphonia, spasmes. Losses of a liquid reach 7-10 % of weight of a body. In blood the level of hemoglobin and erythrocyte raises, is characteristic moderated leukocytosis with shift leukocytic formulas to the left.

The most frequent clinical variant at gastrointestinal a salmonellosis gastroenteritis. Destructive changes at a salmonellosis in a thick gut are registered only in 5-8 % of cases. Gastroenterology and colitis variants of a salmonellosis should be diagnosed only if in a clinical picture of disease displays colitis prevail and is available bacteriological or serologic acknowledgement of the diagnosis as these variants of a salmonellosis are rather similar on current to a sharp dysentery.

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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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Asthma in adults

Highlights

New Asthma Guidelines Released

In 2007, the U.S. National Asthma Education and Prevention Program (NAEPP) released updated guidelines for the diagnosis and management of asthma. The new guidelines are the first to be released in a decade. Key points include:

• Assessment and Monitoring. Doctors should use multiple measures to determine a patients current condition and future risk for worsening of condition. Even patients who show few daily effects of asthma may be in danger of sudden worsening of symptoms.
• Patient Education. Patients should be taught skills to self-monitor and manage asthma. Doctors should give patients a written asthma action plan, which includes information on daily treatment and ways to recognize worsening asthma.
• Control of Environmental Factors and Other Asthma Triggers. The guidelines outline new approaches for reducing exposure to allergens. They also address how treating co-existing chronic conditions (rhinitis, sinusitis, gastroesophageal reflux, obesity) can help improve asthma control.
• Medications. A stepwise approach is recommended where medication types and doses are increased or decreased based on the level of asthma control.

New Inhaled Corticosteroid Approved

In January 2008, the Food and Drug Administration (FDA) approved ciclesonide (Alvesco), a new inhaled corticosteroid drug, for patients ages 12 years and older.

Introduction

The word asthma originates from an ancient Greek word meaning panting. Essentially, asthma is an inability to breathe properly. When any person inhales, the air travels through the following structures:

• Air passes into the lungs and flows through progressively smaller airways called bronchioles. The lungs contain millions of these airways.
• All bronchioles lead to alveoli, which are microscopic sacs where oxygen and carbon dioxide are exchanged.

The major features of the lungs include the bronchi, the bronchioles, and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

Asthma is a chronic condition in which these airways undergo changes when stimulated by allergens or other environmental triggers. Such changes appear to be two specific responses:

• The hyperreactive response (also called hyperresponsiveness)
• The inflammatory response

These actions in the airway cause coughing, wheezing, and shortness of breath (dyspnea), the classic symptoms of asthma.

Hyperreactive Response

In the hyperreactive response, smooth muscles in the airways of the lungs constrict and narrow excessively in response to inhaled allergens or other irritants. Everyone's airways respond by constricting when exposed to allergens or irritants, but a special hyperreactive response occurs in people with asthma:

• When people without asthma breathe in and out deeply, the airways relax and open to rid the lungs of the irritant.
• When people with asthma try to take those same deep breaths, their airways do not relax and narrow, causing patients to pant for breath. Smooth muscles in the airways of people with asthma may have a defect, perhaps a deficiency in a critical chemical that prevents the muscles from relaxing.

Inflammatory Response

The hyperreactive stage is followed by the inflammatory response, which generally contributes to asthma in the following way:

• In response to allergens or other environmental triggers, the immune system delivers white blood cells and other immune factors to the airways.
• These so-called inflammatory factors cause the airways to swell, to fill with fluid, and to produce a thick sticky mucus.
• This combination results in wheezing, breathlessness, an inability to exhale properly, and a phlegm-producing cough.

Click the icon to see an image of a normal bronchiole versus an asthmatic bronchiole.

Inflammation appears to be present in the lungs of all patients with asthma, even those with mild cases, and plays a key role in all forms of the disease.

Symptoms

Asthma symptoms vary in severity from occasional mild bouts of breathlessness to daily wheezing that lasts even when a patient takes large doses of medication. After exposure to asthma triggers, symptoms rarely develop abruptly but progress over a period of hours or days. Occasionally, the airways have become seriously obstructed by the time the patient calls the doctor.

The classic symptoms of an asthma attack include:

• Wheezing when breathing out is nearly always present during an attack. Usually the attack begins with wheezing and rapid breathing, and, as it becomes more severe, all breathing muscles become visibly active.
• Shortness of breath (dyspnea). Shortness of breath is a major source of distress in patients with asthma. However, the severity of this symptom does not always reflect the degree to which lung function is impaired. Some patients are not even aware that they are experiencing shortness of breath. These patients are at particular risk for very serious and even life-threatening asthma attacks, since they are less conscious of symptoms. Those at highest risk for this effect tend to be older, female, and to have had the disease for a longer period of time.
• Coughing. In some people, the first symptom of asthma is a nonproductive cough. Some patients find this cough even more distressing than wheezing or sleep disturbances.
• Chest tightness or pain. Initial chest tightness without any other symptoms may be an early indicator of a serious attack.
• Rapid heart rate
• Sweating

The end of an attack is often marked by a cough that produces thick, stringy mucus. After an initial acute attack, inflammation lasts for days to weeks, often without symptoms. (The inflammation itself must still be treated, however, because it usually causes relapse.)

Symptoms of a Life-Threatening Attack

The following signs and symptoms may indicate a life-threatening situation:

• As the chest labors to bring enough air into the lungs, breathing often becomes shallow.
• Lacking enough oxygen, the skin becomes bluish.
• The flesh around the ribs of the chest appears to be sucked in.
• The patient may begin to lose consciousness.

Asthma often progresses very slowly to a serious condition or may develop to a fatal or near-fatal attack within a few minutes. It is very difficult to predict when an attack will become very serious.

Early symptoms or lack thereof do not always reflect the ultimate severity of an attack. In fact, some studies suggest that people at high risk for fatal or near-fatal asthma attacks are those with poor awareness of their own reduced ability to breathe and who are therefore slow in seeking help. Those at highest risk for this effect tend to be older, female, and have had the disease for a longer period of time. Monitoring peak flow rates is an important management component since it provides a more accurate assessment of lung function than symptoms alone.

Exercise-Induced Asthma

Exercise-induced asthma (EIA) is a limited form of asthma in which exercise triggers coughing, wheezing, or shortness of breath. This condition generally occurs in children and young adults, most often during intense exercise in cold dry air. Symptoms are generally most intense about 10 minutes after exercising and then gradually resolve.

EIA is triggered only by exercise and is distinct from ordinary allergic asthma in that it does not produce a long duration of airway activity, as allergic asthma does. (However, some people have both forms of asthma.) People who have only EIA do not appear to need long-term maintenance therapy.

Nocturnal Asthma

Asthma occurs primarily at night (nocturnal asthma) in as many as 75% of patients with asthma. Attacks often occur between 2 and 4 a.m. Some experts believe that nocturnal asthma may actually be a unique form, with its own specific biologic mechanisms occuirng only at night and reducing natural steroid hormones (which block inflammation).

Causes

Asthma has dramatically risen worldwide over the past decades, particularly in developed countries, and experts are puzzled over the cause of this increase. The mechanisms that cause asthma are complex and vary among population groups and even from individual to individual. Many asthma sufferers have allergies, and some researchers are targeting common factors in both these conditions. Not all people with allergies have asthma, however, and asthma is not always due to an allergic response.

Asthma is most likely caused by a several factors that can include genes and environmental and biologic triggers (such as infections, dietary patterns, hormonal changes in women, and allergens).

The Allergic Response

Nearly half of adults with asthma have an allergy-related condition, which, in most cases developed first in childhood. (In patients who first develop asthma during adulthood, the allergic response usually does not play a strong causal role.)

The Allergic Process. The allergic process, called atopy, and its connection to asthma are not completely understood. The process involves various airborne allergens, or other triggers, that set off a cascade of events in the immune system, leading to inflammation and hyperreactivity in the airways. Here is an example of the allergic process:

• The conductor in an orchestra of immune factors that contribute to allergies and asthma appears to be a category of white blood cells known as helper T cells, in particular a subgroup called Th2 cells.
• Th2 cells overproduce interleukins (ILs), immune factors that are molecular members of a family called cytokines, which are involved in the inflammatory process.
• During an allergic attack, these IgE antibodies can bind to special cells in the immune system called mast cells, which are concentrated in the lungs, skin, and mucous membranes. This bond triggers the release of several active chemicals, importantly potent molecules known as leukotrienes. These chemicals cause airway spasms, overproduce mucus, and activate nerve endings in the airway lining.
• One specific cytokine, interleukin 5, attracts white blood cells known as eosinophils. These cells accumulate and remain in the airways after the first attack. They persist for weeks and mediate the release of other damaging particles that remain in the airways.

Over several years, the repetition of the inflammatory events involved in asthma can cause irreversible structural and functional changes in the airways, a process called remodeling. The remodeled airways are persistently narrow and can cause chronic asthma. Researchers are trying to determine how this process occurs:

• Interleukins. Some researchers are looking at potent immune factors, including interleukins 11 and 13. They have been linked to a number of processes possibly involved in remodeling, including scarring in the airways and overgrowth of cells in the smooth muscles that line the airways.
• Growth Factors. Compounds known as vascular endothelial growth factor (VEGF) have been observed in the airways of patients with asthma. VEGF is a powerful promoter of cell growth in blood vessel linings, and some researchers believe it may be major factor in remodeling.

Environmental Factors

An asthma attack can be induced or aggravated by direct irritants to the lungs. Studies indicate that the more indoor allergens a child is allergic to, the higher the risk for severe asthma. Important irritants or allergens include:

• Dust mites, specifically mite feces, which are coated with enzymes that contain a powerful allergen. These are the primary allergens in the home.
• Animal dander. Cats harbor significant allergens, which can even be carried on clothing; dogs usually cause fewer problems. People with asthma who already have pets and are not allergic to them probably have a low risk for developing allergies later on.
• Smoking, or exposure to secondhand smoke
• Pollen. An asthma attack from an allergic response to pollen is more likely to occur during extreme air changes, such as thunderstorms. Major weather changes, such as El Nino, can affect the timing of allergy seasons. For example, in 1998, when the effects of El Nino were very strong, allergy and asthma attacks occurred earlier and were markedly increased.
• Molds might produce a worse asthma attack in adults than other allergens.
• Fungi
• Cockroaches. Cockroaches are major asthma triggers and may reduce lung function even in people without a history of asthma.
• Fossil Fuels. Certain chemicals may trigger allergic rhinitis. Some experts believe that refined fossil fuels, such as diesel fuel and particularly kerosene, may be important triggers for allergic rhinitis. And, in people who already have allergies or asthma, exposure to such fossil fuels may worsen symptoms.

Genetic Factors

About one-third of all persons with asthma share this condition with another member of their immediate family. Asthma may be more likely to pass to children from their mother than from their father. Both allergies and asthma are strongly associated with hereditary factors, sharing certain genetic markers, but they are not always inherited together.

Research on the genetics of these conditions is confusing. Of some significant promise, researchers have identified a gene (ADAM33), which has been linked to asthma. The gene regulates one of the enzymes called metalloproteases, which are involved with the smooth muscle in the airway. A mutation of this gene could play a role in airway changes that occur after inflammation.

Treatment

General Approach for Treating and Managing Asthma

While medications play an essential role in the management of asthma, appropriate management of asthma involves much more:

• Identifying and avoiding allergens and other asthma triggers
• Following appropriate drug treatments
• Home monitoring performed by either patient or family
• Good communication between the doctor and patient
• Needed psychosocial support
• Treatment of asthma in all environments (school, work, exercise)

The severity of asthma has now been classified into four groupings: Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent. Six specific components of severity are used to classify patients. These components are:

• Symptom frequency, ranging from fewer than 2 days per week to throughout the day
• Nighttime awakenings, ranging from none to nightly
• Short-acting beta2-agonist use for symptom control, ranging from 2 or fewer days per week to several times per day
• Interference with normal activity, ranging from none to extremely limited
• Lung function as measured by FEV1 and FEV1/FVC, measured with pulmonary function testing at the doctor's office
• Number of exacerbations (sudden worsening) requiring oral corticosteroids, ranging from none to two or more in the last 6 months

Treating Symptoms Versus Controlling the Disease

Patients can greatly reduce the frequency and severity of asthma attacks by understanding the difference between coping with asthma attacks and controlling the disease over time.

Medications for asthma fall into two categories:

• Rescue (Quick-Relief) Medication. Medications that open the airways (bronchodilators, or inhalers) are used to quickly relieve any moderate or severe asthma attack. These drugs are usually short-acting beta-adrenergic agonists (beta2-agonists). Other drugs used in special cases include corticosteroids taken by mouth and anticholinergic drugs. Beta2-agonists and anticholinergics do not have any effect on the disease process itself. They are only useful for treating symptoms.
• Long-Term Control (Maintenance) Medication. Simply coping with asthma symptoms without also controlling the damaging inflammatory response is a common and serious error. For adults and children over age 5 with moderate-to-severe persistent asthma, experts now recommend inhaled corticosteroids and long-acting beta2-agonists.

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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 nerve injuries 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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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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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 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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Gallstones - Symptoms - Treatments - Prevention

Gallstones are the most common and costly digestive disease in the United States, causing more than 800,000 hospitalizations annually at estimated cost of over five billion dollars. More than 20 million Americans have gallstones and approximately one million new cases are diagnosed each year. Women are twice as likely as men to develop gallstones; the higher prevalence of gallstones in women is thought to be caused by multiple pregnancies, obesity, and rapid weight loss. Well over half a million people undergo cholecystectomy (surgical removal of the gallbladder) each year.

The normal function of the gallbladder is to store bile produced by the liver, and to aid in the digestion and absorption of fats in the duodenum (the first portion of the small intestine). Gallstones compose a solid formation of cholesterol and bile salts. However, research shows that approximately 80 to 90 percent of all gallstones are cholesterol gallstones which form when the liver begins secreting bile that is abnormally saturated with cholesterol. The excess cholesterol crystallizes and then forms stones which are stored in the gallbladder or the cystic duct. Gallstones can also form due to low levels of bile acids and bile lecithin.

Who Is At Risk For Gallstones?

When I was diagnosed with gallstones at 26, I was told that the typical gallstone patient was fair, fat, and forty. Today gallstones are seen in younger patients, perhaps due to the large amount of fast foods being consumed. My daughter went through five years of vomiting beginning at age 15, leading me to almost believe that she was bulimic, before she was diagnosed with gallstones at age 20. Risk factors which can lead to increased incidence of gallstones include the "Four Fs:" fat, female, fertile, and flatulent, as well as sickle cell disease (bilirubin), cirrhosis, Crohn's disease, diabetes, pancreatic disease, and hyperparathyroidism.

When the symptoms of gallstones occur they are often called an "attack" because they occur suddenly. The typical gallstone attack includes:

• Steady, severe pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours.
• Pain in the back between the shoulder blades.
• Pain under the right shoulder.
• Nausea or vomiting.

Gallstone attacks often follow fatty meals, and they may occur during the night. Although I was lucky not to have too much nausea and vomiting with my gallstones, one of my most vivid childhood memories is of my mother up at night, in the bathroom, vomiting.

Other symptoms of gallstones include:

• Abdominal bloating.
• Recurring intolerance of fatty foods.
• Colic.
• Belching.
• Gas.
• Indigestion.

The following symptoms are indication that you should seek immediate medical attention:

• Sweating.
• Chills.
• Low-grade fever.
• Yellowish color of the skin or whites of the eyes.
• Clay-colored stools.

Many people have gallstones with no symptoms, these people are called asymptomatic. Gallstones that cause no symptoms are called "silent stones." Silent stones do not interfere in gallbladder, liver, or pancreas function and do not require treatment.

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Foot Ulcers

What Is It?

A foot ulcer is an open sore on the foot. A foot ulcer can be a shallow red crater that involves only the surface skin. A foot ulcer also can be very deep. A deep foot ulcer may be a crater that extends through the full thickness of the skin, and may involve tendons, bones and other deep structures.

People with diabetes and people with poor circulation are more likely to develop foot ulcers. In people with these conditions, even a small foot ulcer can become infected if it is not treated quickly and efficiently.

If such an infection is allowed to progress, it can develop into an abscess (a pocket of pus), a spreading infection of the skin and underlying fat (cellulitis), a bone infection (osteomyelitis) or gangrene. Gangrene is an area of dead, darkened body tissue caused by poor blood flow. Among people with diabetes, a foot ulcer is the beginning stage of approximately 85% of severe foot infections that ultimately require some part of the toe, foot or lower leg to be amputated.

Foot ulcers are especially common in people who have one or more of the following health problems:

• Peripheral neuropathy This is nerve damage in the feet or lower legs. When nerves in the feet are damaged, they can no longer warn about pain or discomfort. When this happens, tight-fitting shoes can trigger a foot ulcer by rubbing on a part of the foot that has become numb. People with peripheral neuropathy may not be able to feel when they've stepped on something sharp or when they have an irritating pebble in their shoes. They can injure their feet significantly and never know it, unless they examine their feet routinely for injury. Many elderly people and diabetics with vision problems also can't see their feet well enough to examine them for problems. Older adults with peripheral neuropathy develop foot ulcers more than nine times more often than those with normal feeling in the feet.
• Circulatory problems Any illness that decreases circulation to the feet can cause foot ulcers. Less blood reaches the feet, which deprives cells of oxygen. This makes the skin more vulnerable to injury and slows the foot's ability to heal. Poor circulation in the leg arteries, called peripheral artery disease, also causes pain in the leg or buttock during walking. It is caused by atherosclerosis, a disease in which fatty deposits of cholesterol build up inside arteries.
• Abnormalities in the bones or muscles of the feet Any condition that distorts the normal anatomy of the foot can lead to foot ulcers, especially if the foot is forced into shoes that don't fit the foot's altered shape. Examples are claw feet, feet with fractures, and cases of severe arthritis.

More than any other group, people with diabetes have a particularly high risk of developing foot ulcers. This is because the long-term complications of diabetes often include neuropathy and circulatory problems. Among the estimated 16 million diabetics living in the United States, approximately 15% eventually will develop an ulcer involving either the foot or ankle. Without prompt and proper treatment, this ulcer may require hospital treatment or may lead to deep infection or gangrene and amputation.

In addition to diabetes, other medical conditions that commonly increase the risk of foot ulcers include:

• Atherosclerosis This condition involves poor circulation to the legs.
• Raynaud's phenomenon This condition causes sudden episodes of decreased blood flow to the fingers and toes. During these episodes, the fingers and toes turn white as the blood supply diminishes, then blue, and red again as the circulation returns to normal. Raynaud's phenomenon tends to strike women aged 20 to 40.

It is rare for a foot ulcer to be unrelated to these risk factors and illnesses. A foot ulcer in a person who has none of these health problems may need to be checked for skin cancer, especially squamous cell carcinoma, which occasionally looks like a foot ulcer.

Symptoms

A foot ulcer looks like a red crater in the skin. Most foot ulcers are located on the side or bottom of the foot or on the top or tip of a toe. This round crater can be surrounded by a border of thickened, callused skin, or this border may develop over time. In very severe ulcers, the red crater may be deep enough to expose foot tendons or bones.

If the nerves in the foot are functioning normally, then the ulcer will be painful. If not, then a person with a foot ulcer may not know it is there, particularly if the ulcer is located on a less obvious portion of the foot. In disabled or elderly patients, a relative or caregiver may first notice the problem when the ulcer becomes infected, drains pus and develops a foul odor.

Diagnosis

In most cases, your doctor can tell that you have a foot ulcer simply by looking at your foot. If you have diabetes, your doctor will assess your control of your blood sugar and will ask about the care that you take to keep your feet healthy and the type of shoes that you usually wear. Your doctor will evaluate the ulcer to determine:

• How deep the ulcer is
• Whether there is an infection
• Whether that infection has developed into cellulitis (a deep skin infection) or osteomyelitis (an infection of the bone near the ulcer)
• Whether you have any foot abnormalities, circulatory problems or neuropathy that will interfere with healing.

Your doctor may ask you to walk as part of your examination because your gait may highlight knee and ankle abnormalities that can cause ulcers. Your doctor will pay attention to structural problems, such as claw foot or fallen arches. To check for neuropathy, your doctor may test the sensation in your feet, check your reflexes and use a tuning fork to see if you can feel the vibration in your toes. Your doctor also can test the circulation in your legs and feet by feeling your pulses and noting whether your feet are pink and warm. If your pulses are weakened, then your doctor may use Doppler flow studies, a type of ultrasound test, to test your circulation.

When your doctor examines the ulcer itself, a cotton swab or other thin probe can be used to see how deep it is and checking for exposed tendons or bones. Your doctor will look closely for redness around the ulcer, since a large margin of redness can be a sign of cellulitis. Your doctor may order other tests to get a better picture of the extent of the ulcer and to determine whether it is infected. These tests may include blood tests, bacterial cultures of the ulcer, and possibly X-rays or other imaging tests, such as magnetic resonance imaging (MRI), computed tomography (CT) scan or a bone scan.

Expected Duration

How long a foot ulcer lasts depends on the depth of the ulcer, whether there is enough blood circulation to supply oxygen and nutrients, whether the ulcer can be protected from rubbing or pressure, and whether the ulcer is infected. In people who have good circulation and good medical care, an ulcer sometimes can heal in as few as three to six weeks. Deeper ulcers may take 12 to 20 weeks, and sometimes require surgery.

Prevention

People who are at risk of foot ulcers, such as those with diabetes, can prevent about 50% of foot ulcers by examining their feet routinely and following good foot-hygiene practices. The following strategies may help prevent foot ulcers:

• Examine every part of your feet every day. If necessary, use a mirror to check the heel and sole. If your vision is not good, ask a relative or caregiver to examine your foot for you.
• Practice good foot hygiene. Wash your feet every day using mild soap and warm water. Dry thoroughly, especially between the toes. Apply moisturizing lotion to dry areas, but not between the toes.
• Wear shoes that fit well and soft, absorbent socks. Always check your shoes for foreign objects and rough areas before you put them on. Change your socks immediately if they become wet or sweaty.
• Trim your toenails straight across with a nail clipper or emery board.
• If you have corns or calluses, ask your doctor about how to care for them. Your doctor may determine that these problems are best treated in his or her office rather than at home.

Treatment

If you have good circulation in your foot, your doctor may treat your foot ulcer by trimming away diseased tissue in a procedure called debridement. He or she also will remove any nearby callused skin. The doctor then will apply a dressing and may prescribe specialized footwear to relieve pressure on the ulcerated area. This specialized footwear may be a cast or a loosely fitting postoperative walking shoe or sandal that can be worn over a bandage.

Your doctor will need to see you frequently to examine and debride the area, and a nurse may need to visit you to change the dressing every several days. Care of a foot ulcer can require multiple visits over weeks or months as long as it takes for your ulcer to heal completely. If there is a possibility of infection, you may be given antibiotics. Researchers are investigating newer approaches to speed the healing of foot ulcers, including gels that contain growth factors, artificial skin, hyperbaric oxygen and a form of a medicine called phenytoin (Dilantin) that can be placed directly on the ulcer. Phenytoin is used in pill form to treat seizures.

Once the ulcer has healed, your doctor may prescribe roomy, well-cushioned footwear that does not put pressure on vulnerable areas of your feet. This footwear will help to prevent ulcers in the future.

Foot ulcers that do not respond to more conservative therapy may require surgery. People with poor circulation may need vascular surgery (usually re-routing of blood flow through the leg using a bypass artery) to correct blood-flow problems in their leg arteries. Without leg surgery, the ulcer may not heal properly.

When To Call A Professional

If you have diabetes, poor circulation or peripheral neuropathy, examine your feet every day. If you see an area of redness, swelling, bleeding, blisters or any other problem on the foot surface, call your doctor promptly.

Prognosis

In people with foot ulcers that are not deep, the outlook for healing is good if circulation to the foot is adequate. With the best wound-care methods available, most ulcers should heal within 12 weeks. However, about 30% of healed ulcers return, particularly in people who do not wear specialized footwear if it is prescribed by their doctors.

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