The Health Blog

DISEASES OF THE ARTERIES AND VEINS: ARTERIAL SPASM – RAYNAUD’S PHENOMENON

admin — Thu, 28 Jul 2011 18:03:45 +0000

Spasm of the arteries is a rare cause of arterial blockage. Often it is associated with taking medications that provoke spasm, especially ergots (which are in some medications used to treat migraine headaches).Raynaud’s Phenomenon. Raynaud’s phenomenon is an exaggerated response to the normal reflex mechanism which causes blood vessels in the hands and feet to narrow (spasm) in the cold or with emotion. It affects 1 in 20 Americans to some degree, mostly women.If you experience Raynaud’s phenomenon, your fingers or toes (and in some people, ears and nose) turn chalky white when you are exposed to cold, and they also sting. Your skin may turn blue or bright red upon return to a warmer environment before normal color returns.*203\252\8*

DISEASES OF THE ARTERIES. ANEURYSM

admin — Sun, 17 Jul 2011 17:56:00 +0000

Who Is Affected by Aneurysm? Abdominal aortic aneurysm is most likely to occur in people older than 60 years, and it affects men more often than women.How Serious Is an Aneurysm? The main risk of an abdominal aortic aneurysm is that, like a balloon that is blown up too far, it may rupture, and rupture results in life-threatening internal hemorrhage (bleeding). The larger the aneurysm gets, the more likely it is to rupture. Timely surgery prevents rupture.Surgery usually is warranted only when the aorta (which normally has a diameter of less than 1 inch) enlarges to about 2 inches, because the likelihood of rupture increases at that point. A 2-inch-wide aneurysm has a 1 in 25 chance of rupturing within 1 year. An aneurysm that is 2 3/4 inches across a 1 in 5 chance of rupturing in the next year. Aneurysms usually grow about to 1/8 inch to 1/4per year, but this rate can be highly variable.Surgical correction often involves replacing a part of the diseased artery with a graft or tube made from synthetic materials.Berry Aneurysm. Important, but less common, types of aneurysm are not related to atherosclerosis. Berry aneurysms are bulges in the walls of arteries within the brain. As the name implies they appear like little berries attached to a blood vessel, usually at a point of branching. They usually do not cause symptoms unless they rupture, in which case they may cause stroke or coma or be fatal.*197\252\8*

SUPPORTIVE CARE OF CHILDREN WITH CANCER: PREVENTION AND TREATMENT OF URINARY TRACT TOXICITY (SUPPORTIVE CARE MEASURES TO AVOID/AMELIORATE TOXICITY

admin — Tue, 05 Jul 2011 17:50:09 +0000

)A. Children with a single kidney or hydronephrosisAre ineligible to receive ifosfamide in rhabdomyosarcoma protocols. The use of ifosfamide is discouraged for all patients with a single kidney.Have greater nephrotoxicity with cisplatin than those without hydronephrosis, in spite of adjustment of doses for decreased GFR.B. Primary prevention of nephrotoxicity including adequate toincreased hydration, maintenance of normal intravascularfluid status, and avoidance of intravascular volume depletionAdequate intravascular hydration and diuresis can be enhanced by the use of 0.45% or 0.9% saline, mannitol, and diuretics.Use mannitol and diuretics to increase diuresis only after determining adequate intravascular hydration.Where possible, avoid:Nephrotoxic antimicrobials and other renal-toxic medications.The use of intravenous contrast dye for computed tomographic scanning during and after infusion of nephrotoxic chemotherapy.Prevention of bladder toxicityProvide hyperhydration to ensure increased urine output to dilute and decrease the bladder mucosal contact time of toxic oxazaphosphorine metabolites.Strongly encourage ample oral intake for the 12-24 hours preceding cyclophosphamide or ifosfamide infusion.Maintain a urine output of > 65 mL/m2/h for at least 18 hours after cyclophosphamide or ifosfamide therapy.4. Encourage the patient to void at least every 2 hours for the 24 hours after oxazaphosphorine treatment.E. Specific measures to prevent renal toxicity from renal-toxic drugs1. Hydrationa. Before infusion of high-dose methotrexate, moderate to high-dose cyclophosphamide, cisplatin, or ifosfamide, give hydration at 125 mL/m2/h (2x maintenance) for a minimum of 2 hours to increase urine output to > 100 mL/m2/h (> 3 mL/kg/h).b. Before the chemotherapy infusion, urine specific gravity should be < 1.010.c. The hydration fluid most frequently used is 596 dextrose /0.4596 NaCl + 10 mEq/L KCL.d. During infusion of these agents, in general, maintain hydration at > 125 mL/m2/h and urine output at >90 mL/m2/h.e. After the infusion of nephrotoxic chemotherapy (including high-dose melphalan), maintain urine output at 65-100 mL/m2/h (depending on agent and protocol) with oral/intravenous fluids to equal 90-125 mL/m2/h.f. Where needed to maintain isovolemic fluid balance (avoidance of over- and underhydration), diuresis can be forced (in the presence of adequate hydration) through the use of mannitol 6 g/m2 (200 mg/kg) in at least 25 mL of fluid over 15-60 minutes and/or furosemide 0.5-1 mg/kg push intravenous (IV).2. AlkalinizationBefore infusion of high-dose methotrexate, urine alkalinization of >pH 6.5 can be achieved with 40-60 rnEq NaHC03/L added to the intravenous hydration fluid.3. Uroprotectanta. Mesna has been used as a uroprotectant with high-dose cyclophosphamide and ifosfamide (oxazaphos-phorines). Mesna, which has a half-life of 90 minutes, binds the toxic oxazaphosphorine metabolite acrolein within the urinary collecting system to detoxify it. In adult patients, Mesna may not be more effective in preventing bladder toxicity than vigorous hydration.b. The dosage guidelines for Mesna vary. The majority of Children’s Cancer Group protocols recommend a total Mesna dose equivalent to the total ifosfamide dose(i.e., 1 mg of Mesna /l mg of ifosfamide) and a total Mesna dose of about 8056 of the total cyclophosphamide dose.c. Studies have shown that lower doses of Mesna may be uroprotective.4. Hypertonic salinea. The effectiveness of prevention of cisplatin nephrotoxicity by infusion in 3/6 saline is controversial.b. Prevention or diminution of nephrotoxicity associated with cisplatin is possible with hydration with normal saline, continuous infusion of cisplatin, and prophylactic supplementation with magnesium.5. Magnesiuma. During infusion of cisplatin, add mannitol in a dose of 15 g/nr (10-24 g/m2/L) and MgS04 in a dose of 20 mEq/L to the hydrating solution to prevent hypomagnesemia.b. Continue postchemotherapy hydration with 5% dextrose/0.45% NaCl + 20 mEq/L KC1 + 20 mEq/L MgS04 + mannitol 20 g/L.c. When chemotherapy includes cisplatin, routine magnesium supplementation with a minimum of 6 mEq/m2/day by mouth (PO) or IV is recommended.6. Continuous versus intermittent infusionFor cisplatin or ifosfamide, there are insufficient data to determine if continuous versus intermittent infusion or dosing by pharmacokinetic measurement of area under the curve can decrease their nephrotoxicity.Adjust the administered dose of chemotherapeutic agents according to the GFR.Limited total dose of agentMore than eight courses of ifosfamide (approximately 72 g/m2) are not recommended, as the incidence of serious nephrotoxic complications increases markedly when this dose is exceeded.Hematuria1. Microscopic hematuriaa. Transient microscopic hematuria (no more than 2 abnormal urinalyses on 2 separate days during a course of therapy); no modification of the oxazaphosphorine or Mesnab. Persistent microscopic hematuria (>2 abnormal urinalyses during a course of therapy)i. Do not modify the oxazaphosphorine dose.ii. Change the Mesna to a continuous infusion: 360 mg/m2 during oxazaphosphorine, followed by 120 mg/m2/h for 24 hours.2. Gross hematuriaEvaluate all episodes of gross hematuria by cystoscopy. Also consider further testing, such as urine culture, excretory urogram, and voiding cystogram, and perform as indicated.a. Transient gross hematuria during or after a course oftherapy (only one episode, which clears to less thangross hematuria)i. Do not modify the oxazaphosphorine dose.ii. Change the Mesna to a continuous infusion: 360 mg/m2 during oxazaphosphorine, followed by 120 mg/m2/h for 24 hours.b. Persistent gross hematuria after completion of a course of therapyi. Hold subsequent oxazaphosphorine until the urine shows less than gross hematuria.ii. Reinstitute oxazaphosphorine at full dose, with the Mesna changed to a continuous infusion: 360 mg/m2 during oxazaphosphorine, followed by 120 mg/m2/h for 24 hours after each dose of oxazaphosphorine.iii. If gross hematuria does not resolve to microscopic hematuria or less, withhold further oxazaphosphorine therapy.c. Persistent gross hematuria occurring during a course of oxazaphosphorinei. Interrupt the oxazaphosphorine.ii. Withhold further oxazaphosphorine until the next course of therapy.iii. If the gross hematuria resolves to microscopic hematuria or less, subsequent courses of oxazaphosphorine may be administered at full dose, with Mesna changed to a continuous infusion: 360 mg/m2 during oxazaphosphorine, followed by 120 mg/m2/h for 24 hours.d. Occurrence of a second episode of gross hematuria or persistence of microscopic hematuria on the continuous infusion regimeni. Continue the oxazaphosphorine when the urine shows less than gross hematuria.ii. Double the loading dose of Mesna to 720 mg/m2 and the subsequent hourly dose to 240 mg/m2/h.iii. Continue to give Mesna by continuous infusionfor 48 hours after the last dose of oxazaphosphorine.e. Persistent gross hematuria in the face of the “doubledose, continuous infusion” regimen Discontinue oxazaphosphorine.G. Renal tubular dysfunctionIf significant renal Fanconi syndrome (serum phosphate <3.5 mg/dL, potassium <3 mEq/L; 1+ glycosuria with serum glucose <150 mg/dL, bicarbonate <17 mEq/L, and ratio of urine protein/urine creatinine <0.2) develops while receiving ifosfamide, consider substituting cyclophosphamide.*36\168\2*

ADJUVANT ANALGESICS: ANTIDEPRESSANT

admin — Wed, 29 Jun 2011 13:57:34 +0000

SIndications-Antidepressants are indicated for the treatment of neuropathic pain and are more effective against the constant burning dysaesthetic type of pain. They are also useful for pain complicated by insomnia or depression. Action-The analgesic effect is seen with doses lower than required for the treatment of depression (50-75 mg/d amitriptyline), occurs more quickly than the antidepressant effect (2-3 days) and has been documented in patients with no features of depression. The action is thought to relate to blocking the re-uptake of serotonin and noradrenaline in the central nervous system. Antidepressants can also aid analgesia by increasing night-time sedation, improving mood and relieving depression. Drugs-For neuropathic pain, a tricyclic antidepressant (amitriptyline, imipramine or doxepin) should be used and may be superior to newer non-tricyclic antidepressants. Amitriptyline is started at a dose of 25-50 mg at night, increasing to 50-75 mg at night. If there is no benefit in one week the drug can be stopped. There is considerable individual variation in patients’ responses to different drugs, and a trial of a second antidepressant is sometimes successful. Side effects-The side effects of these drugs (sedation, anticholinergic effects and postural hypotension) are usually mild when used in low dose for neuropathic pain.*62\55\2*

HIV INFECTION AND ITS EFFECTS ON THE BODY: PNEUMOCYSTIS CARINII PNEUMONIA

admin — Fri, 17 Jun 2011 13:50:54 +0000

Pneumocystis carinii pneumonia (PCP) is an infection of the lung (pneumonia) caused by a parasite called Pneumocystis carinii. The parasite appears to be in the lungs of almost everyone, presumably acquired sometime early in life. {Pneumocystis carinii is found almost exclusively in the lungs, but like most-facts in medicine, this is not an absolute, and pneu-mocystis infections have occasionally occurred in other parts of the body.) The parasite causes no problem unless the balance between the immune system and the microbial world is heavily tilted in favor of the microbe. As a result, physicians initially saw PCP mostly in malnourished children, in people with certain types of cancer, and in those who had received organ transplants. At present, over 95 percent of people with PCP have HIV infection. The reason so many people with HIV infection get PCP is probably that the CD4 cell, which is infected by HIV, is also important in keeping Pneumocystis carinii in check. As the supply of CD4 cells decreases, Pneumocystis carinii is less constrained. In approximately 50 percent of the people with HIV infection, PCP is the first AIDS-defining diagnosis. This means that this infection is the first condition that meets the CDC’s criteria for AIDS; it also means that the loss of immune defenses is relatively severe. Without treatment, about 8t) percent of all people with AIDS will develop PCP at some time during the course of the disease. PCP in people with AIDS evolves slowly. In fact, most people have had the symptoms for weeks before they seek medical attention. The disease can be serious, and at first approximately 25 percent of people with PCP died. The prognosis is better now because of earlier medical intervention and improved treatments.
*51\191\2*

MEDICAL TREATMENT OF PMS: VITAMIN B6 (PYRIDOXIN)

admin — Thu, 09 Jun 2011 13:44:37 +0000

Doctors usually start with a treatment that will have the fewest side-effects. If it works, good. If not men something else will have to be tried. This is one of the oldest PMS therapies and dates from the discovery that B6 is involved in the production of serotonin and dopamine, two of the ‘happy’ chemicals in the brain.The current therapy is 100 mg a day taken by mouth. The treatment is taken for the whole month, not just when you are likely to be premenstrual.But the evidence for vitamin B6′s efficacy is shaky. An analysis of 12 clinical trials of vitamin B6 found three with positive results, five with ambiguous results and four with negative results. Dutch researchers who analysed the B6 trials said: ‘At the moment there is no evidence that vitamin B6 is efficacious in the treatment of patients with PMS’.Despite this, some women do seem to improve when they are taking vitamin B6 and for this reason many doctors are prepared to give it a try.High doses of vitamin B6 are known to cause nerve damage resulting in symptoms like pins and needles, muscle weakness and even eye damage. The general consensus is that 100 mg a day is unlikely to cause problems and it is well worth sticking to that dose if you have been prescribed this medicine.*42\120\4*

IMAGING STUDIES ON RHEUMATOID ARTHRITIS

admin — Tue, 17 May 2011 13:33:02 +0000

Are X-rays helpful in diagnosing RA?X-rays are very useful in making the diagnosis of the various forms of arthritis. They can help confirm doctors’ suspicions of rheumatoid arthritis and can enable doctors to find bone deformities, extra growths, thinned bone, bleached bone, or actual erosions of bone. Bone erosions are the most important findings in RA, as they are the hallmarks of this disease-causing process. One of the first signs of RA in a young person with early disease might not be erosions but blanching of the bone around the joints. This condition is called osteopenia. When it occurs around the joints, it is called periarticular osteopenia. Doctors look for this early on.
Are there other imaging techniques that might help the doctor diagnose RA?The plain X-ray film is really the best and least expensive way to diagnose RA. Other tests are good for ruling out specific problems that are of a greater magnitude and might require an extra look. However, the best imaging technique for RA is the basic X-ray.
What is an MRI?MRI stands for magnetic resonance imaging. It is the use of a magnet to get the atoms in the area being observed to vibrate in order to produce signals, which are translated into images on the computer. MRI is useful for determining the density of tissues. This very complicated and somewhat expensive test should be reserved for special situations. It is most effective for looking at the “soft” tissues like the brain and the spinal cord. While it can be used to look at tendons, capsules of the joints, and bone, generally the plain X-ray film is just as effective and less expensive.
What is a CAT scan?CAT stands for computerized axial tomography. CAT scans are an advanced type of X-ray involving the shooting of several X-rays from different planes and different vantage points around the area being viewed. The final image is viewed on a computer screen rather than on film.
What is a bone scan?The bone scan is another technique for the imaging of bone problems. A radioactive substance is injected into the patient’s arm. This substance sticks to bone and can be seen on an X-ray. Doctors can detect new bone growth based on the distribution of the radioactive substance on the X-ray. New bone can grow as a result of injury, infection, or inflammation. Bone scans are very useful in some patients where the diagnosis is not really solid. The most common radioactive material used in this process is technetium-99 (Tc99).*27/141/5*

IBS AND CANDIDA ALBICANS: BOWEL INFECTIONS & PARASITES

admin — Thu, 05 May 2011 11:29:29 +0000

Bowel InfectionsMany people with the Irritable Bowel Syndrome can date it from a bowel infection, often after a trip abroad, after flu or a cold where they have swallowed a lot of mucus or any condition where they have been given antibiotics.ParasitesIt is commonly supposed that infestation with parasites is only a problem in tropical countries; in fact it is a source of bowel problems in Europe, America and Australia. Infection with protozoa (single-celled organisms) Giardia lambia and Entamoeba histolytica can be spread through water, food and pets. It multiplies rapidly, causes a watery diarrhoea with bloating, abdominal pain and exhaustion. Medical help is necessary for this condition which can be diagnosed by investigation of the stool, or mucus from the wall of the rectum. There are drugs for this condition but the herb Artemia annua has been found to be very effective. Raw garlic also kills parasites. If parasite infections are neglected they can cause chronic ill-health. Irritable Bowel Syndrome and food intolerance can often be traced back to Giardia infestation.*78\326\8*

DIFFICULTY FALLING OR STAYING ASLEEP: INSOMNIA IS NOT SO MUCH A DISORDER AS IT IS A SYMPTOM

admin — Wed, 27 Apr 2011 11:24:11 +0000

Remember that insomnia is not so much a disorder as it is a symptom, one that stems from any number of causes. Nor is it merely a measurement of the number of hours of sleep experienced on a given night. The pattern of sleep disruption and the resulting quality of sleep are critical elements: when did sleep occur and when was it interrupted? Was it deep and restorative or light and fragmented? Armed with these facts, the physician can begin to penetrate the darkness.Popular media, including television, magazines, and the tabloids, only add to the confusion about insomnia. Advertising often portrays a world in which sleep problems disappear after merely taking a pill. And articles aimed at the layman may oversimplify or misstate the nature of insomnia. One recent publication invented a set of clumsy names—as if more were needed—for the various types of sleep disorders. For example, the inability to fall asleep promptly was called “initardia.” Other varieties were given such names as “pleisomnia,” sleep interrupted by awakenings; “scurzomnia,” short sleep; “hyperlixia,” excessive light sleep; and “turbula,” sleep laden with uneasy dreams.Naturally, as a physician, I prefer to use the more precise, if less colorful, terminology agreed upon by experts who, over the last dozen years or more, have wrestled with the problem of identifying and classifying sleep problems. Precise categorization is not simply an exercise in academics—far from it. The symptoms of different forms of insomnia may appear to be very similar on the surface; patients may even use the same phrases in describing them to a physician. Their causes, however, may be radically different. To cite a parallel example: you may sneeze because of an allergy to dust, or because you are infected with a cold virus. While the symptom sneezing is the same, the causes, as well as the remedies, are completely different. By the same token, therapies that work for one form of sleep problem often prove to be ineffective—or worse, counterproductive—for another.*105\226\8*

HOW TO ASCERTAIN ASTHMA: THE DIAGNOSTIC TESTS – SKIN TESTS

admin — Mon, 18 Apr 2011 11:18:47 +0000

When medical history, physical examination and laboratory tests show that allergies have an important impact on a child’s asthma, skin tests should be taken.The skin tests detect the present of antibodies or reagins which are present not only in blood but also in the skin. The reaction of the antibody the skin with the corresponding antigen applied in the skin tests, causes the release of histamine or histamine-like substance by the tissues, and results in a weal and redness around the test site.Skin tests are done with the extracts of the pollens, dusts and moulds. It is essential that the extracts be prepared methodically and these be active and potent and not old. Skin tests can be done by either of the two techniques:1. Scratch test, and2. Intracutaneous test.Scratch Test. A series of superficial scratches or abrasions about 1/4 cm long are made on the cleansed skin of the arm or the forearm. Care is taken to ensure that scratches do not cause bleeding. A small drop of each of the test substances i.e. different allergy causing allergens, is placed on the child’s forearm. The outermost layer of the skin is gently lifted with a needle tip to let each drop flow in. The procedure is almost painless and therefore can be done on children with ease, without causing any apprehension to the parents. After 15 to 20 minutes, the reactions at the test sites are observed and interpreted on the basis of comparison with a control test. The control test is made with harmless diluent devoid of the allergy priinciple.Intracutaneous Test. These involve the introduction of about 0.02 ml of each of the sterile allergenic extracts into the skin by a syringe. The reactions resulting from the intracutaneous techniques are generally larger than those obtained with the scratch technique, and the tandard of recording and interpretation vary with each procedure. Intracutaneous tests, if not performed with care, can sometimes cause allergic reactions.Within a few minutes of the test a positive reaction is shown by a small, white, itching bump appearing, which may be surrounded by some reddening of the skin. The intensity of the allergy is related to the size of the lump, but even the most severe reactions in this type of test disappear after half an hour or so, leaving no after effects. Almost every asthmatic child will have at least one or two positive reactions, if not several reactions. Unless the substance under test has also been noticed to cause the child to wheeze regularly, the positive test just shows that he produces harmless allergic antibodies in his blood more easily than usual.*51\260\8*