Our Medical Center

Stop Smoking Tips

2008-04-11T02:22:00.000-07:00

The benefits of stopping smoking are clear: only 20 minutes after a smoker last cigarette, blood pressure and heart rate begin to return to normality. Yet millions of smokers are virtually impossible to escape. What are the best long-term solutions?

Nicotine is "seriously underestimated". So much so that some evil is that addiction has been compared to that of heroin, says Prof. Chris Bolliger, pulmonary expert at the University of Stellenbosch (US) Faculty of Health Sciences.

There are more factors involved in smoking addiction than mere nicotine addiction and these factors make smoking a complex and demanding process.

Research has shown that the majority of ex-smokers pledged to maintain their resolution after they have managed to abstain for at least one year.

According to a study conducted by Boston University's School of Dental Medicine, only two to four percent of ex-smokers generally pick up the habit again each year after the initial period of two years.

The best results, which has yet to be scientifically verified, indicate a maximum success rate of 50 percent after six months, it is estimated that 35 per cent after one year, and it is estimated that the 30 per cent after two years.

Some of the options available that may lead to a long-term solution, include nicotine replacement therapy (gum, inhaler or patches), the new drug Zyban, a combination of the above, the Smokenders programme, or quitting all alone . Choose the one that suits you best.

1. The nicotine replacement therapy (NRT)
According to Prof. Bolliger, any form of NRT increases the rate of success of a programme of smoking cessation. All the different types of NRT have been shown to be effective, with little or no side effects.

NRT can be regarded as a temporary solution that helps smokers overcome the first obstacle on their journey to long-term smoking.

A suggestion for ex-smokers: Always carry a batch of gum or another type of NRT with you while you travel. "The call could come at any time," says Bolliger.

2. Zyban alone
The antidepressant Zyban (bupropion) is the latest aid in smoking. The drug seems to increase levels of dopamine and norepinephrine in the brain, leading to a greater feeling of pleasure.

Not only did bupropion been an effective tool to help smokers quit many, but it seems to prevent relapse, according to researchers at Mayo Clinic Nicotine Dependence Center. Unfortunately, the relapse-free period not persist. At the end of the first year, 55% of the Zyban group and the Mayo Clinic study were still smoke-free, but two years later, the number of similar and not Zyban Zyban groups had relapsed.

In the longer term treatment of bupropion may prevent relapse, but more research on long-term benefits of Zyban is necessary before accurate conclusions can be drawn.

Some people should not use Zyban. People who should not take Zyban include:

* Seizure of people with disorders such as epilepsy,
* Those who have shown an allergic response to bupropion,
* People with a Corsican or the first diagnosis of bulimia, anorexia nervosa or bipolar disorder,
* People with liver disease,
* Kidney problems,
* Heart problems,
* Hypertension,
* Traumatic brain injury,
* A brain or spinal tumor,
* Diabetes, or
* People who use alcohol or benzodiazipine sleeping tablets.

Zyban is available only on prescription.

3. Combination Therapy
Combination Therapy, which includes consulting, the simultaneous administration of NRT (patches and / or gum) and / or the drug Zyban, appears to be an effective solution for many smokers. Preliminary research results indicate a 50 per cent six months success rate for the combination therapy.

The dose and the use of NRT and / or Zyban vary depending on the individual. The usual recommendation is to take NRT and / or Zyban for a period of three months - and then make or not. If you do not make, it is not useful to try again immediately. To accept and have another go in six months' time, the Board of Bolliger.

Of advice is an integral part of the project Stop, a program of smoking cessation that runs at the US Department of Health Sciences.

4. Smokenders' behavioral changes
Some experts do not believe NRT only as a long-term solution, but as a temporary replacement. This substitution method does not address the heart psychological factors involved in smoking addiction.

According Mercia Axon, managing director of Smokenders, nicotine addiction is only one aspect of smoking addiction. This factor is blown out of proportion, he said. The long-term focus of smoking should be on behavioral changes.

"Most smokers will acknowledge that the emotional bond with their cigarettes is the biggest problem. Our program gives people a tool for managing stress and helps them to rebuild their emotional support system," says Axon.

Smokenders International, the group deals in particular with the emotional and psychological aspects involved in smoking. These factors are addressed during seven group sessions with clients. Long-term success is tied to appropriate forms of emotions and stress management - without cigarettes. The first six months is the most difficult for many smokers. Customers who feel the need to light during this period, should immediately contact their advisers, Axon recommends.

The group claims that they have a success rate of 92 percent after one year and a 70 percent to 75 percent success rate after five years.

Bolliger, however, the query high success rates of some programs smoking cessation. He speculates that inaccurate feedback from clients may be the strengthening of the figures.

5. Kicking the habit on their own
Closing all alone is not easy, but not impossible.

The biggest reason for the relapse, in general, is to let the feeling of being concerned for her without cigarettes. Other reasons include missing the pleasure of smoking, feeling pressure from family members or friends who smoke or feeling addicts. Men who drank more than five alcoholic drinks a day were more likely to relapse. Drinking more than six cups of coffee a day, also increases the risk of relapse.

These results from Boston researchers suggest that the techniques of stress management, as exercise or yoga, can play an important role in long-term success, if you want to stop by yourself or join a program.

People who have committed themselves to stop smoking should make it easier for themselves by monitoring their diet to prevent weight gain and cutting back on excess intake of alcohol and caffeine to reduce the risk of relapse.

"Whatever works is good," says Bolliger. "In the end, most people are standing alone."

Quit Smoking Tips

Blood Sugar Level

2008-03-05T03:13:00.000-08:00

What is the level of blood sugar?

The level of blood sugar is the amount of glucose (sugar) in the blood. Also known as serum glucose level. It is expressed as millimoles per litre (mmol / l).

Normally, blood glucose levels stay within narrow limits throughout the day: 4 to 8mmol / l. But they are higher after a meal and usually lowest in the morning.

In diabetes the level of blood sugar moves outside these limits until treatment. Even with a good control of diabetes, the level of blood sugar is derived sometimes even outside of this normal range.

Why control of the levels of blood sugar?

For reasons that are not well understood, when very high levels of glucose in the blood are present for years, leading to damage to small blood vessels.

This in turn increases the risk of developing late-stage complications of diabetes, such as:

* Retinopathy (eye disease)

* Nephropathy (kidney disease)

* Neuropathy (nerve disease)

* Cardiovascular diseases such as heart attacks, hypertension, heart failure, stroke and problems caused by poor circulation, such as gangrene, in the worst case.

With Type 1 diabetes, these complications can begin to appear 10 to 15 years after diagnosis.

It is often less than 10 years after diagnosis of type 2 diabetes, because this type of diabetes is often present for years before it is recognized.

By keeping the blood sugar stable, significantly reduce their risk of these complications.

How do I measure the levels of blood sugar?

Good advice
Home testing kits come in a variety of shapes and sizes.
A pharmacist or nurse clinic diabetes can recommend the best model.
You can usually get a blood glucose in the metro little or no cost through the clinical diabetes.
Testing strips are available on NHS prescription.
You can learn to measure levels of blood sugar quickly and simply with a home blood glucose test kit. All kits have at least two things: a measuring device and a strip.

To check the level of sugar in his blood, put a small amount of blood on the strip. Now place the band in the product. After about 30 seconds to show the level of glucose in the blood.

The best way to take a sample of blood by pricking the finger with a lancet that strong designed to penetrate the skin only to the extent necessary to extract a drop of blood.

What should be glucose levels?

The ideal values are:

* 4 to 7mmol / L before meals.

* Less than 10mmol / l 90 minutes after a meal

* Around 8mmol / l at bedtime.

How often should blood glucose was measured?

It depends on your lifestyle - the needs of a person with diabetes who is also an instructor of PE are very different from someone who sits at a computer all day.

If you use insulin

In general, people who have type 1 diabetes should measure their blood sugar levels daily before meals. Some days one or two tests can be done, whereas in another four or five might be necessary.

The measurement of the levels of blood sugar in the morning before any meal gives an indication of the amount of insulin needed overnight.

If you have type 2 diabetes being treated with insulin, you should also follow this schedule.

If oral treatments

If diabetes is treated with tablets or a special diet (type 2), should measure their blood glucose levels once or twice a week - either before meals or 90 minutes after a meal.

It must also make a profile of 24 hours once or twice a month. This means the measurement of glucose levels before each meal.

Not everyone with type 2 diabetes has to carry out regular checks of blood glucose.

For the elderly and people with other medical problems, it is often sufficient to control glucose in the urine - usually before breakfast and dinner.

This is because while a good control of diabetes is important, cardiovascular complications (heart attack, stroke, angina pectoris) is the leading cause of severe illness and death in people with this type of diabetes.

Therefore, people with type 2 diabetes will benefit from the fight against the factors contributing to their cardiovascular risk by:

Or controlling blood pressure more rigorously

Or lowering cholesterol levels with medication

Or the beginning or increasing exercise

Or quit.

Levels of blood glucose at bedtime

The level of blood sugar at bedtime should be between 7 and 10 mmol / l.

If the blood glucose is too low or too high at bedtime, you may need to adjust your food intake or insulin dose. Be sure to discuss this with your doctor.

At what other times the levels of blood glucose should be measured?

The blood glucose should be measured at any time of discomfort or think your blood sugar level is too high or low.

If you have type 1 diabetes and have more than 20mmol / l glucose in the blood, you have to use a strip of urine to verify the presence of ketones.

If organs are ketones in the urine is a warning sign of diabetic acidosis. If this is the case, you should consult your doctor immediately.

How is the level of blood sugar control over a period of time?

A test known as the HbA1c test can show the average level of blood sugar during the last six to eight weeks.

The proof is in HbA1c levels in a sample of blood.

Term clock
Hemoglobin
The substance in red blood cells that binds and transports oxygen throughout the bloodstream.
HbA1c is a compound produced by the chemical reaction between hemoglobin and glucose in the blood. HbA1c is also known as glycosylated hemoglobin.

High blood sugar levels to produce more HbA1c. But because the process happens over several weeks, an upturn occasional high blood sugar is not enough to influence the level of HbA1c.

This means that only consistently high levels of glucose in HbA1c due to the height - and why HbA1c used as a measure of diabetes control.

* HbA1c is about 6 percent of total hemoglobin in people without diabetes. This is the aim of targeting with strict blood sugar control - although 7 percent or less is very good.

* HbA1c of 7.5 percent shows just diabetes control.

* HbA1c above 8.5 percent demonstrates the lack of control of diabetes.

Any increase in the level of HbA1c indicates poorer diabetes control.

The United Kingdom Prospective Diabetes Study (UKPDS) Group was 20 years of research long trial in diabetes.

It showed that for every 1 percent increase in HbA1c, a person with type 2 diabetes is 30 percent more likely to develop late-stage complications arising from damage to small blood vessels.

In type 1 diabetes, the same relationship between high levels of HbA1c and strengthening the development of complications was demonstrated by the Diabetes Control and Complications Trial in the United States.

Based on a text by Dr Jan Erik Henriksen, and Dr Henning Bech-Nielsen, professor and consultant
source: netdoctor.co.uk
Blood Sugar Level

Canker sores

2008-02-21T01:37:00.000-08:00

What are the thrush?
Canker sores are shallow, painful mouth sores. They are usually red or may sometimes have a layer of white paint on them. It is possible to get inside the lips, the inside of their cheeks, the base of the gums or in their language. Canker sores are different from fever blisters, which are generally on the outside of the lips or the corners of the mouth.

Anyone can get thrush, but women and people in their teens and 20s make them more often. Canker sores may run in families, but they are not contagious. Doctors do not know what causes canker sores, but can be triggered by stress, poor nutrition, food allergies and menstrual periods.

How do they treat canker sores?
Canker sores usually disappear without any treatment. For pain relief, you can try taking ibuprofen (brand name: Advil) or acetaminophen (brand name: Tylenol). Other drugs, such as Anbesol, Orajel, Orabase and Zilactin-B, could maintain its thrush becoming irritated by eating, drinking or brushing your teeth. These medications are applied directly on the wound.

You can also mix equal amounts of Milk of Magnesia and Benadryl Allergy liquid. After it is mixed, you can swish a teaspoon in the mouth of 1 minute and then spit out. If it does every 4 to 6 hours, your canker sores may hurt less.

Some people think that sucking candies zinc, taking vitamin C or vitamin B complex, using a sage and chamomile mouthwash or take a supplement lysine helps her heal faster canker sores.

When should I call my family doctor about the thrush?
If canker sores are large, last longer than 2 weeks or so adolorida that you can not eat or drink, you should make an appointment to see your doctor. You must make an appointment with your doctor, too, if you also have a fever or feel sick when you have thrush. Tell your doctor if you have thrush more than 3 times a year.

What can my doctor to help my thrush?
Several prescription medicines can help with canker sores. If your canker pain is great, painful or not cure, your doctor may prescribe an anti-inflammatory (Aphthasol or Kenalog in Orabase) or inhibitor of collagenase (Peridex or tetracycline). Talk with your doctor to decide what treatment is best for you.

What is the correct way to use medication for my canker sores?
You may be asked to "swish and swallow" or "swish and spit" medicine. This means that you swish around medicine in the mouth, especially around your pain canker, for a few minutes before swallowing or spitting it out.

If your doctor has to use a drug to put on the canker pain, the pain should be dry with a tissue. Next, put a small amount of medicine in a cotton swab (like a Q-Tip). Then put the medicine in its canker pain using cotton swab. Do not eat or drink for 30 minutes. If it does, the medicine will be washed away. Be sure to use medication for as many days as her doctor.

What can I do to prevent thrush?
Unfortunately, doctors are not aware of everything that prevents the formation of ulcers. However, using a toothpaste that does not contain SLS (sodium lauryl sulfate) or other ingredients irritant, avoid chewing gum, hard, crunchy or spicy foods can help reduce irritation of the mouth. Brush teeth after meals, with a soft toothbrush and flossing every day also keep your mouth free foods that can cause a canker sore. If you get canker sores often, or if they are very painful, talk to your family doctor.

Why is it important to weight loss?

2008-02-10T21:47:00.001-08:00

Maintenance of a healthy body weight is important for maintaining both physical and emotional well-being and preventing disease. Maintenance of a healthy body weight is important for maintaining physical and emotional well-being and the prevention of disease. Both having being overweight and obesity are associated with an increased risk of numerous conditions, including: Both overweight and obesity have been associated with an increased risk of numerous conditions, including:

* Heart disease, diseases of the heart,
* High blood pressure, high blood pressure,
* Stroke, cerebrovascular accidents,
* Diabetes, Diabetes,
* Osteoarthritis, Osteoarthritis,
* Some types of cancers, several types of cancer
* Sleep apnea, and Apnea during sleep, and
* Elevated blood cholesterol levels. The elevated levels of blood cholesterol.

Many overweight people also report improved mood, increased in self-esteem and motivation, and feeling healthier in general after they have lost weight. Many overweight people also report improved morale, increased self-esteem and motivation, feeling healthier and, in general, having lost weight.

7 Tips for successful weight loss 7 Tips for successful weight loss

1. The desire to lose weight must come from the individual. If you're truly ambivalent about making changes in your lifestyle or are doing this to please someone else, you're likely to fail. The desire to lose weight should come from the individual. If you are truly ambivalent about making changes in their lifestyle or are doing so to please someone else, it is very likely to fail. When making changes, decide what's right for your lifestyle. When you make changes, decide what's right for their lifestyle. Your best friend's diet and exercise plan may be completely wrong for your habits and interests. His best friend of diet and exercise plan can be totally wrong for your habits and interests. The key is to find a system that works for you. The key is to find a system that works for you.

2. Do not blame yourself if you are not perfect. If you fail at your eleven attempt to curtail your overeating, it does not mean you are a failure at weight control and that you should just give up. Do not blame yourself if you are not perfect. If you fail once in their attempt to reduce its excess, it does not mean that you are a failure in weight control, and that you should just resign. Accept that you made a poor choice, but do not let that poor choice influence the rest of your plan. Accept that you made a bad choice, but do not let that poor choice influence the rest of his plan. The same holds true with exercise! The same applies to exercise! Skipping a few workouts does not mean you can not get back on track. Skipping some workouts does not mean that you can not get back on track. Weight control does not involve making perfect choices all the time, rather, it's about attempting to make good choices more often than poor ones. Weight control does not make perfect choices all the time, rather, it is about trying to make good decisions more often poor.

3. Avoid surroundings where you know you're tempted to make poor food choices. Everyone has a time when we're most likely to overeat, whether it's the morning coffee break or after work with friends. Avoid the area around where we know if we are tempted to make poor food choices. Everybody has a time when we are very likely to overeat, if the morning coffee break or after work with friends. Try to plan other activities or distractions for those times, or plan in advance how you're going to handle them and stick to it. Try to plan activities or other distractions for the moment, or plan in advance how you will deal with them and they adhere to it.

4. Surround yourself with people who support your efforts. Even our good friends can knowingly or unknowingly sabotage weight loss attempts. Rodearse people who support their efforts. Even our good friends knowingly or unknowingly, may sabotage attempts at weight loss. Spend time with those people who will not pressure you to make poor food choices. Spend time with people who do not pressure you to make poor food choices.

5. Decide on some non-food rewards for yourself when you reach interim goals. For examples, at the end of the first week of healthy eating or after the first five pounds lost buy yourself a new CD or book. Deciding on some non-food products reward yourself when you reach the interim objectives. For example, at the end of the first week of healthy eating or after the first five pounds lost you buy a new CD or book.

6. Stock your pantry and refrigerator with healthy foods. Get rid of the high-calorie, low-nutrition snacks like chips and candy. Stock your pantry and refrigerator with healthy foods. Get rid of high-calorie, low-nutrition snacks like chips and sweets. But do not forget to have plenty of healthier options available as well, such as popcorn (hold the butter, Parmesan cheese try sprinkles), low-fat cheese and yogurt, fruit, instant cocoa without added sugar, sugar-free popsicles or puddings , or whatever appeals to you when you're hungry for a snack. But do not forget to have plenty of healthier options, such as popcorn (hold the butter, Parmesan try sprinkles), cheese and low-fat yogurt, fruit, cocoa instant without added sugar, or sugar-free popsicles puddings, or whatever appeals to you when hungry for a snack.

7. September small goals and focus on these rather than the "big picture." Decides to where you want to be in a week, in a month, rather than focusing on the total amount of weight you'd like to lose. Set small goals and focus on those instead of the "vision". Decide where you want to be in one week, one month, rather than focusing on the total amount of weight you want to lose.

What about the plans for special diet (fad diets and popular diets)?

2008-02-10T21:39:00.000-08:00

Many people prefer to have a set of rules to follow when a diet. Others may crave the emotional support of attending meetings or counseling sessions. Diet products, books, and services have become an industry of billions of dollars, it is clear that there are many people seeking help with weight control. Before we jump into the band latest diet, remember that organized the plans and diet programs can only result in weight loss if you burn more calories than you consume. No dietary supplements, exercise devices, food combinations, or specific patterns of eating is going to change this fact.

Some examples of the popular Atkins diet plans include diet, the South Beach Diet, Weight Watchers, Jenny Craig, Body for Life, Dr. Andrew Weil plan diet, and Ornish Diet. All these diets have their proponents, and all of them have been successful for some people. Because eating habits and preferences vary widely among individuals, before deciding on a diet plan, ask yourself if the plan sounds realistic for you. If the plan is the precise measurement of portions and counting calories, which are equal to the challenge? If it is forbidden to eat certain foods, will develop cravings for them? Do you feel that you will feel comfortable joining the diet guidelines? Is the diet requirements fit easily into your daily schedule? Finally, we believe that once you have lost weight, you can regain weight if you return to your previous eating habits, so any weight loss plan should be something that can live for a long time. For more on the comparison of diet plans, please read the People Comparing Weight Loss diets article.

Remember that the greatest success comes from weight loss and dietary changes fruits and vegetables that will stay with you through time, not diets that you leave without feeling deprived, or give rise to episodes will eat binge.
from medicinenet.com

The non-diet approach to weight control

2008-02-10T20:54:00.000-08:00

By adopting sensible eating habits and practice portion control, you can eat nutritious foods so that you take in as many calories you need to maintain their health and welfare at its ideal weight. Often, weight loss occurs on its own, just when you start making better food choices, such as avoiding:

* Food prosecuted,
* Sugar-laden foods,
* Bread and white pasta (whole substitute instead of the berry varieties)
* Food with a high percentage of calories from fat, and
* Alcoholic beverages.

While nothing is absolutely forbidden, when he does succumb to the temptation, keep portion size small and add a little more exercise to their daily routines.

By replacing some reckless with the choice of healthy food, which goes to the reduction of calories. By adding some moderate physical activity, you have the perfect plan for weight loss without the need for special or inconvenient (and often expensive) plans diet.

Let's look at an example of a successful non-diet weight loss program:

A 45-year-old woman complains that little by little has twelve pounds in the past year. In the last month, which is facing a stressful work period, and added another four pounds to his frame.

This individual goal is to lose sixteen pounds he has acquired. Since its weight has been increasing gradually, she knows that is consuming more calories than it burns, especially with their sedentary work. She decides that a weight loss of one pounds per week (equivalent to a shortfall of about 3500 calories, or cut 500 calories per day) would be acceptable and enable it to reach its goal in about four months.

She decided to make some changes that allow it to cut an average of 250 calories per day.

* Skipping a glass of iced tea sweetened save about 200 calories.
* Replacement of mineral water for drinks queue periodically during meetings can save another 150 calories.
* Previous bun their morning snack (or eat just half a bun) also can save 250 calories or more.

To achieve its goal of a 500 calories per day savings, adds a little exercise.

* Getting there early for a hike of 20 minutes before work and the addition of a ten-minute walk during your lunch join a half-hour walk each day, which can burn about 200 calories.
* The weekend is going to walk for 60 minutes a day and spend an hour a day after gardening for increased burning of calories. If you walk for 60 minutes is too much, two 30-minute walks a day would have the same results.
* Twice a week is going to stop at the gym on the way home from work, if only for half an hour stationary bicycle or swimming (burn up to 250 calories each).

By making just a few cuts above and diet after some moderate exercise, this individual can "save" the 3500 calories per week needed for a pound of weight, giving rise to a rate of weight loss without denial or deprivation extreme. In addition, changes in your diet and lifestyle are small and gradual, and that the changes she can maintain over time.
from medicenenet.com

How is "losing" weight?

2008-02-10T20:46:00.000-08:00

The most effective method for weight loss is to reduce the number of calories you consume while increasing the number of calories burned through physical activity. To lose a pound, you need an expenditure of approximately 3500 calories. You can accomplish this either by reducing their food intake by increasing physical activity, or ideally, therefore.

For example, if you consume 500 (7 500 3500 calories, or the number of calories in a pound of it Gain weight). Similarly, if you eat 500 calories less per day for a week or burn 500 calories a day through exercise a week, will lose a pound.

Examples of calorie content of some popular foods and beverages include:

* 1 slice original style of pizza crust pepperoni - 230 calories
* 1 cup of dry white wine - 160 calories
* 1 can of cola - 150 calories
* 1 quarter-pound hamburger with cheese - 500 calories
* 1 banana nut muffin jumbo - 580 calories

Activities that you do throughout the day are added to your BMR (basal metabolic rate) to determine the total number of calories you burn every day. For example, a person who spends 170 pounds 45 minute walk, burned about 300 calories. The same time spent cleaning burns about 200 calories, and mowing the lawn for 45 minutes consumes about 275 calories. For more, please read the Calories Burned During Physical Activities article.

What speed wait to lose weight?

Most experts agree that a safe, healthy rate of weight loss is one to 1 ½ pounds per week. Changing eating habits, along with regular exercise is the most effective way to lose weight over the long term. It is also the ideal way to ensure that the weight stays off.

Hunger in the diet can cause rapid weight loss, weight loss, but it is nearly impossible to maintain for most people. When food intake is severely limited (below approximately 1200 calories per day), the body begins to adapt to this state of poor nutrition by the closure of its metabolic rate, which could make it even more difficult to lose weight. It is also possible to experience hunger, episodes of hypoglycemia, headaches, mood swings and a diet too strict. These symptoms can lead to binge eating goes and weight gain. Since a very restrictive diet is almost impossible to maintain for a long time, people trying to hunger themselves thin often start to gain weight again when they stop dieting.

from medicinenet.com

Introduction To Weight Loss

2008-02-10T20:14:00.000-08:00

Whether you are trying to lose five pounds or over 50, the same laws of physics simply determine whether or not you will lose weight and the speed of your weight loss will happen. Remember these simple instructions and putting them into practice can lead to weight loss, without the aid of special diet plans, books or medicines.

Our weight is determined by the amount of energy that we have in food, and the amount of energy spent on the activities of our day. The energy is measured in calories. If the weight is constant, probably taking the same amount of calories burned each day. If you are gaining weight slowly over time, it is likely that their caloric intake is greater than the number of calories you burn through their daily activities.

Everyone is in controlling the amount of food he or she consumes each day, so that the caloric intake is something that we can control. For further extent, we can control our production of energy, or the number of calories burned each day. The number of calories burned each day depends on:

* Our basal metabolic rate (BMR), the number of calories burned per hour, simply by being alive and the maintenance of bodily functions,
* In addition to our level of physical activity.

For some people, because of the genetic (hereditary) or other factors, the resting metabolic rate may be slightly higher or lower than average. Our weight also plays a role in determining the amount of calories burned at rest - we need more calories to maintain their body in its current state, the highest weight of his body. A 100 lb person requires less energy (food) to maintain their body weight for a person who weighs 200 pounds.

Lifestyle and work habits in part to determine the number of calories you need each day. Someone whose job is to work heavy physical naturally burning more calories in a day than someone who sits at a desk most of the day (a sedentary). For people who do not have jobs that require intense physical activity, exercise or increased physical activity can increase the number of calories burned.

As a rough estimate, an average of 31-50 year-old woman who leads a sedentary lifestyle needs about 1800 calories a day to maintain a normal weight. A man of the same age need about 2200 calories. Participation in a moderate level of physical activity (exercise 3-5 days per week), requires about 200 extra calories per day.

from medicinenet.com

Preeclampsia FAQ

2008-02-06T00:44:00.000-08:00

What is the difference between Preeclampsia, Toxemia, PET, and PIH?

Preeclampsia, Toxemia, PIH, PET, as well as gestosis ephegesis serious concern, closely associated with pregnancy hypertension conditions. Toxemia is the older term based on the belief that the condition is the result of toxins (poisons), in the blood. PET (preeclamptic toxaemia) is a term used for older doctors in the UK and other countries. Ephegesis gestosis, rarely used in the United States, is a term that is usually associated with preeclampsia. PIH, the new terms, means Hypertension Induced abortion. In Preeclampsia Foundation uses the term "preeclampsia" as a generic term to cover all options for hypertensive disorders of pregnancy. Researchers will be more specific and relate to each subgroup syndrome as separate entities. Although the medical point of view of researchers, these can be subtle differences, they all represent a serious condition that you should not ignore.

What is Eclampsia?

Eclampsia is one of the most serious complications of severe preeclampsia. In the developed world, it is extremely rare and is almost always treatable, if necessary, intervene quickly sought. According to the "Pre-Eclampsia: Facts" (Redman, Walker, copyrights 92)

Pre-eclampsia so called because it was originally defined as a violation of previous eclampsia, although it is now known that eclamptic seizures is only one of several possible complications of the disease.
These cramps, which resulted in temporary loss of consciousness, look no different from epileptic fits… with spasms stop breathing with the mother, to make it bite her tongue, and sometimes cause urinary urine…

Eclamptic suits typically occur as a complication of acute tertiary level before eclampsia. But sometimes they arise from the blue, without any evidence of previous unrest…

These exceptions can happen at any time during the second half of pregnancy… in 1974, the case of eclampsia by 16 weeks reported in the Journal of the American Medical Association.… At the other extreme was one case, as reported at the end of 3 weeks after birth.

Without treatment eclamptic seizures can lead to coma, brain damage and, possibly, maternal and infant mortality.

How Poor Eclampsia?

Standard treatment eclampsia is magnesium sulfate. This simple salt save the mother's life. In accordance with the Joint Judicial Eclampsia (CLASP), published in The Lancet, June 95, women, magnesium sulfate was

* 52% less risk of repeated seizures than those of diazepam;
* Those who did have current exemptions were lower than those of diazepam;
* 26% lower risk of maternal death than those of diazepam;
* Children of mothers on magnesium are in a better position after childbirth, and are unlikely to need special care;
* Less likely to be ventilated or develop pneumonia or need intensive treatment than those on phenytoin;
* 67% less risk of repeated seizures than those on phenytoin;
* 50% lower risk of maternal death than those on phenytoin.

However, magnesium sulfate, is not favorable drug, and must be used for qualified medical services with appropriate infrastructure. Overdoses can, and did not raise.

It is important to note that while magnesium sulfate is often compared with Epsom salt - is not the same thing. Analysis Epsom salts of magnesium or vitamin supplements have not been shown to prevent maternal deaths due eclamptic seizures.

What is HELLP syndrome?

HELLP syndrome occurs in 4 percent to 12 percent of women who have preeclampsia. It is one of the most severe forms of preeclampsia. HELLP means: hemolysis, elevated liver enzymes, as well as reduce platelets. HELLP syndrome most often affects the liver, stomach and right shoulder pain. HELLP syndrome is the most dangerous, because it could happen before the show classic symptoms of preeclampsia. Very often mistaken for influenza or gall bladder problems. It is imperative that you listen to your body: if you do not feel right to check with their health professional. If you have these symptoms, contact your health professional immediately. An excellent source of support and information is HELLP Syndrome Society started Stephen and Jennifer Bohach after the death of their daughter, Hope Taylor.

What is the definition of eclampsia?

Main Entry: eclamp sia
Pronunciation: i-'klam (r) - sE-and
Function: noun
C.: New Latin, from Greek eklampsis sudden flashing of lights in eklampein states of the former shone in lampein +
Date: about 1860
: a convulsive state; features: an attack of convulsions during pregnancy and parturition - eclamp tic / I-'klam (r) - tik / adjective

Merriam-Webster dictionary on the Internet

Who gets Preeclampsia?

Preeclampsia occurs in 5-8 percent of all pregnancies, although it is most common in first pregnancies. Some studies show that an increased risk of preeclampsia in the first pregnancy with a new partner / husband, but recent studies have shown that the key factor that increased risk is not new husband, but it is actually increasing the age mother. The most significant risk factors for preeclampsia include:

* Previous history of preeclampsia, especially if it prior to the third trimester
* The history of chronic high blood pressure, diabetes and kidney disorder
* Family history disorder (such as mothers, sisters, aunts or grandmothers, who have disorders)
* Women with more than 30% of body mass index (BMI). To determine your BMI, click on the link and follow the instructions http://nhlbisupport.com/bmi/bmicalc.htm.
* Multiple pregnancies
* In the 40 or 18 years before
* Polycystic ovarian syndrome
* Volk or other autoimmune diseases such as rheumatoid arthritis, sarcoidosis, or MS.

Preeclampsia What are the causes?

There are several theories, ranging from too much blood to the influx of too little. Some modern theories include:

Medical Description layperson description
Uterus ischemia / underperfusion inadequate inflow of blood to the uterus
Prostacyclin / thromboxane imbalance (ASA) Violation of the balance of hormones, which have a diameter of blood vessels.
Endothelial activation and dysfunction Damage to the lining of blood vessels, which regulates the diameter of blood vessels under the liquid and protein inside the blood vessels and keeps the coagulation of blood.
Calcium deficiency of calcium helps maintain vasodilation, and the deficit will impair function vasodilation (see above)
Hemodynamic vascular lesions injuries to the blood vessels, because of the influx of too much blood, that is the garden hose hooked to the fire hydrant
Previously existing maternal conditions Mother has undiagnosed high blood pressure or other preexisting problems, such as diabetes, lupus, sickle-cell disorders, hypothyroidism, kidney disorders, etc.
Immunological activation of immune system is of the opinion that the damage was caused by blood vessel, and in trying to correct the "injury" actually makes the problem worse (for example, scar tissue), and adds to the process.
Problems nutrition / Poor diet is not enough protein, excessive protein is not enough fresh fruit and vegetables (antioxidants), among other theories.
High body fat High fat can be a symptom of this trend relates to genetic disorders trend high blood pressure, diabetes and insulin resistance.
Lack of magnesium oxide and magnesium B6 stabilizes vascular smooth muscles and helps regulate vascular tone. Too much magnesium acts as a laxative and is not absorbed into the body.
Genetic tendency

What do preeclampsia?

It can cause your blood pressure to rise, and puts you at risk of stroke or kidney function violation, the violation of liver function, blood coagulation problems, pulmonary edema (fluid in the lungs), seizures, and in severe forms, maternal and infant mortality. Because preeclampsia affects the blood and the placenta, babies can be smaller, and often born prematurely. Ironically, sometimes children can be much higher. Although maternal death from preeclampsia rare in the United States, it is a major cause of morbidity and mortality in the world for mothers and babies.

As preeclampsia affects pregnancy?

Preeclampsia is often silent, appears unexpectedly during routine checks of blood pressure and urine tests. In cases like this, if a child is short-term (after 36 weeks) induced a child and the mother put watched and sent home, as usual.

If preeclampsia occurs at the beginning of pregnancy, especially for mothers expecting multiple births, its impact is more profound. Duration of work, a place of rest, medication and even hospitalization may be required to keep blood pressure under control. It is in the interest of kids to be kept in utero as long as possible. Unfortunately, the only "cure" for the disease is to deliver the child. Sometimes it is in the best interest of the mother to deliver the child to term. Medical staff may prescribe anti-hypertensive drugs, such as beta-blockers and, in rare cases, or lasix Diuretics (water pills), despite the fact that usually is not recommended. If blood pressure can be managed with medication and treatment, and the mother and / or child's health is at risk, the mother may be given steroids to help in the maturation of the infant lungs, and the child will be delivered.

When preeclampsia in pregnancy occur?

Preeclampsia can occur at any time during the pregnancy, delivery and up to six weeks after partum, although it is most frequent in the last trimester, and is converted within 48 hours after birth. Preeclampsia can develop gradually, or come on quite suddenly, even burning in a matter of hours, although the signs and symptoms may be present for months undetected or unnoticed.

Can preeclampsia occur after childbirth?

In some cases, preeclampsia does not appear until the time of delivery, or up to two weeks after partum. Although it is less dangerous for the child, it is actually the most critical time for the mother. Any of the above signs and symptoms should be cause for concern, and the mother must immediately contact its medical services.

As preeclampsia affect the child?

Prematurity

Preeclampsia is responsible for 15% of premature births in the United States each year. It is the leading known cause of premature birth. According to the March Dimes, in 2001, 476250 babies born prematurely… more than half of unknown causes. Preeclampsia is 30% of the known causes of premature - or about 70000 premature births.

A child is considered premature until 36 weeks of pregnancy (earlier this month), but the most serious problems for premature infants born before 32 weeks, approximately, in the developed countries, and later in developing countries. (In developing countries often lack the critical level of service that require preemies). Effect of prematurity, not fully aware that, even in infants, which were only slightly premature.

Intrauterine Growth Restriction (IUGR)

Reducing the inflow of blood to the placenta restricts the supply of food for the child and could lead to food shortages and the subsequent famine. As a result, they may be less for their gestational age. Ultrasounds can help identify IUGR. The good news is that many children who suffer from IUGR may catch up on their growth in the next few months.
It is important to note that many women blame themselves or poor nutrition for IUGR. Such problems caused by the absence of the placenta, but not the mother diet. A woman can have all the right things, but if the placenta is not capable of withstanding such nutrients together - the child will suffer.

Acidosis

The child survives, taking nutrients and oxygen through the placenta. In preeclampsia, the placenta becomes compromised, and the child begins restricting blood flow authority to limbs, kidneys and stomach in order to maintain the vital supply to the brain and heart. If the child reaches the point where there is no more margin of oxygen (as placenta separates or dies) Child body can take their energy from fuel without oxygen. This process creates toxic waste product - lactic acid. If too much lactic acid builds up the child will develop "acidosis" and become unconscious and move. Delivery is important at this stage. (thanks: Pre-Eclampsia: Facts on Redman, Walker, 92).

Death

The infant mortality rate is one of the most devastating effects of preeclampsia. It is impossible to say how many children die each year, but, according to our estimates, at least 1200 children die as a result of preeclampsia in the United States alone. Many countries do not have the means to preserve the premature baby alive. In these countries - is a significant number of deaths.

At Preeclampsia Foundation full 20% of our members have lost at least one child, or suffered a miscarriage. Because the disease can manifest in a very short time - a woman can have a normal prenatal appointments in the morning and lose their child in the afternoon. We encourage our women to unnecessary caution.

Current life tasks

Preeclampsia was associated with a variety of problems for children born prematurely, including the training of people with disabilities, cerebral palsy, epilepsy, blindness and deafness. What also raises the risk of premature extended hospitalization, and the small size of pregnancy interruption of valuable bonding time for the family. Prematurity stresses family, and this stress is compounded when the mother is also ill.

Some studies have shown that children are born with preeclamptic mothers had an increased risk of high blood pressure and diabetes later in life. Very few studies, which followed the health of these children.

Education, vigilance and being active patients can reduce some of these deaths, but ultimately, we need further studies. We need to find a remedy.

What is the treatment?

The only treatment is to deliver the child. When developing preeclampsia, a mother and her child are carefully managed. There are medicines and treatments that could prolong the pregnancy, which can increase the chances of child health and survival. Unfortunately, after the course has begun preeclampsia, maternal health must be constantly compare the health of the child. In some cases, the child must be delivered immediately, regardless of the duration of pregnancy to save the mother and / or child in your life.

What can we do?

Right now, early detection through a simple verification measures and good prenatal care can predict or delay many of the consequences of the condition. Surgical treatment saves lives. Research can provide analysis of the causes of this state, and even help to develop treatments. In Preeclampsia Foundation could help fund the research needed to find work, treatment and bring the information we already have to those who need it most. In developing countries, at least 30 per cent of maternal mortality caused by preeclampsia, and part of our mission is to reduce maternal and infant mortality rates at the international level. With your help we can achieve that mission.

Will I be able to get preeclampsia in subsequent pregnancies?

When my first pregnancy was normal…

If you had a normal first pregnancy, the risk of preeclampsia in the next pregnancy is very low, but if you have other risk factors (such as advanced maternal age, overweight, family history of hypertension), you should still be careful and Alert early warning signs. A study conducted in Aberdeen, Scotland, found that nearly 1 in 150 women, whose blood pressure was quite naturally in their first pregnancy had preeclampsia in the second pregnancy. (1992)

If I preeclampsia in my first pregnancy or earlier…

There was no significant prospective studies on the recurrence rate in subsequent pregnancies, but the consensus among experts is that preeclampsia in a previous pregnancy is the biggest risk factor for developing preeclampsia. It is absolutely wrong to say that if it had, in his first - you do not get it again. The danger, she again is approximately 20%, but the experts cite the range of 5-80%, depending on where you are in the previous pregnancy, and how much you have it.

The risk increases if your previous pregnancy after you have developed chronic hypertension, diabetes, or if you are having IVF, twins or other multiples, as well as the risk factors noted above.

If I had it in the first rather than the second…

If you do not have preeclampsia in the second pregnancy, the risk of a recurrence in the third is at a low level, although this may happen.

If I was encouraged to receive pregnant again…

Some preeclampsia traumatic experience for those who care for you as well. Sometimes the doctor feels its depth and will make recommendations for future pregnancy because they do not know what will happen, and they fear for the safety and well-being. We advise all women in this position to seek pre-pregnancy consultation with the perinatologist who specializes in preeclampsia and related diseases. They can review your chart and give you a clearer idea about your risks. Even well-meaning PCs might not have the experience to this call. No one can decide for you, but they can help you weigh your options.

Some of our experts who weighed in on this topic in the forum.

More answers to your questions that will be coming soon!

Effect of preeclampsia
After preeclampsia
Dealing with loss
What if the wife or partner of preeclampsia?
What are the long-term consequences for preeclampsia my child?
Preeclampsia and Loss
Pregnancy after preeclampsia
Global implications

If you have a question, you think we should publish on "Frequently Asked Questions" please write us directly to info@preeclampsia.org

from preeclampsia.org

Preeclampsia Sign And Symptoms

2008-02-06T00:34:00.000-08:00

None

High blood pressure is a silent killer. Most women diagnosed with preeclampsia do not feel sick. Many signs and symptoms of preeclampsia mirror other "normal" effects of pregnancy on your body. Women diagnosed with preeclampsia may be disappointed when prescribed bedrest because they feel fine. If you feel fine, it might be difficult for you or your partner understand that preeclampsia is a serious condition.

What you can do ...

Adequate prenatal care is crucial. Tests taken at these tests: Weighing in your blood pressure, your urine clad all done to screen preeclampsia. Especially after 20 weeks - do not miss your prenatal appointments. As with any pregnancy, prenatal good diet full of vitamins, antioxidants, minerals and basic food groups is important; reduce foods, refined sugars, caffeine and disconnection, alcohol and any drugs not covered by the doctor is important. It is also advisable to talk to your health care professional before taking any supplements, herbal or otherwise.

Hypertension (high blood pressure)

High blood pressure is defined as a blood pressure of 140/90 or higher, as measured in two separate cases within six hours. However, a woman who typically has a low baseline blood pressure, such as 90/60, can be considered hypertension on blood pressure less than that - especially if she has other symptoms. A rise in the diastolic (the lower number) by 15 degrees or more, a rise in systolic (top number) at 30 degrees or more a cause for concern.

In 1990, the National Institutes of Health, the National High Blood Pressure Education Program: Report of the Working Group on High blood pressure during pregnancy has issued the following research guidelines:

In the past, it was recommended that an increase of 30 mm Hg systolic and 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even if the absolute value of less than 140/90 mm Hg. This definition was not included in our criteria, because the only available evidence indicates that women in this group are not likely to suffer more adverse outcomes. Nevertheless, it is the collective view of the clinical team that women who have an increase of 30 mm Hg systolic and 15 mm Hg diastolic blood pressure requires close monitoring, especially in the case for embryo and hyperuricemia (uric acid [UA] greater than or equal to 6 mg / dl) were also present.

In addition, it should be noted that 4 Preeclampsia Foundation Board member medical board and our executive director participated in the working group. There was considerable discussion of eliminating baseline BP, as a diagnostic, and that is why the final verdict was included. In Preeclampsia Foundation continues to encourage its women, particularly low-baseline BPs, know their reference and to be aware of significant changes, and make any concerns about these changes, know their medical services.

What you can do ...

Know your basic blood pressure (your blood pressure before pregnancy), find out what it means, and ask: "What are my numbers" on each page. If you said "This is normal, repeat," What are my numbers? " If you had preeclampsia before, or if you have chronic high blood pressure, consult a specialist, with a high risk of a PC or perinatologist, about your pregnancy. You can find a perinatologist near you who specializes in hypertension during pregnancy, moving to the North American Society for the Study of Hypertension in Pregnancy (www.nasshp.com). Women who have had preeclampsia in a previous pregnancy should be required to complete the survey in perinatologist to exclude any underlying disease or problems such as hypertension, chronic, autoimmune diseases, thrombophilias, kidney disease, etc. Women with a previous history of preeclampsia subsequent pregnancies should be under the control of an obstetrician or perinatologist. The only big risk factor for obtaining a history of preeclampsia, and it has been before.

If you are inactive or higher than the average body mass index (BMI), make sure to exercise moderately and get yourself in the best shape you can. (You can calculate your BMI). Women with a BMI of 30 or above, are at increased risk of preeclampsia, and efforts should be made to reduce this risk by following the advice of his doctor.
Finally, you can buy your own monitor blood pressure in most pharmacies. Some pharmacies have a monitor for your use. Keep a journal of your blood pressure taken at the same time every day, if possible, and in the same position. Share with your care provider. If you have your own monitor, you can take it with you to your appointment and calibrated to match those in the office. You can also ask your doctor when they last had their calibrated monitor.

It should be noted that in the House, is not always accurate, as in its clinic or hospital. Home readings should not be a substitute for prenatal visits, as well as the "normal" reading means ignoring symptoms, which can be markers of preeclampsia. Main testimony can be used only to help the mother will play a more active role in her care.

If you are diagnosed with preeclampsia, many doctors will recommend bedrest and, in late pregnancy, lying on the left side. Although health care is not always agree that lying on the left side of help, there is no evidence of harm. In thinking is that lies at the bottom on the back may result in the pregnant uterus (and the weight of the child), to limit the vein that supplies the heart.

Swelling and edema (particularly of the hands or face)

Some tumor during pregnancy, that's fine. Edema is the accumulation of excess fluid. This is particularly about where it accumulates in the face (eyes), or with your hands. It is normal to have trouble wearing rings throughout pregnancy.

What you can do ...

Find a picture just before pregnancy. Share with your provider if you think your face is too puffy. If your swelling of the extremities becomes severe, you may notice, pitting edema (when you press your finger on the skin, an indentation remains for a few seconds), or the colour of your legs. If this happens, notify your provider, put their feet every day (but avoid meeting for extended periods), and drink water to keep hydrated.

Embryo (protein in your urine)

Embryo is the result of proteins, usually boils down to blood spilling in your urine, as well as the small blood vessels in the kidneys become damaged. A simple dipstick test your urine at each prenatal check-up of the embryo may screen.

What you can do ...

At each prenatal visit to ask for the results of the urine test. Usually nurse dips reagent strip in your urine sample, and then waiting a minute for the results. Tapes are marked for "tracking", 1 +, 2 +, etc. A reading trace protein is relatively common, and are usually not a cause for concern. If strip shows reading 1 + or greater, it may mean the beginning of preeclampsia, even if blood pressure less than 140/90. If you have 2 + reading, call your health services immediately. If you are concerned or have preeclampsia in the past, you can buy the reagent strip in some pharmacies or on the Internet. They are not cheap, and insurance may not cover them.

Sometimes health care workers will have to take a mother of 24 - hour urine collection for the official laboratory evaluation. This is not a particularly pleasant task, but if you have requested to do so, please follow the directions of your medical services carefully, and make every effort to ensure accurate.

Dark yellow urine, usually as a result of inadequate reception fluids and dehydration. However, urine, which is very dark or reddish color of cola, may indicate a problem. If you have these symptoms, let your care provider.

Sudden weight gain

A gain of more than 2 pounds a week, or 6 pounds per month, could be cause for concern.

What you can do ...

In general, there is usually, and do everything possible to fresh raw fruits and vegetables, your prenatal vitamin, and folic acid in addition to the diet. Do not try to diet or lose weight. It is important that you eat a healthy, balanced diet. Avoid excessive salt. And, as always, no alcohol, caffeine, smoking and recreational drugs. Consult with your provider of non-prescription drugs, and any herbal medicines can be taken. In Preeclampsia Foundation recognizes the importance of a good diet, but does not endorse any particular diet or juice product. Given that preeclampsia is a complex disease that women will develop it for different reasons. We call on all women to share with their doctors any diet or product they are trying. For some women - a good diet can make a significant difference, but we urge caution when trying to diet, particularly those that contribute a large amount of protein. For women with major kidney disease - excessive protein can be unsafe. Similarly, while women can use low doses of aspirin - studies show that he was associated with an increase in placental abruption and error, and therefore should not be taken as pregnant women, unless they were not informed of their physician.

Be sure to drink plenty of water, and receive regular moderate exercise. Your prenatal visits are not trying to hide any weight in skipping breakfast, using diet pills or post a day. The exact weight is vital for proper diagnosis.

Headaches

Dull, throbbing headaches, often described as migraine, that would simply will not go away.

What you can do ...

Talk to your care provider. If you tried-seizure medication information without assistance, or if the headache is very painful, or you have a light sensitivity required immediately and ask for a doctor on the same day.

Nausea and Vomiting

Nausea and vomiting is particularly important when a sudden onset, and in the second or third trimesters.

What you can do ...

Talk to your care provider. Nausea and vomiting can be confused with the flu, so be sure to get your blood pressure checked and ask your urine is checked for embryo. Insist on both.

Changes in vision

Vision changes include temporary loss of vision, a sense of flashing lights, auras, light sensitivity, and blurry vision or spots. For some women who are farsighted, vision may even improve.

What you can do ...

If you have any of these symptoms, you may be developing preeclampsia. Symptoms such as these can be associated with irritation of the central nervous system, and they should be taken seriously. They can measure cerebral edema (brain tumor). It is very important that you consult with your provider as soon as possible. If he or she is not available, then you should go directly to the hospital. We see these symptoms, as a potentially very serious, and they should not be left until the morning, tomorrow and, in particular, not to the end of weekend. With preeclampsia, it is better to have the health professionals tell you it was nothing than take chances that might risk your child or his life. No doctor all died of a woman seen too much time.

Racing pulse, mental confusion, increased anxiety, problems catching breath

If the symptoms are new to you, they may indicate elevated blood pressure.

What you can do ...

Contact your doctor if these symptoms are new. If not, be sure to mention them on your next visit.

Stomach and / or right-Shoulder pain

This type of pain in the stomach, called epigastric pain, medical practitioners, as a rule, in accordance with the right side of the ribs. It may be confused with heartburn, gall bladder problems, influenza, and understand the pain of the child or his feet. Shoulder pain is often referred to as the transfer of pain, as it radiates from the liver under the right ribs. Lower back pain, muscle strain differs from the common to pregnancy. This tends to be more acute and specific. Anything can be a sign of HELLP syndrome or related problem in the liver. Shoulder pain may feel like someone pinching you deeply along brassiere strap, or it can be painful to lie on the right side.

What you can do ...

Pain in this area should be taken very seriously, does not relieve him and go to sleep. Talk to your health professional immediately.

Lower back pain

Lower back pain is one of the most common complaints during pregnancy. However, sometimes it may indicate a problem with the liver, especially if accompanied by other symptoms or preeclampsia.

What you can do ...

Read also stomach and right Shoulder Pain (above), and to celebrate this symptom to your doctor. If the pain is accompanied by one or more other symptoms, you should call your health care immediately.

Hyperreflexia

Hyperreflexia when your reflexes are so strong that when they checked, your legs bounce back hard.

What you can do ...

This is usually not something you notice yourself, but if you are bumped and you will notice an abnormally strong reflexive response, it may be worthy of a call to your health care provider.

from preeclampsia.org

What is Preeclampsia ?

2008-02-06T00:26:00.000-08:00

Pre-eclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the fetus. That affects at least 5-8% of all pregnancies, is rapidly progressive which is characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden increase in weight, headaches and vision changes are important symptoms, but some women with the disease progresses rapidly report few symptoms.

In general, pre-eclampsia occurs after 20 weeks of gestation (in the late 2 nd and 3 rd quarter in mid or late pregnancy), but may occur sooner. Good prenatal care is essential to diagnose and treat preeclampsia. Preeclampsia, hypertension induced by pregnancy (PIH), toxaemia and conditions are closely related. HELLP Syndrome and eclampsia are other manifestations of the same syndrome. It is important to note that research shows that a larger number of women who die from pre-eclampsia and eclampsia one is not necessarily worse than the other.

Preeclampsia and other hypertensive disorders of pregnancy are the leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76000 deaths each year.

Neurocysticercosis

2008-01-28T03:54:00.000-08:00

Abstract

Neurocysticercosis is a leading cause of seizures and epilepsy in the developing world and is an increasingly important health issue in the United States. Recent results from the Cysticercosis Working Group in Peru provide new evidence supporting the use of antiparasitic agents in highly selected patients with active cysts and seizures.

Introduction

Cysticercosis is a parasitic infection that results from ingestion of eggs from the adult tapeworm, Taenia solium (T. solium) (1,2). When cysticercosis involves the central nervous system, it is called neurocysticercosis. Neurocysticercosis is the most common parasitic infection of the brain and a leading cause of epilepsy in the developing world, especially Latin America, India, Africa, and China (1–12).

Once largely the domain of the developing countries, neurocysticercosis is currently a growing public health problem in the United States (13,14). Because millions of people have immigrated to the United States from Latin America in recent years, neurocysticercosis has become an increasingly important cause of seizures in the United States (14). For example, between 1994 and 1998, an average of 120 patients with cysticercosis were admitted to Los Angeles County/USC Medical Center per year (15,16), which was a substantial increase from 1983, when 80 cases were identified in all four Los Angeles County hospitals together (13). Cysticercosis now accounts for up to 10% of emergency room visits for seizures in the southwestern United States

Natural History

Neurocysticercosis is acquired through consumption of food contaminated with feces of a T. solium tapeworm carrier (i.e., through fecal–oral contract) (4,5,12). The life cycle of T. solium is shown in Fig. 1. Eggs of the tapeworm are shed in stool and contaminate food through poor hygiene. When these eggs are ingested and exposed to gastric acid in the human stomach, they lose their protective capsule and turn into larval cysts, called oncospheres. Oncospheres cross the gastrointestinal tract and migrate via the vascular system to the brain, muscle, eyes, and other structures. Once in the brain, the larval cysts (cysticerci) initially generate a minimal immune response and may remain in the brain as viable cysts for years.

FIGURE 1

Life cycle of Taenia solium.

Figure 2 shows the four stages of cysts within the parenchyma of the brain: vesicular, colloidal, nodular/granular, and calcified granulomas. The viable larval cyst is known as a vesicular cyst (Fig. 2A) and has minimal enhancement, which is due to little or no host immune response. At this stage, the scolex usually is identified as an eccentric nodule within the cyst. As the cyst degenerates, fluid from the larval cyst leaks into the parenchyma, generating a strong immune response, characterized by enhancement on contrast computed tomography (CT) and magnetic resonance imaging (MRI). An enhancing cyst, without a well-defined scolex, is termed a colloidal cyst (Fig. 2B). As the cyst further deteriorates, it forms a nodule, which continues to demonstrate contrast enhancement (Fig. 2C). Finally the degenerating cyst forms a calcified granuloma, which is recognized as nonenhancing punctuate calcifications on CT (Fig. 2D). Cysts that lodge in the cisterns or ventricles of the brain may cause hydrocephalus and frequently do not have a scolex (e.g., racemic cysts).

FIGURE 2

Brain imaging demonstrating the four stages of parenchymal neurocysticercosis. A: Magnetic resonance imaging (MRI) of a vesicular cyst. Note the well-defined scolex, minimal contrast enhancement, and mass effect. B: MRI of a colloidal cyst. Note ring (more ...)

Presentation

Neurocysticercosis typically is first seen either with seizures (70% to 90% of acutely symptomatic patients) or headache (4,5,7,11,12). Headache usually indicates the presence of hydrocephalus, meningitis, or increased intracranial pressure. When hydrocephalus is present, the use of antiparasitic drugs is relatively contraindicated, unless a shunt is placed before administration. The mortality rate of patients with hydrocephalus or increased intracranial pressure is higher than the mortality rate of patients with seizures (16).

Epileptogenesis in Neurocysticercosis

Generally, patients with neurocysticercosis have partial-onset seizures with or without secondary generalization (6). At the time of a first seizure, most patients have an active cyst—either a vesicular cyst (Fig. 2A) or a colloidal cyst (Fig. 2B) (11). New-onset seizures are commonly associated with active cysts rather than calcified granulomas (11,19). Chronic epilepsy is usually associated with calcified granulomas (6,11,17–19). Cysts that are active and undergoing degeneration (colloidal cysts) are the most epileptogenic. Cysts degenerate fastest within 6 to 12 months after initial presentation (19). Seizure-recurrence rates also increase during the same period, because of the conversion from vesicular cysts to colloidal cysts (19). Animal data support the concept that active or degenerating cysts (vesicular or colloidal) are the most epileptogenic (20). Products from acute cysts injected into animal brains are significantly more epileptogenic than are products from chronic granulomas (20).

Epileptogenesis in patients with neurocysticercosis can be attributed to several factors: inflammation, gliosis, genetics, and predilection for the cysts to travel to the frontal and temporal lobes (17,18,20–23). The host response to degenerating cysts plays an important role in the associated epileptogenesis (22). In children and young women, a profound host reaction develops to parasitic infection of the brain, whereas adults have a more variable response. Within-subject responses also vary. For example, in the same patient, intense inflammation may surround one cyst, whereas an adjacent cyst may show no inflammation (17,19).

Treatment

Albendazole and praziquantel are the principal antiparasitic drugs used to treat neurocysticercosis (1,2,12,19,22–27). Whether and when antiparasitic drugs should be administered is controversial. Data from open-label trials suggest that praziquantel and albendazole reduce the number of cysts and frequency of seizures (23–25,30). In a seminal study, Vasquez and Sotelo (30) found that seizure-free rates at 3 years, for those offered antiparasitic therapy, were significantly higher than those of a nonrandomized control group (94% seizure free). This finding is supported by data from Del Brutto et al. (11), who found that 83% of those individuals who received antiparasitic treatment became seizure free, compared with only 26% of those patients who did not receive treatment.

Some authors suggest that antiparasitic treatment might be counterproductive and expose patients to increased risk (12,27). The risks of antiparasitic therapy include gastrointestinal side effects, acute seizures, increased intracranial pressure, and rarely, death (1,12,16,26). Side effects, although usually mild, include nausea, headache, seizures, and occasionally, cerebral edema (26,27). Deaths associated with antiparasitic treatment are rare (1% to 4%) and occur primarily in patients with hydrocephalus, increased intracranial pressure, and heavy cyst burden (i.e., more than 20 cysts) (16). In the first randomized comparison of albendazole, praziquantel, and steroids for the treatment of active cysts, Carpio (27) found no significant difference in seizure-free rates among the three treatment groups.

Recently, however, the Cysticercosis Working Group in Peru compared the efficacy and safety of albendazole (400 mg twice a day) with placebo for the treatment of active cysts associated with seizures (31). As in the study of Carpio et al., total seizure-recurrence rates at long-term follow-up were no different for the active and control groups (27,31). However, patients randomized to albendazole experienced a significant (67%) reduction in generalized tonic–clonic seizures compared with the control group (31). Safety was excellent, and no deaths were reported. The low death rate may have been due to the relatively small size of the study (n= 120; 60 in each treatment group) and the exclusion of patients with increased intracranial pressure. This study is a major advance, for it is the first randomized, placebo-controlled clinical trial to demonstrate that albendazole substantially reduces generalized tonic–clonic seizure recurrence (31).

Prognosis

In adults and children first seen with new-onset seizures and active cysts, seizure recurrence rates at 4 years are as high as 49% (19). After a second seizure, the estimated risk of recurrence is 68% at 6 years (19). Prognosis is best for those patients in whom imaging studies normalize. The recurrence rate for those patients with persisting, active cysts (61%) is more than double the rate of patients with normal imaging (22%) (19). Seizure recurrence is reduced in patients who initially have calcifications rather than active cysts (11,17,18). Del Brutto et al. (11) found that patients first seen with new-onset seizures and calcifications fared better than those with active cysts: 100% with calcifications were seizure free at 2 years, compared with 83% with active cysts. Durón et al. similarly found that among 25 patients initially seen with calcifications, seizures remitted in 62.8% (17).

Conclusion

Neurocysticercosis is a leading cause of epilepsy in the developing world and is increasingly prevalent in the United States. New data from the Cysticercosis Working Group indicate that treatment with albendazole significantly improves the prognosis for the recurrence of generalized tonic–clonic seizures in highly selected patients. Results of this trial should not be applied to high-risk patients, such as those with heavy cyst burden or increased intracranial pressure. Better understanding of the mechanisms of neurocysticercosis and the life cycle of T. solium is needed to develop appropriate intervention and prevention programs. Global strategies for prevention and control should be developed and enforced with the aid of international health organizations, including the World Health Organization.

from pubmedcentral.nih.gov

http://our-medical-center.blogspot.com/2008/01/neurocysticercosis.html

Top 10 Stress Relievers: The Best Ways To Feel Better

2008-01-28T03:43:00.000-08:00

There are many ways to reduce tension and relax. Here are the ten stress relievers I believe are most effective for the amount of work and time involved. Some can be learned in the time it takes to read this page, while others take a little more practice, but there's something here for everyone!

1. Breathing Exercises

Deep breathing is an easy stress reliever that has numerous benefits for the body, including oxygenating the blood, which ‘wakes up’ the brain, relaxing muscles and quieting the mind. Breathing exercises are especially helpful because you can do them anywhere, and they work quickly so you can de-stress in a flash. The Karate Breathing Meditation is a great exercise to start with, and this basic breathing exercise can be done anywhere!

2. Meditation

Meditation builds on deep breathing, and takes it a step further. When you meditate, your brain enters an area of functioning that’s similar to sleep, but carries some added benefits you can’t achieve as well in any other state, including the release of certain hormones that promote health. Also, the mental focus on nothingness keeps your mind from working overtime and increasing your stress level. Here's an article on different types of meditation to help you get started.

3. Guided Imagery

It takes slightly more time to practice guided imagery, but this is a great way to leave your stress behind for a while and relax your body. Some find it easier to practice than meditation, as lots of us find it more doable to focus on ‘something’ than on ‘nothing’. You can play natural sounds in the background as you practice, to promote a more immersive experience.

4. Visualizations

Building on guided imagery, you can also imagine yourself achieving goals like becoming healthier and more relaxed, doing well at tasks, and handling conflict in better ways. Also, visualizing yourself doing well on tasks you’re trying to master actually functions like physical practice, so you can improve your performance through visualizations as well!

5. Self-hypnosis

Self-hypnosis incorporates some of the features of guided imagery and visualizations, with the added benefit of enabling you to communicate directly you’re your subconscious mind to enhance your abilities, more easily give up bad habits, feel less pain, more effectively develop healthier habits, and even find answers to questions that may not be clear to your waking mind! It takes some practice and training, but is well worth it. Learn more about using hypnosis to manage stress in your life.

6. Exercise

Many people exercise to control weight and get in better physical condition to become more healthy or physically attractive, but exercise and stress management are also closely linked. Exercise provides a distraction from stressful situations, as well as an outlet for frustrations, and gives you a lift via endorphins as well. This article can tell you more about the stress management benefits of exercise, and help you get more active in your daily life.

7. Progressive Muscle Relaxation

By tensing and relaxing all the muscle groups in your body, you can relieve tension and feel much more relaxed in minutes, with no special training or equipment. Start by tensing all the muscles in your face, holding a tight grimace ten seconds, then completely relaxing for ten seconds. Repeat this with your neck, followed by your shoulders, etc. You can do this anywhere, and as you practice, you will find you can relax more quickly and easily, reducing tension as quickly as it starts!

8. Sex

You probably already know that sex is a great tension reliever, but have you officially thought of it as a stress-relieving practice? Perhaps you should. The physical benefits of sex are numerous, and most of them work very well toward relieving stress. Sadly, many people have less sex when their stress levels are high. Learn how to avoid this trap!

9. Music

Music therapy has shown numerous health benefits for people with conditions ranging from mild (like stress) to severe (like cancer). When dealing with stress, the right music can actually lower your blood pressure, relax your body and calm your mind. Here are some suggestions of different types of music to listen to, and how to use music in your daily life for effective stress management.

10. Yoga

Yoga is one of the oldest self-improvement practices around, dating back over 5 thousand years! It combines the practices of several other stress management techniques such as breathing, meditation, imagery and movement, giving you a lot of benefit for the amount of time and energy required. Learn more about how to manage stress with yoga.

from stress.about.com
http://our-medical-center.blogspot.com/2008/01/top-10-stress-relievers-best-ways-to.html

Get Rid of Stress

2008-01-28T03:40:00.000-08:00

You can't eliminate most of the things that cause stress in your life like finances, spouses, bosses and kids. But you can alleviate the symptoms of stress by using yoga, meditation and sex.

If you’re feeling stressed on the road, look for a hip hotel from the Kimpton boutique chain. They offer a complimentary yoga program, including mats, a brochure and TV channel showing yoga positions and techniques to offer you relaxation techniques. (Sadly, there isn’t yet a hotel chain offering free sex brochures to stressed-out travelers, so you’re on your own there.)

But maybe the most fun way (OK, the second most fun way) to reduce stress in your life is by using laughter as your own best medicine

from makeover.about.com
http://our-medical-center.blogspot.com/2008/01/get-rid-of-stress.html

Miscarriage Prevention

2008-01-14T03:52:00.001-08:00

There is no way to predict or prevent a miscarriage. Certain steps can be taken, however, to give your pregnancy every chance to continue to term.

Get prenatal care and follow the advice of your health care provider (family doctor, obstetrician, midwife).

Avoid alcohol, nicotine, and street drugs, especially cocaine, during pregnancy.

Avoid or cut down on caffeine.
Control high blood pressure and diabetes.
Identify and treat any bacterial and certain viral infections.

from emedicinehealth.com
http://our-medical-center.blogspot.com/2008/01/miscarriage-prevention.html

Miscarriage Self-Care at Home

2008-01-14T03:51:00.001-08:00

If you are not sure if you are pregnant, a home pregnancy test will confirm or exclude pregnancy in most cases.

If the test is negative, discuss the bleeding and cramping with your health care provider.

If the test is positive and you have bleeding or cramping, call your provider.
Rest and avoid sexual intercourse.
You may also safely take acetaminophen (Tylenol) at any time during pregnancy. Do NOT take aspirin, ibuprofen (Motrin or Advil), or naproxen (Aleve) if you are pregnant.

from emedicinehealth.com

http://our-medical-center.blogspot.com/2008/01/miscarriage-self-care-at-home.html

Miscarriage Treatment

2008-01-14T03:50:00.000-08:00

If your health care provider feels that you are having a spontaneous abortion or miscarriage, little can be done in the way of prevention. If you are actively miscarrying and your health care provider does not think you have a living pregnancy, you will also be seen by an obstetrician (specialist in women’s reproductive health), who may recommend ending the pregnancy. A procedure called dilation and curettage (D&C) can be performed or further observation takes place to let nature take its course.

If you have a urinary tract infection, antibiotics that are safe to take in pregnancy will be prescribed.

In certain situations, you and your baby may have incompatible blood types. If your blood sample shows that you are Rh factor negative (a certain blood type), you will be given medication (RhoGAM) to prevent a possible blood type interaction with the baby (which could occur if the baby were Rh positive).

You will be counseled and given materials or instruction concerning the possibility of spontaneous abortion. If the mouth of your uterus is closed, if you are not bleeding heavily, your lab work is normal, and an ultrasound shows you do not have an ectopic pregnancy, you may rest at home with the following instructions:

Get plenty of rest.

Avoid douching and sexual intercourse.

Watch for the passage of any white or gray material from your vagina. This may represent what are known as the products of conception.

Return to the emergency department if bleeding or pain worsens, or if you develop fever, weakness, or dizziness.

Go to your doctor to be reexamined in about 48 hours.

from emedicinehealth.com
http://our-medical-center.blogspot.com/2008/01/miscarriage-treatment.html

Miscarrage Exams and Tests

2008-01-14T03:49:00.000-08:00

Medical history: You will be asked questions about your pregnancy, such as the following:

How far along is your pregnancy?
When was your last normal period?
How many times have you been pregnant?
How many living children do you have?
How many miscarriages have you had?
Have you ever had an ectopic (tubal) pregnancy?
How many abortions have you had?
Were you using any sort of birth control when you got pregnant this time?
Is this a planned pregnancy?
Do you plan to keep this pregnancy?
Have you had any prenatal care?
Have you had any problems urinating?
Have you had an ultrasound yet to show that the pregnancy is in the right place?
Do you know your blood type?
What medical problems do you have?
What medications do you take every day?
What herbs or other products do you take every day?

Physical exam: For the pelvic exam, you will lie on your back with your knees bent and your feet in stirrups.

You may have a speculum exam. A metal or plastic device is put in your vagina and then opened, spreading the walls of your vagina apart so the health care provider can look right at the mouth of your womb. If a lot of blood or clots are present, the provider may use a clamp or gauze to remove them. You should not feel any pain during this part of the exam, although you may be embarrassed and uncomfortable.
You may bleed from the vagina before, during, and even after a miscarriage. The health care provider will assess the opening of the entrance to the womb (called the os) and, depending on the findings, will be able to tell you more accurately which of the stages of miscarriage you might be experiencing.

The health care provider may put gloved fingers in your vagina and feel your abdomen with the other hand. He or she can feel whether the mouth of your uterus is open, how big your uterus may be, and whether any signs of infection or tubal pregnancy exist. The size of your uterus may be smaller than expected for the fetus if you have already miscarried.

Lab tests: Pregnancy tests can be either urine tests or blood tests. Your health care provider or emergency department doctor, if you go to the hospital with alarming symptoms, will act quickly to determine if you are pregnant.

A urine pregnancy test along with blood samples will be sent to the laboratory to check for blood loss or anemia, blood type, and the level of the pregnancy hormone. This hormone is called human chorionic gonadotropin or hCG.
- A number too low may suggest that the pregnancy is abnormal. No single number is "normal." A very low number (under 1,000) suggests an abnormal pregnancy, although it could just reflect an early stage of pregnancy.
- A very high number (over 100,000) strongly suggests a normal living pregnancy. Most other hCG numbers by themselves do not help a lot but can be compared to another test done in two to three days to see if everything is developing normally.
A complete blood count may be drawn. If you have been bleeding a lot, you may be anemic (loss of too much blood) and need special care. If you have a fever, your white cell count may suggest you have an infection.
If you do not know your blood type, this will also be checked.
If you have symptoms of a urinary infection, a urine sample will be taken and examined.

Ultrasound: If you are pregnant, an ultrasound may be performed to look for evidence of a pregnancy within the uterus. If the radiologist, gynecologist, or emergency department doctor cannot find evidence of a pregnancy within the uterus, you will likely be evaluated further for a pregnancy that is outside your uterus. When the fertilized egg implants in the fallopian tube, this is called a tubal or ectopic pregnancy.

Your bladder has to be full for this test, so you will have to drink a lot of water, or the technician will give you fluid in your vein and ask you not to go to the bathroom until after the test is done.
The technician will put some cold jelly on your abdomen and press down with a probe to see your internal organs. The ultrasound technician may also use a vaginal probe inside your vagina to get a better look at your tubes and ovaries. Neither of these studies should be painful.

from emedicinehealth.com
http://our-medical-center.blogspot.com/2008/01/miscarrage-exams-and-tests.html

When Miscarriage to Seek Medical Care

2008-01-14T03:48:00.000-08:00

Call your health care provider if you know or suspect you are pregnant and you are experiencing any of the following:

Vaginal bleeding

Abdominal pain or cramping, or low back pain

Weakness or dizziness

Uncontrollable or severe nausea or vomiting

Urinary symptoms such as burning, frequency, or pain with urination

Go immediately to the hospital's emergency department if any of the following are true:

You know or suspect you are pregnant and have heavy vaginal bleeding (soaking more than one pad every hour) or pain in the back or the abdomen.
You are passing something that looks like tissue (place what you have passed into a jar or container and take it with you to the hospital).
You have a history of ectopic (tubal) pregnancy.
You are extremely dizzy or pass out.
You have a known pregnancy accompanied with passage of clots or other material.
You have a fever of greater than 100.4°F.
You are vomiting; nothing stays down.

from emedicinehealth.com

http://our-medical-center.blogspot.com/2008/01/m.html

Miscarriage Symptoms

2008-01-14T03:47:00.000-08:00

If you are having a spontaneous miscarriage, you will probably have vaginal bleeding, abdominal pain, and cramping.

Bleeding may be only slight spotting, or it can be quite severe. Your health care provider will ask about how much you have bled—usually the number of pads you've soaked through. You will also be asked about blood clots or whether you saw any tissue.

Pain and cramping occur in the lower abdomen. They may occur on only one side, both sides, or in the middle. The pain can also go into your lower back, buttocks, and genitals.
You may no longer have signs of pregnancy such as nausea or breast swelling/tenderness if you have experienced a miscarriage.

from emedecinehealth.com
http://our-medical-center.blogspot.com/2008/01/miscarriage-symptoms.html

Miscarriage Causes

2008-01-14T03:46:00.000-08:00

Miscarriage is caused by the separation of the fetus and placenta from the uterine wall. Although the actual cause of the miscarriage is frequently unclear, the most common reasons include the following:

An abnormal fetus causes almost all miscarriages during the first three months of pregnancy (first trimester). Problems in the genes are responsible for an abnormal fetus and are found in more than half of miscarried fetuses. The risk of defective genes increases with the woman's age, especially over if she is older than 35 years.

Miscarriage during the fourth through sixth months of pregnancy (second trimester) is usually related to an abnormality in the mother rather than in the fetus.

Chronic illnesses, including diabetes, severe high blood pressure, kidney disease, lupus, and underactive or overactive thyroid gland, are frequent causes of a miscarriage. Prenatal care is important because it screens for some of these diseases.

Acute infections, including German measles, CMV (cytomegalovirus), mycoplasma ("walking" pneumonia) and other unusual germs, and severe emotional shock, can also cause miscarriage.

Diseases and abnormalities of the internal female organs can also cause miscarriage. Some examples are an abnormal womb, fibroids, poor muscle tone in the mouth of the womb, abnormal growth of the placenta (also called the afterbirth), and multiple gestations that place a stress on your system.
Other factors, especially certain drugs, including caffeine, alcohol, tobacco, and cocaine, may be related to miscarriage.

from emedicinehealth.com
http://our-medical-center.blogspot.com/2008/01/miscarriage-causes.html

Miscarriage Overview

2008-01-14T03:45:00.000-08:00

A miscarriage (also termed spontaneous abortion) is any pregnancy that spontaneously ends before the fetus can survive. Any vaginal bleeding, other than spotting, during early pregnancy is considered a threatened miscarriage. Vaginal bleeding is very common in early pregnancy. About one out of every four pregnant women has some bleeding during the first few months. About half of these women stop bleeding and complete a normal pregnancy.

Threatened miscarriage - Vaginal bleeding during early pregnancy. The bleeding and pain with threatened miscarriage are usually mild and the cervical os (the mouth of the womb) is closed. Your health care provider will be able to determine if the cervical os is open upon performing a pelvic exam. Typically, no tissue is passed from the womb. The womb and fallopian tubes may be tender.
Inevitable miscarriage - Vaginal bleeding along with opening of the cervical os. In this situation, vaginal bleeding is present, and the mouth of the womb is open (dilated). Bleeding is usually more severe, and abdominal pain and cramping often occur.
Incomplete miscarriage - Expulsion of some, but not all, of the products of conception before the twentieth week of pregnancy. With incomplete miscarriage, the bleeding is heavier, and abdominal pain is almost always present. The mouth of the womb is open, and the pregnancy is being expelled. Ultrasound would show some material still remaining in the womb.
Complete miscarriage - Expulsion of all products of conception from the womb including fetus and placental tissues. Complete miscarriage is just as it sounds. Bleeding, abdominal pain, and the passing of tissue have all occurred, but the bleeding and pain have usually stopped. If you can see the fetus, you have miscarried. Ultrasound shows an empty womb.

A miscarriage occurs when a pregnancy ends without obvious cause before the fetus is capable of survival, typically corresponsing to the twentieth to 22^nd week. This time is measured from the first day of your last menstrual period. Miscarriage is a common complication of pregnancy. It can occur in up to 20% of all recognized pregnancies. This ending of pregnancy is called a spontaneous abortion. In the medical field, the term abortion is often used to describe a miscarriage.

from emedicinehealth.com
http://our-medical-center.blogspot.com/2008/01/miscarriage-overview.html

Cellular Phone Causes Cancer

2008-01-04T01:45:00.000-08:00

"If Mobile Phones Were a Type of Food, They Simply Would Not be Licensed"

Cellular phone increases the risk of brain cancer (brain tumor).

Cellular phones can do biological damage through heating effects.

Cellular phone causes symptoms: including headaches, earaches, blurring of vision, short-term memory loss, numbing, tingling, and burning sensations, bad sleep,fatigue, Anxiety.

Single and double strand DNA breaks in brain cells increased after exposure to RF. Exposure to both continuous wave and pulsed RF (mobil phone) produced DNA damage. Double strand breaks, if not repaired, are known to lead to cell death.

Research by other scientists indicates that prolonged use of mobile phones may cause hot-spots to develop inside the brain, causing damage which could lead to Alzheimer’s disease or cancer (brain tumor).

Dr Henry Lai and Dr N. P. Singh from the University of Washington in Seattle believe the radiation changed brain cell membranes in the rats - and the effects are so severe that it could affect humans, too.

info@cancer-health.org

This statement was not uttered by some uneducated anti-technology activist, but rather was written by British physicist Dr. Gerald Hyland and was printed in the prestigious medical journal The Lancet.

A recent issue of the journal published 2 papers on the subject of cell phone safety, as well as an accompanying editorial. The editorial, written by Philip P. Dendy of Cambridge, UK, and entitled "Mobile phones and the illusory pursuit of safety" puts the 'safety' issue into perspective:

The deceptively simple question, much loved by television and radio interviewers, "Is it safe?" is the scientist's banana skin. A Nobel prize awaits the person who first designs an experiment to show that anything is "safe".

In the light of experience with ionizing radiation and radioactive materials, out-of-hand dismissal of the possibility of subtle effects of low-intensity, pulsed, microwave radiation is most unwise.

Early in the 20th century radon and radium-enriched spa waters were "recommended" for a wide range of aches and minor ailments. As knowledge of the harmful effects of ionizing radiation has increased and quantitative risk estimates have become possible (notwithstanding rather large error bands), the permitted annual dose limit has been progressively reduced from the 1930s to the present day.

Dr. Hyland writes an excellent paper, covering the possible mechanisms by which mobile phones, or cell phones, may cause adverse effects in people. Below are some exerpts from his paper, entitled "Physics and Biology of Mobile Telephony":

…there is evidence that the low intensity, pulsed radiation currently used can exert subtle non-thermal influences. If these influences entail adverse health consequences, current guidelines would be inadequate.This review will focus on this possibility.

The radiation used is indeed of very low intensity, but an oscillatory similitude between this pulsed microwave radiation and certain electrochemical activities of the living human being should prompt concern. …there are consistencies between some of these effects and the neurological problems reported by some mobile-telephone users and people exposed longterm to base-station radiation.

The Stewart Report (1), published in May, 2000, makes some sensible recommendations, but unfortunately some of its greyer areas are now being exploited by the industry to obfuscate the issue.

As yet unresolved is the question of adverse health impacts provoked by the contentious non-thermal effects of the low intensity, pulsed microwave radiation (MWR) used. For these effects are not taken into account in current safety guidelines (2), which simply restrict the intensity of the radiation to prevent tissue heating in excess of what the body's thermoregulatory mechanism can cope with….in the case of living systems (and only living ones) there are many reports over the past 30 years that MWR can exert non-thermal influences, at intensities well below those necessary to cause any detectable heating (3).

The purpose of this review is to introduce clinicians to the physics of mobile telephony and to explain how low-intensity, pulsed microwaves can affect living organisms, both thermally and non-thermally; and then to identify some of the reported biological impacts of exposure to this radiation, particularly those provoked by the contentious non-thermal effects.

Physics of Mobile Telephony

A base-station antenna typically radiates 60 W and a handset between 1 and 2 W (peak). The antenna of a handset radiates equally in all directions but a base-station produces a beam that is much more directional. In addition, the stations have subsidiary beams called side-lobes, into which a small fraction of the emitted power is channelled. Unlike the mean beam, these side-lobes are localized in the immediate vicinity of the mast, and, despite their low power, the power density can be comparable with that of the main beam much further away from the mast. At 150-200 m, for example, the power density in the main beam near ground level is typically tenths of a µW/cm (2).

A handset that is in operation also has a low-frequency magnetic field (EMF) associated, not with the emitted microwaves, but with surges of electric current from the battery that are necessary to implement "time division multiple access" (TDMA), the system currently used to increase the number of people who can simultaneously communicate with a base-station. With handsets that have an energy-saving discontinuous transmission mode (DTX), there is an even lower frequency pulsing at 2 Hz, which occurs when the user is listening but not speaking.

Biological Impacts: Thermal

Heating of biological tissue is a consequence of microwave energy absorption by the tissue's water content. The amount of heating produced in a living organism depends primarily on the intensity (or power density) of the radiation once it has penetrated the system, on certain electrical properties of the biomatter, and on the efficiency of the body's thermoregulation mechanism.

Above a certain intensity of the microwaves, temperature homoeostasis is not maintained, and effects on health ensue once the temperature rise exceeds about 1°C. Safety guidelines impose upper limits on the radiation intensity to ensure that this does not happen.

Heating occurs whether the organism is alive or dead. The frequency of the radiation, as opposed to the intensity, is taken into account only in so far as it affects (via size resonance) the ability of the organism to absorb energy from the irradiating field.

Amongst the most thermally vulnerable areas of the body (2), because of their low blood supply, are the eyes and the testes, and cataract formation and reduced sperm counts are well-documented acute exposure hazards.

Animal studies indicate that a variety of behavioral and physiological disorders can be provoked by temperature rises below 1°C--ie, under much less acute exposure conditions…there are reports of adverse health effects of subthermal intensities, the possible origin of which will now be considered.

Biological Effects: Non-Thermal

The possibility that the pulsed, low-intensity MWR currently used in GSM mobile telephony can exert subtle, non-thermal influences on a living organism arises because microwaves are waves; they have properties other than the intensity that is regulated by safety guidelines. This microwave radiation has certain well-defined frequencies, which facilitate its discernment by a living organism (despite its ultralow intensity), and via which the organism can, in turn, be affected.

The human body is an electrochemical instrument of exquisite sensitivity whose orderly functioning and control are underpinned (6) by oscillatory electrical processes of various kinds, each characterised by a specific frequency, some of which happen to be close to those used in GSM. Thus some endogenous biological electrical activities can be interfered with via oscillatory aspects of the incoming radiation, in much the same way as can the reception on a radio.

The biological electrical activities that are vulnerable to interference from GSM radiation include highly organised electrical activities at a cellular level whose frequency happens to lie in the microwave region, and which are a consequence of metabolism.7 Although not universally accepted, there is experimental evidence7-9 consistent with these endogenous activities, in terms of which effects of ultralow-intensity microwave radiation of a specific frequency on processes as fundamental as cell division, for example, can be understood in a rather natural way.10

Furthermore, the DTX pulse frequency at 2 Hz and the TDMA frequency of 8·34 Hz correspond to frequencies of electrical oscillations found in the human brain, specifically the delta and alpha brain-waves, respectively. It is thus quite possible that living organisms have a two-fold sensitivity to the pulsed GSM signal--ie, to both the microwave carrier and the lower frequency pulsings of the TDMA and DTX signals.

To deny this possibility yet admit the importance of ensuring electromagnetic compatibility with electronic instruments by banning the use of mobile phones on aircraft (11) and hospitals (a prohibition driven by concerns about non-thermal interference) seems inconsistent.

The intensity of radiation needed for this recognition is many orders of magnitude below even that currently associated with non-thermal effects. This influence is possible only when the organism is alive, with excited endogenous frequencies; the dead have flat electroencephalograms.

Non-thermal effects thus depend on the state of the person when exposed to the radiation--ie, non-thermal effects are non-linear. A low-intensity field can entail a seemingly disproportionately large response (or none at all), and vice versa, quite unlike the predictable thermal responses. Thus not everyone can be expected to be affected in the same way by identical exposure to the same radiation.

A good example of human vulnerability to a non-thermal,electromagnetic influence is the ability of a light flashing at about 15 Hz to induce seizures in people with photosensitive epilepsy (12). It is not so much the amount of energy absorbed from the light that provokes the seizure, but rather the information transmitted to the brain by the (coherent) regularity of its flashing, at a frequency that the brain "recognises" because it matches or is close to a frequency utilised by the brain itself.

What do we know experimentally about non-thermal biological influences of MWR (both pulsed and continuous) of an intensity close to that near a mobile phone handset, but often at higher microwave carrier frequencies? A selection of in vitro studies is given in panel 1.

Panel 1: Selected in vitro studies of non-thermal effects of microwave radiation of various frequencies and intensities

Effect	Reference
Epileptic activity in rat brain slices in conjunction with certain drugs	13
Resonant effects on cell division of Saccharomyces cerevisiae, and on the genome conformation of Escherichia coli	9, 14
Synchronisation of cell division in S carlsbergenis	15
"Switch-on" of epigenetic processes, such as -phage and colicin synthesis	16, 17
Altered ornithine decarboxylase activity	18
Reduced lymphocyte cytotoxicity	19
Increased permeability of erythrocyte membrane	20
Effects on brain electrochemistry (calcium efflux)	21
Increase in chromosome aberrations and micronuclei in human blood lymphocytes	22
Synergism with cancer-promoting drugs such as phorbol ester	23

In vivo evidence of non-thermal influences, including exposure to actual GSM radiation, comes predominantly from animal studies (panel 2).

Panel 2: Selected in vivo studies of non-thermal microwave exposure, including GSM radiation

Effect	Reference
Epileptiform activity in rats, in conjunction with certain drugs	24
Depression of chicken immune systems (melatonin, corticosterone and IgG levels)	25
Increase in chick embryo mortality	25
Increased permeability of blood-brain barrier in rats	26
Effects on brain electrochemistry (dopamine, opiates)	27
Increases in DNA single and double strand breaks in rat brain	28
Promotion of lymphomas in transgenic mice	29
Synergistic effects with certain psychoactive drugs	30

Finally, human in vivo studies, under GSM or similar conditions, include effects on the EEG and on blood pressure. A delayed increase in spectral power density (particularly in the alpha band) has been corroborated (31) in the "awake" EEG of adults exposed to GSM radiation. Influences on the "alseep" EEG include a shortening of rapid-eye-movement (REM) sleep during which the power density in the alpha band increases (32), and effects on non-REM sleep (33). Exposure to mobile phone radiation also decreases the preparatory slow potentials in certain regions of the brain (34) and affects memory tasks (35). In 1998, Braune et al (36) recorded increases in resting blood pressure during exposure to radiofrequencies.

Non-thermal effects have proved controversial, and independent attempts to replicate them have not always been successful. Such difficulties are not unexpected, however, because these effects depend on the state of the organism when it is exposed, particularly in vivo.

Possible Associated Adverse Health Reactions

…GSM radiation does seem to affect non-thermally a variety of brain functions (including the neuroendocrine system), and health problems reported anecdotally do tend to be neurological, although formal confirmation of such reports, based on epidemiological studies, is still lacking.

For example:

reports of headache are consistent with the effect of the radiation on the dopamine-opiate system of the brain27 and
the permeability of the blood-brain barrier (26), both of which have been connected to headache (40,41).
Reports of sleep disruption are consistent with effects of the radiation on melatonin levels (25) and
on rapid-eye-movement sleep (32).

Furthermore, since there is no reason to suppose that the seizure-inducing ability (12) of a flashing visible light does not extend to microwave radiation (which can access the brain through the skull) flashing at a similarly low frequency, together with the fact that exposure to pulsed MWR can induce epileptic activity in rats (24), reports of epileptic activity in some children exposed to base-station radiation are perhaps not surprising.

Finally, the significant increase (by a factor of between 2 and 3) in the incidence of neuroepithelial tumours (the laterality of which correlates with cell-phone use) found in a nationwide US study (42) is consistent not only with the genotoxicity of GSM radiation, as indicated by increased DNA strand breaks (28) and formation of chromosome aberrations and micronuclei but also with its promotional effect on tumour development (43).

…it cannot be denied that non-thermal effects of the MWR used in mobile telephony do have the potential to induce adverse health reactions of the kind reported, and this possibility should not be ignored even if only a small minority of people are at risk.

Whether a person is affected or not could depend, for example, on the level of stress before exposure; if it is high enough, the additional contribution from MWR exposure might be sufficient to trigger an abnormality that would otherwise have remained latent.

It is often argued that anecdotal reports of health problems should be dismissed. However, given the paucity of systematic epidemiological studies of this new technology, such reports are an indispensable source of information, a point acknowledged in the 1999 report of the UK parliamentary committee (44).

Preadolescent children can be expected to be more vulnerable to any adverse health effects than adults because absorption of GSM microwaves is greatest (5) in an object about the size of a child's head, because of the "head resonance" effect and the greater ease with which the radiation can penetrate the thinner skull of an infant (1).

Also the multiframe repetition frequency of 8·34 Hz and the 2 Hz pulsing in the DTX mode of cellphones lie in the range of the alpha and delta brain-waves, respectively.

In a child, alpha waves do not replace delta waves as a stable activity until the age of about 12 years. Furthermore, the immune system, whose efficacy is degraded (19,25) by this kind of radiation, is less robust in children.

This makes them less able to cope with any adverse health effect that might be provoked by chronic exposure, not only to the pulsed microwave radiation but also to the the more penetrating low-frequency magnetic fields associated with the current surges from the handset battery which can reach 40 µT (peak) near the back of the case (45). Indications of the biological noxiousness of these magnetic fields (in animals) can be found in ref 25.

In the context of base-station radiation, reports relating to animals are of particular value since it cannot here be claimed that the effects are psychosomatic. Of particular interest is a publication on cattle (43), recording severely reduced milk yields, emaciation, spontaneous abortions, and stillbirths. When cattle are removed to pastures well away from the mast, their condition improves, but it deteriorates once they are brought back. The adverse effects appeared only after GSM microwave antennae were installed on a tower formerly used to transmit only non-pulsed television and radio signals.

Finally, in support of the reality of an adverse health impact of non-thermal influences of the kind of radiation used today in mobile telephony, we should recall that during the "cold war" the Soviet irradiation of western embassies with microwave radiation (of an intensity intermediate between that in the vicinity of a handset and a base-station), done with the express intention of inducing adverse health effects, was quite successful (47).

The references to this excellent review by Dr. Hyland are given below.

Risks on the Road

In a separate Lancet report, Massachusetts scientist Dr. Kenneth Rothman said his research indicated the main public health concern was motor vehicle collisions rather than any possible link to brain cancer.

He notes that one study found that the risk of a car accident was 4 times greater when the driver was using the telephone or soon after a call and that heavy mobile users were involved in twice as many fatal road accidents than light users.

In addition, use of 'hands-free' units was no less risky than holding the telephone to the ear with one hand while talking.

The Lancet, November 25, 2000; 356: 1833-36, 1837-40

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More Bad News for Hands Free Mobile Phones

Many people concerned with possible adverse health effects, including myself, have recommended the use of "Hands Free" units as a way to greatly reduce the microwave exposure. However, as we reported several weeks ago this may not necessarily be any safer.

Now, upon further review of the safety evidence, including the results of tests conducted by the British Consumers Association and published in their magazine Which? the British government has decided to withdraw its recommendation that mobile phone users switch to handsfree units.

In addition, they plan to start issuing leaflets warning buyers of the unknown, but potentially harmful impact of mobile phone usage by children, according to a report in Newsbytes.com.

The warnings follow the British government's continuing funding of tests into the effects of mobile phone radio frequency (RF) radiation on the soft tissue of the brain and head.

Liam Donaldson, the UK's chief medical officer, said that the government's decision to remove the health approval on handsfree kits followed a number of investigations that claim handsfree devices may even channel radiation to the users head. "We don't have good enough science so far to say definitely one way or the other," he said, adding that further research is being conducted urgently to provide an answer to the question.

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For more information regarding the safety of cell phones go to EMFacts Consultancy's Mobile Phone Health Hazard's page which is likely the best compilation of data on the mobile phone issue.

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DR. MERCOLA'S COMMENT:

This is the most comprehensive detailed and well referenced report on cell phone dangers I have yet to see.

Cell phones are becoming increasingly popular, yet most are absolutely blinded to the damage they are doing to their brains by exposing themselves to this radiation. Even the conservative British journal The Lancet is warning that the dangers from this radiation can NOT be dismissed.

My recommendation? Keep the use down to as low as possible (my use is less than five minutes per YEAR). Let's keep those brain cells alive!

MOBILE phone users don’t usually get much sympathy from the rest of us - and quite rightly so. If they’re not bawling into a handset in a train carriage, they’re veering wildly across the carriageway as they try to make a call, eat a sandwich and steer a Vauxhall Vectra at the same time.
Should mobile phones carry a health warning?

But in what seems like an act of divine retribution, it has been discovered that not only do mobile phones make you look like a complete prat, they could give you cancer, asthma and Alzheimer’s. And if that’s not enough to make the buggers shut up, I don’t know what is.
Researchers at the Royal Adelaide Hospital in Australia discovered earlier this year that the electromagnetic field that surrounds electrical appliances can be positively linked to development of cancer in mice (or negatively linked, if you look at it the mouse’s point of view).
“This is the first scientific study to show such an effect,” said Dr Michael Repacholi, whose research is being funded by The World Health Organisation as part of a £2.2 million five-year investigation into the effects of electromagnetic fields which started in June 1996.
The National Radiological Protection Board in Didcot, Oxon, which has our best interests at heart, said the findings will provide a focus for more research, but that the implications for human health were far from clear.
Research by other scientists indicates that prolonged use of mobile phones may cause hot-spots to develop inside the brain, causing damage which could lead to Alzheimer’s disease or cancer.
Dr Peter French, an immunologist from New Zealand, told BBC 1’s WatchDog consumer affairs program that he now only uses his mobile phone when it’s absolutely essential, and switches sides if a call lasts for more than a couple of minutes.
But despite the warnings, users of mobile phones remain committed to their high-tech toys. Speaking from inside a special lead-lined helmet, Paul Pettengale, associate editor of technology magazine T3, poo-poohed the research, saying “The chances of you developing a brain tumor by using a mobile phone is so incredibly slim, it’s not even a consideration. Such
suggestions are little more than scaremongery.”
“We're not saying GSM radiation is harmful. We're saying that if you're concerned about it then we've got a solution for you”
— ANGUS BROWN
Sales Director, Hagenuk However, new research has found that a far worse danger is the link between the use of mobile phones and loss of concentration and lapses in short-term memory. Boffins at a mobile phone safety conference in Brussels showed the microwave radiation like that emitted by mobile phones had the power to temporarily impair the ability of rats to learn simple tasks.
Dr Henry Lai and Dr N P Singh from the University of Washington in Seattle believe the radiation changed brain cell membranes in the rats - and the effects are so severe that it could affect humans, too.
The mobile phone industry has so far been slow to respond to the health worries. German mobile phone company Hagenuk is the first to produce a phone that blocks radiation. “We’re not saying GSM radiation is harmful,” said sales director Angus Brown, “We’re saying that if you’re concerned about it then we’ve got a solution for you.”
Hagenuk’s new phone has an antenna with a special radiating shield for the users head, so the potentially harmful electromagnetic energy is emitted in a kidney-shaped pattern away from the user.
Mitsubishi and Hitachi have also designed low-radiation phones with patents stating that the aim is to prevent damage to users’ health, but Hagenuk’s is currently the only safe phone on the market.
So the next time you see a Vectra swerving wildly between lanes on the motorway, don’t condemn the driver as a dangerous, idiotic show-off - he’s probably just forgotten how to drive his car. Poor sod.
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Study: Hands-Free Cell Phones Just as Dangerous for Drivers

Aug. 16, 2001

(CBS) College student Tony Dhaliwal is about to attempt a very dangerous mission: In the safety of a simulator, he'll try to drive and talk on a cell phone at the same time.

He goes over a shopping list on the phone: "You want bread, cheerios, hamburger, and--"

Just then, the accident happens. Tony Dhaliwal just flunked the test.

"I could have killed this guy. This is my fault," he says. But he also helped drive home an important safety point.

"We've found a clear pattern of impaired driving behavior while you're talking on a cell phone," says Dr. David Strayer.

Strayer, who headed a new University of Utah study on this subject, says talking on a cell phone is far riskier for drivers than, say, listening to the radio. Those using phones miss signals and are slow to react.

Most importantly, the new study revealed, it doesn't matter if the driver is actually holding the cell phone.

"We found that you are just as impaired when you're talking with a hands-free device as when you were using a handheld cell phone," he says.

That suggests that new laws, like one in New York that bans handheld cell phones, won't reduce the risk of accidents.

The distraction, experts say, is the conversation itself. Drivers can't focus on two things at once, so many tend to forget about the road.

"The problem with talking on the phone is that you actually have to think about what you are saying. So it is not simply just listening to somebody as you might listen to music on the radio, which you can sort of put into the background of what you do," says Dr. Jordan Grafman of the National Institutes of Health.

Safety experts expect that the risk will grow: Seventy-five percent of drivers say they routinely use cell phones on the road, where the consequences are real and not just simulated.

©MMII CBS Worldwide Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.
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Reuters) Britain announced plans Friday for a $10 million research program into the potential health hazards of cellular phones.

England's Chief Medical Officer Liam Donaldson said leaflets advising people to keep calls short and to discourage children from using them will also be included with each new phone.

"It is essential that we provide people with the evidence on this issue to allow them to make an informed choice about using their mobile phones," said Donaldson.

Although there is no irrefutable medical evidence about health risks the government is taking a precautionary approach.

Nearly half of Britain's population, more than 25 million people, own a cell phone. A quarter of users are under 18 years old.

The research program and leaflets follow a report from a government inquiry into the safety of cell phones that was published in May.

Sir William Stewart, who led the inquiry, will head the research program that will be funded by the government and the cell phone industry.

"On the basis of the precautionary approach outlined in the Stewart report, the leaflets provide advice that, if you use a mobile phone, you can choose to minimize your exposure to radio waves by keeping your calls short," Donaldson added.

The leaflets will also contain information about living near cellular phone base stations and the specific absorption rate (SAR), which is how much radio wave energy the body absorbs from each phone.

Beginning next year there will be a European Standard method for measuring SAR which will be provided with each phone.

Scientists say the jury is still out on whether cell phones cause brain tumors or other health problems. Some researchers claim they are the cause of headaches, sleeping disorders and memory loss.

Children could be more vulnerable to any potential ill effects because they have thinner skulls, smaller heads and their nervous system is still developing.

A study released earlier this month showed hands-free phone kits could boost the brain's exposure to radiation. The government leaflet said more studies are needed to assess the SAR of the hands-free kit.

Research in the United States has shown that heavy users of cell phones are involved in more fatal road accidents than people who use them less often.

from cancer-health.org
http://our-medical-center.blogspot.com/2008/01/cellular-phone-caused-cancer.html

Porcelain Crowns

2008-01-03T23:35:00.000-08:00

http://our-medical-center.blogspot.com/2008/01/porcelain-crowns.html

With old technology, dental crowns always needed to be made with a metal foundation. Today, we can make them out of pure porcelain, ceramic or aesthetic reinforced resins. There are still occasions on the back teeth when the durability of a metal crown makes it the restoration of choice. But for crowns that show, wouldn't you rather have one that looks as natural as possible? See photos at the bottom of the page that show the beauty of pure porcelain.

WHY A PORCELAIN CROWN IS NEEDED

It is needed when a tooth is badly broken down - there are existing large fillings or a large area of tooth decay, because a filling isn't strong enough. And in the front of the mouth, you will want a porcelain crown that looks exactly like a tooth. If done by an expert cosmetic dentist, it will be very difficult for people to tell that it isn't real. For information on locating an expert cosmetic dentist in your area, please see our cosmetic dentist referral page.

Years ago, it had to be fused to a metal framework in order to create a crown strong enough to resist breaking in use. But bonding technology developed since the 1980s has allowed dentists to bond these ceramic crowns directly to the teeth. With this strong bond, it becomes strong enough to function under even heavy chewing pressures. The photo to the left shows one that is functioning even under the heavy stresses of a molar tooth.

A beautiful porcelain crown may have a cost that exceed your dental insurance plan allotment. If your interests are purely functional - you don't care how it looks - then you may not want to spend the extra money.

On back teeth, many cosmetic dentists do what are called porcelain onlays. These are very similar to all crowns, and sometimes the terms are used interchangeably. Using the term onlay, however, means that we are grinding away less of the tooth - we leave the healthy tooth structure alone as much as possible. With an onlay, since we can keep the margins away from the gum, we greatly reduce the tendency to gum inflammation that can occur with dental crowns. It also is metal-free. However, under very heavy biting pressures, there is a cracking risk with a porcelain onlay.

Dentists need special training in cosmetic dentistry in order to place these restorations. If you would like referral to a competent cosmetic dentist who is trained to do this type of work, feel free to e-mail Dr. Hall with your request.

The Cerec crown is merely a variation of all-porcelain. It is made out of all ceramic, but rather than being made by a laboratory technician, it is milled by a computer in the dentist's office.

The Empress crown is also a variation of all-porcelain which uses the Empress pressed ceramic material. Other ceramic materials are Procera, In-Ceram, and feldspathic porcelain. A cosmetic dentist will be familiar with all of these materials and will use the best crown for each clinical situation. They all have their advantages and disadvantages.

Porcelain fused to metal crowns have a nearly natural appearance, subject to two limitations: Because they have a metal framework underneath, they require the use of an opaquer to cover the metal, which makes it impossible to re-create the translucency of natural teeth. They also eventually will show a dark line at the edge, next to the gum. Dentists try to hide this line under the gum, but sometimes they are unable to do this; and sometimes the line doesn't show when the crown is first placed but shows later, as the gum recedes. But they are stronger than all porcelain.

Below is a comparison of the appearance of porcelain fused to metal with bonded all-ceramic. Notice the picture on the left: Jo has several crowns across the front. Even though I have never met this patient and know nothing more than these pictures, I can pick out immediately the teeth that have crowns on them. How? Because they are opaque and have a dark line near the gumline. Contrast this with the after picture of Jo's teeth on the right, which shows beautiful bonded all-ceramic work. This work was done by Dr. Craig Carlson, a www.mynewsmile.com cosmetic dentist from San Antonio, Texas. See how natural they look. For contact information for Dr. Carlson, please see our Texas cosmetic dentists page.

before (click here to see a larger photo)

after (click here to see a larger photo)

Here is another example on a patient of mynewsmile.com network dentist Dr. Duane Delaune of Metairie, Louisiana. (See our Louisiana cosmetic dentists page. This patient had a mal-formed lateral incisor that made her self-conscious. Notice the beauty of the crown in the after picture that blends so perfectly with her natural teeth. You have to view the larger version of this case to fully appreciate it:

before (click here for larger photo)

after (click here for larger photo)

Read about dental bridges, and about the ovate pontic technique for creating the illusion that the false tooth is growing out of the gum.

You may also want to read Dr. Hall's blog posts about porcelain crowns, where he answers questions from visitors.

from mynewsmile.com

http://our-medical-center.blogspot.com/2008/01/porcelain-crowns.html

How to lose weight safely and effectively

2008-01-03T23:22:00.000-08:00

http://our-medical-center.blogspot.com/2008/01/how-to-lose-weight-safely-and.html

If you have decided to try and lose weight it is important to set a realistic, achievable target. Discuss this with your doctor, health adviser or dietician who can help you set short and long term goals.

ve and seek support

The best way to lose weight is a combination of eating less food and being more physically active. Choose activities that you enjoy, which are practical and easy for you to include as part of your lifestyle.

It is very helpful to get support from family or friends, or from joining a group. Having encouragement and support is essential to long term successful weight management. Remember to give yourself a pat on the back too - use positive affirmations to encourage yourself.

Reward yourself in a suitably healthy way for your achievements - for example you could buy yourself a new outfit to complement your new trim body, but don't use food as a reward!

Only eat when you are hungry - it may be that your body really needs something else, such as exercise, or even water.
Eat slowly, chewing every mouthful thoroughly and only eat to the point of feeling comfortably full. Don't feel guilty about leaving food on your plate once you feel full
Try and avoid eating late in the evening and if you do, choose fruit or a low fat milky drink.

Setting goals for weight loss and dietary changes

Aim to lose no more than 0.5 to 1kg (1 to 2lbs) in weight every week. Remember, there is no quick fix answer to long term weight loss - it does take time. If you would like to record your weight, plot a graph so that you can monitor your progress - use a large scale so that a small but steady weight loss really shows. Rather than relying too much on what you weigh to give you a pat on the back, try and focus on how you feel and look and notice any positive changes as a result of changing what you eat.

During the initial few days of restricting energy intake, you will lose some water and glycogen (a type of energy stored in your liver and muscles) and not much fat. The rate of weight loss will then slow down and the proportion of fat lost should increase.

When you lose weight, you lose both lean tissue and body fat. What is important is the relative proportions of each. The ideal proportion is 75% fat loss and 25% from lean body tissue. This should occur when following a healthy eating plan which results in slow, gradual weight loss (0.5 to 1kg; 1 to 2lbs/week). Following a "crash diet" in which rapid weight loss is occurring, results in a greater loss of lean body tissue and less fat. There is evidence that crash dieting also results in your eventually putting on more weight than you lost.

Making changes to your diet in order to lose weight does not necessarily mean eating less food but it does mean choosing different types of food.

Decide on small, achievable changes that you feel able to make. Dietary changes should be practical and include foods that you enjoy.

Follow a healthy, well-balanced diet

Always try and follow the principles of a healthy, well-balanced diet, the details of which are outlined in this section. In summary, try to:

eat regularly
base your meals on bread, potatoes, rice or pasta
eat plenty of fresh fruit and vegetables
use only the minimum of spreading fats and vegetable oils
choose low fat varieties of dairy products and meat, fish and alternatives
eat only very occasionally snacks such as chocolate, cakes, biscuits, instant puddings, crisps etc as they are high in either fat, sugar or both

from bupa.co.uk
http://our-medical-center.blogspot.com/2008/01/how-to-lose-weight-safely-and.html

Bipolar Disorder

2007-12-29T03:34:00.000-08:00

http://our-medical-center.blogspot.com/2007/12/bipolar-disorder.html

What is bipolar disorder?

Bipolar disorder is a mental illness that causes extreme mood swings. This condition is also called manic-depressive illness. It may be caused by a chemical imbalance in the brain.

Bipolar disorder sometimes runs in families. If you have a parent who has bipolar disorder, you have a greater chance of having it. Both men and women can have bipolar disorder. People of all ages can have it.

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What are some of the signs of bipolar disorder?

At times, a person who has bipolar disorder may feel very happy, full of energy and able to do anything. The person might not even want to rest when he or she feels this way. This feeling is called mania (say: "may-nee-ah"). At other times, a person who has bipolar disorder may feel very sad and depressed. The person may not want to do anything when he or she feels this way. This is called depression. People with bipolar disorder can quickly go from mania to depression and back again.

Other signs of mania may include the following:

Feeling very irritable or angry
Thinking and talking so fast that other people can't follow your thoughts
Not sleeping at all
Feeling very powerful and important
Having trouble concentrating
Spending too much money
Abusing alcohol and drugs
Having sex without being careful to prevent pregnancy or disease

Other signs of depression may include the following:

No interest or pleasure in things you used to enjoy, including sex
Feeling sad or numb
Crying easily or for no reason
Feeling slowed down, or feeling restless and irritable
Feeling worthless or guilty
Change in appetite; unintended change in weight
Trouble recalling things, concentrating or making decisions
Headaches, backaches or digestive problems
Problems sleeping, or wanting to sleep all of the time
Feeling tired all of the time
Thoughts about death and suicide

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How is bipolar disorder treated?

Bipolar disorder can be treated by your family doctor. Your family doctor may want you to see a psychiatrist too. You and your doctors will work together to control your mood swings and make sure you stay well.

Bipolar disorder is treated with medicines to stop the mood swings. Mood stabilizers are used to even out highs and lows in your mood. Antidepressant medicine can help reduce the symptoms of depression. Your doctor may add other medicines as you need them. These medicines don't start to work right away, but you will start to notice a difference in your moods after a few weeks. Be sure to take your medicines just as your doctor tells you.

Counseling can help you with stress, family concerns and relationship problems. It's important to get counseling if you have bipolar disorder.

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What can I do to help myself get better?

Read about bipolar disorder and tell your family what you learn. Your doctor can suggest resources to help you learn more.
Have a regular routine. Go to bed and wake up at about the same time every day. Eat your meals and exercise at regular times.
Take your medicine every day, and don't stop taking it even if you start feeling better. Avoid caffeine and over-the-counter medicines for colds, allergies and pain. Ask your doctor before you drink alcohol or use any other medicines.
Try to avoid stress.
Learn the early warning signs of your illness. Tell your doctor when you notice changes in your mood or behavior.
Join a local support group. You and your family can share information and experiences with the support group.

from familydoctor.org
http://our-medical-center.blogspot.com/2007/12/bipolar-disorder.html

Prostate cancer

2007-12-28T02:38:00.000-08:00

http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.

Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States.^[1] According to the American Cancer Society, prostate cancer is least common among Asian men and most common among black men, with figures for white men in-between.^[2]^[3] However, these high rates may be affected by increasing rates of detection.^[4]

Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.

Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test. There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope. Further tests, such as X-rays and bone scans, may be performed to determine whether prostate cancer has spread.

Prostate cancer can be treated with surgery, radiation therapy, hormonal therapy, occasionally chemotherapy, proton therapy, or some combination of these. The age and underlying health of the man as well as the extent of spread, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease. Since prostate cancer is a disease of older men, many will die of other causes before a slowly advancing prostate cancer can spread or cause symptoms. This makes treatment selection difficult.^[5] The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life.

Prostate

Main article: Prostate

The prostate is a male reproductive organ which helps make and store seminal fluid. In adult men a typical prostate is about three centimeters long and weighs about twenty grams.^[6] It is located in the pelvis, under the urinary bladder and in front of the rectum. The prostate surrounds part of the urethra, the tube that carries urine from the bladder during urination and semen during ejaculation.^[7] Because of its location, prostate diseases often affect urination, ejaculation, and rarely defecation. The prostate contains many small glands which make about twenty percent of the fluid constituting semen.^[8] In prostate cancer the cells of these prostate glands mutate into cancer cells. The prostate glands require male hormones, known as androgens, to work properly. Androgens include testosterone, which is made in the testes; dehydroepiandrosterone, made in the adrenal glands; and dihydrotestosterone, which is converted from testosterone within the prostate itself. Androgens are also responsible for secondary sex characteristics such as facial hair and increased muscle mass.

Symptoms

Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation.^[9]

Advanced prostate cancer may cause additional symptoms as the disease spreads to other parts of the body. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis or ribs, from cancer which has spread to these bones. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.^[10]

Pathophysiology

When normal cells are damaged beyond repair, they are eliminated by apoptosis. Cancer cells avoid apoptosis and continue to multiply in an unregulated manner.

Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system. Prostate cancer is considered a malignant tumor because it is a mass of cells which can invade other parts of the body. This invasion of other organs is called metastasis. Prostate cancer most commonly metastasizes to the bones, lymph nodes, rectum, and bladder.

Etiology

The specific causes of prostate cancer remain unknown.^[11] A man's risk of developing prostate cancer is related to his age, genetics, race, diet, lifestyle, medications, and other factors. The primary risk factor is age. Prostate cancer is uncommon in men less than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70.^[12] However, many men never know they have prostate cancer. Autopsy studies of Chinese, German, Israeli, Jamaican, Swedish, and Ugandan men who died of other causes have found prostate cancer in thirty percent of men in their 50s, and in eighty percent of men in their 70s.^[13] In the year 2005 in the United States, there were an estimated 230,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer.^[14]

A man's genetic background contributes to his risk of developing prostate cancer. This is suggested by an increased incidence of prostate cancer found in certain racial groups, in identical twins of men with prostate cancer, and in men with certain genes. In the United States, prostate cancer more commonly affects black men than white or Hispanic men, and is also more deadly in black men.^[15] Men who have a brother or father with prostate cancer have twice the usual risk of developing prostate cancer.^[16] Studies of twins in Scandinavia suggest that forty percent of prostate cancer risk can be explained by inherited factors.^[17] However, no single gene is responsible for prostate cancer; many different genes have been implicated. Two genes (BRCA1 and BRCA2) that are important risk factors for ovarian cancer and breast cancer in women have also been implicated in prostate cancer.^[18]

Dietary amounts of certain foods, vitamins, and minerals can contribute to prostate cancer risk. Men with higher serum levels of the short-chain ω-6 fatty acid linoleic acid have higher rates of prostate cancer. However, the same series of studies showed that men with elevated levels of long-chain ω-3 (EPA and DHA) had lowered incidence.^[19] A long-term study reports that "blood levels of trans fatty acids, in particular trans fats resulting from the hydrogenation of vegetable oils, are associated with an increased prostate cancer risk."^[20] Other dietary factors that may increase prostate cancer risk include low intake of vitamin E (Vitamin E is found in green, leafy vegetables), omega-3 fatty acids (found in fatty fishes like salmon), and the mineral selenium. A study in 2007 cast doubt on the effectiveness of lycopene (found in tomatoes) in reducing the risk of prostate cancer.^[21] Lower blood levels of vitamin D also may increase the risk of developing prostate cancer. This may be linked to lower exposure to ultraviolet (UV) light, since UV light exposure can increase vitamin D in the body.^[22]

There are also some links between prostate cancer and medications, medical procedures, and medical conditions. Daily use of anti-inflammatory medicines such as aspirin, ibuprofen, or naproxen may decrease prostate cancer risk.^[23] Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk.^[24] More frequent ejaculation also may decrease a man's risk of prostate cancer. One study showed that men who ejaculated five times a week in their 20s had a decreased rate of prostate cancer, though others have shown no benefit.^[25]^[26] Infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer. In particular, infection with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to increase risk.^[27] Finally, obesity^[28] and elevated blood levels of testosterone^[29] may increase the risk for prostate cancer.

Research released in May 2007, found that US war veterans who had been exposed to Agent Orange had a 48% increased risk of prostate cancer recurrence following surgery.^[30]

Prostate cancer risk can be decreased by modifying known risk factors for prostate cancer, such as decreasing intake of animal fat.^[31]

One research study, by the Cancer Council Victoria, has shown that men who report that they regularly ("more than five times per week") masturbate have up to one third fewer occurrences of prostate cancer.^[32] The researchers hypothesize that this could be because regular ejaculation reduces the buildup of carcinogenic deposits which could damage the cells lining the prostate. The researchers also speculated that frequent ejaculation may cause the prostate to mature fully, making it less susceptible to carcinogens. It is also possible that there is another factor (such as hormone levels) that is a common cause of both a reduced susceptibility to prostate cancer and a tendency toward frequent masturbation. There is also some evidence that frequent sexual intercourse is associated with reduced risk of prostate cancer, although contrarily the risks associated with STDs have been shown to increase the risk of prostate cancer.^[33] Once the lining of the prostate is affected with cancer, the only known treatments are surgery and radiation therapy. Both may limit the ability to have erections afterward.

Prevention

Several medications and vitamins may also help prevent prostate cancer. Two dietary supplements, vitamin E and selenium, may help prevent prostate cancer when taken daily. Estrogens from fermented soybeans and other plant sources (called phytoestrogens) may also help prevent prostate cancer.^[34] The selective estrogen receptor modulator drug toremifene has shown promise in early trials.^[35]^[36] Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride^[37] and dutasteride,^[38] have also shown some promise. The use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. The problem with these medications is that they may preferentially block the development of lower-grade prostate tumors, leading to a relatively greater chance of higher grade cancers, and negating any overall survival improvement. Green tea may be protective (due to its polyphenol content), though the data is mixed.^[39]^[40] A 2006 study of green tea derivatives demonstrated promising prostate cancer prevention in patients at high risk for the disease.^[41] In 2003, an Australian research team led by Graham Giles of The Cancer Council Australia concluded that frequent masturbation by males appears to help prevent the development of prostate cancer.^[42] Recent research published in the Journal of the National Cancer Institute suggests that taking multivitamins more than seven times a week can increase the risks of contracting the disease.^[43] This research was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label. Scientists recommend a healthy, well balanced diet rich in fiber, and to reduce intake of meat. A 2007 study published in the Journal of the National Cancer Institute found that men eating cauliflower, broccoli, or one of the other cruciferous vegetables, more than once a week were 40% less likely to develop prostate cancer than men who rarely ate those vegetables.^[44] Scientists believe the reason for this phenomenon has to do with a phytochemical called Diindolylmethane in these vegetables that has anti-androgenic and immune modulating properties. This compound is currently under investigation by the National Cancer Institute as a natural therapeutic for prostate cancer.

Capsaicin

Capsaicin, the chemical found in peppers, has been shown to cause 80% of cancerous prostate cells to undergo apoptosis in mice. For prostate cancer cells whose growth is dependent upon testosterone, Capsaicin curbed the proliferation of such cells by freezing the cells in a non-proliferate state, and cancerous prostate cells that are androgen independent "suicided" as well.^[45]

"Capsaicin had a profound anti-proliferative effect on human prostate cancer cells in culture," said Sören Lehmann, M.D., Ph.D., visiting scientist at the Cedars-Sinai Medical Center and the UCLA School of Medicine. "It also dramatically slowed the development of prostate tumors formed by those human cell lines grown in mouse models."^[46]

Peppers which rank higher on the Scoville scale and thus have a higher piquancy contain a higher amount of Capsaicin. Habaneros, for example, have a Scoville rating of over 300,000, while red chili peppers have a rating of 5,000. While the UCLA and Samuel Oschin Comprehensive Cancer Institute studies show promising implications, the same effects have not yet been duplicated in men.^[47]

Screening

Main article: Prostate cancer screening

Prostate cancer screening is an attempt to find unsuspected cancers. Screening tests may lead to more specific follow-up tests such as a biopsy, where small pieces of the prostate are removed for closer study. Prostate cancer screening options include the digital rectal exam and the prostate specific antigen (PSA) blood test. Screening for prostate cancer is controversial because it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments.

Prostate cancer is usually a slow-growing cancer, very common among older men. In fact, most prostate cancers never grow to the point where they cause symptoms, and most men with prostate cancer die of other causes before prostate cancer has an impact on their lives. The PSA screening test may detect these small cancers that would never become life threatening. Doing the PSA test in these men may lead to overdiagnosis, including additional testing and treatment. Follow-up tests, such as prostate biopsy, may cause pain, bleeding and infection. Prostate cancer treatments may cause urinary incontinence and erectile dysfunction. Therefore, it is essential that the risks and benefits of diagnostic procedures and treatment be carefully considered before PSA screening.

No major scientific or medical organizations currently support routine screening for prostate cancer.^[48]

In 2002, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to recommend for or against routine screening for prostate cancer using PSA testing or digital rectal examination (DRE).^[49] The previous 1995 USPSTF recommendation was against routine screening.
In 1997, American Cancer Society (ACS) guidelines began recommending that beginning at age 50 (age 45 for African-American men and men with a family history of prostate cancer, and since 2001, age 40 for men with a very strong family history of prostate cancer), PSA testing and DRE be offered annually to men who have a life-expectancy of 10 or more years (average life expectancy is 10 years or more for U.S. men under age 76)^[50] along with information on the risks and benefits of screening.^[51] The previous ACS recommendations since 1980 had been for routine screening for prostate cancer with DRE annually beginning at age 40, and since 1992 had been for routine screening with DRE and PSA testing annually beginning at age 50.^[52]
The 2007 National Comprehensive Cancer Network (NCCN) guideline recommends offering a baseline PSA test and DRE at ages 40 and 45 and annual PSA testing and DRE beginning at age 50 (with annual PSA testing and DRE beginning at age 40 for African-American men, men with a family history of prostate cancer, and men with a PSA ≥ 0.6 ng/mL at age 40 or PSA > 0.6 ng/mL at age 45) through age 80, along with information on the risks and benefits of screening. Biopsy is recommended if DRE is positive or PSA ≥ 4 ng/mL, and biopsy considered if PSA > 2.5 ng/mL or PSA velocity ≥ 0.35 ng/mL/year when PSA ≤ 2.5 ng/mL.^[53]
Some U.S. radiation oncologists and medical oncologists who specialize in treating prostate cancer recommend obtaining a baseline PSA in all men at age 35^[54] or beginning annual PSA testing in high risk men at age 35.^[55]

Since there is no firm evidence or general agreement that the benefits of PSA screening outweigh the harms, major scientific and medical organizations recommend that clinicians use a process of shared decision-making that includes discussing with patients the risks of prostate cancer, the potential benefits and harms of screening, and involving the patients in the decision.^[56]

However, because PSA screening is widespread in the United States, following the recommendations of major scientific and medical organizations to use shared decision-making is legally perilous in some U.S. states.^[57] In 2003, a Virginia jury found a family practice residency program guilty of malpractice and liable for $1 million for following national guidelines and using shared decision-making, thereby allowing a patient (subsequently found to have a high PSA and incurable advanced prostate cancer) to decline a screening PSA test, instead of routinely ordering without discussion PSA tests in all men ≥ 50 years of age as four local physicians testified was their practice, and was accepted by the jury as the local standard of care.^[58]

An estimated 20 million PSA tests are done per year in North America and possibly 20 million more outside of North America.^[59]

In 2000, 34.1% of all U.S. men age ≥ 50 had a screening PSA test within the past year and 56.8% reported ever having a PSA test.^[56]
In 2000, 33.6% of all U.S. men age 50–64 and 51.3% of men age ≥ 65 had a PSA test within the past year.^[60]
In 2005, 33.5% of all U.S. men age 50–64 had a PSA test in the past year.
- 37.5% of men with private health insurance, 20.8% of men with Medicaid insurance, 14.0% of currently uninsured men, and 11.5% of men uninsured for > 12 months.^[61]

In 2000–2001, 34.1% of all Canadian men age ≥ 50 had a screening PSA test within the past year and 47.5% reported ever having a screening PSA test.^[62]
Canadian men in Ontario were most likely to have had a PSA test within the past year and men in Alberta were least likely to have had a PSA test with the past year or ever.^[63]

Digital rectal examination

Digital rectal examination (DRE) is a procedure where the examiner inserts a gloved, lubricated finger into the rectum to check the size, shape, and texture of the prostate. Areas which are irregular, hard or lumpy need further evaluation, since they may contain cancer. Although the DRE only evaluates the back of the prostate, 85% of prostate cancers arise in this part of the prostate. Prostate cancer which can be felt on DRE is generally more advanced.^[64] The use of DRE has never been shown to prevent prostate cancer deaths when used as the only screening test.^[65]

Prostate specific antigen

Main article: Prostate specific antigen

The PSA test measures the blood level of prostate-specific antigen, an enzyme produced by the prostate. Specifically, PSA is a serine protease similar to kallikrein. Its normal function is to liquify gelatinous semen after ejaculation, allowing spermatozoa to more easily navigate through the uterine cervix.

The risk of prostate cancer increases with increasing PSA levels.^[66] 4 ng/mL was chosen arbitrarily as a decision level for biopsies in the clinical trial upon which the FDA in 1994 based adding prostate cancer detection in men age 50 and over as an approved indication for the first commercially available PSA test.^[67] 4 ng/mL was used as the biopsy decision level in the PLCO trial, 3 ng/mL was used in the ERSPC and ProtecT trials, and 2.5 ng/mL is used in the 2007 NCCN guideline.

PSA levels can change for many reasons other than cancer. Two common causes of high PSA levels are enlargement of the prostate (benign prostatic hypertrophy (BPH)) and infection in the prostate (prostatitis). It can also be raised for 24 hours after ejaculation and several days after catheterization. PSA levels are lowered in men who use medications used to treat BPH or baldness. These medications, finasteride (marketed as Proscar or Propecia) and dutasteride (marketed as Avodart), may decrease the PSA levels by 50% or more.

Several other ways of evaluating the PSA have been developed to avoid the shortcomings of simple PSA screening. The use of age-specific reference ranges improves the sensitivity and specificity of the test. The rate of rise of the PSA over time, called the PSA velocity, has been used to evaluate men with PSA levels between 4 and 10 ng/ml, but it has not proven to be an effective screening test.^[68] Comparing the PSA level with the size of the prostate, as measured by ultrasound or magnetic resonance imaging, has also been studied. This comparison, called PSA density, is both costly and has not proven to be an effective screening test.^[69] PSA in the blood may either be free or bound to other proteins. Measuring the amount of PSA which is free or bound may provide additional screening information, but questions regarding the usefulness of these measurements limit their widespread use.^[70]^[71]

Diagnosis

Normal prostate (A) and prostate cancer (B). In prostate cancer, the regular glands of the normal prostate are replaced by irregular glands and clumps of cells, as seen in these pictures taken through a microscope.

When a man has symptoms of prostate cancer, or a screening test indicates an increased risk for cancer, more invasive evaluation is offered.

The only test which can fully confirm the diagnosis of prostate cancer is a biopsy, the removal of small pieces of the prostate for microscopic examination. However, prior to a biopsy, several other tools may be used to gather more information about the prostate and the urinary tract. Cystoscopy shows the urinary tract from inside the bladder, using a thin, flexible camera tube inserted down the urethra. Transrectal ultrasonography creates a picture of the prostate using sound waves from a probe in the rectum.

Biopsy

Main article: Prostate biopsy

If cancer is suspected, a biopsy is offered. During a biopsy a urologist obtains tissue samples from the prostate via the rectum. A biopsy gun inserts and removes special hollow-core needles (usually three to six on each side of the prostate) in less than a second. Prostate biopsies are routinely done on an outpatient basis and rarely require hospitalization. Fifty-five percent of men report discomfort during prostate biopsy.^[72]

Gleason score

Main article: Gleason score

The tissue samples are then examined under a microscope to determine whether cancer cells are present, and to evaluate the microscopic features (or Gleason score) of any cancer found.

Tumor markers

Main article: Tumor markers

Tissue samples can be stained for the presence of PSA and other tumor markers in order to determine the origin of maligant cells that have metastasized.^[73]

New tests being investigated

Currently, an active area of research involves non-invasive methods of prostate tumor detection. Adenoviruses modified to transfect tumor cells with harmless yet distinct genes (such as luciferase) have proven capable of early detection. So far, though, this area of research has only been tested in animal and LNCaP models.^[74]

PCA3

Another potential non-invasive methods of early prostate tumor detection is through a molecular test that detects the presence of cell-associated PCA3 mRNA in urine. PCA3 mRNA is expressed almost exclusively by prostate cells and has been shown to be highly over-expressed in prostate cancer cells. PCA3 is not a replacement for PSA but an additional tool to help decide if, in men suspected of having prostate cancer, a biopsy is really needed. The higher the expression of PCA3 in urine, the greater the likelihood of a positive biopsy, i.e. the presence of cancer cells in the prostate. Company Diagnocure has an exclusive worldwide license for all diagnostic and therapeutic applications related to PCA3

Early prostate cancer

It was reported in April 2007 that a new blood test for early prostate cancer antigen-2 (EPCA-2) is being researched that may alert men if they have prostate cancer and how aggressive it will be.^[75]^[76]

Staging

Main article: Prostate cancer staging

An important part of evaluating prostate cancer is determining the stage, or how far the cancer has spread. Knowing the stage helps define prognosis and is useful when selecting therapies. The most common system is the four-stage TNM system (abbreviated from Tumor/Nodes/Metastases). Its components include the size of the tumor, the number of involved lymph nodes, and the presence of any other metastases.

The most important distinction made by any staging system is whether or not the cancer is still confined to the prostate. In the TNM system, clinical T1 and T2 cancers are found only in the prostate, while T3 and T4 cancers have spread elsewhere. Several tests can be used to look for evidence of spread. These include computed tomography to evaluate spread within the pelvis, bone scans to look for spread to the bones, and endorectal coil magnetic resonance imaging to closely evaluate the prostatic capsule and the seminal vesicles. Bone scans should reveal osteoblastic appearance due to increased bone density in the areas of bone metastisis - opposite to what is found in many other cancers that metastisize.

After a prostate biopsy, a pathologist looks at the samples under a microscope. If cancer is present, the pathologist reports the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow. The Gleason system is used to grade prostate tumors from 2 to 10, where a Gleason score of 10 indicates the most abnormalities. The pathologist assigns a number from 1 to 5 for the most common pattern observed under the microscope, then does the same for the second most common pattern. The sum of these two numbers is the Gleason score. The Whitmore-Jewett stage is another method sometimes used. Proper grading of the tumor is critical, since the grade of the tumor is one of the major factors used to determine the treatment recommendation.

Risk assessment

Many prostate cancers are not destined to be lethal, and most men will ultimately die from causes other than of the disease. Decisions about treatment type and timing may therefore be informed by an estimation of the risk that the tumor will ultimately recur after treatment and/or progress to metastases and mortality. Several tools are available to help predict outcomes such as pathologic stage and recurrence after surgery or radiation therapy. Most combine stage, grade, and PSA level, and some also add the number or percent of biopsy cores positive, age, and/or other information.

The D’Amico classification stratifies men to low, intermediate, or high risk based on stage, grade, and PSA. It is used widely in clinical practice and research settings. The major downside to the 3-level system is that it does not account for multiple adverse parameters (e.g., high Gleason score and high PSA) in stratifying patients.

The Partin tables predict pathologic outcomes (margin status, extraprostatic extension, and seminal vesicle invasion) based on the same 3 variables, and are published as lookup tables.

The Kattan nomograms predict recurrence after surgery and/or radiation therapy, based on data available either at time of diagnosis or after surgery. The nomograms can be calculated using paper graphs, or using software available on a website or for handheld computers. The Kattan score represents the likelihood of remaining free of disease at a given time interval following treatment.

The UCSF Cancer of the Prostate Risk Assessment (CAPRA) score predicts both pathologic status and recurrence after surgery. It offers comparable accuracy as the Kattan preoperative nomogram, and can be calculated without paper tables or a calculator. Points are assigned based on PSA, Grade, stage, age, and percent of cores positive; the sum yields a 0–10 score, with every 2 points representing roughly a doubling of risk of recurrence. The CAPRA score was derived from community-based data in the CaPSURE database.

Treatment

Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, High Intensity Focused Ultrasound (HIFU), chemotherapy, cryosurgery, hormonal therapy, or some combination. Which option is best depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors are the man's age, his general health, and his feelings about potential treatments and their possible side effects. Because all treatments can have significant side effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.

The selection of treatment options may be a complex decision involving many factors. For example, radical prostatectomy after primary radiation failure is a very technically challenging surgery and may not be an option.^[77] This may enter into the treatment decision.

If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors who treat prostate cancer use a variety of nomograms to predict the probability of spread. Treatment by watchful waiting, HIFU, radiation therapy, cryosurgery, and surgery are generally offered to men whose cancer remains within the prostate. Hormonal therapy and chemotherapy are often reserved for disease which has spread beyond the prostate. However, there are exceptions: radiation therapy may be used for some advanced tumors, and hormonal therapy is used for some early stage tumors. Cryotherapy, hormonal therapy, and chemotherapy may also be offered if initial treatment fails and the cancer progresses.

Watchful waiting and active surveillance

Watchful waiting, also called "active surveillance," refers to observation and regular monitoring without invasive treatment. Watchful waiting is often used when an early stage, slow-growing prostate cancer is found in an older man. Watchful waiting may also be suggested when the risks of surgery, radiation therapy, or hormonal therapy outweigh the possible benefits. Other treatments can be started if symptoms develop, or if there are signs that the cancer growth is accelerating (e.g., rapidly rising PSA, increase in Gleason score on repeat biopsy, etc.). Most men who choose watchful waiting for early stage tumors eventually have signs of tumor progression, and they may need to begin treatment within three years.^[78] Although men who choose watchful waiting avoid the risks of surgery and radiation, the risk of metastasis (spread of the cancer) may be increased. For younger men, a trial of active surveillance may not mean avoiding treatment altogether, but may reasonably allow a delay of a few years or more, during which time the quality of life impact of active treatment can be avoided. Published data to date suggest that carefully selected men will not miss a window for cure with this approach. Additional health problems that develop with advancing age during the observation period can also make it harder to undergo surgery and radiation therapy.

Clinically insignificant prostate tumors are often found by accident when a doctor incorrectly orders a biopsy not following the recommended guidelines (abnormal DRE and elevated PSA). The urologist must check that the PSA is not elevated for other reasons, Prostatitis, etc. An annual biopsy is often recommended by a urologist for a patient who has selected watchful waiting when the tumor is clinically insignificant (no abnormal DRE or PSA). The tumors tiny size can be monitored this way and the patient can decide to have surgery only if the tumor enlarges which may take many years or never.

Surgery

Surgical removal of the prostate, or prostatectomy, is a common treatment either for early stage prostate cancer, or for cancer which has failed to respond to radiation therapy. The most common type is radical retropubic prostatectomy, when the surgeon removes the prostate through an abdominal incision. Another type is radical perineal prostatectomy, when the surgeon removes the prostate through an incision in the perineum, the skin between the scrotum and anus. Radical prostatectomy can also be performed laparoscopically, through a series of small (1cm) incisions in the abdomen, with or without the assistance of a surgical robot.

Radical prostatectomy is effective for tumors which have not spread beyond the prostate;^[79] cure rates depend on risk factors such as PSA level and Gleason grade. However, it may cause nerve damage that significantly alters the quality of life of the prostate cancer survivor. The most common serious complications are loss of urinary control and impotence. Reported rates of both complications vary widely depending on how they are assessed, by whom, and how long after surgery, as well as the setting (e.g., academic series vs. community-based or population-based data). Although penile sensation and the ability to achieve orgasm usually remain intact, erection and ejaculation are often impaired. Medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may restore some degree of potency. For most men with organ-confined disease, a more limited "nerve-sparing" technique may help avoid urinary incontinence and impotence.^[80]

Radical prostatectomy has traditionally been used alone when the cancer is small. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has a higher risk of complications.

Laparoscopic radical prostatectomy, LRP, is the more modern form of the historical open radical retropubic prostatectomy. Contrasted with the open surgical form of prostate cancer surgery, laparoscopic radical prostatectomy does not require a large incision. Relying on modern technology, such as miniaturization, fiber optics, and the like, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment and a departure from what historically required the application of relatively primitive surgical techniques. Laparoscopic radical prostatectomy is not a new prostate cancer treatment. Rather, laparoscopic radical prostatectomy is a modern means of performing prostate cancer surgery, the oldest treatment for prostate cancer.

The LRP technical manual was published in 1999 by Drs. Bertrand Guillonneau, Arnon Krongrad, and Guy Vallancien. LRP is laparoscopic prostate surgery, not laser prostate surgery.

Transurethral resection of the prostate, commonly called a "TURP," is a surgical procedure performed when the tube from the bladder to the penis (urethra) is blocked by prostate enlargement. TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small tube (cystoscope) is placed into the penis and the blocking prostate is cut away.

In metastatic disease, where cancer has spread beyond the prostate, removal of the testicles (called orchiectomy) may be done to decrease testosterone levels and control cancer growth. (See hormonal therapy, below).

Radiation therapy

Brachytherapy for prostate cancer is administered using "seeds," small radioactive rods implanted directly into the tumor.

Radiation therapy, also known as radiotherapy, uses ionizing radiation to kill prostate cancer cells. When absorbed in tissue, Ionizing radiation such as Gamma and x-rays damage the DNA in cells, which increases the probability of apoptosis (cell death). Two different kinds of radiation therapy are used in prostate cancer treatment: external beam radiation therapy and brachytherapy.

External beam radiation therapy uses a linear accelerator to produce high-energy x-rays which are directed in a beam towards the prostate. A technique called Intensity Modulated Radiation Therapy (IMRT) may be used to adjust the radiation beam to conform with the shape of the tumor, allowing higher doses to be given to the prostate and seminal vesicles with less damage to the bladder and rectum. External beam radiation therapy is generally given over several weeks, with daily visits to a radiation therapy center. New types of radiation therapy may have fewer side effects then traditional treatment, one of these is Tomotherapy.

External beam radiation therapy for prostate cancer is delivered by a linear accelerator, such as this one.

Permanent implant brachytherapy is a popular treatment choice for patients with low to intermediate risk features, can be performed on an outpatient basis, and is associated with good 10-year outcomes with relatively low morbidity^[81] It involves the placement of about 100 small "seeds" containing radioactive material (such as iodine-125 or palladium-103) with a needle through the skin of the perineum directly into the tumor while under spinal or general anesthetic. These seeds emit lower-energy X-rays which are only able to travel a short distance. Although the seeds eventually become inert, they remain in the prostate permanently. The risk of exposure to others from men with implanted seeds is generally accepted to be insignificant.^[82]

Radiation therapy is commonly used in prostate cancer treatment. It may be used instead of surgery for early cancers, and it may also be used in advanced stages of prostate cancer to treat painful bone metastases. Radiation treatments also can be combined with hormonal therapy for intermediate risk disease, when radiation therapy alone is less likely to cure the cancer. Some radiation oncologists combine external beam radiation and brachytherapy for intermediate to high risk situations. One study found that the combination of six months of androgen suppressive therapy combined with external beam radiation had improved survival compared to radiation alone in patients with localized prostate cancer.^[83] Others use a "triple modality" combination of external beam radiation therapy, brachytherapy, and hormonal therapy.

Less common applications for radiotherapy are when cancer is compressing the spinal cord, or sometimes after surgery, such as when cancer is found in the seminal vesicles, in the lymph nodes, outside the prostate capsule, or at the margins of the biopsy.

Radiation therapy is often offered to men whose medical problems make surgery more risky. Radiation therapy appears to cure small tumors that are confined to the prostate just about as well as surgery. However, some issues remain unresolved, such as whether radiation should be given to the rest of the pelvis, how much the absorbed dose should be, and whether hormonal therapy should be given at the same time.

Side effects of radiation therapy might occur after a few weeks into treatment. Both types of radiation therapy may cause diarrhea and rectal bleeding due to radiation proctitis, as well as urinary incontinence and impotence. Symptoms tend to improve over time.^[84] Men who have undergone external beam radiation therapy will have a higher risk of later developing colon cancer and bladder cancer.^[85]

Cryosurgery

Cryosurgery is another method of treating prostate cancer. It is less invasive than radical prostatectomy, and general anesthesia is less commonly used. Under ultrasound guidance, a method invented by Dr. Gary Onik,^[86] metal rods are inserted through the skin of the perineum into the prostate. Highly purified Argon gas is used to cool the rods, freezing the surrounding tissue at −196 °C (−320 °F). As the water within the prostate cells freeze, the cells die. The urethra is protected from freezing by a catheter filled with warm liquid. Cryosurgery generally causes fewer problems with urinary control than other treatments, but impotence occurs up to ninety percent of the time. When used as the initial treatment for prostate cancer and in the hands of an experienced cryosurgeon, cryosurgery has a 10 year biochemical disease free rate superior to all other treatments including radical prostatectomy and any form of radiation^[87] Cryosurgery has also been demonstrated to be superior to radical prostatectomy for recurrent cancer following radiation therapy.

Hormonal therapy

Hormonal therapy in prostate cancer. Diagram shows the different organs (purple text), hormones (black text and arrows), and treatments (red text and arrows) important in hormonal therapy.

Hormonal therapy uses medications or surgery to block prostate cancer cells from getting dihydrotestosterone (DHT), a hormone produced in the prostate and required for the growth and spread of most prostate cancer cells. Blocking DHT often causes prostate cancer to stop growing and even shrink. However, hormonal therapy rarely cures prostate cancer because cancers which initially respond to hormonal therapy typically become resistant after one to two years. Hormonal therapy is therefore usually used when cancer has spread from the prostate. It may also be given to certain men undergoing radiation therapy or surgery to help prevent return of their cancer.^[88]

Hormonal therapy for prostate cancer targets the pathways the body uses to produce DHT. A feedback loop involving the testicles, the hypothalamus, and the pituitary, adrenal, and prostate glands controls the blood levels of DHT. First, low blood levels of DHT stimulate the hypothalamus to produce gonadotropin releasing hormone (GnRH). GnRH then stimulates the pituitary gland to produce luteinizing hormone (LH), and LH stimulates the testicles to produce testosterone. Finally, testosterone from the testicles and dehydroepiandrosterone from the adrenal glands stimulate the prostate to produce more DHT. Hormonal therapy can decrease levels of DHT by interrupting this pathway at any point.

There are several forms of hormonal therapy:

Orchiectomy is surgery to remove the testicles. Because the testicles make most of the body's testosterone, after orchiectomy testosterone levels drop. Now the prostate not only lacks the testosterone stimulus to produce DHT, but also it does not have enough testosterone to transform into DHT.
Antiandrogens are medications such as flutamide, bicalutamide, nilutamide, and cyproterone acetate which directly block the actions of testosterone and DHT within prostate cancer cells.
Medications which block the production of adrenal androgens such as DHEA include ketoconazole and aminoglutethimide. Because the adrenal glands only make about 5% of the body's androgens, these medications are generally used only in combination with other methods that can block the 95% of androgens made by the testicles. These combined methods are called total androgen blockade (TAB). TAB can also be achieved using antiandrogens.
GnRH action can be interrupted in one of two ways. GnRH antagonists suppress the production of LH directly, while GnRH agonists suppress LH through the process of downregulation after an initial stimulation effect. Abarelix is an example of a GnRH antagonist, while the GnRH agonists include leuprolide, goserelin, triptorelin, and buserelin. Initially, GnRH agonists increase the production of LH. However, because the constant supply of the medication does not match the body's natural production rhythm, production of both LH and GnRH decreases after a few weeks.^[89]

The most successful hormonal treatments are orchiectomy and GnRH agonists. Despite their higher cost, GnRH agonists are often chosen over orchiectomy for cosmetic and emotional reasons. Eventually, total androgen blockade may prove to be better than orchiectomy or GnRH agonists used alone.

Each treatment has disadvantages which limit its use in certain circumstances. Although orchiectomy is a low-risk surgery, the psychological impact of removing the testicles can be significant. The loss of testosterone also causes hot flashes, weight gain, loss of libido, enlargement of the breasts (gynecomastia), impotence and osteoporosis. GnRH agonists eventually cause the same side effects as orchiectomy but may cause worse symptoms at the beginning of treatment. When GnRH agonists are first used, testosterone surges can lead to increased bone pain from metastatic cancer, so antiandrogens or abarelix are often added to blunt these side effects. Estrogens are not commonly used because they increase the risk for cardiovascular disease and blood clots. The antiandrogens do not generally cause impotence and usually cause less loss of bone and muscle mass. Ketoconazole can cause liver damage with prolonged use, and aminoglutethimide can cause skin rashes.

Palliative care

Palliative care for advanced stage prostate cancer focuses on extending life and relieving the symptoms of metastatic disease. Chemotherapy may be offered to slow disease progression and postpone symptoms. The most commonly used regimen combines the chemotherapeutic drug docetaxel with a corticosteroid such as prednisone.^[90] Bisphosphonates such as zoledronic acid have been shown to delay skeletal complications such as fractures or the need for radiation therapy in patients with hormone-refractory metastatic prostate cancer.^[91]

Bone pain due to metastatic disease is treated with opioid pain relievers such as morphine and oxycodone. External beam radiation therapy directed at bone metastases may provide pain relief. Injections of certain radioisotopes, such as strontium-89, phosphorus-32, or samarium-153, also target bone metastases and may help relieve pain.

High Intensity Focused Ultrasound (HIFU)

HIFU for prostate cancer utilizes high intensity focused ultrasound (HIFU) to ablate/destroy the tissue of the prostate. During the HIFU procedure, sound waves are used to heat the prostate tissue thus destroying the cancerous cells. Essentially, ultrasonic waves are precisely focused on specific areas of the prostate to eliminate the prostate cancer with minimal risks of effecting other tissue or organs. Temperatures at the focal point of the sound waves can exceed 100oC.^[92] In lay terms, the HIFU technology is similar to using a magnifying glass to burn a piece of paper by focusing sunlight at a small precise point on the sheet. The ability to focus the ultrasonic waves leads to a relatively low occurrence of both incontinence and impotence. (0.6% and 0-20%, respectively)^[93] According to international studies, when compared to other procedures, HIFU has a high success rate with a reduced risk of side effects. Studies using the Sonablate 500 HIFU machine have shown that 94% of patients with a pretreatment PSA (Prostate Specific Antigen) of less than 10 g/ml were cancer-free after three years.^[94] However, many studies of HIFU were performed by manufacturers of HIFU devices, or members of manufacturers' advisory panels.^[95]

HIFU was first used in the 1940’s and 1950’s in efforts to destroy tumors in the central nervous system. Since then, HIFU has been shown to be effective at destroying malignant tissue in the brain, prostate, spleen, liver, kidney, breast, and bone.^[96] Today, the HIFU procedure for prostate cancer is performed using a transrectal probe. This procedure has been performed for over ten years and is currently approved for use in Japan, Europe, Canada, and parts of Central and South America.

Although not yet approved for use in the Unites States, many patients have received the HIFU procedure at facilities in Canada, and Central and South America. Currently, therapy is available using the Sonablate 500 or the Ablatherm. The Sonablate 500 is designed by Focus Surgery of Indianapolis, Indiana and is used in international HIFU centers around the world.

Prognosis

Prostate cancer rates are higher and prognosis poorer in developed countries than the rest of the world. Many of the risk factors for prostate cancer are more prevalent in the developed world, including longer life expectancy and diets high in red meat and dairy products.^[97] Also, where there is more access to screening programs, there is a higher detection rate. Prostate cancer is the ninth most common cancer in the world, but is the number one non-skin cancer in United States men. Prostate cancer affected eighteen percent of American men and caused death in three percent in 2005.^[98] In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s.^[99] In India in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years.^[100] African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China.^[101] In Nigeria, two percent of men develop prostate cancer and 64% of them are dead after two years.^[102]

In patients who undergo treatment, the most important clinical prognostic indicators of disease outcome are stage, pre-therapy PSA level and Gleason score. In general, the higher the grade and the stage, the poorer the prognosis. Nomograms can be used to calculate the estimated risk of the individual patient. The predictions are based on the experience of large groups of patients suffering from cancers at various stages.^[103]

Progression

In 1941, Charles Huggins reported that androgen ablation therapy causes regression of primary and metastatic androgen-dependent prostate cancer.^[104] However, it is now known that 80–90% of prostate cancer patients develop androgen-independent tumors 12–33 months after androgen ablation therapy, leading to a median overall survival of 23–37 months from the time of initiation of androgen ablation therapy.^[105] The actual mechanism contributes to the progression of prostate cancer is not clear and may vary between individual patient. A few possible mechanisms have be proposed.^[106] Scientists have established a few prostate cancer cell lines to investigate the mechanism involved in the progression of prostate cancer. LNCaP, PC-3, and DU-145 are commonly used prostate cancer cell lines. The LNCaP cancer cell line was established from a human lymph node metastatic lesion of prostatic adenocarcinoma. PC-3 and DU-145 cells were established from human prostatic adenocarcinoma metastatic to bone and to brain, respectively. LNCaP cells express androgen receptor (AR), however, PC-3 and DU-145 cells express very little or no AR. AR, an androgen-activated transcription factor, belongs to the steroid nuclear receptor family. Development of the prostate is dependent on androgen signaling mediated through AR, and AR is also important during the development of prostate cancer. The proliferation of LNCaP cells is androgen-dependent but the proliferation of PC-3 and DU-145 cells is androgen-insensitive.Elevation of AR expression is often observed in advanced prostate tumors in patients.^[107]^[108] Some androgen-independent LNCaP sublines have been developed from the ATCC androgen-dependent LNCaP cells after androgen deprivation for study of prostate cancer progression. These androgen-independent LNCaP cells have elevated AR expression and express prostate specific antigen upon androgen treatment. Androgens paradoxically inhibit the proliferation of these androgen-independent prostate cancer cells.^[109]^[110]^[111] Androgen at a concentration of 10-fold higher than the physiological concentration has also been shown to cause growth suppression and reversion of androgen-independent prostate cancer xenografts or androgen-independent prostate tumors derived in vivo model to an androgen-stimulated phenotype in athymic mice.^[112]^[113] These observation suggest the possibility to use androgen to treat the development of relapsed androgen-independent prostate tumors in patients. Oral infusion of green tea polyphenols, a potential alternative therapy for prostate cancer by natural compounds, has been shown to inhibit the development, progression, and metastasis as well in autochthonous transgenic adenocarcinoma of the mouse prostate (TRAMP) model, which spontaneously develops prostate cancer.

from wikipedia

http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html

Obsessive Compulsive Disorder

2007-12-28T02:19:00.000-08:00

http://our-medical-center.blogspot.com/2007/12/obsessive-compulsive-disorder.html

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an illness that causes people to have unwanted thoughts (obsessions) and to repeat certain behaviors (compulsions) over and over again. We all have habits and routines in our daily lives, such as brushing our teeth before bed. However, for people with OCD, patterns of behavior get in the way of their daily lives.

Most people with OCD know that their obsessions and compulsions make no sense, but they can't ignore or stop them.

What are obsessions?

Obsessions are ideas, images and impulses that run through the person's mind over and over again. A person with OCD doesn't want to have these thoughts and finds them disturbing, but he or she can't control them. Sometimes these thoughts just come once in a while and are only mildly annoying. Other times, a person who has OCD will have obsessive thoughts all the time.

What are compulsions?

Obsessive thoughts make people who have OCD feel nervous and afraid. They try to get rid of these feelings by performing certain behaviors according to "rules" that they make up for themselves. These behaviors are called compulsions. (Compulsive behaviors are sometimes also called rituals.) For example, a person who has OCD may have obsessive thoughts about germs. Because of these thoughts, the person may wash his or her hands repeatedly after using a public toilet. Performing these behaviors usually only makes the nervous feelings go away for a short time. When the fear and nervousness return, the person who has OCD repeats the routine all over again.

What are some common obsessions?

The following are some common obsessions:

Fear of dirt or germs
Disgust with bodily waste or fluids
Concern with order, symmetry (balance) and exactness
Worry that a task has been done poorly, even when the person knows this is not true
Fear of thinking evil or sinful thoughts
Thinking about certain sounds, images, words or numbers all the time
Need for constant reassurance
Fear of harming a family member or friend

What are some common compulsions?

The following are some common compulsions:

Cleaning and grooming, such as washing hands, showering or brushing teeth over and over again
Checking drawers, door locks and appliances to be sure they are shut, locked or turned off
Repeating, such as going in and out of a door, sitting down and getting up from a chair, or touching certain objects several times
Ordering and arranging items in certain ways
Counting over and over to a certain number
Saving newspapers, mail or containers when they are no longer needed
Seeking constant reassurance and approval

How common is OCD?

For many years, OCD was thought to be rare. Some recent studies show that as many as 3 million Americans ages 18 to 54 may have OCD at any one time. This is about 2.3% of the people in this age group. OCD affects men and women equally.

What causes OCD?

No one has found a single, proven cause for OCD. Some research shows that it may have to do with chemicals in the brain that carry messages from one nerve cell to another. One of these chemicals, called serotonin (say "seer-oh-tone-in"), helps to keep people from repeating the same behaviors over and over again. A person who has OCD may not have enough serotonin. Many people who have OCD can function better when they take medicines that increase the amount of serotonin in their brain.

Are other illnesses associated with OCD?

People who have OCD often have other kinds of anxiety, like phobias (such as fear of spiders or fear of flying) or panic attacks.

People who have OCD also may have depression, attention deficit hyperactivity disorder (ADHD), an eating disorder or a learning disorder such as dyslexia.

Having one or more of these disorders can make diagnosis and treatment more difficult, so it's important to talk to your doctor about any symptoms you have, even if you're embarrassed.

How is OCD treated?

Several medicines are available to treat OCD. These medicines include: clomipramine (brand name: Anafranil), fluoxetine (brand name: Prozac), sertraline (brand name: Zoloft), paroxetine (brand name: Paxil) and fluvoxamine (brand name: Luvox). These drugs can cause side effects such as dry mouth, nausea and drowsiness. Sometimes they also affect a person's sexual performance. It may be several weeks before you see an improvement in your behavior.

Under the guidance of a trained therapist, behavioral therapy can also be used to treat OCD. In behavioral therapy, people face situations that cause or trigger their obsessions and anxiety. Then they are encouraged not to perform the rituals that usually help control their nervous feelings. For example, a person who is obsessed with germs might be encouraged to use a public toilet without washing his or her hands more than once. To use this method, a person who has OCD must be able to tolerate the high levels of anxiety that can result from the experience.

from familydoctor.org
http://our-medical-center.blogspot.com/2007/12/obsessive-compulsive-disorder.html

Brain Tumor

2007-12-22T03:14:00.001-08:00

http://our-medical-center.blogspot.com/2007/12/brain-tumor.html

Brain Tumor At A Glance

Brain tumors can be either malignant or benign.
The causes of brain tumors are not known.
Brain tumors can occur at any age.
Primary brain tumors initially form in the brain tissue.
Secondary brain tumors are cancers that have spread to the brain tissue from tissue elsewhere in the body.
The symptoms of brain tumors depend on their size and their location in the brain.
Brain tumors are diagnosed by the doctor based on the results of a medical history and physical examination and results of a variety of specialized tests of the brain and nervous system.
Treatment of a brain tumor depends on the type, location, and size of the tumor, as well as the age and health of the patient.

What is the brain?

The brain is a soft, spongy mass of tissue. It is protected by the bones of the skull and three thin membranes called meninges. Watery fluid called cerebrospinal fluid cushions the brain. This fluid flows through spaces between the meninges and through spaces within the brain called ventricles.

The brain and nearby structures

A network of nerves carries messages back and forth between the brain and the rest of the body. Some nerves go directly from the brain to the eyes, ears, and other parts of the head. Other nerves run through the spinal cord to connect the brain with the other parts of the body. Within the brain and spinal cord, glial cells surround nerve cells and hold them in place.

The brain directs the things we choose to do (like walking and talking) and the things our body does without thinking (like breathing). The brain is also in charge of our senses (sight, hearing, touch, taste, and smell), memory, emotions, and personality.

The three major parts of the brain control different activities:

Cerebrum—The cerebrum is the largest part of the brain. It is at the top of the brain. It uses information from our senses to tell us what is going on around us and tells our body how to respond. It controls reading, thinking, learning, speech, and emotions.

The cerebrum is divided into the left and right cerebral hemispheres, which control separate activities. The right hemisphere controls the muscles on the left side of the body. The left hemisphere controls the muscles on the right side of the body.

Cerebellum—The cerebellum is under the cerebrum at the back of the brain. The cerebellum controls balance and complex actions like walking and talking.
Brain Stem—The brain stem connects the brain with the spinal cord. It controls hunger and thirst. It also controls breathing, body temperature, blood pressure, and other basic body functions.

Major parts of the brain

What is cancer?

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

What are benign and malignant brain tumors?

Brain tumors can be benign or malignant:

Benign brain tumors do not contain cancer cells:
- Usually, benign tumors can be removed, and they seldom grow back.
- The border or edge of a benign brain tumor can be clearly seen. Cells from benign tumors do not invade tissues around them or spread to other parts of the body. However, benign tumors can press on sensitive areas of the brain and cause serious health problems.
- Unlike benign tumors in most other parts of the body, benign brain tumors are sometimes life threatening.
- Very rarely, a benign brain tumor may become malignant.
Malignant brain tumors contain cancer cells:
- Malignant brain tumors are generally more serious and often are life threatening.
- They are likely to grow rapidly and crowd or invade the surrounding healthy brain tissue.
- Very rarely, cancer cells may break away from a malignant brain tumor and spread to other parts of the brain, to the spinal cord, or even to other parts of the body. The spread of cancer is called metastasis.
- Sometimes, a malignant tumor does not extend into healthy tissue. The tumor may be contained within a layer of tissue. Or the bones of the skull or another structure in the head may confine it. This kind of tumor is called encapsulated.

Tumor Grade

Doctors sometimes group brain tumors by grade—from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells look under a microscope. Cells from high-grade tumors look more abnormal and generally grow faster than cells from low-grade tumors.

What are primary brain tumors?

Tumors that begin in brain tissue are known as primary tumors of the brain. (Information about secondary brain tumors appears in the following section.) Primary brain tumors are named according to the type of cells or the part of the brain in which they begin.

The most common primary brain tumors are gliomas. They begin in glial cells. There are many types of gliomas:

Astrocytoma—The tumor arises from star-shaped glial cells called astrocytes. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum, and the cerebellum. A grade III astrocytoma is sometimes called an anaplastic astrocytoma. A grade IV astrocytoma is usually called a glioblastoma multiforme.
Brain stem glioma—The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and middle-aged adults.
Ependymoma—The tumor arises from cells that line the ventricles or the central canal of the spinal cord. They are most commonly found in children and young adults.
Oligodendroglioma—This rare tumor arises from cells that make the fatty substance that covers and protects nerves. These tumors usually occur in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. They are most common in middle-aged adults.

Some types of brain tumors do not begin in glial cells. The most common of these are:

Medulloblastoma—This tumor usually arises in the cerebellum. It is the most common brain tumor in children. It is sometimes called a primitive neuroectodermal tumor.
Meningioma—This tumor arises in the meninges. It usually grows slowly.
Schwannoma—A tumor that arises from a Schwann cell. These cells line the nerve that controls balance and hearing. This nerve is in the inner ear. The tumor is also called an acoustic neuroma. It occurs most often in adults.
Craniopharyngioma—The tumor grows at the base of the brain, near the pituitary gland. This type of tumor most often occurs in children.
Germ cell tumor of the brain—The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger than 30. The most common type of germ cell tumor of the brain is a germinoma.
Pineal region tumor—This rare brain tumor arises in or near the pineal gland. The pineal gland is located between the cerebrum and the cerebellum.

What are secondary brain tumors?

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. Cancer that spreads to the brain from another part of the body is different from a primary brain tumor. When cancer cells spread to the brain from another organ (such as the lung or breast), doctors may call the tumor in the brain a secondary tumor or metastatic tumor. Secondary tumors in the brain are far more common than primary brain tumors.

What causes and who is at risk for brain tumors?

No one knows the exact causes of brain tumors. Doctors can seldom explain why one person develops a brain tumor and another does not. However, it is clear that brain tumors are not contagious. No one can "catch" the disease from another person.

Research has shown that people with certain risk factors are more likely than others to develop a brain tumor. A risk factor is anything that increases a person's chance of developing a disease.

The following risk factors are associated with an increased chance of developing a primary brain tumor:

Being male—In general, brain tumors are more common in males than females. However, meningiomas are more common in females.
Race—Brain tumors occur more often among white people than among people of other races.
Age—Most brain tumors are detected in people who are 70 years old or older. However, brain tumors are the second most common cancer in children. (Leukemia is the most common childhood cancer.) Brain tumors are more common in children younger than 8 years old than in older children.
Family history—People with family members who have gliomas may be more likely to develop this disease.
Being exposed to radiation or certain chemicals at work:
- Radiation—Workers in the nuclear industry have an increased risk of developing a brain tumor.
- Formaldehyde—Pathologists and embalmers who work with formaldehyde have an increased risk of developing brain cancer. Scientists have not found an increased risk of brain cancer among other types of workers exposed to formaldehyde.
- Vinyl chloride—Workers who make plastics may be exposed to vinyl chloride. This chemical may increase the risk of brain tumors.
- Acrylonitrile—People who make textiles and plastics may be exposed to acrylonitrile. This exposure may increase the risk of brain cancer.

Scientists are investigating whether cell phones may cause brain tumors. Studies thus far have not found an increased risk of brain tumors among people who use cell phones.

Scientists also continue to study whether head injuries are a risk factor for brain tumors. So far, these studies have not found an increased risk among people who have had head injuries.

Most people who have known risk factors do not get brain cancer. On the other hand, many who do get the disease have none of these risk factors. People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

What are symptoms of brain tumors?

The symptoms of brain tumors depend on tumor size, type, and location. Symptoms may be caused when a tumor presses on a nerve or damages a certain area of the brain. They also may be caused when the brain swells or fluid builds up within the skull.

These are the most common symptoms of brain tumors:

Headaches (usually worse in the morning)
Nausea or vomiting
Changes in speech, vision, or hearing
Problems balancing or walking
Changes in mood, personality, or ability to concentrate
Problems with memory
Muscle jerking or twitching (seizures or convulsions)
Numbness or tingling in the arms or legs

These symptoms are not sure signs of a brain tumor. Other conditions also could cause these problems. Anyone with these symptoms should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.

How are brain tumors diagnosed?

If a person has symptoms that suggest a brain tumor, the doctor may perform one or more of the following procedures:

Physical exam—The doctor checks general signs of health.
Neurologic exam—The doctor checks for alertness, muscle strength, coordination, reflexes, and response to pain. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and brain.
CT scan—An x-ray machine linked to a computer takes a series of detailed pictures of the head. The patient may receive an injection of a special dye so the brain shows up clearly in the pictures. The pictures can show tumors in the brain.
MRI—A powerful magnet linked to a computer makes detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed. Sometimes a special dye is injected to help show differences in the tissues of the brain. The pictures can show a tumor or other problem in the brain.

The doctor may ask for other tests:

Angiogram—Dye injected into the bloodstream flows into the blood vessels in the brain to make them show up on an x-ray. If a tumor is present, the doctor may be able to see it on the x-ray.
Skull x-ray—Some types of brain tumors cause calcium deposits in the brain or changes in the bones of the skull. With an x-ray, the doctor can check for these changes.
Spinal tap—The doctor may remove a sample of cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). This procedure is performed with local anesthesia. The doctor uses a long, thin needle to remove fluid from the spinal column. A spinal tap takes about 30 minutes. The patient must lie flat for several hours afterward to keep from getting a headache. A laboratory checks the fluid for cancer cells or other signs of problems.
Myelogram—This is an x-ray of the spine. A spinal tap is performed to inject a special dye into the cerebrospinal fluid. The patient is tilted to allow the dye to mix with the fluid. This test helps the doctor detect a tumor in the spinal cord.
Biopsy—The removal of tissue to look for tumor cells is called a biopsy. A pathologist looks at the cells under a microscope to check for abnormal cells. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to diagnose a brain tumor.
Surgeons can obtain tissue to look for tumor cells in three ways:
- Needle biopsy—The surgeon makes a small incision in the scalp and drills a small hole into the skull. This is called a burr hole. The doctor passes a needle through the burr hole and removes a sample of tissue from the brain tumor.
- Stereotactic biopsy—An imaging device, such as CT or MRI, guides the needle through the burr hole to the location of the tumor. The surgeon withdraws a sample of tissue with the needle.
- Biopsy at the same time as treatment—Sometimes the surgeon takes a tissue sample when the patient has surgery to remove the tumor.

Sometimes a biopsy is not possible. If the tumor is in the brain stem or certain other areas, the surgeon may not be able to remove tissue from the tumor without damaging normal brain tissue. The doctor uses MRI, CT, or other imaging tests instead.

A person who needs a biopsy may want to ask the doctor the following questions:

Why do I need a biopsy? How will the biopsy affect my treatment plan?
What kind of biopsy will I have?
How long will it take? Will I be awake? Will it hurt?
What are the chances of infection or bleeding after the biopsy? Are there any other risks?
How soon will I know the results?
If I do have a brain tumor, who will talk to me about treatment? When?

What is the treatment for brain tumors?

Many people with brain tumors want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, shock and stress after a diagnosis of a brain tumor can make it hard to think of everything to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor—to take part in the discussion, to take notes, or just to listen.

The doctor may refer the patient to a specialist, or the patient may ask for a referral. Specialists who treat brain tumors include neurosurgeons, neurooncologists, medical oncologists, and radiation oncologists. The patient may be referred to other health care professionals who work together as a team. The medical team may include a nurse, dietitian, mental health counselor, social worker, physical therapist, occupational therapist, and speech therapist. Children may need tutors to help with schoolwork. (The section on "Rehabilitation" has more information about therapists and tutors.)

Getting a second opinion

Before starting treatment, the patient might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it.

There are a number of ways to find a doctor for a second opinion:

The patient's doctor may refer the patient to one or more specialists. At cancer centers, several specialists often work together as a team.
The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.
A person with a brain tumor can request a consultation with a team of specialists in NCI's Neuro-Oncology Branch of the Warren Grant Magnuson Clinical Center at the National Institutes of Health in Bethesda, Maryland (301-402-6298).
A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")

Preparing for Treatment

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.

Treatment depends on a number of factors, including the type, location, size, and grade of the tumor. For some types of brain cancer, the doctor also needs to know whether cancer cells were found in the cerebrospinal fluid.

These are some questions a person may want to ask the doctor before treatment begins:

What type of brain tumor do I have?
Is it benign or malignant?
What is the grade of the tumor?
What are my treatment choices? Which do you recommend for me? Why?
What are the benefits of each kind of treatment?
What are the risks and possible side effects of each treatment?
What is the treatment likely to cost?
How will treatment affect my normal activities?
Would a clinical trial (research study) be appropriate for me? Can you help me find one?

People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

Methods of Treatment

People with brain tumors have several treatment options. Depending on the tumor type and stage, patients may be treated with surgery, radiation therapy, or chemotherapy. Some patients receive a combination of treatments.

In addition, at any stage of disease, patients may have treatment to control pain and other symptoms of the cancer, to relieve the side effects of therapy, and to ease emotional problems. This kind of treatment is called symptom management, supportive care, or palliative care.

The doctor is the best person to describe the treatment choices and discuss the expected results.

A patient may want to talk to the doctor about taking part in a clinical trial, which is a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

Surgery is the usual treatment for most brain tumors. Surgery to open the skull is called a craniotomy. It is performed under general anesthesia. Before surgery begins, the scalp is shaved. The surgeon then makes an incision in the scalp and uses a special type of saw to remove a piece of bone from the skull. After removing part or all of the tumor, the surgeon covers the opening in the skull with that piece of bone or with a piece of metal or fabric. The surgeon then closes the incision in the scalp.

These are some questions a person may want to ask the doctor before having surgery:

How will I feel after the operation?
What will you do for me if I have pain?
How long will I be in the hospital?
Will I have any long-term effects? Will my hair grow back? Are there any side effects from using metal or fabric to replace the bone in the skull?
When can I get back to my normal activities?
What is my chance of a full recovery?

Sometimes surgery is not possible. If the tumor is in the brain stem or certain other areas, the surgeon may not be able to remove the tumor without damaging normal brain tissue. Patients who cannot have surgery may receive radiation or other treatment.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill tumor cells. The radiation may come from x-rays, gamma rays, or protons. A large machine aims radiation at the tumor and the tissue close to it. Sometimes the radiation may be directed to the entire brain or to the spinal cord.

Radiation therapy usually follows surgery. The radiation kills tumor cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

The patient goes to a hospital or clinic for radiation therapy. The treatment schedule depends on the type and size of the tumor and the age of the patient. Each treatment lasts only a few minutes.

Doctors take steps to protect the healthy tissue around the brain tumor:

Fractionation—Radiation therapy usually is given five days a week for several weeks. Giving the total dose of radiation over an extended period helps to protect healthy tissue in the area of the tumor.
Hyperfractionation—The patient gets smaller doses of radiation two or three times a day instead of a larger amount once a day.
Stereotactic radiation therapy—Narrow beams of radiation are directed at the tumor from different angles. For this procedure, the patient wears a rigid head frame. An MRI or CT scan creates pictures of the tumor's exact location. The doctor uses a computer to decide on the dose of radiation needed, as well as the sizes and angles of the radiation beams. The therapy may be given during a single visit or over several visits.
3-dimensional conformal radiation therapy—A computer creates a 3-dimensional image of the tumor and nearby brain tissue. The doctor aims multiple radiation beams to the exact shape of the tumor. The precise focus of the radiation beams protects normal brain tissue.
Proton beam radiation therapy—The source of radiation is protons rather than x-rays. The doctor aims the proton beams at the tumor. Protons can pass through healthy tissue without damaging it.

These are some questions a person may want to ask the doctor before having radiation therapy:

Why do I need this treatment?
When will the treatments begin? When will they end?
How will I feel during therapy? Are there side effects?
What can I do to take care of myself during therapy?
How will we know if the radiation is working?
Will I be able to continue my normal activities during treatment?

Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat brain tumors. The drugs may be given by mouth or by injection. Either way, the drugs enter the bloodstream and travel throughout the body. The drugs are usually given in cycles so that a recovery period follows each treatment period.

Chemotherapy may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, the patient may need to stay in the hospital.

Children are more likely than adults to have chemotherapy. However, adults may have chemotherapy after surgery and radiation therapy.

For some patients with recurrent cancer of the brain, the surgeon removes the tumor and implants several wafers that contain chemotherapy. Each wafer is about the size of a dime. Over several weeks, the wafers dissolve, releasing the drug into the brain. The drug kills cancer cells.

Patients may want to ask these questions about chemotherapy:

Why do I need this treatment?
What will it do?
Will I have side effects? What can I do about them?
When will treatment start? When will it end?
How often will I need checkups?

What are the side effects of treatment for brain tumors?

Because treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend on many factors, including the location of the tumor and the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, the health care team will explain possible side effects and suggest ways to help the patient manage them.

Surgery

Patients often have a headache or are uncomfortable for the first few days after surgery. However, medicine can usually control their pain. Patients should feel free to discuss pain relief with the doctor or nurse.

It is also common for patients to feel tired or weak. The length of time it takes to recover from an operation varies for each patient.

Other, less common, problems may occur. Cerebrospinal fluid or blood may build up in the brain. This swelling is called edema. The health care team monitors the patient for signs of these problems. The patient may receive steroids to help relieve swelling. A second surgery may be needed to drain the fluid. The surgeon may place a long, thin tube (shunt) in a ventricle of the brain. The tube is threaded under the skin to another part of the body, usually the abdomen. Excess fluid is carried from the brain and drained into the abdomen. Sometimes the fluid is drained into the heart instead.

Infection is another problem that may develop after surgery. If this happens, the health care team gives the patient an antibiotic.

Brain surgery may damage normal tissue. Brain damage can be a serious problem. The patient may have problems thinking, seeing, or speaking. The patient also may have personality changes or seizures. Most of these problems lessen or disappear with time. But sometimes damage to the brain is permanent. The patient may need physical therapy, speech therapy, or occupational therapy.

Radiation Therapy

Some patients have nausea for several hours after treatment. The health care team can suggest ways to help patients cope with this problem. Radiation therapy also may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try to stay as active as they can.

In addition, radiation therapy commonly causes hair loss. Hair usually grows back within a few months. Radiation therapy also may affect the skin in the treated area. The scalp and ears may become red, dry, and tender. The health care team can suggest ways to relieve these problems.

Sometimes radiation therapy causes brain tissue to swell. Patients may get a headache or feel pressure. The health care team watches for signs of this problem. They can provide medicine to reduce the discomfort.

Radiation sometimes kills healthy brain tissue. This side effect is called radiation necrosis. Necrosis can cause headaches, seizures, or even the patient's death.

In children, radiation may damage the pituitary gland and other areas of the brain. This could cause learning problems or slow down growth and development. In addition, radiation during childhood increases the risk of secondary tumors later in life. Researchers are studying whether chemotherapy may be used instead of radiation therapy in young children with brain tumors.

Side effects may be worse if chemotherapy and radiation therapy are given at the same time. The doctor can suggest ways to ease these problems.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs that are used. The most common side effects include fever and chills, nausea and vomiting, loss of appetite, and weakness. Some side effects may be relieved with medicine.

Patients who receive an implant (a wafer) that contains a drug are monitored by the health care team for signs of infection after surgery. An infection can be treated with an antibiotic.

Supportive Care

At any stage of disease, people with brain tumors receive supportive care to prevent or control problems and to improve their comfort and quality of life during treatment. Patients may have treatment to control pain and other symptoms of a brain tumor, to relieve the side effects of therapy, and to ease emotional problems.

These are common types of supportive care for people with brain tumors:

Steroids—Most patients with brain tumors need steroids to help relieve swelling of the brain.
Anticonvulsant medicine—Brain tumors can cause seizures. Patients may take an anticonvulsant medicine to prevent or control seizures.
Shunt—If fluid builds up in the brain, the surgeon may place a shunt to drain the fluid. Information about shunts is under "Surgery" in the "Side Effects" section.

Many people with brain tumors receive supportive care along with treatments intended to slow the progress of the disease. Some decide not to have antitumor treatment and receive only supportive care to manage their symptoms.

What about rehabilitation after treatment for brain tumors?

Rehabilitation can be a very important part of the treatment plan. The goals of rehabilitation depend on the person's needs and how the tumor has affected daily activities. The health care team makes every effort to help the patient return to normal activities as soon as possible. Several types of therapists can help:

Physical therapists—Brain tumors and their treatment may cause paralysis. They may also cause weakness and problems with balance. Physical therapists help patients regain strength and balance.
Speech therapists—Speech therapists help patients who have trouble speaking, expressing thoughts, or swallowing.
Occupational therapists—Occupational therapists help patients learn to manage activities of daily living, such as eating, using the toilet, bathing, and dressing.

Children with brain tumors may have special needs. Sometimes children have tutors in the hospital or at home. Children who have problems learning or remembering what they learn may need tutors or special classes when they return to school.

What happens after treatment for brain tumors?

Regular followup is very important after treatment for a brain tumor. The doctor checks closely to make sure that the tumor has not returned. Checkups may include careful physical and neurologic exams. From time to time, the patient may have MRI or CT scans. If the patient has a shunt, the doctor checks to see that it is working well. The doctor can explain the followup plan—how often the patient must visit the doctor and what tests will be needed.

What support is available to patients with brain tumors?

Living with a serious disease such as a brain tumor is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group. Groups may offer support in person, over the telephone, or on the Internet.

People living with a brain tumor may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

The Cancer Information Service can provide information to help patients and their families locate programs, services, and publications.

The promise of cancer research

Doctors all over the country are conducting many types of clinical trials. These are research studies in which people take part voluntarily. Studies include new ways to treat brain tumors. Research has already led to advances, and researchers continue to search for more effective approaches.

Patients who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take very careful steps to protect their patients.

Researchers are testing new anticancer drugs, doses, and treatment schedules. They are working with various drugs and drug combinations, as well as combinations of drugs and radiation therapy. They also are testing new methods and schedules of radiation therapy.

Patients who are interested in being part of a clinical trial should talk with their doctor. NCI's Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. This section of the Web site provides general information about clinical trials. It also offers detailed information about ongoing studies of treatment for brain tumors. The Cancer Information Service at 1-800-4-CANCER can answer questions and provide information about clinical trials.

from medicinenet.com

http://our-medical-center.blogspot.com/2007/12/brain-tumor.html

Lung Cancer

2007-12-21T03:07:00.000-08:00

http://our-medical-center.blogspot.com/2007/12/lung-cancer.html

Lung Cancer At A Glance

Lung cancer is the number-one cause of cancer deaths in both men and women in the U.S. and worldwide.
Cigarette smoking is the principal risk factor for development of lung cancer.
Passive exposure to tobacco smoke can also cause cancer.
The two types of lung cancer, which grow and spread differently, are the small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC).
The stage of lung cancer refers to the extent to which the cancer has spread in the body.
Treatment of lung cancer can involve a combination of surgery, chemotherapy, and radiation therapy as well as newer experimental methods.
The general prognosis of lung cancer is poor, with overall survival rates of about 16% at five years.
Smoking cessation is the most important measure that can prevent the development of lung cancer.

What is cancer of the lung?

Cancer of the lung, like all cancers, results from an abnormality in the body's basic unit of life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that cells divide to produce new cells only when needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor.

Tumors can be benign or malignant; when we speak of "cancer," we refer to those tumors that are considered malignant. Benign tumors can usually be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system which spread the tumor to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread, or metastasize, very early in its course, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs—particularly the adrenal glands, liver, brain, and bone—are the most common sites for lung cancer metastasis.

The lung is also a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original, or primary, tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer.

Lung Cancer Picture

The principal function of the lungs is the exchange of gases between the air we breathe and the blood. Through the lung, carbon dioxide is removed from the body and oxygen from inspired air enters the bloodstream. The right lung has three lobes, while the left lung is divided into two lobes and a small structure called the lingula that is the equivalent of the middle lobe. The major airways entering the lungs are the bronchi, which arise from the trachea. The bronchi branch into progressively smaller airways called bronchioles that end in tiny sacs known as alveoli, where gas exchange occurs. The lungs and chest wall are covered with a thin layer of tissue called the pleura.

Lung cancers can arise in any part of the lung, and 90%-95% of cancers of the lung are thought to arise from the epithelial, or lining cells of the larger and smaller airways (bronchi and bronchioles); for this reason, lung cancers are sometimes called bronchogenic carcinomas or bronchogenic cancers. Cancers can also arise from the pleura (the thin layer of tissue that surrounds the lungs), called mesotheliomas, or rarely from supporting tissues within the lungs, for example, blood vessels.

How common is lung cancer?

Lung cancer is responsible for the most cancer deaths in both men and women throughout the world. The American Cancer Society estimates that 213,380 new cases of lung cancer in the U.S. will be diagnosed and 160,390 deaths due to lung cancer will occur in 2007. Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with the condition are over 65 years of age, while less than 3% of cases occur in people under age 45.

Lung cancer was not common prior to the 1930s but increased dramatically over the following decades as tobacco smoking increased. In many developing countries, the incidence of lung cancer is beginning to fall following public education about the dangers of cigarette smoking and effective smoking-cessation programs. Nevertheless, lung cancer remains among the most common types of cancers in both men and women worldwide.

Lung cancer has also surpassed breast cancer in causing the most cancer-related deaths in women in the United States.

What causes lung cancer?

Smoking

The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes smoked over time; doctors refer to this risk in terms of pack-years of smoking history (the number of packs of cigarettes smoked per day multiplied by the number of years smoked). For example, a person who has smoked two packs of cigarettes per day for 10 years has a 20 pack-year smoking history. While the risk of lung cancer is increased with even a 10 pack-year smoking history, those with 30 pack-year histories or more are considered to have the greatest risk for the development of lung cancer. Among those who smoke two or more packs of cigarettes per day, one in seven will die of lung cancer.

Pipe and cigar smoking can also cause lung cancer, although the risk is not as high as with cigarette smoking. While someone who smokes one pack of cigarettes per day has a risk for the development of lung cancer that is 25 times higher than a nonsmoker, pipe and cigar smokers have a risk of lung cancer that is about five times that of a nonsmoker.

Tobacco smoke contains over 4,000 chemical compounds, many of which have been shown to be cancer-causing, or carcinogenic. The two primary carcinogens in tobacco smoke are chemicals known as nitrosamines and polycyclic aromatic hydrocarbons. The risk of developing lung cancer decreases each year following smoking cessation as normal cells grow and replace damaged cells in the lung. In former smokers, the risk of developing lung cancer begins to approach that of a nonsmoker about 15 years after cessation of smoking. For more, please read the Smoking and Quitting Smoking article.

Passive smoking

Passive smoking, or the inhalation of tobacco smoke from other smokers sharing living or working quarters, is also an established risk factor for the development of lung cancer. Research has shown that nonsmokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with other nonsmokers. An estimated 3,000 lung cancer deaths occur each year in the U.S. that are attributable to passive smoking.

Asbestos fibers

Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue following exposure to asbestos. The workplace is a common source of exposure to asbestos fibers, as asbestos was widely used in the past for both thermal and acoustic insulation materials. Today, asbestos use is limited or banned in many countries, including the Unites States. Both lung cancer and mesothelioma (a type of cancer of the pleura or of the lining of the abdominal cavity called the peritoneum) are associated with exposure to asbestos. Cigarette smoking drastically increases the chance of developing an asbestos-related lung cancer in exposed workers. Asbestos workers who do not smoke have a fivefold greater risk of developing lung cancer than nonsmokers, and those asbestos workers who smoke have a risk that is 50 to 90 times greater than nonsmokers.

Radon gas

Radon gas is a natural, chemically inert gas that is a natural decay product of uranium. It decays to form products that emit a type of ionizing radiation. Radon gas is a known cause of lung cancer, with an estimated 12% of lung cancer deaths attributable to radon gas, or 15,000 to 22,000 lung cancer-related deaths annually in the U.S., making radon the second leading cause of lung cancer in the U.S. As with asbestos exposure, concomitant smoking greatly increases the risk of lung cancer with radon exposure. Radon gas can travel up through soil and enter homes through gaps in the foundation, pipes, drains, or other openings. The U.S. Environmental Protection Agency estimates that one out of every 15 homes in the U.S. contains dangerous levels of radon gas. Radon gas is invisible and odorless, but it can be detected with simple test kits.

Familial predisposition

While the majority of lung cancers are associated with tobacco smoking, the fact that not all smokers eventually develop lung cancer suggests that other factors, such as individual genetic susceptibility, may play a role in the causation of lung cancer. Numerous studies have shown that lung cancer is more likely to occur in both smoking and nonsmoking relatives of those who have had lung cancer than in the general population. Recent research has localized a region on the long (q) arm of the human chromosome number 6 that is likely to contain a gene that confers an increased susceptibility to the development of lung cancer in smokers.

Lung diseases

The presence of certain diseases of the lung, notably chronic obstructive pulmonary disease (COPD), is associated with a slightly increased risk (four to six times the risk of a nonsmoker) for the development of lung cancer even after the effects of concomitant cigarette smoking are excluded.

Prior history of lung cancer

Survivors of lung cancer have a greater risk than the general population of developing a second lung cancer. Survivors of non-small cell lung cancers (NSCLCs, see below) have an additive risk of 1%-2% per year for developing a second lung cancer. In survivors of small cell lung cancers (SCLCs), the risk for development of second cancers approaches 6% per year.

Air pollution

Air pollution from vehicles, industry, and power plants can raise the likelihood of developing lung cancer in exposed individuals. Up to 1% of lung cancer deaths are attributable to breathing polluted air, and experts believe that prolonged exposure to highly polluted air can carry a risk similar to that of passive smoking for the development of lung cancer.

What are the types of lung cancer?

Lung cancers, also known as bronchogenic carcinomas ("carcinoma" is another term for cancer), are broadly classified into two types: small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). This classification is based upon the microscopic appearance of the tumor cells themselves. These two types of cancers grow and spread in different ways, so a distinction between these two types is important.

SCLC comprise about 20% of lung cancers and are the most aggressive and rapidly growing of all lung cancers. SCLC are strongly related to cigarette smoking, with only 1% of these tumors occurring in nonsmokers. SCLC metastasize rapidly to many sites within the body and are most often discovered after they have spread extensively. Referring to a specific cell type often seen in SCLC, these cancers are sometimes called oat cell carcinomas.

NSCLC are the most common lung cancers, accounting for about 80% of all lung cancers. NSCLC has three main types that are named based upon the type of cells found in the tumor:

Adenocarcinomas are the most commonly seen type of NSCLC in the U.S. and comprise up to 50% of NSCLC . While adenocarcinomas are associated with smoking like other lung cancers, this type is especially observed as well in nonsmokers who develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs. Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.

Squamous cell carcinomas were formerly more common than adenocarcinomas; at present, they account for about 30% of NSCLC. Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.

Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.

Mixtures of different types of NSCLC are also seen.

Other types of cancers can arise in the lung; these types are much less common than NSCLC and SCLC and together comprise only 5%-10% of lung cancers:

Bronchial carcinoids account for up to 5% of lung cancers. These tumors are generally small (3-4 cm or less) when diagnosed and occur most commonly in people under 40 years of age. Unrelated to cigarette smoking, carcinoid tumors can metastasize, and a small proportion of these tumors secrete hormone-like substances. Carcinoids generally grow and spread more slowly than bronchogenic cancers, and many are detected early enough to be amenable to surgical resection.

Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involved in the immune response can rarely occur in the lung.

As discussed previously, metastastatic cancers from other primary tumors in the body are often found in the lung. Tumors from anywhere in the body may spread to the lungs either through the bloodstream, through the lymphatic system, or directly from nearby organs. Metastatic tumors are most often multiple, scattered throughout the lung, and concentrated in the peripheral rather than central areas of the organ.

What are the signs and symptoms of lung cancer?

Symptoms of lung cancer are varied dependent upon where and how widespread the tumor is. Warning signs of lung cancer are not always present or easy to identify. A person with lung cancer may have the following kinds of symptoms:

No symptoms: In up to 25% of people who get lung cancer, the cancer is first discovered on a routine chest x-ray or CT scan as a solitary small mass sometimes called a coin lesion. These patients with small single masses often report no symptoms of lung cancer at the time it is discovered.

Symptoms related to the cancer: The growth of the cancer and invasion of lung tissues and surroundings may interfere with breathing, leading to symptoms such as cough, shortness of breath, wheezing, chest pain, and coughing up blood (hemoptysis). If the cancer has invaded nerves, for example, it may cause shoulder pain that travels down the outside of the arm (called Pancoast's Syndrome) or paralysis of the vocal cords leading to hoarseness. Invasion of the esophagus may lead to difficulty swallowing (dysphagia). If a large airway is obstructed, collapse of a portion of the lung may occur and cause infections (abscesses, pneumonia) in the obstructed area.

Symptoms related to metastasis: Lung cancer that has spread to the bones may produce excruciating pain at the sites of bone involvement. Cancer that has spread to the brain may cause a number of neurologic symptoms that may include blurred vision, headaches, seizures, or symptoms of stroke such as weakness or loss of sensation in parts of the body.

Paraneoplastic symptoms: Lung cancers frequently are accompanied by so-called paraneoplastic syndromes that result from production of hormone-like substances by the tumor cells. Paraneoplastic syndromes occur most commonly with SCLC but may be seen with any tumor type. A common paraneoplastic syndrome associated with SCLC is the production of a hormone called adrenocorticotrophic hormone (ACTH) by the cancer cells, leading to oversecretion of the hormone cortisol by the adrenal glands (Cushing's syndrome). The most frequent paraneoplastic syndrome seen with NSCLC is the production of a substance similar to parathyroid hormone, resulting in elevated levels of calcium in the bloodstream.

Nonspecific symptoms: Nonspecific symptoms seen with many cancers including lung cancers include weight loss, weakness, and fatigue. Psychological symptoms such as depression and mood changes are also common.

When should one consult a doctor?

One should consult a health care provider if they develop the symptoms associated with lung cancer, in particular, if they have

a new persistent cough or worsening of an existing chronic cough

blood in the sputum,

persistent bronchitis or repeated respiratory infections

chest pain

unexplained weight loss and/or fatigue

breathing difficulties such as shortness of breath or wheezing.

How is lung cancer diagnosed?

Doctors use a wide range of diagnostic procedures and tests to diagnose lung cancer. These include:

The history and physical examination may reveal the presence of symptoms or signs that are suspicious for lung cancer. In addition to asking about symptoms and risk factors for cancer development, doctors may detect signs of breathing difficulties, airway obstruction, or infections in the lungs. Cyanosis, a bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood, suggests compromised function of the lung. Likewise, changes in the tissue of the nail beds, known as clubbing, may also indicate lung disease.

The chest x-ray is the most common first diagnostic step when any new symptoms of lung cancer are present. The chest x-ray procedure often involves a view from the back to the front of the chest as well as a view from the side. Like any x-ray procedure, chest x-rays expose the patient briefly to a minimum amount of radiation. Chest x-rays may reveal suspicious areas in the lungs but are unable to determine if these areas are cancerous. In particular, calcified nodules in the lungs or benign tumors called hamartomas may be identified on a chest x-ray and simulate lung cancer.

CT (computerized axial tomography scan, or CAT scan) scans may be performed on the chest, abdomen, and/or brain to examine for both metastatic and primary tumor. A CT scan of the chest may be ordered when x-rays are negative or do not yield sufficient information about the extent or location of a tumor. CT scans are x-ray procedures that combine multiple images with the aid of a computer to generate cross-sectional views of the body. The images are taken by a large donut-shaped x-ray machine at different angles around the body. One advantage of CT scans is that they are more sensitive than standard chest x-rays in the detection of lung nodules. Sometimes intravenous contrast material is given prior to the procedure to help delineate the organs and their positions. A CT scan exposes the patient to a minimal amount of radiation. The most common side effect is an adverse reaction to intravenous contrast material that may have been given prior to the procedure. There may be resulting itching, a rash, or hives that generally disappear rather quickly. Severe anaphylactic reactions (life-threatening allergic reactions with breathing difficulties) to contrast material are rare. CT scans of the abdomen may identify metastatic cancer in the liver or adrenal glands, and CT scans of the head may be ordered to reveal the presence and extent of metastatic cancer in the brain.

A technique called a low-dose helical CT scan (or spiral CT scan) is sometimes used in screening for lung cancers. This procedure requires a special type of CAT scanner and has been shown to be an effective tool for the identification of small lung cancers in smokers and former smokers. However, it has not yet been proven whether the use of this technique actually saves lives or lowers the risk of death from lung cancer. The heightened sensitivity of this method is actually one of the sources of its drawbacks, since lung nodules requiring further evaluation will be seen in approximately 20% of people with this technique. Of the nodules identified by low-dose helical screening CTs, 90% are not cancerous but require up to two years of costly and often uncomfortable follow-up and testing. Trials are underway to further determine the utility of spiral CT scans in screening for lung cancer.

Magnetic resonance imaging (MRI) scans may be indicated when precise detail about a tumor's location is required. The MRI technique uses magnetism, radio waves, and a computer to produce images of body structures. As with CT scanning, the patient is placed on a moveable bed which is inserted into the MRI scanner. There are no known side effects of MRI scanning, and there is no exposure to radiation. The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the body. People with heart pacemakers, metal implants, artificial heart valves, and other surgically implanted structures cannot be scanned with an MRI because of the risk that the magnet may move the metal parts of these structures.

Positron emission tomography (PET) scanning is a specialized imaging technique that uses short-lived radioactive substances to produce three-dimensional colored images of those substances functioning within the body. While CT scans and MRI scans look at anatomical structures, PET scans measure metabolic activity and functioning of tissue. PET scans can determine whether a tumor tissue is actively growing and can aid in determining the type of cells within a particular tumor. In PET scanning, the patient receives a short half-lived radioactive drug and receives approximately the amount of radiation exposure as with two chest x-rays. The drug discharges positrons from wherever they are used in the body. As the positrons encounter electrons within the body, a reaction producing gamma rays occurs. A scanner records these gamma rays and maps the area where the drug is located. For example, combining glucose (a common energy source in the body) with a radioactive substance will show where glucose is being used in a growing tumor.

Bone scans are used to create images of bones on a computer screen or on film. Doctors may order a bone scan to determine whether a lung cancer has metastasized to the bones. In a bone scan, a small amount of radioactive material is injected into the bloodstream and collects in the bones, especially in abnormal areas such as those involved by metastatic tumors. The radioactive material is detected by a scanner, and the image of the bones is recorded on a special film for permanent viewing.

Sputum cytology: The diagnosis of lung cancer always requires confirmation of malignant cells by a pathologist, even when symptoms and x-ray studies are suspicious for lung cancer. The simplest method to establish the diagnosis is the examination of sputum under a microscope. If a tumor is centrally located and has invaded the airways, this procedure, known as a sputum cytology examination, may allow visualization of tumor cells for diagnosis. This is the most risk-free and inexpensive tissue diagnostic procedure, but its value is limited since tumor cells will not always be present in sputum even if a cancer is present. Also, noncancerous cells may occasionally undergo changes in reaction to inflammation or injury that makes them look like cancer cells.

Bronchoscopy: Examination of the airways by bronchoscopy (visualizing the airways through a thin probe inserted in a tube through the nose or mouth) may reveal areas of tumor that can be sampled for pathologic diagnosis. A tumor in the central areas of the lung or arising from the larger airways is accessible to sampling using this technique. Bronchoscopy may be performed using a rigid or a flexible, fiberoptic bronchoscope and can be performed in a same-day outpatient bronchoscopy suite, an operating room, or on a hospital ward. The procedure can be uncomfortable and require sedation or anesthesia. While the procedure is relatively safe, the procedure must be carried out by a lung specialist (pulmonologist or surgeon) experienced in the procedure. When a tumor is visualized and adequately sampled, an accurate cancer diagnosis is generally possible. Some patients may cough up dark-brown blood for one to two days after the procedure. More serious, and rare, complications include a greater amount of bleeding, decreased levels of oxygen in the blood, and heart arrhythmias as well as complications from sedative medications and anesthesia.

Needle biopsy: Fine needle aspiration (FNA) through the skin, most commonly performed with radiological imaging for guidance, may be useful in retrieving cells for diagnosis from tumor nodules in the lungs. Needle biopsies are particularly useful when the lung tumor is peripherally located in the lung and not accessible to sampling by bronchoscopy. A small amount of local anesthetic is given prior to insertion of a thin needle through the chest wall into the abnormal area in the lung. Cells are suctioned into the syringe and are examined under the microscope for tumor cells. This procedure is generally accurate when the tissue from the affected area is adequately sampled, but in some cases, adjacent or uninvolved areas of the lung may be mistakenly sampled. A small risk (3%-5%) of an air leak from the lungs (called a pneumothorax, which can easily be treated) accompanies the procedure.

Thoracentesis: Sometimes lung cancers involve the lining tissue of the lungs (pleura) and lead to an accumulation of fluid in the space between the lungs and chest wall (called a pleural effusion). Aspiration of a sample of this fluid with a thin needle (thoracentesis) may reveal the cancer cells and establish the diagnosis. As with the needle biopsy, a small risk of a pneumothorax is associated with this procedure.

Major surgical procedures: If none of the aforementioned methods yields a diagnosis, surgical methods must be employed to obtain tumor tissue for diagnosis. These can include mediastinoscopy (examining the chest cavity between the lungs through a surgically inserted probe with biopsy of tumor masses or lymph nodes) or thoracotomy (surgical opening of the chest wall with removal of as much tumor as possible). Thoracotomy is rarely able to completely remove a lung cancer, and both mediastinoscopy and thoracotomy carry the risks of major surgical procedures (complications such as bleeding, infection, and risks from anesthesia and medications). These procedures are performed in an operating room, and the patient must be hospitalized.

Blood tests: While routine blood tests alone cannot diagnose lung cancer, they may reveal biochemical or metabolic abnormalities in the body that accompany cancer. For example, elevated levels of calcium or of the enzyme alkaline phosphatase may accompany cancer that is metastatic to the bones. Likewise, elevated levels of certain enzymes normally present within liver cells, including aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT), signal liver damage, possibly through the presence of metastatic tumor.

Schematic illustration of a lung cancer located in the right upper lobe of the lung.

What is staging of lung cancer?

The stage of a tumor refers to the extent to which a cancer has spread in the body. Staging involves both evaluation of a tumor's size as well as the presence or absence of metastases in the lymph nodes or in other organs. Staging is important for determining how a particular tumor should be treated, since lung cancer therapies are geared toward specific tumor stages. Staging of a tumor is also critical in estimating the prognosis of a given patient, with higher-stage tumors generally having a worse prognosis than lower-stage tumors.

Doctors may use several tests to accurately stage a lung cancer, including laboratory (blood chemistry) tests, x-rays, CT scans, bone scans, and MRI scans. Abnormal blood chemistry tests may signal the presence of metastases in bone or liver, and radiological procedures can document the size of a tumor as well as possible spread to other organs.

NSCLC are assigned a stage from I to IV in order of severity:

In stage I, the cancer is confined to the lung.

In stages II and III, the cancer is confined to the chest (with larger and more invasive tumors classified as stage III).

Stage IV cancer has spread away from the chest to other parts of the body.

SCLC are staged using a two-tiered system:

Limited stage (LS) SCLC refers to cancer that is confined to its area of origin in the chest.

In extensive-stage (ES) SCLC, the cancer has spread beyond the chest to other parts of the body.

How is lung cancer treated?

Treatment for lung cancer can involve surgical removal of tumor, chemotherapy, or radiation therapy, as well as combinations of these methods. The decision about which treatments will be appropriate for a given individual must take into account the localization and extent of the tumor as well as the overall health status of the patient.

As with other cancers, therapy may be prescribed that is intended to be curative (removal or eradication of a cancer) or palliative (measures that are unable to cure a cancer but can reduce pain and suffering). More than one type of therapy may be prescribed. In such cases, the therapy that is added to enhance the effects of the primary therapy is referred to as adjuvant therapy. An example of adjuvant therapy is chemotherapy or radiotherapy administered after surgical removal of a tumor in order to be certain that all tumor cells are killed.

Surgery: Surgical removal of the tumor is generally performed for limited-stage (stage I or sometimes stage II) NSCLC and is the treatment of choice for cancer that has not spread beyond the lung. About 10%-35% of lung cancers can be removed surgically, but removal does not always result in a cure, since the tumors may already have spread and can recur at a later time. Among people who have an isolated, slow-growing lung cancer removed, 25%-40% are alive five years after diagnosis. Surgery may not be possible if the cancer is too close to the trachea or if the person has other serious conditions (such as severe heart or lung disease) that would limit their ability to tolerate an operation. Surgery is less often performed with SCLC because these tumors are less likely to be localized to one area that can be removed.

The surgical procedure chosen depends upon the size and location of the tumor. Surgeons must open the chest wall and may perform a wedge resection of the lung (removal of a portion of one lobe), a lobectomy (removal of one lobe), or a pneumonectomy (removal of an entire lung). Sometimes lymph nodes in the region of the lungs are also removed (lymphadenectomy). Surgery for lung cancer is a major surgical procedure that requires general anesthesia, hospitalization and follow-up care for weeks to months. Following the surgical procedure, patients may experience difficulty breathing, shortness of breath, pain, and weakness. The risks of surgery include complications due to bleeding, infection, and complications of general anesthesia.

Radiation: Radiation therapy may be employed as a treatment for both NSCLC and SCLC. Radiation therapy uses high-energy x-rays or other types of radiation to kill dividing cancer cells. Radiation therapy may be given as curative therapy, palliative therapy (using lower doses of radiation than with curative regimens) or as adjuvant therapy to surgery or chemotherapy. The radiation is either delivered externally, by using a machine that directs radiation toward the cancer, or internally through placement of radioactive substances in sealed containers within the area of the body where the tumor is localized. Brachytherapy is a term used to describe the use of a small pellet of radioactive material placed directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope. A type of external radiation therapy called the "gamma knife" is sometimes used to treat single brain metastases. In this procedure, multiple beams of radiation are focused on the tumor over a few minutes to hours while the head is held in place by a rigid frame. Radiation therapy can be given if a person refuses surgery, if a tumor has spread to areas such as the lymph nodes or trachea making surgical removal impossible, or if a person has other conditions that make them too ill to undergo major surgery. Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10%-15% of people it leads to long-term remission and palliation of the cancer. Combining radiation therapy with chemotherapy can further increase the chances of survival when chemotherapy is administered. External radiation therapy can generally be carried out on an outpatient basis while internal radiation therapy requires a brief hospitalization. A person who has severe lung disease in addition to a lung cancer may not be able to receive radiotherapy to the lung.

For external radiation therapy, a process called simulation is necessary prior to treatment. Using CT scans, computers, and precise measurements, simulation maps out the exact location where the radiation will be delivered, called the treatment field or port. This process usually takes 30 minutes to two hours. The external radiation treatment itself generally is done over four or five days a week for several weeks.

Radiation therapy does not carry the risks of major surgery, but it can have unpleasant side effects including tiredness and lack of energy. A reduced white cell count (rendering a person more susceptible to infection) and low blood platelet levels (making blood clotting more difficult) can also occur with radiation therapy. If the digestive organs are in the field exposed to radiation, patients may experience nausea, vomiting, or diarrhea. Radiation therapy can irritate the skin in the area that is treated, but this irritation generally improves with time after treatment has ended.

Chemotherapy: Both NSCLC and SCLC may be treated with chemotherapy. Chemotherapy refers to the administration of drugs that stop the growth of cancer cells by killing them or preventing them from dividing. Chemotherapy may be given alone, as an adjuvant to surgical therapy, or in combination with radiotherapy. While a number of chemotherapeutic drugs have been developed, the platinum-based drugs have been the most effective in treatment of lung cancers.

Chemotherapy is the treatment of choice for most SCLC, since these tumors are generally widespread in the body when they are diagnosed. Only half of people who have SCLC survive for four months without chemotherapy. With chemotherapy, their survival time is increased up to four- to fivefold. Chemotherapy alone is not particularly effective in treating NSCLC, but when NSCLC have metastasized, it can prolong survival in many cases.

Chemotherapy may be given as pills, as an intravenous infusion, or as a combination of the two. Chemotherapy treatments are usually given in an outpatient setting. A combination of drugs is given in a series of treatments, called cycles, over a period of weeks to months, with breaks in between cycles. Unfortunately, the drugs used in chemotherapy also kill normally dividing cells in the body, resulting in unpleasant side effects. Damage to blood cells can result in increased susceptibility to infections and difficulties with blood clotting (bleeding or bruising easily). Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea, and mouth sores. The side effects of chemotherapy vary according to the dosage and combination of drugs used and may also vary from individual to individual. Medications have been developed that can treat or prevent many of the side effects of chemotherapy. The side effects generally disappear during the recovery phase of the treatment or after its completion.

Brain prophylactic radiation: SCLC often spreads to the brain. Sometimes people with SCLC that is responding well to treatment are treated with radiation therapy to the head to treat very early spread to the brain (called micrometastasis) that is not yet detectable with CT or MRI scans and has not yet produced symptoms. Brain radiation therapy can cause short-term memory problems, fatigue, nausea and other side effects.

Treatment of recurrence: Lung cancer that has returned following treatment with surgery, chemotherapy, and/or radiation therapy is called recurrent or relapsed. If a recurrent cancer is confined to one site in the lung, it may be treated with surgery. Relapsed tumors generally do not respond to the chemotherapeutic drugs that were previously administered. Since platinum-based drugs are generally used in initial chemotherapy of lung cancers, these agents are not useful in most cases of recurrence. A type of chemotherapy referred to as second-line chemotherapy is used to treat recurrent cancers that have previously been treated with chemotherapy, and a number of second-line chemotherapeutic regimens have been proved effective at prolonging survival. People with recurrent lung cancer who are well enough to tolerate therapy are also good candidates for experimental therapies (see below) including clinical trials.

Targeted therapy: One alternative to standard chemotherapy is the drug erlotinib (Tarceva) which may be used in patients with NSCLC who are no longer responding to chemotherapy. It is a so-called targeted drug, a drug that more specifically targets cancer cells, resulting in less damage to normal cells. Erlotinib targets a protein called the epidermal growth factor receptor (EGFR) which helps cells to divide. This protein is found at abnormally high levels on the surface of some types of cancer cells, including many cases of non-small cell lung cancer. Erlotinib is taken by mouth in pill form.

Other attempts at targeted therapy include drugs known as antiangiogenesis drugs, which block the development of new blood vessels within a tumor. The antiangiogenic drug bevacizumab (Avastin) has recently been found to prolong survival in advanced lung cancer when it is added to the standard chemotherapy regimen. Bevacizumab is given intravenously every two to three weeks. However, since this drug may cause bleeding, it is not appropriate for use in patients who are coughing up blood, if the lung cancer has spread to the brain, or in people who are receiving anticoagulation therapy ("blood thinner" medications). Bevacizumab is also not used in cases of squamous cell cancer, because it leads to bleeding from this type of lung cancer.

Photodynamic therapy (PDT): One newer therapy used for different types and stages of lung cancer (as well as some other cancers) is photodynamic therapy. In photodynamic treatment, a photosynthesizing agent (such as a porphyrin, a naturally occurring substance in the body) is injected into the bloodstream a few hours prior to surgery. During this time, the agent deposits itself selectively in rapidly growing cells such as cancer cells. A procedure then follows in which the physician applies a certain wavelength of light through a handheld wand directly to the site of the cancer and surrounding tissues. The energy from the light activates the photosensitizing agent, causing the production of a toxin that destroys the tumor cells. PDT has the advantages that it can precisely target the location of the cancer, is less invasive than surgery, and can be repeated at the same site if necessary. The drawbacks of PDT are that it is only useful in treating cancers that can be reached with a light source and is not suitable for treatment of extensive cancers. Research is ongoing to further determine the effectiveness of PDT in lung cancer.

Experimental therapies: Since no therapy is currently available that is absolutely effective in treating lung cancer, patients may be offered a number of new therapies that are still in the experimental stage, meaning that doctors do not yet have enough information to decide whether these therapies should become accepted forms of treatment for lung cancer. New drugs or new combinations of drugs are tested in so-called clinical trials, which are studies that evaluate the effectiveness of new medications in comparison with those treatments already in widespread use. Experimental treatments known as immunotherapies are being studied that involve the use of vaccine-related therapies or other therapies that attempt to utilize the body's immune system to fight cancer cells.

What is the prognosis (outcome) of lung cancer?

The prognosis of lung cancer refers to the chance for recovery and is dependent upon the localization and size of the tumor, the presence of symptoms, the type of lung cancer, and the overall health status of the patient.

SCLC has the most aggressive growth of all lung cancers, with a median survival time of only two to four months after diagnosis when untreated. (That is, by two to four months, half of all patients have died.) However, SCLC is also the type of lung cancer most responsive to radiation therapy and chemotherapy. Because SCLC spreads rapidly and is usually disseminated at the time of diagnosis, methods such as surgical removal or localized radiation therapy are less effective in treating this tumor type. However, when chemotherapy is used alone or in combination with other methods, survival time can be prolonged four- to fivefold. Of all patients with SCLC, only 5%-10% are alive five years after diagnosis. Most of those who survive have limited stage (LS) SCLC.

In non-small cell lung cancer (NSCLC), results of standard treatment are generally poor in all but the most localized cancers that can be surgically removed. However, in stage I cancers that can be completely removed, the five-year survival rate can approach 75%. Radiation therapy can produce a cure in a small minority of patients with NSCLC and leads to relief of symptoms in most patients. In advanced-stage disease, chemotherapy offers modest improvements in survival time, although overall survival rates are poor.

The overall prognosis for lung cancer is poor when compared with some other cancers. Survival rates for lung cancer are generally lower than those for most cancers, with an overall five-year survival rate for lung cancer of about 16% compared to 65% for colon cancer, 89% for breast cancer, and over 99% for prostate cancer.

How can lung cancer be prevented?

Smoking cessation is the most important measure that can prevent lung cancer. Many products, such as nicotine gum, nicotine sprays, or nicotine inhalers, may be helpful to people trying to quit smoking. Minimizing exposure to passive smoking is also an effective preventive measure. Using a home radon test kit can identify and allow correction of increased radon levels in the home, which can also cause lung cancers. Methods that allow early detection of cancers, such as the helical low-dose CT scan, may also be of value in the identification of small cancers that can be cured by surgical resection and prevention of widespread, incurable metastatic cancer.

from medicinenet.com
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