IMAGING STUDIES OF FEVER OF UNKNOWN ORIGIN

Posted on December 28, 2010 by admin
Diagnostic imaging has in many ways revolutionized the evaluation of FUO. Abdominal and pelvic computed tomography (CT) may be of great utility in the course of the work-up of an undiagnosed fever. These aids in determining invasive diagnostic testing, which can be carried out via radiologically guided biopsies and aspirations or by surgery, when necessary. Direct communication of the patient’s history with the evaluating radiologist is helpful in ensuring proper understanding of potential abnormalities. One drawback to CT scanning is that it may be too sensitive and may identify abnormalities that are unrelated to the cause of fever and that lead the further diagnostic work-up astray.
Ultrasonography in the form of echocardiography has a well-established and useful role. Ultrasonography of the right upper quadrant can occasionally give better biliary tract detail than an abdominal CT scan. Ultrasonography of the lower extremities may be useful in establishing the diagnosis of occult deep venous thromboses as a cause of fever in a few patients.
Given its utility in diagnosing many different causes of fever, echocardiography is also useful in the evaluation of an FUO. An initial transthoracic echocardiogram may identify valvular vegetations or thrombi. When a transthoracic echocardiogram is unrevealing, a transesophageal echocardiogram (TEE) is recommended. TEE has superior ability to visualize cardiac valvular abnormalities as well as to detect the presence of a pericardial effusion.
Nuclear medicine modalities have several roles in localizing disease, and their role continues to evolve. These studies are most useful in further elucidating potential infectious or inflammatory foci. Different radiopharmaceuticals are used to localize sites of inflammation via different mechanisms, lndium-111-labeled autologous leukocytes have been considered the nuclear medicine gold standard for identifying inflammation and infection because of their specificity. There is high uptake in any predominantly neutrophilic infiltrates, and lesions can be apparent early in their evolution. The gallium-67 scan is sometimes considered a better initial test because it has greater sensitivity in imaging acute, chronic, granulomatous inflammation and malignancy as well. Gallium binds to transferrin in blood and extravasates at sites of inflammation and infection.
More recently, it has been shown that positron emission tomography may have even greater utility in localizing different causes of an FUO. The positron emitting tracer, F-deoxyglucose, is taken up in metabolically active cells. Increased F-deoxyglucose uptake has been reported in many neoplastic and infectious diseases as well as vasculitides and granulomatous diseases. Positron emission tomography scanning may become an effective modality in the evaluation of FUO as its benefits and limitations continue to be defined.
*153/348/5*

IMAGING STUDIES OF FEVER OF UNKNOWN ORIGINDiagnostic imaging has in many ways revolutionized the evaluation of FUO. Abdominal and pelvic computed tomography (CT) may be of great utility in the course of the work-up of an undiagnosed fever. These aids in determining invasive diagnostic testing, which can be carried out via radiologically guided biopsies and aspirations or by surgery, when necessary. Direct communication of the patient’s history with the evaluating radiologist is helpful in ensuring proper understanding of potential abnormalities. One drawback to CT scanning is that it may be too sensitive and may identify abnormalities that are unrelated to the cause of fever and that lead the further diagnostic work-up astray.Ultrasonography in the form of echocardiography has a well-established and useful role. Ultrasonography of the right upper quadrant can occasionally give better biliary tract detail than an abdominal CT scan. Ultrasonography of the lower extremities may be useful in establishing the diagnosis of occult deep venous thromboses as a cause of fever in a few patients.Given its utility in diagnosing many different causes of fever, echocardiography is also useful in the evaluation of an FUO. An initial transthoracic echocardiogram may identify valvular vegetations or thrombi. When a transthoracic echocardiogram is unrevealing, a transesophageal echocardiogram (TEE) is recommended. TEE has superior ability to visualize cardiac valvular abnormalities as well as to detect the presence of a pericardial effusion.Nuclear medicine modalities have several roles in localizing disease, and their role continues to evolve. These studies are most useful in further elucidating potential infectious or inflammatory foci. Different radiopharmaceuticals are used to localize sites of inflammation via different mechanisms, lndium-111-labeled autologous leukocytes have been considered the nuclear medicine gold standard for identifying inflammation and infection because of their specificity. There is high uptake in any predominantly neutrophilic infiltrates, and lesions can be apparent early in their evolution. The gallium-67 scan is sometimes considered a better initial test because it has greater sensitivity in imaging acute, chronic, granulomatous inflammation and malignancy as well. Gallium binds to transferrin in blood and extravasates at sites of inflammation and infection.More recently, it has been shown that positron emission tomography may have even greater utility in localizing different causes of an FUO. The positron emitting tracer, F-deoxyglucose, is taken up in metabolically active cells. Increased F-deoxyglucose uptake has been reported in many neoplastic and infectious diseases as well as vasculitides and granulomatous diseases. Positron emission tomography scanning may become an effective modality in the evaluation of FUO as its benefits and limitations continue to be defined.*153/348/5*

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WHY YOU CAN’T STAY AWAKE: OTHER TYPES OF DOES – “SLEEP DRUNKENNESS”

Posted on December 23, 2010 by admin
I like to describe this condition as a “severe case of Monday morning, every day of the week.” Victims, mostly male, undergo a prolonged time of transition between sleeping and wakefulness. In some cases their feelings of sleepiness can last until noon or later. During that interval their movements may be clumsy or uncoordinated, their ability to make decisions is reduced, and the few judgments they do make are cloudy or inappropriate. Obviously such a pattern can impair one’s ability to function. I recently counseled a patient who was extremely distraught because she was fired from her job as a secretary after her boss publicly accused her of drinking on the job. A lifelong teetotaler and devoutly religious person, she had to cope with extreme feelings of shame, anger, and depression. Psychological and supportive counseling were called for; another strategy that proved helpful, she reported, was finding a split-shift job that allowed her to begin work at one in the afternoon. Unfortunately, her condition of delayed morning arousal still persists.
While there is insufficient research on this syndrome to understand it thoroughly, it appears to arise from a malfunction in the arousal mechanism of the brain, and it may be an inherited trait. The urine of a sleep-drunk patient often shows low levels of homovanillic acid, a by-product of dopamine, which is a neurotransmitter involved in the arousal process. Experts interpret this finding to mean that victims of sleep drunkenness have reduced amounts of this crucial chemical. The problem is made worse if the victim is forced to awaken during Stage 3 or 4 of the sleep cycle. Sleep deprivation, physical fatigue, or use of some drugs can also compound the problem. Some victims find that abstaining from stimulants, including coffee can make it easier to stir in the morning.
*159\226\8*

WHY YOU CAN’T STAY AWAKE:   OTHER TYPES OF DOES – “SLEEP DRUNKENNESS”I like to describe this condition as a “severe case of Monday morning, every day of the week.” Victims, mostly male, undergo a prolonged time of transition between sleeping and wakefulness. In some cases their feelings of sleepiness can last until noon or later. During that interval their movements may be clumsy or uncoordinated, their ability to make decisions is reduced, and the few judgments they do make are cloudy or inappropriate. Obviously such a pattern can impair one’s ability to function. I recently counseled a patient who was extremely distraught because she was fired from her job as a secretary after her boss publicly accused her of drinking on the job. A lifelong teetotaler and devoutly religious person, she had to cope with extreme feelings of shame, anger, and depression. Psychological and supportive counseling were called for; another strategy that proved helpful, she reported, was finding a split-shift job that allowed her to begin work at one in the afternoon. Unfortunately, her condition of delayed morning arousal still persists.While there is insufficient research on this syndrome to understand it thoroughly, it appears to arise from a malfunction in the arousal mechanism of the brain, and it may be an inherited trait. The urine of a sleep-drunk patient often shows low levels of homovanillic acid, a by-product of dopamine, which is a neurotransmitter involved in the arousal process. Experts interpret this finding to mean that victims of sleep drunkenness have reduced amounts of this crucial chemical. The problem is made worse if the victim is forced to awaken during Stage 3 or 4 of the sleep cycle. Sleep deprivation, physical fatigue, or use of some drugs can also compound the problem. Some victims find that abstaining from stimulants, including coffee can make it easier to stir in the morning.*159\226\8*

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PREVENTING ASTHMA: SOME NECESSARY PRECAUTIONS – DAILY ROUTINE AND TOBACCO SMOKING

Posted on December 14, 2010 by admin
Daily Routine. A regular routine induces a feeling of well being. Any irregularity in the sleeping and waking hours affects these children. Therefore, regularity in daily routine is a must. Children should get up in the morning at more or less a fixed time and go to bed at a regular hour, not too late.
Regularity in daily routine is an essential theme of managing asthma in children.
Tobacco Smoking. Several studies of children and teenagers have shown that if one of both parents are cigarette smokers, there is higher likelihood of their child being at increased risk of asthma, than if parents do not smoke. A positive correlation has been established between the degree of tobacco exposure and the development of asthma.
Reducing smoking, specially during and just after pregnancy, can help control asthma. In adults, active smoking is associated with the presence of higher total IgE levels, and in certain situations, specially occupational, such smoking may predispose a person to become more sensitive to allergenic agents.
*90\60\8*

PREVENTING ASTHMA: SOME NECESSARY PRECAUTIONS – DAILY ROUTINE AND TOBACCO SMOKINGDaily Routine. A regular routine induces a feeling of well being. Any irregularity in the sleeping and waking hours affects these children. Therefore, regularity in daily routine is a must. Children should get up in the morning at more or less a fixed time and go to bed at a regular hour, not too late.Regularity in daily routine is an essential theme of managing asthma in children.Tobacco Smoking. Several studies of children and teenagers have shown that if one of both parents are cigarette smokers, there is higher likelihood of their child being at increased risk of asthma, than if parents do not smoke. A positive correlation has been established between the degree of tobacco exposure and the development of asthma.Reducing smoking, specially during and just after pregnancy, can help control asthma. In adults, active smoking is associated with the presence of higher total IgE levels, and in certain situations, specially occupational, such smoking may predispose a person to become more sensitive to allergenic agents.*90\60\8*

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INVESTIGATION IN GENITAL ULSERS 2

Posted on October 8, 2010 by admin

Demonstration of spirochaetes by dark ground microscopy confirms the diagnosis of early syphilis. Antibiotics or antiseptics should not be used until satisfactory examination has been completed. Dark ground examination is not suitable for oral lesions.

Although the diagnosis can usually be made on clinical grounds, HSV infection should be confirmed by culture of the virus or, more rapidly, by examination of smears for multinucleated cells and characteristic intranuclear inclusions (Tzank smear) or by the use of commercially available kits for the detection of HSV antigens by ELISA or immunofluorescence techniques (see p.34).

The diagnosis of donovanosis is established by the demonstration of the causative organisms in smears from scrapings or in biopsies from lesions. The organism can be identified as bipolar rods in large mononuclear cells (see p.30). The features of chancroid and of lymphogranuloma venereum are described on pages 31 and 32 respectively.
*21/56/1*
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SEROLOGY; INVESTIGATION OF GENITAL ULCERS

Posted on October 8, 2010 by admin

Serological tests provide indirect evidence of infection and are useful in the diagnosis of some STDs, notably syphilis, HIV infection and hepatitis B. The non-specific reagin tests are also useful in the follow up of treament of early syphilis. The role of serology in the diagnosis of other STDs is limited. Seroconversion or a four-fold increase in litre of chlamydial antibodies in paired serum samples may retrospectively confirm chlamydial infection. A high titre of IgG antibody and the presence of IgM antibody probably indicates recent active infection and negative serology may exclude chlamydial infection

Serological tests have no role in the diagnosis of HSV infection. The only possible role for serology is to define persons who are seronegative and therefore susceptible.

The various causes of genital ulceration including herpes, syphilis, donovanosis, chancroid, lymphogranuloma venereum, cutaneous amoebiasis and neoplasms may be distinguished by appropriate tests. Scrapings from ulcers after removal of the crust, exudate and debris can be examined directly and by culture on specific media leading to presumptive or definitive diagnosis. In some conditions, particularly if the diagnosis of malignancy must be excluded, biopsy is appropriate. Serology is important in the diagnosis of syphilis.
*20/56/1*
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WHAT PLASTIC SURGERY CAN DO FOR YOU

Posted on October 5, 2010 by admin

•   Facelift. The surgeon stretches out wrinkles and sagging skin by lifting up and pulling back the skin of the face. Many doctors also tighten the underlying tissue. (This combination technique lasts 7 to 10 years, rather than the usual 5 to 7 years.) A facelift achieves only surface changes.
•   Facial sculpting. By adding plastic material or natural bone -or taking bone away from the jaw, brow or, cheek -surgeons can actually change the shape of the face below the skin. Such facial contouring often is accompanied by dental reconstruction and nose reshaping, or even surgery of the eyes and ears. The total cost for reshaping can go as high as 18,000 dollars including hospitalization, anesthesia, and the surgeon’s fee.
•   Nose reshaping. The doctor removes humps on the bridge of the nose, makes the tip thinner, or lifts the tip of the nose.
•   Eye surgery. The surgeon reduces the bags under the eyes or the sagging puffiness on the upper lid.
•   Hair transplant. Tufts of hair with skin attached are transferred from one part of the scalp to another to provide greater hair density in visible areas.
•   Ear reshaping. Ears that stand out can be “pinned back.” And new methods of taking cartilage from the ribs and carving it into ear shapes provide ears for victims of birth defects, accidents, and disease.
•   Brow lift. This procedure raises the eyebrows and reduces brow wrinkles by adjusting the brow muscles and pulling the brow up.
•   Skin repair. Small wrinkles and discolorations can be removed with a chemical peel, in which a chemical is applied that destroys the upper layer of skin and allows new skin to grow in its place. Dermabrasion, another technique, is often used to treat acne scars. The doctor applies a high-speed rotating steel brush to the skin to remove the upper layer.
*144/266/5*

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USE OF ACTH AND CORTISONE IN THE TREATMENT OF INFLAMMATION

Posted on October 3, 2010 by admin

Let us leave the field of battle and metaphor and speak of a new development which concerns inflammation. ACTH and cortisone, which from now on is used to include related substances, diminish all the activities, which grouped together constitute inflammation. Just as a bishop of London could say of the body social, “None make more trouble than those who go about doing good,” so in the physical body, inflammation, intended for our good, can often do more harm than the condition which it is aiming to combat. This is strikingly so on the surface of the eye. The after-result of inflammation is, in perhaps most cases, the formation of scar tissue. Scar tissue on the front of the eyeball will not transmit light well. Therefore trouble here is excellently handled by cortisone. The remarkable effect of cortisone on arthritis is well known. Joint surfaces, like the eye, are too delicate to take well the strenuous action of inflammation. But cortisone does not cure, on the eye or in the joints.
However, it is well recognized now that it may be very unsafe to use cortisone or ACTH in some infections. Patients getting these drugs may feel comfortable and contented as they are not being disturbed by the aggravating activities of inflammation. But meanwhile the disease may be raging unchecked. Nature is unrelenting and we must be very careful how we interfere with her ways.
*83/276/5*

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TOXIC EFFECTS OF DRUGS

Posted on October 1, 2010 by admin

All chemical drugs are toxic, more or less. All drugs can cause harmful side effects. It is estimated (very conservatively) that at least 10 percent of all patients suffer from drug-caused diseases. Even such an “innocent” drug as aspirin, consumed in the U.S. at the rate of 30 tons a day, has caused many deaths and millions of serious injuries.
Most drugs also interfere with normal enzyme and vitamin action in the body, causing derangement in metabolism and vital body processes.
Drugs destroy vital vitamins and minerals and/or prevent their absorption. Many drugs damage the liver, kidneys and can cause serious diseases, including impotence, infertility, birth defects and cancer. Of course, there are situations in which drugs are necessary and can be life-saving. But drugs should be used only in absolute emergencies, and only if ordered by a competent doctor.

Protection
1. When any kind of drugs is taken, increase your intake of the following vitamins:

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SOME PROTECTIVE MEASURES TO HELP OUR SURVIVAL IN POISONED WORLD

Posted on September 29, 2010 by admin

1. Make every effort to move away from the smoggy cities. Buy a cottage or a little farm outside of the city, and, if necessary, drive one or two hours to work. Then you can also grow most of your own poison-free foods. If you must live in a smoggy city, get out to smog-free air, at least a few weeks each year, to give your body, your liver and your lungs a chance to regenerate themselves and build a certain health reserve.
2. Make every effort to eat only organically grown foods. Many health food stores now carry a good supply of them. Or transform your backyard into your own organic garden. Organic foods, or your own backyard vegetables will not be completely poison-free, but they will be better than the regular produce you buy at supermarkets.
3. If you are an apartment dweller, get a green thumb by growing wheat grass in boxes on your balcony or kitchen window. Also, everyone can grow his own sprouts.
4. If you must eat supermarket-bought produce, wash all your vegetables and fruits very carefully, with soap and warm water. Just rinsing with water would not do any good. Those fruits and vegetables that cannot be washed should be peeled.
Here’s one method recommended to remove residues of arsenic, DDT and other toxic sprays from vegetables and fruits: Mix 1 ounce of pure hydrochloric acid (sold in drugstores) with 3 quarts of water (use only glass or earthenware utensils). Place vegetables in solution for five minutes, then remove and rinse well with pure water. The solution can be saved and reused many times. Some claim that hydrochloric acid solution much weaker than this can be used.
5. Stop using any and all toxic chemicals in your household: garden sprays, air fresheners, fly strips, cleaning fluids, detergents, bug killers, etc. Use soap as your only cleaning material, even for washing clothes. Avoid dry cleaning of your clothes. If dry cleaning is necessary, ventilate the clothes for several days after the cleaning.
6. Optimum nutrition will help you to better withstand the polluted environment. The Airola Diet of optimum nutrition will assure you of the optimum nutrition and maximum protection against a toxic environment.

*87/103/5*

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SODIUM RESTRICTED DIETS FOR PEOPLE WITH HEART DISEASES NOMENCLATURE

Posted on September 27, 2010 by admin

Normally the daily sodium intake is 3 to 7 gm (3000 to 7000 mg). A sodium-restricted diet is limited to a specified amount of sodium, and ranges from a mild to severe restriction. Terms such as “salt free,” “salt poor,” and “low salt” are so indefinite that the patient might well receive a diet with much more sodium than he should have or, perhaps, one with less than he could have.    The levels of sodium restriction described in booklets published by the American Heart Association are:
250 mg sodium (11 mEq), Very Low-Sodium Diet. Used primarily for hospital patients.
500 mg sodium (22 mEq), Strict Low-Sodium Diet. Used primarily for hospital patients.
1000 mg sodium (43 mEq), Moderate Sodium-Restricted Diet. Sometimes used as a maintenance diet for patients at home.
Mild Sodium Restriction. Sodium content of this diet varies from about 2400 to 4500 mg. This is essentially a normal diet but omits salty foods. This is frequently prescribed as a maintenance diet for patients at home.
*144/234/5*

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