Medical Articles, Medicine Information. Health related information and news from around the world.

Charlie looks like a healthy eight-year-old boy. But nothing could be further from the truth. He now has to deal with incontinence. In a couple of months he will have to undergo yet another operation to stop the bladder from leaking. Until then, he needs to wear diapers. Hopefully this surgery will be a success. The leaking will then be a thing of the past, but the catheters will be with him for the rest of his life. His undersized bladder was augmented using part of his intestines and this “new bladder” will exit at his waist. Since Charlie’s new bladder will have no sensation of the need to urinate, he will learn to regulate his input of fluids and will have to empty his bladder every 2-4 hours for the rest of his life.The doctors don’t know if Charlie will able to function sexually when he’s older nor if he will be fertile. Because of his undersized penis, he has had to be given testosterone treatments to create more growth in order to do some surgeries. Aside from all that Charlie has endured, Liz is most worried about Charlie’s self-esteem. “Will he and others like him ever have a half-normal life? They are scared to go out on a date or to ever let anyone see them. From their embarrassing and stinky diapers to their undersized genitalia, there are many cases of sad and lonely older kids out there.”*38/165/1*

Answer: Either you are eating a meal that is too high in carbohydrates for lunch or breakfast, or you are eating a food to which you are allergic. Pay careful attention to wheat and dairy products. They typically cause inappropriate sleepiness or fatigue. Keep a food diary for a few days and see if you can discover which food is causing this energy drop. Make sure your meals contain enough protein and that your meals are not too high in carbohydrates.If you have to wait too long between meals (longer than four hours or so), you may need to grab a little snack between meals to keep up your blood sugar. Some excellent snack foods are raw almonds or other raw nuts and seeds—a good choice is pumpkin seeds. A small handful of raw or roasted pumpkin seeds will often take away the need to munch on something crunchy and restore your energy level. Don’t worry about the fat content; it’s the beneficial kind of fat we’ve already talked about.*61\319\2*

Psychiatric treatmentMany patients with migraine have some degree of depression but this may be secondary to their headaches rather than a primary cause. In these cases, the opinion of a psychiatrist is of great value since their training facilitates assessment of which patient will respond best to a particular method of therapy. Some experts favour a more complex interpretation of headaches based on psychoanalytic theory but this approach has not often proved helpful.
BiofeedbackBiofeedback is the term used for the methods by which conscious control can be gained of functions that are usually automatic. This is achieved by ‘feeding back’ to the patient information about the automatic function so that its control can be modified. Possibly the commonest use of biofeedback is in the control of blood pressure, where patients are told to concentrate in various ways and the results of their efforts are relayed to them; most people can learn a technique which will reduce their blood pressure, an effect which can be maintained. Epileptic patients often say ‘I almost had an attack but I felt it coming and fought it off-an interpretation of events verified using EEG monitoring; patients can be taught to suppress epileptic activity when the EEG information is fed back to them but the mechanism of this suppression is unknown.There have been many attempts to treat migraine in the same way. Three types of information can be relayed to the migraine sufferer, the first of which is the degree of distension of the temporal artery. During an attack of migraine, the temporal artery becomes dilated and it is possible for sufferers to learn to reduce the diameter of the temporal artery, and so abort attacks.Muscle contraction can also be brought under feedback control. When a patient develops a migraine associated with neck muscle tension, contraction of the neck can be recorded using a machine – the electromyograph (EMG). Therapy consists of feeding back to the patient information on the amount of muscle activity in the neck, so encouraging him to relax. Results have been fairly encouraging but there is a great placebo effect; the relief of tension can work by affecting the stress provoking the migraine attack, and other forms of relaxation not using biofeedback can also relieve the tension in the muscles of the neck.Thirdly, there is an increase in temperature over the head during a migraine attack with an increase in blood flow; this is most marked during an attack of cluster headache. The response of blood vessels of the limbs to increased blood flow is abnormal in migraine sufferers, and increasing the blood flow through the skin of the hand is associated with a decreased flow of blood to the skin of the forehead. People can alter the blood flow through their hands following appropriate concentration using biofeedback and, interestingly enough, it is the dominant hand which shows the best response. Using biofeedback, the patient can be trained to warm his hand when an attack is coming on. This technique is not effective in all sufferers, however, because the responses of the blood vessels vary. (Similar responses to the same stimuli occur in anger: some people go white due to constriction of their blood vessels whilst others go red, due to dilation of their blood vessels.)Hand-warming is worth trying as the biofeedback apparatus required is fairly simple, and consists of a surface thermometer attached to the hand with a means of relaying the information to the patient; these devices are becoming available commercially and are not too expensive. The patient sits in a relaxed position and attempts various thoughts in order to obtain vessel constriction until a satisfactory lessening in blood flow is obtained, as evidenced by a small decrease in temperature. It is the skin temperature that is important so there is no point in clenching the hand. With practice, when the technique has been mastered, changes in temperature of one to two degrees can be achieved.Anecdotal reports bear out the usefulness of the method: one patient, who suffered from severe cluster headaches, spontaneously said ‘I know it sounds funny, but I think that if I concentrate I can make my hand feel warmer and then the pain in my head seems to get better.’
*45/152/5*

ImpetigoAn inflammatory skin complaint, marked by an eruption of pustules, which usually attacks the face round the nose and the mouth. It is considered to be of a microbic nature, but it always gets a footing on a skin that is low in natural immunity. The pustules have very thin crusts and appear in clusters, and once they have been seen they are easily recognized. Sores of a similar nature may sometimes accompany the serious chronic diseases, but this, of course, is determined by the general condition of the patient.
KeloidThe simpler kinds are formed by scar tissue, especially in relation to bad cases of acne that have been neglected. The more serious kinds involve the deeper tissues.
Leukoderma The skin shows white patches where there is deficient pigmentation. It is said to be hereditary, but very little is actually known about it. It is probably due to some deficiency in nutrition, and external treatment is of no value in its treatment. Everything should be done to restore the general health of the body and the skin.
MiliariaThis term is employed to denote the condition that is commonly called prickly heat. The sweat glands are obstructed and inflamed and feel slightly rough under the fingers.   There is a good deal of discomfort and itching with this complaint, which usually responds to proper treatment.
*30/154/5*

If a beneficial response can follow suggestion, it is not unexpected that the same applies to unpleasant effects. This is called the nocebo (‘I will harm’) response. All packets of medicine contain a leaflet describing the compound and at the bottom, in very small print, there is a section entitled ‘adverse drug reactions’. To choose an example at random, the leaflet accompanying a powerful medicine for the treatment of migraine reads: ‘Adverse Drug Reactions may include: nausea, dizziness, warm sensation, fatigue, dry mouth, somnolence, heaviness or pressure in throat, neck, limbs and chest, muscle pain, muscle weakness and pins and needles’. If a double-blind trial is carried out, the patient is instructed, of course, on the expected beneficial effects but is also warned of the possible side effects. When the patient receives a placebo they may exhibit the beneficial response but they will also respond with a variety of the side effects about which they have been warned. In the old days, when Britain still had colonial troops, the army regulations included a special section for these men. In the part for East African troops, it was a capital offence for a soldier to put a death curse on a comrade. That is the ultimate nocebo.*67\219\2*

Dependence and withdrawal symptoms: there has been concern for many years regarding benzodiazepine dependence (Br.Med.J. 1980: 280, 910-912). Such dependence is becoming increasingly worrying. Withdrawal symptoms include anxiety, tremor, confusion, insomnia, perception disorders, fits, depression, gastrointestinal and other somatic symptoms. These may sometimes be difficult to distinguish from the symptoms of the original illness.It is important to note that withdrawal symptoms can occur with benzodiazepines following therapeutic doses given for short periods of time. Withdrawal effects usually appear shortly after stopping abenzodiazepine with a short half-life. Symptoms may continue for weeks or months. No epidemiological evidence is available to suggest that one benzodiazepine is more responsible for the development of dependency or withdrawal symptoms than another. The Committee on Safety of Medicines recommends that the use of benzodiazepines should be limited in the following ways:As anxiolytics1 Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic organic or psychotic illness.2 The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable.As hypnotics [Sleep inducing drugs]1.Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress.*88\326\8*

From their research into the body’s own blood-pressure control mechanisms, scientists have developed several classes of drugs:•   Diuretics (water pills). These chemicals stimulate the kidneys to remove water and salt from the blood system, reducing blood pressure.•   Beta-blockers. These medicines block the action of epinephrine (also known as adrenaline) and norepinephrine, thereby decreasing the heartbeat rate and the vigor of each contraction.•   Calcium channel blockers. They prevent calcium from entering the tiny artery muscles and causing them to constrict, which raises blood pressure.•   ACE inhibitors. ACE stands for angiotensin converting enzyme. Angiotensin II, a hormone originating in the kidneys, raises blood pressure by constricting the artery muscles. The new drugs inhibit or halt production of angiotensin II. Without angiotensin II, the arteries relax and blood pressure drops.• Vasodilators. These drugs work directly on the artery muscles, relaxing them.•   Central agents. These chemicals work primarily in the lower part of the brain, where they prevent nerves from sending out signals to release the hormones that, in turn, raise blood pressure.Several studies, involving more than 10,000 patients, clearly show that these drugs not only lower pressure but also reduce the incidence of strokes and other cardiovascular problems, thereby lowering death rates.Tests of the newest classes of drugs – calcium channel blockers and ACE inhibitors – show that they do lower blood pressure, but proof that they save lives is lacking. Doctors are increasingly prescribing them because they have fewer side effects than the old medications. The chief drawback is that they are expensive.Katherine Echols of Atlanta discovered that her blood pressure was 162/113, placing her at risk of a stroke or heart attack. Doctors prescribed diuretics, which reduced the pressure. She also lost weight, cut her salt intake, and began a walking program for exercise. Her pressure came down. Then she tried one of the new drugs, and her last reading stood at 119/85 – definitely within the healthy range.”Once you get high blood pressure, it’s a lifetime thing,” says Ms. Echols, “It’s not a cure, but you can be helped.”*4/266/5*

Mr. Alok had recently got up after typhoid fever. He was very weak physically. The thought of impending university examination had very much unsettled him. He had become very irritable. He was quite well up in his studies and remembered his lessons alright, but what could he do if his fingers got tired after writing half of the paper. This thought gave him a feeling of inadequacy before sitting for examination, and consequent irritation.’IMPATIENS’ for irritation, ‘CENTAURY” for weakness after illness and HORN BEAM for feeling of inadequacy—the 3 remedies were given T.D.S for 1 week, after which he felt normal except some physical weakness for which a combination of Centaury and Olive was given for another week.Alok sat for the examination with confidence and came out with flying colours.*127\308\8*

Patients with a positive tuberculin skin test without active tuberculosis are identified as having latent tuberculosis infection. After an initial, often clinically silent infection with tuberculosis, infection with tuberculosis can remain dormant, with the potential to progress to active infection at a later time. Approximately 5% of patients with latent tuber-will develop active infection in the first 2 years after primary infection, and an additional 5% will develop active infection later in life. In addition, patients who are immunocompromised will develop active infection at a much higher rate. Progression from latent to active tuberculosis in those who have coexisting human immunodeficiency (HIV) infection is approximately 10% per year. The only clinical indicator of latent tuberculosis infection in a patient may be a positive tuberculin skin test. Administration of the tuberculin skin test allows the identification of individuals with latent tuberculosis, and these people will benefit from treatment of their infection.The terms prophylaxis or preventative therapy have previously been used to describe what is now more accurately called treatment of latent tuberculosis infection. This change in nomenclature was made to help foster a better understanding of the need for tuberculin skin testing and treatment of latent tuberculosis infection.*53/348/5*

Perhaps women today are more likely to have and to report extramarital affairs than they were two or three decades ago for a variety of reasons. The social structure of the American family is changing, with women “allowed” more varied roles and more freedom than in earlier generations. More women are a part of the work force and thus have more opportunities than they previously had to become acquainted with possible extramarital partners. And our society as a whole is now more conscious of sexuality and there is more open and honest discussion of sexual matters. Maybe women today are just more willing to admit to this behavior than were Kinsey’s respondents. However, at this time we cannot unequivocally state that women today are more likely to have engaged in extramarital relationships. Perhaps future, better designed studies will yield more meaningful data on this question. Nevertheless, both Kinsey’s results and recent surveys These, then, have been some of the major findings of the surveys of sexual attitudes and behaviors conducted during the last few years. They seem to indicate that sexuality is a topic more open to free and honest discussion than in the past. Married couples and single people are engaging in sexual activities more often, are utilizing a greater variety of sexual techniques, and are beginning these sexual activities at an earlier age. Paradoxically, a significant portion of the population still experience anxiety or guilt concerning their sexuality, although these negative feelings do not seem as prevalent as they were only a few years ago. The overall social and cultural changes experienced by our society seem also to have impacted on the sexual arena. Women have gained more equality both sexually and in other aspects of their lives, with the result that today’s male and female patterns of sexual expression are becoming more alike. Finally, the differences between the sexual attitudes and activities of individuals of varying socioeconomic strata are diminishing, although some consistent patterns do continue to be related to several demographic factors.
*89\265\8*