Friday, October 16, 2009

Leukoencephalopathy (brain white matter changes)

Leukoencephalopathy (brain white matter changes) is caused by the reactivation of a common virus in the central nervous system of individuals with lowered immune defenses, such as individuals with acquired immune deficiency syndrome (AIDS); people undergoing chronic corticosteroid or immunosuppressive therapy; and individuals with cancer. This disorder may be associated with neurofibromatosis type 1 that can also develop cancer. Other clinical studies eported that leucoencephalopathy can also be due to gene mutation.
The symptoms of leucoenecephalopathy are the result of loss of white matter (which is made up of myelin, a substance the surrounds and protects nerve fibers) in multiple areas of the brain. Without the protection of myelin, nerve signals can’t travel successfully from the brain to the rest of the body. The most prominent symptoms are clumsiness; progressive weakness; and visual, speech, and sometimes, personality changes. In general, the progression of deficits leads to life-threatening disability and death over weeks to months, although some survive till adult age left with severe neurological disabilities. People with this disorder are particularly vulnerable to stresses such as infection, mild head trauma or other injury, or even extreme fright. These stresses may trigger the first symptoms of the condition or worsen existing symptoms, and can cause affected individuals to become lethargic or comatose.

Tuesday, October 13, 2009

Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is a progressive disorder, which means most symptoms will worsen over time. In general, most people with NF1 will develop mild to moderate symptoms, and have a normal life expectancy.

The condition is caused by mutation of gene that could result in overactive cell growth, learning impairments, and skeletal defects. Clinical manifestations of neurofibromatosis type 1 may vary greatly in range and severity from case to case, Some findings are as follows:
· flat patches on the skin that are darker than the surrounding area. These spots increase in size and number as the individual grows older.
· noncancerous (benign) tumors, named neurofibromas that are usually located on or just under the skin. These tumors may also occur in nerves near the spinal cord or along nerves elsewhere in the body. Some (3-5%) develop cancerous tumors that grow along nerves, and/or develop other cancers, including brain tumors and cancer of blood-forming tissue (leukemia).
· episodes of seizures, learning disabilities (50% of children with the condition), speech difficulties, attention deficit hyperactive disorders, and skeletal malformations, including progressive curvature of the spine (scoliosis), and bowing of the lower legs.
· high blood pressure

Treatments for the condition are aimed at controlling or relieving symptoms. Headache and seizures are treated with medications. Benign tumours may be removed surgically. Cancerous tumours may be treated with surgery, chemotherapy, and/or radiotherapy.

Thursday, October 8, 2009

Small Bowel Obstructions

Small bowel obstruction, a mechanical bowel blockage arising from a structural abnormality, presents a physical barrier to the progression of gut contents. Patient of such a condition may then experience abdominal pain, bloating, and vomiting. Small-bowel obstructions can result from a variety of causes. Peritoneal adhesions are the most common cause of Small Bowel Obstruction (SBO) accounting for approximately 65% to 75% of cases. It is estimated that the risk of SBO is 1% to 10% after appendectomy, 6.4% after open cholecystectomy, and 10% to 25% after intestinal surgery. It is also estimated that 93% to 100% of patients who undergo transperitoneal surgery will develop postoperative adhesions. Most patients with adhesions do not experience any overt clinical symptoms. However, clinical symptoms may manifest when complication resulting from the adhesions are eventually developed.

Bowel obstruction may take many years to develop after abdominal/transperitoneal surgery. A clinical study reported that 21% of bowel obstructions caused by adhesions occur within the first month after surgery, 18% of bowel obstructions caused by postoperative adhesions occur between 1 month and 1 year after surgery, 21% occur between 1 and 5 years and 28% occur after 5 years.

About peritoneal adhesions, they are scar tissues forming abnormal attachments between organs or tissues or both in the abdominal cavity that are normally separated. Most are acquired as a result of peritoneal injury, the most common cause of which is abdomino-pelvic surgery.4 Less commonly, adhesions may form as the result of inflammatory conditions, intraperitoneal infection or abdominal trauma. The extent of adhesion formation varies but is most dependent on the type and magnitude of surgery performed, as well as whether any postoperative complications develop.

Friday, October 2, 2009

Myoma or Uterine Fibroid

Myoma or Uterine Fibroids are noncancerous tumours that grow slowly within the muscular wall of the womb (also known as uterus in medical term). It is estimated that 25% of women over the age of 35 have fibroids at some time during their life. One clinical study using pelvic ultrasound in women in the U.S. ,with no symptom aged 35-49, found that over 50% of women did have fibroids on pelvic ultrasound exam. Small fibroids may not cause problems, but larger ones may cause prolonged/heavy menstrual bleeding, abdominal pain during menstruations, infertility or recurrent miscarriages. Fibroids may also press on the bladder, causing a need to pass urine often, or on the rectum, causing low back pain. Generally fibroids do not need treatment when they are not symptomatic. However, they should be checked regularly by your doctor to make sure that they have not grown. If treatment is necessary, fibroids may be removed surgically. Some fibroids are treated using an injection of a substance that blocks the blood vessels supplying them, causing the fibroids to shrink.

Friday, September 25, 2009

Endometriosis

Endometriosis is a condition in which the tissue (named “endometrium”), that is normally lining the womb, grows outside the womb and attaches to other organs. Mostly organs in the pelvic area including ovaries, outer surface of womb, bowels, and bladders, are affected; but endometriosis has also been found in the lungs, the brain and even on arms and thighs. The condition afflicts over 70 million women and girls throughout the world, knowing no racial or socio-economic barriers, and affecting women ranging from adolescence to post-menopause.
During the menstrual cycle the thickness of the endometrium increases in readiness for the fertilized egg. If pregnancy does not occur the lining is shed as a 'period'. Similarly, in each menstrual cycle, endometrium that grows outside of the womb, is also built up and then breaks down and bleeds in the same way as the lining of the womb. Such internal bleeding may lead to inflammation, pain, and formation of scar tissues in organs outside of the womb.
Endometriosis is not an infection, not contagious, and not cancer either. Of the theories, the most widely accepted is retrograde menstruation. According to this theory some of the menstrual blood flows backwards down into the pelvis.
The considerations about what type of treatment should depend on age, severity of the symptoms, desire to have children, and severity of the condition. Painkillers, like aspirin, may help relieving the pain. Hormonal treatment designed to interfere with ovulation generally provides effective pain relief, but the recurrence rate following cessation of therapy is high, and this type of treatment will contradict with the woman’s pregnancy. Surgical treatment provides pain relief, improves pregnancy rates, and is the preferred initial treatment for infertility caused by endometriosis. Removal of the womb, ovaries, and all growths is a radical surgery for patients with intractable pain, if childbearing is no longer desired. Complementary therapies, such as acupuncture, aromatherapy, herbal therapy, and nutrition have not been clinically proven to treat endometriosis. However, many women do have improvement of their symptoms whilst using such therapies. It is probably wise to seek help from a qualified practitioner and not self medicate.

Monday, September 21, 2009

Treatments for Bed-wetting

Bed-wetting is normal and very common among preschoolers, affecting 40 percent of children at age 3, occurring in 20 percent of 5-year-olds, 10 percent of 6-year-olds, and 3 percent of 12-year-olds.
It is a complex neurodevelopmental process for the bladder to send the signal, for the brain to receive it and for the child to respond by awakening and using the toilet. For the child who wets the bed, parents need to remain supportive and encouraging. They should be sensitive to the child's embarrassment or discomfort over this problem. A child who sleep-wets is likely to stop eventually. The purpose of a treatment program is to make this happen sooner. There are different approaches, both medical and behavioral, to bedwetting. Behavioral approach stresses changes in behavior, such as having the children take responsibility by helping with the wet sheets, and having them read a picture book about bed-wetting each night to reinforce staying dry. Medical approach uses medicine(s) to reduce the number of wet nights, but there was some evidence that this was not sustained after treatment stopped.

Wednesday, September 16, 2009

Kidney Failure

Kidneys are a pair of bean-shaped organs that lie on either side of your spine in the lower middle of your back. The main function of the kidneys is to remove waste products and excess water from the blood. Good kidney’s functions allow us to continue to consume a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood. If the kidney fails to function, this can ultimately result in death.
Kidney failure occurs when the kidneys partly or completely lose their ability to carry out normal functions. This failure is caused by a number of conditions including diabetes, hypertension, glomerulonephritis, and cystic kidney disease.
When someone’s kidney failure becomes permanent called End-stage renal disease (ESRD), he/she requires either dialysis or a kidney transplant to maintain life. Hemodialyis is one kind of dialysis where the blood is filtered through a machine that acts like an artificial kidney and returned back into the body. This procedure needs to be performed in a designated dialysis centre. It is usually needed about 3 times per week, with each episode taking about 3-4 hours. Haemodialysis in Singapore can cost about 2,500 to 3500 Singapore Dollar per month.
Another kind of dialysis is Peritoneal dialysis, where the blood is cleaned without being removed from the body. A solution (mainly made up of salts and sugars) is injected into the abdomen that encourages filtration such that the waste is transferred from the blood to the solution. There are 2 types of Peritoneal Dialysis - continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). CAPD needs to be done 3 to 5 times every day, but does not require a machine. In Singapore, this can cost around 1500 Singapore dollar per month. APD uses an automated cycler machine to perform 3 to 5 exchanges during the night while the patient is asleep. This can cost around 2,000 Singapore dollar per month.
Each treatment option has its own advantages and disadvantages, which vary with the condition of the patient and presence of underlying diseases. Hence, it is important for every patient that develops ESRD to discuss the various treatment options with his/her doctor before starting treatment.

Saturday, September 5, 2009


Diagram di atas menunjukkan hasil pengukuran tekanan darah pasien dengan kondisi tekanan darah tinggi yang memonitor tekanan darahnya sehari-hari. Pasien ini diharuskan dokter minum obat tekanan darah tinggi setiap hari. Selain itu, pasien ini mengukur tekanan darahnya setiap hari meggunakan alat pengukur tekanan darah digital dengan teknologi telemedicine. Dengan teknologi ini, setiap kali, hasil ukuran tekanan darahnya dikirim oleh alat pengukur tekanan darah tersebut secara otomatis ke website dimana dokter yang merawat pasien juga bisa memonitor tekanan darah pasien secara berkala dan memberikan saran-saran kesehatan berkenaan dengan perawatan kondisi tekanan darah tinggi pasien.
Di awal program pengukuran tekanan darah pasien dengan teknologi telemedicine (di bulan November 2008), tekanan darah pasien nampak naik turun, dan cenderung tinggi. Tercatat 8 kali pengukuran tekanan darah atas (Sistolik) dan / atau tekanan darah bawah (Diastolik) yang melebihi batas normal. Tekanan darah atas (Sistolik) dan tekanan darah bawah (Diastolik) nampak naik-turun, tidak stabil, dan cenderung meninggi. Sembilan bulan berikutnya (di bulan Agustus 2009), ukuran tekanan darah pasien tersebut, baik tekanan darah atas (Sistolik) maupun tekanan darah bawah (Diastolik), menurun, lebih rendah dari tahun lalu, menjadi dalam batas normal, dan stabil. Hal ini menunjukkan bahwa tekanan darah pasien menjadi lebih terkontrol.

Thursday, September 3, 2009

Self Monitoring Blood Pressure

One of the greatest problems in treating high blood pressure is patient’s self compliance to the prescribed medication and medical advice. The treatment is for long term, mostly for long life, and may be associated with side effects, without having significant symptoms, and therefore does not experience a decisive improvement of symptoms through the treatment.
This requires the patient’s involvement in his/her own treatment in related to the selection of anti-hypertensives drug(s) used, the patient’s commitment to change lifestyle, and the patient’s participation in controlling his or her blood pressure (BP).
Self BP measurement is recommended by the European Society of Hypertension as a very sensitive method of adjusting treatment. Hence, telemetric BP monitoring opens up new possibilities of improving patient compliance in the treatment of hypertension. It improves the relationship of the patients to their own disease – and thus the basis for treatment.
A clinical study reveals that telemetric BP monitoring is a useful way of involving patients communicatively in their treatment through self-measuring BP. It opens up the possibility of interaction between physician and the patients. This produces an unusually high rate of BP normalisation.

Friday, August 28, 2009

Tekanan Darah Tinggi

Tekanan darah tinggi adalah tanda adanya kelainan pada daya kerja jantung dan kelainan kondisi pembuluh darah. Pada seseorang dengan kelemahan otot jantung, organ jantung perlu bekerja keras untuk mempompa cukup darah ke seluruh tubuh. Hal demikian juga bisa terjadi bilamana ada penyempitan di pembuluh darah. Dalam hal ini, organ jantung juga harus bekerja lebih keras untuk dapat mempompa cukup darah melalui pembuluh – pembuluh darah yang menyempit tersebut. Hal-hal ini adalah beberapa kondisi yang menyebabkan tekan darah tinggi. Hal-hal tersebut biasanya berhubungan dengan penyakit/kondisi yang lain, seperti:
· Kegemukan, dimana kelebihan lemak dalam tubuh mengendap di pembuluh darah dan menyebabkan penyempitan pembuluh darah
· Penyakit kencing manis, dimana kelebihan gula di dalam tubuh menyebabkan kerusakan pada pembuluh-pembuluh darah kecil di organ tubuh, termasuk di jantung. Akibatnya, sebagian otot jantung mati atau tidak berfungsi baik.
Tekanan darah tinggi perlu benar-benar dirawat, dengan:
* Gaya hidup yang lebih sehat, seperti olah raga rutin yang teratur, tidak makan berlebihan, mengurangi konsumsi makan berlemak dan mengurangi konsumsi garam, dan lain-lain.
* Obat pengontrol tekanan darah dan kondisi-kondisi yang berhubungan dengan tekanan darah tinggi (bila perlu dan sesuai dengan anjuran dokter)

Chronic Lymphocitic Leukemia

Chronic Lymphocitic Leukemia is a type of cancer that starts from a group of white blood cells in bone marrow named Lymphocytes which function to protect human body from infections. Eventually the cancerous cells spread into human’s blood circulation. This type of cancer is called chronic because the cancer progresses more slowly than other types of Leukemia. In 25% of this type of cancer cases, when the cancer was first diagnosed, it has already in end stage of cancer development (i.e. stage IV). Peak incidence of this cancer is higher from 55 years old population. The cancer is usually treated with chemotherapy regimen, which would destroy not only the cancer cells but also all other normal cells. So, in many cases, after completing chemotherapy sessions, bone marrow transplantation might be done to inject healthy bone marrow producing normal blood cells.

Saturday, August 22, 2009

Penangan Penyakit Asma

Asma adalah penyakit peradangan menahun dari saluran pernafasan.Dalam proses peradangan yang menahun tersebut, tubuh penderirta asma bereaksi dengan menghasilkan cairan kental di saluran pernafasannya, yang selanjutnya membuat saluran nafas menyempit atau tersumbat. Akibatnya, penderita asma mengalami sesak nafas, dikurangi batuk-batuk, dan gejala-gejala asma yang lain.
Perawatan pasien asma yang efektif harus memfokuskan pada peengendalian penyakit asma tersebut. Pasien asma umumnya harus diobati dengan obat untuk mencegah munculnya gejala asma, mencegah serangan asma mendadak, dan meningkatkan funsi paru-paru. Jika asma-nya masih tidak terkontrol, pengobatan asma-nya harus ditingkatkan, dengan tambahan obat-obatan dan/atau tambahan dosis obat yang dipakai.
Bilamana gejala asma-nya sudah terkendali, pengobatannya bisa dikurangi secara bertahap sampai mencapai dosis yang paling rendah tapi efektif.
Cara penanganan asma ini dinamakan “a step approach” oleh Global Initiative for Asthma (GINA). Penanganan semacam ini perlu diterapkan secara berkelanjut untuk pengendalian penyakit asma secara efektif.

Thursday, August 20, 2009

Statistics of Mental Illnesses/Statistik berkenaan dengan Penyakit Kejiwaan

Various researches on mental illnesses conclude the following few points:
* 25% of population may have mental illnesses, and most of them are not diagnosed
* Mental illnesses affect and are affected by other chronic illnesses, such as hypertension and coronary heart disease.
* Mentally ill group of people have higher morbidity and mortality rates than non mentally ill group of people
* The higher the severity of a depressive condition, the higher morbidity and mortality rates of the depressed patients
* Among depressed elderly, men tend to have higher mortality rates than women
* However, studies show that mild depression does not affect or does not significantly affect morbidity and/or mortality rates

Tuesday, August 18, 2009

Dysmenorrhoea (or "Nyeri pada masa haid" in Indonesian languange)

Dysmenorrhoea is cyclical lower abdominal or pelvic pain, which may also radiate to the back and thighs, occurring prior to or during menstruation, or both. In general, we can classify dysmenorrhoea into two types:
* Primary dysmenorrhoea occurs in the absence of any obvious underlying disease. Cause is unknown.
* Secondary dysmenorrhoea is due to an underlying disease, most commonly endometriosis. Other possible causes are fibroid, adenomyosis, pelvic inflammatory disease, intrauterine device, and cervical stenosis. Secondary dysmenorrhoea usually are often present with other gynaecological symptoms, such as intermenstrual bleeding, painful sexual intercourse, and post-coital bleeding.
Dysmenorrhoea’s management itself is meant to relieve/reduce the pain using the following treatments:
* Drug treatment including Non Steroid Anti Inflamatory Drugs (pain killers), combined oral contraceptive pills (for patient who also requires contraception), and menstrual cycle suppressant (e.g. danazol)
* Non drug and surgical treatment including neurectomy, uterine nerve ablation, and transcutaneus electrical nerve stimulation.

Monday, August 17, 2009

Marfan Syndrome Patients

Marfan syndrome is a condition in which your body's connective tissue is abnormal due to a genetic disorder. Connective tissue helps support all parts of our body and helps control how our body grows and develops. Marfan syndrome predominantly affects connective tissue supporting heart and blood vessels, eyes, and bones. Most people with Marfan syndrome have heart and blood vessel problems, such as a weakness in the aorta or heart valves that leak. They are often very tall, thin and loose jointed. They may also have problems with their eyes, skin, nervous system and lungs.
Marfan syndrome patients had average lifespan of 40 to 50 years, height of 186 ± 12 cm, and 10-year survival of 82%. For those undiagnosed and untreated, the average age of death is 32.

Tuesday, August 11, 2009

Wolff-Parkinson-White Pathways

Patients with Wolff-Parkinson-White (WPW) pathways have extra electrical pathways between heart chambers (i.e. between the atria and the ventricles), known as accessory pathways (short cut) that look like normal heart muscle, but they may conduct impulses faster than normal and/or conduct impulses in both directions instead of normal one direction from the atria to the ventricles. These symptoms occur in about 50 percent of people with WPW; some may have atrial fibrillation, a common irregular heart rhythm distinguished by disorganized, rapid, and irregular heart rhythm. The greatest concern for people with WPW is the possibility of having atrial fibrillation with a fast ventricular response that worsens to a life-threatening arrhythmia. Most people experience symptoms between the ages of 11 and 50 years old. The highest incidence occurs between the ages of 30 and 40 years old. In the general population, men have a higher incidence of WPW than women do, and there is a higher incidence of multiple accessory pathways in men.
Patients who have such symptoms because of this abnormality are said to have the WPW syndrome. During tachycardia (when heart pulses are faster than normal), patients may experience sudden heart pounding, fluttering, racing feeling in the chest, shortness of breath, dizziness, lightheadedness, anxiety, fainting, or rarely sudden death.
Some patients have the WPW pathway, but no experience in heart beats that are faster than normal. They do not have WPW syndrome, but may develop it at some point. These patients are said to have a WPW pattern, which can be detected on a routine electrocardiogram (ECG). They do not need treatment.
However, patients with WPW syndrome require treatment when or if they have an episode of tachycardia due to the serious potential risks. Treatment focuses on stopping the tachycardia and preventing its from recurring. The most common treatment options for Wolff-Parkinson-White syndrome are medications and catheter radiofrequency ablation, a minimally-invasive procedure to remove the abnormal, extra electrical heart pathway. Rarely, open-heart surgery may be performed if patients have other heart conditions in addition to WPW syndrome.

Sunday, August 9, 2009

Pembawa Virus Hepatitis B

Sebagian pasien yang terinfeksi virus Hepatitis B sembuh tapi tidak benar-benar bebas dari virus Hepatitis B. Lima sampai 10 persen pasien Hepatitis B usia dewasa, dan sekitar 90% pasien Hepatitis B usia bayi membawa virus tersebut seumur hidupnya. Pasien semacam ini dinamakan pembawa virus Hepatitis B atau “Hepatitis B Carriers”. Mereka biasanya tidak tampak sakit, atau tidak merasa sakit, dan tidak mengalami kerusakan organ hati. Akan tetapi, tes darah mereka menunjukan bahwa mereka masih membawa virus Hepatitis B di dalam darah tubuh mereka, dan mereka masih tidak mempunyai daya tahan tubuh terhadap virus Hepatitis B. Pasien semacam ini masih dapat menyebarkan infeksi kepada orang lain, ataupun virus Hepatitis B yang mereka bawa dapat berlipat ganda dan berkembang menyebabkan Infeksi organ hati kronik. Diperkirakan sekitar 25% dari pasien pembawa virus Hepatitis B menderita Infeksi organ hati kronik, dan beresiko untuk mempunyai penyakit organ hati yang lebih serius seperti pengerasan organ hati and kanker hati. Kendati jarang, Hepatitis B juga dapat menyebabkan komplikasi di luar organ hati, seperti kerusakan organ ginjal dan kelainan kulit. Dalam hal yang semacam ini, tes fungsi organ hati mungkin tidak nampak ada kelainan, tetapi tanda-tanda medis yang lain mungkin menunjukan bahwa kondisi di luar organ hati tersebut disebabkan oleh virus Hepatitis B.

Hepatitis B Carriers

Some patients who were infected by Hepatitis B virus do not recover completely. Five to 10% of adults and about 90% of babies who get hepatitis B will go on to "carry" or keep the virus for the rest of their lives. These people are called "hepatitis B carriers." Hepatitis B virus carriers feel healthy, do not feel sick or look sick, have no ongoing hepatitis or liver damage. However, their blood tests show they still have the virus and have not developed Hepatitis B antibodies. Therefore, they can pass on the virus to other people or replication of the Hepatitis virus in their blood can active again and cause their own liver damages. About a quarter of the carriers would develop chronic hepatitis, and at increased risk of having serious liver disease including cirrhosis and liver cancer.
Although rare, Hepatitis B can also cause complications outside the liver (non liver condition), such as kidney damages, and skin lesions. It may or may not involve liver. If no liver involvement, the client's liver function may appear relatively normal, but medical evidence may show that Hepatitis B virus was the main cause of the condition.

Friday, August 7, 2009

Bird Flu and Swine Flu Infections

There are 3 types of influenza viruses - A, B and C. Only types A and B cause significant human disease. Influenza A is further sub-typed into 15 different H types (H1, H2, H3, etc) and 9 different N types (N1, N2, N3, etc). The past outbreak of Bird Flu in poultry which affected humans is caused by H5N1 subtype of Influenza A virus or we named it as A/H5N1 virus. Bird Flu spreads to humans mainly through contact with infected birds, which shed the virus in their saliva, nasal secretions and faeces. Very rarely, inefficient and limited human-to-human transmission “may” occur. Unlike Bird Flu, the current Swine Flu pandemic is caused by novel H1N1 subtype of Influenza A virus. It is contagious and spreading from human to human through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
There is currently no vaccination to prevent against both Bird Flu and Swine Flu in humans. The available vaccination is for protection against human strains of the influenza virus. Two drugs, oseltamivir (commercially known as Tamiflu) and zanamivir (commercially known as Relenza) can reduce the severity and duration of illness caused by seasonal influenza. The efficacy of the two drugs depend on their administration within 48 hours after symptom onset. For cases of human infection with H5N1/H1N1, the drugs may improve prospects of survival, if administered early, but clinical data are limited. If there are no complications, most of the symptoms of influenza usually disappear after 6-7 days, although a cough may persist for over 2 weeks.

Wednesday, August 5, 2009

Piles

Haemorrhoids (often known as Piles) are enlarged and engorged blood vessels in or around the back passage (anus). You may notice a pain, itch, or ache around the anus and lower bowel (rectum), which can be really quite severe. There may be bleeding from the back passage. This will be bright red blood, not usually mixed in with the motion, but often seen on the toilet paper. There is often a feeling of something coming down, or a bulge or lump at the anus. If a haemorrhoid at the outside of the anus gets a blood clot in it (thrombosed external pile) it leads to a particularly tender, hardish lump.
Haemorrhoids are very common, especially in countries where the diet has traditionally been more processed and low in fibre. The main contributory causes are those things that cause us to raise the pressure in the abdomen, such as those chronically straining with constipation, overweight people, and people with heavy lifting jobs. This causes the blood vessels to swell and become engorged.

As implied above, useful aspects of prevention are:
* Avoid becoming overweight, and lose weight if you are.
* Eat a high fibre diet
* Exercise regularly

It is usually best, with haemorrhoids, to get by with the least treatment possible, as even after the most extensive treatments they may still return. Many times they will settle down over a matter of days without any treatment. But the majority of patients with mild haemorrhoidal symptoms would be more appropriately treated by fibre supplements, life-style changes and possibly apply cream or suppositories, bullet-shaped tablets to be inserted into the anus, may be bought over the counter. These soothe itching and pain, and cause swelling and bleeding to diminish. Cold compresses, even ice can be helpful. If you do not get better with these approaches, then you should see your doctor.

Monday, August 3, 2009

PET/CT Scan

PET Scan stands for Positron emission tomography, also called PET imaging is a type of nuclear medicine imaging that uses small amounts of radioactive material to measure important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning or to detect certain abnormalities within the body, including many types of cancers, and heart disease.
Whereas CT scan — also called computerized tomography is an X-ray technique that produces images of the body that can provide excellent information about internal organ structure.
Nowadays, most PET scans are performed on instruments that are combined PET and CT scanners. The combined PET/CT scans produce special pictures offering details on both the structure and function of organs and tissues. They are more accurate to detect presence and severity of cancers, neurological/brain conditions, and cardiovascular disease, and recurrence of cancer than the two scans performed separately.Total scanning time is approximately 30 minutes.
In USA, PET scan charges range from USD1200-USD3500, depending on the type of scan. In Taiwan, a hospital based nuclear medicine facility offers PET/CT Scan examination package for about USD1700. In Singapore, PET/CT Scan procedure costs about USD1500.

Saturday, August 1, 2009

Gallbladder Sludge

Gallbladder sludge is a mixture of particulate matter and bile that occurs when solutes in bile precipitate. The formation of gallbladder sludge is due to an imbalance between bile salts and cholesterol, then the bile fluid turns to sludge. This thickened fluid consists of a mucus gel containing cholesterol and calcium bilirubinate. If the imbalance worsens, cholesterol crystals can eventually form gallstones.
It is generally a slow process, and usually causes no pain or other symptoms. The clinical course of biliary sludge varies. It can develop complications like abdominal pain, inflammation of biliary tract (i.e. cholecystitis), and formation of gallstone. However, in about 50% of cases, gallbladder sludge spontaneously disappears and in 20% of cases persists but no symptom over a 3-year period.

Thursday, July 30, 2009

Fibroadenoma of Breast

Fibroadenomas are benign tumors composed of stromal and epithelial elements. The stroma varies from myxoid and hypocellular to fibrous and moderately cellular. Involution is common with increasing age of the lesion. The stroma becomes less cellular, more fibrotic and hyalinized. Hence, fibroadenoma with mixoid features should be seen normally in young age women. The cause of these tumors is unknown. Approximately 10% of fibroadenomas disappear spontaneously each year, and most stop growing after they reach 2-3 cm. In 72% of cases, they spontaneously resolve over a period of 7 years.
In most cases, fibroadenoma is considered to be abberation of normal breast development.
However, it is an abnormal variant of mixoid fibroadenoma, when it is associated with Carney's Syndrome, a rare inherited (autosomal dominant) abnormality that involve the following conditions: (1) adrenal gland, a small gland located above each kidney, over produces cortisol hormone with various manifestation such as skin easily bruises, obesity, and menstrual irregularities; (2) multiple pigmented lesions/spots of the skin (e.g. face, eyelid) or mucosa (e.g. conjunctiva, mouth); and (3) a variety of tumors (i.e. mixoid features of benign breast tumour/fibroadenoma is one of them).

Wednesday, July 29, 2009

Acoustic Radiation to Relieve Pain

Extracorporeal shockwave therapy (ESWT) is a method of treatment by application of high-density acoustic radiation that literally breaks the speed of sound, thereby creating a shockwave. This technique is commonly used for treatment of certain clinical conditions (e.g. musculoskeletal conditions like Achilles tendinopathy). Clinical studies done worldwide reported that ESWT is an effective and
safe treatment modality for chronic and painful lesions at bone-tendon junctions.

Extracorporeal shockwave therapy (ESWT) is sometimes alternatively known as shockwave biosurgery, although ESWT isn't surgery as the “surgery” word that people usually understand. It’s called that way because of how the therapy works, as follows:

* Trigger the body's repair mechanism. One of the manifestations of this is the gradual formation of new blood vessels in the targeted area. This shockwave exerts a mechanical pressure and tension force on the afflicted tissue. This has been shown to create an increase in cell membrane permeability, thereby increasing microscopic circulation (right) to the tissues and the metabolism within the treated tissues, both of which promote healing and subsequent dissolution of pathological deposits of calcification. Also, the ESWT shock waves pressure creates what are known as "cavitation bubbles", simply small empty cavities, which tend to expand to a to a maximum size, then collapse, much like a bubble popping. As these bubbles burst, a resultant force is created. In the human body, this force is strong enough to help break down pathological deposits of calcification in soft tissues, which can be the cause of chronic inflammation/pain in the affected soft tissue. ESWT shockwaves have also been shown to stimulate fibroblasts, the cells responsible for the healing
of connective tissues such as tendon, and ligaments.

*Over-stimulate pain transmission nerves. This leads to an immediate reduction in pain and sensitivity. This is where the nerves sending signals of pain to the brain are stimulated so much that their activity diminishes, thereby decreasing or eliminating pain. It is also sometimes thought of as activating a sort of "reset" button that recalibrates pain perception that set higher pain tolerance/threshold.

Tuesday, July 28, 2009

Early Puberty

Precocious puberty is an unusually early onset of puberty, the process of sexual maturation triggered by the brain or exogenous chemicals, which usually begins in late childhood and results in reproductive maturity and completion of growth. There are two following types:
* Early puberty which is natural in every way except age is termed idiopathic central precocious puberty (i.e. normal MRI scan brain, normal thyroid gland, normal physical examination, no abnormal symptom except her pubertal growth). There is no underlying medical problem. In other words, this early puberty is a variation of normal development.
* Secondary sexual development induced by sex steroids from other abnormal sources (gonadal or adrenal tumors, congenital adrenal hyperplasia, etc.) is referred to as peripheral precocious puberty or precocious pseudopuberty.
The goal of treating precocious puberty is to halt or even reverse sexual development and stop the rapid growth and bone maturation that can eventually result in adult short stature. In the idiopathic case, there is no medical underlying cause to be treated. The medications (e.g. decapeptyl and cyproterone acetate) are to lower the high levels of sex hormones to stop sexual development from progressing. It is generally safe and usually causes no side effects in kids. With the treatments, the child's behavior usually becomes more age appropriate as well.

Monday, July 27, 2009

Terapi Hormon Progesterone untuk Wanita Hamil

Pengobatan wanita yang sedang hamil dengan hormone progesterone (seperti Crinone, Cygest) bertujuan untuk meningkatkan atau menstabilkan kadar hormone progesterone di dalam tubuh wanita hamil. Dalam hal ini, Progesterone therapy ditujukan untuk menguatkan kandung / mencegah keguguran / mencegah kelahiran prematur.

Pengobatan dengan progesterone untuk wanita hamil bisa sampai 16 minggu atau bahkan sampai 20 minggu usia kehamilan. Hal ini berdasarkan pertimbangan bahwa:
* kadar progesterone cenderung menurun dalam masa transisi dari trimester pertama ke trimester kedua (13-16 minggu)
* sekiranya ada risiko lahir prematur, semakin besar umur kandungannya (>20 minggu) semakin baik untuk kondisi kesehatan ibu dan bayinya

Selama menjalani terapi dengan progesterone, efek samping yang sering dialami pasien yang hamil adalah rasa sakit di daerah perut (abdominal pain), kembung (bloating), dan sembelit (constipation). Untuk mengurangi keluhan akibat efek samping tersebut, biasanya dokter memberi pasien yang hamil obat anti maag. Kalau keluhan semacam tersebut di atas masih berlanjut kendati sudah minum obat anti maag dari dokter, sebaiknya pasien periksa lebih lanjut dengan dokter kandungannya. Sementara itu, mengurangi konsumi makanan / minuman dari kacang-kacangan juga dapat membantu mengurangi rasa kembung dan rasa sakit di daerah perut.

Selain itu, pasien yang hamil perlu juga dimonitor:
* Kadar hormon progesterone di dalam darahnya ( sekitar 2 minggu sekali)
* Fungsi liver / hati (seperti kadar SGOT, SGPT, Billirubin, GGT dalam darah), sekitar 4 minggu sekali
* Fungsi ginjal (seperti kadar Kreatinin, BUN dalam darah), sekitar 4 minggu sekali

Kalau ada hal lain yang masih kurang jelas, sebaiknya didiskusikan lebih lanjut dengan dokter ahli kandungan.

Sunday, July 26, 2009

Sources of Stem Cells

Stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In many tissues, they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells.
There are two kinds of stem cells:
* Embryonic stem cells are derived from embryos that develop from eggs that have been fertilized (found in 4-5 days old embryos). They can become all cell types of the body.
* Non embryonic/adult stem cells are found in a tissue or organ that can renew itself and can differentiate to yield some or all of the major specialized cell types of the tissue or organ. For example: for adult stem cell transplant, the stem cell source is from bone marrow, and it's known as a bone marrow transplant. If the stem cell source is from an umbilical cord, then it's called as umbilical cord blood transplant.

Fitness with Fat burners

Be aware of possible unwanted effects from taking Fish Oil.
Fish oil contains Omega 3 fatty acids including both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These are good fats. If the fish oil you are taking is very low in EPA and DHA and rich in useless fats that the human body often has a hard time metabolizing, hence it may lead to weight gain. Also be aware that low grade fish oil may contain mercury that could cause cancers.

If you are taking a more purified EPA and DHA concentrate, at about 5 grams of EPA and DHA per day, there will be four primary benefits. First, is the reduction of inflammation in the adipose tissue that causes weight gain. The second is the reduction of endocannabinoids in the brain that generate constant hunger signals. Third is the increase in the hormone adiponectin that reduces insulin resistance and eventually enable the body to use these fats into energy which will make way for "burned" fats. Finally, the fish oil will increase the production of enzymes to burn fat faster. It eventually helps you to lose weight.
Evidence from several studies has also suggested that amounts of DHA and EPA in the form of fish or fish oil supplements lowers triglycerides (bad cholesterole), slows the buildup of atherosclerotic plaques ("hardening of the arteries"), lowers blood pressure slightly, as well as reduces the risk of death, heart attack, dangerous abnormal heart rhythms, and strokes in people with known heart disease. However, high doses may have harmful effects, such as an increased risk of bleeding.

If you start incorporating fish oil in your daily fitness regimen, please look for a high grade supplement. Please also remember that fish oil for weight loss will work well if you combine it with exercise. Regular exercise will make the fat burning process possible. And unlike the other weight loss pills, fish oil as supplement will provide you with untiring energy levels and promote healthy feelings of self-worth.

The above long description of fish oil as supplement should also make you aware about need of taking other fat burner supplements. They could help but may also have functions that overlap one to another. Hence, be wary of overdoses!!.
 

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