Two years ago, Jean Magazzu began having trouble breathing. Her doctor thought it could be allergy-related — or perhaps a case of bronchitis.
But multiple rounds of antibiotics didn’t help, and her breathing worsened to the point where she couldn’t even walk across a room without sitting down.
An X-ray revealed the frightening truth: Her lungs were filled with blood clots and scar tissue, a symptom of pulmonary hypertension (PH). She was immediately transferred to Allegheny General Hospital, where cardiologist Dr. Raymond Benza diagnosed her. “Pulmonary hypertension is a rare disease, affecting only 15 people in 1 million,” says Dr. Benza, a nationally recognized leader in the treatment of PH. “It’s also rapidly progressing and deadly — probably as mortal as any cancer we treat.”
Jean’s form of PH — related to the chronic clots in her lungs — was even more rare.
The disease is characterized by high blood pressure in the lung’s pulmonary artery, which forces the heart to essentially work itself to death. “When she came to us, she was already in the throes of severe heart failure,” says Dr. Benza.
Along with his team, he determined that Jean needed to undergo an extremely delicate and difficult surgery to remove the clots and scar tissue. The procedure can take 12 hours, and requires stopping the heart and deep-chilling the body and brain; it’s performed in only a handful of U.S. institutions.
Fortunately, AGH recently joined that exclusive club. Dr. Benza had arranged for AGH cardiothoracic surgeon Dr. Robert Moraca to receive the months-long training necessary to perform the procedure, which took Dr. Moraca to hospitals in San Diego, Canada and Alabama.
Jean was the first person to undergo this procedure at AGH, but she says Dr. Benza’s manner helped lessen her fears. “He understood this was scary, but he explained things so I could understand them — and told me, matter-of-factly, what they were going to do,” she says. “I really wanted to know, so I appreciated that. His and Dr. Moraca’s confidence really helped.”
Jean’s surgery required a bypass machine to produce total circulatory arrest. “You can’t have any blood going through the lungs because that’s where we were operating,” Dr. Benza explains.
After her body and brain were chilled, lead surgeon Dr. Moraca opened up all the blood vessels in her lungs and carefully teased away the clots from the vessels. “Deciding what’s real tissue and abnormal tissue inside the vessels is one of the real challenges here,” explains Dr. Benza. “And if you make a mistake and puncture a blood vessel, that’s usually fatal.”
The positive results of Jean’s surgery were apparent immediately — the high pressure in her lungs dropped to normal, and her circulation responded in kind. “Although I was weak from the surgery, I remember sitting up and taking a breath and thinking, Wow, a real improvement!” Jean says. “I was only in the hospital a week, and back to normal quickly.”
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Wednesday, August 24, 2016
Medical Mystery
In June 2011, 23-year-old Lauren Cantalope, an X-ray technician in Hastings, Pa., began suffering from terrible headaches. It was the start of a medical mystery that would land her in a coma — and near death — until the tangled threads of her symptoms were unraveled by Pittsburgh neurologist Neil Busis.
Lauren’s headaches were soon accompanied by a high fever, facial numbness and severe nausea. “At first, my doctor thought it could be migraines or a stomach bug,” she recalls, “but I kept getting worse.” She had tests done at an Altoona hospital, but the results only muddied the waters, revealing that it might be meningitis or encephalitis.
A spinal tap showed inflammation and unusual cells, suggesting meningitis again — or even leukemia. By this point, Lauren had sunk into a state of severe fatigue and confusion. She was transferred to the Hillman Cancer Center, a division of UPMC Presbyterian Shadyside Hospital, for what doctors thought would be a cancer diagnosis. Dr. Busis, the hospital’s chief of neurology, was asked to consult on her case. “I didn’t think it was cancer,” he says. Instead, he suspected a benign ovarian tumor, called a teratoma, which he noticed on her CT scan might be the cause of her symptoms, albeit in a very unexpected way.
Meanwhile, Lauren’s condition became critical. “Within two days of arriving, she was comatose, on a ventilator and seizing,” says Dr. Busis. “Highly unusual for a healthy young woman.” As he was pondering the mystery of Lauren’s condition, Dr. Busis remembered a neurology lecture he’d attended a year earlier. “A light bulb went off,” he says. The speaker had briefly mentioned the very rare paraneoplastic syndrome, in which young women with tumors like Lauren’s suffered from brain disease when the tumors triggered the body’s autoimmune response.
Although only 150 cases of the disease had ever been documented, Dr. Busis realized that Lauren’s symptoms were almost identical. “The immune system fights off the tumor threat with antibodies,” he explains. “[The] problem is [that] the antibodies cross-react with normal brain tissue and make the brain sick.” Curing the syndrome called for tumor removal and treatment of the immune system. “So I called an obstetrician/gynecologist here at the hospital,” Dr. Busis says, “and told him, ‘I think the teratoma is the problem. I’d like you to take it out; it might save her life.’”
The simple operation went off without a hitch. Post-surgery treatment of Lauren’s immune system included intravenous immunoglobin to block bad antibodies and steroids. Lauren’s symptoms abated; Dr. Busis had made the right call. While she had only been in a coma for 24 hours, she did not wake up for 3 weeks after the surgery. Only then did she began to learn about all she’d been through and about the doctor who had saved her life. “Honestly, everything from that July to September is a blur to me,” she admits. “I don’t remember much about Altoona or Shadyside … or meeting Dr. Busis. But my family told me how great he was, along with everyone else at the hospital.” It took Lauren a long time to feel truly better, but given her grave illness, Dr. Busis calls it “a remarkable recovery;” she spent a month in the hospital and several more months in physical, speech and occupational therapy in Altoona. Today, she’s home in Hastings, working again and also engaged. She says “things are finally normal again.”
Lauren’s headaches were soon accompanied by a high fever, facial numbness and severe nausea. “At first, my doctor thought it could be migraines or a stomach bug,” she recalls, “but I kept getting worse.” She had tests done at an Altoona hospital, but the results only muddied the waters, revealing that it might be meningitis or encephalitis.
A spinal tap showed inflammation and unusual cells, suggesting meningitis again — or even leukemia. By this point, Lauren had sunk into a state of severe fatigue and confusion. She was transferred to the Hillman Cancer Center, a division of UPMC Presbyterian Shadyside Hospital, for what doctors thought would be a cancer diagnosis. Dr. Busis, the hospital’s chief of neurology, was asked to consult on her case. “I didn’t think it was cancer,” he says. Instead, he suspected a benign ovarian tumor, called a teratoma, which he noticed on her CT scan might be the cause of her symptoms, albeit in a very unexpected way.
Meanwhile, Lauren’s condition became critical. “Within two days of arriving, she was comatose, on a ventilator and seizing,” says Dr. Busis. “Highly unusual for a healthy young woman.” As he was pondering the mystery of Lauren’s condition, Dr. Busis remembered a neurology lecture he’d attended a year earlier. “A light bulb went off,” he says. The speaker had briefly mentioned the very rare paraneoplastic syndrome, in which young women with tumors like Lauren’s suffered from brain disease when the tumors triggered the body’s autoimmune response.
Although only 150 cases of the disease had ever been documented, Dr. Busis realized that Lauren’s symptoms were almost identical. “The immune system fights off the tumor threat with antibodies,” he explains. “[The] problem is [that] the antibodies cross-react with normal brain tissue and make the brain sick.” Curing the syndrome called for tumor removal and treatment of the immune system. “So I called an obstetrician/gynecologist here at the hospital,” Dr. Busis says, “and told him, ‘I think the teratoma is the problem. I’d like you to take it out; it might save her life.’”
The simple operation went off without a hitch. Post-surgery treatment of Lauren’s immune system included intravenous immunoglobin to block bad antibodies and steroids. Lauren’s symptoms abated; Dr. Busis had made the right call. While she had only been in a coma for 24 hours, she did not wake up for 3 weeks after the surgery. Only then did she began to learn about all she’d been through and about the doctor who had saved her life. “Honestly, everything from that July to September is a blur to me,” she admits. “I don’t remember much about Altoona or Shadyside … or meeting Dr. Busis. But my family told me how great he was, along with everyone else at the hospital.” It took Lauren a long time to feel truly better, but given her grave illness, Dr. Busis calls it “a remarkable recovery;” she spent a month in the hospital and several more months in physical, speech and occupational therapy in Altoona. Today, she’s home in Hastings, working again and also engaged. She says “things are finally normal again.”
When you have rearest Cancer in the world.
After experiencing serious food poisoning for several days, Susan Killmeyer knew she needed to visit UPMC Presbyterian Shadyside Hospital, where she works as a clinical director.
There in the ER, a CT scan of her abdomen revealed a danger much greater than a routine case of food poisoning: a cancerous tumor on her inferior vena cava, the vein that carries blood from the lower half of the body into the heart.
The food poisoning may have saved her life, says Dr. David Bartlett, a cancer surgery specialist at UPMC CancerCenter. “Her cancer is among the rarest — [it affects] about five in a million,” he says, “and it takes so long to develop symptoms that by the time it does, it’s usually beyond what we could treat.” Dr. Bartlett, along with a team that included Dr. Herbert Zeh, a cancer surgeon at UPMC CancerCenter, determined that Susan would have to undergo a long, complex operation to remove the tumor. “It wasn’t easy news to hear,” she says, “but I’m a take-charge person — I don’t feel sorry for myself. So from my hospital bed I compiled a list of physicians for my ‘team’ — and Dr. Bartlett was on it. I knew he was a good surgeon.” “Her tumor was in a tricky area and involved her liver, so to reach the tumor, we had to take out the vena cava,” Dr. Bartlett says.
This created complications, including problems with blood pressure and clotting as well as serious bleeding — all of which put Susan’s brain at risk. Throughout the nine-hour operation, continuous efforts to keep her alive were made — including massive transfusions of blood products, and both medication and intermittent clamping of the heart’s main blood vessel to maintain pressure to the brain. “It was a Herculean effort by a large team,” says Dr. Bartlett.
The surgery was a success, but Susan was back in the operating room several hours later because of bleeding. More surgeries followed, including one where she was so unstable that she couldn’t be moved from the ICU. “So we did the operation there,” Dr. Bartlett says. Multiple surgeries contributed to Susan’s kidneys failing, while the length of her sedation led, temporarily, to total body paralysis. “Her case was unique,” says Dr. Bartlett. “She seemed to have every problem you could have.” Susan was in the hospital for three months. “The day I left, I could barely sit on the side of the bed,” she recalls. “I had to learn to feed myself and to walk again.” Her recovery was arduous, but Susan was able to return home (and get back to work). “The psychological aspect of a recovery like Susan’s is huge,” Dr. Bartlett, says, “and she was very strong.
Even when paralyzed — her kidneys failing — she maintained good spirits.” Thinking about her adult twin daughters gave her strength, Susan says. “My husband died 17 years ago, and there was no way in hell I was leaving my kids without a parent.” Susan’s short-term goal was to see her girls get married. “One daughter’s wedding was last October and I was able to walk her down the aisle,” she says. “My other daughter is getting married this month, so I’ll be doing it again.” “It’s rewarding to take a challenging case like Susan’s and give her hope for the future,” says Dr. Bartlett. “What allows us to do it are all the people and resources at this hospital — from the anesthesiology department to the ICU nurses and many others. The whole system supports a case like this.
There in the ER, a CT scan of her abdomen revealed a danger much greater than a routine case of food poisoning: a cancerous tumor on her inferior vena cava, the vein that carries blood from the lower half of the body into the heart.
The food poisoning may have saved her life, says Dr. David Bartlett, a cancer surgery specialist at UPMC CancerCenter. “Her cancer is among the rarest — [it affects] about five in a million,” he says, “and it takes so long to develop symptoms that by the time it does, it’s usually beyond what we could treat.” Dr. Bartlett, along with a team that included Dr. Herbert Zeh, a cancer surgeon at UPMC CancerCenter, determined that Susan would have to undergo a long, complex operation to remove the tumor. “It wasn’t easy news to hear,” she says, “but I’m a take-charge person — I don’t feel sorry for myself. So from my hospital bed I compiled a list of physicians for my ‘team’ — and Dr. Bartlett was on it. I knew he was a good surgeon.” “Her tumor was in a tricky area and involved her liver, so to reach the tumor, we had to take out the vena cava,” Dr. Bartlett says.
This created complications, including problems with blood pressure and clotting as well as serious bleeding — all of which put Susan’s brain at risk. Throughout the nine-hour operation, continuous efforts to keep her alive were made — including massive transfusions of blood products, and both medication and intermittent clamping of the heart’s main blood vessel to maintain pressure to the brain. “It was a Herculean effort by a large team,” says Dr. Bartlett.
The surgery was a success, but Susan was back in the operating room several hours later because of bleeding. More surgeries followed, including one where she was so unstable that she couldn’t be moved from the ICU. “So we did the operation there,” Dr. Bartlett says. Multiple surgeries contributed to Susan’s kidneys failing, while the length of her sedation led, temporarily, to total body paralysis. “Her case was unique,” says Dr. Bartlett. “She seemed to have every problem you could have.” Susan was in the hospital for three months. “The day I left, I could barely sit on the side of the bed,” she recalls. “I had to learn to feed myself and to walk again.” Her recovery was arduous, but Susan was able to return home (and get back to work). “The psychological aspect of a recovery like Susan’s is huge,” Dr. Bartlett, says, “and she was very strong.
Even when paralyzed — her kidneys failing — she maintained good spirits.” Thinking about her adult twin daughters gave her strength, Susan says. “My husband died 17 years ago, and there was no way in hell I was leaving my kids without a parent.” Susan’s short-term goal was to see her girls get married. “One daughter’s wedding was last October and I was able to walk her down the aisle,” she says. “My other daughter is getting married this month, so I’ll be doing it again.” “It’s rewarding to take a challenging case like Susan’s and give her hope for the future,” says Dr. Bartlett. “What allows us to do it are all the people and resources at this hospital — from the anesthesiology department to the ICU nurses and many others. The whole system supports a case like this.
Great Solution
Imagine a lifelong diet so restrictive that you can’t eat meat or dairy. Even vegetables must be rationed. The stakes are high, since a dietary misstep can lead to brain damage or death. That’s been the reality for people with Maple Syrup Urine Disease (MSUD), an inherited genetic disorder that prevents the body from processing certain amino acids found in proteins.
MSUD is rare — affecting less than one in 200,000 children — and dangerous. Even the severe diet can’t prevent a minor illness from potentially triggering a fatal metabolic crisis. But a cure now exists, in the form of liver transplants performed at Children’s Hospital of Pittsburgh of UPMC.
A new liver gives MSUD patients the enzymes necessary to process proteins. About a decade ago, the transplant center at Children’s — under the direction of Dr. George Mazariegos, director of pediatric transplantation — developed the world’s first comprehensive, multidisciplinary medical protocol for performing these transplants for MSUD patients. “This program really constitutes a medical breakthrough,” Dr. Mazariegos says. Late last year, 15-year-old Crystal Martin of Lancaster County became the 50th MSUD patient whose life was improved by a liver transplant at Children’s.
Before the operation, Crystal’s disorder had a significant impact on her whole family, says her mother, Lorraine. “Starting with the food restrictions — she could hardly eat anything. And we’d always have to worry about her amino-acid levels. If they went up, she wouldn’t feel well. She got sick easily and missed so much school — it affected her ability to think clearly, too. We [also] had a cloud hanging over us of possible brain damage.” Crystal’s family heard about the transplant option at a symposium Children’s hosted at the Clinic For Special Children, a genetic-disorders treatment center near their home. “I was privileged to collaborate with a remarkable team of people in the development of this program,” says Dr. Mazariegos.
The group includes geneticists, gastroenterologists, hepatologists and metabolic specialists from Children’s and the Clinic For Special Children. “Experts from different institutions working together isn’t that common,” Dr. Mazariegos explains, “but these colleagues put individual and institutional goals behind the shared goal of what would be best for the patients.” Transplant surgery for MSUD patients differs from conventional transplant procedures in several ways, including routine surgical issues. “There’s the potential for serious metabolic and neurological crises during and after surgery if we’re not very careful,” explains Dr. Mazariegos, “so we developed contingency plans for everything.” On Nov. 27, the Martins were notified via phone that a donor liver was available. Crystal underwent a successful transplant at Children’s the next day. “She can’t stop telling everyone how happy she is,” says Lorraine. “It’s a miracle how this changed things. She says her mind is totally clear, and she’s really eating for the first time — she never knew what meat, eggs or pizza tasted like! We’re so appreciative of that awesome hospital and so grateful to the donor’s family. We can’t thank them enough.”
Performing 50 successful MSUD transplants is precisely what Dr. Mazariegos had planned. “We feel a high degree of responsibility with this program,” he says. “Any misstep could impact subsequent patients, as well as the transplant field as a whole. It’s exciting to see these transplants lead to dramatic changes for MSUD patients, their families and communities.”
MSUD is rare — affecting less than one in 200,000 children — and dangerous. Even the severe diet can’t prevent a minor illness from potentially triggering a fatal metabolic crisis. But a cure now exists, in the form of liver transplants performed at Children’s Hospital of Pittsburgh of UPMC.
A new liver gives MSUD patients the enzymes necessary to process proteins. About a decade ago, the transplant center at Children’s — under the direction of Dr. George Mazariegos, director of pediatric transplantation — developed the world’s first comprehensive, multidisciplinary medical protocol for performing these transplants for MSUD patients. “This program really constitutes a medical breakthrough,” Dr. Mazariegos says. Late last year, 15-year-old Crystal Martin of Lancaster County became the 50th MSUD patient whose life was improved by a liver transplant at Children’s.
Before the operation, Crystal’s disorder had a significant impact on her whole family, says her mother, Lorraine. “Starting with the food restrictions — she could hardly eat anything. And we’d always have to worry about her amino-acid levels. If they went up, she wouldn’t feel well. She got sick easily and missed so much school — it affected her ability to think clearly, too. We [also] had a cloud hanging over us of possible brain damage.” Crystal’s family heard about the transplant option at a symposium Children’s hosted at the Clinic For Special Children, a genetic-disorders treatment center near their home. “I was privileged to collaborate with a remarkable team of people in the development of this program,” says Dr. Mazariegos.
The group includes geneticists, gastroenterologists, hepatologists and metabolic specialists from Children’s and the Clinic For Special Children. “Experts from different institutions working together isn’t that common,” Dr. Mazariegos explains, “but these colleagues put individual and institutional goals behind the shared goal of what would be best for the patients.” Transplant surgery for MSUD patients differs from conventional transplant procedures in several ways, including routine surgical issues. “There’s the potential for serious metabolic and neurological crises during and after surgery if we’re not very careful,” explains Dr. Mazariegos, “so we developed contingency plans for everything.” On Nov. 27, the Martins were notified via phone that a donor liver was available. Crystal underwent a successful transplant at Children’s the next day. “She can’t stop telling everyone how happy she is,” says Lorraine. “It’s a miracle how this changed things. She says her mind is totally clear, and she’s really eating for the first time — she never knew what meat, eggs or pizza tasted like! We’re so appreciative of that awesome hospital and so grateful to the donor’s family. We can’t thank them enough.”
Performing 50 successful MSUD transplants is precisely what Dr. Mazariegos had planned. “We feel a high degree of responsibility with this program,” he says. “Any misstep could impact subsequent patients, as well as the transplant field as a whole. It’s exciting to see these transplants lead to dramatic changes for MSUD patients, their families and communities.”
Tuesday, August 23, 2016
8 Best Fruits for a Diabetes
The Best Fruits to Manage Your Blood Sugar
Warm weather means lots of luscious fruit. But if you have diabetes, you may be wondering how these seasonal treats can fit into your diet plan. According to the American Diabetes Association (ADA), fruits are loaded with vitamins, minerals, and fiber and should be a part of a diabetes-friendly diet — just keep track of them as you do with all carbs. The key is to keep an eye on portion sizes and to stay away from fruits canned in syrups or contained in other types of added sugar. If you're using the glycemic index (GI) — a measure of how foods affect your blood sugar levels — to manage your diabetes, most fruits are a good choice because they rate low on the ranking. Satisfy your sweet tooth and keep your blood sugar in check with the following fresh or frozen low-GI choices.
1.Berries for Antioxidants
Whether you love blueberries, strawberries, or any other type of berry, you have the go-ahead to indulge. According to the ADA, berries are a diabetes superfood because they're packed with antioxidants, vitamins, and fiber, plus they're low-GI. Three quarters of a cup of fresh blueberries has 62 calories and 16 grams (g) of carbohydrates. If you can resist the urge to just pop them into your mouth, try berries in a parfait, alternating layers of fruit with plain non-fat yogurt — it makes a great dessert or breakfast.
2.Tart Cherries to Fight Inflammation
Tart cherries are a low-GI choice and a smart addition to a diabetes-friendly diet. One cup has 78 calories and 19 g of carbs, and they may be especially good at fighting inflammation, too. Tart cherries are also packed with antioxidants, which may help fight heart disease, cancer, and other diseases. These fruits can be purchased fresh, canned, frozen, or dried. But since many canned and dried fruits contain added sugar, be sure to check the labels.
3.Peaches for Potassium
Fragrant, juicy peaches are a warm-weather treat and can also be included in your diabetes-friendly diet. Peaches contain vitamins A and C, potassium, and fiber and are delicious on their own or tossed into iced tea for a fruity twist. When you want a snack, whip up a quick smoothie by pureeing peach slices with low-fat buttermilk, crushed ice, and a touch of cinnamon or ginger.
4.Apricots for Fiber
Apricots are a sweet summer fruit staple and a wonderful addition to your diabetes meal plan. One apricot has just 17 calories and 4 g of carbohydrates. Four fresh apricots equal one serving and provide more than 50 percent of your daily vitamin A requirement. These fruity jewels are also a good source of fiber. Try mixing some diced fresh apricots into hot or cold cereal, or toss some in a salad.
5.Apples for Vitamins
An apple a day really might keep the doctor away. Toss one in your purse or tote bag if you're on the go; a small apple is a great fruit choice, with just 77 calories and 21 g carbs. Apples are also loaded with fiber and a good source of vitamin C. Don't peel your apples, though — the skins are the most nutritious part, full of antioxidants.
6.Oranges for Vitamin C
Eat one orange and you've gotten all the vitamin C you need in a day. This low-GI choice comes in at only 15 g of carbohydrates and 62 calories. Oranges also contain folate and potassium, which may help normalize blood pressure. And while you're enjoying this juicy treat, don't forget that other citrus fruits, like grapefruit, are also great choices.
7.Pears for Vitamin K and Fiber
Because pears are an excellent source of fiber and a good source of vitamin K, they make a wise addition to your diabetes meal plan. Plus, unlike most fruit, they actually improve in texture and flavor after they're picked. Store pears at room temperature until they're ripe and perfect for eating (they can then be stored in the refrigerator). Here's a tasty treat: Slice up a pear and toss it into your next spinach salad.
8.Low-Carb Kiwi
If you've never tried a kiwi, you might not know that its brown fuzzy peel hides a zesty bright green fruit. Delicious kiwi is a good source of potassium, fiber, and vitamin C. One large kiwi has about 56 calories and 13 g of carbohydrates, so it's a smart addition to your diabetes-friendly diet. Kiwis are available year-round and will last in the refrigerator for up to three weeks.
Warm weather means lots of luscious fruit. But if you have diabetes, you may be wondering how these seasonal treats can fit into your diet plan. According to the American Diabetes Association (ADA), fruits are loaded with vitamins, minerals, and fiber and should be a part of a diabetes-friendly diet — just keep track of them as you do with all carbs. The key is to keep an eye on portion sizes and to stay away from fruits canned in syrups or contained in other types of added sugar. If you're using the glycemic index (GI) — a measure of how foods affect your blood sugar levels — to manage your diabetes, most fruits are a good choice because they rate low on the ranking. Satisfy your sweet tooth and keep your blood sugar in check with the following fresh or frozen low-GI choices.
1.Berries for Antioxidants
Whether you love blueberries, strawberries, or any other type of berry, you have the go-ahead to indulge. According to the ADA, berries are a diabetes superfood because they're packed with antioxidants, vitamins, and fiber, plus they're low-GI. Three quarters of a cup of fresh blueberries has 62 calories and 16 grams (g) of carbohydrates. If you can resist the urge to just pop them into your mouth, try berries in a parfait, alternating layers of fruit with plain non-fat yogurt — it makes a great dessert or breakfast.
2.Tart Cherries to Fight Inflammation
Tart cherries are a low-GI choice and a smart addition to a diabetes-friendly diet. One cup has 78 calories and 19 g of carbs, and they may be especially good at fighting inflammation, too. Tart cherries are also packed with antioxidants, which may help fight heart disease, cancer, and other diseases. These fruits can be purchased fresh, canned, frozen, or dried. But since many canned and dried fruits contain added sugar, be sure to check the labels.
3.Peaches for Potassium
Fragrant, juicy peaches are a warm-weather treat and can also be included in your diabetes-friendly diet. Peaches contain vitamins A and C, potassium, and fiber and are delicious on their own or tossed into iced tea for a fruity twist. When you want a snack, whip up a quick smoothie by pureeing peach slices with low-fat buttermilk, crushed ice, and a touch of cinnamon or ginger.
4.Apricots for Fiber
Apricots are a sweet summer fruit staple and a wonderful addition to your diabetes meal plan. One apricot has just 17 calories and 4 g of carbohydrates. Four fresh apricots equal one serving and provide more than 50 percent of your daily vitamin A requirement. These fruity jewels are also a good source of fiber. Try mixing some diced fresh apricots into hot or cold cereal, or toss some in a salad.
5.Apples for Vitamins
An apple a day really might keep the doctor away. Toss one in your purse or tote bag if you're on the go; a small apple is a great fruit choice, with just 77 calories and 21 g carbs. Apples are also loaded with fiber and a good source of vitamin C. Don't peel your apples, though — the skins are the most nutritious part, full of antioxidants.
6.Oranges for Vitamin C
Eat one orange and you've gotten all the vitamin C you need in a day. This low-GI choice comes in at only 15 g of carbohydrates and 62 calories. Oranges also contain folate and potassium, which may help normalize blood pressure. And while you're enjoying this juicy treat, don't forget that other citrus fruits, like grapefruit, are also great choices.
7.Pears for Vitamin K and Fiber
Because pears are an excellent source of fiber and a good source of vitamin K, they make a wise addition to your diabetes meal plan. Plus, unlike most fruit, they actually improve in texture and flavor after they're picked. Store pears at room temperature until they're ripe and perfect for eating (they can then be stored in the refrigerator). Here's a tasty treat: Slice up a pear and toss it into your next spinach salad.
8.Low-Carb Kiwi
If you've never tried a kiwi, you might not know that its brown fuzzy peel hides a zesty bright green fruit. Delicious kiwi is a good source of potassium, fiber, and vitamin C. One large kiwi has about 56 calories and 13 g of carbohydrates, so it's a smart addition to your diabetes-friendly diet. Kiwis are available year-round and will last in the refrigerator for up to three weeks.
Monday, August 22, 2016
What Is Autism?
What Is Autism? What is Autism Spectrum Disorder?
Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. With the May 2013 publication of the DSM-5 diagnostic manual, all autism disorders were merged into one umbrella diagnosis of ASD. Previously, they were recognized as distinct subtypes, including autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art. Autism appears to have its roots in very early brain development. However, the most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age. Autism Speaks continues to fund research on effective methods for earlier diagnosis, as early intervention with proven behavioral therapies can improve outcomes. Increasing autism awareness is a key aspect of this work and one in which our families and volunteers play an invaluable role.
How Common Is Autism?
Autism statistics from the U.S. Centers for Disease Control and Prevention (CDC) identify around 1 in 68 American children as on the autism spectrum–a ten-fold increase in prevalence in 40 years. Careful research shows that this increase is only partly explained by improved diagnosis and awareness. Studies also show that autism is four to five times more common among boys than girls. An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States. ASD affects over 3 million individuals in the U.S. and tens of millions worldwide. Moreover, government autism statistics suggest that prevalence rates have increased 10 to 17 percent annually in recent years. There is no established explanation for this continuing increase, although improved diagnosis and environmental influences are two reasons often considered.
What Causes Autism?
Not long ago, the answer to this question would have been “we have no idea.” Research is now delivering the answers. First and foremost, we now know that there is no one cause of autism just as there is no one type of autism. Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by themselves. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development. In the presence of a genetic predisposition to autism, a number of nongenetic, or “environmental,” stresses appear to further increase a child’s risk. The clearest evidence of these autism risk factors involves events before and during birth. They include advanced parental age at time of conception (both mom and dad), maternal illness during pregnancy and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the baby’s brain. It is important to keep in mind that these factors, by themselves, do not cause autism. Rather, in combination with genetic risk factors, they appear to modestly increase risk. A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception. Increasingly, researchers are looking at the role of the immune system in autism. Autism Speaks is working to increase awareness and investigation of these and other issues, where further research has the potential to improve the lives of those who struggle with autism.
What Does It Mean to Be “On the Spectrum”?
Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About one third of people with ASD are nonverbal but can learn to communicate using other means. Autism Speaks’ mission is to improve the lives of all those on the autism spectrum. For some, this means the development and delivery of more effective treatments that can address significant challenges in communication and physical health. For others, it means increasing acceptance, respect and support
Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. With the May 2013 publication of the DSM-5 diagnostic manual, all autism disorders were merged into one umbrella diagnosis of ASD. Previously, they were recognized as distinct subtypes, including autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art. Autism appears to have its roots in very early brain development. However, the most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age. Autism Speaks continues to fund research on effective methods for earlier diagnosis, as early intervention with proven behavioral therapies can improve outcomes. Increasing autism awareness is a key aspect of this work and one in which our families and volunteers play an invaluable role.
How Common Is Autism?
Autism statistics from the U.S. Centers for Disease Control and Prevention (CDC) identify around 1 in 68 American children as on the autism spectrum–a ten-fold increase in prevalence in 40 years. Careful research shows that this increase is only partly explained by improved diagnosis and awareness. Studies also show that autism is four to five times more common among boys than girls. An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States. ASD affects over 3 million individuals in the U.S. and tens of millions worldwide. Moreover, government autism statistics suggest that prevalence rates have increased 10 to 17 percent annually in recent years. There is no established explanation for this continuing increase, although improved diagnosis and environmental influences are two reasons often considered.
What Causes Autism?
Not long ago, the answer to this question would have been “we have no idea.” Research is now delivering the answers. First and foremost, we now know that there is no one cause of autism just as there is no one type of autism. Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by themselves. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development. In the presence of a genetic predisposition to autism, a number of nongenetic, or “environmental,” stresses appear to further increase a child’s risk. The clearest evidence of these autism risk factors involves events before and during birth. They include advanced parental age at time of conception (both mom and dad), maternal illness during pregnancy and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the baby’s brain. It is important to keep in mind that these factors, by themselves, do not cause autism. Rather, in combination with genetic risk factors, they appear to modestly increase risk. A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception. Increasingly, researchers are looking at the role of the immune system in autism. Autism Speaks is working to increase awareness and investigation of these and other issues, where further research has the potential to improve the lives of those who struggle with autism.
What Does It Mean to Be “On the Spectrum”?
Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About one third of people with ASD are nonverbal but can learn to communicate using other means. Autism Speaks’ mission is to improve the lives of all those on the autism spectrum. For some, this means the development and delivery of more effective treatments that can address significant challenges in communication and physical health. For others, it means increasing acceptance, respect and support
Thursday, August 18, 2016
A Miraculous Birth
In 2008, after seven years of fertility treatments, Liane Santilli became pregnant with twins. Naturally, Liane — a nurse anesthetist at Allegheny General Hospital — and her husband were thrilled.
But there were concerns about one of the embryos. “When I had my first ultrasound at three weeks, it wasn’t even visible — it looked like a bruise on my uterus,” says Liane. Doctors initially thought the embryo would be reabsorbed by the body and not progress to the fetus stage. Yet this baby would defy almost everyone’s expectations. Dr. Ronald Thomas, director of maternal-fetal medicine for West Penn Allegheny Health System, specializes in high-risk pregnancies, and Liane’s certainly fit that bill: She carried twins (a boy and a girl), was of “advanced” maternal age (at 32) and had undergone fertility treatments. “It was clear that the [female] twin was not growing well,” Dr. Thomas says. “Liane even heard from one specialist that there was ‘no hope.’” Dr. Thomas felt otherwise.
Five months into the pregnancy, Liane experienced significant bleeding and suddenly became a patient at her workplace. At first, it looked as though neither twin would survive, and Liane was advised to consider terminating the pregnancy for medical reasons. “My family was there in my hospital room [with] all my friends — we talked about the choice I had to make and prepared ourselves for the end,” she recalls. “Then Dr. Thomas walked in with a list of medications [I could take]. He said, ‘You can sit in this room as long as you want. It’s up to you.’” He wasn’t guaranteeing, but he was giving me an option. So I looked at my friend and said, ‘I’m not [terminating]. I’m gonna sit here as long as I want.’ Dr. Thomas never gave up on us.” Liane stayed put for two months, as Dr. Thomas and the rest of the crew in Allegheny General Hospital’s Program for High-Risk Obstetrics worked to monitor the health and development of the twins.
There were two crucial markers they needed to reach for a viable live birth: a minimum gestation of 27 weeks and a baby weight of at least 600 grams (one-and-a-half pounds). As the girl continued to lag behind in growth, it became, Dr. Thomas says, “an ongoing tightrope walk to reach those goals — and even if we did, there were concerns about survival.” Other problems developed, including the boy’s unusually low-lying placenta and the girl’s partially separated placenta (which could have led to dangerous bleeding at delivery). Then, at just over 29 weeks — less than seven months — Liane began bleeding again and went into labor. Dr. Thomas determined that the boy had developed an infection; the twins had to be delivered immediately via C-section. The boy came out first, weighing more than 3 pounds, followed by the girl, who weighed just about the minimum — one-and-a-half pounds.
Both babies were rushed to the neonatal unit, placed on ventilators and treated for infection, as well as the respiratory distress common to preterm infants. From that point on, though, Isabella and her brother John would continue to make forward progress. She stayed longer in the unit than he did, but in time, she was growing and thriving. More than three years later, there have been only minor complications from Liane’s difficult pregnancy. Now, she says, “they’re normal, healthy kids. John is into cars, trains and trouble. Isabella had some feeding issues [which are common with premature babies] that we worked through. She’s a bit small for her age, but no one ever believes she started out at a pound-and-a-half.”
But there were concerns about one of the embryos. “When I had my first ultrasound at three weeks, it wasn’t even visible — it looked like a bruise on my uterus,” says Liane. Doctors initially thought the embryo would be reabsorbed by the body and not progress to the fetus stage. Yet this baby would defy almost everyone’s expectations. Dr. Ronald Thomas, director of maternal-fetal medicine for West Penn Allegheny Health System, specializes in high-risk pregnancies, and Liane’s certainly fit that bill: She carried twins (a boy and a girl), was of “advanced” maternal age (at 32) and had undergone fertility treatments. “It was clear that the [female] twin was not growing well,” Dr. Thomas says. “Liane even heard from one specialist that there was ‘no hope.’” Dr. Thomas felt otherwise.
Five months into the pregnancy, Liane experienced significant bleeding and suddenly became a patient at her workplace. At first, it looked as though neither twin would survive, and Liane was advised to consider terminating the pregnancy for medical reasons. “My family was there in my hospital room [with] all my friends — we talked about the choice I had to make and prepared ourselves for the end,” she recalls. “Then Dr. Thomas walked in with a list of medications [I could take]. He said, ‘You can sit in this room as long as you want. It’s up to you.’” He wasn’t guaranteeing, but he was giving me an option. So I looked at my friend and said, ‘I’m not [terminating]. I’m gonna sit here as long as I want.’ Dr. Thomas never gave up on us.” Liane stayed put for two months, as Dr. Thomas and the rest of the crew in Allegheny General Hospital’s Program for High-Risk Obstetrics worked to monitor the health and development of the twins.
There were two crucial markers they needed to reach for a viable live birth: a minimum gestation of 27 weeks and a baby weight of at least 600 grams (one-and-a-half pounds). As the girl continued to lag behind in growth, it became, Dr. Thomas says, “an ongoing tightrope walk to reach those goals — and even if we did, there were concerns about survival.” Other problems developed, including the boy’s unusually low-lying placenta and the girl’s partially separated placenta (which could have led to dangerous bleeding at delivery). Then, at just over 29 weeks — less than seven months — Liane began bleeding again and went into labor. Dr. Thomas determined that the boy had developed an infection; the twins had to be delivered immediately via C-section. The boy came out first, weighing more than 3 pounds, followed by the girl, who weighed just about the minimum — one-and-a-half pounds.
Both babies were rushed to the neonatal unit, placed on ventilators and treated for infection, as well as the respiratory distress common to preterm infants. From that point on, though, Isabella and her brother John would continue to make forward progress. She stayed longer in the unit than he did, but in time, she was growing and thriving. More than three years later, there have been only minor complications from Liane’s difficult pregnancy. Now, she says, “they’re normal, healthy kids. John is into cars, trains and trouble. Isabella had some feeding issues [which are common with premature babies] that we worked through. She’s a bit small for her age, but no one ever believes she started out at a pound-and-a-half.”
Saving lives is above all
Eric Tocco was playing racquetball last fall when he suffered a heart attack — yet the 43-year-old had no history of heart disease. An automated external defibrillator was used, but Eric’s heart didn’t immediately recover. Paramedics transported him to nearby UPMC St. Margaret Hospital, where CPR was performed for a full 30 minutes before he finally regained a pulse.
Once stabilized, Eric was transported to UPMC Presbyterian Hospital, where he spent more than a week in a coma and on life support. Cardiac arrest is brutal, as the risk of death is 10 times higher than physical trauma and three times higher than stroke. But Eric’s chances for recovery were significantly improved, thanks to UPMC Presbyterian’s Post Cardiac Arrest Service (PCAS), a coordinated care program for all patients who’ve undergone CPR.
PCAS is used from the earliest moments of a patient’s treatment through their discharge from the hospital and subsequent rehabilitation. “This was an effort we began in the last decade to improve the quality of care we provide to cardiac-arrest patients,” says Dr. Clifton Callaway, one of the program’s co-creators. The multidisciplinary program involves cardiologists and neurologists, as well as critical-care, emergency-medicine and rehabilitation specialists. “We haven’t invented new technology or new drugs,” Dr. Callaway says. “It’s taking critical pieces of care and sticking them together in a coordinated fashion.” At UPMC Presbyterian, Eric initially underwent therapeutic hypothermia, which lowers the body temperature to 92 degrees Fahrenheit (thus preventing further brain damage). “The most common cause of death for cardiac-arrest patients who’ve undergone CPR is brain injury [due to lack of oxygenated blood],” explains Dr. Callaway. “About two-thirds of those who survive CPR and make it to an intensive-care unit have brain damage so severe that they don’t survive.” Before Eric awoke from his coma, the extent of his brain damage was not known.
Over the next several days, Eric received the care that PCAS is designed to provide. Intensive-care doctors maintained his blood pressure and electrolytes (minerals in body fluids), and his ventilator was managed to promote brain blood flow. Eric’s brain had swelled, so doctors gave him fluids and positioned him strategically in his bed to treat the swelling. And when he experienced myoclonic seizures, neurologists were able to treat him instantly and aggressively. “Traditionally, patients simply didn’t survive myoclonic seizures after cardiac arrest,” Dr. Callaway says, “and now, remarkably, we’re seeing them discharged from the hospital.” Meanwhile, though Eric was still comatose, cardiologists provided timely cardiac catheterization to open the blockage causing his heart attack..
On day no. 9 in the hospital, Eric awoke from his coma. “The first person I saw was my daughter,” he recalls. “I kept trying to say, ‘I love you’. My mouth was moving, but nothing [came out]. The most important thing is that I’m here. I’m alive and kicking.” Because of the PCAS program, survival rates for patients like him have risen from about 30 percent to above 40 percent, says Dr. Callaway. “Eric had a number of features that traditionally — and by that I mean seven or eight years ago — were fatal,” he says. Today, Eric — one of over 200 patients treated by PCAS at UPMC Presbyterian last year — continues his rehab for slight memory problems and a leg injury related to his CPR chest compressions. “Even though I have a little way to go, I’m willing to do what it takes. I’m grateful for where I am,” he says. “I know it’s a bit of a miracle.”
Once stabilized, Eric was transported to UPMC Presbyterian Hospital, where he spent more than a week in a coma and on life support. Cardiac arrest is brutal, as the risk of death is 10 times higher than physical trauma and three times higher than stroke. But Eric’s chances for recovery were significantly improved, thanks to UPMC Presbyterian’s Post Cardiac Arrest Service (PCAS), a coordinated care program for all patients who’ve undergone CPR.
PCAS is used from the earliest moments of a patient’s treatment through their discharge from the hospital and subsequent rehabilitation. “This was an effort we began in the last decade to improve the quality of care we provide to cardiac-arrest patients,” says Dr. Clifton Callaway, one of the program’s co-creators. The multidisciplinary program involves cardiologists and neurologists, as well as critical-care, emergency-medicine and rehabilitation specialists. “We haven’t invented new technology or new drugs,” Dr. Callaway says. “It’s taking critical pieces of care and sticking them together in a coordinated fashion.” At UPMC Presbyterian, Eric initially underwent therapeutic hypothermia, which lowers the body temperature to 92 degrees Fahrenheit (thus preventing further brain damage). “The most common cause of death for cardiac-arrest patients who’ve undergone CPR is brain injury [due to lack of oxygenated blood],” explains Dr. Callaway. “About two-thirds of those who survive CPR and make it to an intensive-care unit have brain damage so severe that they don’t survive.” Before Eric awoke from his coma, the extent of his brain damage was not known.
Over the next several days, Eric received the care that PCAS is designed to provide. Intensive-care doctors maintained his blood pressure and electrolytes (minerals in body fluids), and his ventilator was managed to promote brain blood flow. Eric’s brain had swelled, so doctors gave him fluids and positioned him strategically in his bed to treat the swelling. And when he experienced myoclonic seizures, neurologists were able to treat him instantly and aggressively. “Traditionally, patients simply didn’t survive myoclonic seizures after cardiac arrest,” Dr. Callaway says, “and now, remarkably, we’re seeing them discharged from the hospital.” Meanwhile, though Eric was still comatose, cardiologists provided timely cardiac catheterization to open the blockage causing his heart attack..
On day no. 9 in the hospital, Eric awoke from his coma. “The first person I saw was my daughter,” he recalls. “I kept trying to say, ‘I love you’. My mouth was moving, but nothing [came out]. The most important thing is that I’m here. I’m alive and kicking.” Because of the PCAS program, survival rates for patients like him have risen from about 30 percent to above 40 percent, says Dr. Callaway. “Eric had a number of features that traditionally — and by that I mean seven or eight years ago — were fatal,” he says. Today, Eric — one of over 200 patients treated by PCAS at UPMC Presbyterian last year — continues his rehab for slight memory problems and a leg injury related to his CPR chest compressions. “Even though I have a little way to go, I’m willing to do what it takes. I’m grateful for where I am,” he says. “I know it’s a bit of a miracle.”
Tuesday, August 16, 2016
This is why I want to become a pediatrician
At just a few months old, Sam Zarpas of Norfolk, Va., faced a dangerous medical crisis unprecedented in babies his age. It began with a rare autoimmune disorder called idiopathic thrombocytopenic purpura (ITP), for which local doctors treated him with steroids — the standard treatment, though the medication often impacts growth in children.
This worked initially, but a few months later,
Sam’s eyes turned yellow; he had become jaundiced, indicating liver failure. Doctors thought he had autoimmune hepatitis, in which the body’s immune system attacks its liver. More steroids were prescribed but didn’t help, and his parents were frustrated and scared. “Health-care [professionals] here couldn’t figure out what was going on,” says his mother, Cindi, “but they kept pumping him full of steroids. They didn’t want to think outside the box.” Fortunately, Cindi was friends with a doctor at Children’s Hospital of Pittsburgh of UPMC, so Sam’s liver biopsy was sent there.
It attracted the attention of Dr. Benjamin Shneider, director of pediatric hepatology: “It’s rare to have ITP at 2 months [and] rare to have liver disease at 7 months,” Dr. Shneider says. “Were the two problems connected? That was the rub. Sam also had significant side effects from the steroids — high blood pressure and growth trouble. He was very sick.”
Though Sam was initially evaluated for a liver transplant, Dr. Shneider knew that this major surgery might prove only a temporary solution. He felt that the key to Sam’s immediate and longterm health would be a thorough and accurate diagnosis of his unheard-of combination of conditions. Examining Sam’s liver cells, Dr. Shneider saw evidence of the rare giant cell hepatitis, and a condition called Coombs’ positive hemolytic anemia, in which antibodies destroy red blood cells. “But in Sam’s case, antibodies were destroying his [blood’s] platelets,” Dr. Shneider explains. “My take was that he had a disease similar to the Coombs’ subset of giant cell hepatitis, but instead of Coombs’, he had ITP. This situation was effectively unique.”
Dr. Shneider felt the medication Rituximab, used for overactive immune systems, could work for Sam, though it had never been used for his specific situation. “We were in uncharted waters with the experimental use of medication on someone so young,” says Cindi, “and the potential side effects were awful! But Dr. Shneider had a wonderful demeanor and confidence, and he kept us calm.” Sam received four weekly doses of Rituximab, and within three months, his blood clotting factors and liver enzymes were just about normal. Doctors tapered his steroids to a minimum, ending his high blood pressure and growth problems. “He’s 3 now, and you’d never know he was sick a day in his life,” says Cindi. “He’s walking, talking, the right size and shape.”
Sam’s eyes turned yellow; he had become jaundiced, indicating liver failure. Doctors thought he had autoimmune hepatitis, in which the body’s immune system attacks its liver. More steroids were prescribed but didn’t help, and his parents were frustrated and scared. “Health-care [professionals] here couldn’t figure out what was going on,” says his mother, Cindi, “but they kept pumping him full of steroids. They didn’t want to think outside the box.” Fortunately, Cindi was friends with a doctor at Children’s Hospital of Pittsburgh of UPMC, so Sam’s liver biopsy was sent there.
It attracted the attention of Dr. Benjamin Shneider, director of pediatric hepatology: “It’s rare to have ITP at 2 months [and] rare to have liver disease at 7 months,” Dr. Shneider says. “Were the two problems connected? That was the rub. Sam also had significant side effects from the steroids — high blood pressure and growth trouble. He was very sick.”
Though Sam was initially evaluated for a liver transplant, Dr. Shneider knew that this major surgery might prove only a temporary solution. He felt that the key to Sam’s immediate and longterm health would be a thorough and accurate diagnosis of his unheard-of combination of conditions. Examining Sam’s liver cells, Dr. Shneider saw evidence of the rare giant cell hepatitis, and a condition called Coombs’ positive hemolytic anemia, in which antibodies destroy red blood cells. “But in Sam’s case, antibodies were destroying his [blood’s] platelets,” Dr. Shneider explains. “My take was that he had a disease similar to the Coombs’ subset of giant cell hepatitis, but instead of Coombs’, he had ITP. This situation was effectively unique.”
Dr. Shneider felt the medication Rituximab, used for overactive immune systems, could work for Sam, though it had never been used for his specific situation. “We were in uncharted waters with the experimental use of medication on someone so young,” says Cindi, “and the potential side effects were awful! But Dr. Shneider had a wonderful demeanor and confidence, and he kept us calm.” Sam received four weekly doses of Rituximab, and within three months, his blood clotting factors and liver enzymes were just about normal. Doctors tapered his steroids to a minimum, ending his high blood pressure and growth problems. “He’s 3 now, and you’d never know he was sick a day in his life,” says Cindi. “He’s walking, talking, the right size and shape.”
Inspirational Doctors stories.
Washington County native Morgan Dysert was finishing up her freshman year at the University of Minnesota in spring 2010. The athletic student figured the minor eye problems she was experiencing came from late-night study sessions. But her vision continued to worsen for a week, so she consulted an ophthalmologist.
The doctor couldn’t find anything wrong with Morgan’s eyes, but suggested she get a brain scan, to be safe. “That’s when we found out about the brain tumor,” Morgan recalls, “and so my mom immediately said, ‘I’ve heard about this Dr. Aziz — we should see him!’” Morgan’s mother was a director of nursing at Allegheny General Hospital, so she was already familiar with Dr. Khaled Aziz, director of the hospital’s Center of Complex Intracranial Surgery. Morgan’s tumor, called a trigeminal schwannoma, was rare. And it was growing — already impacting the nerves that controlled eye movement and facial sensations. Her face was beginning to go numb.
The tumor was benign, but her symptoms would continue to worsen and eventually become unbearable. Dr. Aziz confirmed that it was a trigeminal schwannoma — and had more difficult news for Morgan and her family: Although these tumors can sometimes be treated with radiation, hers was too advanced. Morgan’s best removal option was a complicated, dangerous operation; the procedure would be particularly difficult due to the tumor’s location underneath her brain, near delicate nerves and the vital carotid artery. Normally, risks associated with this surgery include bleeding, strokes and infections — yet Morgan says that Dr. Aziz approached her and her family with a confidence and compassion that allayed their fears. “He told me and my mother [about] everything that would happen [in the surgery] and all the horrible things that could go wrong — but [my mom] came out of that discussion smiling and believing everything would be fine. [That discussion] sticks with me. That was amazing.” The surgery Dr. Aziz and his team performed on Morgan took about eight hours (the first hours were spent on the crucial positioning of Morgan for the extremely precise procedures to come).
A separate team of specialists was involved in preparing an electrovisiologic monitoring system, which would watch her nervous system function throughout the surgery. Dr. Aziz made a small incision at the base of Morgan’s skull above the jaw and went in underneath the brain (but outside the brain covering). Once that layer was dissected, he was able to follow her trigeminal nerve (a cranial nerve with ties to facial sensation, biting and chewing, and more) back to the tumor. The trick was to remove the tumor carefully without injuring any vital structures. He employed microsurgical techniques to ensure accuracy and also utilized a special computerized navigation system — similar to a car’s — as he moved, helping him to quickly target the tumor. Finally, he used delicate ultrasonic aspirators to break up and suction out the tumor without damaging surrounding nerves and tissue — another example of the high-tech tools that allow today’s brain surgeons to cure what was once inoperable. “We were able to take out the tumor with minimum manipulation,” Dr. Aziz says, “so her symptoms began to disappear.” Morgan’s recovery progressed swiftly. She was only in the hospital for five days, and her symptoms were gone in a week. She was able to start the fall semester of her sophomore year, with a pretty amazing story about what she’d done on her summer vacation.
The doctor couldn’t find anything wrong with Morgan’s eyes, but suggested she get a brain scan, to be safe. “That’s when we found out about the brain tumor,” Morgan recalls, “and so my mom immediately said, ‘I’ve heard about this Dr. Aziz — we should see him!’” Morgan’s mother was a director of nursing at Allegheny General Hospital, so she was already familiar with Dr. Khaled Aziz, director of the hospital’s Center of Complex Intracranial Surgery. Morgan’s tumor, called a trigeminal schwannoma, was rare. And it was growing — already impacting the nerves that controlled eye movement and facial sensations. Her face was beginning to go numb.
The tumor was benign, but her symptoms would continue to worsen and eventually become unbearable. Dr. Aziz confirmed that it was a trigeminal schwannoma — and had more difficult news for Morgan and her family: Although these tumors can sometimes be treated with radiation, hers was too advanced. Morgan’s best removal option was a complicated, dangerous operation; the procedure would be particularly difficult due to the tumor’s location underneath her brain, near delicate nerves and the vital carotid artery. Normally, risks associated with this surgery include bleeding, strokes and infections — yet Morgan says that Dr. Aziz approached her and her family with a confidence and compassion that allayed their fears. “He told me and my mother [about] everything that would happen [in the surgery] and all the horrible things that could go wrong — but [my mom] came out of that discussion smiling and believing everything would be fine. [That discussion] sticks with me. That was amazing.” The surgery Dr. Aziz and his team performed on Morgan took about eight hours (the first hours were spent on the crucial positioning of Morgan for the extremely precise procedures to come).
A separate team of specialists was involved in preparing an electrovisiologic monitoring system, which would watch her nervous system function throughout the surgery. Dr. Aziz made a small incision at the base of Morgan’s skull above the jaw and went in underneath the brain (but outside the brain covering). Once that layer was dissected, he was able to follow her trigeminal nerve (a cranial nerve with ties to facial sensation, biting and chewing, and more) back to the tumor. The trick was to remove the tumor carefully without injuring any vital structures. He employed microsurgical techniques to ensure accuracy and also utilized a special computerized navigation system — similar to a car’s — as he moved, helping him to quickly target the tumor. Finally, he used delicate ultrasonic aspirators to break up and suction out the tumor without damaging surrounding nerves and tissue — another example of the high-tech tools that allow today’s brain surgeons to cure what was once inoperable. “We were able to take out the tumor with minimum manipulation,” Dr. Aziz says, “so her symptoms began to disappear.” Morgan’s recovery progressed swiftly. She was only in the hospital for five days, and her symptoms were gone in a week. She was able to start the fall semester of her sophomore year, with a pretty amazing story about what she’d done on her summer vacation.
Monday, August 15, 2016
Stethoscope History
The word stethoscope is derived from the two Greek words, stethos (chest) and scopos (examination). Apart from listening to the heart and chest sounds, it is also used to hear bowel sounds and blood flow noises in arteries and veins.
Since mankind first began to study human physiology, and the physical characteristics associated with various ailments, it has been obvious that the heart plays a crucial role in our bodies. The sounds it makes, as well as the sounds that the surrounding organs, such as the lungs, make can be crucial indicators when examining a patient.
The act of listening to these sounds, known as auscultation, has been refined using even more powerful tools to aid physicians in this crucial examination. In the early 1800’s, and prior to the development of the stethoscope, physicians would often perform physical examinations using techniques such as percussion and immediate auscultation. In immediate auscultation, physicians placed their ear directly on the patient to observe internal sounds.
Rene-Theophile-Hyacinthe Laennec Drawings stethoscope 1819 Drawings of the early stethoscope by Rene Theophile Hyacinthe Laënnec, 1819. This technique suffered from several drawbacks, the foremost being that it required physical contact between the physician and the patient and proper placement of the ear. In addition, the sounds observed by the physician were not amplified in any way, creating the possibility of missing key sounds that might indicate potential illness. Finally, the act of performing immediate auscultation could be awkward for both the physician and patient. To resolve the limitations of immediate auscultation, a French doctor named Rene Theophile Hyacinthe Laënnec (1781–1826) at the Necker-Enfants Malades Hospital in Paris invented the first stethoscope in 1816. During an examination of a patient, he was afforded few diagnostic clues from application of a hand to the chest or the commonly used percussion method. Reluctant to perform immediate auscultation on the young female patient, he used a rolled sheet of paper to create an aural tube and facilitate auscultation. He was excited to discover that the heart sounds were clearly audible, and this discovery later lead to the development of the first device specifically for this purpose.
The first stethoscope consisted of a wooden tube and was monaural. Similar to a hearing aid known as an ear trumpet, it allowed the physician to more comfortably perform auscultation.
Laennec - Théobald Chartran Rene Theophile Hyacinthe Laënnec examines a patient in front of his students at Necker Hospital in this painting by Theobald Chartran. It would not be until 1851 when the stethoscope had its next major improvement, which was to make the device bi-aural. Invented by Irish physician Arthur Leared, it was refined in 1852 by George Cammann for commercialization. Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible.
Initially there was some concern that the bi-aural stethoscope could create hearing imbalances which might be problematic during examinations, but by the early 1900’s these concerns had largely subsided and the bi-aural stethoscope was a commonly used diagnostic instrument.
Throughout the 20th century many minor improvements were made to these iconic devices to reduce weight, improve acoustic quality, and filter out external noise to aid in the process of auscultation. Electronic versions of the stethoscope were introduced to further amplify sound. Stethoscopes are now available in a wide array of styles, with designs available for virtually every branch of medicine.
Despite all of the improvements and changes, the basic principle behind the stethoscope continues to remain the same; to provide physicians with the means to perform auscultation and identify specific sounds within the body.
Since mankind first began to study human physiology, and the physical characteristics associated with various ailments, it has been obvious that the heart plays a crucial role in our bodies. The sounds it makes, as well as the sounds that the surrounding organs, such as the lungs, make can be crucial indicators when examining a patient.
The act of listening to these sounds, known as auscultation, has been refined using even more powerful tools to aid physicians in this crucial examination. In the early 1800’s, and prior to the development of the stethoscope, physicians would often perform physical examinations using techniques such as percussion and immediate auscultation. In immediate auscultation, physicians placed their ear directly on the patient to observe internal sounds.
Rene-Theophile-Hyacinthe Laennec Drawings stethoscope 1819 Drawings of the early stethoscope by Rene Theophile Hyacinthe Laënnec, 1819. This technique suffered from several drawbacks, the foremost being that it required physical contact between the physician and the patient and proper placement of the ear. In addition, the sounds observed by the physician were not amplified in any way, creating the possibility of missing key sounds that might indicate potential illness. Finally, the act of performing immediate auscultation could be awkward for both the physician and patient. To resolve the limitations of immediate auscultation, a French doctor named Rene Theophile Hyacinthe Laënnec (1781–1826) at the Necker-Enfants Malades Hospital in Paris invented the first stethoscope in 1816. During an examination of a patient, he was afforded few diagnostic clues from application of a hand to the chest or the commonly used percussion method. Reluctant to perform immediate auscultation on the young female patient, he used a rolled sheet of paper to create an aural tube and facilitate auscultation. He was excited to discover that the heart sounds were clearly audible, and this discovery later lead to the development of the first device specifically for this purpose.
The first stethoscope consisted of a wooden tube and was monaural. Similar to a hearing aid known as an ear trumpet, it allowed the physician to more comfortably perform auscultation.
Laennec - Théobald Chartran Rene Theophile Hyacinthe Laënnec examines a patient in front of his students at Necker Hospital in this painting by Theobald Chartran. It would not be until 1851 when the stethoscope had its next major improvement, which was to make the device bi-aural. Invented by Irish physician Arthur Leared, it was refined in 1852 by George Cammann for commercialization. Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible.
HIV/AIDS
You may have heard about HIV and AIDS, but many people don't know the basic facts about them.
HIV causes AIDS. HIV stands for human immunodeficiency virus. It breaks down the immune system — our body's protection against disease. HIV causes people to become sick with infections that normally wouldn't affect them.
AIDS is short for acquired immune deficiency syndrome. It is the most advanced stage of HIV disease.
In the United States, more than 980,000 cases of AIDS have been reported to the government. About 40,000 women and men in the United States get HIV each year.
Sympyoms :
HIV
Some people develop HIV symptoms shortly after being infected. But it usually takes more than 10 years. There are several stages of HIV disease. The first HIV symptoms may include swollen glands in the throat, armpit, or groin. Other early HIV symptoms include slight fever, headaches, fatigue, and muscle aches. These symptoms may last for only a few weeks. Then there are usually no HIV symptoms for many years. That is why it can be hard to know if you have HIV.
AIDS
AIDS symptoms appear in the most advanced stage of HIV disease. In addition to a badly damaged immune system, a person with AIDS may also have thrush — a thick, whitish coating of the tongue or mouth that is caused by a yeast infection and sometimes accompanied by a sore throat severe or recurring vaginal yeast infections chronic pelvic inflammatory disease severe and frequent infections periods of extreme and unexplained tiredness that may be combined with headaches, lightheadedness, and/or dizziness quick loss of more than 10 pounds of weight that is not due to increased physical exercise or dieting bruising more easily than normal long periods of frequent diarrhea frequent fevers and/or night sweats swelling or hardening of glands located in the throat, armpit, or groin periods of persistent, deep, dry coughing increasing shortness of breath the appearance of discolored or purplish growths on the skin or inside the mouth unexplained bleeding from growths on the skin, from the mouth, nose, anus, or vagina, or from any opening in the body frequent or unusual skin rashes severe numbness or pain in the hands or feet, the loss of muscle control and reflex, paralysis, or loss of muscular strength confusion, personality change, or decreased mental abilities.
HOW IS HIV SPREAD
People have lots of questions about the ways you can get HIV. HIV is transmitted in blood, semen, vaginal fluids, and breast milk. The most common ways HIV is spread are by having vaginal or anal intercourse without a condom with someone who has HIV/AIDS sharing needles or syringes with someone who has HIV/AIDS being deeply punctured with a needle or surgical instrument contaminated with HIV getting HIV-infected blood, semen, or vaginal secretions into open wounds or sores Babies born to women with HIV/AIDS can get HIV from their mothers during birth or from breastfeeding. HIV is not transmitted by simple casual contact such as kissing, sharing drinking glasses, or hugging. Getting and Giving Blood Some people are concerned about the risk of HIV when getting or giving blood. Hospitals, blood banks, and health care providers in the United States are extremely careful. Syringes and needles are only used once. And blood is always tested before it's banked. So, today, there is practically no risk of getting or spreading HIV by giving or receiving blood.
How can i Prevent ?
There are many ways you can protect yourself from HIV. The surest way is to abstain from sexual intercourse and from sharing needles and "works" if you use steroids, hormones, or other drugs. Many people have been infected with HIV by sharing needles. If you are using needles for steroids, hormones, or other drugs Never share needles. Get into a needle-exchange program. Be sure to disinfect the needles you use. Don't share personal items that may have blood on them. This includes toothbrushes, razors, needles for piercing or tattooing, and blades for cutting or scarring. If you choose to have sex, have safer sex to reduce the risk of exchanging blood, semen, or vaginal fluids with your sex partner(s).
Safer Sex and HIV Some kinds of sex play are "safer" because they have lower risk of infection than others. "Safer-sex" activities are those we choose to lower our risk of exchanging blood, semen, or vaginal fluids — the body fluids most likely to spread HIV. Each of us must decide what risks we will take for sexual pleasure. Here are some common sexual behaviors grouped according to risk. VERY LOW RISK — No reported HIV infections due to these behaviors fantasy, cyber sex, or phone sex using clean sex toys masturbation or mutual masturbation manual stimulation of one another touching or massage fondling or body rubbing kissing oral sex on a man with a condom oral sex on a woman with a Glyde dam or plastic wrap LOW RISK — Very few reported HIV infections due to these behaviors deep kissing that causes bleeding vaginal intercourse with a condom or female condom anal intercourse with a condom or female condom oral sex (Try not to get semen, vaginal fluids, or blood into the mouth or on broken skin.) HIGH RISK — Millions of reported HIV infections due to these behaviors vaginal intercourse without a condom anal intercourse without a condom.
Talk with your health care provider about testing and treatment for STDs. Women and men with open sores from herpes and other infections get HIV more easily than other people.
Sympyoms :
HIV
Some people develop HIV symptoms shortly after being infected. But it usually takes more than 10 years. There are several stages of HIV disease. The first HIV symptoms may include swollen glands in the throat, armpit, or groin. Other early HIV symptoms include slight fever, headaches, fatigue, and muscle aches. These symptoms may last for only a few weeks. Then there are usually no HIV symptoms for many years. That is why it can be hard to know if you have HIV.
AIDS
AIDS symptoms appear in the most advanced stage of HIV disease. In addition to a badly damaged immune system, a person with AIDS may also have thrush — a thick, whitish coating of the tongue or mouth that is caused by a yeast infection and sometimes accompanied by a sore throat severe or recurring vaginal yeast infections chronic pelvic inflammatory disease severe and frequent infections periods of extreme and unexplained tiredness that may be combined with headaches, lightheadedness, and/or dizziness quick loss of more than 10 pounds of weight that is not due to increased physical exercise or dieting bruising more easily than normal long periods of frequent diarrhea frequent fevers and/or night sweats swelling or hardening of glands located in the throat, armpit, or groin periods of persistent, deep, dry coughing increasing shortness of breath the appearance of discolored or purplish growths on the skin or inside the mouth unexplained bleeding from growths on the skin, from the mouth, nose, anus, or vagina, or from any opening in the body frequent or unusual skin rashes severe numbness or pain in the hands or feet, the loss of muscle control and reflex, paralysis, or loss of muscular strength confusion, personality change, or decreased mental abilities.
HOW IS HIV SPREAD
People have lots of questions about the ways you can get HIV. HIV is transmitted in blood, semen, vaginal fluids, and breast milk. The most common ways HIV is spread are by having vaginal or anal intercourse without a condom with someone who has HIV/AIDS sharing needles or syringes with someone who has HIV/AIDS being deeply punctured with a needle or surgical instrument contaminated with HIV getting HIV-infected blood, semen, or vaginal secretions into open wounds or sores Babies born to women with HIV/AIDS can get HIV from their mothers during birth or from breastfeeding. HIV is not transmitted by simple casual contact such as kissing, sharing drinking glasses, or hugging. Getting and Giving Blood Some people are concerned about the risk of HIV when getting or giving blood. Hospitals, blood banks, and health care providers in the United States are extremely careful. Syringes and needles are only used once. And blood is always tested before it's banked. So, today, there is practically no risk of getting or spreading HIV by giving or receiving blood.
How can i Prevent ?
There are many ways you can protect yourself from HIV. The surest way is to abstain from sexual intercourse and from sharing needles and "works" if you use steroids, hormones, or other drugs. Many people have been infected with HIV by sharing needles. If you are using needles for steroids, hormones, or other drugs Never share needles. Get into a needle-exchange program. Be sure to disinfect the needles you use. Don't share personal items that may have blood on them. This includes toothbrushes, razors, needles for piercing or tattooing, and blades for cutting or scarring. If you choose to have sex, have safer sex to reduce the risk of exchanging blood, semen, or vaginal fluids with your sex partner(s).
Safer Sex and HIV Some kinds of sex play are "safer" because they have lower risk of infection than others. "Safer-sex" activities are those we choose to lower our risk of exchanging blood, semen, or vaginal fluids — the body fluids most likely to spread HIV. Each of us must decide what risks we will take for sexual pleasure. Here are some common sexual behaviors grouped according to risk. VERY LOW RISK — No reported HIV infections due to these behaviors fantasy, cyber sex, or phone sex using clean sex toys masturbation or mutual masturbation manual stimulation of one another touching or massage fondling or body rubbing kissing oral sex on a man with a condom oral sex on a woman with a Glyde dam or plastic wrap LOW RISK — Very few reported HIV infections due to these behaviors deep kissing that causes bleeding vaginal intercourse with a condom or female condom anal intercourse with a condom or female condom oral sex (Try not to get semen, vaginal fluids, or blood into the mouth or on broken skin.) HIGH RISK — Millions of reported HIV infections due to these behaviors vaginal intercourse without a condom anal intercourse without a condom.
Talk with your health care provider about testing and treatment for STDs. Women and men with open sores from herpes and other infections get HIV more easily than other people.
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma (NHL) is a group of blood cancers that includes all types of lymphoma except Hodgkin's lymphomas. Symptoms include enlarged lymph nodes, fever,night sweats, weight loss, and feeling tired. Other symptoms may include bone pain, chest pain, or itchiness. Some forms are slow growing while others are fast growing.
Lymphomas are types of cancer that develops from lymphocytes, a type of white blood cell.Risk factors include poor immune function, autoimmune diseases, Helicobacter pyloriinfection, hepatitis C, obesity, and Epstein-Barr virus infection.The World Health Organization (WHO) classifies lymphomas into five major groups, including one for Hodgkin's lymphoma. Within the four groups for NHL there are over 60 specific types of lymphoma. Diagnosis is by examination of a bone marrow or lymph node biopsy. Medical imagingis done to help with cancer staging.
Treatment depends of if the lymphoma is slow or fast growing and if it is in one area or many areas. Treatments may include chemotherapy, radiation, immunotherapy, targeted therapy, stem cell transplantation, surgery, or watchful waiting. If the blood becomes overly thick due to antibodies, plasmapheresis may be used. Radiation and some chemotherapy; however, increase the risk of other cancers, heart disease, or nerve problems over the subsequent decades. In 2013 about 2.96 million people had non-Hodgkin lymphoma and 226,000 died. In the United States 2.1% of people are affected at some point in their life. The most common age of diagnosis is between 65 to 75 years old. The percentage of people who survive five years in the United States is 71%. Signs and symptoms Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and feeling tired. Other symptoms may include bone pain, chest pain, or itchiness. Some forms are slow growing while others are fast growing. Causes[edit] The many different forms of lymphoma probably have different causes. These possible causes and associations with at least some forms of NHL include the following: Infectious agents: Epstein-Barr virus: associated with Burkitt's lymphoma, Hodgkin's lymphoma, follicular dendritic cell sarcoma, extranodal NK-T-cell lymphoma Human T-cell leukemia virus: associated with adult T-cell lymphoma Helicobacter pylori: associated with gastric lymphoma HHV-8: associated with primary effusion lymphoma, multicentric Castleman disease Hepatitis C virus: associated with splenic marginal zone lymphoma, lymphoplasmacytic lymphoma and diffuse large B-cell lymphoma HIV infection Some chemicals, like polychlorinated biphenyls (PCBs), diphenylhydantoin, dioxin, and phenoxy herbicides. Medical treatments, like radiation therapy and chemotherapy Genetic diseases, like Klinefelter's syndrome, Chédiak-Higashi syndrome, ataxia telangiectasia syndrome Autoimmune diseases, like Sjögren’s syndrome, celiac sprue, rheumatoid arthritis, and systemic lupus erythematosus.
HIV/AIDS[edit] The Center for Disease Control and Prevention (CDC) included certain types of non-Hodgkin's lymphoma as AIDS-defining cancers in 1987.Immune suppression rather than HIV itself is implicated in the pathogenesis of this malignancy, with a clear correlation between the degree of immune suppression and the risk of developing NHL. Additionally, other retroviruses such as HTLV may be spread by the same mechanisms that spread HIV, leading to an increased rate of co-infection. The natural history of HIV infection has been greatly changed over time. As a consequence, the incidence of non-Hodgkin's lymphoma (NHL) in HIV infected patients has significantly declined in recent years.
Treatment depends of if the lymphoma is slow or fast growing and if it is in one area or many areas. Treatments may include chemotherapy, radiation, immunotherapy, targeted therapy, stem cell transplantation, surgery, or watchful waiting. If the blood becomes overly thick due to antibodies, plasmapheresis may be used. Radiation and some chemotherapy; however, increase the risk of other cancers, heart disease, or nerve problems over the subsequent decades. In 2013 about 2.96 million people had non-Hodgkin lymphoma and 226,000 died. In the United States 2.1% of people are affected at some point in their life. The most common age of diagnosis is between 65 to 75 years old. The percentage of people who survive five years in the United States is 71%. Signs and symptoms Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and feeling tired. Other symptoms may include bone pain, chest pain, or itchiness. Some forms are slow growing while others are fast growing. Causes[edit] The many different forms of lymphoma probably have different causes. These possible causes and associations with at least some forms of NHL include the following: Infectious agents: Epstein-Barr virus: associated with Burkitt's lymphoma, Hodgkin's lymphoma, follicular dendritic cell sarcoma, extranodal NK-T-cell lymphoma Human T-cell leukemia virus: associated with adult T-cell lymphoma Helicobacter pylori: associated with gastric lymphoma HHV-8: associated with primary effusion lymphoma, multicentric Castleman disease Hepatitis C virus: associated with splenic marginal zone lymphoma, lymphoplasmacytic lymphoma and diffuse large B-cell lymphoma HIV infection Some chemicals, like polychlorinated biphenyls (PCBs), diphenylhydantoin, dioxin, and phenoxy herbicides. Medical treatments, like radiation therapy and chemotherapy Genetic diseases, like Klinefelter's syndrome, Chédiak-Higashi syndrome, ataxia telangiectasia syndrome Autoimmune diseases, like Sjögren’s syndrome, celiac sprue, rheumatoid arthritis, and systemic lupus erythematosus.
HIV/AIDS[edit] The Center for Disease Control and Prevention (CDC) included certain types of non-Hodgkin's lymphoma as AIDS-defining cancers in 1987.Immune suppression rather than HIV itself is implicated in the pathogenesis of this malignancy, with a clear correlation between the degree of immune suppression and the risk of developing NHL. Additionally, other retroviruses such as HTLV may be spread by the same mechanisms that spread HIV, leading to an increased rate of co-infection. The natural history of HIV infection has been greatly changed over time. As a consequence, the incidence of non-Hodgkin's lymphoma (NHL) in HIV infected patients has significantly declined in recent years.
Friday, August 12, 2016
Melanoma Cancer
WHAT IS MELANOMA?
The most dangerous form of skin cancer, these cancerous growths develop when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors. These tumors originate in the pigment-producing melanocytes in the basal layer of the epidermis. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease. Melanoma kills an estimated 10,130 people in the US annually. If melanoma is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. In 2016, an estimated 76,380 of these will be invasive melanomas, with about 46,870 in males and 29,510 in women.
BASIC TYPES
The Four Basic Types Melanomas fall into four basic categories. Three of them begin in situ — meaning they occupy only the top layers of the skin — and sometimes become invasive; the fourth is invasive from the start. Invasive melanomas are more serious, as they have penetrated deeper into the skin and may have spread to other areas of the body.
Superficial spreading melanoma is by far the most common type, accounting for about 70 percent of all cases. This is the one most often seen in young people. As the name suggests, this melanoma grows along the top layer of the skin for a fairly long time before penetrating more deeply. The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat asymmetrical in form. The color varies, and you may see areas of tan, brown, black, red, blue or white. This type of melanoma can occur in a previously benign mole. The melanoma can be found almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both.
Lentigo maligna is similar to the superficial spreading type, as it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown or dark brown discoloration. This type of in situ melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms and upper trunk. Lentigo maligna is the most common form of melanoma in Hawaii. When this cancer becomes invasive, it is referred to as lentigo maligna melanoma.
Acral lentiginous melanoma also spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. This type of melanoma is sometimes found on dark-skinned people, and can often advance more quickly than superficial spreading melanoma and lentigo maligna. It is the most common melanoma in African-Americans and Asians, and the least common among Caucasians.
Nodular melanoma is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. It is usually black, but occasionally is blue, gray, white, brown, tan, red or skin tone. The most frequent locations are the trunk, legs, and arms, mainly of elderly people, as well as the scalp in men. This is the most aggressive of the melanomas, and is found in 10 to 15 percent of cases.
Since its inception in 1979, The Skin Cancer Foundation has always recommended using a sunscreen with an SPF 15 or higher as one important part of a complete sun protection regimen. Sunscreen alone is not enough, however. Read our full list of skin cancer prevention tips.
Seek the shade, especially between 10 AM and 4 PM.
Do not burn.
Avoid tanning and never use UV tanning beds.
Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB)sunscreen with an SPF of 30 or higher.
Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months. Examine your skin head-to-toe every month.
See your physician every year for a professional skin exam.
The most dangerous form of skin cancer, these cancerous growths develop when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors. These tumors originate in the pigment-producing melanocytes in the basal layer of the epidermis. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease. Melanoma kills an estimated 10,130 people in the US annually. If melanoma is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. In 2016, an estimated 76,380 of these will be invasive melanomas, with about 46,870 in males and 29,510 in women.
BASIC TYPES
The Four Basic Types Melanomas fall into four basic categories. Three of them begin in situ — meaning they occupy only the top layers of the skin — and sometimes become invasive; the fourth is invasive from the start. Invasive melanomas are more serious, as they have penetrated deeper into the skin and may have spread to other areas of the body.
Superficial spreading melanoma is by far the most common type, accounting for about 70 percent of all cases. This is the one most often seen in young people. As the name suggests, this melanoma grows along the top layer of the skin for a fairly long time before penetrating more deeply. The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat asymmetrical in form. The color varies, and you may see areas of tan, brown, black, red, blue or white. This type of melanoma can occur in a previously benign mole. The melanoma can be found almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both.
Lentigo maligna is similar to the superficial spreading type, as it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown or dark brown discoloration. This type of in situ melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms and upper trunk. Lentigo maligna is the most common form of melanoma in Hawaii. When this cancer becomes invasive, it is referred to as lentigo maligna melanoma.
Acral lentiginous melanoma also spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. This type of melanoma is sometimes found on dark-skinned people, and can often advance more quickly than superficial spreading melanoma and lentigo maligna. It is the most common melanoma in African-Americans and Asians, and the least common among Caucasians.
Nodular melanoma is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. It is usually black, but occasionally is blue, gray, white, brown, tan, red or skin tone. The most frequent locations are the trunk, legs, and arms, mainly of elderly people, as well as the scalp in men. This is the most aggressive of the melanomas, and is found in 10 to 15 percent of cases.
Since its inception in 1979, The Skin Cancer Foundation has always recommended using a sunscreen with an SPF 15 or higher as one important part of a complete sun protection regimen. Sunscreen alone is not enough, however. Read our full list of skin cancer prevention tips.
Seek the shade, especially between 10 AM and 4 PM.
Do not burn.
Avoid tanning and never use UV tanning beds.
Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB)sunscreen with an SPF of 30 or higher.
Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months. Examine your skin head-to-toe every month.
See your physician every year for a professional skin exam.
Thursday, August 11, 2016
Top 10 Surgeons of all time
Some of the most respected people work in the medical field. Surgeons are among those who get a great deal of respect. This is because surgery is demanding and requires specific skills. However, you don’t have to have earned an M.D. to be part of a surgical team. Surgical technicians help prepare the room, and play a vital role as part of the team. But you don’t often hear about them. You are more likely to hear about surgeons — even though surgeons themselves aren’t particularly famous. Here are 10 famous surgeons from history:
1. John Heysham Gibbon: One of the most famous surgeons in history is John Heysham Gibbon. Gibbon was born in 1903 and died in 1973. Gibbon followed in the footsteps of a long line of medical doctors. He was known for the invention of the heart-lung machine, and for being the first to perform open heart surgery. Gibbon served in World War II, as well as being a well-known surgeon.
2.Joseph Lister: One of the biggest advancements in the history of surgery was the introduction of sterility to medicine. While many thought that “bad air” was the cause of infection, Joseph Lister observed that other issues may be at work. He introduced the idea of sterilizing surgical instruments with carbolic acid (which is now referred to as phenol), as well as using antiseptics to clean wounds.
3.Frederic E. Mohs: One of the biggest breakthroughs in cancer research was that made by Frederic E. Mohs. While a medical student at the University of Wisconsin — Madison, Mohs developed the Mohs Micrographic Surgery (MMS) technique. This technique is used to remove skin cancer lesions. The technique pioneered by this famous surgeon is so effective that the cure rate is close to 100% for some conditions. It is a technique still widely in use today in order to help those with skin cancer.
4.Gavril Ilizarov: This surgeon is known for his work with bone growth. Gavril Ilizarov was born in what is now known as Belarus, and grew up in what is now Azerbaijan. He worked in rural hospitals for a good portion of his career. Ilizarov’s specialty was orthopedic surgery, and his research into bone development led him to invent the procedure used to this day to reshape or lengthen the bones in legs or arms.
5.Norman Bethune: Surgeon Norman Bethune was born in Canada, and was well known for his contributions to medical science. Bethune served in the Spanish Civil War, as well as in the Second Sino-Japanese War. His main claim to fame, though, is his development of a mobile blood transfusion process. Bethune was a prominent humanitarian who was against war in general (saying it was motivated by profits), and who was an early proponent of universal health care. One of the reasons for this was his annoyance that those whose lives he saved with surgery often became sick due to squalid living conditions and lack of health care.
6.Lars Laksell: If you have been the beneficiary of a radiosurgery treatment, then you have Lars Laksell to thank for it. Laksell was a professor of surgery, as well as a neurosurgeon. He looked to some of the pioneering work done by other neurosurgeons, and even received some inspiration from an apparatus developed for animal experimentation. After making some adjustments, Leksell developed a stereotactic apparatus meant for human neurosurgery — the first device of its kind. Other neurosurgeons have learned from Laksell, and he is concerned a pioneer in the field.
7.Paul Randall Harrington: One of the most well known orthopedic surgeons out there is Paul Randall Harrington. He was offered a basketball scholarship, and that is what made him decide to go to college. A good thing that he decided to attend school; Harrington invented the Harrington Rod, a device that has helped more than one million people. The Harrington Rod is designed to help straighten the spine and keep it immobilized, helping those with scoliosis. Harrington’s rod was in use from the 1960s all the way until the late 1990s.
8. John Hunter: One of the most famous surgeons is John Hunter. Hunter was a Scottish surgeon who lived between 1728 and 1793. Hunter was well known for his contributions to the development of modern surgery. Hunter went to London to be with his brother, and worked with him at an anatomy school. Hunter was known for bringing the scientific method to the practice of surgery. He determined that observation was necessary to understanding what needed to be done for patients, and how to approach surgery from a scientific standpoint. Hunter was also known for his compassion, and often waived fees for his poorer patients.
9.Sanjay Gupta: While he hasn’t invented any amazing techniques, Sanjay Gupta is probably the most well known surgeon alive. He is a practicing neurosurgeon, as well as being a medical correspondent for CNN. Indeed, he has won an Emmy and contributed to the Peabody honor for CNN during Hurricane Katrina. Rumors are that he was offered the post of Surgeon General when Barack Obama took office (he asked to have his name withdrawn from consideration). He is the author of bestselling books, as well as a columnist and health advocate.
10.John Ronald Brown: A more accurate description of this final surgeon on the list is actually “infamous.” John Ronald Brown was the son of a respected doctor and a gifted child. He served in the Army during World War II and scored well enough on the classification test that the Army sent him to medical school. While he qualified as a general practitioner, Brown didn’t manage to pass his exam to qualify as a surgeon. He passed his written tests, but became too nervous during the oral exams. Brown didn’t let that stop him, though. He soon became the go-to guy for transsexual surgery. Brown performed low cost surgeries in garages and other similar places. Many of his patients were maimed. When his medical license was revoked, Brown went to Mexico to continue his career. As a result of his activities, Brown was finally convicted of second-degree murder when one of his patients died.
1. John Heysham Gibbon: One of the most famous surgeons in history is John Heysham Gibbon. Gibbon was born in 1903 and died in 1973. Gibbon followed in the footsteps of a long line of medical doctors. He was known for the invention of the heart-lung machine, and for being the first to perform open heart surgery. Gibbon served in World War II, as well as being a well-known surgeon.
2.Joseph Lister: One of the biggest advancements in the history of surgery was the introduction of sterility to medicine. While many thought that “bad air” was the cause of infection, Joseph Lister observed that other issues may be at work. He introduced the idea of sterilizing surgical instruments with carbolic acid (which is now referred to as phenol), as well as using antiseptics to clean wounds.
3.Frederic E. Mohs: One of the biggest breakthroughs in cancer research was that made by Frederic E. Mohs. While a medical student at the University of Wisconsin — Madison, Mohs developed the Mohs Micrographic Surgery (MMS) technique. This technique is used to remove skin cancer lesions. The technique pioneered by this famous surgeon is so effective that the cure rate is close to 100% for some conditions. It is a technique still widely in use today in order to help those with skin cancer.
4.Gavril Ilizarov: This surgeon is known for his work with bone growth. Gavril Ilizarov was born in what is now known as Belarus, and grew up in what is now Azerbaijan. He worked in rural hospitals for a good portion of his career. Ilizarov’s specialty was orthopedic surgery, and his research into bone development led him to invent the procedure used to this day to reshape or lengthen the bones in legs or arms.
5.Norman Bethune: Surgeon Norman Bethune was born in Canada, and was well known for his contributions to medical science. Bethune served in the Spanish Civil War, as well as in the Second Sino-Japanese War. His main claim to fame, though, is his development of a mobile blood transfusion process. Bethune was a prominent humanitarian who was against war in general (saying it was motivated by profits), and who was an early proponent of universal health care. One of the reasons for this was his annoyance that those whose lives he saved with surgery often became sick due to squalid living conditions and lack of health care.
6.Lars Laksell: If you have been the beneficiary of a radiosurgery treatment, then you have Lars Laksell to thank for it. Laksell was a professor of surgery, as well as a neurosurgeon. He looked to some of the pioneering work done by other neurosurgeons, and even received some inspiration from an apparatus developed for animal experimentation. After making some adjustments, Leksell developed a stereotactic apparatus meant for human neurosurgery — the first device of its kind. Other neurosurgeons have learned from Laksell, and he is concerned a pioneer in the field.
7.Paul Randall Harrington: One of the most well known orthopedic surgeons out there is Paul Randall Harrington. He was offered a basketball scholarship, and that is what made him decide to go to college. A good thing that he decided to attend school; Harrington invented the Harrington Rod, a device that has helped more than one million people. The Harrington Rod is designed to help straighten the spine and keep it immobilized, helping those with scoliosis. Harrington’s rod was in use from the 1960s all the way until the late 1990s.
8. John Hunter: One of the most famous surgeons is John Hunter. Hunter was a Scottish surgeon who lived between 1728 and 1793. Hunter was well known for his contributions to the development of modern surgery. Hunter went to London to be with his brother, and worked with him at an anatomy school. Hunter was known for bringing the scientific method to the practice of surgery. He determined that observation was necessary to understanding what needed to be done for patients, and how to approach surgery from a scientific standpoint. Hunter was also known for his compassion, and often waived fees for his poorer patients.
9.Sanjay Gupta: While he hasn’t invented any amazing techniques, Sanjay Gupta is probably the most well known surgeon alive. He is a practicing neurosurgeon, as well as being a medical correspondent for CNN. Indeed, he has won an Emmy and contributed to the Peabody honor for CNN during Hurricane Katrina. Rumors are that he was offered the post of Surgeon General when Barack Obama took office (he asked to have his name withdrawn from consideration). He is the author of bestselling books, as well as a columnist and health advocate.
10.John Ronald Brown: A more accurate description of this final surgeon on the list is actually “infamous.” John Ronald Brown was the son of a respected doctor and a gifted child. He served in the Army during World War II and scored well enough on the classification test that the Army sent him to medical school. While he qualified as a general practitioner, Brown didn’t manage to pass his exam to qualify as a surgeon. He passed his written tests, but became too nervous during the oral exams. Brown didn’t let that stop him, though. He soon became the go-to guy for transsexual surgery. Brown performed low cost surgeries in garages and other similar places. Many of his patients were maimed. When his medical license was revoked, Brown went to Mexico to continue his career. As a result of his activities, Brown was finally convicted of second-degree murder when one of his patients died.
Tuesday, August 9, 2016
Leukemia
Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system.
Many types of leukemia exist. Some forms of leukemia are more common in children. Other forms of leukemia occur mostly in adults.
Leukemia usually involves the white blood cells. Your white blood cells are potent infection fighters — they normally grow and divide in an orderly way, as your body needs them. But in people with leukemia, the bone marrow produces abnormal white blood cells, which don't function properly.
Treatment for leukemia can be complex — depending on the type of leukemia and other factors. But there are strategies and resources that can help to make your treatment successful.
Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and symptoms include: Fever or chills Persistent fatigue, weakness Frequent or severe infections Losing weight without trying Swollen lymph nodes, enlarged liver or spleen Easy bleeding or bruising Recurrent nosebleeds Tiny red spots in your skin (petechiae) Excessive sweating, especially at night Bone pain or tenderness.
When to see a doctor?
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you. Leukemia symptoms are often vague and not specific. You may overlook early leukemia symptoms because they may resemble symptoms of the flu and other common illnesses. Rarely, leukemia may be discovered during blood tests for some other condition.
Causes
Scientists don't understand the exact causes of leukemia. It seems to develop from a combination of genetic and environmental factors. How leukemia forms In general, leukemia is thought to occur when some blood cells acquire mutations in their DNA — the instructions inside each cell that guide its action. There may be other changes in the cells that have yet to be fully understood could contribute to leukemia. Certain abnormalities cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia. How leukemia is classified Doctors classify leukemia based on its speed of progression and the type of cells involved. The first type of classification is by how fast the leukemia progresses: Acute leukemia. In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can't carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment. Chronic leukemia. There are many types of chronic leukemias. Some produce too many cells and some cause too few cells to be produced. Chronic leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years. The second type of classification is by type of white blood cell affected: Lymphocytic leukemia. This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system. Myelogenous (my-uh-LOHJ-uh-nus) leukemia. This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells. Types of leukemia The major types of leukemia are: Acute lymphocytic leukemia (ALL). This is the most common type of leukemia in young children. ALL can also occur in adults. Acute myelogenous leukemia (AML). AML is a common type of leukemia. It occurs in children and adults. AML is the most common type of acute leukemia in adults. Chronic lymphocytic leukemia (CLL). With CLL, the most common chronic adult leukemia, you may feel well for years without needing treatment. Chronic myelogenous leukemia (CML). This type of leukemia mainly affects adults. A person with CML may have few or no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly. Other types. Other, rarer types of leukemia exist, including hairy cell leukemia, myelodysplastic syndromes and myeloproliferative disorders.
Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and symptoms include: Fever or chills Persistent fatigue, weakness Frequent or severe infections Losing weight without trying Swollen lymph nodes, enlarged liver or spleen Easy bleeding or bruising Recurrent nosebleeds Tiny red spots in your skin (petechiae) Excessive sweating, especially at night Bone pain or tenderness.
When to see a doctor?
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you. Leukemia symptoms are often vague and not specific. You may overlook early leukemia symptoms because they may resemble symptoms of the flu and other common illnesses. Rarely, leukemia may be discovered during blood tests for some other condition.
Causes
Scientists don't understand the exact causes of leukemia. It seems to develop from a combination of genetic and environmental factors. How leukemia forms In general, leukemia is thought to occur when some blood cells acquire mutations in their DNA — the instructions inside each cell that guide its action. There may be other changes in the cells that have yet to be fully understood could contribute to leukemia. Certain abnormalities cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia. How leukemia is classified Doctors classify leukemia based on its speed of progression and the type of cells involved. The first type of classification is by how fast the leukemia progresses: Acute leukemia. In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can't carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment. Chronic leukemia. There are many types of chronic leukemias. Some produce too many cells and some cause too few cells to be produced. Chronic leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years. The second type of classification is by type of white blood cell affected: Lymphocytic leukemia. This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system. Myelogenous (my-uh-LOHJ-uh-nus) leukemia. This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells. Types of leukemia The major types of leukemia are: Acute lymphocytic leukemia (ALL). This is the most common type of leukemia in young children. ALL can also occur in adults. Acute myelogenous leukemia (AML). AML is a common type of leukemia. It occurs in children and adults. AML is the most common type of acute leukemia in adults. Chronic lymphocytic leukemia (CLL). With CLL, the most common chronic adult leukemia, you may feel well for years without needing treatment. Chronic myelogenous leukemia (CML). This type of leukemia mainly affects adults. A person with CML may have few or no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly. Other types. Other, rarer types of leukemia exist, including hairy cell leukemia, myelodysplastic syndromes and myeloproliferative disorders.
Kidney Cancer
What Is Kidney Cancer?
Kidney cancer -- also called renal cancer -- is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma. The good news is that most of kidney cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected. The kidneys are two bean-shaped organs, each about the size of a fist. They lie in your lower abdomen on each side of your spine. Their main job is to clean your blood, removing waste products and making urine. Doctors don't know the causes of kidney cancer. But certain factors appear to increase the risk of getting kidney cancer. For example, kidney cancer occurs most often in people older than age 40. These are some other risk factors for kidney cancer: Smoking . If you smoke cigarettes, your risk for kidney cancer is twice that of nonsmokers. Smoking cigars may also increase your risk. Being male. Men are about twice as likely as women to get kidney cancer. Being obese. Extra weight may cause changes to hormones that increase your risk. Using certain pain medications for a long time. This includes over-the-counter drugs in addition to prescription drugs. Having advanced kidney disease or being on long-term dialysis, a treatment for people with kidneys that have stopped working Having certain genetic conditions, such as von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma Having a family history of kidney cancer. The risk is especially high in siblings. Being exposed to certain chemicals, such as asbestos, cadmium, benzene, organic solvents, or certain herbicides Having high blood pressure. Doctors don't know whether high blood pressure or medication used to treat it is the source of the increased risk. Being black. The risk in blacks is slightly higher than in whites. No one knows why. Having lymphoma. For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma. Having these risk factors does not mean you will get kidney cancer. And it's also true that you can have none of them and still get the disease.
Symptoms
In many cases, people may have no early symptoms of kidney cancer. As the tumor grows larger, symptoms may appear. You may have one or more of these kidney cancer symptoms: Blood in your urine A lump in your side or abdomen A loss of appetite A pain in your side that doesn't go away Weight loss that occurs for no known reason Fever that lasts for weeks and isn't caused by a cold or other infection Extreme fatigue Anemia Swelling in your ankles or legs Kidney cancer that spreads to other parts of your body may cause other symptoms, such as:
Shortness of breath Coughing up blood Bone pain How Do I Know If I Have Kidney Cancer?
Maybe you've had kidney cancer symptoms such as pain in your side, weight loss, or extreme fatigue. Or maybe your doctor has found a lump in your side during a routine exam or a sign of kidney cancer during a test for another disease. Regardless, to confirm a diagnosis of kidney cancer, you will need a thorough physical exam, health history, and tests. Your doctor will feel your abdomen and side for lumps and check for fever and high blood pressure, among other things. You will also answer questions about your health habits, any past illnesses, and types of treatment. To make a diagnosis of kidney cancer, your doctor will also order one or more tests like these: Urine tests check for blood in your urine or other signs of problems. Blood tests show how well your kidneys are working. Intravenous pyelogram (IVP) involves X-raying your kidneys after the doctor injects a dye that travels to your urinary tract, highlighting any tumors. Ultrasound uses sound waves to create a picture of your kidneys. It can help tell if a tumor is solid or fluid-filled. A CT scan uses X-rays and a computer to create a series of detailed pictures of your kidneys. This may also require an injection of dye. CT scans have virtually replaced pyelogram and ultrasound as a tool for diagnosing kidney cancer. Magnetic resonance imaging (MRI) uses strong magnets and radio waves to create detailed images of soft tissues in your body. You may need an injection of a contrast agent to create better pictures. Renal arteriogram. This test is used to evaluate the blood supply to the tumor. It is not given often, but may help diagnose small tumors. It has other uses, as well.
What Are the Treatments for Kidney Cancer?
Once you have a diagnosis and know your stage of kidney cancer, you and your doctor can plan treatment. You may want to gather information to help you feel more informed about your decision. Your doctor may refer you to a specialist for treatment. This could include an urologist, a medical or radiation oncologist, or a surgeon. Before beginning treatment, many people find it helpful to get a second opinion about the diagnosis of kidney cancer and the treatment plan. Kidney cancer is one of the more common cancers to undergo spontaneous remission. However, the incidence is quite low (approximately 0.5%). There are several standard types of treatment for kidney cancer. In most cases, surgery is the first step. Even if surgery removes the entire tumor, though, your doctor may suggest an extra treatment to kill any remaining cancer cells that can't be seen. Surgery for kidney cancer These are the main types of surgery for kidney cancer. Which type you have depends on how advanced your cancer is. Radical nephrectomy removes the kidney, adrenal gland, and surrounding tissue. It also often removes nearby lymph nodes. It is the most common surgery for kidney cancer and can now be done through a small incision with a laparoscope. Simple nephrectomy removes the kidney only. Partial nephrectomy removes the cancer in the kidney along with some tissue around it. This procedure is used for patients with smaller tumors (less than 4 cm) or in those patients in which a radical nephrectomy might hurt the other kidney. You can survive with just a part of one kidney as long as it is still working. If the surgeon removes both kidneys or if both kidneys are not working, you will need a machine to clean your blood (dialysis) or a new kidney (kidney transplant). A transplant is possible if your cancer was found only in your kidney and a donated kidney is available. If surgery can't remove your kidney cancer, your doctor may suggest another option to help destroy the tumor. Cryotherapy uses extreme cold to kill the tumor. Radiofrequency ablation uses high-energy radio waves to "cook" the tumor. Arterial embolization involves inserting material into an artery that leads to the kidney. This blocks blood flow to the tumor. This procedure may be done to help shrink the tumor before surgery
Kidney cancer -- also called renal cancer -- is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma. The good news is that most of kidney cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected. The kidneys are two bean-shaped organs, each about the size of a fist. They lie in your lower abdomen on each side of your spine. Their main job is to clean your blood, removing waste products and making urine. Doctors don't know the causes of kidney cancer. But certain factors appear to increase the risk of getting kidney cancer. For example, kidney cancer occurs most often in people older than age 40. These are some other risk factors for kidney cancer: Smoking . If you smoke cigarettes, your risk for kidney cancer is twice that of nonsmokers. Smoking cigars may also increase your risk. Being male. Men are about twice as likely as women to get kidney cancer. Being obese. Extra weight may cause changes to hormones that increase your risk. Using certain pain medications for a long time. This includes over-the-counter drugs in addition to prescription drugs. Having advanced kidney disease or being on long-term dialysis, a treatment for people with kidneys that have stopped working Having certain genetic conditions, such as von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma Having a family history of kidney cancer. The risk is especially high in siblings. Being exposed to certain chemicals, such as asbestos, cadmium, benzene, organic solvents, or certain herbicides Having high blood pressure. Doctors don't know whether high blood pressure or medication used to treat it is the source of the increased risk. Being black. The risk in blacks is slightly higher than in whites. No one knows why. Having lymphoma. For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma. Having these risk factors does not mean you will get kidney cancer. And it's also true that you can have none of them and still get the disease.
Symptoms
In many cases, people may have no early symptoms of kidney cancer. As the tumor grows larger, symptoms may appear. You may have one or more of these kidney cancer symptoms: Blood in your urine A lump in your side or abdomen A loss of appetite A pain in your side that doesn't go away Weight loss that occurs for no known reason Fever that lasts for weeks and isn't caused by a cold or other infection Extreme fatigue Anemia Swelling in your ankles or legs Kidney cancer that spreads to other parts of your body may cause other symptoms, such as:
Shortness of breath Coughing up blood Bone pain How Do I Know If I Have Kidney Cancer?
Maybe you've had kidney cancer symptoms such as pain in your side, weight loss, or extreme fatigue. Or maybe your doctor has found a lump in your side during a routine exam or a sign of kidney cancer during a test for another disease. Regardless, to confirm a diagnosis of kidney cancer, you will need a thorough physical exam, health history, and tests. Your doctor will feel your abdomen and side for lumps and check for fever and high blood pressure, among other things. You will also answer questions about your health habits, any past illnesses, and types of treatment. To make a diagnosis of kidney cancer, your doctor will also order one or more tests like these: Urine tests check for blood in your urine or other signs of problems. Blood tests show how well your kidneys are working. Intravenous pyelogram (IVP) involves X-raying your kidneys after the doctor injects a dye that travels to your urinary tract, highlighting any tumors. Ultrasound uses sound waves to create a picture of your kidneys. It can help tell if a tumor is solid or fluid-filled. A CT scan uses X-rays and a computer to create a series of detailed pictures of your kidneys. This may also require an injection of dye. CT scans have virtually replaced pyelogram and ultrasound as a tool for diagnosing kidney cancer. Magnetic resonance imaging (MRI) uses strong magnets and radio waves to create detailed images of soft tissues in your body. You may need an injection of a contrast agent to create better pictures. Renal arteriogram. This test is used to evaluate the blood supply to the tumor. It is not given often, but may help diagnose small tumors. It has other uses, as well.
What Are the Treatments for Kidney Cancer?
Once you have a diagnosis and know your stage of kidney cancer, you and your doctor can plan treatment. You may want to gather information to help you feel more informed about your decision. Your doctor may refer you to a specialist for treatment. This could include an urologist, a medical or radiation oncologist, or a surgeon. Before beginning treatment, many people find it helpful to get a second opinion about the diagnosis of kidney cancer and the treatment plan. Kidney cancer is one of the more common cancers to undergo spontaneous remission. However, the incidence is quite low (approximately 0.5%). There are several standard types of treatment for kidney cancer. In most cases, surgery is the first step. Even if surgery removes the entire tumor, though, your doctor may suggest an extra treatment to kill any remaining cancer cells that can't be seen. Surgery for kidney cancer These are the main types of surgery for kidney cancer. Which type you have depends on how advanced your cancer is. Radical nephrectomy removes the kidney, adrenal gland, and surrounding tissue. It also often removes nearby lymph nodes. It is the most common surgery for kidney cancer and can now be done through a small incision with a laparoscope. Simple nephrectomy removes the kidney only. Partial nephrectomy removes the cancer in the kidney along with some tissue around it. This procedure is used for patients with smaller tumors (less than 4 cm) or in those patients in which a radical nephrectomy might hurt the other kidney. You can survive with just a part of one kidney as long as it is still working. If the surgeon removes both kidneys or if both kidneys are not working, you will need a machine to clean your blood (dialysis) or a new kidney (kidney transplant). A transplant is possible if your cancer was found only in your kidney and a donated kidney is available. If surgery can't remove your kidney cancer, your doctor may suggest another option to help destroy the tumor. Cryotherapy uses extreme cold to kill the tumor. Radiofrequency ablation uses high-energy radio waves to "cook" the tumor. Arterial embolization involves inserting material into an artery that leads to the kidney. This blocks blood flow to the tumor. This procedure may be done to help shrink the tumor before surgery
Sunday, August 7, 2016
Endometrial Cancer
Endometrial cancer
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Endometrial cancer is
cancer that starts in the endometrium, the lining of the uterus (womb).
Causes
Endometrial cancer is
the most common type of uterine cancer. The exact cause of endometrial cancer
is unknown. An increased level of estrogen may play a role. Estrogen helps
stimulate the buildup of the lining of the uterus. This can lead to overgrowth
of the endometrium and cancer.
Most cases of
endometrial cancer occur between the ages of 60 and 70. A few cases may occur
before age 40.
The following factors
related to your hormones increase your risk of endometrial cancer:
Estrogen replacement
therapy without the use of progesterone
History of
endometrial polyps
Infrequent periods
Never being pregnant
Obesity
Polycystic ovary
syndrome (PCOS)
Starting menstruation
at an early age (before age 12)
Starting menopause
after age 50
Tamoxifen, a drug
used for breast cancer treatment
Women with the
following conditions also seem to be at a higher risk of endometrial cancer:
Colon or breast
cancer
Diabetes
Gallbladder disease
High blood pressure
Symptoms
Symptoms of
endometrial cancer include:
Abnormal bleeding
from the vagina, including bleeding between periods or spotting/bleeding after
menopause
Extremely long,
heavy, or frequent episodes of vaginal bleeding after age 40
Lower abdominal pain
or pelvic cramping
Thin white or clear
vaginal discharge after menopause
Exams and Tests
During the early
stages of disease, a pelvic exam is often normal. As the cancer becomes more
advanced, there may be changes in the size, shape, or feel of the uterus or
surrounding structures.
Tests that may be
done include:
Endometrial biopsy
Dilation and
curettage (D and C)
Pap smear (may raise
a suspicion for endometrial cancer, but does not diagnose it)
If cancer is found,
imaging tests may be done to see if the cancer has spread to other parts of the
body. This is called staging.
Stages of endometrial
cancer are:
Stage 1: The cancer
is only in the uterus.
Stage 2: The cancer
is in the uterus and cervix.
Stage 3: The cancer
has spread outside of the uterus, but not beyond the true pelvis area. Cancer
may involve the lymph nodes in the pelvis or near the aorta (the major artery
in the abdomen).
Stage 4: The cancer
has spread to the inner surface of the bowel, bladder, abdomen, or other
organs.
Cancer is also
described as grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is
the most aggressive. Aggressive means that the cancer grows and spreads
quickly.
Treatment
Treatment options
include surgery, radiation therapy, and chemotherapy.
Surgery to remove the
uterus (hysterectomy) may be done in women with early stage 1 cancer. The
doctor may also recommend removing the tubes and ovaries.
Surgery combined with
radiation therapy is another treatment option. It is often used for women with
Stage 1 disease that
has a high chance of returning, has spread to the lymph nodes, or is a grade 2
or 3.
Stage 2 disease.
Chemotherapy or
hormonal therapy may be considered in some cases, most often for those with
stage 3 and 4 disease.
Colorectal Cancer
Colorectal cancer,
also known as bowel cancer, colon cancer or rectal cancer, is any cancer (a
growth, lump, tumor) of the colon and the rectum. The World Health Organization
and CDC say it is the second most common cancer worldwide, after lung cancer.
The American Cancer
Society suggests that about 1 in 20 people in the US will develop colorectal
cancer during their lifetime, with the risk being slightly higher for men than
for women. Due to advances in screening techniques and improvements in treatments,
the death rate from colorectal cancer has been dropping for over 20 years.
A colorectal cancer
may be benign or malignant. Benign means the tumor will not spread, while a
malignant tumor consists of cells that can spread to other parts of the body
and damage them.
The colon and rectum
The colon reabsorbs
large quantities of water and nutrients from undigested food products as they
pass along it.The colon and rectum belong to our body's digestive system -
together they are also known as the large bowel.
The rectum is at the
end of the colon and stores feces (stools, waste material) before being
expelled from the body.
Symptoms of
colorectal cancer
Going to the toilet
more often.
Diarrhea.
Constipation.
A feeling that the
bowel does not empty properly after a bowel movement.
Blood in feces
(stools).
Pains in the abdomen.
Bloating in the
abdomen.
A feeling of fullness
in the abdomen (maybe even after not eating for a while).
Vomiting.
Fatigue (tiredness).
Inexplicable weight
loss.
A lump in the tummy
or a lump in the back passage felt by your doctor.
Unexplained iron
deficiency in men, or in women after the menopause.
As most of these
symptoms may also indicate other possible conditions, it is important that the
patient sees a doctor for a proper diagnosis. Anybody who experiences some of
these symptoms for four weeks should see their doctor.
Causes of colorectal
cancer
Experts say we are
not completely sure why colorectal cancer develops in some people and not in
others. However, several risk factors have been identified over the years - a
risk factor is something which may increase a person's chances of developing a
disease or condition.
The possible risk
factors for colorectal factors are:
Being elderly - the
older you are the higher the risk is.
A diet that is very
high in animal protein.
A diet that is very
high in saturated fats.
A diet that is very
low in dietary fiber.
A diet that is very
high in calories.
A diet that is very
high in alcohol consumption.
Women who have had
breast, ovary and uterus cancers.
A family history of
colorectal cancer.
Patients with
ulcerative colitis.
Being
overweight/obese.
Smoking. This study
found that smoking is significantly associated with an increased risk for
colorectal cancer and death.
Being physically
inactive.
Presence of polyps in
the colon/rectum. Untreated polyps may eventually become cancerous.
Having Crohn's
disease or Irritable Bowel Disease have a higher risk of developing colorectal
cancer.
Most colon cancers
develop within polyps (adenoma). These are often found inside the bowel wall.
Saturday, August 6, 2016
Bladder Cancer
Bladder cancer is a
type of cancer that begins in your bladder — a balloon-shaped organ in your
pelvic area that stores urine.
Bladder cancer begins
most often in the cells that line the inside of the bladder. Bladder cancer
typically affects older adults, though it can occur at any age.
The great majority of
bladder cancers are diagnosed at an early stage — when bladder cancer is highly
treatable. However, even early-stage bladder cancer is likely to recur. For
this reason, bladder cancer survivors often undergo follow-up tests for years
after treatment to look for bladder cancer recurrence.
Symptoms
Bladder cancer signs
and symptoms may include:
Blood in urine
(hematuria) — urine may appear bright red or cola colored. Or urine may appear
normal, but blood may be detected in a microscopic examination of the urine.
Frequent urination.
Painful urination.
Back pain.
Pelvic pain.
When to see a doctor
Make an appointment
with your doctor if you have any signs or symptoms that worry you, such as
blood in your urine.
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