What is Dementia? What Causes Dementia? Symptoms of Dementia

The word dementia comes from the Latin de meaning "apart" and mens from the genitive mentis meaning "mind". Dementia is the progressive deterioration in cognitive function - the ability to process thought (intelligence).

Progressive means the symptoms will gradually get worse. The deterioration is more than might be expected from normal aging and is due to damage or disease. Damage could be due to a stroke, while an example of a disease might be Alzheimer's.

Dementia is a set of signs and symptoms

Dementia is a non-specific syndrome in which affected areas of brain function may be affected, such as memory, language, problem solving and attention. Dementia, unlike Alzheimer's, is not a disease in itself. When dementia appears the higher mental functions of the patient are involved initially. Eventually, in the later stages, the person may not know what day of the week, month or year it is, he may not know where he is, and might not be able to identify the people around him.

Dementia is significantly more common among elderly people. However, it can affect adults of any age.

What are the symptoms of dementia?

• Memory loss - the patient may forget his way back home from the shops. He may forget names and places. He may find it hard to remember what happened earlier on during the day.


• Moodiness - the patient may become more and more moody as parts of the brain that control emotion become damaged. Moods may also be affected by fear and anxiety - the patient is frightened about what is happening to him.


• Communicative difficulties - the affected person finds it harder to talk read and/or write.

As the dementia progresses, the patient's ability to carry out everyday tasks diminishes and he may not be able to look after himself.

Diseases that cause dementia

• Alzheimer's disease - This is by far the most common cause of dementia. The chemistry and structure of the brain of a person with Alzheimer's disease changes and his brain cells die prematurely.


• Stroke (Vascular problems) - this means problems with blood vessels (veins and arteries). Our brain needs a good supply of oxygen-rich blood. If this supply is undermined in any way our brain cells could die - causing symptoms of vascular dementia. Symptoms may appear suddenly, or gradually. A major stroke will cause symptoms to appear suddenly while a series of mini strokes will not.


• Dementia with Lewy bodies - spherical structures develop inside nerve cells. Brain cells are nerve cells; they form part of our nervous system. These spherical structures in the brain damage brain tissue. The patient's memory, concentration and ability to speak are affected. Dementia with Lewy bodies is sometimes mistaken for Parkinson's disease because the symptoms are fairly similar.


• Fronto-temporal dementia - this includes Pick's disease. The front part of the brain is damaged. The patient's behavior and personality are affected first, later his memory changes.


• Other diseases - progressive supranuclear palsy, Korsakoff's syndrome, Binswanger's disease, HIV and AIDS, and Creutzfeldt-Jakob disease (CJD). Dementia is also more common among patients who suffer from Parkinson's disease, Huntington's disease, Motor Neurone disease and Multiple Sclerosis. People who suffer from AIDS sometimes go on to develop cognitive impairment.

There are two main categories of dementia

According to most experts, there are two main categories of dementia - cortical and subcortical dementias.

• Cortical Dementia - The cerebral cortex is affected. This is the outer layer of the brain. The cerebral cortex is vital for cognitive processes, such as language and memory. Alzheimer's disease is a form of cortical dementia, as is CJD (Creutzfeldt-Jakob disease).


• Subcortical Dementia - A part of the brain beneath the cortex (deeper inside) becomes affected or damaged. Language and memory are not usually affected. A patient with subcortical dementia will usually experience changes in his personality, his thinking may slow down, and his attention span may be shortened. Dementias which sometimes result from Parkinson's disease are subcortical dementias, as are those caused by AIDS and Huntington's disease.

A patient with multi-infarct dementia will have both the cortical and subcortical parts of the brain affected or damaged.

Diagnosis of dementia

Although there are some brief tests, a more reliable diagnosis needs to be carried out by a specialist, such as a geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist.

The following tests are commonly used:

• AMTS (Abbreviated Mental Test Score) A score lower than six out of ten suggests a need for further evaluation.
• MMSE (Mini Mental State Examination) A score lower than twenty-four out of thirty suggests a need for further evaluation)
• 3MS (Modified Mini-Mental State Examination)
• CASI (Cognitive Abilities Screening Instrument)

It is important that the patient's score is interpreted in context with his socio-economic, educational and cultural background. The tester must also factor in the patient's present physical and mental state - does the patient suffer from depression, is he in great pain?

What is the treatment for dementia?

In the majority of cases dementia is incurable. Researchers are making inroads into treatments that may slow down dementia's progress. Cholinestaerase inhibitors are frequently administered during the early stages. Cognitive and behavioral therapies may also be useful. Several studies have found that music therapy helps patients with dementia. It is important to remember that the patient's caregiver also needs training and emotional support.

In the USA, Tacrine (Cognex), donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) have been approved for the treatment of dementia caused by Alzheimer's disease - some physicians prescribe these drugs for vascular dementia as well. Selegiline, which is used for treating Parkinson's disease, has been found to slow down the progress of dementia.

In Canada, a country where two languages are spoken, English and French, researchers found that bilingual people who develop dementia do so four years later than monolingual people who develop dementia. The four year difference prevails even after factoring for such variables as cultural differences, education, employment, gender and immigration.

How common is dementia?

• United Kingdom - According to a report by the Alzheimer's Society (UK), approximately 700,000 people in the United Kingdom have dementia, out of a total population of about 61 million. Your chances of having dementia are 1 in 100 during your late 60s, this rises to 6 in 100 in your late 70s, and 20 in 100 in your late 80s. As people live longer experts predict dementia will rise significantly. According to predictions, there will be 940,000 people with dementia in the United Kingdom by 2021.


• Worldwide - According to a study published in The Lancet, approximately 24.3 million people had dementia worldwide in 2005, with 4.6 million new cases every year. The number of people with dementia will double every two decades and reach 81.1 million by 2040. The rate of increase is expected to be faster in developing countries which have rapidly-growing life expectancies. (Lancet. 2005 Dec 17;366(9503):2112-7)

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What are Hemroids? What are Hemorrhoids?

Hemroids (or hemorrhoids) are also known as piles. Although they can be extremely unpleasant and painful for many people, they can be easily treated and often prevented. As hemorrhoids generally get worse as time goes by, health care professionals say they should be treated as soon as they appear.

At least four-fifths of adults in Europe and North America will experience hemorrhoids at some point in their lives. Doctors say a large number of people who go and have a checkup are found to have hemorrhoids.

The older you are the more likely you are to suffer from hemorrhoids. This does not mean, however, that young people and children do not get them. Hemorrhoids are much more common among men than women. A woman is most likely to get them when she is pregnant.

What are hemroids / hemorrhoids?

When the veins around the anus or in the rectum are swollen or inflamed the patient has hemorrhoids. They can occur for the following reasons:

• pregnancy
• aging
• chronic diarrhea
• chronic constipation
• straining to move stool (related to the previous one)
• sitting for long periods (especially sitting for long periods at a time in the toilet)
• anal intercourse
• obesity
• genetics - some people inherit a tendency to develop hemorrhoids

Hemorrhoids can occur both inside and above the inside of the anus. They can also appear externally, under the skin of the anus.

Symptoms of hemorrhoids

• bleeding, usually painless. The patient may notice red on the toilet paper or in the toilet bowl.
• itching and/or irritation in the anal area
• discomfort and pain in the anal region
• lumps protruding from the anal region
• swelling in the anal region
• a lump near your anus, this can sometimes be sensitive (painful)
• feces may leak (without your wanting it to happen)

Internal hemorrhoids, which lie inside the rectum, usually have no symptoms; the patient is not aware of them as they do not generally cause any discomfort. However, straining when passing a stool may cause them to bleed. Straining can also push an internal hemorrhoid so that it protrudes through the anus this is called a protruding or prolapsed hemorrhoid and can be painful.

When a patient has external hemorrhoids they will lie under the skin around the anus. They can become very itchy and may bleed. Sometimes the blood may accumulate and form a thrombus (clot), which can be painful the area will swell and become inflamed.

When should I see my doctor?

If you experience any of the symptoms related to hemorrhoids it would be advisable to contact your doctor. Bear in mind that rectal bleeding can be caused by other things, including colorectal and anal cancers. It might be a mistake to assume that anal bleeding is simply the result of hemorrhoids and, because of this, decide not to see a doctor.

Your doctor can carry out a physical examination and perform other tests to determine whether or not you have hemorrhoids. If your hemorrhoids do not improve, even after using home remedies, you should see your doctor.

If your symptoms started with a significant alteration in bowel habits, or if your stools are very dark or even black, if there are blood clots or blood mixed in with the stools, you should see a doctor immediately so that they can determine whether your bleeding is taking place in another part of your digestive tract.

If your symptoms include large amounts of bleeding, dizziness and a sensation that you are going to faint you should immediately seek emergency care.

Hemorrhoids - four surgical classifications

1. First degree hemorrhoids. These bleed but do not protrude outside the anus.


2. Second degree hemorrhoids. These protrude (prolapsed) outside the anal canal when the patient is passing a stool, and then draw back immediately.


3. Third degree hemorrhoids. These need to be manually placed back inside the anal canal after protruding (prolapsing).


4. Fourth degree hemorrhoids. The protruding (prolapsing) hemorrhoids cannot be manually replaced. The tissue is thrombosed or strangulated.

Treatment for hemorrhoids

In the majority of cases the patient can take some simple measures which will alleviate symptoms while the problem gets better on its own. However, medicines and even surgery may sometimes be needed.

Medicines

Most hemorrhoid medicines are OTC (over-the-counter); this means you do not need a doctor's prescription to get them. They include ointments, pads or suppositories. Such active ingredients as hydrocortisone and witch hazel are known to relieve itching and pain. These medicines should not be used for more than about seven days (unless your doctor has told you otherwise).

Simple incisions

Your doctor may carry out a simple incision if a clot has formed around an external hemorrhoid. These incisions are usually effective. More continuous bleeding may require rubber band ligation, sclerotherapy (injection) or coagulation.

Surgery to treat hemorrhoids

Surgery is recommended if the patient has not benefited from the simple procedures, or if the hemorrhoids are very large. In some cases the patient may go home straight after the procedure, while in others they may have to be hospitalized. Surgery may involve hemorrhoidectomy or stapling.

What you can do on your own

There are things you can do to relieve the symptoms. Bear in mind that they will not eliminate the hemorrhoids.

• Topical creams and ointments. You can apply an OTC cream or suppository which contains hydrocortisone. There are also pads which contain witch hazel, or a topical numbing agent.


• Bathing the affected area. Bathe gently with warm water. Do not use soap if you think it will make the problem worse. Dry the area gently with a hair drier after bathing.


• Ice packs and cold compresses. If you apply these to the affected area it may help with the swelling.


• Sitz bath. Use warm water. The sitz bath is placed over the toilet. Some pharmacies sell them.


• Use moist towelletes. Dry toilet paper may aggravate the problem.


• Analgesics. Some painkillers, such as aspirin, ibuprofen and paracetamols (Tylenol) may alleviate the pain and discomfort.

How can I prevent hemorrhoids from appearing in the first place?

If your stools are always soft your chances of developing hemorrhoids are greatly reduced.

Nutrition. If you eat lots of fruits and vegetables, as well as whole grains, your stools will nearly always be soft. If you drink plenty of fluids your stools are more likely to be soft (this does not include alcohol).

Straining. When you go to the toilet try not to strain or hold your breath, as this creates pressure in the veins in the lower rectum.

Go when you need to. If you have the urge to go to the toilet, go. Do not wait. The longer you wait, the drier the stools will be.

Be physically active. Physical inactivity, sitting or standing still for long periods puts pressure on the veins.

Keep your bodyweight down. Obesity an overweight significantly raise a person's risk of having hemorrhoids.

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What is MRSA? Why is MRSA a Concern? How is MRSA Treated?

MRSA stands for methicillin-resistant Staphylococcus aureus. The term is used to describe a number of strains of the bacteria, Staphylococcus aureus, that are resistant to a number of antibiotics, including methicillin.

What is Staphylococcus aureus?

Staphylococcus aureus is a group of bacteria that live on the surface of people's skin and inside the nose. It is normally harmless: most people who are carrying it are totally unaware that they have it. In fact, it is thought that up to 30% of the general UK population carries these bacteria in their nose or on their skin.

This group of bacteria can be spread quite easily from person to person through contact.

Why is MRSA a concern?

Problems occur if Staphyloccocus aureus bacteria are able to enter the body through a cut or wound.

Most healthy people have strong immune systems and are able to fight off a Staphylococcus aureus infection themselves and have only mild symptoms. However, people with weakened immune systems (for example due to other illnesses) or who have undergone sugery (for example heart surgery or hip replacement) can develop more serious problems. In more vulnerable people, Staphyloccocus aureus bacteria have been known to cause boils, abscesses, impetigo, septic wounds, heart-valve problems and toxic shock syndrome. In extreme cases, it can result in death.

People with weakened immune systems who have been infected with Staphylococcus aureus require treatment with antibiotics to help clear the infection. The concern with MRSA strains of bacteria is that they are resistant to a number of the antibiotics that are normally used to treat Staphylococcus aureus infections.

How is MRSA treated?

Because MRSA is resistant to a number of different antibiotics, it is harder to treat than non-resistant bacteria. However, MRSA is not resistant to every antibiotic and most strains of MRSA can still be treated with vancomycin, teicoplanin and mupirocin.

For people with weakened immune systems who have become infected with MRSA, the best treatments are with the antibiotics vancomycin or teicoplanin. These two antibiotics are given as injections or through an intravenous drip and so are only given to people in hospital.

Certain groups of people are at a higher risk of infection with MRSA. For this reason, some healthy people are screened for MRSA by having a swab of their skin or inside of their nose taken. If these healthy people are found to be carrying MRSA on their skin or in their noses, they are normally treated with an antibiotic cream - mupirocin. This is applied to the affected areas of the body. This is done to reduce the chance of the bacteria entering the body through an open wound and the chance of other people catching MRSA.

Where does MRSA come from?

MRSA has appeared for three reasons: the widespread use of antibiotics, genetic selection and our dislike of tablets.

Bacteria are constantly evolving because their genes are constantly changing. The result of this is that some of the bacteria will have more resistance to a certain antibiotic than others. So, when the weaker bacteria encounter that antibiotic, they are killed. But the more resistant ones will take longer to die. If these more resistant bacteria are not killed off, they will survive and multiply. Their "offspring" will have this resistance to the antibiotic and further changes to their genes will mean that some will be even more resistant to the antibiotic.

Over time this combination of bacterial genetic change and our dislike of taking tablets has resulted in strains of Staphylococcus aureus that are resistant to many of today's antibiotics. Normally these strains are resistant to just one or two antibiotics but, as in the case of MRSA, they can be resistant to more.

This is why doctors encourage us to finish the whole course of antibiotics when we are prescribed them. The antibiotic will rapidly kill off the weaker bacteria and we will start to feel better.

Many doctors believe that if we stop taking the antibiotic at this point, the stronger bacteria will survive and could produce more drug-resistant "offspring". If the next person who is infected also fails to finish the whole course of the antibiotic, then even more resistant bacteria will result. For this reason, it is thought that this can all be avoided if we take the whole course of antibiotics in the first place: by taking all the tablets, all the bacteria (including the more resistant ones) should be killed off and no offspring can be produced.

Why is MRSA particularly important in hospitals?

MRSA is particularly important in hospitals for three reasons:

• hospitals contain a large number of people with weakened immune systems who could become infected with MRSA and develop unwanted symptoms


• many of the patients in a hospital have an intravenous drip or a catheter that creates a "wound" through which MRSA can enter the body


• in some hospitals, people are in close proximity to each other, which increases the chances of MRSA infecting patients. However, in others patients stay in separate rooms which helps to lower this risk


• hospitals offer many opportunities for Staphylococcus aureus bacteria to encounter a wide range of antibiotics and, through genetic change and survival, develop resistance to all of them.

What can be done to protect people?

If a person is suspected of being infected with MRSA, a swab of the infected wound or a sample of blood or urine is taken. Any bacteria in the sample are grown in a laboratory and then identified. The results can take several days as it takes this long for the bacteria to grow.

If a healthy person is found to be carrying MRSA, they are normally treated with an antibiotic cream - mupirocin. This is applied to the affected areas of the body. This is done to reduce the chance of other people catching MRSA.

If a person with a weakened immune system is infected with MRSA, they are treated with either vancomycin or teicoplanin. At the moment, very few strains of MRSA are resistant to either of these two antibiotics. These two antibiotics are given as injections or through an intravenous drip and so are only given to people in hospital.

In hospital, to prevent other patients becoming infected, people with MRSA are treated using "barrier nursing" techniques. This form of nursing means that the person may be placed in a separate room and they will be treated by doctors and nurses who will be wearing disposable gloves and aprons. To prevent other people from becoming infected with MRSA, the gloves and aprons will be disposed of and hands will be washed before the healthcare professionals treat another patient. It is worth mentioning that such measures are often used in hospitals and the use of gloves or aprons does not automatically mean that a person has MRSA.

What can be done to keep antibiotic resistance under control?

In the wider world, there is now concern that antibiotic resistance could continue to develop to the point where some bacteria are resistant to all antibiotics. To stop this from happening, the medical profession has taken a number of steps:

1. Reducing its levels of antibiotic prescribing by no longer prescribing antibiotics for viral infections. For example, many coughs and colds are caused by viruses and antibiotics will have no effect whatsoever. In the past, antibiotics were prescribed to help prevent co-infection with bacteria, however this only served to increase antibiotic resistance and has been stopped.


2. Encouraging patients to finish their whole course of antibiotics, regardless of whether they feel better earlier or not. This measure is particularly important in preventing resistant bacteria from surviving and multiplying.


3. Using infection control measures in hospitals, including handwashing between patients, to minimise the chances of bacteria being passed from one patient to another.

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What Is Leukemia? What Causes Leukemia?

The word Leukemia comes from the Greek leukos which means "white" and aima which means "blood". It is cancer of the blood or bone marrow (which produces blood cells). A person who has leukemia suffers from an abnormal production of blood cells, generally leukocytes (white blood cells).

The DNA of immature blood cells, mainly white cells, becomes damaged in some way. This abnormality causes the blood cells to grow and divide chaotically. Normal blood cells die after a while and are replaced by new cells which are produced in the bone marrow. The abnormal blood cells do not die so easily, and accumulate, occupying more and more space. As more and more space is occupied by these faulty blood cells there is less and less space for the normal cells - and the sufferer becomes ill. Quite simply, the bad cells crowd out the good cells in the blood.

In order to better understand what goes on we need to have a look at what the bone marrow does.

Function of the bone marrow

The bone marrow is found in the inside of bones. The marrow in the large bones of adults produces blood cells. Approximately 4% of our total bodyweight consists of bone marrow.

There are two types of bone marrow: 1. Red marrow, made up mainly of myeloid tissue. 2. Yellow marrow, made up mostly of fat cells. Red marrow can be found in the flat bones, such as the breast bone, skull, vertebrae, shoulder blades, hip bone and ribs. Red marrow can also be found at the ends of long bones, such as the humerus and femur.

White blood cells (lymphocytes), red blood cells and platelets are produced in the red marrow. Red blood cells carry oxygen, white blood cells fight diseases. Platelets are essential for blood clotting. Yellow marrow can be found in the inside of the middle section of long bones.

If a person loses a lot of blood the body can convert yellow marrow to red marrow in order to raise blood cell production.

White blood cells, red blood cells and platelets exist in plasma - Blood plasma is the liquid component of blood, in which the blood cells are suspended.

Types of leukemia

Chronic and Acute

Experts divide leukemia into four large groups, each of which can be Acute, which is a rapidly progressing disease that results in the accumulation of immature, useless cells in the marrow and blood, or Chronic, which progresses more slowly and allows more mature, useful cells to be made. In other words, acute leukemia crowds out the good cells more quickly than chronic leukemia.

Lymphocytic and Myelogenous

Leukemias are also subdivided into the type of affected blood cell. If the cancerous transformation occurs in the type of marrow that makes lymphocytes, the disease is called lymphocytic leukemia. A lymphocyte is a kind of white blood cell inside your vertebrae immune system. If the cancerous change occurs in the type of marrow cells that go on to produce red blood cells, other types of white cells, and platelets, the disease is called myelogenous leukemia.

To recap, there are two groups of two groups - four main types of leukemia, as you can see in the illustration below:



Acute Lymphocytic Leukemia (ALL), also known as Acute Lymphoblastic Leukemia - This is the most common type of leukemia among young children, although adults can get it as well, especially those over the age of 65. Survival rates of at least five years range from 85% among children and 50% among adults. The following are all subtypes of this leukemia: precursor B acute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia.

Chronic Lymphocytic Leukemia (CLL) - This is most common among adults over 55, although younger adults can get it as well. CLL hardly ever affects children. The majority of patients with CLL are men, over 60%. 75% of treated CLL patients survive for over five years. Experts say CLL is incurable. A more aggressive form of CLL is B-cell prolymphocytic leukemia.

Acute Myelogenous Leukemia (AML) - AML is more common among adults than children, and affects males significantly more often than females. Patients are treated with chemotherapy. 40% of treated patients survive for over 5 years. The following are subtypes of AMS - acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.

Chronic Myelogenous Leukemia (CML) - The vast majority of patients are adults. 90% of treated patients survive for over 5 years. Gleevec (imatinib) is commonly used to treat CML, as well as some other drugs. Chronic monocytic leukemia is a subtype of CML.

Symptoms of leukemia

• Blood clotting is poor - As immature white blood cells crowd out blood platelets, which are crucial for blood clotting, the patient may bruise or bleed easily and heal slowly - he may also develop petechiae (a small red to purple spot on the body, caused by a minor hemorrhage).


• Affected immune system - The patient's white blood cells, which are crucial for fighting off infection, may be suppressed or not working properly. The patient may experience frequent infections, or his immune system may attack other good body cells.


• Anemia - As the shortage of good red blood cells grows the patient may suffer from anemia - this may lead to difficult or labored respiration (dyspnea) and pallor (skin has a pale color caused by illness).


• Other symptoms - Patients may also experience nausea, fever, chills, night sweats, flu-like symptoms, and tiredness. If the liver or spleen becomes enlarged the patient may feel full and will eat less, resulting in weight loss. Headache is more common among patients whose cancerous cells have invaded the CNS (central nervous system).


• Precaution - As all these symptoms could be due to other illnesses. A diagnosis of leukemia can only be confirmed after medical tests are carried out.

What causes leukemia?

Experts say that different leukemias have different causes. The following are either known causes, or strongly suspected causes:

• Artificial ionizing radiation
• Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus)
• Benzene and some petrochemicals
• Alkylating chemotherapy agents used in previous cancers
• Maternal fetal transmission (rare)
• Hair dyes
• Genetic predisposition - some studies researching family history and looking at twins have indicated that some people have a higher risk of developing leukemia because of a single gene or multiple genes.
• Down syndrome - people with Down syndrome have a significantly higher risk of developing leukemia, compared to people who do not have Down syndrome. Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk.
• Electromagnetic energy - studies indicate there is not enough evidence to show that ELF magnetic (not electric) fields that exist currently might cause leukemia. The IARC (International Agency for Research on Cancer) says that studies which indicate there is a risk tend to be biased and unreliable.

Treatments for leukemia

As the various types of leukemias affect patients differently, their treatments depend on what type of leukemia they have. The type of treatment will also depend on the patient's age and his state of health.

In order to get the most effective treatment the patient should get treatment at a center where doctors have experience and are well trained in treating leukemia patients. As treatment has improved, the aim of virtually all health care professionals should be complete remission - that the cancer goes away completely for a minimum of five years after treatment.

Treatment for patients with acute leukemias should start as soon as possible - this usually involves induction therapy with chemotherapy, and takes place in a hospital.

When a patient is in remission he will still need consolidation therapy or post induction therapy. This may involve chemotherapy, as well as a bone marrow transplant (allogeneic stem cell transplantation).

If a patient has Chronic Myelogenous Leukemia (CML) his treatment should start as soon as the diagnosis is confirmed. He will be given a drug, probably Gleevec (imatinib mesylate), which blocks the BCR-ABL cancer gene. Gleevec stops the CML from getting worse, but does not cure it. There are other drugs, such as Sprycel (dasatinib) and Tarigna (nilotinb), which also block the BCR-ABL cancer gene. Patients who have not had success with Gleevec are usually given Sprycel and Tarigna. All three drugs are taken orally. A bone marrow transplant is the only current way of curing a patient with CML. The younger the patient is the more likely the transplant will be successful.

Patients with Chronic Lymphocytic Leukemia (CLL) may not receive any treatment for a long time after diagnosis. Those who do will normally be given chemotherapy or monoclonal antibody therapy. Some patients with CLL may benefit from allogeneic stem cell transplantation (bone marrow transplant).

All leukemia patients, regardless of what type they have or had, will need to be checked regularly by their doctors after the cancer has gone (in remission). They will undergo exams and blood tests. The doctors will occasionally test their bone marrow. As time passes and the patient continues to remain free of leukemia the doctor may decide to lengthen the intervals between tests.

How common is leukemia?

According to the Leukemia and Lymphoma Society, there were approximately 13,410 new cases of AML (2007), 5,200 new cases of ACL (2007), 4,570 cases of CML (2007), and 15,110 new cases of CLL (2008) diagnosed in the USA.

What is the difference between Leukemia and Lymphoma?

Leukemia is a cancer of the blood. Lymphoma is of the lymphatic system (lymph glands).

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What is Cholesterol? What Causes High Cholesterol?

Cholesterol is a fat (lipid) which is produced by the liver and is crucial for normal body functioning. Cholesterol exists in the outer layer of every cell in our body and has many functions. It is a waxy steroid and is transported in the blood plasma of all animals. It is the main sterol synthesized by animals - small amounts are also synthesized in plants and fungi.

The word "cholesterol" comes from the Greek word chole, meaning "bile", and the Greek word stereos, meaning "solid, stiff".

What are the functions of cholesterol?

• It builds and maintains cell membranes (outer layer), it prevents crystallization of hydrocarbons in the membrane
• It is essential for determining which molecules can pass into the cell and which cannot (cell membrane permeability)
• It is involved in the production of sex hormones (androgens and estrogens)
• It is essential for the production of hormones released by the adrenal glands (cortisol, corticosterone, aldosterone, and others)
• It aids in the production of bile
• It converts sunshine to vitamin D
• It is important for the metabolism of fat soluble vitamins, including vitamins A, D, E, and K
• It insulates nerve fibers

There are three main types of lipoproteins

Cholesterol is carried in the blood by molecules called lipoproteins. A lipoprotein is any complex or compound containing both lipid (fat) and protein. The three main types are:

• LDL (low density lipoprotein) - people often refer to it as bad cholesterol. LDL carries cholesterol from the liver to cells. If too much is carried, too much for the cells to use, there can be a harmful buildup of LDL. This lipoprotein can increase the risk of arterial disease if levels rise too high. Most human blood contains approximately 70% LDL - this may vary, depending on the person.


• HDL (high density lipoprotein) - people often refer to it as good cholesterol. Experts say HDL prevents arterial disease. HDL does the opposite of LDL - HDL takes the cholesterol away from the cells and back to the liver. In the liver it is either broken down or expelled from the body as waste.


• Triglycerides - these are the chemical forms in which most fat exists in the body, as well as in food. They are present in blood plasma. Triglycerides, in association with cholesterol, form the plasma lipids (blood fat). Triglycerides in plasma originate either from fats in our food, or are made in the body from other energy sources, such as carbohydrates. Calories we consume but are not used immediately by our tissues are converted into triglycerides and stored in fat cells. When your body needs energy and there is no food as an energy source, triglycerides will be released from fat cells and used as energy - hormones control this process.

What are normal cholesterol levels?

The amount of cholesterol in human blood can vary from 3.6 mmol/liter to 7.8 mmol/liter. The National Health Service (NHS), UK, says that any reading over 6 mmol/liter is high, and will significantly raise the risk of arterial disease. The UK Department of Health recommends a target cholesterol level of under 5 mmo/liter. Unfortunately, two-thirds of all UK adults have a total cholesterol level of at least five (average men 5.5, average women 5.6).

Below is a list of cholesterol levels and how most doctors would categorize them in mg/dl (milligrams/deciliter) and 5mmol/liter (millimoles/liter).

• Desirable - Less than 200 mg/dL
• Bordeline high - 200 to 239 mg/dL
• High - 240 mg/dL and above


• Optimum level: less than 5mmol/liter
• Mildly high cholesterol level: between 5 to 6.4mmol/liter
• Moderately high cholesterol level: between 6.5 to 7.8mmol/liter
• Very high cholesterol level: above 7.8mmol/liter

Dangers of high cholesterol levels

High cholesterol levels can cause:

• Atherosclerosis - narrowing of the arteries.


• Higher coronary heart disease risk - an abnormality of the arteries that supply blood and oxygen to the heart.


• Heart attack - occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. This causes your heart muscle to die.


• Angina - chest pain or discomfort that occurs when your heart muscle does not get enough blood.


• Other cardiovascular conditions - diseases of the heart and blood vessels.


• Stroke and mini-stroke - occurs when a blood clot blocks an artery or vein, interrupting the flow to an area of the brain. Can also occur when a blood vessel breaks. Brain cells begin to die.

If both blood cholesterol and triglyceride levels are high, the risk of developing coronary heart disease rises significantly.

Symptoms of high cholesterol (hypercholesterolaemia)

Symptoms of high cholesterol do not exist alone in a way a patient or doctor can identify by touch or sight. Symptoms of high cholesterol are revealed if you have the symptoms of atherosclerosis, a common consequence of having high cholesterol levels. These can include:

• Narrowed coronary arteries in the heart (angina)


• Leg pain when exercising - this is because the arteries that supply the legs have narrowed.


• Blood clots and ruptured blood vessels - these can cause a stroke or TIA (mini-stroke).


• Ruptured plaques - this can lead to coronary thrombosis (a clot forming in one of the arteries that delivers blood to the heart). If this causes significant damage to heart muscle it could cause heart failure.


• Xanthomas - thick yellow patches on the skin, especially around the eyes. They are, in fact, deposits of cholesterol. This is commonly seen among people who have inherited high cholesterol susceptibility (familial or inherited hypercholesterolaemia).

What causes high cholesterol?

Lifestyle causes

• Nutrition - although some foods contain cholesterol, such as eggs, kidneys, eggs and some seafoods, dietary cholesterol does not have much of an impact in human blood cholesterol levels. However, saturated fats do! Foods high in saturated fats include red meat, some pies, sausages, hard cheese, lard, pastry, cakes, most biscuits, and cream (there are many more).


• Sedentary lifestyle - people who do not exercise and spend most of their time sitting/lying down have significantly higher levels of LDL (bad cholesterol) and lower levels of HDL (good cholesterol).


• Bodyweight - people who are overweight/obese are much more likely to have higher LDL levels and lower HDL levels, compared to people who are of normal weight.


• Smoking - this can have quite a considerable effect on LDL levels.


• Alcohol - people who consume too much alcohol regularly, generally have much higher levels of LDL and much lower levels of HDL, compared to people who abstain or those who drink in moderation.

Treatable medical conditions

These medical conditions are known to cause LDL levels to rise. They are all conditions which can be controlled medically (with the help of your doctor, they do not need to be contributory factors):

• Diabetes
• High blood pressure (hypertension)
• High levels of triglycerides
• Kidney diseases
• Liver diseases
• Under-active thyroid gland

Risk factors which cannot be treated

These are known as fixed risk factors:

• Your genes 1 - people with close family members who have had either a coronary heart disease or a stroke, have a greater risk of high blood cholesterol levels. The link has been identified if your father/brother was under 55, and/or your mother/sister was under 65 when they had coronary heart disease or a stroke.


• Your genes 2 - if you have/had a brother, sister, or parent with hypercholesterolemia (high cholesterol) or hyperlipidemia (high blood lipids), your chances of having high cholesterol levels are greater.


• Your sex - men have a greater chance of having high blood cholesterol levels than women.


• Your age - as you get older your chances of developing atherosclerosis increase.


• Early menopause - women whose menopause occurs early are more susceptible to higher cholesterol levels, compared to other women.


• Certain ethnic groups - people from the Indian sub-continent (Pakistan, Bangladesh, India, Sri Lanka) are more susceptible to having higher cholesterol levels, compared to other people.

How is high cholesterol diagnosed?

Blood and cholesterol screening results 

 

Cholesterol levels may be measured by means of a simple blood test. It is important not to eat anything for at least 12 hours before the blood sample is taken. The blood sample can be obtained with a syringe, or just by pricking the patient's finger.

The blood sample will be tested for LDL and HDL levels, as well as blood triglyceride levels. The units are measure in mg/dl (milligrams/deciliter) or 5mmol/liter (millimoles/liter).

People who have risk factors should consider having their cholesterol levels checked.

What are the treatments for high cholesterol?

Lifestyle

Most people, especially those whose only risk factor has been lifestyle, can generally get their cholesterol and triglyceride levels back to normal by:

• Doing plenty of exercise (check with your doctor)
• Eating plenty of fruits, vegetables, whole grains, oats, good quality fats
• Avoiding foods with saturated fats
• Getting plenty of sleep (8 hours each night)
• Bringing your bodyweight back to normal
• Avoiding alcohol
• Stopping smoking

Many experts say that people who are at high risk of developing cardiovascular disease will not lower their risk just by altering their diet. Nevertheless, a healthy diet will have numerous health benefits.

Cholesterol-controlling medications

If your cholesterol levels are still high after doing everything mentioned above, your doctor may prescribe a cholesterol-lowering drug. They may include the following:

• Statins (HMG-CoA reductase inhibitors) - these block an enzyme in your liver that produces cholesterol. The aim here is to reduce your cholesterol levels to under 4 mmol/liter and under 2 mmol/liter for your LDL. Statins are useful for the treatment and prevention of atherosclerosis. Side effects can include constipation, headaches, abdominal pain, and diarrhea. Atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin are examples of statins.


• Aspirin - this should not be given to patients under 16 years of age.


• Drugs to lower triglyceride levels - these are fibric acid derivatives and include gemfibrozil, fenofibrate and clofibrate.


• Niacin - this is a B vitamin that exists in various foods. You can only get very high doses with a doctor's prescription. Niacin brings down both LDL and HDL levels. Side effects might include itching, headaches, hot flashes (UK: flushes), and tingling (mostly very mild if they do occur).


• Anti hypertensive drugs - if you have high blood pressure your doctor may prescribe Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin || receptor blockers (ARBs), Diuretics, Beta-blockers, Calcium channel blockers.

In some cases cholesterol absorption inhibitors (ezetimibe) and bile-acid sequestrants may be prescribed. They have more side effects and require considerable patient education to achieve compliance (to make sure drugs are taken according to instruction).

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What Is Vertigo? What Causes Vertigo?

Vertigo is a sensation that everything around you is spinning or moving, which is usually caused by a problem in the inner ear, but can also be caused by vision problems. People with vertigo commonly feel things are moving when they are standing completely still and everything around them is still.

Vertigo is medically different from dizziness, lightheadedness, and unsteadiness. Lay people commonly use the terms dizziness and vertigo indistinctly. If this happens, it is important for a doctor to determine exactly what the patient is trying to describe.

Doctors say that vertigo is more severe than dizziness, which commonly happens when a person stands up and feels light-headed. People with vertigo may find it harder to move around because the spinning sensation tends to affect balance.

"Vertigo" is often used, incorrectly, to describe the fear of heights, but the correct term for this is acrophobia. The medical term vertigo can occur at any time and may last for days, weeks, months, and even years, while acrophobia symptoms only occur only when the person is high up and looking down. However, vertigo is so commonly used 'incorrectly' by lay people that it would be naive today to say it only has one meaning.

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What are the symptoms of vertigo?

The patient may feel that his/her surroundings seem to be moving either vertically or horizontally. There may also be a sensation of spinning. Sometimes the feeling may be so slight that it is hardly noticeable. However, for some people the severity of symptoms makes it hard to keep balance and carry out everyday tasks.

A bout of vertigo can last from a few minutes to several days, and sometimes much longer. The following symptoms are possible:

• A sensation that everything around you is moving or spinning
• Loss of balance
• Nausea
• Vomiting
• Light-headedness
• Problems walking properly
• Problems standing still properly
• Blurred vision
• Earache

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What are the causes of vertigo?

The vertigo can be caused by a problem with the balance mechanisms of the inner ear, a problem with the brain, or a problem with the nerves that connect the brain to the middle ear.

Labyrinthitis

Inflammation of the labyrinth, a system of canals and cavities within the inner ear which gives us our sense of balance. The sudden onset of a feeling of vertigo caused by labirynthitis is triggered by head or body movement, and is usually accompanied by a feeling of nausea and malaise.

Labyrinthitis may be caused by a viral or bacterial infection. Viral infections, such as a common cold or flu can spread to the labyrinth - labyrinthitis. Bacterial infections are less common.

The patient may also have a painful ear and fever.

Vestibular neuritis

The vestibule is in the inner ear. It is like an internal carpenter's level. The vestibule and the semicircular canals work with the brain to control balance. Vestibular neuritis is inflammation of the vestibular nerve - the nerve running to the vestibule. Vestibular neuritis often follows an upper respiratory infection. Patients will experience vertigo, but will not usually have ringing in the ear (tinnitus) or hearing problems.

Benign paroxysmal positional vertigo (BPPV)

The vestibular labyrinth, inside the ear, includes semicircular canals (loop-shaped structures) that contain fluid and tiny hair-like sensors that monitor the rotation of the head. The otolith organs, also in the ear, monitor movements of the head and its position. There are crystals in the otolith organs that make us sensitive to movement. Sometimes, when the patient is lying down, these crystals can become dislodged and move into one of the semicircular canals, making it sensitive to head position changes - something it would not normally do. This unusual response to head movements by the semicircular canal can give patients vertigo symptoms.

BBPV most commonly occurs in elderly patients. A blow to the head can cause BBPV; even a minor blow. BBPV can also be caused by disorders that damage the inner ear, infection, ear surgery damage, or if the patient has been lying on his/her back for too long.

Most BBPV attacks clear up within a few days. The condition generally goes away within a few weeks or months, but can sometimes recur.

Meniere's disease

Dysfunction of the semi-circular canals (endolymphatic sac) in the inner ear. Patients experience recurrent vertigo, as well as tinnitus and loss of hearing in the affected ear, abnormal eye movements, nausea, and vomiting. People with Meniere's disease usually find that the tinnitus gets worse over time. Hearing loss may start off as intermittent, but gradually progresses until it becomes permanent.

Head injury

Some patients can develop vertigo after a head injury. If you have had a head injury and subsequently experience vertigo or dizziness you should tell your doctor straight away.

Migraine

Usually characterized by periodic headaches and some vision problems, such as seeing stars (as if someone had quickly flashed a strong light in your eyes). Some migraine patients also experience dizziness and vertigo. In fact, for some migraine patients, vertigo can eventually become the only symptom. Some studies have shown that migraine patients who experience vertigo during their attacks tend to show a higher lifetime prevalence of migraine.

Chronic otitis media

Long-term infection of the inner ear, or infection of the inner ear that recurs over a long period. Some patients with chronic otitis media have episodes of vertigo.

Acoustic neuroma

A benign (non-cancerous) tumor that develops on the acoustic nerve of the inner ear; this nerve is involved in helping us balance. Patients who do experience vertigo usually have mild symptoms.

Dehydration

Dehydration may lead to feelings of lightheadedness, dizziness, and/or vertigo, especially when changing positions. This symptom is due to a drop in blood pressure.

Some medications

Salicylates, quinine, and aminoglycosides may sometimes cause vertigo.

Boat, airplane, car travel (motion sickness)

Some people experience vertigo during and/or after a plane, boat, or even a car trip. This may last from a few minutes, hours to a couple of days.

Earthquakes

Some people who have been in a strong earthquake can suddenly feel that the firm ground around them moves long after the earthquake is over. This sudden sensation can occur on-and-off over a number of days, and sometimes weeks.

I was in the devastating Mexico City earthquake of 1985 (Richter 8.2). For a couple of weeks I would occasionally feel that the firm ground was wobbling - the sensation would last a couple of seconds and slightly affected my balance. I know a number of people who had to sit down when this happened to them.

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What Is Edema? What Causes Edema?

Edema, is swelling caused by fluid retention - excess fluid is trapped in the body's tissues. In the UK/Ireland/Australasia and some other countries the word is spelled oedema. Swelling caused by edema commonly occurs in the hands, arms, ankles, legs and feet. It is usually linked to the venous or lymphatic systems. Edema was formerly known as dropsy or hydropsy.

Edema may be generalized or local. It can appear suddenly, but usually develops subtly - the patient may first gain weight, or wake up with puffy eyes. Many patients wait until symptoms are well advanced before seeking medical help.

The rest of this article refers mainly to generalized edema, unless otherwise specified.

According to Medilexicon's medical dictionary, edema is:

"1. An accumulation of an excessive amount of watery fluid in cells or intercellular tissues.
2. At the gross level, used to describe the physical sign commonly likened to swelling or increased girth that often accompanies the accumulation of fluid in a body part, most often a limb."

The English word "edema" comes from the Greek word oidema, meaning "a swelling tumor", which is derived from the Greek verb oidein meaning "to swell".

It is estimated that approximately 4.4 million people in USA have edema.

There are many types of edema. The most common ones are:

• Peripheral edema - in the feet (pedal edema), ankles, legs, hands and arms.


• Cerebral edema - in and around the brain (cerebral edema).


• Eye edema - in and around the eyes, e.g. macular edema, corneal edema, periorbital edema (puffiness around the eys. Macular edema is a serious complication of diabetic retinopathy. The CDC (Centers for Disease Control and Prevention) estimates that the number of cases of diabetic retinopathy will triple from 5.5 million in 2005 to 16 million in 2050.

What causes edema?

If the capillaries (tiny blood vessels) leak fluid into the surrounding tissue the area will start to swell. This could be due to capillary damage or increased pressure.

Leaking capillaries will cause the kidneys to accumulate higher than normal quantities of sodium (salt) and water in order to compensate for the capillary fluid loss. This results in more blood circulating in the body, which in turn causes even more capillary leakage into the surrounding tissue, which produces additional swelling - a vicious cycle.

Edema is most commonly caused by:

• Physical inactivity - edema is more prevalent among people who do not exercise at all, and walk very little.


• Standing or sitting still for long - if you stand or sit still for a long time there is a much higher chance of swelling.


• Genes - researchers in Spain identified the genes that cause blindness produced by corneal edema.


• Surgery - there is usually some swelling after a surgical procedure.


• High altitudes - especially when combined with physical exertion. Acute mountain sickness can lead to high altitude pulmonary edema or high altitude cerebral edema.


• Heat - especially when combined with physical exertion. During high temperatures the body is less efficient at removing fluid from tissues, especially around the ankles.


• Burns - the skin reacts to a burn by retaining fluid, causing localized swelling.


• Pregnancy - during pregnancy the woman releases hormones which encourage the body to retain fluids. Pregnant women tend to retain much more sodium and water than women who are not pregnant. When a woman is pregnant her face will typically swell, as will her hands, lower limbs and feet.
  
  When the woman is resting in a reclined position the enlarged uterus occasionally compresses the inferior vena cava, causing obstruction of both femoral veins, leading to edema.
  
  A pregnant woman's blood is hypercoaguble (clots more easily), raising the risk of deep venous thrombosis (DVT), a cause of edema. Eclampsia, which results from pregnancy-induced hypertension (high blood pressure), can also cause edema.


• Menstruation and pre-menstruation - hormone levels fluctuate during the menstrual cycle. During the days before menstrual bleeding there will be a reduction in the levels of the hormone progesterone, which may cause fluid retention.


• The contraceptive pill - any medication that includes estrogen can cause fluid retention. It is not uncommon for women to put on weight when they first go on the pill.


• Menopause - around the period of the menopause as well as after it, hormone fluctuations can cause fluid retention. Hormone replacement therapy after the menopause can also cause edema.


• Certain medications - such as vasodilators (drugs that open blood vessels), calcium channel blockers, NSAIDs (non-steroidal anti-inflammatory drugs), estrogens, several chemotherapy drugs, and some diabetes drugs, such as thiazolidinediones. Scientists in the University of Utah discovered why thiazolidinediones cause edema
.

• Excessive salt intake - this is especially the case for people who are susceptible to developing edema.


• Malnutrition and/or bad diet - dietitians say low consumption of thiamine (vitamin B1), as well as insufficient vitamins B6 and B5 may contribute toward fluid retention. Low levels of albumin levels may also play a part - low albumin levels can also be caused by kidney disease.

Edema can also be caused by the following diseases:

• Kidney disease/damage - patients with kidney disease may not be able to eliminate enough fluid and sodium from the blood. This results in more pressure on the blood vessels, which causes some of the liquid to leak out. Kidney disease patients with edema will generally have swelling around their legs and eyes.
  
  Damage to the capillaries in the kidneys (glomeruli) that filter waste and excess fluids from the blood can result in nephrotic syndrome. Among the many symptoms of nephrotic syndrome is an insufficient level of blood albumin, which leads to edema.


• Heart failure - this is when the heart cannot pump blood properly to all parts of the body. If one or both of the lower chambers of the heart lose the ability to pump blood effectively, the blood can accumulate in the limbs, causing edema.


• Chronic lung disease - this includes many lung diseases, such as asthma, chronic bronchitis, COPD, emphysema, pulmonary fibrosis and sarcoidosis. Some patients may experience an accumulation of fluids in the lungs - pulmonary edema.


• Liver disease - such as cirrhosis, which causes scarring of the liver. This affects liver function, which causes the secretion of hormones and fluid-regulating chemicals to change. People with cirrhosis of the liver also have increased pressure within the portal vein - a large vein that carries blood from the intestines, spleen and pancreas into the liver. The problems can lead to fluid retention in the legs and ascites (abdominal cavity).


• Diabetes - a patient with diabetes may have edema for several different reasons, including cardiovascular disease and its complications, acute renal failure, acute liver failure, protein losing enteropathy (disease of the intestine causing protein loss), and some medications. Diabetic macular edema is the swelling of the retina in diabetes.


• Allergies - some foods and insect bites may cause edema in susceptible people.


• Arthritis - people with arthritis most commonly have swelling in the ankles, feet, legs, and calves - peripheral edema. Arthritis may cause swelling for many reasons, for example, sporadic ankle swelling in rheumatoid arthritis is common and occurs mainly as a result of active inflammatory synovitis (inflammation of the synovial membrane, the lining of the joint).


• Thyroid disease - people with a disorder of the thyroid gland commonly experience edema.


• Brain tumor - a brain tumor will accumulate water around itself, especially as it builds new blood vessels.


• Head injury - a blow to the head may result in an accumulation of fluids in the brain or between the brain and the skull.

Edema in the leg is most commonly caused by:

• A blood clot - any blockage, such as a clot in one of the veins can impede the flow of blood. This causes an increase in pressure in the vein, which may result in leakage of fluids into the surrounding tissue, causing edema.


• Varicose veins - these often accompany symptoms of edema. Varicose veins usually occur because valves become damaged; static pressure increases, resulting in the bulging veins. The static pressure also increases the risk of leakage of fluids into the surrounding tissue.


• Infection/inflammation - the lymph nodes may swell in response to infection.


• A cyst/growth/tumor - edema can causes cysts, which can then cause more edema. Any lump can cause edema for a number of reasons. The lump may press against a vein causing a build-up of pressure in that vein, which may result in fluids leaking into surrounding tissue. The lymph nodes may react to a tumor and swell.


• Lymphedema - the lymphatic system helps get rid of excess fluid from tissues. If this system is damaged the lymph nodes and lymph vessels which continually drain an area may not work as they should, it could result in edema.
  
  If the damage is due to lymphedema it is called primary lymphedema, if it is caused by a disease or medical condition, such as an infection or cancer, it is caused secondary lymphedema.

What are the symptoms of edema?

Symptoms will mainly depend on the underlying cause. The following refer to generalized edema:

• Swelling of the skin.
• Skin may be stretched and shiny.
• The skin may retain a dimple after being pressed for about ten seconds.
• Puffiness of the ankles, face or eyes.
• Aching body parts.
• Stiff joints.
• Weight gain.
• Weight loss.
• Hand and neck veins are fuller.
• Raised pulse rate.
• Hypertension - raised blood pressure.
• Ascites - increased abdominal size.

What is the diagnosis of edema?

A GP (general practitioner, primary care physician) will want to determine what the underlying cause of the edema is. The patient will be asked questions about his/her:

• Medical history.
• Current state of health.
• How long the signs and symptoms have existed.
• How permanent or intermittent the signs and symptoms are.
• Whether the patient has had edema before.

The physician will also carry out a physical exam. If there are indications that there may be an underlying medical condition causing the edema the doctor may order some tests, these may include:

• A chest X-ray
• Blood tests
• Urine tests
• Liver function tests
• Heart function tests

What is the treatment for edema?

In order to treat the edema the doctor has to diagnose the condition that is causing it first.

• Diuretics
  
  These are drugs that raise the rate of urination, providing a means of forced dieresis. Diuresis is the increased production of urine by the kidney. There are several types of diuretics - they increase the excretion of water from the body in various different ways. Diuretics are not suitable if the patient is pregnant, or has chronic venous insufficiency (weakened valves in the veins of the legs).
  
  Many medications appear to cause pedal edema (foot edema), especially estrogens, vasodilators, NSAIDS, and calcium channel blockers. Most edemas caused by medications are the types that are caused by high blood pressure in the capillaries. For these patients diuretics are not an effective treatment. Physicians report that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers give better results.


• Antiangiogenesis therapy (controlling blood vessel growth)
  
  The beneficial effects of anti-angiogenesis drugs in the treatment of the glioblastomas (deadly brain tumors) appear to result primarily from reduction of edema, researchers at the Massachusetts General Hospital reported.


• Oxygen therapy
  
  Oxygen delivered through the nose may improve poor vision caused by diabetic macular edema, say researchers at Johns Hopkins.

A good GP will also recommend the following self-care techniques which may help resolve the fluid retention problem:

• Cut down salt consumption.


• If the patient is overweight, to lose weight.


• Do regular exercise.


• Raise the legs several times per day to improve circulation.


• Wear supporting stockings.


• Not to sit/stand still for too long.


• Get up and walk about regularly when travelling by car, train, boat or plane.


• Avoid extremes of temperature, such as hot baths, showers, and saunas. Dress warmly if it is cold.


• Massage - if the affected area is stroked firmly in the direction of the heart it may help move the fluid. It is important that the hand movements do not cause pain. A qualified masseuse or physical therapist will know how to do this more effectively.

What are the complications of edema?

Edema is usually caused by an underlying disease or condition. If that condition is not treated, the health consequences could be serious. Untreated edema can cause:

• Painful swelling. The pain can gradually get worse.


• Walking difficulty.


• Stiffness.


• Awkward gait.


• Skin can become stretched, itchy and bothersome.


• The swollen area is more likely to become infected.


• Scarring may occur between the layers of tissue.


• Poor blood circulation.


• Arteries, veins, and joints may lose their elasticity.


• Ulcerations of the skin.

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What Is a Stroke? What Causes a Stroke?

A stroke is a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in an impairment in speech, movement, and memory.

The two main types of stroke include ischemic stroke and hemorrhagic stroke. Ischemic stroke accounts for about 75% of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke. A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage). Both result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.

The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking, incontinence, and bladder problems.

Who gets stroke?

Anyone can suffer from stroke. Although many risk factors for stroke are out of our control, several can be kept in line through proper nutrition and medical care. Risk factors for stroke include the following:

• Over age 55
• Male
• African American, Hispanic or Asian/Pacific Islander
• A family history of stroke
• High blood pressure
• High cholesterol
• Smoking cigarettes
• Diabetes
• Obesity and overweight
• Cardiovascular disease
• A previous stroke or transient ischemic attack (TIA)
• High levels of homocysteine (an amino acid in blood)
• Birth control use or other hormone therapy
• Cocaine use
• Heavy use of alcohol

What causes stroke?

Ischemic strokes are ultimately caused by a thrombus or embolus that blocks blood flow to the brain. Blood clots (thrombus clots) usually occur in areas of the arteries that have been damaged by atherosclerosis from a buildup of plaques. Embolus type blood clots are often caused by atrial fibrillation - an irregular pattern of heart beat that leads to blood clot formation and poor blood flow.

Hemorrhage strokes can be caused by uncontrolled high blood pressure, a head injury, or aneurysms. High blood pressure is the most common cause of cerebral hemorrhage, as it causes small arteries inside the brain to burst. This deprives brain cells of blood and dangerously increases pressure on the brain.

Aneurysms - abnormal blood-filled pouches that balloon out from weak spots in the wall of an artery - are the most common cause of subarachnoid hemorrhage. If an aneurysm ruptures, blood spills into the space between the surfaces of the brain and skull, and blood vessels in the brain may spasm. Aneurysms are often caused or made worse by high blood pressure.

A study found that a Single Gene Defect Can Lead To Stroke And Deadly Diseases Of The Aorta And Coronary Arteries.

A less common from of hemorrhage stroke is when an arteriovenous malformation (AVM) ruptures. AVM is an abnormal tangle of thin-walled blood vessels that is present at birth.

A study found that migraines increase stroke risk during pregnancy.

What are the symptoms of stroke?

Within a few minutes of having a stroke, brain cells begin to die and symptoms can become present. It is important to recognize symptoms, as prompt treatment is crucial to recovery. Common symptoms include:

• Dizziness, trouble walking, loss of balance and coordination
• Speech problems
• Numbness, weakness, or paralysis on one side of the body
• Blurred, blackened, or double vision
• Sudden severe headache

Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.

A possible sign that a stroke is about to occur is called a transient ischemic attack (TIA) - a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a shorter time period and do not leave noticeable permanent damage.

A study found that women are more likely to experience non-traditional stroke symptoms.

MRI brain scan">

How is stroke diagnosed?

A stroke is a medical emergency, and anyone suspected of having a stroke should be taken to a hospital immediately so that tests can be run and the correct treatment can be provided as quickly as possible.

Physicians have several tools available to screen for stroke risk and diagnose an active stroke. These include:

• Physical assessment - blood pressure tests and blood tests to see cholesterol levels, blood sugar levels, and amino acid levels


• Ultrasound - a wand waved over the carotid arteries in the neck can provide a picture that indicates any narrowing or clotting


• Arteriography - a catheter is inserted into the arteries to inject a dye that can be picked up by X-rays


• Computerized tomography (CT) scan - a scanning device that creates a 3-D image that can show aneurysms, bleeding, or abnormal vessels within the brain


• Magnetic resonance imaging (MRI) - a magnetic field generates a 3-D view of the brain to see tissue damaged by stroke


• CT and MRI with angiography - scans that are aided by a dye that is injected into the blood vessels in order to provide clearer and more detailed images


• Echocardiography - an ultrasound that makes images of the heart to check for embolus

How is stroke treated?

The primary goal in treating ischemic stroke is to restore blood flow to the brain. This will be attempted using blood clot-busting drugs such as aspirin, heparin, or tissue plasminogen activators that must be administered within three hours of the stroke. In addition, surgical procedures may be performed that can open up or widen arteries. These include carotid endarterectomy (removal of plaque and widening of the carotid artery) and angioplasty (a balloon that widens the cartoid artery and is held open with a metallic mesh tube called a stent).

A study found that cholesterol lowering drugs can prevent stroke recurrence.

Hemorrhagic stroke is treated differently than ischmic stroke. Surgical methods used to treat this stroke variant include aneurysm clipping, aneurysm embolisation, and arteriovenous malformation (AVM) removal. Aneurysm clipping consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of it's attached artery and keeps the aneurysm from bursting or re-bleeding. Aneurysm embolisation (coiling) uses a catheter inserted into the aneurysm to deposit a tiny coil that coil fills the aneurysm, causing clotting and sealing off the aneurysm off from arteries. AVM removal is a surgical procedure to remove usually smaller AVMs or AMVs that are in more accessible portion of the brain in order to eliminate the risk of rupture.

US researchers found that patients who had experienced strokes as long as six months earlier were able to regain brain function through the help of a novel robotic device that they squeezed with their hand.

Most stroke victims will require rehabilitation after the event. A person's condition is generally dependent on the area of the brain and the amount of tissue that was damaged. It is common for the rehabilitation process to include speech therapy, occupational therapy, physical therapy, and family education.


A stroke patient was intravenously injected with his own bone marrow stem cells as part of a research trial at The University of Texas Medical School at Houston.

How can stroke be prevented?

One way to prevent a stroke is to notice a transient ischemic attack (TIA) - or mini stroke - that provides symptoms similar to stroke. Knowing the symptoms of stroke can lead to earlier treatment and better recovery.

Much of stroke prevention is based on living a healthy lifestyle. This includes:

• Knowing and controlling blood pressure
• Finding out if you have atrial fibrillation
• Not smoking
• Lowering cholesterol, sodium, and fat intake
• Following a healthy diet
• Drinking alcohol only in moderation
• Treating diabetes properly
• Exercising regularly. Moderate aerobic fitness can reduce stroke risk, a study found.
• Managing stress
• Not using drugs
• A study found that drinking three cups of tea per day reduces the risk of stroke
• Taking preventive medications such as anti-platelet and anticoagulant drugs to prevent blood clots
• Cholesterol lowering drugs can prevent stroke recurrence

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What Is Anal Itching? What Is Itchy Bottom? What Causes Anal Itching?

Anal itching, also known as itchy bottom, pruritus ani or anusitis, is irritation and sometimes inflammation of the anus - located at the exit of the rectum. Itching severity varies and is usually exacerbated by such factors as type of clothing worn, whether the patient is seated or upright, moisture levels, pressure and general rubbing of the anal area. Anal itching can become so severe that some people find it intolerable, describing the sensation as one of incredible burning and soreness.

Anal itching is not a disease in itself, but rather a sign or symptom. In the majority of cases, there is an underlying cause or condition which causes the anal itching. However, sometimes the underlying cause is never found.

Regardless of the cause, virtually every type of anal itching sign or symptom can be successfully treated.

Anal itching is much more common than people realize, probably because it is not exactly something most people will reveal to others, apart from the their doctors. According to the National Health Service (NHS), UK, about 1 in every 20 British people experience "itchy bottom". It is four times more prevalent in males than in females. Although anybody can develop anal itching, people aged 40 years and more are more likely to get it, compared to younger individuals.

According to Medilexicon's medical dictionary,  

pruritus ani is "itching of varying intensity at the anus; may be paroxysmal or constant, associated with seborrheic candidiasis or moniliasis, with irritated and enlarged hemorrhoidal veins, or may occur independently of any cutaneous lesions in association with systemic disease."

What are the signs and symptoms of anal itching?

A symptom is something the patient feels or reports, while a sign is something that other people, including the doctor detects. A headache may be an example of a symptom, while a rash may be an example of a sign.

Most humans and other animals sometimes scratch their bottoms. For a person with pruritus ani (anal itching) the urge to scratch around the anus is very strong and persistent. Although the urge may occur at any time of day or night, it is more common after going to the toilet; especially if stools are liquidy. Some patients say the itching becomes more intense just prior to falling asleep in bed at night.

The symptoms of anal itching are self explanatory - "itching of the anus and the anal area". The patient generally experiences:

• Burning
• Intense itching
• Soreness
• Pain (sometimes)

Symptoms may be short-term or persistent. Some individuals may experience irritation that is so intense that the desire to scratch must be satisfied there and then - this can be embarrassing.

What can set off anal itching or exacerbate it?

• Anxiety
• Heat
• Mental stress
• Moisture
• Soiling (defecating or pooing in one's clothing)
• Some clothing or bedding materials, such as wool
• Having nowhere private to go into nearby

What are the causes of anal itching?

Anal itching is usually a sign or symptom of a harmless physical problem with no long-term health consequences. Unfortunately, it can also be an indication of something more serious, such as:

• Skin type - if the skin around the anal area is too dry there is a significantly greater risk of developing persistent and sometimes severe anal itching.


• Moisture levels - if moisture levels around the anal area are high, the chances of having anal itching are raised. High moisture levels can be the result of several different factors, including over-sweating, allergies, diarrhea, very wet and sticky stools, inappropriate clothing, fecal incontinence, and not having access to toilet paper or any means of cleaning oneself.


• Abrasive rubbing - cleaning your bottom with toilet paper can aggravate anal itching if the sensitive skin area is rubbed too hard, for too long, or too often.


• Over-washing the anal area - if harsh soaps affect the skin, especially if not rinsed off properly, the chances of itching in the anal area may increase.


• Some chemicals - some substances found in some soaps, douches, laundry detergents and body sprays may irritate the skin and cause anal itching.


• Type of toilet paper - the texture and substances added to toilet paper may irritate and inflame the skin in the anal area, resulting in itching.


• Some foods - some people may develop anal itching after consuming certain types of hot sauces or spices. The irritation may occur when the food is anywhere in the digestive system, even when stools are exiting through the anus.
  
  If a stool is not smooth and does not come out with the minimum of friction, irritation may occur and then subsequent itching - some people find that their anus becomes irritated after passing stools which originated from eating tomatoes, nuts, popcorn, chocolate, and even drinking alcoholic beverages. If some foods make people have diarrhea, their risk of developing anal itching is greater (because of the diarrhea).


• Some medicines - some medications, such as antibiotics can cause diarrhea, which can cause anal itching.


• Laxative abuse - if laxatives are used inappropriately and the patient has diarrhea or very liquidy stools, the probability of anal itching occurring becomes much greater.


• Hemorrhoids - when the veins around the anus or in the rectum are swollen or inflamed the patient has hemorrhoids. Hemorrhoids can occur both inside and above the inside of the anus. They can also appear externally, under the skin of the anus. People with hemorrhoids commonly suffer from anal itching.


• STDs (sexually transmitted diseases) - also known as STIs (sexually transmitted infections) cause anal as well as genital itching.


• Parasites- some parasites may cause anal itching. Parasites are more commonly a cause of anal itching in tropical countries, or tropical regions of countries.


• Skin conditions - such as eczema, seborrhea, and psoriasis, which may include itching in many parts of the body's surface, often have characteristic focal areas of irritation. People with these skin conditions commonly experience anal itching.


• Some yeast infections - this generally affects women. Yeast infections which affect the genital area, may spread to the anus, causing intense irritation.


• Forced bowel movement - if the stool is dry and large and the individual heaves and still pushes it through, there is a risk of an anal abrasion (small tear in the anus). A deeper tear is called an anal fissure, which may also cause itching.


• Tumors - a tumor in the anal region may cause anal itching. The tumor may be cancerous (malignant) or non-cancerous (benign). This is rare.

How is anal itching diagnosed?

In order for doctors to diagnose the cause of your symptoms, they will need to know your medical history. They might ask what soaps, creams or powders you use on your anus or if your symptoms worsen after the consumption of certain food types.

Your GP may also ask about when the itching is at its worst, and how long it lasts. They might also want to know if anyone else in your family has had or is suffering from anal itching. The doctors may be able to come up with a diagnosis just from these questions alone; however, if the cause is not clear you may be referred to a proctologist (doctor specializing in rectal and anal problems) or dermatologist (skin expert).

Diagnosis might be made just from a rectal exam. This will involve a GP checking the anal area for any skin that is inflamed, cracked or bleeding. An internal exam may then be required; the doctor inserts his/her finger into the patient's anus. Doing this can help determine what is causing the anal itching as well as eliminating more serious conditions, such as colorectal cancer. Sometimes a more detailed exam of the digestive system, such as a colonoscopy or a proctoscopy may be required.

What are the treatment options for anal itching?

Most of the time itchy bottom is easy to treat and responds well to treatment. However, this does not stop it from recurring in the future. The type of treatment chosen is dependent on the cause of the anal itching. The various methods of treatment may include:

• Anal cleanliness/dryness - When suffering from anal itching, keeping your anus clean and dry is very important. Each time you pass a stool and before going to bed it is advised that the skin around the anus is carefully cleaned using water and then dried thoroughly.
  
  When drying, be gentle, avoid vigorous rubbing as this could further irritate the area. Another option is using a hair dryer on low heat or patting with a dry pad.


• Be careful when washing with soap - When washing the skin around the anus avoid perfumed soap, try using one which is mild and unscented, and be sure to rinse away all the soap with water.


• When travelling - The above options may not be possible when on the move or away from home. In this case try using damp toilet tissues to clean yourself.


• If the area keeps getting moist due to sweat - Putting a cotton tissue in your underwear will absorb the sweat/moisture and reduce itching.


• Avoiding consumption of certain foods - There are a number of food types that can make the anal itching worse. If you notice the urge to itch getting worse after eating a particular kind of food, you should try to cut down on it. Below is a list of foods that are known to make anal itching worse:
  
  
  • Chocolate
  • Citrus fruits
  • Coffee
  • Dairy Products
  • Nuts
  • Spicy food
  • Tomatoes
  • Unnecessary amounts of liquids


• Things you can do yourself - There are some other ways you can keep control of your anal itching symptoms. These are as follows:
  
  
  • Use colorless plain toilet paper
  • Make sure you have a shower every day
  • Wear underwear that is made of cotton and not too tight.
  • Be sure to wear clean underwear every day.
  • Trim your fingernails regularly; scratching the anal area with long fingernails can damage the skin. Ideally scratching the area should be avoided altogether, as it can make the itching worse.


• Prescription Medication - Doctors can prescribe medication to help relieve the symptoms.


• Creams - Doctors can also prescribe creams or ointments.


• Corticosteroids - Patients with anal itching where the anal area is tender and inflamed may be prescribed a short course of corticosteroids (less than 7 days). It is applied onto the skin around the anus and will relieve the itching impulse and inflammation. It is known on occasion to make the itching worse, if this is the case it you should stop taking it and contact your doctor.


• Antihistamines - This is to be taken at night and can alleviate your itching and help you sleep.


• Treating the underlying cause - If the anal itching is the result of an underlying cause, the doctor will nead to treat that first. In most cases, if that underlying cause is effectively treated, the anal itching will resolve itself.

What are the complications of anal itching?

Scratching the anus too often can cause damage to the skin and may tear it. This can lead to the following complications:

• Lichenification - the skin around the anal area becomes thick and leathery.
• Ulceration - the skin becomes sore and breaks.
• Excoriation - the top layer of the skin wears away.
• Infection- this complication can be easily treated if the patient has prompt treatment.

Even though these complications are unpleasant, most of them can be treated effectively if you see your doctor as soon as symptoms appear.

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What is Tiredness or Fatigue? How Can I Beat Tiredness?

Experts say that 10% of us at any one time are suffering from persistent tiredness. Persistent tiredness is more common among women than men. General Practitioners say they regularly see patients who come in complaining of severe tiredness.

As a consequence of our busy and stressful modern lifestyles, most of us will at some time experience tiredness. On most occasions, fatigue can be relieved after a good night's sleep. However, this is not the case for everybody. Some people find that tiredness becomes a chronic problem which undermines their day-to-day functioning - i.e. it significantly affects their quality of life.

What are The Causes of Tiredness?

Tiredness can be caused by several different factors. Here is a list of some common causes of tiredness:

• a recent illness
• a current illness
• pregnancy
• bereavement
• moving home
• divorce
• work problems
• jet lag
• depression
• boredom
• lack of sleep
• some type of poisoning
• a vitamin or mineral deficiency
• anemia

Tiredness Can Have Physical Causes

Chronic tiredness can become a vicious circle. If a person feels tired he may avoid most forms of physical activity. He could then become physically unfit and will be even more tired when trying to do something physical.

If your bodyweight is too high or too low for your height you may feel tired because of this. An overweight person's body has to work harder to do everyday things, compared to a person whose bodyweight is normal. A person who is underweight might have less muscle strength and will tire more easily.

If your thyroid gland is not working properly - if it is underactive - you might feel exhausted all the time. Patients who suffer from heart disease or heart failure tend to feel tired most of the time, as do patients with anemia.

Tiredness May Have Emotional or Mental Causes

Some stress can be invigorating - in fact, many of us need some kind of mental pressure to get going. However, when stress levels are too high they commonly trigger fatigue - stress and worry are two emotions that most frequently cause tiredness. If your stress reaches such a point that you are unable to see the 'light at the end of the tunnel', the sensation can be draining. Some people say that when they have no control over a situation it makes them feel frustrated, irritable and tired. Depression can lead to tiredness for many reasons. It could be the depression itself, or the patient may not sleep properly and feel tired as a result.

Your Lifestyle Could Be Making You Tired

There are some jobs which are more likely to cause tiredness. Nurses, firefighters, doctors, the police, and shift-workers in general may have irregular sleep patterns which will often cause tiredness.

If there is a baby in the house you may find that getting a good night's sleep is a distant memory. Small children may often cause their parent(s) to sleep less.

If you consume too many caffeinated or alcoholic drinks your ability to fall or stay asleep may be affected, especially if you consume them close to your bedtime.

How Do People Define Tiredness?

Patients who experience tiredness say:

• They lack energy
• They feel discomfort
• They feel unwell
• They feel sleepy
• They have lost motivation
• Their concentration is poor
• They find it hard to make decisions
• They find daily tasks difficult to carry out
• They feel depressed

What is Fatigue - Video

Learn about the causes and symptoms of tiredness and fatigue in this video clip from Expert Village.


Watch the Video Here

What You Can Do To Help Yourself

1) Try to get some decent sleep

• Aim for a regular sleep routine - this means going to bed and getting up at the same time each day
• Make sure your bedroom is neither too hot nor too cold
• Don't eat too close to your bedtime
• Make sure your thoughts and activities are relaxing ones as bedtime nears - listen to soothing music, have a warm bath
• Try to clear your mind of worrying thoughts as bedtime approaches
• Some people find that writing their thoughts down in a diary helps

2) Eat and drink in a way that helps you sleep better

• You need to consume a balanced diet. People who have a well balanced diet tend to be better sleepers than those who don't
• If you are too thin, eat more
• If you are overweight, eat less
• Crash dieting can cause you to have sleeping problems
• Do not consume alcohol and/or caffeine in the evenings. Some people find that cutting alcohol and caffeine altogether helps

3) Become physically more active

Remember that vicious circle. Unfit people are more likely to feel tired, meaning they often don't exercise enough. You need to break that cycle. Make sure your physical activity increases gradually. Dozens of studies have shown that people who exercise regularly enjoy better sleep than those who don't.

In most cases tiredness can be solved with some simple steps, such as getting some good and regular sleep and changing your lifestyle. However, in some cases chronic tiredness can have a major impact on your life. If the simple steps cannot solve your problem, you should seek professional help.

Sources: National Health Service (NHS), UK, The Mayo Clinic, Wikipedia, HHS (Department of Health and Human Services USA), NIH (National Institutes of Health, USA).

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What Is A Cyst? What Causes Cysts?

A cyst is a closed sac-like structure - an abnormal pocket of fluid, like a blister - that contains either liquid, gaseous, or semi-solid substances. A cyst is located within a tissue, and can occur anywhere in the body and can vary in size - some are so small they can only be viewed through a microscope, while others may become so big that they displace normal organs.

In anatomy, a cyst can also refer to any normal bag or sac in the body, such as the bladder. In this article, cyst refers to an abnormal sac or pocket in the body that contains either liquid, gaseous or semi-solid substances.

A cyst is not a normal part of the tissue where it is located. It has a distinct membrane and division on nearby tissue - the outer or capsular portion of a cyst is called the cyst wall. If the sac is filled with pus it is not a cyst, it is an abscess.

The English word cyst comes from the Latin word cystis, which came from the Ancient Greek word kystis, meaning "bladder" or "pouch".

What causes cysts?

Cysts can be caused by:

• Tumors
• Genetic conditions
• Infections
• A fault in an organ of a developing embryo
• A defect in the cells
• Chronic inflammatory conditions
• Blockages of ducts in the body which cause a fluid build-up
• A parasite
• Impact injury that breaks a vessel

Benign and malignant cysts

Most cysts are benign and are caused by plugged ducts or other natural body outlets for secretions. However, some cysts may be tumors and are formed inside tumors - these can be potentially malignant. Examples include keratocysts and dermoid cysts.

What are the possible signs and symptoms of a cyst?

Signs and symptoms vary enormously, depending on what type of cyst it is. In most cases the patient becomes aware of an abnormal lump - as is usually the case with cysts of the skin or just below the skin.

A cyst in the mammary glands (breasts) may be noticeable when the breasts are examined by touching them - the lump will be palpable. Breast cysts are often painful.

Some cysts in the brain can cause headaches, as well as other symptoms.

Many internal cysts, such as those in the kidneys or the liver may not have any symptoms and go unnoticed until an imaging scan (MRI scan, CAT scan, ultrasound) detects them.

What is the treatment for a cyst?

Treatment for a cyst will depend on various factors, including the type of cyst, where it is, its size, and the degree of discomfort it is causing.

A very large cyst that causes symptoms can be surgically removed. Sometimes the doctors may decide to drain or aspirate the cyst by inserting a needle or catheter into the cavity. If the cyst is not easily accessible, drainage or aspiration is often done with the help of radiologic imaging so that the doctor can accurately guide the needle/catheter into the target area.

Sometimes the aspirated liquid is examined under a microscope to determine whether cancerous cells are present.

If doctors suspect the cyst may be cancerous it may be removed surgically, or a biopsy of the capsule (cyst wall) may be ordered.

Many cysts arise as a result of a chronic or underlying medical condition, as may be the case with fibrocystic breast disease or polycystic ovary syndrome - in such cases the focus of treatment is on the medical condition.

Types of cysts

Below is a list of some of the most common cysts:

• Acne cyst - go to What is cystic acne?


• Arachnoid cyst - the arachnoid membrane covers the brain. During fetal development the arachnoid membrane doubles up or splits to form an abnormal pocket of cerebrospinal fluid. In some cases doctors need to drain the cyst. Arachnoid cysts may affect newborn babies.


• Baker's cyst - also called a popliteal cyst. The patient experiences a bulge and a feeling of tightness behind the knee. Pain gets worse when extending the knee or during physical activity. Usually caused by a problem with the knee joint, such as arthritis or a cartilage tear.


• Bartholin's cyst - may occur if the ducts of the Bartholin glands (situated inside the vagina) become blocked. Patients may undergo surgery and/or be prescribed antibiotics.


• Breast cyst - often painful and usually need to be drained. Some studies have indicated that breast cysts may point to a raised breast cancer risk.


• Chalazion cyst - very small eyelid glands (meibomian glands) make a lubricant that comes out of tiny openings in the edges of the eyelids. Cysts can form if the ducts are blocked.


• Colloid cyst - a cyst containing gelatinous material in the brain. In most cases, the recommended treatment is surgical removal of the cyst.


• Dentigerous cyst - a cyst surrounding the crown of an unerupted tooth.


• Dermoid cyst - a type of cyst that has mature skin, hair follicles, sweat glands, even clumps of long hair sometimes, as well as fat, bone, cartilage, and thyroid tissue.


• Epididymal cyst - a cyst (spermatocele) that forms in the vessels attached to the testes. This type of cyst is estimated to affect 30% of American males and doesn't typically impair fertility or require treatment. If it causes discomfort a doctor may suggest surgery.


• Ganglion cyst - go to What is a ganglion? What is a ganglion cyst?


• Hydatid cyst - a relatively small tapeworm forms cysts in the lungs or liver. Treatment includes surgery and medication.


• Ovarian cyst - the majority of ovarian cysts are benign. Some can become so large that the woman looks pregnant. Ovarian cysts 5cm long or less are common during a woman's reproductive years.


• Pancreatic cysts - most are pseudocysts; they don't have the type of cells found in true cysts. May include cells normally found in other organs, such as the stomach or intestines.


• Periapical cyst - also known as radicular cysts. It is the most common odontogenic (relating to the formation and development of teeth) cyst. Usually caused by inflammation of the pulp, pulp death, or dental caries.


• Pilar cyst - also known as a trichilemmal cyst. It is a fluid-filled cyst that forms from a hair follicle. Most commonly found in the scalp.


• Pilonidal cyst - forms in the skin near the tailbone (lower back), and can sometimes contain ingrown hair. This type of cyst can grow in clusters which sometimes create a hole or cavity in the skin.


• Renal cyst (kidneys) - several types of cysts can develop in the kidneys. Solitary cysts contain fluids and may sometimes also have blood. Some are present at birth. Others may be caused by tubular blockages. Patients with kidney vascular diseases may have cysts formed by the dilatation of blood vessels.


• Pineal gland cyst - a benign cyst that forms in the pineal gland in the brain. According to autopsy records, pineal gland cysts are fairly common.


• Sebaceous cyst - the skin is lubricated by sebaceous fluid which can build up inside a pore or hair follicle and form a lump filled with thick, greasy substances. Most commonly found on the skin of the face, back, scalp and scrotum.


• Tarlov cyst - also known as perineural/perineurial cysts, as well as sacral nerve root cysts. The cysts are located at the base of the spine and are filled with cerebrospinal fluid.


• Vocal fold cyst - there are two types, mucus retention cysts and epidermoid cysts. Vocal fold cysts can interfere with the quality of the patient's speech, sometimes causing vocal cords to produce multiple tones simultaneously (diplophonia), or hoarseness and breathy speech (dysphonia).

Sources: National Health Service (NHS), UK, The Mayo Clinic, Wikipedia, HHS (Department of Health and Human Services USA), NIH (National Institutes of Health, USA).

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