Tuesday, July 3, 2012

What Are Genital Warts? What Causes Genital Warts?

Genital warts are also called venereal warts or condylomata acuminate. Genital warts are one of the most common kinds of STDs (sexually transmitted diseases) or STIs (sexually transmitted infections). According to Medilexicon's medical dictionary, a genital wart is "a contagious projecting warty growth on the external genitals or at the anus, consisting of fibrous overgrowths covered by thickened epithelium showing koilocytosis, due to sexual contact with infection by human papillomavirus; it is usually benign, although malignant change has been reported, associated with particular types of the virus."

Genital warts are an infection of the skin of the genital and anal area, as well as the lining (mucous membranes) of the vagina, cervix and rectum.

It used to be thought that young children with genital warts or anal warts were victims of child abuse. However, this article explains that this may not necessarily be the case.

This article does not cover non-genital warts. We have a separate article called What are warts? What causes warts?

What causes genital warts?

Genital warts, like other non-STD warts, are caused by various types of the human papilloma virus (HPV) that infect the top layers of the skin. There are over 100 different types of HPV that may cause warts, but only a small number of strains can cause genital warts. Those that do cause genital warts, unlike other wart-causing HPVs, are highly contagious and are passed on through sexual contact with a person who is infected. HPV types 6 and 11 cause the majority of genital warts.

It is estimated that over 60% of people who have sexual relations with a person who has genital warts will become infected and develop them too. Generally, the genital warts will appear about three months after infection - however, in some cases there may be no symptoms for many years.

A study found that 10% of young women in England have been infected with one or more strains of the human papillomavirus by the age of 16. Another study found that 26% of US girls aged 14 to 19 have at least one sexually transmitted disease.

What are the risk factors for genital warts?

  • Having unprotected sex
  • Having unprotected sex with many different people
  • Having sex with a person whose sexual history is unknown
  • Starting sexual relations at a young age (however, this study seems to contradict this)
  • Having stress and other viral infections (such as HIV or herpes) at the same time
A US study found that women with certain gene variations appear to be protected against cervical cancer.

What are the complications of genital warts?

  • Cancer - HPV infection has been closely association with cervical cancer, as well as cancer of the vulva, anus and penis. The majority of cervical cancers globally are caused by HPV infection. Even though not all HPV infections lead to cervical cancer, it is crucial for a woman's long-term health that she has regular Pap tests. This study revealed that some HPV infections are also closely linked to head and neck cancers. Another report says that HPV is also linked to oral cancer.

  • Pregnancy problems - pregnant women who have genital warts may have problems urinating. If there are warts on the vaginal wall her vaginal tissues may stretch less during childbirth. There is a very small risk that a mother with genital warts when she gives birth may cause the baby to have warts in his/her throat (laryngeal papillomatosis) - when this does happen surgery may be needed to prevent the airway from becoming obstructed.

    Hormonal changes that occur during pregnancy may cause genital warts to grow, bleed, or increase in number.

  • Diagnosing genital warts

    • Women - genital warts may exist on the vulva, cervix, upper thighs, inside the vagina, on the anus, and inside the anus. (vulva = lips around the opening of the vagina. Cervix = entrance to the uterus or womb)

    • Men - genital warts may exist on the penis, scrotum, urethra, upper thighs, on the anus, and inside the anus. (urethra = tube than urine passes through. scrotum = sac that holds the testicles)
    If oral sex raises the risk of genital warts developing in the mouth or throat.

    A patient needs to be examined by a health care professional - this could be a nurse - to confirm a diagnosis of genital warts. In the UK people can either go to their GP (general practitioner, primary care physician), a GUM (genitourinary medicine) clinic, or a sexual health clinic.

    Even if a person's partner has no symptoms it is still possible to have genital warts. People should go for a checkup if:
    • The patient or partner has genital warts symptoms
    • The patient recently had unprotected sex with a new partner
    • The patient or partner have had unprotected sex with somebody else
    • The patient's partner tells him/her that he/she has an STD
    • The patient has an STD
    • The patient is pregnant
    • The patient is trying to get pregnant
    A healthcare professional can usually diagnose genital warts if any are visible. The examination may involve looking inside the vagina or anus. On rare occasions a biopsy of the wart may be taken.

    Sometimes, even if no warts are detected, the doctor or nurse may ask the patient to come back at a later date. Visible warts may not appear straight after infection.

    What do genital warts look like?

    • They may appear as flesh-colored or gray swellings (bumps) in the patient's genital area.

    • If several are clustered together they may appear to have a cauliflower shape.

    • Some genital warts are so tiny that they can only be detected with a colposcopic exam of the cervix and vagina or a Pap smear.

    What is the treatment for genital warts?

    Doctors will only treat patients who have visible warts. The type of treatment depends on:
    • The location of the warts
    • How many warts there are
    • What the warts look like
    Treatment is aimed at getting rid of the visible warts and lowering the number of viruses present. If the amount of viruses can be lowered the patient's immune system has a better chance of fighting them off. The following treatments are effective in getting rid of visible warts:
    • Topical medication - a cream or liquid is applied directly onto the warts for a few days each week. This may be either administered by the patient at home or at a clinic - it depends on the kind of treatment. Treatment may continue for several weeks.

    • Cryotherapy - the warts are frozen, often with liquid nitrogen. The freezing causes a blister to form around the wart. As the skin heals the lesions slide off, allowing new skin to appear. Sometimes repeated treatments are needed.

    • Electrocautery - electric current is used to destroy the wart. The patient will generally be given a local anesthetic.

    • Surgery - the wart will be cut out (excised). A local anesthetic will be used for this.

    • Laser treatment - an intensive beam of light is used to destroy the wart.
    It is not uncommon for doctors to use more than one treatment at the same time. Treatments are not painful, but may sometimes be uncomfortable, with some soreness and irritation for one or two days. Ordinary over-the-counter painkillers may be taken by patients after treatment. Some patients who feel sore may find that a warm bath helps. After the bath make sure you dry the affected area completely. Do not use bath oils, soap, creams, etc., until well after the treatment is completed.

    Over-the-counter treatments for ordinary warts (non genital warts) are not suitable for genital warts treatment.

    Genital warts will usually eventually go away, even if left untreated. They do sometimes get bigger in size and populate in larger numbers, without treatment. Experts say that untreated genital warts are not harmful for to the health of the infected person, but they may be uncomfortable and not look appealing. However, treating warts greatly reduces the risk of passing them on to another person.

    A US Study found that male circumcision cuts the risk of genital herpes and human papillomavirus (HPV) infection, but not syphilis. However, the USA has - by far - the highest rate of male circumcision in the developed world, and also a much higher rate of sexually transmitted diseases among males.

    Why are Pap tests important?

    A pap test is also known as a Pap smear. It is a procedure to test for cervical cancer in women. The test involves collecting cells from the woman's cervix. Cervical cancer is a possible complication of HPV infection.

    Women should have regular pelvic exams and Pap tests. These also help detect cervical and vaginal changes which may be triggered by genital warts.

    Experts say that a woman should have a Pap test either at the age of 21 or within three years of having sex, whichever comes first. Women who have had genital warts should have a Pap test every three to six months.

    There is a greater chance of curing a woman's cervical cancer if it is detected and treated early. A Pap smear can also detect changes in the woman's cervical cells that may indicate a higher probability of cancer developing in future.
    Continue to Read more ...

    What Is Hepatitis? Symptoms, Causes and Treatments

    The word hepatitis comes from the Ancient Greek word hepar (root word hepat) meaning 'liver', and the Latin itis meaning inflammation. Hepatitis means injury to the liver with inflammation of the liver cells.

    What is the liver?

    The liver is the largest gland in the human body. It weighs approximately 3 lb (1.36 kg). It is reddish brown in color and is divided into four lobes of different sizes and lengths. It is also the largest internal organ (the largest organ is the skin). It is below the diaphragm on the right in the thoracic region of the abdomen. Blood reaches the liver through the hepatic artery and the portal vein. The portal vein carries blood containing digested food from the small intestine, while the hepatic artery carries oxygen-rich blood from the aorta.

    The liver is made up of thousands of lobules, each lobule consists of many hepatic cells - hepatic cells are the basic metabolic cells of the liver.

    The liver has a wide range of functions, including:
    • Detoxification (filters harmful substances form the blood, such as alcohol)
    • Stores vitamins A, D, K and B12 (also stores minerals)
    • Protein synthesis (makes certain amino acids - the building blocks of proteins)
    • The production of biochemicals needed for digestion, such as bile
    • Maintains proper levels of glucose in the blood
    • Produces 80% of your body's cholesterol (cholesterol is vital)
    • The storage glycogen (also converts glucose to glycogen)
    • Decomposing red blood cells
    • Synthesizing plasma protein
    • The production of hormones
    • Produces urea (the main substance of urine)
    Hepatitis can heal on its own with no significant consequence, or it can progress to scarring of the liver. Acute hepatitis lasts under six months, while chronic hepatitis lasts longer.

    Most liver damage is caused by 3 hepatitis viruses, called hepatitis A, B and C. However, hepatitis can also be caused by alcohol and some other toxins and infections, as well as from our own autoimmune process (the body attacks itself).

    About 250 million people globally are thought to be affected by hepatitis C, while 300 million people are thought to be carriers of hepatitis B.

    Not all forms of hepatitis are infectious. Alcohol, medicines, and chemical may be bad for the liver and cause inflammation. A person may have a genetic problem, a metabolic disorder, or an immune related injury. Obesity can be a cause of liver damage which can lead to inflammation. These are known as non-infectious, because they cannot spread form person-to-person.

    How many types of hepatitis are there?

    There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E - plus types X and G.
    • Hepatitis A - this is caused by eating infected food or water. The food or water is infected with a virus called HAV (Hepatitis A Virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full recovery - it does not lead to chronic disease.

    • Hepatitis B - this is an STD (sexually transmitted disease). It is caused by the virus HBV (Hepatitis B Virus) and is spread by contact with infected blood, semen, and some other body fluids. You get Hepatitis B by:

      • Unprotected sexual intercourse with an infected person (unprotected sex means without using a condom) Using a syringe that was previously used by an infected person (most commonly happens with drug addicts and people who inject steroids).

      • Having your skin perforated with unsterilized needles, as might be the case when getting a tattoo, or being accidentally pricked. People who work in health care risk becoming infected by accident in this way. Sharing personal items, such as a toothbrush or razor, with an infected person.

      • A baby can become infected through his mother's milk if she is infected.

      • Being bitten by someone who is infected.
      The liver of a person infected with Hepatitis B swells. The patient can suffer serious liver damage due to infection, resulting in cancer. For some patients the hepatitis becomes chronic (very long-term or lifelong). Donated blood is always tested for Hepatitis B.

    • Hepatitis C - Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It is caused by the virus HCV (Hepatitis C Virus). The liver can swell and become damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increased in people with cirrhosis and only 20% of hep C patients get cirrhosis. Feces is never a route of transmission in hepatitis C. Donated blood is also tested for Hepatitis C.

    • Hepatitis D - only a person who is already infected with Hepatitis B can become infected with Hepatitis D. It is caused by the virus HDV (Hepatitis D Virus). Infection is through contact with infected blood, unprotected sex, and perforation of the skin with infected needles. The liver of a person with Hepatitis D swells.

    • Hepatitis E - a person can become infected by drinking water that contains HEV (Hepatitis E Virus). The liver swells but there is no long-term consequence. Infection is also possible through anal-oral sex.

    • Hepatitis X - if a hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called Hepatitis X. In other words, hepatitis of an unknown virus.

    • Hepatitis G - this is a type of hepatitis caused by the Hepatitis G virus (HGV). Usually there are no symptoms. When there are symptoms they are very mild.

    What are the signs and symptoms of hepatitis?

    Many people with Hepatitis experience either mild symptoms or none at all. Remember that an infected person's feces are always infectious to other people. When symptoms appear, they usually do so about 15 to 180 days after the person has become infected.

    The acute phase of hepatitis - symptoms

    The initial phase of hepatitis is called the acute phase. The symptoms are like a mild flu, and may include:
    • Diarrhea
    • Fatigue
    • Loss of appetite
    • Mild fever
    • Muscle or joint aches
    • Nausea
    • Slight abdominal pain
    • Vomiting
    • Weight loss
    The acute phase is not usually dangerous, unless it develops into the fulminant or rapidly progressing form, which can lead to death.

    As the patient gets worse, these symptoms may follow:
    • Circulation problems (only toxic/drug-induced hepatitis)
    • Dark urine
    • Dizziness (only toxic/drug-induced hepatitis)
    • Drowsiness (only toxic/drug-induced hepatitis)
    • Enlarged spleen (only alcoholic hepatitis)
    • Headache (only toxic/drug-induced hepatitis)
    • Hives
    • Itchy skin
    • Light colored feces, the feces may contain pus
    • Yellow skin, whites of eyes, tongue (jaundice)
    Patient outcomes after the acute phase depend on various factors, especially the type of hepatitis.

    Treatments for hepatitis

    • Hepatitis A - There is no treatment specifically for hepatitis A. Doctor will advise the patient to abstain from alcohol and drugs during the recovery. The vast majority of patients with Hepatitis A will recover spontaneously.

    • Hepatitis B - A patient with Hepatitis B needs to rest. He will require a diet that is high in protein and carbohydrate - this is to repair damaged liver cells, as well as to protect the liver. If this is not enough, the doctor may prescribe interferon. Interferon is an antiviral agent.

    • Hepatitis C - A patient with Hepatitis C will be prescribed pegylated interferon and ribavirin.

    • Hepatitis D or E - So far, there is no effective treatment for either Hepatitis D or E.

    • Non-Viral Hepatitis - If the patient has non-viral hepatitis, the doctor needs to remove the harmful substance. It will be flushed out of the stomach by hyperventilation or induced vomiting. Patients with drug-induced hepatitis may be prescribed corticosteroids.

    How to prevent hepatitis

    How to prevent Hepatitis A
    • Wash your hands with soap after going to the toilet
    • Only consume food that has just been cooked
    • Only drink commercially bottled water, or boiled water if you unsure of local sanitation
    • Only eat fruits that you can peel if you are somewhere where sanitation is unreliable
    • Only eat raw vegetables if you are sure they have been cleaned/disinfected thoroughly
    • Get a vaccine for Hepatitis A if you travel to places where hepatitis may be endemic
    How to prevent Hepatitis B
    • Tell the partner if you are a carrier or try to find out whether he/she is a carrier
    • Practice safe sex
    • Only use clean syringes that have not been used by anyone else
    • Do not share toothbrushes, razors, or manicure instruments
    • Have a Hepatitis B series of shots if you are at risk
    • Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.)
    How to prevent Hepatitis C
    • If you are infected do not let others share your toothbrush, razor, manicure equipment
    • If you are infected cover open wounds
    • Do not share needles, toothbrushes, or manicure equipment
    • If your skin is to be pierced, make sure equipment is well sterilized (tattoo, etc.)
    • Go easy on the alcohol
    • Do not share drug equipment
    How to prevent Hepatitis D
    • Use the same guidelines as for Hepatitis B. Only a person who is infected with Hepatitis B can become infected with Hepatitis D.
    How to prevent Hepatitis E
    • Do the same as you would to protect yourself from Hepatitis A infection.
    How to prevent Alcoholic Hepatitis
    • Go easy on the alcohol, or abstain from consuming alcohol
    How to prevent Toxic/Drug Induced Hepatitis
    • Make sure you know about the lethal contents of all chemicals
    • Make sure the spray is not pointing at you
    • Make sure you wear protective gear if you have to
    Continue to Read more ...

    What Is a Nosebleed? What Causes Nosebleeds?

    The medical term for nosebleed is epistaxis. We can also say nasal hemorrhage. The human nose, and those of many animals are rich in blood vessels. Because of the position of the nose - right in the middle of the face - and all its blood vessels, most of us will have had at least one nosebleed at some time during our lives.

    According to Medilexicon's medical dictionary, epistaxis means "Bleeding from the nose". Nosebleeds are seldom a cause for alarm but can be life threatening in rare cases.

    Spontaneous nosebleeds are fairly common, especially in children. When the mucous membrane (a mucus-secreting tissue) inside the nose dries, crusts, or cracks (the skin splits open) and is then picked, it is likely to bleed.

    Because the nose is full of blood vessels and is inconveniently situated in the middle of the face, any minor injury to the face can cause the nose to bleed profusely.

    Nosebleeds are also common in people taking anti-coagulants (blood-thinning medications, such as Aspirin), as well as in older people whose blood may take longer to clot. If the patient is taking anti-coagulants, has hypertension (high blood pressure), or a blood-clotting disorder, the bleeding may be harder to stop and could last over 20 minutes.

    The English word "epistaxis" is derived from the ancient Greek word epistazo. The prefix epi means "above, upon or besides" and stazo means "to drip from the nostril"; hence, the Greek word epistazo, which means "to bleed from the nose".

    There are two types of nosebleeds:

    • Anterior nosebleed

      The bleeding originates from the lower nasal septum (nasal partition - the wall between the two nostrils). This part of the nose contains many delicate blood vessels that receive blood from the carotid arteries, two principal arteries in the front of the neck that supply blood to the head and neck. The slightest knock or bump can cause these vessels to bleed. Anterior nosebleeds are easily treated at home. This is likely to be the type of nosebleed seen in a child.

    • Posterior nosebleed

      The bleeding originates further back and higher up the nose where artery branches supply blood to the nose, which is why it is heavier. Posterior nosebleeds are often more serious than anterior nosebleeds and may require medical attention. They are more common in adults.

    What causes nosebleeds?

      Causes of anterior nosebleeds
      Sometimes, the cause of anterior nosebleeds is idiopathic (unknown). However, common causes include:

      • Blowing your nose hard - also blowing your nose too frequently.

      • Picking the inside of your nose - especially if this is done often, if the fingernails are long, and if the inside of the nose is already irritated or tender.

      • A knock or blow to the nose - could damage the delicate blood vessels of the mucous membrane.

      • Sinusitis - an inflammation of the sinuses (air-filled cavities of the bone and skull surrounding the nose)

      • A cold or flu - this could be for various reasons. Partly because people with colds and flu blow their nose more often - nose blowing raises the risk of nosebleeds. The inside of the nose may be irritated and tender during a vital infection, making it more susceptible to bleeding.

      • Deviated septum - when the wall separating the two nostrils is off center, or deviated.

      • Climate - hot climates with low humidity or changes from bitter cold to warm, dry climates can cause drying and cracking inside the nose, which can lead to a nosebleed.

      • High altitude - as altitude increases, the availability of oxygen decreases, making the air thinner and drier. The dryness could cause the nose to bleed.

      • Nasal allergies.

      • Excessive use of certain kinds of medications, such as anticoagulants (blood thinners) or non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen.

      • Liver disease can interfere with blood clotting and result in frequent and/or severe nosebleeds.

      • Excessive use of illegal drugs, such as cocaine.

      Causes of posterior nosebleeds:

      • Hypertension (high blood pressure)
      • Nasal surgery (surgery of the nose)
      • Calcium deficiency
      • Exposure to chemicals that may irritate the mucous membrane

      Posterior nosebleeds are sometimes symptoms of other conditions, such as blood diseases (e.g. leukemia or hemophilia) or tumors.

    What are the risk factors for a nosebleed?

    A risk factor is something that increases the chances of developing a disease or condition. For example, smoking increases the risk of developing lung cancer. Therefore smoking is a risk factor for lung cancer.

    Common risk factors for nosebleeds are:
    • Infection
    • Self-induced minor injuries such as picking the nose
    • Hypertension (high blood pressure)
    • Alcohol abuse
    • Inherited bleeding disorders
    • Certain contact sports, such as martial arts, boxing, and rugby

    What are the signs and symptoms of a nosebleed?

    The main symptom of a nosebleed is blood coming out of the nose, which can range from light to heavy. The blood comes out of either nostril (usually only one nostril is affected).

    If the nosebleed occurs while you are lying down, you may feel liquid in the back of your throat before the blood actually comes out of your nose. Do not swallow the blood as it could cause you to become nauseous and vomit.

    Severe nosebleeds require immediate medical attention. Things to watch for include heavy bleeding, palpitations (an irregular heartbeat), swallowing large amounts of blood that cause you to vomit, shortness of breath, or turning pale.

    What are the treatment options for a nosebleed?

    The first step to stopping any nosebleed is always the same: stop the bleeding. This can be done by complying with the following steps:
    • Sit down and pinch the soft parts of your nose firmly, breathing through your mouth.

    • Lean forward, not backward, in order to prevent the blood from draining into your sinuses and throat, which can result in inhaling the blood or gagging.

    • Sit upright so that your head is higher than your heart to reduce blood pressure and consequently stop further bleeding.

    • Continue putting pressure on the nose, leaning forward, and sitting upright for a minimum of five minutes and up to 20 minutes so that the blood clots. If bleeding persists for more than 20 minutes, medical attention is required.

    • Apply an ice pack to your nose and cheek to soothe the area and try not to strain yourself for the next few days.
    It is recommended that you seek medical attention if you suffer from frequent nosebleeds (it could be an indication of an underlying problem), had an injury to the head, or take anticoagulants (blood thinning medications) and the bleeding does not stop.

    If your physician suspects there is an underlying cause, such as hypertension (high blood pressure), anemia, or a nasal fracture, they may run further tests, such as checking your blood pressure and pulse rate or an X-ray, before recommending a suitable treatment option.

    A broken nose can permanently change the shape of your nose. If this is the case, a physician can attempt to set the nose back in place manually, but sometimes surgery is required.

    There is an array of treatment options physicians have to offer. Some of them include:
    • Nasal packing - stuffing ribbon gauze or special nasal sponges as far back into your nose as possible, putting pressure on the source of the bleed.

    • Cautery - a minor procedure that cauterizes (burns) the area where the bleeding is coming from to seal it off; used if the specific blood vessel can be identified. However, the area around the cautery sometimes begins to bleed. Be sure to go over the risks and benefits with your physician.

    • Septal surgery - a surgical procedure to straighten a crooked septum (the wall between the two nose channels), whether it was like that from birth or from an injury. This can reduce the occurrence of nosebleeds. Your physician will be able to explain the procedure and its risks and benefits in detail.

    • Ligation - a "last resort" surgical procedure that involves tying the ends of the identified blood vessels causing the bleeding. Sometimes even the artery from which the blood vessels stem is tied off. If the source of the bleed is further back, more major surgery may be required. Be sure to go over details with your physician.

    How can a nosebleed be prevented?

    • Avoid picking your nose.

    • Apply lubricating ointment, such as petroleum jelly (Vaseline), inside your nose; especially in children whose nosebleeds are most commonly attributed to crusting inside the nostrils.

    • Avoid blowing your nose too hard, or too frequently.

    • Use a humidifier at high altitudes or in dry climates.

    • If you are prescribed anticoagulants (blood-thinning medications) discuss your concerns with your physician.

    • To prevent recurring nosebleeds, avoid exerting or straining yourself for a minimum of one week after the previous one.
    Continue to Read more ...

    What Is Appendicitis? What Causes Appendicitis?

    Appendicitis is a condition in which the appendix becomes swollen, inflamed, filled with pus. The appendix is a small pouch shaped like a small finger. It is on the right side of the abdomen, connected to the colon.

    Experts are not sure what the appendix is for. Charles Darwin theorized that even though the appendix has no use for modern humans, it might have been an organ our ancestors used to digest plants. Recent studies indicate that it may be a dedicated environment for friendly bacteria which facilitate digestion and fight infection.

    Appendicitis generally strikes people aged between 10 and 30, but it can affect people of any age. Approximately 250,000 appendectomies are performed in the United States each year to treat apendicitis.

    What causes appendicitis?

    Experts believe there are two likely causes:
    • Infection - a stomach infection may have found its way to the appendix.

    • Obstruction - a hard piece of stool may have got trapped in the appendix. The bacteria in the trapped stool may then have infected the appendix.
    Scientists at the University of Calgary, Canada, found a link between high pollution levels and a higher incidence of appendicitis.

    What are the symptoms of appendicitis?

    Initially, some pain can be felt anywhere in the stomach area, but later, as it intensifies, its location becomes more defined in the lower right-hand side of the abdomen - an area known as McBurney point.

    The following symptoms are common:
    • Progressively worsening pain
    • Coughing or sneezing is painful
    • Nausea
    • Vomiting
    • Diarrhea
    • Inability to pass gas (break wind, fart)
    • Fever
    • Constipation
    • Loss of appetite
    Anybody who experiences a progressively worsening pain in the abdomen should seek medical attention. Other conditions may have similar symptoms, such as urinary tract infection; even so, they all require urgent medical attention.

    Diagnosing appendicitis

    Diagnosing appendicitis can be challenging. Half of all patients who have appendicitis do not have typical symptoms - the pain may be located in different parts of the body. Other conditions may have very similar symptoms, such as gastroenteritis, urinary tract infection, ectopic pregnancy, Crohn's disease, or a kidney stone.

    Not everybody has their appendix in exactly the same place - some are located behind the colon, behind the liver, or in the pelvis.

    A GP (general practitioner, primary care physician) will examine the patient and ask some questions related to symptoms. He/she will apply pressure to the area to see if it worsens the pain.

    If typical appendicitis signs and symptoms are detected, the GP will diagnose appendicitis. If they are not, further tests will be ordered:
    • A blood test - to determine whether there is an infection.

    • Urine test - this will identify a kidney or bladder infection. Researchers at the Proteomics Center at Children's Hospital Boston, USA, demonstrated that a protein detectable in urine might serve as a biomarker for appendicitis.

    • An MRI, CT or ultrasound scan - to view a 3-D image of the appendix and see whether it is inflamed (swollen). Color Doppler ultrasound, not CT, should be the first imaging examination for adult patients with suspected acute appendicitis, say researchers at Rambam Health Care Campus in Haifa, Israel.
    Sometimes a decision will be made to surgically remove the appendix because it is too risky to wait around for the tests to confirm the diagnosis.

    Researchers at the University of California, Los Angeles, found that pregnant women suspected of having appendicitis are often misdiagnosed and undergo unnecessary appendectomies that can result in early delivery or loss of the fetus.

    What is the treatment for appendicitis?

    Doctors may decide to treat the patient with antibiotics. This is rare and the infection would need to be very mild. In most cases an appendectomy will be performed - the appendix will be surgically removed.
    • Laparoscopy (keyhole surgery)

      Laparoscopic surgery is also known as minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery. The surgeon inserts a very thin tube (laparoscope), which has a tiny video camera and its own lighting, into the abdomen through a cannula. A cannula is a hollow instrument.

      Thanks to the tiny video camera, the surgeon can view the insides of the abdomen with magnification on a monitor. Tiny instruments respond to the movements of the surgeon's hands and the appendix is removed through small abdominal incisions.

      Thanks to the precision of the operation, minimal loss of blood, and the need for very small incisions, the patient recovers much faster and with less scarring, compared to traditional open surgery. In most cases it is no longer necessary to open the patient up with a large incision.

      However, a report in the Journal of the American College of Surgeons suggests that a traditional, open appendectomy may be preferable to a less-invasive laparoscopic appendectomy for most patients with acute appendicitis, contrary to recent trends. Apparently, laparoscopic surgery increases costs and may raise the risk of complications in the majority of appendectomy patients.

    • Sometimes traditional surgery is necessary

      If the appendix has ruptured and infection has spread, or if there is an abscess, a larger incision will be made so that the area inside the abdominal cavity can be cleaned.

      Traditional appendectomy is also used if the patient has tumors in the digestive system, if a woman is in her third trimester of pregnancy, or if the patient had many abdominals surgeries before.

      After the operation the patient will be given antibiotics intravenously.

    • Delaying surgery

      If the patient has had symptoms for at least five days the doctor may recommend a course of antibiotics in order to shrink the appendix and clear up surrounding infection, and perform surgery later.

      If there is an abscess the doctor may decide to drain it first and operate at a later date.

    What are the complications of appendicitis?

    • Peritonitis

      If the appendix ruptures and releases the infection into the abdomen the patient may develop peritonitis. The peritoneum will become inflamed. The peritoneum is the membrane that lines the abdominal cavity and covers most of the abdominal organs. Peritonitis causes the bowels to shut down - bowel movements will stop and the bowel will become blocked. The patient will develop a fever and could go into shock. Peritonitis requires urgent treatment.

    • Abscess

      If the infection seeps out of the appendix and mixes with intestinal contents, it may form an abscess. If the abscess is not treated it can cause peritonitis. Sometimes abscesses are treated with antibiotics. Often they are surgically drained with the aid of a tube which is placed into the abdomen.


    Countries with lower incidences of appendicitis also tend to have more fiber in their people's diets, compared to other countries. It would therefore be logical to assume that a high fiber diet may help reduce your chances of developing appendicitis. One theory is that with a high fiber diet the resulting softer stools are less likely to get trapped in the appendix.
    Continue to Read more ...

    What Is Vitamin B12 Deficiency? What Causes Vitamin B12 Deficiency?

    Vitamin B12 is crucial for the proper formation of red blood cells, as well as the health of nerve tissue. Vitamin B12 deficiency, or B12 deficiency, if left untreated can result in anemia, as well as irreversible nerve and brain damage.

    A lack of vitamin B12 in the blood can lead to a blood disorder called pernicious anemia. Those with the disorder are unable to produce enough of a protein substance - IF (intrinsic factor) - in their stomach that allows their body to absorb vitamin B12. Vitamin B12 is injected straight into the patient's blood, therefore bypassing the stomach which is unable to absorb it properly.

    Apart from creating red blood cells and keeping our nervous system healthy, we also need vitamin B12 in order to be able to absorb folic acid. Vitamin B12 also helps to release energy.

    According to Medilexicon's medical dictionary:
      Vitamin B12 is a "generic descriptor for compounds exhibiting the biologic activity of cyanocobalamin; the antianemia factor of liver extract that contains cobalt, a cyano group, and corrin in a cobamide structure. Several substances with similar formulas and with the characteristic hematinic action have been isolated and designated: B12a, hydroxocobalamin; B12b, aquacobalamin; B12c, nitritocobalamin; B12r, cob(II)alamin; B12s, cob(I)alamin; B12III, factors A and V1a (cobyric acid) and pseudovitamin B12. Vitamins B12a and B12b are known to be tautomeric compounds; B12b has been obtained from cultures of Streptomyces aureofaciens; B12c has been obtained from cultures of Streptomyces griseus and is distinguishable from B12 by differences in its absorption spectrum. The physiologically active vitamin B12 coenzymes are methylcobalamin and deoxyadenosinecobalamin. A deficiency of vitamin B12 is often associated with certain methylmalonic acidurias."

    What are the signs and symptoms of vitamin B12 deficiency?

    A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

    Vitamin deficiencies tend to develop gradually and slowly; sometimes over a period of several years. At first, signs and symptoms may be subtle - but as time goes by they become more noticeable.

    Our cells need vitamin B12 in order to multiply properly. We produce millions of red blood cells every minute. A vitamin B12 deficiency affects the production of red blood cells. Subsequently, the red blood cell count drops and the patient develops anemia. The most common symptoms of anemia are:
    • Fatigue (tiredness)
    • Panting (shortness of breath)
    • Palpitations (disagreeable sensations of irregular and/or heavy beating of the heart)
    B12 deficiency anemia may also be caused by a lack of intrinsic factor - pernicious anemia. The patient's digestive system cannot absorb B12 properly. Signs and symptoms of pernicious anemia may include:
    • Fatigue
    • Shortness of breath
    • Palpitations
    Anemia may also have the following signs and symptoms:
    • A sore mouth and/or tongue
    • Weight loss
    • Pale or yellowish skin
    • Diarrhea (sporadic)
    • Menstrual problems
    • Higher susceptibility to infections
    If the deficiency continues untreated the patient may have the following neurological signs and symptoms:
    • Tingling or numbness of the fingers
    • Tingling or numbness of the toes
    • General muscle weakness
    • Difficulty walking properly (staggering)
    • Irritability
    • Confusion
    • Forgetfulness
    • Tender calves

    What are the causes of vitamin B12 deficiency?

    • Causes of pernicious anemia - pernicious anemia is caused by an autoimmune disease; the person's own immune system attacks good parts of the body, as if they were bacteria or viruses.

      The immune system of patients with pernicious anemia creates antibodies which attack the lining of the stomach, damaging cells that produce intrinsic factor. Intrinsic factor is a substance that is secreted by the gastric mucous membrane (lining of the stomach) and is vital for the absorption of vitamin B12 in the intestines. If the production of intrinsic factor is undermined, vitamin B12 cannot be absorbed into the body properly.

    • Bowel problem - patients with Crohn's disease, as well as people who have had their bowels surgically shortened, may have problems absorbing vitamin B12 into their bloodstream. Short bowel syndrome is a term used for people who have had their bowel shortened (half or more of their small intestine removed). Patients with short bowel syndrome typically experience diarrhea, cramping and heartburn. It is not uncommon for individuals to become malnourished because what is left of the small intestine cannot absorb adequate quantities of vitamins, water and other nutrients.

    • Vegan diet - some people who follow a vegan diet may suffer from B12 deficiency if they do not eat fortified foods, or some types of yeast.

    How is B12 deficiency diagnosed?

    A GP (general practitioner, primary care physician) will interview the patient and carry out a physical examination, looking out for such signs as an accelerated pulse and pale/yellowish skin.
    • Blood test - to determine whether the red blood cell count is low. The appearance of the red blood cells is also checked, because they may have an unusual shape. A blood test can also determine what the level of B12 is.

      The GP may also want to check the patient's blood intrinsic factor antibody levels, in order to determine whether the person has pernicious anemia.

    • Bone marrow biopsy - the aim here is to rule out other possible causes of red cell abnormalities or anemia.

    What are the treatment options for B12 deficiency?

    Hydroxocobalamin injections - this is a form of B12. It is injected into a muscle every two to four days. After about six injections the patient should have a good store of B12.

    In the majority of cases the patient will notice significant improvements in symptoms soon after receiving injections.

    Annual blood tests are common, to monitor the success of treatment.

    Most patients require booster injections of B12 every three months for the rest of their lives.

    Prevention of B12 deficiency

    • Vegans and some vegetarians - vegetarians who do not eat eggs, as well as vegans should make sure their B12 intake is adequate. There are various breakfast cereals which are fortified with vitamin B12. Some brands of nutritional yeast are also good sources of B12. Some types of soy milk are fortified with B12.

    • People who eat meat and/or fish - a balanced diet containing fish, meat and dairy foods should have enough B12 for human requirements.
    There is no way to prevent pernicious anemia caused by an autoimmune condition.
    Continue to Read more ...

    What Is a CT Scan? What Is a CAT Scan?

    A CT scan stands for Computed Tomography scan. It is also known as a CAT (Computer Axial Tomography) scan. It is a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device (the machine) is called a CTG scanner; it is a large machine and uses X-rays. It used to be called an EMI scan, because it was developed by the company EMI. Undergoing a CT scan is a painless procedure.

    The CT scanner uses digital geometry processing to generate a 3-dimensional (3-D) image of the inside of an object. The 3-D image is made after many 2-dimensional (2-D) X-ray images are taken around a single axis of rotation - in other words, many pictures of the same area are taken from many angles and then placed together to produce a 3-D image. The Greek word tomos means "slice", and the Greek word graphein means "write".

    How does a CT scan work?

    A CT scanner emits a series of narrow beams through the human body as it moves through an arc, unlike an X-ray machine which sends just one radiation beam. The final picture is far more detailed than an X-ray one.

    Inside the CT scanner there is an X-ray detector which can see hundreds of different levels of density. It can see tissues inside a solid organ. This data is transmitted to a computer, which builds up a 3-D cross-sectional picture of the part of the body and displays it on the screen.

    Sometimes a contrast dye is used because it shows up much more clearly on the screen. If a 3-D image of the abdomen is required the patient may have to drink a barium meal. The barium appears white on the scan as it travels through the digestive system. If images lower down the body are required, such as the rectum, the patient may be given a barium enema. If blood vessels are the target images the barium will be injected.

    The accuracy and speed of CT scans may be improved with the application of spiral CT. The X-ray beam takes a spiral path during the scanning - it gathers continuous data with no gaps between images. For a spiral scan of the chest, for example, the patient will be asked to hold his/her breath for a few seconds.

    What is a CT scan like for the patient?

    Most places will provide the patient with a gown. He/she will need to undress, usually down to their underwear, and put the gown on. If the place does not provide a gown the patient should wear loose-fitting clothes.

    Any woman who suspects she may be pregnant should tell her doctor beforehand.

    Doctors may ask the patient to fast (eat nothing) and even refrain from consuming liquids for a specific period before the scan.

    The patient will be asked to lie down on a motorized examination table, which then goes into the giant doughnut-like machine. The couch with the patient goes into the doughnut hole.

    Some patients may be given a contrast dye or substance which is either swallowed, given as an enema, or injected. This improves the picture of some blood vessels or tissues. If a patient is allergic to contrast material he/she should tell the doctor beforehand. There are some medications that reduce allergic reactions to contrast materials.

    As metal interferes with the workings of the CT scanner the patient will need to remove all jewelry and metal fastenings. In the majority of cases the patient will lie on his/her back, facing up. But sometimes it may be necessary to lie face-down or sideways.

    After the machine has taken one X-ray picture, the couch will move slightly, and then another picture is taken, etc. The patient needs to lie very still for best results.

    During the scan everybody except for the patient will leave the room. The radiographer will still be able to communicate with the patient, and vice-versa, through an intercom. If the patient is a child, a parent or adult might be allowed to stand or sit nearby - that person will have to wear a lead apron to prevent radiation exposure.

    Although the scan is painless, some people experience discomfort for having to be completely still for what for them is a long time. If you find the whole experience is going to be stressful you can ask your doctor for a mild sedative.

    When is a CT scan used?

    CT scanning is useful to get a very detailed 3-D image of certain parts of the body, such as soft tissues, the pelvis, blood vessels, the lungs, the brain, abdomen, and bones.

    It is often the preferred method of diagnosing many cancers, such as liver, lung, and pancreatic cancers. The image allows a doctor to confirm the presence of a tumor. The tumor's size can be measured, plus its exact location, as well as to determine how much the tumor has affected nearby tissue.

    A scan of the head can provide the doctor with important information about the brain - he/she may want to know whether there is any bleeding, swelling of the arteries, or tumors.

    A CT scan will tell the doctor whether the patient has a tumor in his/her abdomen, and whether any internal organs in that area are swollen or inflamed. It will reveal whether there are lacerations of the spleen, kidneys or liver.

    As a CT scan can detect abnormal tissue it is a useful device for planning areas for radiotherapy and biopsies.

    A CT scan can also provide valuable data on the patient's vascular condition. Vascular refers to blood flow. Many vascular conditions can lead to stroke, kidney failure, and even death. It can help a doctor asses bone diseases, bone density, and the state of the patient's spine.

    A CT scan can reveal vital data about injuries to the patient's hands, feet and other skeletal structures - even small bones can be seen clearly, as well as their surrounding tissue.

    Who analyzes the image?

    A radiologist who is trained in supervising and interpreting radiology examinations will analyze the images and send his/her report to the patient's doctor. A radiologist is a doctor.

    What is the difference between a radiologist and a radiographer (or radiologic technician)?

    Radiology is a branch of medicine. A radiologist is a fully qualified doctor who specializes in radiology - MRI, CT scans, radiographs, nuclear medicine scans, mammograms and sonograms.

    A radiologic technologist or radiographer is the X-ray technician. The person who takes the x-rays.

    The radiologist is a doctor; the radiographer is not a doctor.

    What is the difference between MRI and CT scans?

    • A CT scan uses X-rays. An MRI does not use X-rays; it uses magnets and radio waves.

    • A CT scan does not show tendons and ligaments, an MRI does.

    • MRI is better for looking at the spinal cord.

    • A CT scan is better for looking at cancer, pneumonia, abnormal chest x-rays, bleeding in the brain (especially from injury).

    • A brain tumor is better seen on MRI.

    • A CT scan shows organ tear and organ injury more quickly - so it may be the best choice for accident victims.

    • Broken bones and vertebrae are better seen on CT scan.

    • CT scans are better at visualizing the lungs and organs in the chest cavity between the lungs.
    Continue to Read more ...

    What Is Dyspraxia? How Is Dyspraxia Treated?

    A person with dyspraxia has problems with movement and coordination. It is also known as "motor learning disability". Somebody with dyspraxia finds it hard to carry out smooth and coordinated movements. Dyspraxia often comes with language problems, and sometimes a degree of difficulty with perception and thought. Dyspraxia does not affect a person's intelligence, but it can cause learning difficulties, especially for children.

    Dyspraxia is also known as Developmental Co-ordination Disorder (DCD), Perceptuo-Motor Dysfunction, and Motor Learning Difficulties. The terms Clumsy Child Syndrome or Minimal Brain Damage are no longer used.

    Developmental dyspraxia is an immaturity of the organization of movement. The brain does not process information in a way that allows for a full transmission of neural messages. A person with dyspraxia finds it hard to plan what to do, and how to do it.

    Experts say that about 10% of people have some degree of dyspraxia, while approximately 2% have it severely. Four out of every 5 children with evident dyspraxia are boys. If the average classroom has 30 children, there is probably one child with dyspraxia in almost each classroom.

    A study carried out by researchers at Orebro University Hospital, Sweden, indicated that poor physical coordination during childhood is linked to a higher risk of obesity later in life.

    The English medical word dyspraxia comes from:

  • The Greek word duspraxia, which means "dyspraxia".

  • The Greek word duspraxia comes from the Greek word Praxis, meaning "to practice; (concretely) an act; by extension, a function".

  • The Greek word Praxis comes from an older Greek word Prassein (prattein), meaning ""to pass through, experience, practice".
  • What are the signs and symptoms of dyspraxia?

    Very early childhood

    The child may take longer than other children to:
    • Sit
    • Crawl (some never go through crawling stage)
    • Walk
    • Speak
    • Stand
    • Become potty trained (get out of diapers/nappies)
    • Build up vocabulary
    • Speak in a clear and articulate way. Many parents of very young children with dyspraxia say they cannot understand what they are trying to say a lot of the time
    Early childhood

    Later on the following difficulties may become apparent:
    • Problems performing subtle movements, such as tying shoelaces, doing up buttons and zips, using cutlery, handwriting.

    • Many will have difficulties getting dressed.

    • Problems carrying out playground movements, such as jumping, playing hopscotch, catching a ball, kicking a ball, hopping, and skipping.

    • Problems with classroom movements, such as using scissors, coloring, drawing, playing jig-saw games.

    • Problems processing thoughts.

    • Difficulties with concentration. Children with dyspraxia commonly find it hard to focus on one thing for long.

    • The child finds it harder than other kids to join in playground games.

    • The child will fidget more than other children.

    • Some find it hard to go up and down stairs.

    • A higher tendency to bump into things, to fall over, and to drop things.

    • Difficulty in learning new skills - while other children may do this automatically, a child with dyspraxia takes longer. Encouragement and practice help enormously.

    • Writing stories can be much more challenging for a child with dyspraxia, as can copying from a blackboard.
    The following are also common at pre-school age:
    • Finds it hard to keep friends
    • Behavior when in the company of others may seem unusual
    • Hesitates in most actions, seems slow
    • Does not hold a pencil with a good grip
    • Such concepts as in, out, in front of are hard to handle automatically
    Later on in Childhood
    • Many of the challenges listed above do not improve, or do so very slightly

    • Tries to avoid sports and PE

    • Learns well on a one-on-one basis, but nowhere near as well in class with other kids around

    • Reacts to all stimuli equally (not filtering out irrelevant stimuli automatically)

    • Mathematics and writing are difficult

    • Spends a long time getting writing done

    • Does not follow instructions

    • Does not remember instructions

    • Is badly organized

    What causes dyspraxia?

    Scientists do not know what causes it. Experts believe the person's nerve cells that control muscles (motor neurons) are not developing correctly. If motor neurons cannot form proper connections, for whatever reasons, the brain will take much longer to process data.

    In some cases dyspraxia can be inherited (Ref: Great Ormond Street Hospital, England).

    One study carried out at Children's Hospital Boston, USA, found that when there was injury to the cerebrum among premature babies; the cerebellum failed to grow to a normal size. The cerebellum grows rapidly late in gestation - much faster than the cerebral hemispheres - premature birth arrests this surge in development. Premature babies with cerebellum problems are likely to have deficits that extend beyond motor, and may benefit from early intervention.

    A study by scientists at the Universite Laval, Canada found that mothers who take omega-3 during the last months of pregnancy will boost their child's motor and cognitive development.

    A study carried out at Johns Hopkins Bloomberg School of Public Health found that fetal heart rates give clues to children's later development during toddler years.

    If a person develops dyspraxia later in life it is usually due to traumas suffered by the brain after a stroke, accident or illness. If a person is born with dyspraxia, it is also known as Developmental Dyspraxia.

    Unfortunately, for many sufferers, there is no obvious cause.

    How is dyspraxia diagnosed?

    A diagnosis of dyspraxia can be made by a clinical psychologist, an educational psychologist, a pediatrician, or an occupational therapist. Any parent who suspects their child may have dyspraxia should see their GP (general practitioner, primary care physician), or a special needs coordinator first.

    When carrying out an assessment, details will be required regarding the child's developmental history, intellectual ability, and gross and fine motor skills:
    • Gross motor skills - this refers to how well the child uses his/her large muscles that coordinate body movement. This includes jumping, throwing, walking, running, and maintaining balance.

    • Fine motor skills - this refers to how well the child can use his/her smaller muscles. Activities which require fine motor skills include tying shoelaces, doing up buttons, cutting out shapes with a pair of scissors, and writing.
    The assessor will need to know when and how developmental milestones, such as walking, crawling, speaking were reached. The child will be screened for balance, touch sensitivity, and variations on walking activities.

    If the assessor, or GP, does not have the necessary training, dyspraxia could be missed altogether and the child will not be referred to a specialist. Training on identifying dyspraxia can be patchy, depending on which part of the world you live in, and also which part of specific countries. The same applies to teachers - in some places they are well trained at identifying potential dyspraxia among their pupils, while in others they are not.

    A new coordination and handwriting test that identifies Developmental Coordination Disorder may identify teenagers who need extra help at secondary school and college.

    What is the treatment for dyspraxia?

    Although dyspraxia is not curable, with time the child can improve. However, the earlier a child is diagnosed, the better and faster his/her improvement will be. The following specialists most commonly help people with dyspraxia:
    • Occupational therapy

      An occupational therapist will first observe how the child manages with everyday functions both at home and at school. He/she will then help the child develop skills specific to activities which may be troublesome.

    • Speech and language therapy

      The speech and language therapist will first carry out an assessment of the child's speech, and then help him/her communicate more effectively.

    • Perceptual motor training

      This involves improving the child's language, visual, movement, and auditory skills. A series of tasks, which gradually becoming more advanced, are set - the aim is to challenge the child so that he/she improves, but not so much that it becomes frustrating or stressful.
    Scientists from the University of Leeds, England, developed a set of practical guidelines for use by teachers, childcare professionals and parents that will help pre-school children with co-ordination difficulties, to improve their dexterity.

    A study carried out by Robert Sekuler, a neuroscientist at Brandeis" Volen Center for Complex Systems, and team, indicates that "What makes one person clumsy and the next person a prima ballerina is a combination of talent and practice" (article not about dyspraxia, but it is interesting).

    Active Play

    Experts say that active play - any play that involves physical activity - which can be outdoors or inside the home, gets the motor activity going in children. Play is a way children learn about the environment and about themselves, and particularly for children aged 3 to 5; it is a crucial part of their learning.

    Active play is where a very young child's physical and emotional learning, their development of language, their special awareness, the development of what their senses are, all come together.

    The more children are involved in active play, the better they will become at interacting with other children successfully.

    Parents, uncles and aunts, and other adults can also become involved with a child's active play - however, sometimes they should take a step back and let the children really explore so they can try out their own understanding of the world. The risk of negative things happening to children if they play outside are far smaller than the risks of negative things happening to them if they don't, such as obesity, poor socialization with other children, and having less fun. It is only by taking risks that children learn the importance of, say, holding on tight, and correcting themselves.

    Parents who have a child with dyspraxia need to balance the risks of negative things happening outside, with the enormous benefits that active play has to offer. Deciding what this balance is depends on many factors, such as the severity of the child's dyspraxia, the outside environment, etc.

    A study by researchers at the University of North Carolina at Chapel Hill's Frank Porter Graham (FPG) Child Development Institute and UNC's School of Education indicates that if both parents work, the father's influence on a very young child's language development may be greater than previously thought (not specific to dyspraxia, but interesting from a child development point of view)
    Continue to Read more ...

    What Is Dialysis? What Is Kidney Dialysis?

    Dialysis is the artificial process of getting rid of waste (diffusion) and unwanted water (ultrafiltration) from the blood. This process is naturally done by our kidneys. Some people, however, may have failed or damaged kidneys which cannot carry out the function properly - they may need dialysis. In other words, dialysis is the artificial replacement for lost kidney function (renal replacement therapy). Dialysis may be used for people who have become ill and have acute kidney failure (temporary loss of kidney function), or for fairly stable patients who have permanently lost kidney function (stage 5 chronic kidney disease).

    When we are healthy our kidneys regulate our body levels of water and minerals, and remove waste. The kidneys also produce erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol) as part of the endocrine system. Dialysis does not correct the endocrine functions of failed kidneys - it only replaces some kidney functions, such as waste removal and fluid removal.

    Dialysis and altitude - A study found that death rates for dialysis patients are 10%-15% lower for those whose homes are higher than 4,000 feet, compared to those who live at sea level.

    Some countries, such as the UK, are predicting a doubling of the number of patients on dialysis machine.

    Why is dialysis necessary?

    Approximately 1,500 liters of blood are filtered by a healthy person's kidneys each day. We could not live if waste products were not removed from our kidneys. People whose kidneys either do not work properly or not at all experience a buildup of waste in their blood. Without dialysis the amount of waste products in the blood would increase and eventually reach levels that would cause coma and death.

    Dialysis is also used to rapidly remove toxins or drugs from the blood.

    There are two main types of dialysis - hemodialysis and peritoneal dialysis

    What type of dialysis a patient should have really does depend on each individual case. Studies have indicated clearly that for kidney disease patients who need to undergo dialysis, one type of treatment is not best for all.

    What is hemodialysis?

    The blood circulates outside the body of the patient - it goes through a machine that has special filters. The blood comes out of the patient through a catheter (a flexible tube) that is inserted into the vein. The filters do what the kidney's do; they filter out the waste products from the blood. The filtered blood then returns to the patient via another catheter. The patient is, in effect, connected to a kind of artificial kidney.

    Patients need to be prepared for hemodialysis. A blood vessel, usually in the arm, needs to be enlarged. Surgery is required for this. The enlarged vein makes the insertion of the catheters possible. US researchers have developed a new way of growing blood vessels using patients' own skin cells to seed the growth of tissue and have tested it in dialysis patients with end stage kidney disease.

    Hemodialysis usually lasts about 3 to 4 hours each week. The duration of each session depends on how well the patient's kidneys work, and how much fluid weight the patient has gained between treatments.

    In the UK hemodialysis is either done in a special dialysis center in a hospital, or at home. When it is carried out at home it is important that the patient, and/or his/her caregiver knows what to do. A study revealed that kidney disease patients who are educated about dialysis are more likely to undergo a standard but under-utilized dialysis-related procedure than less knowledgeable patients The following people may have hemodialysis done at home:
    • People who can and want to learn how to do it at home.
    • People who are willing to carry on doing it at home.
    • People whose condition has been stable while on dialysis.
    • People who do not suffer from other diseases which would make home hemodialysis unsafe.
    • People who have suitable blood vessels for the insertion of the catheters.
    • People who have a caregiver, and that caregiver is willing to help with hemodialysis.
    • People whose homes can be adapted for hemodialysis equipment.
    In the UK, the National Institutes of Health and Clinical Excellence (NICE) recommends that every patient deemed suitable for home dialysis should have both home dialysis and hospital offered.

    What is peritoneal dialysis?

    A sterile (dialysate) solution rich in minerals and glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semi-permeable membrane.

    The abdomen is the area between the chest and hips - it contains the stomach, small intestine, large intestine, liver, gallbladder, pancreas and spleen. Peritoneal dialysis uses the natural filtering ability of the peritoneum - the internal lining of the abdomen. In other words, peritoneal dialysis uses the lining of the abdomen as a filter of waste products from the blood.

    The dialysate is left there for some time so that it can absorb waste products. Then it is drained out through a tube and discarded. This exchange, or cycle, is generally repeated several times during the day - with an automated system it is often done overnight. The elimination of unwanted water (ultrafiltration) occurs through osmosis - as the dialysis solution has a high concentration of glucose, it results in osmotic pressure which causes the fluid to move from the blood into the dialysate. Consequently, a larger quantity of fluid is drained than introduced.

    Although peritoneal dialysis is not as efficient as hemodialysis, it is carried out for longer periods. The net effect in terms of total waste product and salt and water removal is about the same as hemodialysis.

    Peritoneal dialysis is done at home by the patient; by a willing and motivated patient. It gives the patient a greater amount of freedom and independence because he/she does not have to come in to the clinic at multiple times each week. It can also be done while traveling with a minimum of specialized equipment. Peritoneal dialysis is said to 'save lives and save money'.

    Before having peritoneal dialysis, the patient needs to have a small surgical procedure to insert a catheter into the abdomen. This is kept closed off, except when fluid is being introduced or taken out of the abdomen.

    There are two principal types of peritoneal dialysis:
    • Continuous ambulatory peritoneal dialysis (CAPD) - this requires no machinery and can be done by the patient or a caregiver. The dialysate is left in the abdomen for up to eight hours. It is then replaced with a fresh solution straight away. This happens every day, about four to five times per day.

    • Continuous cyclic peritoneal dialysis (CCPD) - a machine does the dialysis fluid exchanges. It is generally done during the night while the patient sleeps. This needs to be done every night. Each session lasts from ten to twelve hours. After spending the night attached to the machine, the majority of people keep fluid inside their abdomen during the day. Some patients may require another exchange during the day. A study found that a significant number of patients prefer "dialysis while you sleep" treatment. Another study found that nocturnal dialysis improves heart disease in patients with end-stage kidney failure.
    Peritoneal is ideal for patients who may find hemodialysis too exhausting, such as elderly people, babies and children. As it can be done while the patient is traveling it is more convenient for those who have to go to school or to work.

    A study found that a combination of aspirin and the anti-platelet drug dipyridamole significantly reduce blockages and extend the useful life of new artery-vein access grafts used for hemodialysis.

    Dialysis helps, but is not as efficient as the kidneys

    Although dialysis helps patients whose kidneys have failed, it is not as efficient as a normal kidney. Consequently, patients on dialysis need to be careful about what and how much they drink and eat. They will also need medications.

    A significant number of patients on dialysis can work and lead normal lives. It is possible to go away on vacation as long as dialysis treatment is possible at their destination.

    Women on dialysis will probably not be able to get pregnant. There will be a higher level of waste products in the body compared to a woman with normal kidneys - this interferes with fertility. Women who do become pregnant while on dialysis will probably need increased dialysis during the pregnancy. If a woman has a successful kidney transplant her fertility should return to normal. Dialysis has some effect on male fertility, but much less than on female fertility.

    What are the symptoms of kidney failure?

    Kidney failure tends to happen gradually. Even if just one kidney works, or both work partially, normal kidney function is still possible. So, it can be a very long time before any symptoms are noticed by the patient. When symptoms do occur they tend to be different from person-to-person, making it harder for doctors to diagnose kidney failure quickly. The following symptoms may be present:
    • Fatigue (tiredness)
    • Frequent need to urinate, especially at night. Frequency grows with time
    • Itchy skin
    • Erectile dysfunction (men have difficulty getting and/or sustaining an erection)
    • Nausea
    • Shortness of breath
    • Water retention (swollen feet, hands, ankles)
    • Blood in urine
    • Protein in urine
    A sudden injury can cause kidney failure. When it does, symptoms tend to appear faster, and progress more rapidly as well.

    Anemia - People with chronic kidney disease are usually affected by anemia (90% of them). When levels of EPO (erythropoietin), which is produced by the kidneys, are low, anemia can develop. EPO makes the body produce red blood cells. When your red blood cell count is low you have anemia. Chronic kidney failure patients who have anemia are usually given an ESA (erythropoiesis-stimulating agent) injection. A study found that Ferumoxytol, a novel intravenous form of iron that permits rapid administration of large doses, is effective for treating iron deficiency in chronic kidney disease (CKD) patients on dialysis.

    What are the causes of kidney disease?

    • Diabetes - thought to cause about half of all cases
    • Hypertension (high blood pressure) - thought to cause about one quarter of all cases
    • Inflammation of the kidney (glomerulonephritis)
    • Malaria
    • Long-term exposure to lead, solvents and fuels
    • Systemic lupus erythematosus - body's own immune system attacks the kidneys
    • Polycystic kidney disease - inherited
    • Physical injury, such as a heavy blow to the kidney
    • Kidney infection (pyelonephritis)
    • Jaundice
    • Over consumption of some medications
    • Unborn baby does not normally developing kidneys
    • Yellow fever
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    What Is Gout? What Causes Gout?

    The word gout comes from Latin gutta and old French gote meaning "a drop". Several hundred years ago gout was thought to be caused by drops of viscous humors that seeped from blood into the joints. In fact, this supposition was not that far from the truth. When a patient experiences the symptoms of a gout attack uric acid has been accumulating in his blood, and uric acid deposits have been forming in the joints.

    Gout is a complex disorder, it is more prevalent among men, and afflicts women more commonly after the menopause. Men have higher uric acid levels in their blood than women.

    What are the symptoms of gout?

    Signs and symptoms of gout are generally acute - they come on suddenly without warning. A significant proportion of patients experience them at night.
    • Severe pain in the joints - The patient may experience pain in his ankles, hands, wrists, knees or feet. More commonly the big toe is affected (podagra). Many patients describe the affected areas as warm/hot. The fluid sacs that cushion tissue (bursae) may become inflamed (bursitis) - when this happens in the elbow it is called olcranon bursitis, while in the knee prepatellar bursitis.

    • Gradually goes away - A bout can last for over a week if left untreated - and then gradually goes away during the following week or two.

    • Itchy and peeling skin later - As the gout subsides the skin around the affected area may be itchy and peel. By the end of it the patient feels fine.

    • Redness and inflammation - The sufferer will most likely have tender, red and swollen joint(s) in the areas that experienced the most pain.

    • Red/purplish skin - The affected area may become red or purplish, making the patient think he has an infection.

    • Fever - Some patients have an elevated temperature.

    • Less flexibility - The affected joint may be harder to use, the patient has limited movement.

    • No symptoms - Some patients experience no symptoms. In these cases it may develop into chronic gout.

    • Nodules - The gout may first appear as tophi (nodules) in the elbows, hands, or ears.

    Gout presenting in the metatarsal-phalangeal joint of the big toe

    What causes gout?

    The levels of uric acid in your blood rise until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens.

    When the human body breaks down chemicals called purines it produces uric acid. Purines can be found naturally in your body, as well as in food, such as organ meats, anchovies, asparagus, mushrooms and herring.

    Most of the time uric acid dissolves and goes into the urine via the kidneys. However, if the body is producing too much uric acid, or if the kidneys are not excreting enough uric acid, it builds up. The accumulation results in sharp urate crystals which look like needles. They accumulate in the joints or surrounding tissue and cause pain, inflammation and swelling.

    Surprisingly, hyperuricemia is commonly found in many people who never develop gout. Scientists are not completely sure what causes hyperuricemia. There is definitely a genetic factor because a person who has close relatives with hyperuricemia is more likely to develop it himself.

    The following have been known to bring about a gout attack and may be contributory causes of gout:
    • obesity
    • heavy alcohol consumption, especially beer
    • a diet high in purine foods, such as seafood and meat, and meat organs
    • extremely low calorie diets
    • regular aspirin use
    • regular niacin use
    • regular use of diuretic medicines
    • medicines taken by transplant patients, such as cyclosporine
    • fast weight loss
    • chronic kidney disease
    • hypertension (high blood pressure)
    • psoriasis
    • tumors
    • myeloma
    • hemolytic anemia
    • lead poisoning
    • hypothyroidism
    • surgery
    • Kelley-Seegmiller syndrome
    • Lesch-Nyhan syndrome

    When should you see a doctor?

    If you have a sudden and intense pain in a joint get in touch with your doctor. If you do not treat it, the gout can gradually get worse over time. If you also have a temperature, and the joint is hot and/or inflamed, get medical attention as soon as possible - it could mean you have an infection.

    How to test for gout?

    After examining you, your doctor may carry our either or both these tests:
    • Blood test - to measure your levels of uric acid. This test is not definitive as some people with high uric acid levels never have gout symptoms; while others who have gout symptoms do not have high levels of uric acid in their blood.
    • Joint fluid test - a needle is used to collect fluid from the affected joint. The liquid is then examined under a microscope to see whether urate crystals are present.

    What are the complications of gout?

    Gout does not commonly cause any further problems. However, some are possible:
    • Recurrent gout - while some people just get one attack, and never experience another one again, others may have recurrent attacks. There are drugs which help reduce the number of recurrent attacks, or even eliminate them.
    • Advanced gout - If the gout is not treated urate crystals may form under the skin in nodules, they are known as tophi. They may become swollen and tender whenever the patient has a gout attack, but are not painful otherwise.
    • Kidney stones - Urate crystals can accumulate in the urinary tract of a patient who suffers from gout. This causes kidneys stones. There are drugs which can lower the chances of developing kidney stones.
    • Damage to joints - if the tophi (nodules) become inflamed the joints could become damaged.
    • Gout might spread - The gout could spread to other joints.

    Treatments for Gout

    1) Medication

    Gout is usually treated with medications, these include:
    • NSAIDs (nonsteroidal anti-inflammatory drugs) - these help combat inflammation and pain. Ibuprofen and naproxen are NSAIDs. There is an increased risk of stomach pain, ulcers and bleeding for some patients who take this drug - the higher the dosage, the higher the risk.
    • Colchicine - an effective drug for gout. However, a number of patients might experience diarrhea, vomiting and/or nausea. Colchicine is often given to patients who are unable to take NSAIDs.
    • Steroids - these may help combat inflammation and relieve pain. The patient may receive the medication orally or it could be injected right into the joint. Some patients who take steroids may experience a thinning of bones, poor wound healing, while others find that their immune systems become weaker and it is harder to fight off infections. Steroids are usually given to patients who are unable to take either colchicines or NSAIDs.
    2) Self Help

    These measures may help ease the pain and swelling:
    • Raise and rest your limb.
    • Some people use a splint to immobilize the joint.
    • Do not do vigorous exercise.
    • Keep the joint cool, apply an ice pack or bag of frozen vegetables wrapped in a towel. Do not apply directly to your skin without a towel as this could damage your skin. Allow the temperature of the affected area to return to normal before repeating this.
    • Do not cover the joint.

    How to prevent gout

    1) Medications

    There are some medicines which can reduce your risk of future gout attacks. These are usually taken after an attack is over:
    • Reducing the production of uric acid - Allupurinol reduces the amount of uric acid your body produces, which in turn lowers your chances of having an attack recurrence. Some patients who take this medication may have a rash, and/or a low blood count.
    • Removing uric acid more effectively - Probenecid helps your kidneys eliminate uric acid more effectively, thus lowering your blood uric acid levels, which in turn reduces your chances of recurrence of an attack. Some patients may develop a rash when taking this medication, while others may have stomach pains, and a very small number may develop kidney stones.
    2) Nutrition

    Although diets have not been proven to reduce a person's risk of gout, this is due to a lack of studies, rather than the existence of studies that prove diet is ineffective. It would make sense not to consume too many foods that are high in purines, such as red meat, meat organs, and seafood. Reducing your consumption of alcoholic drinks may also be beneficial. Some say you should consume more low-fat dairy products, while others mention a good intake of whole-grain breads. If you drink plenty of water you might dilute the amount of uric acid in your blood, some say.
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    What Is Cellulite? What Causes Cellulite?

    Cellulite is a term used to describe the dimpled appearance of skin caused by fat deposits that are just below the surface of the skin. It generally appears on skin in the abdomen, lower limbs, and pelvic region, and it usually occurs after puberty. Cellulite is also known as adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy in the medical field and as orange peel syndrome, cottage cheese skin, hail damage, and the mattress phenomenon in colloquial language.

    Cellulite is often classified using three grades. Grade 1 classification sees no clinical symptoms, but a microscopic examination of cells from the area detects underlying anatomical changes. Grade 2 cellulite requires the skin to show pallor (pastiness), be lower temperature, and have decreased elasticity in addition to anatomical changes noted by microscopic examinations. Grade 3 cellulite has visible roughness of the skin (like an orange peel) along with all grade 2 signs. Cellulite occurs in both men and women, but it is much more common in women because they are more likely to have particular types of fat and connective tissue.

    What causes cellulite?

    The causes of cellulite are not well understood, but there are several theories that have been put forth as explanations. Among these are:
    • Hormonal factors - hormones likely play an important role in cellulite development. Many believe estrogen, insulin, noradrenaline, thyroid hormones, and prolactin are part of the cellulite production process.

    • Genetics - certain genes are required for cellulite development. Genes may predispose an individual to particular characteristics associated with cellulite, such as gender, race, slow metabolism, distribution of fat just underneath the skin, and circulatory insufficiency.

    • Diet - people who eat too much fat, carbohydrates, or salt and too little fiber are likely to have greater amounts of cellulite.

    • Lifestyle factors - cellulite may be more prevalent in smokers, those who do not exercise, and those who sit or stand in one position for long periods of time.

    • Clothing - underwear with tight elastic across the buttocks (limiting blood flow) may contribute to the formation of cellulite.

    How can cellulite be removed?

    There are several therapies that have been suggested to remove cellulite, but none have been supported in the scientific or medical literature.

    Therapeutic methods that are physical or mechanical include pneumatic massages, massages that stimulate lymphatic flow, heat therapy, ultrasound, radio frequency therapy, magnetic therapy, radial waves therapy, Endermologie, and electrical stimulation. However, there is no solid evidence that these methods are effective.

    A second class of cellulite removal strategies consists of drugs that are supposed to act on fatty tissues. There is a wide variation of pharmacological agents used, such as methylxanthines (caffeine and theobromine), pentoxifylline, beta-agonists and adrenaline, alpha-antagonists, amino acids, ginkgo biloba, rutin, and Indian chestnut among others. People with cellulite have tried to apply these agents topically, orally, or by injection, but none have been proved effective.

    Some people with cellulite wear special clothing called compression garments to reduce the appearance of cellulite. These garments try to compress arteries and increase blood and lymph flow to reduce visual cellulite.

    Cellulite reduction techniques such as liposuction and dieting actually do not remove cellulite. However, eating a healthful, balanced diet and exercising may be the best way to reduce the fat content in cells and reduce the appearance of cellulite.

    How can cellulite be prevented?

    Eating healthy, low fat foods such as fruits, vegetables, and fiber can help one to avoid cellulite. Similarly exercising regularly, maintaining a healthy weight, and reducing stress are recommended to prevent cellulite. In addition wearing thongs, boyshorts, or looser fitting undergarments can prevent cellulite that might form due to tight elastic.
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    What Is Bronchitis? What Causes Bronchitis?

    The bronchial tubes, or bronchi, connect the windpipe to the lungs. When the lining of the bronchial tubes becomes inflamed or infected, the condition is called bronchitis. Bronchitis reduces the amount of air and oxygen that can flow into the lungs and causes a heavy mucus or phlegm to form in the airways.

    Bronchitis is considered to be acute or chronic. Acute bronchitis is a shorter illness that commonly develops after a cold or viral infection such as the flu. It generally consists of a cough with green sputum, chest discomfort or soreness, fever, and sometimes shortness of breath. Acute bronchitis usually lasts a few days or weeks.

    Chronic bronchitis is characterized by a persistent, mucus-producing cough on most days of the month, three months of a year for two successive years in absence of a secondary cause of the cough. People with chronic bronchitis have varying degrees of breathing difficulties, and symptoms may get better and worsen during different parts of the year.

    What causes bronchitis?

    Bronchitis is caused by viruses, bacteria, and other particles that irritate the bronchial tubes.

    Acute bronchitis is usually caused by a viral infection in the bronchi - often the same viruses that causes cold and flu. Bronchitis is actually part of the immune response to fighting against the infection, since additional swelling occurs in the bronchial tubes as the immune system's actions generate mucus. In addition to viruses, bacteria, exposure to tobacco smoke, exposure to pollutants or solvents, and gastroesophageal reflux disease (GERD) can also cause acute bronchitis.

    Chronic bronchitis is most commonly caused by cigarette smoking. However, it can also be the result of continuous attacks of acute bronchitis. Air pollution, dust, toxic gases, and other industrial fumes are known to be responsible for the condition.

    Who gets bronchitis?

    People at increased risk of getting bronchitis and increased risk of having more severe symptoms include:
    • Smokers
    • People who are exposed to a lot of secondhand smoke
    • People with weakened immune systems
    • The elderly and infants
    • People with gastroesophageal reflux disease (GERD)
    • Those who are exposed to irritants at work, such as chemical fumes from ammonia, strong acids, chlorine, hydrogen sulfide, sulfur dioxide or bromine

    What are the symptoms of bronchitis?

    Signs and symptoms for both acute and chronic bronchitis include:
    • Inflammation or swelling of the bronchi
    • Coughing
    • Production of clear, white, yellow, grey, or green mucus (sputum)
    • Shortness of breath
    • Wheezing
    • Fatigue
    • Fever and chills
    • Chest pain or discomfort
    • Blocked or runny nose
    Acute bronchitis usually results in a nagging cough that lingers for several weeks even after the bronchitis resolves. Chronic bronchitis's long-term inflammation leads to scarring of the bronchial tubes and airways, which leads to production of excessive mucus. Additional symptoms of chronic bronchitis include frequent respiratory infections and a cough that is worse in the mornings and in damp weather.

    How is bronchitis diagnosed?

    In addition to an examination of family and personal medical histories, there are several tests that are used to diagnose bronchitis. If a doctor hears wheezing or abnormal sounds when listening to your lungs with a stethoscope, he or she will often order chest X-rays. A pulmonary lung function test using a device called a spirometer may be employed to check for asthma or emphysema. Physicians will also order an analysis of sputum (material coughed up from lungs) called a sputum culture, which can reveal the type of bacteria, if any, that is present in your body. Additional tests include blood tests and oxygen saturation measurements.

    Video: What is Chronic Bronchitis?

    View Video Here

    How is bronchitis treated?

    People suffering from bronchitis are usually instructed to rest, drink fluids, breath warm and moist air, and take over-the-counter cough suppressants and pain relievers in order to manage symptoms and ease breathing. Many cases of acute bronchitis actually may go away without any specific treatment, but there is no cure for chronic bronchitis.

    To keep bronchitis symptoms under control and relieve symptoms, doctors may prescribe:
    • Antibiotics - these are effective for bacterial infections, but not for viral infections. They may also prevent secondary infections.

    • Cough medicine - one must be careful not to completely suppress the cough, for it is an important way to bring up mucus and remove irritants from the lungs.

    • Bronchodilators - these open the bronchial tubes and clear out mucus.

    • Mucolytics - these thin or loosen mucus in the airways, making it easier to cough up sputum.

    • Anti-inflammatory medicines and glucocorticoid steroids - these are for more persistent symptoms.

    • Pulmonary rehabilitation program - this includes work with a respiratory therapist to help breathing.
    Additional behavioral remedies include:
    • Avoiding tobacco smoke and quitting smoking
    • Using a humidifier
    • Cold-air face masks (if cold air aggravates cough)
    • Pursed-lip breathing (to slow breathing)

    How can bronchitis be prevented?

    Bronchitis is a somewhat preventable disease. Prevention methods include:
    • Avoiding tobacco smoke and exposure to second hand smoke
    • Quitting smoking
    • Avoiding people who are sick with colds or the flu
    • Getting a yearly flu vaccine
    • Getting a pneumonia vaccine (especially for those over 60 years of age)
    • Washing hands regularly
    • Avoiding cold, damp locations or areas with a lot of air pollution
    • Wearing a mask around people who are coughing and sneezing
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    What Is A PET Scan? How Does A PET Scan Work?

    A PET scan uses radiation, or nuclear medicine imaging, to produce 3-dimensional, color images of the functional processes within the human body. PET stands for positron emission tomography. The machine detects pairs of gamma rays which are emitted indirectly by a tracer (positron-emitting radionuclide) which is placed in the body on a biologically active molecule. The images are reconstructed by computer analysis. Modern machines often use a CT X-ray scan which is performed on the patient at the same time in the same machine.

    PET scans can be used to diagnose a health condition, as well as for finding out how an existing condition is developing. PET scans are often used to see how effective an ongoing treatment is.

    How does a PET scan work?

    Radiotracer - Before carrying out a PET scan, a radioactive medicine is produced in a cyclotron (a type of machine). The radioactive medicine is then tagged to a natural chemical. This natural chemical could be glucose, water, or ammonia. The tagged natural chemical is known as a radiotracer. The radiotracer is then inserted into the human body.

    When it is inside the radiotracer will go to areas inside the body that use the natural chemical. For example, FDG (fluorodeoxyglucose - a radioactive drug) is tagged to glucose to make a radiotracer. The glucose goes into those parts of the body that use glucose for energy. Cancers, for example, use glucose differently from normal tissue - so, FDG can show up cancers.

    Detecting positrons - A PET scan detects the energy emitted by positively-charge particles (positrons). As the radiotracer is broken down inside the patient's body positrons are made. This energy appears as a 3-dimensional image on a computer monitor.

    The image - The image reveals how parts of the patients body function by the way they break down the radiotracer. A PET image will display different levels of positrons according to brightness and color.

    When the image is complete it will be examined by a radiologist who reports his/her findings to a doctor. A radiologist is a doctor who specializes in interpreting these types of images, as well as MRI scan, CT scan, Ultrasound and X-ray images.

    A radiologist prepares a patient for the PET-CT scannerA radiologist prepares a patient for the PET-CT scanner

    Why are PET scans required?

    PET scans are generally used alongside X-rays or MRI (magnetic resonance imaging) scans. Doctors use PET scans as a complementary test to these main ones. They are used to make a diagnosis or to get more data about a health condition. As mentioned above, they are also useful in finding out how effective current treatment is. The use of combined imaging technologies may hold the key to stopping - and even preventing - heart attacks, a study revealed.

    The biggest advantage of a PET scan, compared to an MRI scan or X-ray, is that it can reveal how a part of the patient's body is functioning, rather than just how it looks. Medical researchers find this aspect of PET scans particularly useful.

    PET scans are commonly used to investigate the following conditions:
    • Epilepsy - it can reveal which part of the patient's brain is being affected by epilepsy. This helps doctors decide on the most suitable treatments.MRI and/or CT scans are recommended for people after a first seizure, this study explains.

    • Alzheimer's disease - it is very useful in helping the doctor diagnose Alzheimer's disease. A PET scan that measures uptake of sugar in the brain significantly improves the accuracy of diagnosing a type of dementia often mistaken for Alzheimer's disease, a study revealed.

    • Cancer - PET scans can show up a cancer, reveal the stage of the cancer, show whether the cancer has spread, help doctors decide on the most appropriate cancer treatment, and give doctors an indication on the effectiveness of ongoing chemotherapy. A PET scan several weeks after starting radiation treatment for lung cancer can indicate whether the tumor will respond to the treatment, a study showed. This article looks at whether PET scans are beneficial during cancer diagnosis, staging and monitoring.

    • Heart disease - a PET scan helps detect which specific parts of the heart have been damaged or scarred. Any faults in the working of the heart are more likely to be revealed with the help of a PET scan. A study revealed how comprehensive diagnosis of heart disease based on a single CT scan is possible.

    • Medical research - researchers, especially those involved in how the brain functions get a great deal of vital data from PET scans.

    What is difference between a PET scan and CT or MRI scans?

    A CT or MRI scan can assess the size and shape of body organs and tissue. However, they cannot assess function. A PET scan looks at function. In other words, MRI or CT scans tell you what is looks like, while a PET scan can tell you how it is working.

    What happens during a PET scan?

    In most cases, the patient does not have to spend the night in hospital when he/she comes in for a PET scan.

    The majority of patients will be told not to consume any food for at least four to six hours before the scan, but to drink plenty of water. Some will be asked to refrain from consuming caffeine for at least 24 hours prior to the PET scan.

    A small quantity of radiotracer will either be injected into the patient's arm or breathed in as a gas. The radiotracer may take anything from 30 minutes to 90 minutes to reach the targeted part of the body. While waiting for the radiotracer to reach its destination the patient will normally be asked to stay still and not talk. Some patients may be given some medication, such as diazepam, to relax.

    When the patient is ready he/she will be taken to the room where the PET scan is and will lie down on a cushioned examination table. The machine has a large hole which the table slides into. Then images of the body are taken.

    In many centers the patient will be able to listen to music during the scan.

    While the scan is in process it is vital that the patient keep as still as possible. Depending on which part of the body is being scanned, the whole process takes from about 30 to 60 minutes.

    If the patient feels unwell he/she can press a buzzer which alerts the staff. During the whole process the patient is being watched by staff.

    The process is not painful.

    Most patients can go home as soon as the scan has been done. Doctors advise people to consume lots of liquids to flush the radioactive drugs out of their system more quickly. Experts say the radiotracers should have left the body completely within three to four hours after entering the body.

    A radiologist reviews a PET/CT image showing lung cancerA radiologist reviews a PET/CT image showing lung cancer

    Who should not have a PET scan?

    Pregnant women and women who are breastfeeding should not have a PET scan as there is a risk for the baby. Any woman who is pregnant should tell her doctor straight away (before the scan).

    Anybody who has just had a PET scan should stay away from pregnant women, babies and young children for a few hours after the scan.
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