Gary W. Chune, MD

• Assistant Professor of Internal Medicine
• Division of Endocrinology, Scott & White Hospitals,
• Texas A&M Health Sciences Center
• Temple, Texas

Contrast agent-Substance ingested so as to highlight anatomical structures in x-ray imaging tests gastritis diet ������� order florinef 0.1mg fast delivery. Glomerulus-A network of capillaries located in the nephron where wastes are filtered from the blood gastritis colitis diet purchase florinef 0.1 mg online. It may be acute (occuring suddenly and usually reversable) or chronic (developing slowly over time as a result of permanent damage) gastritis causes and symptoms trusted 0.1 mg florinef. Kidneys already weakened by conditions such as diabetes can be particularly susceptible to nephrotoxic injury gastritis black stool florinef 0.1mg visa. Nephrotoxic injury is most commonly caused by drugs chronic gastritis gerd order florinef with american express, primarily antibiotics gastritis acid diet buy generic florinef 0.1 mg line, analgesics, and contrast agents. In some cases, such as with aminoglycosides and amphotericin B, the drug itself will damage the kidneys. In others, such as with methicillin, sulphonamides, and some contrast agents, the drug provokes an allergic reaction that destroys the kidneys. In hospitals, the most common form of nephrotoxic injury is antibiotic nephropathy, which usually occurs when antibiotics are given to patients with already weakened kidneys. Lead nephropathy, arising from lead poisoning, and nephropathy, from ingestion of the solvent carbon tetrachloride, are also more common forms of nephrotoxic injury. Risk factors for nephrotoxic injury include: Symptoms of nephrotoxic injury are wide ranging and, in some cases, depend upon the type of toxin involved. In general, symptoms are similar to those of renal failure and include excess urea in the blood (azotemia), anemia, increased hydrogen ion concentration in the blood (acidosis), excess fluids in the body (overhydration), and high blood pressure (hypertension). Diagnosis Damage to the kidneys is assessed through a combination of physical examination, blood tests, urine tests, and imaging procedures. Information regarding preexisting conditions, current prescriptions, and environmental exposures to toxins aid the physician in determining what toxin, if any, has caused the kidneys to malfunction. Removal methods are targeted to specific toxins and may include the use of diuretics or chelates to enhance excretion of the toxin in urine, or, in extreme cases, the direct removal of toxins from the blood via hemodialysis or passing the blood over an absorbent substance such as charcoal. Support of kidney function depends on the extent of damage to the organs and ranges from monitoring fluid levels to dialysis. Neuralgia Definition Neuralgia is defined as an intense burning or stabbing pain caused by irritation of or damage to a nerve. Description Different types of neuralgia occur depending on the reason the nerve has been irritated. Neuralgia can be triggered by a variety of causes, including tooth decay, eye strain, or shingles (an infection caused by the herpes zoster virus). Pain is usually felt in the part of the body that is supplied by the irritated nerve. Prognosis the outcome of nephrotoxic injury is determined by the cause and severity of the damage. In cases where damage has not progressed beyond acute renal failure, kidney function can be fully restored once the toxin is removed from the system and equilibrium restored. However, if permanent damage has resulted in chronic renal failure, lifelong dialysis or a kidney transplant may be required. Demographics Statistics on neuralgia vary according to the type and population surveyed. Regarding trigeminal neuralgia, an estimated one individual in 15,000 is afflicted, although numbers may be significantly higher due to frequent misdiagnosis. Neuralgia usually develops after the age of 40, although there have been cases with patients being as young as three years of age. When taking antibiotics or analgesics, recommended dosages should be strictly followed. Healthcare workers should be aware of any underlying conditions, such as diabetes or allergies to antibiotics, that may heighten the effect of a potential nephrotoxin. When using solvents or handling heavy metals, procedures regarding their safe use should be employed. The location of the pain depends on the underlying condition that is irritating the nerve or the location of the particular nerve that is being irritated. Neuralgia can result from tooth decay, poor diet, eye strain, nose infections, or exposure to damp and cold. Postherpetic neuralgia is an intense debilitating pain felt at the site of a previous attack of shingles. Trigeminal neuralgia (also called tic douloureux, the most common type of neuralgia), causes a brief, searing pain along the trigeminal nerve, which supplies sensation to the face. The facial pain of migraine neuralgia lasts between 30 minutes and an hour and occurs at the same time on successive days. Bridget Travers 3572 Glossopharyngeal neuralgia is an intense pain felt at the back of the tongue, in the throat, and in the ear-all areas served by the glossopharyngeal nerve. The pain can occur spontaneously, or it can be triggered by talking, eating, or swallowing (especially cold foods such as ice cream). There are two occipital nerves, each located at the back of the neck, each supplying feeling to the skin over half of the back of the head. These nerves can be pinched due to factors ranging from arthritis to injury, but the result is the same: numbness, pain, or tingling over half the base of the skull. The surgery destroys the area where damaged nerves join the central nervous system, thereby interfering with inappropriate pain messages from nerves to the brain. Glossopharyngeal neuralgia-Sharp recurrent pain deep in the throat that extends to the area around the tonsils and possibly the ear. Migraine neuralgia-A variant of migraine pain, also called cluster headache, in which severe attacks of pain affect the eye and forehead on one side of the face. Occipital neuralgia-Pain on one side of the back of the head caused by entrapment or pinching of an occipital nerve. Postherpetic neuralgia-Persistent pain that occurs as a complication of a herpes zoster infection. Electrodes placed over the painful area deliver a mild electrical impulse to nearby nerve pathways, thereby easing pain. Trigeminal neuralgia-Brief episodes of severe shooting pain on one side of the face caused by inflammation of the root of the trigeminal nerve. Diagnosis Neuralgia is a symptom of an underlying disorder; its diagnosis depends on finding the cause of the condition creating the pain. To diagnose occipital neuralgia, a doctor can inject a small amount of anesthetic into the region of the occipital nerve. If the pain temporarily disappears, and there are no other physical reasons for the pain, the doctor may recommend surgery to deal with the pinched nerve. Treatment Glossopharyngeal, trigeminal, and postherpetic neuralgias sometimes respond to anticonvulsant drugs, such as carbamazepine or phenytoin, or to painkillers, such as acetaminophen. Trigeminal neuralgia may also be relieved by surgery in which the nerve is cut or decompressed. In some cases, compression neuralgia (including occipital neuralgia) can be relieved by surgery. People with shingles should see a doctor within three days of developing the rash, since aggressive treatment of the blisters that appear with the rash can ease the severity of the infection and minimize the risk of developing postherpetic neuralgia. However, it is not clear whether the treatment can prevent postherpetic neuralgia. If postherpetic neuralgia develops, a variety of treatments can be tried, since their effectiveness varies from person to person. For example, black cohosh (Cimicifuga racemosa) appears to have anti-inflammatory properties based on some research. Neuroblastoma Neuroblastoma Definition Neuroblastoma is a type of cancer that usually originates either in the tissues of the adrenal gland or in the ganglia of the abdomen or in the ganglia of the nervous system. Prognosis the effectiveness of the treatment depends on the cause of the neuralgia, but many cases respond to pain relief. Trigeminal neuralgia tends to come and go, but successive attacks may be disabling. Most people, however, experience some pain after treatment, and a few receive no relief at all. Some people live with this type of neuralgia for the rest of their lives, but for most, the condition gradually fades within five years. It occurs most often in children, and it is the third most common cancer that occurs in children. Close to 50% of cases of neuroblastoma occur in children younger than two years old. The disease is sometimes present at birth, but is usually not noticed until later. By the time the disease is diagnosed, it has often spread to the lymph nodes, liver, lungs, bones, or bone marrow. Demographics According to some reports, African-American children develop the disease at a slightly higher rate than Caucasian children (8. The first symptom of a neuroblastoma is usually an unusual growth or lump, found in most cases in the abdomen of the child, causing discomfort or a sensation of fullness and pain. Other symptoms such as numbness and fatigue, arise because of pressure caused by the tumor. If it has spread to the area behind the eye, the cancer may cause protruding eyes and dark circles around the eyes; in a few cases, blindness may be the presenting symptom. High blood pressure, persistent diarrhea, rapid heartbeat, reddening of the skin, and sweating occur occasionally. Some children may also have uncoordinated or jerky muscle movements, or uncontrollable eye movements, but these symptoms are rare. Localized resectable (able to be cut out) neuroblastoma is confined to the site of origin, with no evidence that it has spread to other tissues, and the cancer can be surgically removed. Localized unresectable neuroblastoma is confined to the site of origin, but the cancer cannot be completely removed surgically. Regional neuroblastoma has extended beyond its original site to regional lymph nodes, and/or surrounding organs or tissues, but has not spread to distant sites in the body. Disseminated neuroblastoma has spread to distant lymph nodes, bone, liver, skin, bone marrow, and/or other organs. Recurrent neuroblastoma means that the cancer has come back, or continued to spread after it has been treated. More than one of these treatments may be used, depending on the stage of the disease. The four types of treatment used are: Neuroblastoma Diagnosis A diagnosis of neuroblastoma usually requires blood and urine tests to investigate the nature and quantity of chemicals (neurotransmitters) released by the nerve cells. Additionally, scanning techniques are used to confirm the diagnosis of neuroblastoma. To confirm the diagnosis, the physician will surgically remove some of the tissue from the tumor or bone marrow, and examine the cells under the microscope (biopsy). Staging Once neuroblastoma has been diagnosed, the physician will perform more tests to determine if the cancer has spread to other tissues in the body. This process, called staging, is important for the physician to determine how to treat the cancer and check liver and kidney function. Before surgery, chemotherapy may be used to shrink the tumor so that it can be more easily removed during surgery; this is called neoadjuvant chemotherapy. Radiation therapy is often used after surgery; high-energy rays (radiation) are used to kill as many of the remaining cancer cells as possible. Chemotherapy (called adjuvant chemotherapy) may also be used after surgery to kill remaining cells. Bone marrow transplantation is used to replace bone marrow cells killed by radiation or chemotherapy. Adrenal gland-Gland located above each kidney consisting of an outer wall (cortex) that produces steroid hormones and an inner section (medulla) that produces other important hormones, such as adrenaline and noradrenaline. Alternative therapy-A therapy is generally called alternative when it is used instead of conventional cancer treatments. Biopsy-A small sample of tissue removed from the site of the tumor to be examined under a microscope. Conventional therapy-Treatments that are widely accepted and practiced by the mainstream medical community. Complementary therapy-A therapy is called complementary when it is used in addition to conventional cancer treatments. Hormone-A substance produced by specialized cells that affects the way the body carries out the biochemical and energy-producing processes required to maintain health (metabolism. Neoadjuvant chemotherapy-Treatment of the tumor with drugs before surgery to reduce the size of the tumor. Neuroblast cells-Cells produced by the fetus which mature into nerve cells and adrenal medulla cells. Monoclonal antibody-A protein substance which is produced in the laboratory by a single population of cells. Salvage therapy-Treatment measures taken late in the course of a disease after other therapies have failed. Staging system-A system based on how far the cancer has spread from its original site, developed to help the physician determine how best to treat the disease. These differences include biopsy techniques, the timing and extent of surgery, chemotherapy dosages, and the types of salvage therapy employed. Alternatives No alternative therapy has yet been reported as a substitute for conventional neuroblastoma treatment. Complementary therapies-such as retinoic acid therapy-have been shown to be beneficial to patients when administered after a conventional course of chemotherapy or transplantation. Infants have a higher rate of cure than do children over one year of age, even when the disease has spread. After completion of a course of treatment for neuroblastoma, physicians sometimes recommend that the child undergo an investigative operation. This procedure allows the treatment team to evaluate how effective treatment has been, and may offer an opportunity to remove more of the tumor if it is still present.

Diseases

• Acromesomelic dysplasia
• Sammartino Decreccio syndrome
• Leprosy
• Epidermal nevus vitamin D resistant rickets
• Urticaria-deafness-amyloidosis
• Acute myeloblastic leukemia type 1
• Greenberg dysplasia

If the bone at the top of the finger has sustained a large fracture gastritis diet ����� buy florinef 0.1mg low price, surgery may be necessary congestive gastritis definition order discount florinef line. If the tendon was damaged due to a cut gastritis diet what to eat for breakfast lunch and dinner florinef 0.1 mg amex, stitches may be required both to repair the tendon and 3179 Demographics Anyone who attempts to catch a ball (such as a football) or contacts an object (such as hitting the finger against a hard gastritis and esophagitis cheap 0.1 mg florinef, stationary table or cabinet) has the potential of getting mallet finger gastritis diet 7 day discount generic florinef uk. Causes and symptoms Mallet finger usually occurs while individuals are playing a sport that involves a ball-for example gastritis ibs diet purchase florinef paypal, reaching out to catch a hard pass in basketball or barehanding a baseball. Instead of landing on the palm of the hand, the ball accidentally hits the tip of an extended (or partially extended) finger. This straight-on impact causes instantaneous stretch of the tendon, which may overextend or tear away. Mallet finger can also result from hitting the hand against a hard object or receiving a cut from a sharp edge such as a knife. Humans have three phalanges to each finger and toe with the exception of the thumb and big toe which have only two each. Tendon-A tough cord of dense white fibrous connective tissue that connects a muscle with some other part, especially a bone, and transmits the force which the muscle exerts. In addition, if blood is present underneath the nail, or if the nail is detached, the possibility of a nail laceration or a compound fracture is present, and medical help should be sought immediately. Greg Annussek Mallory-Weiss syndrome Definition Mallory-Weiss syndrome is bleeding from an arterial blood vessel in the upper gastrointestinal tract, caused by a mucosal gastric tear at or near the point where the esophagus and stomach join. Prognosis With proper treatment, most people regain full use of the affected finger. However, in some cases, although the finger regains its normal position, the person never regains full extension of the fingertip. While treatment is in progress, the device to hold the finger stationary sometimes causes a pressure sore over the distal interphalengeal joint. When damage to the bone or nail occurs, complications can result, such as stiffness, infection, and tenderness. Description Mallory-Weiss syndrome causes about 5% of all upper gastrointestinal bleeding. The condition was originally diagnosed in alcoholics and is associated with heavy alcohol use, although it can also be found in patients who are not alcoholics. Earlier episodes of heavy hiccupping, vomiting, and retching are reported by about half the patients who are diagnosed with Mallory-Weiss syndrome. It is thought that the tear or laceration occurs when there is a sudden increase in intra-abdominal pressure. Patients with increased pressure in the vein leading into the liver (portal hypertension) are more likely to bleed heavily from an esophageal laceration than those whose blood pressure is normal. Electrolytes control the fluid balance of the body and are important in muscle contraction, energy generation, and almost every major biochemical reaction in the body. Endoscopy-A procedure in which an instrument containing a camera and a light source is inserted into the gastrointestinal tract so that the doctor can visually inspect the gastrointestinal system. In 90-95% of patients whose bleeding does not stop spontaneously, cauterization without surgery will stop the bleeding. Patients at highest risk for a recurrence of bleeding are those with portal hypertension. Causes and symptoms In Mallory-Weiss syndrome, a tear occurs in the gastric mucosa, near where the esophagus and stomach join. Most are either right at the junction of the esophagus and stomach or in the stomach just slightly below the junction. Bleeding from the tear causes a disruption in fluid and electrolyte balance of the body. The patient often produces vomit tinged with either fresh blood or older, blackish blood. Malnutrition Definition Malnutrition is the condition that develops when the body acquires a disproportionate, inadequate, or unbalanced amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function. It may also develop when the body has problems digesting or absorbing nutrients, or has certain medical conditions. When malnutrition occurs, many different disorders may arise depending on the specific nutrient(s) involved in the malnutrition. Diagnosis A Mallory-Weiss syndrome tear is not visible on standard upper gastrointestinal x rays. Endoscopy also shows that in 35% of patients there is another potential cause for gastrointestinal bleeding, such as peptic ulcer, erosive gastritis, or esophageal varices. Demographics Malnutrition is a major problem all over the world, but it is more likely to occur in the poorest countries of the world where natural disasters, political instabilities and wars, and poverty are more likely to be present. It is an exceptionally serious problem with infants, children, and adolescents because such nutrients are important during this period of extreme physical and mental growth. Malnutrition is estimated to occur in over 70% of children living in Asia, about 26% in Africa, and around 4% in Latin America and the Caribbean. When bleeding does not stop, patients are treated with an injection of epinephrine (adrenaline) and/or the bleeding artery is cauterized with heat. In this same period of time, it is estimated that poor nutrition was a contributing factor in approximately 5 million of the 10. Malnutrition that it eventually cannot digest any protein, with irreversible and fatal results. Overnutrition In the United States, nutritional deficiencies have generally been replaced by dietary imbalances or excesses associated with many of the leading causes of death and disability. Overnutrition results from eating too much, eating too many of the wrong foods, not exercising enough, or taking too many vitamins or other dietary replacements. Risk of overnutrition is also increased by being more than 20% overweight, consuming a diet high in fat and salt, and taking high doses of the following: Description Undernutrition Infants, young children, and teenagers need additional nutrients. Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding (hemorrhage), or kidney failure. For instance, someone who has an untreated medical disorder-such as celiac disease in which gluten (a protein found in barley, rye, and wheat) is not digestible; or lactose intolerance, in which milk and other dairy products are difficult to digest-is at a higher risk for malnutrition than someone without such disorders. The leading cause of death in children in developing countries is protein-energy malnutrition. This type of malnutrition is the result of inadequate intake of calories from proteins, vitamins, and minerals. Iron is an important nutrient that is found in red meat, eggs, and foods fortified with iron. Two types of protein-energy malnutrition have been described-kwashiorkor and marasmus. Kwashiorkor occurs with fair or adequate calorie intake but inadequate protein intake, while marasmus occurs when the diet is inadequate in both calories and protein. With a marasmus diet the body may receive so little protein 3182 Nicotinic acid (niacin) to lower elevated cholesterol levels Vitamin B6 to relieve premenstrual syndrome Vitamin A to clear up skin problems Iron or other trace minerals not prescribed by a doctor Nutritional disorders can affect any system in the body and the senses of sight, taste, and smell. Alterations in enzyme levels, tissue abnormalities, and organ malfunction may be followed by illness and death. Causes and symptoms Causes Poverty and lack of food are the primary reasons why malnutrition occurs in the United States. Proteinenergy malnutrition occurs in 50% of surgical patients and in 48% of all other hospital patients. Another cause of malnutrition is loss of appetite associated with the aging process. Malnutrition affects one in four elderly Americans, in part because they may lose interest in eating. There is an increased risk of malnutrition associated with chronic diseases, especially disease of the intestinal tract, kidneys, and liver. People with drug or alcohol dependencies are also at increased risk of malnutrition. People with anorexia or bulimia may restrict their food intake to such extremes that they become malnourished. Some people with food allergies may find it difficult to obtain food that they can digest. In addition, people with food allergies often need additional calorie intake to maintain their weight. Failure to absorb nutrients in food following bariatric (weight loss) surgery are yet another cause of malnutrition. Bariatric surgery includes such techniques as stomach stapling (gastroplasty) and various intestinal bypass procedures to help people eat less and lose weight. Visual disturbances include night blindness and increased sensitivity to light and glare. Diagnosis Overall appearance, behavior, body-fat distribution, and organ function can alert a family physician, internist, or nutrition specialist to the presence of malnutrition. X rays can determine bone density and reveal gastrointestinal disturbances, and heart and lung damage. This process enables a clinical nutritionist or registered dietician to confirm the presence of malnutrition, assess the effects of the disorder, and formulate diets that will restore adequate nutrition. Tube feeding is often used to provide nutrients to patients who have suffered burns or who have inflammatory bowel disease. This procedure involves inserting a thin tube through the nose and carefully guiding it along the throat until it reaches the stomach or small intestine. If long-term tube feeding is necessary, the tube may be placed directly into the stomach or small intestine through an incision in the abdomen. Anorexia nervosa-Eating disorder marked by malnutrition and weight loss, commonly occurring in young women. Calorie-A unit of heat measurement used in nutrition to measure the energy value of foods. A Calorie is the amount of heat energy needed to raise the temperature of 1 kilogram of water 1 C. Marasmus-Severe malnutrition in children caused by a diet lacking in calories as well as protein. Micronutrients-Essential dietary elements that are needed only in very small quantities. They include copper, zinc, selenium, iodine, magnesium, iron, cobalt, and chromium. However, if the cause is an illness, then the condition must be first eliminated so that the patient can completely recover from malnutrition. In some cases, the damage done by malnutrition may be irreversible even though it is not severe enough to cause death. Death usually results from heart failure, electrolyte imbalance, or low body temperature. Engage in moderate physical activity for at least 30 minutes, at least several times a week Achieve or maintain their ideal weight Use alcohol sparingly or avoid it altogether Prevention Breastfeeding a baby for at least six months is considered the best way to prevent early-childhood malnutrition. Malocclusion Demographics Most humans have various tiny degrees of malocclusion, with most problems being handed down from generation to generation (hereditary). However, others have more serious forms of malocclusion; often times require orthodontic or surgical treatment. Description Occlusion refers to the alignment of teeth, specifically the way that the upper set of teeth fit slightly over the lower set of teeth. Misalignment can occur when the upper jaw is a different size from the lower jaw or when the size of the jaws does not accommodate the size of the teeth. Frey, PhD Malocclusion Definition Malocclusion is a misalignment in the way the upper and lower sets of teeth fit together in biting or chewing. Distocclusion (retrognathism or 'overbite'): the upper jaw and its teeth overlap the bottom jaw and its teeth. Mesiocclusio (prognathism or 'underbite'): the lower jaw protrudes forward, which causes the lower jaw and its teeth to overlap the upper jaw and its teeth. Inherited conditions include too many or too few teeth, too much or too little space between teeth, irregular mouth and jaw size and shape, and atypical formations of the jaws and face, such as a cleft palate. Malocclusions may be acquired from habits like finger or thumb sucking (or pacifier use), tongue thrusting, premature loss of teeth from an accident or dental disease, and medical conditions such as enlarged tonsils and adenoids that lead to mouth breathing. However, when it is more serious malocclusion may be remedied by orthodontic treatment; orthodontics is a specialty of dentistry that manages the growth and correction of dental and facial structures. Braces are the most commonly used orthodontic appliances in the treatment of malocclusion. Bureau of Labor Statistics, about 5,000 orthodontists were practicing in the United States in 2008. At any given time, approximately 4 million people in the United States are wearing braces, including about 800,000 adults. Braces apply constant gentle force to slowly change the position of the teeth, straightening them and properly aligning them with the opposing teeth.

Infidelity issues Sexual problems Financial difficulties Physical disabilities Mental illnesses Anger management problems Domestic abuse Alcohol/substance abuse Communications difficulties Children and other family members interactions Description Marriage counseling is usually a short-term therapy that may take only a few sessions to work out problems in the relationship gastritis diet fruit quality 0.1 mg florinef. Therapy often begins as the couple analyzes the good and bad aspects of the relationship diet during acute gastritis generic florinef 0.1mg with mastercard. The marriage counselor then works with the couple to help them understand that gastritis diet 123 generic florinef 0.1mg without a prescription, in most cases gastritis liver purchase florinef 0.1mg mastercard, both partners are contributing to problems in the relationship gastritis beans buy 0.1mg florinef otc. When this is understood gastritis zungenbrennen discount florinef 0.1mg amex, the two can then learn to change how they interact with each other to solve problems. The partners may be encouraged to draw up a contract in which each partner describes the behavior that partner will be trying to maintain. Sometimes counseling is also provided for the entire family, not just for a couple. Marriage is not a requirement for two people to get help from a marriage counselor. Any single person wishing to improve his or her relationships can acquire help with behavioral problems, relationship issues, or with mental or emotional disorders. Marriage counselors also offer treatment (pre-marital therapy) for couples before they get married to help them understand potential problem areas. A third type of marriage counseling involves post-marital therapy, in which divorcing couples who share children seek help in working out their differences. Couples in the midst of a divorce find that marriage therapy during separation can help them find a common ground as they negotiate interpersonal issues and child custody. Choosing a therapist A marriage counselor is trained to use different types of therapy in work with individuals, couples, and groups. Also, questions should be asked concerning fees, insurance coverage, the average length of therapy, and so on. Turkington Marshall-Marchetti-Krantz procedure Definition the Marshall-Marchetti-Krantz procedure surgically reinforces the bladder neck in order to prevent unintentional urine loss. Purpose the Marshall-Marchetti-Krantz procedure is performed to correct stress incontinence in women, a common result of childbirth and/or menopause. Incontinence also occurs when an individual involuntarily loses urine after pressure is placed on the abdomen (like during exercise, sexual activity, sneezing, coughing, laughing, or hugging). Bladder training-A behavioral modification program used to treat stress incontinence. Bladder training involves putting the patient on a toilet schedule, and gradually increasing the time interval between urination. A catheter is used to drain the bladder of urine during a Marshall-Marchetti-Krantz procedure. Patients should contact their physician immediately if they experience fever, dizziness, or extreme nausea, or if their incision site becomes swollen, red, or hard. Each patient should undergo a full diagnostic workup to determine the best course of treatment. Description the Marshall-Marchetti-Krantz procedure, also known as retropubic suspension or bladder neck suspension surgery, is performed by a surgeon in a hospital setting. The urethra is then lifted, and the sutures are attached to the pubic bone itself, or to tissue (fascia) behind the pubic bone. The sutures support the bladder neck, helping the patient gain control over urine flow. Risks the Marshall-Marchetti-Krantz procedure is an invasive surgical procedure, and, as such, it carries risks of infection, internal bleeding, and hemorrhage. Preparation A complete evaluation to determine the cause of incontinence is critical to proper treatment. A thorough medical history and general physical examination should be performed on candidates for the Marshall-Marchetti-Krantz procedure. Diagnostic testing may include x rays, ultrasound, urine tests, and examination of the pelvis. It may also include a series of urodynamic testing exams that measure bladder pressure and capacity, and urinary flow. Patients undergoing a Marshall-Marchetti-Krantz procedure must not eat or drink for eight hours prior to the surgery. Results Approximately 85% of women who undergo the Marshall-Marchetti-Krantz procedure are cured of their stress incontinence. Patients are 3210 American Urological Association Foundation, 1000 Corporate Blvd. Massage therapy Description Origins Massage therapy is one of the oldest healthcare practices known to history. References to massage are found in Chinese medical texts more than 4,000 years old. Massage has been advocated in Western healthcare practices at least since the time of Hippocrates, the 'Father of Medicine. Hippocrates wrote, 'The physician must be acquainted with many things and assuredly with rubbing' (the ancient Greek term for massage was rubbing). Ling established the Royal Central Gymnastic Institute in Sweden in 1813 to teach his methods. Modern, scientific massage therapy was introduced in the United States in the 1850s by two New York physicians, brothers George and Charles Taylor, who had studied in Sweden. The first clinics for massage therapy in the United States were opened by two Swedish physicians after the Civil War period. Doctor Baron Nils Posse operated the Posse Institute in Boston and Hartwig Nissen opened the Swedish Health Institute near the Capitol in Washington, D. Although there were periods when massage fell out of favor, in the 1960s it made a comeback in a different way as a tool for relaxation, communication, and alternative healing. It is used by conventional, as well as alternative, medical communities and is now covered by some health insurance plans. Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of a group of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body. While massage therapy is applied primarily with the hands, sometimes the forearms or elbows are used. These techniques affect the muscular, skeletal, circulatory, lymphatic, nervous, and other systems of the body. The basic philosophy of massage therapy embraces the concept of vis Medicatrix naturae, which 3211 Purpose Generally, massage is known to affect the circulation of blood and the flow of blood and lymph, reduce muscular tension or flaccidity, affect the nervous system through stimulation or sedation, and enhance tissue healing. These effects provide a number of benefits: reduction of muscle tension and stiffness relief of muscle spasms greater flexibility and range of motion increase of the ease and efficiency of movement relief of stress and aide of relaxation promotion of deeper and easier breathing improvement of the circulation of blood and movement of lymph relief of tension-related conditions, such as headaches and eyestrain promotion of faster healing of soft tissue injuries, such as pulled muscles and sprained ligaments, and reduction in pain and swelling related to such injuries reduction in the formation of excessive scar tissue following soft tissue injuries enhancement in the health and nourishment of skin improvement in posture through changing tension patterns that affect posture reduction in stress and an excellent stress management tool creation of a feeling of well-being reduction in levels of anxiety increase in awareness of the mind-body connection promotion of a relaxed state of mental awareness Massage therapy also has a number of documented clinical benefits. For example, massage can reduce anxiety, improve pulmonary function in young people with asthma, reduce psycho-emotional distress in persons suffering from chronic inflammatory bowel disease, increase weight and improve motor development in premature infants, and may enhance immune system functioning. While massage can be described in terms of the type of techniques performed, touch is not used solely in a mechanistic way in massage therapy. Because massage usually involves applying touch with some degree of pressure and movement, the massage therapist must use touch with sensitivity in order to determine the optimal amount of pressure to use for each person. For example, using too much pressure may cause the body to tense up, while using too little may not have enough effect. Because touch is also a form of communication, sensitive touch can convey a sense of caring-an essential element in the therapeutic relationship-to the person receiving massage. In practice, many massage therapists use more than one technique or method in their work and sometimes combine several. Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, and sometimes combined with active and passive movements of the joints. It is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeper layers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension. Sports massage uses techniques that are similar to Swedish and deep tissue, but are specially adapted to deal with the effects of athletic performance on the body and the needs of athletes regarding training, performing, and recovery from injury. It is used primarily to release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and also to increase blood flow. Acupressure applies finger or thumb pressure to specific points located on the acupuncture meridians (channels of energy flow identified in Asian concepts of anatomy) in order to release blocked energy along these meridians that causes physical discomforts, and rebalance the energy flow. The cost of massage therapy varies according to geographic location, experience of the massage therapist, and length of the massage. If a person is receiving massage for a specific problem, frequency can vary widely based on the condition, though it usually will be once a week. Some people incorporate massage into their regular personal health and fitness program. They will go for massage on a regular basis, varying from once a week to once a month. The first appointment generally begins with information gathering, such as the reason for getting massage therapy, physical condition and medical history, and other areas. The massage therapist may use an oil or cream, which will be absorbed into the skin in a short time. To receive the most benefit from a massage, generally the person being massaged should give the therapist accurate health information, report discomfort of any kind (whether it is from the massage itself or due to the room temperature or any other distractions), and be as receptive and open to the process as possible. Massage therapy Preparations Going for a massage requires little in the way of preparation. Massage therapists generally work by appointment and usually will provide information about how to prepare for an appointment at the time of making the appointment. Research and general acceptance Before 1939, more than 600 research studies on massage appeared in the main journals of medicine in English. Massage therapy research picked up again in the 1980s, as the growing popularity of massage paralleled the growing interest in complementary and alternative medicine. Well designed studies have documented the benefits of massage therapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema, nausea, muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psycho-emotional stress, which may aggravate mental illness. Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study of 40 low-birth-weight babies found that the 20 massaged babies had a 47% greater weight gain per day and stayed in the hospital an average of six days less than 20 infants who did not receive massage, resulting a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm infants given massage three times daily for a 10-day period showed significant improvement. Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10 day period, had a 28% greater daily weight gain, and demonstrated more mature motor behaviors. A study comparing 52 hospitalized depressed and adjustment disorder children and adolescents with a control group that viewed relaxation videotapes, found massage therapy subjects were less depressed and anxious and had lower saliva cortisol levels (an indicator of less depression). Another study showed massage therapy produced relaxation in 18 elderly subjects, demonstrated in measures such as decreased blood pressure and heart rate and increased skin temperature. A combination of massage techniques for 52 subjects with traumatically induced spinal pain led to significant improvements in acute and chronic pain and increased muscle flexibility and tone. This study also found massage therapy to be extremely cost effective, with cost savings ranging from 15-50%. Massage should not be used locally on affected areas for the following conditions: rheumatoid arthritis flare up, eczema, goiter, and open skin lesions. Massage may be used on the areas of the body that are not affected by these conditions. In some cases, precautions should be taken before using massage for the following conditions: pregnancy, high fevers, osteoporosis, diabetes, recent postoperative cases in which pain and muscular splinting. The decision on whether to use massage must be based on whether it may cause harm. For example, if someone has osteoporosis, the concern is whether bones are strong enough to withstand the pressure applied. If one has a health condition and has any hesitation about whether massage therapy would be appropriate, a physician should be consulted. Sometimes people are concerned that massage may leave them too relaxed or too mentally unfocused. Fibromyalgia is an example of a condition that may be favorably affected by this effect. Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to control lymphedema secondary to radical mastectomy, consequently using massage to control lymphedema would significantly lower treatment costs. A study found that massage therapy can have a powerful effect upon psycho-emotional distress in persons suffering from chronic inflammatory bowel disease. Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients. A study of chronic fatigue syndrome subjects found that a group receiving massage therapy had lower depression, emotional distress, and somatic symptom scores, more hours of sleep, and lower epinephrine and cortisol levels than a control group. Cancer treatment Breast cancer is treated with mastectomy when one or more of the following is the case: the cancer is advanced, and all of the breast tissue and possibly lymph nodes and muscles must be removed. The tumor is large and would be difficult to remove with good cosmetic results by breast-conserving surgery. The breast is small or shaped such that breast-conserving surgery would leave very little tissue. A sufficient amount of normal tissue surrounding the tumor-the margin of resection-cannot be removed along with the tumor. Radiation therapy following breast-conserving surgery is not appropriate or possible. Elliot Greene Many women with earlier-stage breast cancers choose to have a full mastectomy rather than a breast-conserving lumpectomy or segmental mastectomy, even though the latter are just as effective and survival rates are just as high as with a mastectomy. A 2013 study found that a majority of women under 40 opted for mastectomies rather than a more modest surgical procedure followed by radiation treatments. Some women fear radiation or are unable to undergo radiation therapy because of pregnancy, an underlying medical condition, or because of the time commitment, travel distance, or cost.

Where magnesium deficiency is severe enough to provoke convulsions gastritis diet restrictions buy florinef 0.1 mg overnight delivery, magnesium needs to be administered by injections or infusions gastritis chronic symptoms trusted 0.1 mg florinef. For infusion gastritis diet ��� purchase generic florinef from india, 500 mL of a 1% solution (1 gram/100 mL) of magnesium sulfate is gradually introduced into a vein over the course of about five hours diet lambung gastritis purchase florinef 0.1mg online. Selenium deficiency in adults can be treated by eating 100 mg selenium per day for a week www gastritis diet com cheap florinef 0.1 mg with mastercard, where the selenium is supplied as selenomethionine gastritis attack diet cheap 0.1mg florinef amex. Diagnosis the diagnosis of deficiencies in water, sodium, potassium, iron, calcium, and phosphate involves chemical testing of the blood plasma, urine, and red blood cells. Iodine deficiency can be diagnosed by measuring the concentration of iodine in the urine. Magnesium deficiency results in hypomagnesemia, which is defined as serum magnesium levels below 0. Some of the symptoms of hypomagnesemia, which include twitching and convulsions, actually result from the hypocalcemia. Other symptoms of hypomagnesemia, such as cardiac arrhythmias, result from low potassium levels. When humans eat diets containing normal levels of zinc (16 mg/day), the level of urinary zinc is about 0. Plasma and urinary zinc levels can be influenced by a variety of factors, and for this reason cannot provide a clear picture of zinc status. Selenium deficiency may be diagnosed by measuring the selenium in plasma or red blood cells, where the normal values are 70 ng/mL and 90 ng/mL, respectively. There is also some interest in measuring the activity of an enzyme in blood platelets, in order to assess selenium status. The symptoms may be relieved promptly or, at most, within two days of starting treatment. In cases of zinc deficiency in Iran and other parts of the Middle East, supplementation of the diets of affected young adults with zinc has been found to provoke the growth of pubic hair and enlargement of genitalia to a normal size within a few months. Where a balanced diet is not available, government programs for treating individuals, or for fortifying the food supply, may be used. Government sponsored programs for the prevention of iron deficiency and iodine deficiency are widespread throughout the world. Selenium treatment programs have been used in parts of the world where selenium deficiency exists. Attention to potassium status, and to the prevention of potassium deficiency, is an issue mainly in patients taking diuretic drugs. In many cases of mineral deficiency, the deficiency occurs because of disease, and individual medical attention, rather than preventative measures, is used. The prevention of calcium deficiency is generally not an issue or concern, however calcium supplements are widely used with the hope of preventing osteoporosis. The prevention of deficiencies in magnesium, zinc, copper, manganese, or molybdenum are not major health issues in the United States. Ensuring an adequate intake of these minerals, by eating a balanced diet or by taking mineral supplements, is the best way to prevent deficiencies. Food and Nutrition Information Center, National Agricultural Library, United States Department of Agriculture, 10301 Baltimore Ave. Mineral excess see Mineral toxicity Mineral toxicity Definition the term mineral toxicity means a condition in which the concentration in the body of any one of a variety of minerals is abnormally high, and in which there is an adverse effect on health. Description In general, mineral toxicity results when there is an accidental consumption of too much of any mineral, as with drinking ocean water (sodium toxicity) or with overexposure to industrial pollutants, household chemicals, or certain drugs. Mineral toxicity may also apply to toxicity that can be the result of certain diseases or injuries. The mineral nutrients are defined as all the inorganic substances that are required for life. The mineral content of the body may be measured by testing samples of blood plasma, red blood cells, and urine. Quantum Supplements: A Total Health and Wellness Makeover with Vitamins, Minerals, and Herbs. Increased plasma sodium, which is called hypernatremia, causes various cells of the body, including those of the brain, to shrink. Shrinkage of brain cells results in confusion, coma, paralysis of the lung muscles, and death. Death has occurred in situations in which table salt (sodium chloride) was accidently used, instead of sugar, for feeding infants. Death due to sodium toxicity has also resulted when baking soda (sodium bicarbonate) was used during attempted therapy of excessive diarrhea or vomiting. Although a variety of processed foods contain high levels of sodium chloride, the levels used are not enough to result in sodium toxicity. Potassium is potentially quite toxic; however toxicity or death due to potassium poisoning is usually prevented because of the vomiting reflex. Consumption of food results in mild increases in the concentration of potassium in the bloodstream, but levels of potassium do not become toxic because of the uptake of potassium by various cells of the body, as well as by the action of the kidneys transferring the potassium ions from the blood to the urine. Ttoxicity results in impairment of the creation of thyroid hormone, resulting in lower levels of thyroid hormone in the bloodstream. This condition has been called kelp acne, because of its association with eating kelp, an ocean plant, which contains high levels of iodine. Hence, a child who accidently eats 20 or more iron tablets may die as a result of iron toxicity. Nitrite poisoning should be considered along with iron toxicity, since nitrite produces its toxic effect by reacting with the iron component of hemoglobin. This protein is responsible for the transport of nearly all of the oxygen, acquired from the lungs, to various tissues and organs of the body. A very small fraction of hemoglobin spontaneously oxidizes per day, producing a protein of a slightly different structure, called methemoglobin. Normally, the amount of methemoglobin constitutes less than one percent of total hemoglobin. Nitrate, which is naturally present in green leafy vegetables and in the water supply is rapidly converted to nitrite by naturally occurring bacteria residing on our tongue, as well as in the intestines, and then absorbed into the bloodstream. Poisoning by nitrite, or nitrate after its conversion to nitrite, results in the inability of hemoglobin to carry oxygen throughout the body. Adverse symptoms occur when over 30% of hemoglobin has been converted to methemoglobin, and these symptoms include cardiac arrhythmias, headache, nausea and vomiting, and in severe cases, seizures. Calcium toxicity is rare, but overconsumption of calcium supplements may lead to deposits of calcium phosphate in the soft tissues of the body. Phosphate toxicity can occur with overuse of laxatives or enemas that contain phosphate. Severe phosphate toxicity can result in hypocalcemia, and in various symptoms resulting from low plasma calcium levels. Moderate phosphate toxicity, occurring over a period of months, can result in the deposit of calcium phosphate crystals in various tissues of the body. Manganese toxicity in miners has been documented in Chile, India, Japan, Mexico, and elsewhere. Symptoms of manganese poisoning typically occur within several months or years of exposure. These symptoms include a mental disorder resembling schizophrenia, as well as hyperirritability, violent acts, hallucinations, and difficulty in walking. Mineral toxicity Diagnosis Zinc toxicity is rare, but it can occur in metal workers who are exposed to fumes containing zinc. Excessive dietary supplements of zinc can result in nausea, vomiting, and diarrhea. Chronic intake of excessive zinc supplements can result in copper deficiency, as zinc inhibits the absorption of copper. Both diseases involve mutations in the proteins that transport copper, that is, in special channels that allow the passage of copper ions through cell membranes. Copper accumulates in the liver, kidney, and brain, resulting in damage to the liver and nervous system. Treatment also involves avoiding foods that are high in copper, such as liver, nuts, chocolate, and mollusks. Selenium toxicity occurs in regions of the world, including some parts of China, where soils contain high levels of selenium. With continued intake of selenium, changes in fingernails and hair loss results, and damage to the nervous system occurs. The breath may acquire a garlic odor, as a result of the increased production of dimethylselenide in the body, and its release via the lungs. Diagnosis of mineral toxicities also involves measuring the metal concentration in the plasma or urine. Concentrations that are above the normal range can confirm the initial, suspected diagnosis. Treatment Iron toxicity is treated by efforts to remove remaining iron from the stomach, by use of a solution of 5% sodium bicarbonate. Treatment of nitrite or nitrate toxicity involves inhalation of 100% oxygen for several hours. If oxygen treatment is not effective, then methylene blue may be injected, as a 1. Prognosis the prognosis for treating toxicity due to sodium, potassium, calcium, and phosphate is usually excellent. Toxicity due to the deposit of calcium phosphate crystals is not usually reversible. For any mineral overdose that causes coma or seizures, the prognosis for recovery is often poor, and death results in a small fraction of patients. For any mineral toxicity that causes nerve damage, the prognosis is often fair to poor. In the case of manganese, toxicity can be prevented by avoiding work in manganese mines. In the case of iodine, toxicity can be prevented by avoiding overconsumption of seaweed or kelp. Minerals Purpose Minerals provide structure to bones and teeth and participate in energy production, the building of protein, blood formation, and several other metabolic processes. Description the amount of minerals present in the body, and their metabolic roles, varies considerably. Minerals are categorized into major and trace minerals, depending on the amount needed per day. Major minerals are those that are required in the amounts of 100 mg (milligrams) or more, while trace minerals are required in amounts less than 100 mg per day. The terms major and trace, however, do not reflect the importance of a mineral in maintaining health, as a deficiency of either can be harmful. Major minerals the major minerals present in the body include sodium, potassium, chloride, calcium, magnesium, phosphorus, and sulfur. The fluid balance in the body, vital for all life processes, is maintained largely by sodium, potassium, and chloride. Fluid balance is regulated by charged sodium and chloride ions in the extracellular fluid (outside the cell) and potassium in the intracellular fluid (inside the cell), and by some other electrolytes across cell membranes. Tight control is critical for normal muscle contraction, nerve impulse transmission, heart function, and blood pressure. Sodium plays an important role in the absorption of other nutrients, such as glucose, amino acids, and water. Chloride is a component of hydrochloric acid, an important part of gastric juice (an acidic liquid secreted by glands in the stomach lining) and aids in food digestion. Calcium, magnesium, and phosphorus are known for their structural roles, as they are essential for the development and maintenance of bones and teeth. Several enzymes, hormones, and proteins that regulate energy and fat metabolism require calcium, magnesium and/or phosphorus to become active. Sulfur is a key component of various proteins and vitamins and participates in drug-detoxifying pathways in the body. Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd. Minerals Definition Minerals are inorganic elements that originate in the earth and cannot be made in the body. They play important roles in various bodily functions and are necessary to sustain life and maintain optimal health and thus are essential nutrients. Most of the minerals in the human diet come directly from plants and water or indirectly from animal foods. An understanding of the important roles and requirements of trace minerals in the human body is fairly recent, and research is still ongoing. The most important trace minerals are iron, zinc, copper, chromium, fluoride, iodine, selenium, manganese, and molybdenum. Some others, such as arsenic, boron, cobalt, nickel, silicon, and vanadium, are recognized as essential for some animals, while others, such as barium, bromine, cadmium, gold, silver, and aluminum, are found in the body, though little is known about their role in health.

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