Acute Pancreatitis – Causes, Symptoms, Diagnosis And Treatment

Acute pancreatitis is a surgical emergency characterized by acute inflammation (with fast-evolving nature of the crisis) of the pancreas. Although it is called pancreatitis, in some cases it can occur in the absence of any inflammatory process (eg trauma, pancreatic stroke).
Normally, pancreatic enzymes do not activate until they reach the duodenum. Under certain conditions, however, these enzymes become active inside the pancreas and start to act destructively on the pancreatic cells (as digesting food). Because the pancreas is not surrounded by a well defined capsule, inflammation can spread easily and beyond. This clinical form is called edematous pancreatitis. If the inflammatory process is not stopped, it can lead to parenchyma necrosis (the main or specilized part of an organ ). In this case the pathology is known as diffuse or localized necrotizing pancreatitis. Necrosis is sometimes accompanied by bleeding and glandular dysfunction, in this case, the clinical presentation is called hemorrhagic pancreatitis.

Acute Pancretitis

Acute pancreatitis is a disease that occurs suddenly and usually resolves in a few days after treatment although in some rare cases can be life threatening.

Causes

The etiology is complex and varies from case to case. The disease occurs between 30 and 60 years with a maximum frequency between 35 and 45.
Etiological factors: situations that cause reflux of bile into the pancreas, causes of reflux of the duodenal juice into the pancreas ; obstruction of the pancreatic ducts, vascular accidents and injuries. The main causes are:

• Obesity, alcoholism, dietary abuses, gallstones, biliary tract infections, chronic liver disease, diabetes, duodenal ulcer, appendicitis, infectious diseases  (epidemic hepatitis typhoid fever).
• Copious meals, excessive alcohol conumption, biliary colic, intense emotions, abdominal trauma

Among the etiologic factors gallstones are the main cause of acute pancreatitis. Occurs in women in 75% of cases (in which gallstones has the same frequency). Another important etiologic factor is acute or chronic alcohol ingestion. Finally, surgery on the abdomen, abdominal trauma and hyperlipidemia play crucial roles in causing acute pancreatitis.

The main process on that acute hemorrhagic pancreatitis and necrotic pancreatic pancreatitis is based is the activation of intra-glandular ferments followed by the digestion of the pancreas  (autodigestion).

Lesions of the pancreas during acute pancreatitis: swelling, bleeding, necrotic areas, suppurations or gangren. Usually there are two types of lesions: edema and hemorrhagic necrosis and they represent two stages with increasing severity. Edema occurs in forms with lower severity and necrosis in more severe forms.

Symptoms

Typical presentation includes upper abdominal pain, nausea, vomiting and low fever. Pain, spontaneous and during palpation is generally limited to the upper abdomen first, in some severe cases pain is part of a diffuse peritoneal irritation syndrome. Sometimes the patient has no pain, but presents abdominal distension, ileus, fever and tachycardia. The pain in acute pancreatitis has a sudden onset, reaching a maximum of intensity several hours later and persists for at least 1-2 days. In patients with acute pancreatitis and biliary origin, pain can be similar to a biliary colic. Biliary colic  pain persistent after treatment suggesst an acute pancreatitis. The severity of pain cause patients to be agitated and constantly change their position in order to relieve pain which is usually located in the epigastric region radiating to the left and right upper quadrant and frequently in the back injury. Abdominal pain is a major symptom but it never comes alone. Nausea and vomiting often accompany abdominal pain, constipation or diarrhea as well. Fever, present in in the first days of illness is usually accompanied by tachycardia.

Diagnosis
Biochemical investigations

1. Serum amylase determination (blood) and urine; amylases are enzymes found in saliva and pancreatic juice, helping the digestion . Elevated serum amylase increase rapidly in the first 12 hours after onset and persist for 3-5 days, after which the values ??normalize. Urinary amylase increases in parallel with serum amylase
2. Determination of lipase. Lipase is an enzyme that breaks down fats; hyperlipasemia appears late and may persist for up to 14 days
3. Enzyme dosage (amylase and lipase) in peritoneal and pleural exudate  – are considered more specific than their serum values
4. Phospholipase A2 serum dosage – phospholipase A2 is an enzyme that catalyzes the hydrolysis of phospholipids but it is a difficult and expensive technique
5. Determination of serum trypsin – Trypsin is an enzyme that catalyzes the transformation of peptide compounds and is a very sensitive indicator.
6. CBC . Leukocytosis – increasing the number of leukocytes in the blood, leukocytosis is moderate, hemoglobin and hematocrit – early growth due to initial hemoconcentration, coagulation – early signs of DIC (disseminated intravascular coagulation)
7. Liver function exploration
8. Metabolic exploration – glucose, serum calcium, blood gases, blood electrolytes, fluids and electrolyte balance, increased serum urea.

Acute Pancreatitis Treatment

Imaging Tests

• Simple abdominal radiography – intestinal transient obstruction, changes in abdominal organ positions
• Chest radiography – left atelectasis
• Abdominal ultrasound – the hallmark and early sign is the increased size of the pancreas, due to diffuse edema (fluid accumulation) and fluid collection in peritoneal cavity.
• Computed tomography (CT) – broadening the limits of the pancreas, distortion and blurred contours.
• magnetic resonance imaging (MRI) – is performed to detect the severity of acute pancreatitis
• Colangio-MRI – is invasive, can be applied to critical patients who require ventilatory support
• ERCP (endoscopic retrograde cholangiography)

Generally to assess the severity of acute pancreatitis and the onset of alcoholic pancreatitis and pancreatitis caused by other unknon causes certain criteria called the Ranson critera are applied .
The evolution is likely to be severe so as the complications that will arise such as if 3 or more of the following criteria are present on admission:

1. Age over 55 years
2. Glucose over 200 mg / dl
3. WBC over 16000/mm
4. Serum LDH over 350 units / l
5. GPT over 250 units / l.

48 hours after admission, poor prognostic indicators:

• Hematocrit decreases by more than 10%
• Arterial oxygen pressure is less than 60 mmHg
• Serum urea increased by more than 5 mg / dl
• Serum calcium less than 8 mg / dl
• Base deficit above 4 mEq / l
• Fluid sequestration estimated to more than 6 liters.

Acute Pancretitis

Treatment
Acute pancreatitis is one of the major therapeutic emergencies. Treatment is complex, individualized for eacg clinical form, etiology and evolutionary trend.

Conservative treatment

Patients with mild acute pancreatitis are admitted to the gastroenterology department,  severe acute pancreatitis patients are admited directly in the intensive care unit for specialist treatment and ongoing monitoring. Therapeutic methods necessary in the first phase are associated in various combinations to achieve analgesia, treatment of shock and MOF (multiple organ failure), pathogenetic chain termination and preventing complications, especially septic complications

Analgesic drugs (relieves pain) that are indicated: procaine, sublingual buprenorphine, bupivacaine in continue epidural anesthesia. Morphine is contraindicated due to the fact that it can induce spasm. Prophylaxis and treatment of shock requires fluid therapy (crystalloid solutions), anti-hypoxia (oxygen mask is placed), and restoring ionic balance and electrolyte balance (sodium intake, potassium, calcium, sodium bicarbonate)
MOF  treatment  is based on restoration of the circulating blood volume to which specific therapies for organ failure are added. Glucose solutions, amino acids and fat emulsions are administered intravenously and oral diet is resumed after clinical remission, normalization of amylase and resumption of digestive tolerance.

Surgery

Acute Pancretitis Surgery

Most patients evolve favorably under conservative treatment with complete remission in80% of cases. They only have surgical indication for removing the causes of pancreatitis (biliary, pancreatic, parathyroid causes) to prevent relapses.

Emergency operations (within 8 hours after the onset of pancreatitis, less than 5% of acute pancreatitis), namely in patients with clinical signs of acute surgical abdomen (emergency caused by damage to one or more abdominal organs as result of an injury or illness, the patient has severe pain and is often in shock) and uncertain diagnosis, unapparent or unspecified acute pancreatitis.

Delayed surgery (3-6 weeks) for the treatment of complications of acute pancreatitis. Pancreatic abscesses have vital surgery indication at the time of diagnosis. Pancreatic pseudocysts which reached the maturation stage are also resolved with surgery.

Pancreatic Cancer – Risk Factors, Causes, Symptoms And Treatment

Pancreatic cancer is a condition with a fairly high frequency, accounting about 2% of all visceral cancers. Although its frequency is lower than colon or esophageal cancer, increasing number of patients are diagnosed with this terrible disease, especially after the age of 50. Unfortunately, most patients become symptomatic when it is already too late. Due to aggressive features (survival after diagnosis, even with treatment, is about 6 months up to 1 year in the majority of cases) and resistance to treatment, mortality is very high.

Pancreatic Cancer

Risk Factors

Most epidemiological studies recorded show that  women have a two times higher risk than man for pancreatic cancer. Among the causes of cancer death, the pancreas ranks fourth in men, after lung, colon and prostate and fifth in women after breast, lung, colon and uterine cancer. Although tumors of this type can be found at any age, their frequency increase gradually after 40 years and has a maximum in the decades 7 and 8.

• Exocrine pancreas cancer is more common in urban areas than in rural areas and globally is twice as common in developed countries than in developing countries. These data seem to be explained by differential exposure to risk factors and longer life expectancy, possibly with different degree of screening.
• Smoking is a significant risk factor due to the presence of carcinogens in the cigarettes smoke like nitrosamines which have a  carcinogenic specific effect to pancreatic cancer as well as other substances that may act indirectly by increasing blood lipids.
• Chronic pancreatitis, regardless of its cause with over 10 years of evolution
• Oncology loaded family history, especially on the pancreatic line can be considered a risk factors, as well as the the existence of the relatives with pernicious anemia, multiple endocrine adenomatosis syndrome and Gardner syndrome (colorectal polyposis).
• Exogenous risk factors can be found in persons working in the chemical industry and who are exoposed to nitrosamines and their metabolites.
• Alcohol and coffee are not considered to be specific pancreatic cancer risk factors.

Pancreas Cancer Risk

Causes

A diet rich in fat and protein is often correlated with  pancreatic cancer (especially in those who underwent gastrectomy surgery). The same relationship was found in those who consume bakery products rich in highly refined flour.
Diets rich in fats effect can be explained by excessive stimulation of production of pancreatic enzymes, whose role in contributing to pancreatic acinar cell proliferation has been proven experimentally. Pancreatic cell proliferation is stimulated both by endogenous and exogenous colecistokinin and as well as glucocorticoids. Changes in digestive hormone metabolism may explain the greater frequency of pancreatic cancer in patients with pancreatic and biliary derivations and colectomies.

Diabetes mellitus, particularly with juvenile-onset, is appreciated as a significant risk factor for pancreatic cancer because the frequency is two times higher in diabetics than in the general population. On the other hand, about 15% of patients with cancer of the exocrine pancreas develop diabetes, whose manifestations usually precede shorlty the clinical onset of the pancreatic cancer.

For acute pancreatitis and chronic pancreatitis a statistically significant relationship with pancreatic cancer has not been prooved.

Pancreatic Cancer Risk Factor

Symptoms

In the development of pancreatic cancer four stages of evolution are described :

1. Asymptomatic or latent period. In this period the diagnosis can be established only incidentally by fine imaging, motivated by another condition or disease.The tumor is small and has no clinical manifestations, general signs, neoplastic impregnation, and symptoms and signs of tumor location are missing.
2. The period of clinical onset characterized by general symptoms and digestive symptoms. Pancreatic cancer symptoms are generally mild  initially, but evolve gradually and sometimes seem inexplicable and the patient may encounter: physical fatigue, mental fatigue and depression, tendency to weight loss, sometimes migratory superficial thrombophlebitis (Trousseau sign). To the general state of decline digestive symptoms can be added: loss of appetite, epigastric discomfort and a discrete dyspepsia, difficult digestion with capricious changes in bowel habits. Correct diagnosis and appropriate surgical indication is rarely established during clinical onset stage of the pancreatic cancer, when surgery could have a radical intent, with significant opportunities for a good and lasting result.
3. The specific clinical picture can be observed in the last stage and the clinical diagnosis and laboratory diagnosis are especially easy to achieve, but the chances of  successful surgery with radical intent, even associated with complex oncological treatments are low.
   General signs of neoplastic impregnation and some digestive disorders are common to all cancers regardless of their location but here are a number of clinical manifestations that vary depending on the topography of pancreatic tumor.

General manifestations more severe than in the onset period that note a severe biological decline:

• Marked physical fatigue
• Decreased exercise capacity
• Marked mental fatigue
• Decreased intellectual ability
• Psychotic disorders, especially depressive syndromes;
• Dramatic weight loss – emaciation, cachexia
• Superficial thrombophlebitis (Trousseau sign)
• Skin and blood paraneoplastic syndromes

Common digestive disorders :

• Anorexia sometimes disgust or intolerance to certain foods
• Sometimes fatty diarrhea and other dyspeptic suggestive symptoms of exocrine pancreas secretory failure, with consequent reduction of intestinal digestion and absorption capacity
• Deep epigastric pain with with radiation to the left upper quadrant ,resistant to common analgesic drugs.

Pancreatic Cancer Pain

Diagnosis

Diagnosis is difficult in the initial stage, when dyspepsia and overall health status can be attributed to other diseases. It is less difficult when the tumor can be felt or jaundice is present, radiology and laboratory examinations greatly ease the diagnosis. Weight loss, loss of appetite, epigastric pain and obstructive jaundice are suggestive for pancreatic cancer. Other explorations specify the diagnosis. Differential diagnosis should be made with all diseases which are accompanied by jaundice and especially the following conditions: cholestatic hepatitis, liver cirrhosis and particularly cholelithiasis. The most difficult diagnosis is exclusion of chronic pancreatitis. The prognosis is severe.

Laboratory tests can reveal : hypochromic anemia, hyperleukocytosis, increased erythrocyte sedimentation rate, changes in pancreatic ferments in the blood, urine and duodenal juice (increased serum amylase and decreased amylase levels in the duodenal juice). For more accurate diagnosis, sometimes more tests are necessary : selective arteriography,ultrasound, scintigraphy.

Pancreatic Cancer

Treatment

The ideal objective in treating exocrine pancreatic cancer has two components:

1. Oncological – the disappearance of the tumor and absence of recurrence and / or metastasis after 5 years of treatment with radical intent;
2. Functional – dealing with complications caused by the expansive tumor: biliary retention, pancreatic retention, possible duodenal stenosis.

This can only be fully achieved surgically by wide excision of the tumor (or sometimes the entire pancreas) and the locoregional lymphatic stations, according to general principles of oncological surgery. In most statistics, when surgery indication is present the proportion of cases with resectable tumors is between 10 and 20%. Of those about 4% are surviving 5 years after syrgery. Recent statistics highlight the improvement of these parameters mainly for intraductal papillary tumors.

The relatively long evolution without significant clinical manifestations delays the diagnosis and radical surgery intervention is impossible. This can be caused by:

•  Advanced tumor evolution with massive invasion of neighboring structures (especially large vessels);
•  Advanced evolution by lymphatic dissemination with regional neoplastic lymph nodes and / or distant metastases (liver, peritoneum)
• Advanced age and associated diseases (wakened body that does not allow a laborious and long intervention).

In these circumstances, the fundamental component the oncological goal is impossible. Therefore, treatment aims only to improve the patient’s quality of life by addressing complications caused by the evolution of the expansive pancreatic tumor:

• Biliary retention
• Pancreatic retention
• Duodenal stenosis
• Pancreatic pain syndrome

Palliative surgery can be performed (conventional or laparoscopic) or by imaging and / or interventional endoscopic techniques.

The symptomatic treatment usually uses analgesics and is the only attempt to ease the suffering of the patient when the evolution and dissemination to locoregional lymph nodes makes impossible or ineffective any palliative measure. Life expectancy is minimal.

Therapeutic means that can be implemented to achieve the therapeutic goals, in relation to the particular situation of each patient are:

• Laparoscopic surgery or classic surgery
• Interventional endoscopy
• Interventional imaging
• Chemotherapy
• Radiation therapy
• Immunotherapy
• Hormone therapy

Stroke (CVA) – Causes, Risk Factors, Symptoms And Treatment

A stroke occurs when a blood vessel (an artery) that supplies blood to a certain area of the brain bursts or becomes clogged by a blood clot. Within minutes, the nerve cells  from that that area are affected and are lacking oxygen and they die within minutes – hours (depending on the severity of  obstruction). As a result, that part of the body that is controlled by the stroke affected area of the brain can not function properly.
If you notice any symptoms of a stroke you must know that it is a medical emergency and immediate treatment is required, just as in the case of a myocardial infarction (a part of the heart muscle dies due to the lack of blood supply to that area). If medical treatment is started soon after the onset of stroke symptoms, the fewer brain cells will die or be affected by the lack of oxygen.

stroke CVA

Stroke Causes

Ischemic stroke is caused by a blood clot that blocks the blood flow to the brain, the blood clot can develop in a narrowed artery that supplies blood  to the brain or may reach the cerebral circulation after it migrated from the heart or  from any other region of the body. Blood clots usually occur as a result of other disorders that cause modifications to the normal blood flow, such as:

• Hardening of the arteries also known as atherosclerosis and it is caused by high blood pressure, diabetes and high cholesterol blood levels
• Atrial fibrillation, or other cardiac arrhythmias (irregular heart rhythms)
• Certain heart valve disorders, such as the presence of an artificial heart valve, a repaired heart valve, valvular heart disease and mitral valve stenosis (narrowing of valvular orifice)
• Heart valve infection (endocarditis)
• The presence of foramen ovale, which is a congenital heart defect (a hole through which blood can enter the left atrium from the right atrium
• Vessel clogging disorders
• Inflammation of blood vessels (vasculitis)
• Myocardial infarction.

Though in rare rare cases low blood pressure (hypotension) may also be the cause of an ischemic stroke. Low blood pressure leads to reduced blood flow to the brain, can be caused by a narrowing of the arteries or damage of heart attack, massive blood loss or a severe infection.
Some surgeries (such as endarterectomy) or other procedures (such as angioplasty) used to treat narrowed carotid arteries may lead to a blood clot at the site where it occurred, causing a subsequent stroke.

Stroke

Causes Of Hemorrhagic Stroke

Hemorrhagic stroke is caused by rupture of blood vessels and bleeding inside the brain (also called intracerebral hemorrhage) or into the space around the brain (called subarachnoid hemorrhage). Elevated values of the blood pressure for long periods can be the cause of a stroke. Bleeding in the space around the brain can be caused by a ruptured aneurysm or blood pressure that was not kept under control.
Other  less common  causes of hemorrhagic stroke,are

• Inflammation of blood vessels, which may occur in syphilis or tuberculosis
• Hemophilia
• Injurys to the neck or head that can affect the blood vessels that can be found in these areas
• Radiation therapy treatments used for treating neck or brain cancers
• Cerebral amyloid angiopathy (a disorder in which blood vessels degenerate).

Stroke Risk Factors

The stroke riks factors are changable risk factors and unchangeble risk factors. Certain conditions are proven to increase the risk of stroke, if these conditions can be kept under control, the risk of stroke may decrease.

The stroke risk factors that can be controlled are:

• High blood pressure (hypertension) is the second most important risk factor after age
• Diabetes. About a quarter of people with diabetes die from a stroke. The presence of diabetes doubles the risk of stroke due to damage to the blood vessels that occurs in this disease.
• Elevevated bad blood cholesterol levels (HDL) can lead to coronary artery disease and myocardial infarction which damages the heart muscle (myocardium) which may increase the risk of a stroke
• Coronary artery disease that can lead to a heart attack and a stroke
• Other heart disease such as atrial fibrillation, endocarditis, heart valve disease, cardiomyopathy, patent foramen ovale
• Smoking, including passive smoking
• Physical inactivity
• Obesity
• Certain drugs such as oral contraceptives – especially in women who smoke or who have other bleeding disorders – and anticoagulants or corticosteroids. It seems that women in menopause that follow a hormone replacement treatment have a lower risk of stroke
• Increased consumption of alcohol, because  people who drink alcohol excessively, especially those with acute alcohol intoxication have a higher risk of stroke.
• Cocaine usage or other illicit drugs.

Uncontraollabe risk factors:

• Age. The risk of stroke increases with age, each ten years double the stroke risk after the age of 55. At least 66 percent of all people with stroke were aged 65 or more.
• Race. Black and Hispanic Americans have a higher risk than people of other races. Compared with whites, young black Americans, both women and men have a risk of 2 to 3 times more likely to make a stroke and die from this cause.
• Sex. Stroke is more common in men than in women up to 75 years, but after this age women are more affected. At all ages, more women than men will die from a stroke.
• Family history. The risk of stroke is greater if a parent, brother or sister had a stroke or transient ischemic atack present in the past.

Stroke Symptoms

Keep in mind that these symptoms of stroke require immediate medical care:

• State of numbness, weakness or paralysis of the face, arm or leg, usually on one side
• Blurred vision in one eye or in both eyes, spots, double vision (diplopia) or blindness
• Confusion, trouble speaking or understanding words spoken by others
• Gait, dizziness, loss of balance or coordination
• Severe headache
• The ischemic stroke symptoms differ from those of hemorrhagic. Symptoms also depend on the location of blood clot or bleeding and expansion of the affected region.
• Symptoms of ischemic stroke (caused by a clot that has blocked a blood vessel) usually occur in the opposite side of the body. For example, a stroke in the right brain gives symptoms in the left side of the body.
• Symptoms of a hemorrhagic stroke (caused by bleeding in the brain) may be similar to those produced by a ischemic stroke, but differ in symptoms related to high blood pressure in the brain, such as severe headaches, nausea and vomiting, stiff neck , dizziness, convulsions, irritability and confusion
• Symptoms of a stroke may progress over several minutes, hours or days, often gradually. For example, mild weakness may progress to an inability to move the arm and leg on one side.

If the stroke is caused by a large blood clot (ischemic) symptoms appear suddenly, within a few seconds, but if an artery already narrowed by atherosclerosis  is blocked, symptoms usually develop gradually, raging from a few minutes to hours or less, in a few days.
In time, if  there are more small strokes, the person may experience a gradual change of thinking, behavior, balance or movement (multi-infarct dementia). The symptoms of a small stroke are not always easily recognized. They can be attributed to wrong conditions that can mimic the stroke symptoms.

Stroke Damage

Stroke Treatment

Initial treatment of a stroke differs because it depends on the cause – whether it was caused by a blood clot (ischemic stroke) or bleeding in the brain (hemorrhagic stroke). Before starting the treatment a head computerized tomography (CT), or a magnetic resonance imaging (MRI) to see the type of stroke. Other tests can determine the location of the clot or bleeding to assess the extent of the brain lession. While determining treatment options, blood pressure will be carefully monitored and oxygen will be administrated if necessary. Initial treatment focuses on restoring the blood flow (for ischemic stroke) or hemorrhage control (in hemorrhagic stroke). As with heart attack, permanent damage due to a stroke often develops in the first few hours.

Ischemic stroke

Emergency treatment for an ischemic stroke depends on the location and cause of clot formation. Measures to stabilize vital signs, including drugs are taken. If the stroke is diagnosed within 3 hours after the onset of symptoms, drugs that dissolve the clots are administrated called tissue plasminogen activator (t-PA) drugs, which could increase the chances of survival and recovery. However, t-PA can not be safely administered to any patient. If the stroke is hemorrhagic, the use of t-PA is extremely dangerous. Choosing to use or not to use t-PA must be evaluated in the emergency room quickly. Aspirin alone or in combination with another antiplatelet drugs can be administrated. However, aspirin is not recommended within 24 hours after administration of t-PA. Other drugs to control blood glucose levels (glucose) or fever and convulsions may be administrated. Generally hypertension is not treated immediately unless systolic pressure is greater than 220 (mm Hg) and diastolic is above 120.

Hemorrhagic stroke

Initial treatment for hemorrhagic stroke is very difficult, efforts are being made to control bleeding, to lower intracranial pressure and stabilize vital signs, especially blood pressure values. Several drugs are administered in the case of a hemorrhagic stroke. Drugs to control blood pressure, decreased brain swelling, blood sugar levels, fever or seizures. Signs of increased intracranial pressure, psychomotor restlessness, confusion, difficulty to perform commands and headaches are closely monitored. Usually surgery is not recommended for controlling mild or moderate bleeding. However, if there was a large amount of bleeding and if the person’s general condition deteriorates rapidly, surgery may be needed to remove the accumulated blood in the brain and decrease the intracranial pressure . If the bleeding is caused by a rupture of an aneurysm, surgery to repair the aneurysm is the only option.

• A metal clip for clipping the aneurysm in order to prevent a new bleeding
• Endovascular embolization, a procedure which involves inserting a small coil inside the aneurysm and block it

Ssurgery decision depends on the location and general condition of the person after stroke.

Stroke

Ongoing treatment

After receiving emergency treatment and the general condition has stabilized, a treatment aimed at recovery and preventing another stroke is started. It is important to control stroke risk factors such as high blood pressure, atrial fibrillation, elevated cholesterol levels and diabetes. Aspirin or other antiplatelet drugs are recommended. In the case of an ischemic stroke (caused by a blood clot), anticoagulants to prevent another stroke are needed. Also drugs such as statins to lower cholesterol or drugs to control blood pressure are needed.

Drugs that lower blood pressure include:

• Inhibitors of angiotensin converting enzyme (ACE)
• Angiotensin II receptor blockers
• Beta blockers
• Diuretic
• Calcium channel blockers.

 Bone Cancer – Symptoms, Causes, Diagnosis And Treatment

There are two types of bone cancer – primary and secondary. Primary cancer is found very rarely in medical practice and few cases are recorded each year.

Primary bone cancers:

• Osteosarcoma that forms in the bone growth tissue
• Chondrosarcoma originates in cartilage tissue
• Ewing sarcoma, which is formed from the immature bone marrow tissue.

Bone Cancer

Symptoms

In all cases of bone cancer pain is present. Theoretically bone cancer can be located in any bone in the body, but occurs with predilection in the long bones.

Symptoms and signs of bone cancer:

• Pain and swollen joints (if the cancer is near a joint or near a joint)
• Bones without resistance with a tendency to fracture easily
• Unexplained fatigue
• Fever
• Unintentional weight loss
• Anemia (usually discovered by chance after a blood test)

Causes

Secondary or metastatic bone cancer originates in other organs but metastasizes to bones. A patient with lung cancer or prostate cancer  can present bone metastasis from the prostate cancer or lung cancer. The bone lesions are secondary locations of the primary cancer (in our case the lung or prostate cancer) and not primary bone cancer. Metastatic bone cancer is more common than primary bone cancer, because many cancers lead to bone metastases.

In most cases the exact causes of primary bone cancer remains unknown. In Padget’s bone disease, involving a multiplication and abnormal development of bone cells, patients are at increased risk for osteosarcoma.

There are a few cases in which bone cancer has a hereditary component:

• Hereditary Retinoblastoma. Retinoblastoma is a type of eye cancer that starts from the retina cells. These patients have an increased risk of developing primary bone tumors.
• Li Fraumeni syndrome. It is a condition that significantly increases the risk of  cancer including brain cancer, breast cancer and osteosarcoma.
• Rothmund-Thomson Syndrome. Disease characterized by skeletal disorders, skin eruptions, and a very high risk for bone cancer.
• Multiple exostosis. It is a hereditary condition that predisposes to cartilage and bone tumors.

In some cases radiation may be culprit behind primary bone cancers. High doses of radiation are necessary though, as with  radiotherapy or nuclear accidents. Undergoing routine radiological investigations (radiography, radioscopy) does not increase the risk of bone cancer.

Osteosarcoma

Medical Consult

In all cases of unexplained pain in the bones, medical consultation is required. Pain is a symptom that accompanies many disease and is not necessarily a sign of bone cancer. Pain may occur with trauma, limb arthritis, benign tumors. For a certainty diagnosis, a bone sample will be analyzed under the microscope.

Diagnosis

• Imaging tests. Simple bone radiography, tomography, ultrasound allows the doctor to visualize the cancer.
• Bone scintigraphy is a procedure in which the patient is injected with a small amount of radioactive material which shall be deposited in the bones, which will be detected and transformed into images to view the bones.
• Biopsy of bone tissue. The certainty diagnosis of any tumor, including bone tumors is based on analysis of tissue samples. Two types of biposy are used – thin needle aspiration, or harvesting a greater portion of the bone using a thicker needle.
• Surgery. Surgery may be excisional (whole tumor excision along with a portion of healthy tissue around it) or incisional, when only a portion of the tumor is removed. Depending on the tumor size and location, local or general anesthesia will be necessary.

Staging of bone cancer

Following the bone tissue analysis, the doctor will determine if the tumor is malignant or benign. If a malignant tumor was found (cancer) the doctor can assess its degree of aggressiveness.

Osteosarcoma and Ewing’s sarcoma are grouped according to their expansion in two stages. If the tumor has only one location or has not spread or it has spread to other parts of the body.

The type of cancer, the stage in which the cancer was found, the presence or absence of tumor metastasis directly influences patient survival rate. A small bone tumor without distant metastases, and with poor tendency twords expanding has a better prognosis than in tumors with high tendency towards expansion.

Treatment

Any type of cancer treatment is conditioned by tumor size, location, the presence of metastases and the health status of the patient.

Radiotherapy is a treatment for bone cancer that uses X-rays or gamma. This radiation affects both healthy cells and cancer cells but healthy cells can regenerate more easily. Most patients with cancer undergo radiation therapy either before surgery (for tumor shrinking) or after surgery to prevent tumor recurrence. Some doctors recommend radiation therapy for reducing symptoms and pain due to tumors that exert pressure on other organs

Surgery is a basic bone cancer treatment and involves removing the tumor along with a portion of healthy tissue around it so that doctors are sure they remove all the tumor.

In osteosarcoma, limb-sparing surgery involves replacing the bone with an artificial prosthesis or bone from another part of the body or from another person (transplant). A well-coordinated team of doctors – including surgeons, oncologists, radiotherapists and specialists in physical therapy and treatment is important to raise the chances of maintaining the limb.

Chemotherapy uses drugs that destroy and inhibit cells that are rapidly dividing. Cells that are dividing extremely fast and uncontrolled are cancer cells, and cells from other tissues like in the stomach mucosa or bone marrow. In most cases healthy cells recover well at the end of chemotherapy (eg the hair grows). The difference between chemotherapy and radiotherapy is that chemotherapy affects the entire body and that way metastatic cells can be targeted.

Chemotherapy

Chemotherapy can be used for the following cases:

• Tumor size reduction before surgery, thus facilitating surgery
• Cancer cells removal throughout the body
• Increased life expectancy by reducing the tumor size and extension
• Removal or relief of symptoms

There are cases in which chemotherapy is the only treatment used, but in most cases chemotherapy is part of complex treatment regimens that also include radiation therapy and surgery.

Happiness Decreases Cardiovascular Disease Risk (Study)

A  new study that will undoubtedly make people happy and pleased and represent another problem for those suffering from depression or anxiety has been recently published. British researchers conducted a study on nearly 8,000 British civil servants (with a mean age of 49 years), after which they concluded that happiness or contentment has beneficial effects on the heart and blood vessels.

Happiness

The study results are published online by the European Heart Journal. Officials responded to a questionnaire about seven specific aspects of their daily life: love affairs, leisure, living standards, profession, family life and sexual identity. They were asked to assess satisfaction in each of the areas, on a scale from 1 (‘very dissatisfied’) to 7 (‘very satisfied’). Notes from each section were combined to give an average figure on life satisfaction as a whole. Then the medical records of patients were reviewed to see which deaths can be linked with coronary artery disease, lethal heart attack and angina, on a period of about six years.

According to researchers, high levels of satisfaction in life decreases with 13% of the risk of coronary heart disease. Both in men and women, four areas seem to be closely related with the cardiovascular risk: occupation, family life and sexual identity (not love affairs, leisure and living standards).

The results do not surprise Professor Nicolas Danchin, cardiologist at the European Hospital “Georges Pompidou” (Paris). It is known for a long time that depression and anxiety are real risk factors for cardiovascular disese and acute stress can be the cause of myocardial infarction . Several epidemiological studies, have proven it says the specialist. Instead, the discovery of the beneficial effects of a positive psychological state is more recent and should be thorough.

However, there is a question nobody can answer yet: The positive effect of satisfaction is real or merely the absence of a negative matter when such persons are nor depressed or anxious? concludes Le Point.

Heatstroke

Known as one of the most dangerous heat related illness, heatstroke is a medical emergency because the affected person’s life may be endangered. The victim may exhibit headaches, incoherent speech, fainting, hallucinations, convulsions and even coma in very serious cases. Body temperature can reach 40 degrees Celsius (or over). The person suffering from heatstroke is so dehydrated that his skin stops sweating and is dry and warm to the touch.

Heatstroke Man

Signs and Symptoms

Symptoms of heatstroke can, in some cases, mimic a heart attack or other medical conditions. In other situations, the patient may manifest symptoms in the first stage of heat exhaustion. The main signs and symptoms of heat exhaustion (which may precede Heatstroke) include:

• Nausea
• Vomiting
• Weakness
• Excessive fatigue
• Headaches
• Muscle cramps or pain
• Confusion

However, some people may suddenly develop symptoms of heatstroke withot any warning signs. The most common symptoms of heatstroke include:

• High body temperature
• Absence of sweating
• Red kis and / or very dry
• Very rapid pulse rate
• Shortness of breath
• Unusual behavio
• Hallucinations
• Feeling confused
• Agitation;
• Disorientation;
• State of shock / or coma.

Heatstrokes Types

Two types of heatstrokes caused by heat: the classical form and the effort form.

Classical heatstroke occurs in people who do not sweat normally, either due to illness or due to certain drugs. If a man does not sweat naturally, it is difficult to deal with a hot and humid climate. Most often, victims of heatstroke are typical older adults who do not have air conditioning and are suffering from chronic health problems such as diabetes. This type of heatstroke is very dangerous and can evolve quickly.
Effort heatstroke has a rapid onsed after just a few hours of physical activity exerted at high temperatures. Practically, although the skin is sweating, the body is overheating due to the hot weather, additional physical activity and dehydration. Effort heatstroke victims of are usually healthy young people such as athletes and football players. This type of heatstroke is triggered under conditions of excessive heat and humidity, plus intense physical effort.

Treatment

The heatstroke treatment both for the classic and the effort type is the same: emergency intervention by any means available that can decrease body temperature – for example, wet compresses, a fan or ice packs applied under the armpits (attention only for short periods of time only), etc.  Also, hydration is very important. Early treatment increases the survival chances of a person suffering from heatstroke.

Heatstroke Treatment

Risk Factors

• Some diseases increase the heatstroke risk of a person. Obesity, sweat glands diseases, diabetes, dehydration, malnutrition, hypotension, cardiovascular disorders, are making the body’s regulating capacity obsolete. In many cases, patients suffer from at least one of these diseases (especially the elderly). There are multiple possibilities that the elderly are following different drug treatments that affect the body’s ability to regulate temperature.
• Some drugs inhibit the activity of sweat glands. These include anticholinergics (used to treat Parkinson’s disease), antihistamines (for allergies), phenothiazines (tranquilizers), tricyclic antidepressants and diuretics. Other drugs that restrict the blood flow to the skin and affect the body’s ability to release heat are cardiovascular drugs such as beta-blockers and vasoconstrictors.
• If a person uses some of these drugs, possible adverse effects that may occur in case of heatstroke must be known very well. Those who use drugs such as LSD, cocaine and amphetamines have an increased risk of heatstroke. They increase muscle activity and body temperature rises. Excessive consumption of alcohol greatly increases the possibility for a person to suffer from heat induced diseases, due to the fact that alcohol stimulates body water removal and therefore dehydrates it.
• People with reduced mobility due to various reasons – for example, disabled, homeless and very poor ones, are prone to diseases caused by heat, because they can not afford to use air conditioning. Also, children under two years may suffer from diseases caused by hot weather because their small bodies can not regulate body temperature as efficiently as adults or older children. Because they are unable to defend against high temperatures tradedys are occurring every summer : young children die from heatstrokes (especially when they are left for short periods of time in cars).

A heatstroke victim needs immediate medical attention. The most important thing is speed: hydration and cooling of the body must take place as soon as possible to increase chances of survival.

Causes

The causes of heatstroke are:

• Warm weather
• Exercise performed in extreme heat conditions, especially people who have a diminished physical condition
• Houses or offices positionig on the upper floors of a buildings without air conditioning
• Inappropriate clothing for summer time
• Excessive alcohol consumption
• Fatigue
• Advanced age (over 65)
• High humidity
• The presence of various medical conditions: alcoholism, neurological disorders, cardiovascular diseases, skin or sweat glands diseases that can inhibit the ability of skin to sweat, diabetes, chronic obstructive pulmonary disease, hyperthyroidism, hypokalemia (potassium deficiency), infections, drug therapy for mental illness.

Heatstroke

Prevention

• Anyone over 65 or receiving treatment for cardiovascular disorders should be very careful in hot weather. There will be no changes in treatment without medical advice. During hot weather air conditioners should be used. Outdoor exercise will be performed in the early morning, evening or later hours, when the weather is cool.
• Body must gradually adapt to heat: physical activity will gradually increase in intensity every day. Studies have shown that a person gradually getting used to hot weather increases the body’s ability to sweat, without losing salts. It takes about two to four weeks of exercise until the body will acclimate.
• Consume lots of water: for exercise, even a liter of water every hour. During gardening, however, only one cup of water sipped constantly. No one should drinq liquids only when thirsty, but before thirst is installed (dehydratation signals are beginning with the thirst sensation).

Heatstroke

Studies have shown that water with salt prevents dehydration as effectively. Do not exaggerate with the amount of salt, too much salt increases the risk renal damage. A wide-brimmed hat to protect from sun and loose clothing to allow sweat to evaporate should be worn and lotions for protection should be applied. It is recommended to stay in rooms with air conditioning in hot days. If this is not possible take cold baths,  spray the body with cold water frequently and  sit near a fan.

 Cellulitis

Cellulite defines hypodermic tissue damage, resulting in accumulation of fat in cells (adipocytes) or in other words fat deposits under the skin. This cellulitis leads to tissue “aging”, because it starts to retain water and toxins harmful to the body (through the action of glucose on collagen and elastin fibers, lymphatic and circulatory system disorders). Cellulitis is also described as an inflammation of the subcutaneous tissue.

Cellulitis

Stages

Cellulite stages are:

1. Laccid cellulitis (orange peel appearance is visible only when the skin is pressed between the fingers)
2. Cocompact cellulitis (at this stage skin irregularities are observed on the skin and sometimes the area is inflamed)
3. Fibrous cellulitis and edematous cellulitis (visible fat deposits in the form of hypodermic nodules, the skin is deformed and irregular. There can be pain in the area affected by cellulitis. Disturbances in lymphatic and blood circulation, oxygenation of cells will be poor.

In these steps, visible skin changes occur: stretch marks, veins extend in some areas, etc..

Causes

The most common causes of cellulitis are:

• Hormonal disorders (especially caused by an imbalance of estrogen)
• An inadequate diet (honey, white sugar, pasta, pizza, animal fats, bread)
• Lack of exercise (which causes poor blood  and lymphatic circulation)
• Obesity
• Hepato-biliary disorders
• Neurosis

Home Remedies & Treatment 

The following recipes can be used to fight cellulitis. The advantage is that most ingredients can be found in anyone’s kitchen.

1. Drink more than two liters of fluid per day. Each day infusion of dandelion will be consumed : put 1-2 teaspoons of dried herb per cup in boiling water, leave 10 minutes, then strain and drink the infusion unsweetened.
2. Boil bean pods, ivy, burdock root, birch leaves in water for several minutes. Drink 250 ml of this liquid 30 minutes before meals.
3. Externally,  compresses with  tincture of hearths and thyme will be applied.
4. Young dandelion leaves picked before the plant blooms will be sprinkled with two tablespoons of olive oil, one tablespoon of lemon, cold water and salt. You can also combine them with watercress leaves, green onion, green garlic or dill.
5. Affected areas will be vigorously massaged with an ointment made from ivy and horsetail for 15 minutes each day.
6. A mixture of rosemary, fennel essential oil and almond oil should be prepared. With this mixture rub the cellulitis affected area every day.
7. A low-fat diet should be followed, with high fiber content, which will include many green vegetables and fresh fruits.
8. Eliminate tobacco, alcohol, coffee and sweet juices.
9. Exfoliate the skin, after bathing, using a soft brush to remove dry dead skin cells. This will stimulate blood circulation and cellulitis will diminish.
10. Two cups of sea salt will be added in the bath water, bathe for at least 20 minutes.
11. Used coffee grounds will be mixed with a smoothing hand cream. With this mixture massage the cellulitis affected area for 1-2 minutes a day and then rinse with warm water.
12. Reduce your salt intake and foods rich in saturated fats and hydrogenated fats
13. Constantly exercise and target the cellulitis affected area
14. Massage yourself with coconut oil
15. Essential oils of juniper, rosemary, cedar, are useful to reduce the unpleasant appearance of cellulite.
16. Because cellulitis is common among women who are overweight you should loose weight or maintain a normal body mass.
17. There are several types of essential oils (rosemary, lavender, sandalwood, cinnamon, chamomile and cloves) that can be used effectively for areas affected by cellulitis . Massage is one of the most useful Cellulitis  remedies.

Kidney Stones And Renal Colic

Most people think kidney stones cause excruciating pain. However there are several treatment methods for removal or destruction without major discomfort. For people diagnosed with large kidney stones , the doctor will recommend a more aggressive treatment. Regardless of size, everyone who has kidney stones should call the doctor to remove them, pain relief due to painkillers does not solve the problem.

Kidney Stones

Kidney stones or urinary calculi develop from salts and minerals that are transported by the urine, with a hard consistency  and  sizes ranging from several millimeters to several centimeters in diameter. Although derived from the kidney, kidney stones will be removed from the body through the urinary tract with difficulty (ureter, bladder and urethra) and often can be even block the flow of urine.

Kidney Stones Risk Factors

• Excessive loss of water by sweating – high concentration and diminished urine volume that leads to precipitation of urine substances
• Obstruction of the urinary tract
• Urinary tract infections
• Metabolic changes like hypercalcemia and hypercalciuria, hyperoxaluria, hyperuricemia, cystinuria.

Stones in Kidney

Kidney Stone Causes

There are some people prone to kidney stones and occur mostly in:

• Males
• People who do not drink enough fluids
• Aged 30-60 years
• Have a family history including the presence of gallstones
• Live in arid and hot zone.

Kidney stones form when urine has too high content of minerals and salts that harden. Sometimes, when the stone passes from the kidney to the ureter, urination is painful and is difficult.

Kidney Stones Symptoms

• Discomfort
• Severe back pain
• Pain that is felt in the pelvis, genitals and lower abdomen
• Intense sensation of burning during urination
• Fever and chills
• Hematuria (bloody urine)
• Vomiting
• Urine cloudy or foul-smelling urine
• Loss of appetite.

Kidney Stones Types and Diagnosis

There are several types of kidney stones:

• Those formed of calcium or calcium oxalate are the most common.
• Struvite stones contain  crystallized magnesium and ammonia . They are formed mainly due to urinary tract infections.
• Uric acid stones occur in people who have a high acidity of urine.
• Cystine stones are rare and usually are found in the same families.

Imaging tests, such as ultrasound, abdominal ultrasound, intravenous pielography, retrograde pielography and computed tomography can be used to indicate the size and location of kidney stones. These investigations can be extremely useful to determine the potential risks of eliminating the kidney stone naturally or whether a minimal intervention or more aggressive treatment is needed.

Kidney Stones Treatment

There are several types of treatments for kidney stones. The doctor may prefer a particular technique over another, depending on the size and location of the kidney stone, and also depending on the treatment that has been followed.

Conservative Treatment

Because many kidney stones are small enough to be eliminated naturally during urination, the doctor may recommend the patient to drink plenty of water (liquids will help remove the stone). In some cases it is necessary to administer painkillers so that pain can be tolerated. When a person removes a stone it is indicated that the stone is preserved and taken to the laboratory to analyze the content. This can determine which foods to avoid (those that could contribute to stone formation). Besides drinking water, lemon juices can be consumed that are designed to stimulate the elimination of the stone.

Other therapeutic strategies

Lithotripsy (ESWL) Extracorporeal Shock Wave. This technique is suitable for breaking a kidney stone. With a special device, shock waves from the skin will be oriented to the kidney stone crushing it into tiny fragments that can be eliminated afterwards naturally through the urinary system.

Surgery

Percutaneous Nephrolitotomy. This procedure is used when kidney stones are large and involves inserting a tube through a small incision in the skin, from the back side to the abdomen and kidneys to help drainage. A fiber optic camera, called nefroscop provides accurate images of the location of the stone. Using a probe supplied with energy, kidney stones will be disintegrated into small pieces.

Uretroscopy (retrograde and anterograde). The Ureteroscope is a small optical instrument with a very thin tube, with a camera and a small case, that is inserted through the urethra, bladder and ureter to the place where the stone is. There are two techniques in wich the kidney stone can be removed: either is caught in the housing and it breaks or it is pulled out through an instrument inserted into the ureteroscope.

Kidney Stones Treatment

Kidney Stones Prevention

Firstly, each person should drink plenty of fluids. If the family has other people who suffered from kidney stones you should pay special attention to your urinary system health. Without enough water, there are more chances that the salt and minerals that are present in urine to form kidney stones. Do not exceed the daily amount of 1-2 cups of caffeinated beverages (tea, coffee, cola, etc.)

Diet will change as follows:

• If the kidney stones are composed of oxalate, the doctor may recommend limiting intake of citrus fruit, chocolate, beer, vitamin C supplements of  green vegetables.
• For kidney stones made of calcium salt will be limited in the diet.
• For uric acid stones red meat, fish and chicken consumption will be reduced to lower the acidity of urine.

The urologist may recommend diuretics, cellulose phosphate or potassium citrate to facilitate the excretion of calcium in people who have had kidney stones composed of calcium.

Mumps

Mumps is a contagious viral infection that increases the parotid glands in volume, making them painful (salivary glands located between the ear and jaw).

Mumps Causes

Mumps is transmitted when an infected person coughs or sneezes and also by contact with recently contaminated objects such as towels, handkerchiefs, glasses or dirty hands. Infection witha a virus known as a Paramyxovirus causes mumps.

Endemic parotitis

Mumps Symptoms

Disease incubation lasts between 17 and 21 days, and it is followed by a moderate fever and ear pain for one or two days. The child is contagious one week before symptoms and about 8 days after their occurrence. Inflammation of parotid glands first appear on one side, then both sides and is manifested by swelling covering the back of the jaw grooves. It causes pain when chewing and when parotids are pressed. Sometimes angina and affected neighboring nodes are associated. Headaches are common. Evolution is often benign and the disease regresses by itself in about ten days. Sometimes, mumps can cause testicle swelling, but that happens rarely in boys before puberty. Lack of appetite and vomiting is also very common in mumps

• Day 1. Facial pain when chewing or pain that the child can not locate exactly, high fever.
• Day 2. Swelling and tenderness of one side of the face (possibly on both sides), pain when opening mouth, high fever, sore throat which increases with swallowing, dry mouth
• Day 3: pronounced swelling of the face, usually bilateral.
• Days 4th and 6th: gradual reduction of swelling and other signs and symptoms
• 13th day: the child is no longer contagious.

Mumps in some cases, has a neuromeningeal form (meningitis, encephalitis, reaching the auditory nerve),  pancreatitis (inflammation of the pancreas) and orchitis (inflammation of the testicles) are also possible and likely to occur without inflammation of the parotids.

Mumps

What you can do when your child has mumps?

Check if the child has high fever, if so give him paracetamol syrup to reduce body temperature. Give the child plenty of fluids, but avoid fizzy drinks or fruit juices. The child can drink through a straw if  mouth opening is painful. If swallowing is painful soup is recommended. Fill a bottle with hot water and wrap it in a towel and then let your child put his face on it to reduce the swelling.

Mumps Treatment

Mumps Treatment

Treatment consists of administration of drugs that fight fever and, in case of pain, the administration of NSAIDs. In most cases mumps is self-limiting disease and the treatment is only relieves symptoms as they occur, primarily through anti-inflammatory and antipyretic drugs. Bed rest is recommended only when needed. With this measure, there are no statistics showing a decrease in the rate of complications and it can be uncomfortable for the patient, so best is required only when desired. Diet is another very important factor to consider. This should match the ability to eat without difficulty. If intake is possible, there is no contraindication to limit supply. The sick child should avoid collectively activities at least 15 days because of the risk of contagion. After he had mumps, the child is immunized completely (for life).

There is an effective vaccine, proposed to adolescents and young adults who did not had mumps and children past the age of 1 year.Vaccine for infants is also associated with rubella and measles vaccine (MMR vaccine).