Pharmasweblog. Medical Weblog

SIGNALS OF HEART DISEASE: SYMPTOMS GUIDE – SORES ON THE SKIN

admin — Fri, 24 Jun 2011 10:40:29 +0000

Nonhealing sores on the skin (ulceration) can also be a consequence of inadequate blood flow to the skin because an artery or vein is blocked or damaged. If tissue does not receive enough blood, it is vulnerable to even minor injury and infection. If the tissue does not receive enough oxygen and nutrients from the blood, it cannot heal.Gangrene is the actual death of tissue. It usually appears as an area of black, shrunken skin in the region affected by the blockage.Associated Symptoms. Pain, paleness or other skin discolorations, and coldness may also accompany nonhealing sores on the skin. Insufficient blood supply may cause inflammation and damage to the nerves (neuritis), which may cause burning, pain, and numbness. (These problems may occur in people with diabetes.)*76\252\8*

PAIN TREATMENT: SURGERY DIRECTED AT PERIPHERAL NERVES

admin — Sun, 12 Jun 2011 10:33:41 +0000

It is, of course, possible to inject local anaesthetics around peripheral nerves or around the sensory roots entering the spinal cord. These injections stop all nerve impulses travelling in that nerve and completely stop pain of peripheral origin. This highly satisfactory treatment can be used for only a day or so, however. The reason for the time limit is that these drugs, which are all children and grandchildren of the herbal origin compound, cocaine, not only stop nerve impulses but also stop the transport of chemicals along fibres. This transport is necessary for feeding the nerve fibres, if it is stopped for more than a few days, the fibres die of starvation. Drugs may be invented which stop only the nerve impulses and these would be candidates for long-term trials.Cutting nerves can, of course, be done by surgery. It is done in some cancer patients who have only a short time to live. If they survive longer, the nerves regenerate, the pain returns and it is difficult to operate a second time. Noordenbros and I learned a salutary lesson in six cases who were astonishingly similar. All of them had partially cut across a nerve in the wrist, the median nerve, which supplies the thumb, neighbouring fingers and the palm of the hand. This nerve is often damaged in accidents, particularly if the hand breaks a window. All of these patients had felt desperate burning pain and tenderness in their useless hand for more than six months and were not helped by any treatments. Hand surgeons have become very skilled in grafting across gaps in nerves by deliberately suturing many strands of a fine nerve from elsewhere in the body to bridge the gap. The nerve fibres regenerate across the bridge and grow on to make contact with the distant structures. This delicate reconstructive surgery works very well if it is done soon after an accident which has torn a gap in a nerve.We persuaded the patients to allow the surgeons to cut out a length of the nerve where it had been damaged and to graft in new nerves so the nerve could reconstruct itself. The immediate effect of the operation was that the pain was completely gone but the hand was numb and paralyzed. Slowly, over six months, the nerves grew back and sensation and movement reappeared in the hand. The sad part of the story in that every patient developed precisely the pain state they had suffered before the operation. One patient killed himself in disappointment.The moral of the story is that you should not operate on peripheral nerves in this state. The pathology that was originally in the nerve had migrated centrally into the spinal cord, where angry nerve cells had become hyperexcitable and were the cause of the pain. Even cutting undamaged nerves or roots, while temporarily stopping the pain, can eventually set off a worse pain generated by central cells.There are, however, operations that are commonly done on peripheral nerves, ganglia or roots. One we have already described, to treat trigeminal neuralgia, involves destroying part of the sensory ganglion or root serving the face. Sometimes these patients suffer grim pains in their numb face, undoubtedly produced by the central migration of the effect of cutting nerves, as we have just described. However, the patient often has a pain-free period for months and years before the pain returns. Frankly, no one understands what is going on. Tiny lesions or gentle surgical manipulation of the ganglion or flooding the area around the ganglion with glycerol all produce long periods of relief. There are even successful cases reported in the literature where the operation was accidentally carried out on the wrong side of the face. All this is very mysterious and suggests some very fragile pathology. Needless to say, none of these many types of operation has ever been subjected to the rigorous test described at the beginning of this chapter.The plot thickens when we examine other types of pain-relieving surgery on limbs. A condition called Morton’s metatarsalgia is characterized by a small, very tender area on the sole of the foot. It is classically believed to be caused by the trapping of one of the fine nerves of the foot that dives down between the small long bones of the foot. The treatment is to dissect out the trapped nerve and cut it out. The Royal National Orthopaedic Hospital routinely examined the piece of tissue cut out and rarely found any nerve fibres at all! What is going on? Is it that the nerve is irrelevant but that there is some damaged tissue which reconstructs itself after surgery?Trapped nerves are a favourite explanation for pains with both patients and surgeons. It all sounds like good old-fashioned mechanical sense. ‘Trapped’ nerves are regularly liberated by surgical dissection of various nerves in the arm, from the carpel tunnel in the wrist to nerves at the elbow and passing over the ribs. Results are variable and evidence for nerve damage is rare. There is no doubt that the surgery is disturbing tissue which is often inflamed but the reason for the results, if any, is a puzzle.Failure to cure pain by therapy directed at the periphery has naturally encouraged surgeons to move centrally. The first obvious target is the dorsal root ganglia, which nestle in their body hole between each vertebra. In the very common cases of back and neck pain with localized areas of tenderness, Skyrme Rees in Australia began an attempt to destroy nerves close to the vertebrae, and these operations have become common. Cuts were made in the region in an attempt to sever the nerves coming from the painful regions. After an initial period lasting some years, when the results were thought brilliant, the method fell into disrepute because of declining success and the obvious variability of which structures were cut.A much more controlled method was developed in Holland in which a thick needle was lowered with precise X-ray guidance to rest on one dorsal root ganglion. The needle contained electrical wires that allowed the tip to be heated to exactly 70°C (15 8 °F) to burn a small area around the tip. It was found that a considerable number of patients were relieved of their pain for fair periods of time. However, the apparent rationale for this treatment has now fallen into doubt. A Dutch team seeking to determine the best temperature for the treatment dropped the tip temperature to 40°C and achieved equally satisfactory results. The reason for the crisis is that this temperature is only tolerably warm and does not destroy tissue. I interpret the results as an inadvertant placebo trial which shows that the hot tip is not the effective component of the trial. The alternative possibilities are either that the effect is the consequence of placebo suggestion or that the presence of the needle without heat is the cause.The most major peripheral surgery for pain is the removal of a herniated disc, which pushes out from the soft cushion of tissue between the vertebrae. Some surgeons also carry out a bone graft to prevent movement of the vertebrae. This operation has been performed for more than seventy years and rose to great popularity, but doubts are increasing. The role of the protruding disc is not clear because the protrusion and the pain vary independently. A placebo trial of a treatment designed to dissolve the disc showed a very high rate of recovery after the injection of innocuous fluid under general anaesthesia. The supposed proof that the disc was cutting motor nerves and causing paralysis is now doubted because the pain can cause muscle wasting by central effects. The formerly enthusiastic proponents of the operation at the University of Miami have given it up in favour of a rigorous rehabilitation programme.Again, it is not at all clear if the beneficial results of the operation are due to suggestion or to some nonspecific disturbance of tissue in the region of the apparent origin of the pain.*56\219\2*

MAJOR RISK FACTORS TOR TYPE 2 DIABETES AND SCREENING FOR TYPE 2 DIABETES

admin — Wed, 01 Jun 2011 10:25:35 +0000

_Family history of diabetes (i.e., parents or siblings with diabetes) Overweight (BMI >= 25 kg/m2) Habitual physical inactivityRace/ethnicity (e.g., African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders) Previously identified IFG or IGT Hypertension (a 140/90 mmHg in adults) HDL cholesterol ? 35 mg/dl and/or a triglyceride level a 250 mg/dl History of GDM or delivery of a baby weighing > 9 lb Polycystic ovary syndromeThe best screening test is a fasting plasma glucose value, determined in a certified laboratory, after an overnight fast of at least 8 hours. It is important to recognize that fingerstick capillary glucose values are not accurate enough for screening purposes. An FPG > =126 mg/dl should be repeated; if still elevated, the test indicates that diabetes is present. If FPG is <= 126 mg/dl and suspicion of diabetes is high, an oral glucose tolerance should be performed. In view of the results of the Diabetes Prevention Program (DPP), an intervention trial done in overweight subjects with IGT, an increased use of oral glucose tolerance testing in people at high risk for type 2 diabetes should be done in the future. Intervention may then be indicated if IGT is found because studies have shown that onset of diabetes can be delayed by intensive diet and exercise or metformin therapy.An interpretation of the screening test should be provided to the patient, and follow-up evaluation and treatment should be recommended. Although community screening programs may increase public awareness of diabetes, they are not recommended as a cost-effective approach to reduce the morbidity and mortality associated with diabetes in presumably healthy people.*19\357\8*

BIOBOMBS: THE THREAT OF BIOTERRORISM

admin — Sun, 22 May 2011 10:17:21 +0000

The goals of terrorists differ from the goals of military strategists, so the drawbacks of biological weapons may not be as disadvantageous for the terrorist. Retaliation against shadowy groups may be difficult; the potential for spread from the site of release may not be so costly if the perpetrator’s “troops” are not in the vicinity; and unpredictability may not be so disadvantageous if the goal is havoc. When the disadvantages of biological weapons are not so prohibitive, the threat may be greater. Not surprisingly, strategists and security groups in governments tend to be more concerned about the use of biological weapons by terrorists than in warfare.As with other terrorism, the actual threat from bioterrorism depends on how self-destructive the terrorists are. The more self-destructive they are, the greater the threat. Still, biological weapons have major drawbacks even for terrorists.Terrorists attempt to attract attention to their causes or gain power by creating spectacular damage. They tend to benefit if a sudden strike is followed by a long lull without any damage. The lull causes people to worry about the horror of what could happen relative to the current peaceful situation. Infectious weapons tend to generate the opposite pattern. The initial attack quickly grows to fearful proportions but then wanes slowly. As the danger lessens during the long waning phase, the fear among the psychological targets is replaced by acceptance of the reality of the situation, a hardening of resolve, and a desire for vengeance. This change in attitude is bad for the terrorists because the hardening of resolve and desire for revenge persist as the frequency of disease diminishes. People do not think well in terms of large numbers, but do respond to the stories of individual people. The ongoing personal interest stories during the waning phase of an infectious outbreak increasingly anger people because as the experience continues, each person has a greater chance of having a direct exposure to someone who has suffered from the disease; each is more likely to have a personal reason to take revenge on the perpetrators. As the time following an infectious terrorist attack increases, the resolve to stamp out the perpetrators may continue to increase.This pattern of impact is quite different from the pattern that would occur after a discrete terrorist act, such as a bombing. As the time following a bombing increases, the number of severely affected people does not increase, and the anger tends to subside. Yet the fear of a recurrence persists, and it is this fear that transforms the shock of the initial damage into a response that provides terrorists their goal, whether that goal be recognition, power, or appeasement. A bomb is a severe cut that heals, whereas an infectious outbreak is a festering wound. After a wound heals, the desire for revenge decreases, though the fear of a similar wound persists. If a wound festers, the desire for revenge is maintained with the continuing injury. Infectious weapons thus make the terrorist’s existence more tenuous by mobilizing persistent opposition to the terrorist group.But there is more bad news for a terrorist who uses infectious weapons. An infectious weapon saps its own power. The power is gained through fear of a second attack, but an infectious outbreak saps this fear because the actual danger of a repetition of the attack is reduced. The outbreak itself has protected the survivors against a second attack by the same organism through the immunity that the first attack generated among the survivors. This immunity results from both the infections generated in the first attack and the increase in vaccination against the weapon that arises in the wake of attack. If the first attack was a howl, the second would be a bark, and the third just a yip. Instead of demonstrating that the terrorist organization is a force to be reckoned with, the subsequent attacks would be a display of relative impotence.Of course, the terrorists could switch to another weapon, but then they would have to start over with the process of educating the targets about the danger the new agent poses. Without this education, the threat of a next agent on the list is too abstract. A bombing reported in vivid detail by the news media is a far more tangible threat than the imagined pathology associated with a new infectious agent. And bombings do not generate immunity in the population.If terrorists played the game of switching infectious agents, they would soon run out of options. Only a handful of agents would be suitable terrorist weapons. If the terrorists chose the most frightening agent to begin with, they would have to shift to progressively less effective agents. Once again they would be confronted with the strategic problem of their howl’s diminishing to a yip.*52\225\2*

WEIGHT LOSS AND INSULIN RESISTANCE: THE ROLE OF MINERALS IN BALANCING BLOOD SUGAR

admin — Thu, 12 May 2011 10:00:55 +0000

If you are deficient in several important blood sugar regulating minerals, your body just can’t get the job done efficiently for you. There are several minerals involved in increasing insulin sensitivity, balancing insulin and glucagon, and reducing insulin resistance. The first of these minerals is chromium.
“I had hopes, but was not totally convinced that at age sixty-three I could lose my unwanted weight. In Jive months I lost thirty pounds and my blood pressure and cholesterol had dropped.”P.E.
Chromium is a trace mineral that was discovered in 1797 by a French chemist, but its biological significance was not determined until the late fifties when researchers learned how important this mineral is in the human body. They initially found that feeding chromium to rats corrected abnormal metabolism of sugar. Later work established that chromium is a cofactor with insulin and is essential for normal glucose utilization, for growth and longevity.Hand in hand with nicotinic acid (niacin) and glutathione (a metabolic derivative of the amino acid glutamine), chromium forms a complex called the glucose tolerance factor, which is critically involved in the function of insulin. Chromium is also required for normal fat and carbohydrate metabolism.Here we run into a problem with our twentieth-century food supply. One textbook captured the problem succinctly:If indeed chromium is essential to the normal metabolism of glucose, this mineral may illustrate a nutritional irony of modern times. Its distribution in foods is largely unknown, but it is recognized that refining removes most of all the chromium in the typical diet. At the same time, people in Western nations are probably increasing their need for chromium by consuming large amounts of sugars and other refined carbohydrate-containing foods. The net result could be marginal chromium deficiency that catapults sensitive adults into mature-onset diabetes.
The problem is not that food doesn’t contain adequate amounts of chromium; the problem is that we’ve refined it out of our naturally produced food, or we’ve chosen not to eat the foods that contain it—foods like brewer’s yeast, oysters, liver, and potatoes. Other foods, such as seafoods, poultry, beef, and some grains, also contain trace amounts, but the average American only gets about 33 micrograms per day in his diet, whereas we need at least 200 micrograms. Strenuous exercise and physical trauma also increases urinary excretion of chromium.
There are a number of chromium deficiency symptoms, includingElevated blood sugarImpaired glucose tolerance (inability of the cells to pick up and use blood sugar)Elevated insulin levelsGlycosuria (blood sugar spilling into the urine)Impaired growthDecreased fertility and sperm count’ Aortic plaquesElevated cholesterol levelsDecreased longevity
We know that in the presence of high amounts of glucose in the blood, chromium is swept out of the bloodstream. Some is excreted in the urine and some simply disappears. One author wrote that “the more insulin we secrete to process sugars from a meal, the more chromium we use and lose. And once used, the mineral is discarded like a wet paper towel. As might be expected, when there’s not enough chromium available, the body simply pumps out more insulin.” We’ve seen the results of more insulin as fat deposited on our hips and thighs!Nearly all of us can benefit from supplemental chromium, but particularly those of us who have trouble controlling both our weight and our blood sugar. As a clinical nutritionist, I have recommended chromium supplementation to a number of my overweight and sugar-craving clients who notice an immediate diminishment of cravings for sweets. A side benefit of chromium may be increased ability to form lean muscle tissue, thus increasing the overall metabolic activity of the body.Another mineral that is absolutely critical for blood sugar regulation and insulin activity is the little known mineral manganese (not to be confused with magnesium, another essential mineral). Manganese is a component of numerous enzymes, but it is also associated with sugar and fat metabolism. One study reported that “manganese-deficient rats exhibited reduced insulin activity, impaired glucose transport, as well as lowered insulin-stimulated glucose oxidation and conversion to triglycerides in adipose cells.While we don’t need very much manganese (about 2.5 milligrams a day), we do need it very badly, and deficiencies lead to lessened insulin sensitivity in fat tissue and a decreased ability to transport glucose through the blood and metabolize it for energy. Deficiency symptoms for manganese include impaired glucose tolerance (or the inability to regulate blood sugar levels), reduced HDL and total serum cholesterol, certain forms of mental illness like schizophrenia (other minerals may be implicated in schizophrenia as well), disc and cartilage problems, reduced brain function, middle-ear imbalances, birth defects, reduced fertility, and growth retardation. Some studies have also shown that manganese deficiency can even cause an inability in mothers to bond with their newborn babies.
“When I started I was 198 lbs. Now, I am 168 lbs and still losing weight.”JORDAN
Vanadium, named after the Scandinavian goddess of beauty, youth, and luster, has just recently come to the forefront of nutritional studies, particularly as it relates to insulin activity. Vanadium not only improves the metabolism of fats, but according to one author,
Vanadium was already a medically recommended treatment for diabetes and some forms of fatigue in the late nineteenth century in the English-speaking world. The 1932 edition of Dorland’s Medical Dictionary listed vanadium as a treatment for diabetes and neurasthenia (mental and physical fatigue or weakness). Although not as successful as injected insulin for the treatment of extreme cases of diabetes (which is the reason it originally disappeared from medical usage) vanadium in the form of vanadyl sulfate (its biologically active form) can mimic many of the activities of insulin. In this respect, vanadyl sulfate is even more impressive than is chromium. Chromium potentiates the body’s insulin, but the vanadyl form of vanadium itself is biologically active even in the absence of insulin. It significantly increases liver glycogen (stored glucose) and it improves the uptake of glucose by muscle tissues. These actions help to spare lean tissue during dieting and to improve athletic performance by lessening fatigue and by reducing the breakdown of muscle protein for energy. . . . Nevertheless, it also acts to inhibit the storage of excess calories from carbohydrates as fat apparently by stabilizing the body’s production of insulin.
Magnesium is another major mineral often overshadowed by its complementary yet oppositional mineral—calcium. Magnesium is critically important for energy production on a cellular level and is a major component of bone structure. Magnesium is used to synthesize the very code of life, DNA and RNA, and functions in nerve transmission throughout the brain and body.Magnesium is part of many enzyme systems throughout the body. Both magnesium and zinc are found in high concentrations in the hippocampus (the area of the brain used for the integration of thoughts, memory, and emotion). Magnesium also helps maintain tissue sensitivity to insulin; that is, adequate amounts of magnesium may help prevent insulin resistance. Magnesium helps control glucose metabolism and participates in the regulation of insulin.These facts become even more important when we look at a list of magnesium deficiency symptoms. This is where science becomes very personal! Check this list to see how many of these symptoms sound familiar to your body.If you experience four, five, or more of these symptoms on a regular basis, you may benefit from supplemental magnesium.Some nutritionists have estimated that for many reasons up to 65 percent of the American population is deficient in this important mineral. First, magnesium is routinely stripped out of the food supply, but more important, we choose not to eat foods that are potentially rich in magnesium, such as green leafy vegetables, nuts, soybeans, and crustacean seafoods—oysters and crabs. Because stress, sugars, and a diet high in calcium rob the body of what little magnesium it receives from food, deficiencies may be magnified many times over.Be sure to check your magnesium intake if, in an attempt to avoid osteoporosis or other degenerative conditions, you use calcium supplements or dairy products. Excessive calcium in relation to magnesium contributes to magnesium deficiency.In previous chapters we’ve talked about the importance of zinc in the human diet. Zinc is used in over two hundred enzyme systems in the brain alone, but it is also a critical force in the regulation of blood sugar. Interestingly, one of the most common of the zinc deficiencies is a craving for carbohydrates, especially a craving for wheat-based products. Zinc-deficient people typically crave breads, pastries, and pastas.When it comes to maintaining normal weight, you don’t want to shortchange yourself on this nutrient. Zinc is used along with vanadium to potentiate insulin’s ability to regulate blood sugar.If you experience three or more of these symptoms on a regular basis you may benefit from supplemental zinc.*52\319\2*

IDEAL MARRIAGE: ROMANTIC LOVE – TO ENABLE ONE TO BECOME ATTACHED TO ALL THE INTRICATE ASPECTS OF ANOTHER’S PERSONALITY

admin — Mon, 02 May 2011 09:54:29 +0000

One of the unctions of romance is to enable one to become attached to all the intricate aspects of another’s personality. The sex impulse when inhibited, delayed or sublimated develops a force which is diffused over the whole mental life and creates bonds of affection for every part of the other person’s being. This love of a whole personality is the only love that can abide, and is therefore of tremendous importance for one’s future happiness. It provides an inexhaustible source of delight and variety, for human personality is infinitely rich in possibilities. Here, if anywhere, one finds escape from the law of diminishing pleasure.The simpler a desire is, the more quickly its satisfaction becomes old and uninteresting—a mere habit with a minimum of consciousness. This is especially applicable to sex desire when it is divorced from the play of personalities. Purely physical sex interest defeats itself and leaves its devotees blase and cynical about life. Sexual intercourse, abstracted from any love-play, turns out to be a rather sorry and commonplace affair, which at best affords only physical relief. Only the varied, self-renewing intricacies of personality can redeem sex life from inanity and staleness, and prevent beauty from turning quickly into ugliness or at best indifference.One who is incapable of a rich, personal love can expect to tire of a husband or a wife easily, and, though he may seek his pleasure elsewhere, he will find frustration there too. And certainly his love cannot survive the changes wrought by advancing years. Even if he were able to find beauty in the same person for any length of time in youth, he certainly could not hope to find it in later age. Only personalized sexual feeling can make the object of one’s love seem beautiful at all ages, for the beauty of the body perishes, but the beauty of a personality does not dimmish—it may even increase with age.*91\275\8*

AIDS PANDEMIC

admin — Sun, 24 Apr 2011 09:45:48 +0000

We noticed the AIDS pandemic while it was spreading, but we missed the initial spread of all the other known and unknown infectious causes of cancer and infertility. For most of these causes we missed the invasion because it happened long ago. We might have missed the initial spread of the AIDS pandemic had it not occurred early and disproportionately among homosexual men because they tend to be seen as a distinct group in our society and were therefore readily categorized as a risk group. If attention had focused on the syndrome in 1991 rather than 1981, we would have seen HIV in almost every country on earth. The situation would have been like the current situation with the cancer-causing papillomaviruses, or with hepatitis viruses, which cause levels of death and suffering that are comparable to those now caused by HIV. Some might say that the deaths from AIDS surely would have led people to recognize promptly the infectious nature of AIDS. But countless thousands of people were dying of liver cancer, cervical cancer, and adult T-cell leukemia long before these diseases were recognized as being caused by infection. And countless thousands have died and are now dying of other cancers that will probably turn out to be caused by infection. Even one of the main indicators of AIDS, a cancer called Kaposi’s sarcoma, had been recognized in Mediterranean populations a century before it was recognized as an infectious disease. The presence of Kaposi’s sarcoma in gay men with AIDS, and its relative absence in other risk groups, alerted researchers to the probable role of infection in its causation. Still, it took a decade of searching for an agent of Kaposi’s sarcoma before researchers finally zeroed in on human herpesvirus 8, newly recognized but long ago globally distributed.*36\225\2*

THE KINDS OF SEIZURE: SPECIAL TERMS USED TO DESCRIBE THE PHASES OF A SEIZURE

admin — Wed, 13 Apr 2011 09:39:10 +0000

Physicians commonly use certain special terms to describe parts of a seizure, terms referred to briefly early in this book: “aura,” “ictus,” and “post-ictal.”Aura. An “aura” is simply the start of a partial seizure. The frightened feeling or look William experienced is called an aura if it precedes a bigger seizure. If the feeling is all that William experiences, he is said to “have had an aura—a simple partial seizure.” This may be the warning of an even more widespread seizure to come. If the seizure spreads within the temporal lobe and affects consciousness, then it becomes a complex partial seizure. If it spreads throughout the brain resulting in stiffening and generalized shaking, it becomes a generalized seizure. But with each seizure, the onset, which may be an abnormal smell, taste, abdominal sensation, or emotion (its focal beginning), is still called the aura.Ictus. “Ictus” is the Latin word for “stroke” or “attack.” Physicians sometimes use the word to mean a seizure. Thus, a simple partial seizure involving the hand, or a complex partial seizure, even a generalized seizure with loss of consciousness and jerking, could each be termed an ictus.Post-ictal. “Post-ictal” means after the attack or seizure. After a person has had a seizure involving motor activity of her arm, the arm may be weak or even paralyzed for minutes or hours. This is termed a “post-ictal” paralysis, also called Todd’s paralysis, after the physician who identified it. After a generalized tonic-clonic seizure, the person may go to sleep for a period. This is called the post-ictal state. After a partial complex seizure, the person may have post-ictal confusion. Each of these conditions occurs after the seizure is over.Just as overexcitement and rapid synchronous firing of the neurons characterize the active phase of the seizure, so in the post-ictal phase the predominant activity of the brain is inhibitory. Neurons are less likely to fire. This effect has helped to quiet the excitability of the cortex and stop the seizure. However, because inhibition also prevents the cells from resuming their normal activity, the person is sleepy or confused or may experience a temporary paralysis.When observers say, “This person’s seizure lasted an hour,” what they really mean is that the individual had a generalized tonic-clonic seizure, which may have lasted only five minutes, but that the person then slept (was in a post-ictal state) for an hour. The difference between the two is important, because there is no danger from the post-ictal state. That quiescent state is simply the time necessary for the brain to recover and return to its normal functioning; whereas, if the seizure (jerking) had lasted for the entire hour, that would have been considered a medical emergency.*55\208\8*

CAUSES OF CANCER: CHEMICALS IN FOODS

admin — Sat, 02 Apr 2011 09:22:48 +0000

Among the food additives suspected of causing cancer is sodium nitrate, a chemical used to preserve and give color to red meat. Research indicates that the actual carcinogen is not sodium nitrate but nitrosamines, substances formed when the body digests the sodium nitrates. Sodium nitrate has not been banned, primarily because it kills the bacterium Clostridium botulinum that causes the highly virulent food-borne disease known as botulism. It should also be noted that the bacteria found in the human intestinal tract may contain more nitrates than a person could ever take in from eating cured meats or other nitrate-containing food products. Nonetheless, concern about the carcinogenic properties of nitrates has led to the introduction of meats that are nitrate-free or that contain reduced levels of the substance.Much of the concern about chemicals in foods today centers on the possible harm caused by pesticide and herbicide residue left on foods by agricultural practices. While some of these chemicals cause cancer at high doses in experimental animals, the very low concentrations found in some foods are well within established government safety levels. Continued research regarding pesticide and herbicide use is essential for maximum food safety, and the continuous monitoring of agricultural practices is necessary to ensure a safe food supply. Scientists and consumer groups stress the importance of balance between chemical use and the production of quality food products. Policies protecting consumer health and ensuring the continued improvement in food production through development of alternative, low-chemical pesticides and herbicides and reduced environmental pollution should be the goal of prevention efforts. *11/277/5*

SURGERY FOR EPILEPSY

admin — Tue, 29 Mar 2011 12:08:35 +0000

Gillian had had partial complex seizures since she started primary school. Now she was 16 and about to have temporal lobe surgery. Even as a child she had felt her epilepsy was a barrier between her and other people, making it hard for her to make friends. Now, at 16, she spent all her time at home and never went out. Although she didn’t seem to mind this, her parents minded for her, especially her mother. “You’ll see, everything will be different after your operation,” her mother used to say. “You ’11 be able to go out, have boyfriends, be just like other girls.”
The operation was a huge success. Gillian’s parents were delighted (as well they might be — they had cashed in an insurance policy and had it done privately so that Gillian wouldn’t have to wait) and so was her doctor. “We’ll need to tail your drugs off gradually for a few months,” he told her, “but then I don’t see why you shouldn’t stop altogether. Fingers crossed of course, but I think we can hope for a 100 per cent cure.”
Two months later Gillian had had no seizures. But she had no social life either. She showed no signs of wanting to leave home or lead an independent life. “You can’t just keep on sitting at home now,” said her mother. “Come on, we’ve paid all that money for your operation so you could start leading a proper life of your own. You should start going out, meeting people, making friends …”
But Gillian had never learnt how to make friends. With people of her own age she felt out of her depth. She didn’t know how to talk to them, she didn’t share their interests. In her heart of hearts she knew she didn’t really want to get to know them — she was scared. Her epilepsy didn’t seem like a barrier any more, more like a protective wall around her which had been suddenly demolished.
The next day Gillian didn’t take her anticonvulsants. She didn’t take them next day, or the day after that. A few days later she had a seizure. Her parents of course were bitterly disappointed. So was Gillian, in a way… but there was a part of her, quite a large part in fact, which felt as though she was welcoming back an old friend.
It is only within the last few years that surgery has been a serious option for someone with epilepsy. The first brain operations tended to be rather hit-or-miss affairs. But modern methods of brain imaging mean that the surgeon can pinpoint the area of the brain which is giving rise to seizures much more accurately and brain surgery is much safer and more successful (and therefore more popular and widely used) than it used to he. The surgeon now knows exactly which part of the brain has to be removed, and can predict much more easily which people will benefit from surgery and what the effects of surgery are likely to be.
Even so, epilepsy surgery is not something to be gone into lightly. It will only be considered if drug treatment has failed. Not every patient will benefit from surgery, not every type of seizure will be improved. You will have to be prepared for months of tests – and you also have to be prepared for disappointment. Each further test is a hurdle at which you may fall.
If epilepsy surgery is being offered to children, it is important for the whole family to be assessed and to know what is involved. Parents who are desperate for a cure for their child may put undue pressure on them to have surgery. And they may also have unrealistic expectations about what surgery can achieve. There can be problems if parents (like Gillian’s parents) expect that the operation will change their child overnight. It will not suddenly give him or her the social skills they need to make friends, for example.
Even the loss of seizures can be a mixed blessing. For a few people their seizures are very much a part of their identity. They may find it hard to come to terms with their loss; in fact, losing their seizures may actually be more traumatic for them at the time than the continuation of their epilepsy. Although children will have experienced the down side of having epilepsy, they may also have grown used to being dependent or to having attention lavished upon them. A new, seizure-free life style may not be entirely welcome if it means they are expected to become independent and allowances are no longer made for them.
There is one question which often worries people who are thinking about epilepsy surgery. One might expect the operation itself to damage the brain and give rise to even more seizures, and yet this does not happen. The reason is that although the clean cut of the surgeon’s knife (provided it is skillfully wielded) obviously damages some cells, the damage is limited and local and usually not sufficient for seizures to arise.

WHO BENEFITS?
Before anyone considers you as a candidate for surgery, you will be put through a whole battery of tests to see if surgery would be likely to abolish or at least reduce the frequency of your seizures. The surgeon also needs to make sure that the surgery itself would not be likely to cause any further damage. You are most likely to benefit from epilepsy surgery:
If you have partial complex seizures due to temporal lobe epilepsy;
If it is quite clear which side of the brain the seizures are coming from;
If you do not have a ‘mix’ of seizures (i.e., all your seizures are of one type);
If your seizures arise from a single, localized focus;
If this focus is in a part of the brain which can be easily removed without causing significant impairment of brain function, or damage to other structures;

Assessment tests
You will have to undergo at least some of the following ranges of tests to check whether you are a good candidate for surgery.
A detailed clinical history is the first and most important check. From it your doctor can usually ensure that you only have one seizure type, and deduce the likely area of the brain from which your seizures are arising.
Routine and sleep EEGs will indicate whether your seizures appear to arise from a localized focus.
Sphenoidal EEG recording, foramen ovale recording or videotelemetry, to check which side and which part of the temporal lobe seizures are coming from.
MRI scan. This gives more accurate information about the origin of your seizures and whether the damage is confined to one side of the brain.
PET scan and SPET. These give a picture of the brain at work, and are used to confirm that the lesion is on a particular side. If there is a lesion it will show up on the scan as a zone of low metabolism (i.e., low brain activity).
Psychometric tests. These will give additional evidence about the focus of the seizures, and also indicate whether your memory or other mental processes would be likely to suffer as a result of an operation.
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