Hypertension

Hypertension, commonly referred to as "high blood pressure" or HTN, is a medical condition in which the blood pressure is chronically elevated. While it is formally called arterial hypertension, the word "hypertension" without a qualifier usually refers to arterial hypertension. Hypertension can be classified as either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Secondary hypertension indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as kidney disease or certain tumors (especially of the adrenal gland). Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.

Hypertension is considered to be present when a person's systolic blood pressure is consistently 140mmHg or greater, and/or their diastolic blood pressure is consistently 90mmHg or greater. Recently, as of 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has defined blood pressure 120/80 mmHg to 139/89 mmHg as "prehypertension." Prehypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension.

Osteoarthritis

What is osteoarthritis?
Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common, affecting over 20 million people in the United States. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females. In the United States, all races appear equally affected. A higher incidence of osteoarthritis exists in the Japanese population, while South African blacks, East Indians and Southern Chinese have lower rates.

Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.

What causes osteoarthritis?
Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases and the protein makeup of cartilage degenerates. Repetitive use of the joints over the years irritates and inflames the cartilage, causing joint pain and swelling. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. Loss of cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility.Inflammation of the cartilage can also stimulate new bone outgrowths (spurs) to form around the joints. Osteoarthritis occasionally can be found in multiple members of the same family, implying an heredity (genetic) basis for this condition.
Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes and other hormone disorders.

Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage. In fact, next to aging, obesity is the most powerful risk factor for osteoarthritis of the knees. The early development of osteoarthritis of the knees among weight lifters is believed to be in part due to their high body weight. Repeated trauma to joint tissues (ligaments, bones and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players. Interestingly, recent studies have not found an increased risk of osteoarthritis in long-distance runners.

Crystal deposits in the cartilage can cause cartilage degeneration, and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.
Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to design abnormalities of these joints that had been present since birth.
Hormone disturbances, such as diabets and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

Autism

What Does Autism Mean?
Autism causes kids to experience the world differently from the way most other kids do. It's hard for kids with autism to talk with other people and express themselves using words. Kids who have autism usually keep to themselves and many can't communicate without special help. They also may react to what's going on around them in unusual ways. Normal sounds may really bother someone with autism — so much so that the person covers his or her ears. Being touched, even in a gentle way, may feel uncomfortable. Kids with autism often can't make connections that other kids make easily. For example, when someone smiles, you know the smiling person is happy or being friendly. But a kid with autism may have trouble connecting that smile with the person's happy feelings.A kid who has autism also has trouble linking words with their meanings. Imagine trying to understand what your mom is saying if you didn't know what her words really mean. It is doubly frustrating then if a kid can't come up with the right words to express his or her own thoughts.

Autism causes kids to act in unusual ways. They might flap their hands, say certain words over and over, have temper tantrums, or play only with one particular toy. Most kids with autism don't like changes in routines. They like to stay on a schedule that is always the same. They also may insist that their toys or other objects be arranged a certain way and get upset if these items are moved or disturbed.

If someone has autism, his or her brain has trouble with an important job: making sense of the world. Every day, your brain interprets the sights, sounds, smells, and other sensations that you experience. If your brain couldn't help you understand these things, you would have trouble functioning, talking, going to school, and doing other everyday stuff. Kids can be mildly affected by autism, so that they only have a little trouble in life, or they can be very affected, so that they need a lot of help.

What Causes Autism?

Autism affects about 1 in every 150 kids, but no one knows what causes it. Some scientists think that some kids might be more likely to get autism because it or similar disorders run in their families. Knowing the exact cause of autism is hard because the human brain is very complicated. The brain contains over 100 billion nerve cells called neurons. Each neuron may have hundreds or thousands of connections to other nerve cells in the brain and body. The connections (which are made by releasing neurotransmitters) let different neurons in different areas of the brain — areas that help you see, feel, move, remember, and much more — work together. For some reason, some of the cells and connections in the brain of a kid with autism — especially those that affect communication, emotions, and senses — don't develop properly or get damaged. Scientists are still trying to understand how and why this happens.

How Is Autism Treated?
There is no cure for autism, but doctors, therapists, and special teachers can help kids with autism overcome or adjust to many difficulties. The earlier a kid starts treatment for autism, the better.

Different kids need different kinds of help, but learning how to communicate is always an important first step. Spoken language can be hard for kids with autism to learn. Most understand words better by seeing them, so therapists teach them how to communicate by pointing or using pictures or sign language. That makes learning other things easier, and eventually, many kids with autism learn to talk.

Therapists also help kids learn social skills, such as how to greet people, wait for a turn, and follow directions. Some kids need special help with living skills (like brushing teeth or making a bed). Others have trouble sitting still or controlling their tempers and need therapy to help them control their behavior. Some kids take medications to help their moods and behavior, but there's no medicine for autism.

Students with mild autism sometimes can go to regular school. But most kids with autism need calmer, more orderly surroundings. They also need teachers trained to understand the problems they have with communicating and learning. They may learn at home or in special classes at public or private schools.

Allergy/Allergies

Introduction

In this review you will learn how allergy relates to the immune system. You will begin understanding how and why certain people become allergic. The most common allergic diseases are discussed briefly in this article.

What does an allergy mean?

An allergy refers to an exaggerated reaction by our immune system in response to bodily contact with certain foreign substances. It is exaggerated because these foreign substances are usually seen by the body as harmless and no response occurs in non- allergic people. Allergic people's bodies recognize the foreign substance and one part of the immune system is turned on. Allergy-producing substances are called "allergens." Examples of allergens include pollens, dust mite, molds, danders, and foods. To understand the language of allergy it is important to remember that allergens are substances that are foreign to the body and can cause an allergic reaction in certain people.

When an allergen comes in contact with the body, it causes the immune system to develop an allergic reaction in persons who are allergic to it. When you inappropriately react to allergens that are normally harmless to other people, you are having an allergic reaction and can be referred to as allergic or atopic. Therefore, people who are prone to allergies are said to be allergic or "atopic."

Austrian pediatrician Clemens Pirquet (1874-1929) first used the term allergy. He referred to both immunity that was beneficial and to the harmful hypersensitivity as "allergy." The word allergy is derived from the Greek words "allos," meaning different or changed and "ergos," meaning work or action. Allergy roughly refers to an "altered reaction." The word allergy was first used in 1905 to describe the adverse reactions of children who were given repeated shots of horse serum to fight infection. The following year, the term allergy was proposed to explain this unexpected "changed reactivity."

What causes allergies?

The immune system is the body's organized defense mechanism against foreign invaders, particularly infections. Its job is to recognize and react to these foreign substances, which are called antigens. Antigens are substances that are capable of causing the production of antibodies. Antigens may or may not lead to an allergic reaction. Allergens are certain antigens that cause an allergic reaction and the production of IgE.

The aim of the immune system is to mobilize its forces at the site of invasion and destroy the enemy. One of the ways it does this is to create protective proteins called antibodies that are specifically targeted against particular foreign substances. These antibodies, or immunoglobulins (IgG, IgM, IgA, IgD), are protective and help destroy a foreign particle by attaching to its surface, thereby making it easier for other immune cells to destroy it. The allergic person however, develops a specific type of antibody called immunoglobulin E, or IgE, in response to certain normally harmless foreign substances, such as cat dander. To summarize, immunoglobulins are a group of protein molecules that act as antibodies. There are five different types; IgA, IgM, IgG, IgD, and IgE. IgE is the allergy antibody.

In the pet cat example, the dad and the youngest daughter developed IgE antibodies in large amounts that were targeted against the cat allergen, the cat dander. The dad and daughter are now sensitized or prone to develop allergic reactions on subsequent and repeated exposures to cat allergen. Typically, there is a period of "sensitization" ranging from months to years prior to an allergic reaction. Although it might occasionally appear that an allergic reaction has occurred on the first exposure to the allergen, there must have been a prior contact in order for the immune system to be poised to react in this way.

IgE is an antibody that all of us have in small amounts. Allergic persons, however, produce IgE in large quantities. Normally, this antibody is important in protecting us from parasites, but not from cat dander or other allergens. During the sensitization period, cat dander IgE is being overproduced and coats certain potentially explosive cells that contain chemicals. These cells are capable of causing an allergic reaction on subsequent exposures to the dander. This is because the reaction of the cat dander with the dander IgE irritates the cells and leads to the release of various chemicals, including histamine. These chemicals, in turn, cause inflammation and the typical allergic symptoms. This is how the immune system becomes exaggerated and primed to cause an allergic reaction when stimulated by an allergen.

On exposure to cat dander, the mom and the other two children produce other classes of antibodies, none of which cause allergic reactions. In these non-allergic members of the family, the dander particles are eliminated uneventfully by the immune system and the cat has no effect on them.

Who is at risk and why?

Allergies can develop at any age, possibly even in the womb. They commonly occur in children but may give rise to symptoms for the first time in adulthood. Asthma may persist in adults while nasal allergies tend to decline in old age.

Why, you may ask, are some people "sensitive" to certain allergens while most are not? Why do allergic persons produce more IgE than those who are non-allergic? The major distinguishing factor appears to be heredity. For some time, it has been known that allergic conditions tend to cluster in families. Your own risk of developing allergies is related to your parents' allergy history. If neither parent is allergic, the chance that you will have allergies is about 15%. If one parent is allergic, your risk increases to 30% and if both are allergic, your risk is greater than 60%.

Although you may inherit the tendency to develop allergies, you may never actually have symptoms. You also do not necessarily inherit the same allergies or the same diseases as your parents. It is unclear what determines which substances will trigger a reaction in an allergic person. Additionally, which diseases might develop or how severe the symptoms might be is unknown.

Another major piece of the allergy puzzle is the environment. It is clear that you must have a genetic tendency and be exposed to an allergen in order to develop an allergy. Additionally, the more intense and repetitive the exposure to an allergen and the earlier in life it occurs, the more likely it is that an allergy will develop.

What is Glaucoma?

Glaucoma is a group of eye diseases that gradually steal sight without warning. In the early stages of the disease, there may be no symptoms. Experts estimate that half of the people affected by glaucoma may not know they have it.

Vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires. It is responsible for carrying images from the eye to the brain.

There is no cure for glaucoma—yet. However, medication or surgery can slow or prevent further vision loss. The appropriate treatment depends upon the type of glaucoma among other factors. Early detection is vital to stopping the progress of the disease.

It was once thought that high pressure within the eye, also known as intraocular pressure or IOP, is the main cause of this optic nerve damage. Although IOP is clearly a risk factor, we now know that other factors must also be involved because even people with “normal” levels of pressure can experience vision loss from glaucoma.

Cancer of Cervix - part1

The cervix is the part of the uterus connected to the upper vagina. It is the structure that dilates during childbirth to allow the baby to traverse the birth canal. There are two major types of cancer that develop from the cervix. Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Adenocarcinomas arise from the glandular lining of the endocervical canal. About 85% of cervical cancers are squamous cell cancers and the remainder adenocarcinomas. Each of these major types has several subtypes that may require special treatment; otherwise they are all managed similarly. Squamous cell cancers are unique because there is a well established progression through premalignant changes before a cancer develops. These premalignant changes are easy to detect by a simple screening test called the Pap test.

SYMPTOMS
There may be no symptoms of a very early cervical cancer, but by the time it is large enough to detect visually it is usually symptomatic with abnormal bleeding. Often this abnormal bleeding occurs after sexual intercourse. Cancers must make new blood vessels as they grow. These new blood vessels are often abnormal and break easily which is why bleeding is a sign of cancer. The cancer also outgrows some of its blood supply, so portions of it are deficient in oxygen. This causes some of the cells to die and for the tissue to become infected. In the cervix this causes a watery or foul discharge that will be noticeable and resistant to most treatments for the usual vaginal infections.

As the cancer increases in size it usually grows laterally toward the pelvic wall. The tubes from the kidneys (ureters) that bring urine to the bladder pass through this area and they are easily obstructed. If that happens to both of the ureters, then this will result in renal failure, coma and death. If the cancer grows into the pelvic wall it will press on the nerves that go to the leg and cause unremitting leg pain. These are symptoms of an advanced cancer. Premalignant changes have no symptoms and are usually not noticeable on visual examination.

Cervical cancers usually do not spread early. They tend to be slow growing and cause most of their problems in the pelvis. Although distant metastases occur they are usually late events. Cervical cancers can spread by way of the lymphatic system. The lymphatic vessels drain from the cervix to clusters of lymph glands along the pelvic wall. The lymphatics follow the large blood vessels so the route of drainage is upward along the pelvic wall, then along the midline of the backbone and then to the chest. If the pelvic lymph nodes on one side of the pelvis become obstructed with cancer then that will cause swelling in the leg on that side. This is another sign of advanced cancer.

TREATMENT

In general, cancers of the cervix are treated with radiation. The major exceptions are for those that are stage I and some that are stage IV. Stage IA cancers that invade less than 3mm deep can sometimes be treated by simple hysterectomy or even in special cases by cone biopsy. All other Stage I cancers are treated either by radical surgery or radical radiation. Some stage IIA cancers can also be considered for surgery. Otherwise, all stage II, III and IV cancers are treated with radiation. Occasionally ultra-radical surgery is done on some stage IVA cancers. Surgery for stage IB and some IIA cancers requires a radical hysterectomy and removal of the pelvic lymph nodes. Radical hysterectomy means that the cervix is removed by staying as far away from it and the cancer as possible. A regular or simple hysterectomy removes the cervix by staying as close to it as possible.

Cancer surgery requires that the cancer be removed with as good a margin of uninvolved tissue as can safely be taken. The radical hysterectomy technique removes all the supporting ligaments to the cervix which means that the dissection is very close to the bladder and to the rectum. The ureters have to be dissected out and the tissue around them removed. A radical hysterectomy with removal of the lymph nodes takes about 4 hours to perform. A simple hysterectomy takes only about 1-2 hours. The ovaries are not a part of the problem with cervical cancer and can be left in place. If after surgery the pathology indicates that there are positive lymph nodes or that the surgical margins are close, then pelvic irradiation with or without chemotherapy may be advised.

Ultraradical pelvic surgery for advanced or recurrent cancer means that all the pelvic organs are removed. The uterus and cervix, vagina, bladder and rectum are removed. Sometimes a vagina can be reconstructed. If the rectum can be reattached then there will be no need for a colostomy. Sometimes a continent urinary reservoir can be constructed. Otherwise a bag will have to be placed for the urine to drain through an ostomy in the abdominal wall. This ultra-radical surgery is done if there is an extensive cancer involving the bladder or rectum, but without spread beyond these structures. It is also done for cancers that recur after pelvic radiation if they are confined to the pelvis.

Radiation therapy usually requires a treatment each day, five days a week, for about five weeks. Each treatment takes only several minutes. This is called external or teletherapy. The entire pelvic area is irradiated by an x-ray beam usually generated by a linear accelerator. Everything in the pelvis is irradiated, bladder, rectum, large intestine, small intestine, bone and skin. Following this treatment, a radioactive source is placed inside the cervix and vagina and left in place several hours or several days. This is called an implant, radium implant, intracavitary implant or any of several other names. A more accurate term is brachytherapy which means slow therapy.

Often when cancer of the cervix is being treated with radiation, chemotherapy is also given to increase the effects of the radiation. Otherwise, chemotherapy is not used as initial treatment for cancer of the cervix. There are some investigational studies in which chemotherapy is given first and then either surgery or radiation performed.

Complications from treatment with surgery are related to anesthesia and injury to other organs such as the bladder and ureters. There is also the risk associated with blood transfusions and infection. These complications usually occur early and are remediable. Radiation complications can occur years later and are difficult to fix.

Osteoarthritis of the Elbow

Osteoarthritis occurs when the cartilage surface of the elbow is damaged or becomes worn. This can happen because of a previous injury such as elbow dislocation or fracture. It may occur due to degeneration of the joint cartilage from age. Osteoarthritis usually affects the weightbearing joints, such as the hip and knee. The elbow is one of the least affected joints due to its well matched joint surfaces and strong stabilizing ligaments. This makes the joint able to tolerate large forces across it without becoming unstable.
A doctor can usually diagnose elbow arthritis based upon a patient's symptoms and standard X-rays (Figure 1). X-rays show the arthritic changes. Most of the time, advanced imaging studies such as CT (computed tomography) or MRI (magnetic resonance imaging) scans are not needed. Elbow osteoarthritis that occurs without previous injury is more common in men than women. It usually begins after age 50, although some patients can have symptoms earlier.

What is the HPV virus?

The human papilloma viruses (HPVs) are a group of more than 100 different types of virus. They are given numbers to distinguish them. HPV's can be transmitted through intimate contact, including sexual intercourse. Some of the HPV viruses can cause genital warts - those numbered HPV 6 and HPV 11.

Some types of HPV are linked to cervical cancer particularly numbers 16, 18, 30 and 33. They are called high risk because just about all cervical cancers are positive for high risk HPV. This association is so strong that scientists in this area think that the very small number of cervical cancers that test negatively for HPV have come about because there was a problem with the HPV testing, rather than because the infection wasn't there in the first place.

On the other hand, many women who are infected with high risk HPVs do not go on to develop cervical cancer. So there are other factors at work too, such as smoking and how well your immune system is working. Women who smoke and have a high risk HPV infection are more likely to go on to get cervical cancer. It is important to remember that regular cervical screening will pick up abnormal cervical cells before they become cervical cancers. So even if you have HPV and smoke, you can prevent cervical cancer. You could also stop smoking, of course!

Those who have lowered immunity also have an increased risk of cervical cancer. This can be because of drugs you are taking for another condition, or because you have an illness that affects your immunity, such as HIV/AIDS. If you have lowered immunity, it is particularly important for you to have regular smear tests.

The HPV virus can be latent. That means that it can be present but not active. It is possible for someone to have been infected at some point in the past and for the virus to be asleep or dormant. HPV can lie dormant and be undetected for many years before it becomes active. It may not cause any symptoms and you might not even know that you have it. Only certain strains cause genital warts and the other strains can be present but go completely unnoticed. Most HPV infections disappear without treatment, as the body's immune system fights the infection.

HPV testing is not routinely available in the NHS. But the NHS has been considering it as part of the cervical cancer screening programme. Women who test positive for a high risk strain of HPV are more likely to need treatment for borderline or mildly abnormal cervical smears than women who are not. At the moment, if you have a mildly abnormal cervical smear, you may have a colposcopy straight away. Or your doctor may ask you to come back for another smear in 6 months time. If the abnormality does not go away by itself (and it sometimes does), you then need a colposcopy. The NHS are considering introducing HPV testing for women with borderline or mildy abnormal smears. If you had HPV, you would have this treated. If not, you would not need treatment. The cell changes would go back to normal on their own.

There are now vaccines available to prevent infection with the human papilloma virus (HPV). As HPV is a risk factor for cervical cancer, these vaccines will help to prevent this type of cancer. The Gardasil cervical cancer vaccine was licensed for use within the European Union in September 2006. There is more information about the HPV vaccine in this section of CancerHelp UK.