Minggu, 29 Agustus 2010

Causes of Occurrence of Esophageal Cancer

Esophagus is a hollow, muscular movements of the liquid feed cable from the throat to the stomach. The walls of the esophagus is composed of several layers of tissue, including mucous membranes, muscles and connective tissue. Esophageal cancer starts inside of the esophagus and spreads through the other layers as it grows.

 
Esophageal cancer is a cancer of the esophagus. There are various subtypes. Esophageal cancer often lead to dysphagia (difficulty swallowing), pain and other symptoms and is diagnosed at biopsy. Small tumors are localized and treated with surgery and advanced cancer treated with chemotherapy, radiotherapy or combinations. The prognosis depends on the extent of disease and other medical problems, but it is pretty poor.
 

 
Symptoms
Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may be present. The liquids and soft foods are widely tolerated, and hard or bulky substances (such as bread and meat) causes many difficulties. Substantial weight loss is characteristic as a result of poor nutrition and cancer active. The pain, often the nature of combustion, can be severe and worsened by swallowing, and can be spasmodic.

 
The presence of the tumor may disrupt normal peristalsis (organized swallowing reflex), leading to nausea and vomiting, regurgitation of food, coughing and an increased risk for aspiration pneumonia. surface of the tumor can be fragile and bleed, causing hematemesis (vomiting blood). Compression of local structures occurs at an advanced stage, leading to problems such as the syndrome of superior vena cava (SVCO).
 
If the disease has spread elsewhere, this can lead to symptoms associated with it: metastases to the liver can cause jaundice and ascites, metastases to the lungs can cause shortness of breath, pleural effusion, etc.
 
 
Causes and Risk Factors
There are several risk factors for esophageal cancer. Some subtypes of cancer are associated with specific risk factors:
  • Age and sex. Most patients are over 60 years and it is more common among men.
  • Smoking and excessive alcohol consumption increases the risk and time seems to increase risk more than these two individually.
  • Swallowing lye or other caustic substances
  • Certain foodstuffs such as nitrosamines
  • An interview with the other head and neck cancer increases the risk of second cancer in the head and neck, including cancer of the esophagus.
  • Plummer-Vinson syndrome (anemia and esophageal strips)
  • Tylosis and Howel-Evans syndrome (hereditary thickening of the skin on the hands and feet)
  • The disease gastroesophageal reflux disease (GERD) and Barrett's esophagus because of increased risk of developing cancer of the esophagus is due to chronic irritation of the lining (adenocarcinoma more common in this state), while all other risk factors predispose more for squamous cell carcinoma.
The risk appears to be lower in patients taking aspirin or related drugs (NSAIDs). Statistically, it appears that Helicobacter pylori is known to increase the risk of gastric cancer, actually decreases the risk of esophageal cancer (O'Connor, 1999), the exact mechanism of this phenomenon is unclear.
 
Diagnosis
 
Eventhough the upper endoscopy procedure occlusive tumor may be suspected on barium swallow or barium, the diagnosis is best made with esophagogastroduodenoscopy (EGD, endoscopy), it implies the end of a flexible tube into the esophagus and the visualization of the wall . Biopsies taken of suspicious changes are then examined histologically for signs of cancer.
 
Most tumors of the esophagus. A very small percentage (less than 10%) leiomyoma (smooth muscle tumor) or gastrointestinal stromal tumors (GIST). The tumors are usually adenocarcinoma, squamous cell carcinoma and small cell cancer, sometimes the latter are a number of properties in lung cancer, and are relatively sensitive to chemotherapy than other types.
 
Location of the tumor is generally measured by the distance between the teeth. Esophagus (25 cm or 10 cm in length) is generally divided into three parts to determine the location. Adenocarcinomas tend to distal and proximal squamous cell carcinomas, but the opposite may be.
 

 
Staging

 
The barium enema for diagnosis of stomach cancer if a biopsy reveals cancer of the esophagus, the treatment depends on the severity of the disease. Establishing the development stage of the disease, commonly known as associated with computed tomography (CT), chest and abdomen. If you are suspected of bone metastases (eg, pain or fractures), bone scan may be performed, and bronchoscopy can be performed in cases of suspected tumor of the trachea or bronchi. In recent years, endoscopic ultrasonography (EUS) is increasingly used to evaluate the local lymph nodes, and is considered superior to CT in this indication.
 
TNM classification of expression in cancer:

  • Cancer: TX (can not be assessed), T0 (can not be detected), Tis (carcinoma in situ), the lamina propria T1 (submucosal or attacks), attacks T2 (muscular propria) attacks T3 ( on the membrane), T4 (invading adjacent structures)
  • Lymph nodes involved •: NX (can not be assessed), N0 (no), N1 (current)
  • Metastases elsewhere: M0 (no metastases) or M1 (metastases now below). M1a is used for the metastases in certain situations, indicating M1b metastases outside the area.

The information is sometimes aggregated AJCC TNM stages:
  • This is Stage 0:, N0, M0 (non-invasive tumor)
  • Phase I: T1, N0, M0
  • Stage II: T2 or T3, N0, M0
  • Stage IIB: T1 or T2, N1, M0
  • Stage III: T3, N1, M0 or T4, any N, M0
  • Stage IV: Any T, any N, M1
  • Stage IVA: Any T, any N, M1a 
  • Stage IVB: Any T, any N, M1B

 
Treatment

 
General approach
Treatment depends on the cell type of cancer (adenocarcinoma or squamous cell carcinoma versus other types), stage of disease, the patient's general condition and other diseases present. On the whole, adequate nutrition must be ensured, and adequate dental care is crucial.
 
If the patient can not swallow at all, you can enter the esophageal stent to maintain the patent. Probes may be necessary to continue the diet for cancer treatment is given, and some patients require a gastrostomy (feeding hole in the skin, which gives direct access to the stomach). The last two are particularly important if you have a tendency to aspirate food or saliva into the airways, predisposing to aspiration pneumonia.

 

 
Tumor therapy
Surgery is possible if the disease is localized, which occurs in 20-30% of all patients. If the tumor is larger, but chemotherapy or local radiation therapy can sometimes shrink the tumor to a point where it becomes the "exploitation". Is the removal of the esophagus of the esophagus because it reduces the distance between the throat and stomach, the stomach or placed in the thoracic cavity or a piece of intestine is interrupted. If the tumor is cancer, surgery is not considered to be of any benefit.
 
Laser therapy is the use of high-intensity light to destroy cancer cells, it affects only the treated area. This is usually done if the cancer can not be removed surgically. Easing the embargo could help to reduce dysphagia and pain. Photodynamic therapy (PDT), the type of laser treatment requires the use of drugs that are absorbed by cancer cells, when exposed to a special light, the drugs begin to act and destroy cancer cells.
 
Chemotherapy depends on the type of tumor, but rather with cisplatin (or carboplatin or oxaliplatin) every three weeks with fluorouracil (5-FU) either continuously or every three weeks. In a recent study, the addition of epirubicin (ECF) was better than other similar regimens in advanced unresectable cancer (Ross et al 2002). Chemotherapy can be administered after surgery (complementary policy to reduce the risk of recurrence), preoperative (neoadjuvant) or if surgery is not possible in this case, cisplatin and 5-FU are used. In clinical trials comparing different combinations of chemotherapy, phase II / III REAL-2 trial - for example - compares four regimens containing epirubicin and cisplatin or oxaliplatin and capecitabine or fluorouracil continuous infusion.
 
Radiation therapy before, during or after chemotherapy or surgery, and sometimes their own control of symptoms. In patients with the disease, but the cons-local indications for surgery, radical radiotherapy "may be used, and radiotherapy.
 

 
Monitoring and Prognosis
Patients are often followed after treatment regime has been completed. Often, other therapy to improve symptoms and maximize nutrition.
 
the prognosis of esophageal cancer is quite poor. Five years, the prognosis is 6-16%. The options are limited when the cancer recurrence, and the emphasis is on symptom control and palliative care, when it does.
 
 
Epidemiology
Esophageal cancer is a relatively rare form of cancer, but some regions have a much greater frequency than others: China, India and Japan and the United Kingdom seems to have a higher incidence, and the region around the Caspian Sea (Stewart andamp; Kleihues 2003).
 
The annual incidence ranges from 3.11 to 0.6 to 6 per 100,000 men and 100,000 women (Stewart andamp; Kleihues 2003).

 
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How To Work Laparoscopy

Laparoscopy is one of the most important for the development of diseases of the uterus and fallopian tubes. The surgery in the management of benign adnexal that progress, carpentry, ovarian cystectomy, unilateral or bilateral ovaries and fallopian tubes, laparoscopy-assisted vaginal hysterectomy (LAVH) with or without unilateral or bilateral salpingo-ovarian.
Ectopic Pregnancy
The risk of ectopic pregnancy is higher among white women. Increases three to four times in women 35-44 compared to bicycles of 15-24 years. About 64% of ectopic pregnancies in a bubble, where fertilization takes place. The recent rise in the incidence of ectopic pregnancies has been attributed to the higher prevalence of sexually transmitted infections, delay the age, the sexual organ of the previous surgery successful clinical detection. Any condition that prevents or inhibits the migration of the fertilized ovum in the uterine cavity may predispose women to ectopic pregnancy.
                                                                 Figure: tubal pregnancy
An ectopic pregnancy usually occurs in 99% of the fallopian tube. You can find it in :
  • Warts (64%)
  • Isthmus (25%)
  • Bell (9%)
  • Landlines (2%)
  • Ovary (0.5%)
  • Cancer of the cervix (0.4%)
  • Stomach (0.1%)
  • Intraligamental (0.05%)


Major risk factors associated with ectopic pregnancy are:
  • Current use of intrauterine devices 11.5%
  • The use of clomiphene citrate 10%
  • Before surgery tubal 5.6%
  • Pelvic inflammatory disease 4.0%
  • Infertility 2.9%
  • Induced abortion 2.5%
  • Accessions 2.4%
  • abdominal surgery 2.3%
  • Cancer T-shaped 2%
  • Myomata 1.7%
  • Progestin-only contraceptives 1.6%

If laparoscopy is planned, the location, size and nature of tubal pregnancy be determined. If the bleeding can be arrested or detained, respectively, of rupture of tubal pregnancy can be effectively treated endoscopically. After controlling the bleeding, the products of conception and blood clots will be removed. If more than 1500 cc hemoperitoneum, laparoscopic-cons is indicated. salt heparin should be used in cases of large hematomas. Require large extracorporeal connection ectopic.
10 mm suction instrument is used to clean the abdominal cavity. forced irrigation with saline solution should remove the clot and the fabric of peritonitis chorionic trophoblast, with minimal damage to the genital structures.
                                     Figure: salpingotomy ectopic pregnancy in the intact
For intact tubal pregnancy oviducts was identified and mobilized to reduce bleeding, 5 to 8 ml of the diluted solution containing 5 units vasopressin in 20 ml of saline is injected into the spinal needle 20 or by laparoscopy. Should be granted in mesosalpinx just below and above the surface of the section tubal ectopic pregnancy antemesentric containing the product. Needles do not add to the depth of intravascular blood vessels, because they can cause acute injection of hypertension, bradycardia, and one day can be fatal.
                                         Figure: salpingotomy ectopic pregnancy in the intact
After stabilization of the manifold in one hand and microelectrodes in the other, linear incision is made on the antimesenteric surface of the extension 1:59 cm in the thinnest parts of the tube. Fine needle should be used in cutting mode, and should barely touch the surface of the fabric. With electrosurgery, heat may spread if large tips are used on large surfaces in contact with the tissues. It is important to be aware of the existence or location of key structures in the neighborhood. If you're not careful gynecologists can not be a chance for injury to adjacent organs.
                                          Figure: suck intact trophoblast to ectopic pregnancy
Pregnancy normally protrude through the incision and slid slowly out of the pipe. You can gently teased to cut electricity or laparoscopic atraumatic forceps. Sometimes a strong opening of irrigation in the fallopian tubes can be removed from the establishment of pregnancy. What is pregnancy or extruded from the tube, some products of conception may request the siting of a ligamentous structure containing blood vessels. Using bipolar coagulation of this structure before removing the tissue. Depending on the size of the product even if the concept of an ectopic is usually removed 10 mm trocar sleeve.
Resection of the segment containing the tubal pregnancy is more salpingostomy isthemic pregnancy or pipe rupture or hemostasis is difficult to obtain. Segmental resection of the fallopian tubes is performed using a bipolar forceps or the harmonic scalpel. Automatic stapling or suturing designs can be used for bloodless resection of the fallopian tubes. Mesosalpinx if the bleeding should be cauterized with a bipolar, attention to the branch curve ovarian and uterine arteries anatomizing. Total salpingectomy is made by gradual coagulation and cutting mesosalpinx the proximal end of the fimbriae. It is separated from the uterus using bipolar coagulation and scissors. isolated segment of the fallopian tube containing the pregnancy removed intact or waste by the handle 10 mm trocar. The product design can be placed in a plastic bag and removed. Multifire stappeling salpingectomy devices require 10 mm trocar. If the fabric large and can not be processed by the cannula, endobag can be used to collect tissues.
Membership or other pathological processes such as endometriosis can be treated simultaneously in the removal of an ectopic pregnancy without significant extension of the action. Less than a week of hCG beta should return to baseline values, ie very low or undetectable.
                                                          Figure: salpingectomy

If the pregnancy is the pore may be associated with a traumatic rupture, hemorrhagic shock and there is an increase of twice the maternal mortality compared to other tubal pregnancies. Delayed diagnosis and increased vascularity of laparoscopy are difficult to do. 2-4% are interstitial ectopic. Anatomy of an ectopic pregnancy, is a growing recognition of its end. Traditional management is better for those words salpingectomy with or without resection of the cornea, and in some cases it may be difficult to remove the uterus. interstitial pregnancy may be suspected during laparoscopy, where large uterus and asymmetric line.
The majority of patients are carried out within 48 hours. A rate higher fertility rates of intrauterine pregnancy in subsequent pregnancies with laparoscopic techniques.
                                                           Figure: hemoperitoneum
Laparoscopic surgery is a good option for extra-uterine rupture and ectopic does not necessarily guarantee a laparotomy. If the patient is hemodynamically stable and preliminary studies indicate laparoscopic moderate blood loss, it may be possible to control the bleeding and to maintain certain laparoscopic procedures. If the patient is in Phase II or Stage III of shock, which has a large hemoperitoneum, laparotomy is the best choice. The management of ectopic pregnancy require a pelvic examination, the ectopic localization, aspiration and blood clots, location and control of bleeding points, or perform salpingectomy and in rare cases, ovaries are performed simultaneously.
Control of bleeding is the most critical procedures, methods, and many can try to achieve hemostasis in turn:
  • Identification of bleeding after careful consideration, dry electro pole
  • Administration of vasopressin in mesosal-pinx,
  • Electro desiccation mesosalpinx,
  • If the bleeding does not stop at these measures salpingectomy whole or in part, as part of the tube and the patient's desire for fertility.
After a good laparoscopic management of ectopic pregnancy, the patient can be discharged the next day. You should come to new FT-hCG in the serum one week after surgery to determine the end of an ectopic pregnancy. Ft-hCG level should be very low or undetectable one week after surgery. If it is above 20 mIU / ml, the blood test re-ordered two weeks later, when the FT-hCG was undetectable.

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Signs and Symptoms of Acute Renal Failure

Is this a sudden drop in kidney function, usually characterized by higher levels of blood urea nitrogen (BUN, BUN) and creatinine, oliguria (less than 500 ml of urine within 24 hours), the hyperkalemia, and sodium retention.
 
Acute renal failure is divided as follows
  • Prerenal - results from the conditions of interruption of blood flow in the kidneys, which reduces renal perfusion (hypovolemia, shock, hemorrhage, burns, impaired cardiac output, diuretics).
  • Postrenal - the obstruction of urine flow.
  • Intrarenal - results of a kidney injury (ischemia, toxins, immunological processes, system and blood vessels).
 
The disease progresses through three distinct phases of clinical anuric oliguric, diuretic, and recovery is primarily distinguished by changes in urine and serum creatinine and urea. Complication of ARF include dysrhythmias, increased susceptibility to infection, electrolyte imbalance, gastrointestinal bleeding from stress ulcers, and multiorgan failure. Untreated ARF can also describe the progress of chronic renal failure, renal failure and terminal uremia, or death from related causes.
 
Rating
  • Anuric-oliguric phase: urine volume below 400 ml per 24 hours, increased serum creatinine, urea, uric acid, organic acids, potassium and magnesium should be 3-5 days in infants and children 10-14 days and young adults.
  • Diuretic phase: begins when the urine output exceeds 500 ml per 24 hours, ending with the BUN and creatinine are increasing, the length available.
  • Recovery phase: asymptomatic; take several months to a year, some scars may remain.
  • In functional kidney disease: decreased tissue turgor, dry mucous membranes, weight loss, flat neck veins, hypotension, tachycardia.
  • In the post-renal disease: changes difficulty urinating in the flow of urine.
  • The intrarenal disease: presentation of different, usually a swelling may have fever, rash.
  • Nausea, vomiting, diarrhea, lethargy and may also occur.
 
Test Evaluation
  1. Urinalysis shows proteinuria, hematuria, casts. urine chemistry distinguishes different forms of ARF (renal replacement therapy, post-renal, intrarenal).
  2. Levels of creatinine and urea 2.Serum are high, blood gas (ABG) level of electrolytes in serum may be invalid.
  3. Untrasonography Renal estimate the size and treat kidney exclude obstructive uropathy.
 
Pharmacological and therapeutic interventions:
  • Surgical barriers may be necessary.
  • Corrections surplus or deficit of base fluids.
  • Correction and control of the biochemical balance.
  • Restore and maintain blood pressure with IV fluids and vasopressors.
  • Maintain adequate food: diet low additional amino acids and vitamins.
  • Initiation of hemodialysis, peritoneal dialysis, or continuous renal replacement therapy in patients with progressive azotemia and other potentially fatal complications.
 
Interventions
  • Monitor the volume of urine for 24 hours following the clinical course of the disease.
  • Monitor BUN, creatinine and electrolytes.
  • Level monitoring of GBS as necessary to evaluate the acid-base balance.
  • Weigh the patient to provide the index of fluid balance.
  • Measuring blood pressure at different times of the day in the supine, sitting and standing positions.
  • Adjust fluid intake to prevent volume overload and dehydration.
  • Watch arrhythmias and heart failure with hyperkalemia, electrolyte imbalance and fluid overload. Is resuscitation equipment available in case of cardiac arrest.
  • Beware of urinary tract infections, urinary catheter, and remove as soon as possible.
  • Use of pulmonary critical care, because the incidence of pulmonary edema, and infection is high.
  • Providing wound care.
  • We carbohydrate diet rich in carbohydrates, because they have more protein and energy savings to provide extra calories.
  • Institute seizure precautions. Benefits padded rails and airways, and suction devices at the bedside.
  • Encourage and assist the patient to turn and go because the drowsiness and lethargy may limit activity.
  • Explain that the patient may experience residual renal defects for a long period after the acute illness.
  • Encourage the patient to report a routine urine test, and other research.
  • Recommend the resumption of activity gradually, because muscle weakness will be present from the excessive catabolism.
 

Signs and Symptoms of Septic Shock

Septic shock is a frequent cause of surgical deaths. Once developed, the patient has a 50% probability of death, even with good unit. Its forecasts are best when young and its history is short. Is this the result of the release of endotoxins lysed bacteria, particularly Gram-negative bacilli on the market. This is not the same as sepsis caused by live bacteria intact. Provided that the bacteria remain intact, the patient may be without sepsis is shocked.
 
Septic shock usually begins suddenly. Fall in blood pressure can be castastrophic. He may be disoriented, confused, delirious, or comatose. Rapid breathing. His blood pressure is low. He is always with fever, and his pulse is rapid. A hallmark of a high rectal (or vaginal) and the temperature of cold extremities. Patients with septic shock is kwasiczą and breathes deeply and rapidly. He may have diarrhea, and obstruction in the same time. It is generally jaundice, anemia, and often subject to little or no urine (bad sign). It may develop DIC (disseminated intravascular coagulation), and bleeding from wounds, nose or gastrointestinal tract, or in his urine. His heart, lungs and kidneys may not cause pulmonary edema and oliguria.
 
There are two types-'warm "and" cold ", can use the cold to hot: (1), less frequent, less deadly type of hot, usually caused by Gram-positive cocci, the patient has a warm, pink ( if Caucasian) members, large pulse pressure and pulse restrictive. (2) The most common, and even more dangerous type of cold, usually caused by Gram-negative, has a wet and cold extremities.
 
I suspect that the patient in septic shock, where it is already infected, and fell gravely ill and hypotensive. Source of infection may be peritonitis, septic abortion, ass infected transfusion of contaminated blood or infected pyaemia instrumentation of the bladder. Or an infection can be masked and difficult to diagnose.
 
The treatment is urgent. The first consideration is its fluid, and to adjust the volume given to the production of urine. CVP its measurement is not useful, even if it can be measured, because it can develop pulmonary edema, when it is in the normal range.
 
Septic shock
 
Take blood cultures, oil and culture of the evolution of septic tank.
  • Oxygen. Give the patient's oxygen mask.
  • Nursing. sponge the year comfort. Do not let it develop hyperthermia.
  • Antibiotics. Give high doses of bactericidal antibiotics at least three, preferably by intravenous bolus injection. The options available are: (1) 5.10 benzylpenicillin megaunits 4-hour with chloramphenicol 1 g 6 hours, or 500 mg of streptomycin 6-hour intervals. (2) Gentamicin 2-5 mg / kg / day by intramuscular or slow intravenous in divided doses every 8 hours. By increasing renal interval between doses. (3) Staphylococcus 1 g intramuscularly or by slow intravenous injection 4-6 hours. (4) kanamycin 15-30 mg / kg / day by slow intravenous injection in divided doses every 8-12 hours. (5) cephaloridine 0.5-1 g every 8-12 hours by slow intravenous or intramuscular. The maximum dose is 6 g per day, or four patients aged over 50 or within 2 days after surgery. Give the children 20-40 mg / kg / day in divided doses, up to 4 g. (6), metronidazole for anaerobes. 400 mg orally every 8 hours. For the rectum 1 g every 8 hours for 3 days, followed by 1 g of 12 hours apart. 500 mg intravenously eight hours to seven days. Give your child 7.5 mg / kg being eight hours.
 
What are the intravenous fluids?
Guided by the serum electrolytes. If these measures can not, give it a 0.9% saline, dextrose 5% in 0.9% saline or Ringer's lactate solution Darrrow. Hyponatremia is common, while only 5% of glucose is dangerous. He probably also benefit from colloids such as dextran.
 
How much fluid?
It may be necessary to 50 ml/kg/24hrs beyond demand and tap water daily. Adults may need 6 liters in 24 hours. Guided by the hourly output of urine. Aim for urine output, at least 30 ml / hr.
 
If pulmonary edema develops, give furosemide 100-200 mg two or three times a day. If possible, watch the sodium and especially potassium levels and correction
 
If you develop an acute left ventricular failure, to give him a dose of 0.5 mg digoxin, repeated if necessary. If the ECG is available, use it as a guide for treatment. Otherwise, the number of pulses and beat up together. If she has a pulse deficit, you have more to scan.
 
Other drugs
When enough liquid, recital with drugs, they are not as important to provide appropriate fluids.
  • Dopamine, which will increase cardiac output and tissue perfusion. Give him 1-4 micrograms / kg / min. De dissolving 4 mg in 500 ml of liquid.
  • Chlorpromazine, which can release the contraction of peripheral vessels. If his legs are cold and wet it chlorpromazine 0.5 mg / kg.
  • Steroids are of questionable value. Give him 50 mg dexamethasone (or equivalent) intravenously, and repeat this every 4-6 hours.
 
Pus drainage
If you can empty the septic focus to do. Timing is important: it must be in the form enough to get the procedure, so that you overcome the shock. For the simplest operation possible. It will take courage, because it will be very sick and can not survive. However, he can save his life. You may need to evacuate septic abortion, brain abscess, pelvic or subphrenic or reconsider his abdomen.
 

Signs and Symptoms of Shock Cardiogenic

Cardiogenic (kar-dee-oh-JE-nik) is a state of shock, in which the weakened heart fails to pump enough blood to meet the needs of the organization. It is a medical emergency and is fatal if not treated immediately. The most common cause of cardiogenic shock is damage to the heart muscle with a severe heart attack.


  
Not everyone who has a heart attack develops cardiogenic shock. In fact, less than 10 percent of people who have a myocardial infarction development. But when there is no cardiogenic shock, it is very dangerous. For people who die of a heart attack at the hospital, cardiogenic shock is the most common cause.

What is a Concussion?
The use of the term "shock" refers to a condition in which not enough blood and oxygen to obtain important organs in the body such as brain and kidneys. In a state of shock, those with blood pressure is very low.
The shock can be many different reasons. Cardiogenic shock is one reason why the shock.

Other causes of shock are:
  • Hypovolemic (HY-Voe-poe-LEE-mik) shock. It's a shock because not enough blood in the body. The most common cause is severe bleeding.
  • Vasodilation (VAZ-oh-oh-Dile-tor-ee) the shock. In this type of shock, blood vessels relax too much and cause very low blood pressure. When blood vessels are too relaxed, there is not enough pressure to push blood through them. Without sufficient pressure, blood does not reach the organs. Bacterial infection in the blood, severe allergic reaction or damage to the nervous system (brain and nerves) may result in expansion of shock.

When a person is in shock (for whatever reason), it is not enough blood or oxygen reaches the organs of the body. If the shock lasts more than a few minutes due to lack of oxygen to the body begins to cause damage. If the shock is not treated early, organ damage can become permanent, a person can die.

Some of the symptoms of shock are:
  • Confusion or lack of vigilance
  • Unconsciousness
  • Sudden, rapid heart
  • Sweating
  • Pallor
  • Weak pulse
  • Breath
  • Decreased urine output or not
  • Cool hands and feet


If you suspect you or someone you are in shock, call 911 and to undergo emergency treatment immediately. Early treatment can prevent or limit permanent damage to the brain and other organs and can prevent death.

Perspective
In the past, almost no one survived the cardiogenic shock. Now, thanks to improved treatment, about 50 percent of people who go into cardiogenic shock survive.
Therefore, people increasingly survive through treatment of cardiogenic shock (drugs and devices) that restore blood flow to the heart and the heart to pump more. In some cases, devices that support the pumping function of the heart are used. The implantation of these devices require major surgery.

What are the causes of cardiogenic shock?
Immediate
Cardiogenic shock happens when the heart can not pump enough blood to the body. It usually occurs when the left ventricle does not work, because the muscle is not enough blood and oxygen due to heart attack continuously. weakening of the heart muscle does not pump enough oxygen-rich blood to the rest of the body.

In about 3 percent of cases of cardiogenic shock, right ventricle does not work. This means that the heart can not pump blood efficiently to the lungs where oxygen in the blood rises to the heart and the rest of the body.

When the heart does not pump enough blood to the rest of the body, organs (such as brain and kidney) did not have enough oxygen and can be damaged. Some things that can happen are as follows.
  • Cardiogenic shock can cause death if the blood flow and oxygen to the organs is not restored quickly. Therefore, the emergency medical treatment is necessary.
  • When the authorities did not have enough blood and oxygen and stop working, cells die in the organs, agencies and can not return to normal operation.
  • As some authorities do not act, they can cause problems with other bodily functions. What may make the impact worse. For example: a). When kidneys do not function properly, levels of important chemical changes in the body. This can cause heart and other muscles become even weaker, limiting blood flow even more. b). When the liver is not functioning properly, the body stops making the proteins that cause blood clotting. This can lead to bleeding if the shock over the loss of blood.
  • As in the brain, kidneys and other organs recover depends on how long a person is in shock. More time in shock, the less damage to organs. This is another reason why it is so important to get medical help immediately.

Who is at risk of cardiogenic shock?
The factor most common risk of cardiogenic shock is a heart attack. If you had a heart attack, the following factors may increase the risk of cardiogenic shock:
  • Old age
  • A history of myocardial infarction or heart failure
  • About coronary heart disease in all major blood vessels, heart

What are the signs and symptoms of cardiogenic shock?
The lack of blood and oxygen to the brain, kidneys, skin and other parts of the body causes the symptoms of cardiogenic shock. The symptoms of cardiogenic shock include:
  • Confusion or lack of vigilance
  • Unconsciousness
  • Sudden, rapid heart
  • Sweating
  • Pallor
  • Weak pulse
  • Breath
  • Decreased urine output or not
  • Cool hands and feet

If anyone of you about these symptoms, immediately call 9-1-1 for emergency medical treatment. Early treatment can prevent or limit permanent damage to the heart and other organs and can prevent sudden death.
How is it diagnosed cardiogenic shock?
The first step in the diagnosis of cardiogenic shock is an indication that the person is in shock. At this point, medical assistance should be established.
After starting emergency treatment, doctors can find the cause of shock. If the reason is the shock that the heart does not pump strongly enough, the diagnosis is cardiogenic shock.
The tests that are useful in the diagnosis of cardiogenic shock include:
  • Blood pressure. With a simple blood pressure cuff and stethoscope, the doctor can determine if a person has a very low blood pressure, most trade shock. This can easily be done before the patient reaches the hospital. A very low blood pressure may also have less serious causes, including simple and low side effects of drugs such as medication to treat hypertension.
  • ECG (electrocardiogram). This test detects and records the heart's electrical activity, measuring the speed and regularity of the heart. Doctors use the ECG to diagnose a severe heart attack and monitor the condition of the heart.
  • Chest radiograph. This test takes pictures of organs and structures inside the chest, including the heart, lungs and blood vessels. Ray chest shows whether the heart is enlarged, if there is fluid in the lungs, which can be a symptom of cardiogenic shock.
  • Echocardiography. This test uses sound waves to create an animated image of the heart. Echocardiography provides information on the size and shape of the heart and how heart chambers and valves are working. The test can also identify areas of myocardial infarction, which normally are not institutions. Not enough blood flows in these areas.
  • Angiography. This study is an x-ray of the heart and blood vessels. The doctor passes a catheter (a thin, flexible tube) into an artery in the leg or arm to the heart. Catheter can measure the pressure inside the various chambers of the heart. Dye, who can be seen on x-ray is injected into the blood through the catheter. Dye allows the doctor to examine blood flow through the heart and blood vessels, and I see no obstacles exist.

certain blood tests are also used to diagnose cardiogenic shock, including:
  • Arterial blood gas measurement. In this study, a sample of blood from the artery to measure oxygen, carbon dioxide and pH (acidity) in the blood. Doctors looking for abnormalities in these levels that are associated with a shock.
  • cardiac enzymes. When heart cells die, they release enzymes in the blood called markers or biomarkers. The measurement of these indicators can show if the heart is damaged and the extent of damage.
  • Studies that measure the function of various organs such as kidneys and liver. If these authorities do not work too well, this may be a sign they are not enough blood and oxygen, which may be a sign of cardiogenic shock.

What is the treatment of cardiogenic shock?
Cardiogenic shock is life threatening and requires emergency medical treatment. In most cases, cardiogenic shock is diagnosed after a person has been admitted to hospital for a heart attack. If the person is no longer in the hospital, emergency treatment can begin as soon as medical personnel to arrive.
The objectives of the emergency treatment of cardiogenic shock is the first time in the treatment of shock, then in the treatment of the cause or causes of shock.
Sometimes both the current and its causes are treated in the same time. For example, physicians can quickly open blocked blood vessels that cause heart damage. Often, the patient's blood vessel opening may be in shock, with an additional treatment or almost.
Emergency Life Support
life in the emergency treatment is necessary to support all types of shocks. This procedure will get the blood flowing and oxygen to the brain, kidneys and other organs. Restoration of blood flow to organs is essential to keep the patient alive and trying to prevent long term damage to organs. life sustaining treatment in an emergency include:
  • Giving patients extra oxygen to breathe, so that more oxygen reaches the lungs, heart and the rest of the body.
  • Give the patient fluids, including blood and blood products, through the needle into the vein (in the case where the shock due to blood loss). The introduction of more blood in the bloodstream can help you get more blood to major organs and the rest of the body. Typically, this is not to cardiogenic shock, because the heart can not pump the blood that are already in the body and too much fluid in the lungs, making breathing difficult.


Drugs
During and after the life of emergencies, doctors are trying to find out what is causing the shock. If the reason is the shock that the heart does not pump strongly enough, the diagnosis is cardiogenic shock.
Depending on what is the cause of cardiogenic shock, treatment may include medications:
  • Increasing the force with which the heart muscle contracts
  • Treatment of myocardial infarction, which may cause electric shock

The medical devices and procedures
Apart from drugs, any drug that may help the heart pump and improve blood circulation. Equipment commonly used in the treatment of cardiogenic shock include:
  • Balloon pump intra-aortic. This unit is located in the aorta (main blood vessel that carries blood from the heart to the body). A large balloon at the end of the device is inflated and break the rhythm, which is identical to the rhythm of cardiac pump function. This helps to weaken the heart muscle that pumps blood, as much, and gets more blood to vital organs like the brain and kidneys.
  • Angioplasty and stents. Angioplasty is a procedure used to restore blood flow in coronary arteries and blocked for a period of treatment of a heart attack. Stent is a small device that is placed in a coronary artery during angioplasty to help keep them open.

Surgery
Sometimes, medicines and medical devices are not sufficient for the treatment of cardiogenic shock. Operations to restore blood flow to the heart and the rest of the body and repair damage to the heart. The operations can help keep the patient alive while recovering from the shock and increase the chances of long-term survival.
Types of operations used to treat the causes of cardiogenic shock include:
  • CABG (Coronary Artery Bypass Grafting). In this operation, arteries or veins from other parts of the body are used to bypass (get around) narrowed coronary arteries.
  • Operations to repair damaged heart valves.
  • Operation repair breaks in the wall between the two chambers of the heart. This break is called a rupture of the septum.
  • Setting the device to assist heart pumps blood to the body. This device is called a left ventricular assist device (LVAD) or mechanical circulatory support. This treatment can be carried out if the damage to the left ventricle is the cause of shock. implant is battery operated pump, which takes over the pumping action of the heart.
  • Heart transplantation. It is rarely performed in emergency situations such as cardiogenic shock due to other options available devices and surgery. In addition, doctors need to test very carefully to ensure you have the benefits of heart transplantation and to find suitable donor heart. However, in some cases, doctors may recommend a transplant, they consider the best way to increase their chances of survival for patients long term.


Sabtu, 28 Agustus 2010

Signs and Symptoms of Dyslipidemia

Some people have a low HDLC ( less than 35 mg / dL) and other disorders of lipid metabolism. These disorders are called "fat" or "dyslipoproteinemias" and are most likely caused by genetic defects deterioration of poor nutrition (obesity can cause serious some of these problems). Dyslipidemia is an increase in plasma cholesterol and / or TG or low HDL level that contributes to the development of atherosclerosis. Causes may be primary (genetic) or secondary. The diagnosis is the measurement of total cholesterol, triglycerides and lipoproteins individual. treatment changes in diet, exercise and lipid-lowering drugs.

Dyslipidemia currently affects approximately 10% of the world population. It is becoming more frequent and medically necessary for the modification of lipid medications in obese patients and patients with type 2 A large proportion of patients with type 2 diabetes have abnormal levels of lipoproteins. In the U.S., Japan and Europe there are over 240 million people with abnormal levels of lipoproteins. Of these, more than 55 million high lipoprotein (HDL) and / or high triglycerides.

There is no natural border between normal and abnormal, because the measures of lipids in lipid levels are continuous. There is probably a linear relationship between lipid levels and cardiovascular risk, as people with "normal" cholesterol benefit of reaching a level even lower. Therefore, there is no numerical definition of dyslipidemia is used in relation to serum lipids, whose treatment has been beneficial. Evidence of benefit is the greater reduction of high levels of LDL, is a smaller reduction in TG high and low HDL cholesterol increased, partly because of high TG and low HDL are methods of cardiovascular risk in women than among men. This scanning electron microscope shows a cross section of color coronary atherosclerosis, fatty plaque (in yellow). diet rich in cholesterol may reduce the blood flow and lead to blood clots or blockages.

The Etiology and Classification

Dyslipidemia traditionally been classified according to the design elevation of lipids and lipoproteins. A more practical categorizes primary or secondary dyslipidemias are characterized only by increasing the concentration of cholesterol (hypercholesterolemia pure or simple), only an increase in triglyceride levels (hypertriglyceridemia pure or isolated), an increase in both cholesterol and TG (mixed or combined hyperlipidemia).

This system does not take into account the specific lipoprotein abnormalities (eg, low HDL or high LDL), which may contribute to disease despite normal cholesterol and TG. The main reason they are single or multiple genetic mutations that lead either to overproduction or defective clearance of TG and LDL cholesterol, or shortages or excessive play in HDL cholesterol. The primary lipid disorders are suspected when a patient has physical symptoms of dyslipidemia (see lipid disorders: symptoms), the premature onset of atherosclerosis ( less than 60 years), family history of atherosclerosis, or cholesterol serum more than 240 mg / dl ( more than 6.2 mmol / L). primary disorder, the most common cause of dyslipidemia in children, do not cause a significant proportion of adults. Reflecting the names of several of the old nomenclature, in which lipoproteins have been detected and identified by how divided the α (HDL) and β (LDL) teams gel electrophoresis.

Secondary causes contribute to most of dyslipidemia in adults. The leading causes of school in developed countries is a sedentary lifestyle, excessive consumption of cholesterol, fat, saturated fat and trans fatty acids (TFA). TFA are polyunsaturated fatty acids with added hydrogen atoms, are widely used in many processed foods and saturated fats in atherosclerosis. Other common secondary causes are diabetes, alcohol abuse, chronic renal failure and / or failure, hypothyroidism, primary biliary cirrhosis and other cholestatic liver diseases and medications such as diuretics thiazide, β-blockers, retinoids, very active antiretroviral agents, estrogen and progestin, and glucocorticoids.


Diabetes is particularly important that the secondary cause of atherosclerosis in patients also have a combination of high TG, high small dense LDL and low HDL fractions (dyslipidemia, hypertriglyceridemia hyperapo B). Patients with type 2 diabetes are particularly at risk. The connection may be a consequence of obesity and / or poorly controlled diabetes, which can increase traffic AGL, which results in increased hepatic VLDL production. TG-rich VLDL TG and then transmits the LDL and HDL to promote the establishment of TG-rich, small dense LDL and HDL clearance of TG-rich. Diabetic dyslipidemia is a significant increase in caloric intake and physical inactivity, which are characteristic of the style of life in patients with type 2 among women with diabetes may be at particular risk for heart disease with this form.

Symptoms may

Dyslipidemia himself no symptoms but can lead to symptomatic vascular disease, including coronary artery disease and peripheral arterial disease. High TG ( more than 1000 mg / dL [ more than 11.3 mmol / L]) can cause acute pancreatitis. High levels of LDL can cause eyelid xanthelasma, corneal arcus and tendon xanthomas located in the Achilles, elbow, knee and tendon and metacarpophalangeal joints. Patients with homozygous familial hypercholesterolemia can form above and flat or cutaneous xanthomas. Patients with elevated TG are serious eruptive xanthomas on the trunk, shoulders, knees, buttocks, knees, hands and legs. Patients may have rare dysbetalipoproteinaemia hands and tuberous xanthomas.

Severe hypertriglyceridemia (more than 2000 mg / dL [more than 22.6 mmol / l]) gives the retinal arteries and veins creamy white appearance (lipemia retina). Very high concentrations of lipids also provide nursing care (milky) appearance of blood plasma.

Treatment

When a diagnosis of genetic disease of lipid metabolism, you must adhere to a diet very strict and complex, and perhaps also take drugs. This is a situation where it must be perceived by experts like Dr. Tapp lipid rather than a GP. Because each of these disorders is very unique and manifests itself differently in different patients, you must work with the healthcare provider to develop an optimal plan. The treatment is based on a combination of different strategies:

  • The loss of weight. This is the most important strategy for overweight people
  • Low calorie diet, rich in nutrients, essential fatty acids. adequate vitamins and minerals
  • Exercise
  • Combinations of drugs

Medicines are in several categories, each category is particularly useful for the type of disorder. Some increase in HDL cholesterol and TG decline in aid, others to reduce total cholesterol and LDL. Your doctor must spend considerable time analyzing problems to determine the cause of their lipid disorders and the best types of drugs for the disease.

Once a decision is reached on the types of drugs to use, we must decide in each type of drug and dose. These decisions relate to the finer aspects of each state. Sometimes you try drugs for a while, then switch to another type to see which one works better and has fewer side effects. Furthermore, drugs can change minimize side effects.

The drug combination may allow a physician to prescribe lower doses of both drugs, thereby reducing the risk of side effects. Remember: all drugs have side effects, and many long-term adverse effects can not be known, because each person has different genes and probably everyone reacts differently to medicine.

Pre Eclampsia / Eclampsia - Pregnancy Complications

Pre-eclampsia, a life-threatening pregnancy complicatio results when a pregnant woman diagnosed with pre-eclampsia (high blood pressure and protein in urine) or coma may develop seizures. In some cases, seizures or coma may be the first recognizable sign that a pregnant woman has pre-eclampsia. main symptoms of pre-eclampsia in women diagnosed with preeclampsia may be severe headache, blurred vision or double vision or spots. Blood poisoning is a common name used to describe pre-eclampsia and eclampsia.
                                                               figure via life123

There was never any evidence that the orderly progression of disease onset, with mild preeclampsia to severe preeclampsia, and then pre-eclampsia. The disease process can start soft and sweet stay, or may be diagnosed as pre-eclampsia, without notice.
  • Approximately 5-7% of pregnancies are complicated by preeclampsia.
  • Pre-eclampsia usually occurs in women at first pregnancy, but can happen the first time during a subsequent pregnancy.
  • Fewer than one in 100 women with preeclampsia or eclampsia (convulsions or seizures) or coma.
  • Up to 20% of pregnancies are complicated by high blood pressure. The complications of blood pressure, pre-eclampsia and eclampsia may represent 20% of all deaths that occur in pregnant women.

Causes of pre-eclampsia
  • Nobody knows exactly what causes pre-eclampsia and eclampsia.
  • Because we do not know what causes pre-eclampsia or eclampsia, we have no effective test to predict the time of preeclampsia or eclampsia occurs in order to prevent or treat pre- eclampsia or eclampsia occurring (or recurring).
  • Pre-eclampsia typically occurs in the first pregnancy. However, pre-eclampsia, one can see the twins (or multiple pregnancy), women aged over 35 years among women with hypertension before pregnancy, in women with diabetes and in women with other health problems (eg, connective tissue disease and kidney disease).
  • For reasons unknown, African-American women are more vulnerable to pre-eclampsia and eclampsia than white women.
  • Pre-eclampsia may be in the family, even if the cause is unknown.
  • Pre-eclampsia is also associated with problems with the placenta, such as bearings too much, too little turnover, turnover, or how it attaches to the uterine wall. Pre-eclampsia is also associated with pregnancy hydatidiform mole in which the placenta is not normal and there is no normal child.
  • There is nothing that any woman can do to prevent preeclampsia or eclampsia occurrence. Therefore, both the unhealthy and not helpful to blame and to examine and events that have occurred rehash or just before pregnancy or early pregnancy, which may contribute to the development of preeclampsia.

The Symptoms of pre-eclampsia
Is caractéristique crisis of preeclampsia. Similar to pre-eclampsia, and other changes of symptoms may be present and the variant function system organ affected. These changes affect mother may, only child, or more commonly affect both mother and child. Some of these symptoms gives women but most do not have.
  • The most common symptom of preeclampsia, and is characterized by an elevated blood pressure. This could be the first symptom or only. Blood pressure may be very first few or quebec rose dangerously principles may be, the symptoms may or may not present do be. However, the degree of elevation of blood pressure varies from the one woman, and changes during the development and resolution process of the disease. There are women who never had significant increase of blood pressure (20% environment which women suffering from eclampsia).
  • Widespread belief in quebec gissement the risk of preeclampsia rises with increasing blood pressure at 160/110 mm Hg Tops
  • The reins unable to effectively filter have blood (as usual). It may lead to the presence of urine protein. Premier signs excess protein often found in urine obtained siège the operator. Overweight women are in rarely made changes symptoms associated with the protein urine. In the case extreme, affecting the reins, the quantity of urine produced significantly reduced.
  • Of changes in the nervous system may specify a block of blurred vision, rather than the car, Severe headache, convulsions and occasional Sami Loss of vision. Any of these symptoms requires immediate medical attention.
  • The changes affect the liver that can cause pain in the upper abdomen and may be confused with indigestion, or a disease of the gallbladder. More subtle changes affecting the liver who may affect the capacity of platelets cause blood clots,  changes May be regarded as the excessive bruising.
  • The changes affect the child's may who may cause problems with blood flow to the placenta and driving and children can not receive the adequate nutrients. Consequently, the child can not be done properly and develop maybe less provided quebec worst seems a blood count, seem reduce frequency and intensity of movements. You should immediately contact your doctor if you notice baby's movements slowing.

Treatment of Eclampsia

After pre-eclampsia develops, treatment is only able baby (if there is a pre-eclampsia before delivery). Eclampsia can also occur after birth (up to 24 hours after birth, usually). Rare, pre-eclampsia can be delayed and occur one week after delivery. There is no cure for pre-eclampsia.
Magnesium sulfate (IV) is the treatment of choice once and for pre-eclampsia develops. This treatment reduces the risk of recurrent seizures. Magnesium is a new treatment, a total of 24-48 hours after the last crisis. Magnesium can be obtained in an intensive care unit or unit of labor and delivery. A magnet is given will be strictly observed, to receive fluids intravenously and Foley catheter inserted in the urine (to measure urine production).
From time to time, the raids will require additional treatment with short-acting barbiturates, such as amobarbital sodium. Other drugs, including diazepam (Valium) or phenytoin (Dilantin) have been used to treat eclampsia, but they are not as effective as magnesium sulfate.
You can also receive treatment with blood pressure during treatment of pre-eclampsia. Common drugs against hypertension (in women with eclampsia) include hydralazine (Apresoline) or labetalol (Normodyne, Trandate).
When the woman's condition is stable after the attack, the doctor prepares to release the child. This can occur either by induction of caesarean or vaginal delivery. If you are already employed, may be allowed to progress, there is no evidence that the child has become a situation "difficult" or threatened by the seizure.
The closer the deadline, the more likely it will Cervical (ready for delivery), and induction of labor will be successful. Sometimes, medications such as oxytocin (Pitocin), are given to commence the work.
  • The earlier in pregnancy (weeks 1924-1934), the greater the chances of success of induction (although induction is still possible). It is more common in cases of caesarean section, when the state requires pre-eclampsia in early pregnancy.
  • If your child shows signs of compromise, such as reduced fetal heart rate, an immediate cesarean delivery to make.


Jumat, 27 Agustus 2010

Iritis Cause in Our Eyes

Definition
Uveitis (iritis) refers directly to the eye inflammation of the middle layer, called "Uvea" but in common usage may refer to any inflammatory process involving the eye.
 
It is estimated that uveitis accounts for about 10% of cases of blindness in the United States. Uveitis requires a thorough examination by an ophthalmologist.
 
Types
 
Uveitis is usually divided anatomically front, intermediate forms and back panuveitic.
  • Anywhere from two thirds to 90% of cases of uveitis are location (anterior uveitis), often called iritis - or inflammation of the iris and anterior chamber. This condition can occur in one episode and disappear with proper treatment or may be recurrent or chronic nature. Symptoms of a red eye, injected conjunctiva, pain and visual impairment. Symptoms include increased ciliary vessels, the presence of cells and flare in the anterior chamber and corneal institutions ("KP") on the rear surface of the cornea.
  • Intermediate uveitis consists of vitritis - inflammatory cells in the vitreous cavity, sometimes with snowbanking or inflammatory material deposition in the pars plana.
  • Posterior uveitis is an inflammation of the retina and choroid.
  • Pan-uveitis is an inflammation of all layers of Uvea.

Symptoms
Depending on the part of the eye is inflammed in uveitis various combinations of these symptoms may be present.
  • Reddening
  • Tenderness
  • Floating
  • Blurred vision
  • Pain
These symptoms can appear suddenly and the pain can not occur. The symptoms described above do not necessarily mean that you have uveitis. However, in cases where one or more of these symptoms, contact your doctor for a thorough eye examination.
 
Treatment
Treatment may include steroid eyedrops, injections or tablets, eye drops, and to expand the pupil and reduce pain. More severe cases of uveitis may even require treatment with chemotherapeutic agents to suppress the immune system.
 

Streptococcus pyogenes-a Gram-positive

Streptococcus pyogenes (group A streptococcus) is a Gram-positive, immobile, nonsporeforming coccus occurring in the network or in pairs of cells. Individual cells are round to ovoid cocci, 0.6 to 1.0 microns in diameter (Fig. 1). Distribution of streptococci in a plane, and therefore occur in pairs, or (particularly in tests of fluid or material) in the network of variable length. The metabolism of S. pyogenes is fermentative, catalase-negative anaerobic organism aérotolérantes anaerobic (facultative anaerobes) and requires enriched medium containing blood to grow. Streptococcus group typically consists of a capsule of hyaluronic acid and beta show hemolysis (clear) on blood agar.



Group A streptococci are human parasites and Streptococcus pyogenes is a human pathogen most frequently. It is estimated that between 5-15% of normal individuals harbor Streptococcus pyogenes, mainly in the respiratory tract, without signs of disease. During the host defense is compromised, or when the body is able to exert its virulence, or when it is placed on the sensitive tissues or hosts, acute infection.

During the last century, infections by S. pyogenes claimed many lives especially since the body is the most important cause of puerperal fever (sepsis after childbirth). Scarlet fever once a serious complication of streptococcal infection, but now, thanks to antibiotic treatment, it is a little more strep throat accompanied by a rash. Similarly, Rose (a type of cellulitis accompanied by fever and systemic toxicity) is less common today. However, there has been a recent increase in the variety, severity and consequences of infection with Streptococcus pyogenes and the resurgence of severe invasive infections, prompting descriptions of skin bacteria "eat" in the media. A full explanation of inheritance and rebirth is not known. Today, the pathogen of major concern because of sporadic cases of rapidly progressive disease and because of the low risk of serious consequences of untreated infections in. These diseases are a major health problem worldwide, and effort is directed to clarify the risks and consequences and the identification of strains and rheumatogenic nephritogenic streptococci.

Acute Streptococcus pyogenes infections may present as pharyngitis (sore throat), scarlet fever (rash), impetigo (infection of the superficial layers of the skin) or cellulitis (infection of the deeper layers of the skin). Invasive, toxic, can cause infection of necrotizing fasciitis, myositis and streptococcal toxic shock syndrome. Patients may also develop the immune system after streptococcal sequelae such as rheumatic fever and acute glomerulonephritis, following acute infections caused by Streptococcus pyogenes.

Streptococcus pyogenes produces a wide range of virulence factors and a wide range of diseases. virulence factors of group A streptococci include: (1) M-protein associated with cellular protein (protein F) and lipoteichoic acid to observe, (2) hyaluronic acid capsule immunological disguise and inhibits phagocytosis, M protein inhibits phagocytosis (3) invasins such as streptokinase, streptodornase (DNase B), hyaluronidase and streptolysin, (4) exotoxins, such as auto-ignition (erythrogenic) toxin which causes a rash of scarlet fever and systemic syndrome toxic shock.

Modes of Transmission of Cholera

Definition
Cholera is an infectious disease caused by bacterial toxin that affects the water absorption in the small intestine.
                                                                   figure via aeschines-afroza

In severe cases, produces a severe diarrhea in a few days. dangerous aspect of cholera is a significant loss of fluids, which can occur in a short period of time. This is especially dangerous in children in developing countries. If untreated, the loss of fluids can cause death within 24 hours of onset. On the other hand, the treatment is simple: replace the liquid with an appropriate combination of sugar and salt - the water itself is not sufficiently absorbed. But the worst cases require hospitalization, where the fluids can be administered directly into the blood infusion.

Damn this is not a tropical disease, but it is related to hygiene standards and quality of drinking water. It was a well in London in 1850-1860, which was the source of the cholera epidemic several separate. John Snow, is considered the father of public health service by its simple but brilliant move to pump water from Broad Street! Improved sanitation and hygiene remains the mainstay of the fight against cholera in those countries in which it occurs.

What are the causes of cholera?
Cholera is caused by a particular bacterium, Vibrio cholerae. With the right amount of bacteria passed into the stomach of food, they accumulate and begin to produce toxic substances (toxins). This toxin, which causes symptoms of the disease. Cholera toxin has an unpleasant effect on the ability of cells of the gastrointestinal tract, so that the victim is not just diarrhea, but also begins to lose large amounts of fluids. It is the loss of fluids, which can be severe.

Damn, how is it transmitted?
The bacteria are excreted in the stool, and if you come into contact with drinking water, bacteria can infect humans. The bacteria can also spread to food, if people do not wash their hands after using the toilet. Food prepared at the funeral of victims of cholera is a common source of secondary spread in Africa!

Diseases can be applied to all fish and shellfish from polluted waters. Shellfish filter large quantities of water and concentrate the bacteria. The cholera outbreak in Peru in 1998 were contaminated by algae, and it seems to be an effective way to disseminate the coast cholera.

Direct infection by contact with another person by their faeces or vomiting may occur, but this rarely happens. A number of bacteria is necessary for persons with normal gastric acid ill (stomach acid can kill a small number of bacteria). Yes, the bacteria need to multiply in the possibility of water or food before actually poses a threat.

Where the hell is happening?
Cholera is widespread in Asia and Africa, where epidemics occur at regular intervals. Unfortunately, the "El Tor bacteria shit" come to the part of Peru in the 1990s. From there it spread rapidly in the rest of South America.

Densely populated regions of poor sanitation and unsatisfactory food hygiene are particularly vulnerable to epidemics.

What are the symptoms?
The incubation period from infection to disease occurs, is usually less than two days, although it may be as long as five days.

The infection is often mild diarrhea common disease, and may even develop without any symptoms. But the body is still capable of transmitting the disease.

usually starts with a shit short time with abdominal pain without nausea. It may also be a slight fever. Then began vomiting and diarrhea and may take several hours.

It is followed by copious, watery diarrhea, pallor and flaky like rice water. The loss of fluids can be as high as 1 liter per hour.

Danger signals
If the loss of fluids and do not receive more than 5 to 10 liters, can be fatal.

Prolonged dehydration can cause skin floppy muscle cramps and a hoarse voice. There is also an impact on the level of consciousness, which can manifest itself in lethargy and confusion.

Electrolyte (salt) balance may be disrupted. Especially in children, it can cause seizures or cardiac arrest.

Perspective
Mild cases of cholera usually recover on their own.

Classic cholera has a high mortality rate if left untreated. In developing countries, mortality among people in the hospital without treatment is 60 percent.

If the disease is treated early and properly, the mortality rate is less than 1 percent, and the patient recovers completely.

How can I avoid infection?
  • Only drink boiled water or water that have been sterilized or treated in any way. The hot coffee and tea, sodas and other bottled beverages are generally safe to drink unpolluted.
  • Boil unpasteurized milk before drinking it.
  • Avoid ice in drinks, unless you can be sure they were made of "pure water"! Ice questionable sources may be contaminated.
  • Food should be well prepared and served hot. If it does not sit at room temperature for several hours of other bacteria such as Escherichia coli, can develop.
  • Avoid raw fish and shellfish.
  • Avoid raw fruits and vegetables unless you peel yourself.
  • Beware of food from street stalls. If you have to eat these foods, think carefully about its preparation. Make sure it contains nothing that has not been sufficiently prepared.

This review not only protects against cholera, but also against a number of bacteria that can cause diarrhea unpleasant. Some bacteria, however, produce toxins, which are not destroyed by cooking. Therefore, proper food storage is also important.

Vaccination against cholera is now possible with the oral vaccine Dukoral. But the vaccine does not protect 100 percent against the disease, and those who received the vaccine will still need to comply with the above measures to avoid disease. The vaccine is most suitable for tourists and business travelers in situations where the biggest risk is the shit (eg refugee camps).

If you think you catch hell for a trip
If you think you catch the shit, you should immediately contact your doctor. But do not despair if you're away from the hospital or doctor.

The most important thing you can do yourself, in all cases of violent diarrhea is to drink plenty of fluids with salt and sugar (alternatives with flat Coca-Cola), even if vomiting between both. These powders with salt, sugar and baking in the appropriate proportions of the mixture, which can be dissolved in water and taken as Dioralyte and Electrolade.

You can also call the following liquid ingredients. The liquid should be about as salty as tears.
  • 1 liter of boiled water.
  • Level 8 or 4 teaspoons of sugar (white, brown or honey).
  • 1 / 2 teaspoon salt.
  • lemon juice or orange juice.
How is the disease diagnosed?
Cause of many diseases, diarrhea. But if it is violence with stools, the doctor treated immediately. For diagnosis, the stool should be examined to detect the cholera bacterium.

How to treat cholera?
In severe cases, the disease must be treated in hospital. The first and most fundamental measure is to replace lost fluids. If speed is important, the liquid can be applied directly into the blood infusion. During the epidemic, 90 percent of those patients would be nice if they drink large quantities of water. The disease can be shortened and the shedding stopped earlier, administration of antibiotics

Types of Microorganisms

There are five types of micro-organisms: bacteria, viruses, protozoa, fungi and worms (worms).

Bacteria
The most common organisms on Earth, bacteria live almost everywhere in soil and water, plants and animals. Is this the shape of balls, rods or spirals, bacteria consists of a single cell. Unlike animal and plant cells, bacterial cells lack nuclei, but can perform all functions necessary for life. Most bacteria are parasites, but a few manufacturing their own food. Some of these parasites are very useful - they contribute to many bodily functions including digestion and aid in other processes such as soil degradation and changes in milk for cheese. The results of the disease, however, when bacteria multiply rapidly (each cell simply divides into two identical cells) and damage or kill human tissue, such as pneumonia and tuberculosis. Diseases can also produce toxins that kill or damage the tissues of humans, as in food poisoning or cholera. Sometimes, the bacteria in the body, help for a while, and then something in the body or the bacteria changes, causing destruction of the host.

Bacteria present in the image from top right: E. coli 0157: H7 (food poisoning cases), pyrogenes Strepococcus (causes strep throat), Mycobacterium tuberculosis (TB cases)


Virus
Certainly the smallest bacteria, viruses can occur in spirals, figure 20 or face a form more complicated. They consist mainly of genetic material - DNA or RNA. Cells, but they are not and can not exercise the functions of life by their own means. Living inside the cells of other species, viruses use host cell growth and the creation of new viral particles. How did they acquire genetic material for breeding, often the death of host cells. Find all groups of living things, bacteria and fungi to plants and animals, hundreds of known viruses can cause various infections, chickenpox, measles, influenza, colds, polio and AIDS. Viruses can not move by itself and must be done to cells by air currents and then by body fluids in the cells. Some viruses may lay dormant for years and starts, as in the case of AIDS. Most diseases from other species, for example: smallpox dogs or cattle, hemorrhagic fever in rodents and monkeys, tuberculosis from cattle and birds, horses with colds and AIDS African monkeys.

Viruses in the right image above: Adenovirus causes colds (), influenza causes (flu), and Hepadnavirus (causes hepatitis B)


Protozoa
Protozoa consist of a single cell that contains the nucleus. Cell also contains structures that carry out specific processes needed for life functions. complex and diverse group, the scope of protozoa in many shapes and sizes. They are parasites that must live in different organisms, or living freely in moist habitats. The similarity of the internal structure of protozoa and human cells, it is difficult to treat infections caused by protozoa. Drugs that may destroy the protozoan may destroy human cells. protozoal infections are amoebic dysentery, malaria and African sleeping sickness.

Protozoa photo clockwise from top: Giardia intestinalis (causes diarrhea), Trypanosoma brucei (causes sleeping sickness), Plasmodium gametocyte (causes malaria)


Parasite
other micro-organisms break down body tissues or absorb digested food. They can cause infections of internal disorders of the skin which can cause death. Includes a group called parasitic flukes, roundworms and tapeworms, many-celled animals with developed organs. Among the many types, some are parasites - organisms that live in or on another species, usually the damage in the process of host species. Because of their size, parasitic worms grow outside of cells and can reach astronomical size of 30 feet long.

Bugs in the photo, from left to right: Ascaris lumbricoides (intestinal roundworm), Schistosoma mansoni (parasitic worm that lives in contaminated water and causes schistosomiasis or bilharzia)


Fungi
Fungi include yeasts (unicellular), and fungi and molds (multicellular). Unlike plants, fungi do not make their own food. Some species of fungi for their food by breaking down the remains of dead plants and animals. Others are parasites. Examples include fungal infections, fungal infections and athlete's foot.

Mushrooms in the photo, from left to right: Histoplasma capsulatum (histoplasmosis causes lung infection), Penicillium notatum (produces the drug penicillin)

via sdnhm