MIn addition to palpating for pain and swelling, the physician will turn the knee in such a way that it stresses the meniscal attachment to the capsule. If the patient experiences pain, it is often localized to the site of the tear. Although it would seem straightforward to palpate the meniscus, it isn’t. The structures are in such proximity that only an experienced knee surgeon can delineate the difference between the meniscus, articular cartilage, synovium, and capsule.Your physician will also check for range of motion. A person with an injured meniscus may be unable to extend his leg comfortably and may feel better in a flexed position—in fact, in many cases, the knee will lock. At one time, it was believed that the meniscus somehow got caught in the joint and was obstructing movement. However, we know now that what actually happens is that the hamstring muscles (the muscles in the back of the leg) go into spasm, thus curtailing forward motion (extension). We don’t know exactly why this happens, but it is believed to be some kind of protective mechanism.*22\185\2*
Because the EEG is best done when a person is relaxed, the room will be quiet and darkened. EEGs should be done when a child is awake (but quiet) and also when he is asleep because some abnormalities show up in one state but not in the other. Many EEG laboratories give the child medicine so he will go to sleep, and older children and adults often fall asleep spontaneously in the relaxing atmosphere of the EEG lab during the hour, approximately, the test usually takes. In special circumstances the EEG may last a longer or a shorter time, depending on what information the physician needs.Usually you may stay with your child to provide reassurance, but only if you also are quiet and still. Any movement and any touching or patting your child may cause electrical disturbances that show up on this very sensitive machine and confuse the EEG tracing. A child’s muscle movements—crying, squirming, squeezing the eyes shut, or clenching the teeth—can cause the EEG machine to go “crazy” as it picks up the electricity from the muscles. Relaxation and quiet for parent and child both are crucial to a good recording.• Yes, your child may eat before the test.• Yes, your child should sleep normally the night before a test unless, as on a rare occasion, your physician wants a “sleep-deprived” EEG.• Yes, your child may bring a favorite doll, soft toy, or blanket if that will make him more comfortable.*76\208\8*
Oncogenes (literally ‘cancer genes’) were first discovered in the genetic material of viruses that are capable of causing cancers in animals. The immediate importance of oncogenes in human cancer became clear with the discovery that most of the virus oncogenes had very close relatives that were present in the normal cell.
• A particular type of gene was first discovered in viruses that can cause cancer in animals by altering the cells in the animals which they infect.
• These genes were then found to be closely related to genes in normal human and animal cells.
• Such genes are called oncogenes.
• It is now known that our oncogenes normally control the proliferation and differentiation of our cells in a beneficial way.
• It is now also known that if our oncogenes become altered or disordered, they can contribute to the development of a cancer.
• Alterations in oncogenes can be brought about in a number of ways.
• It is thought likely that at least some of the ’causes of cancer’ that we shall identify, such as smoking and radiation, produce cancer by altering oncogenes and other genes.
*9\194\4*
In these first few days you are going to feel pretty confused and ill. You can give yourself the tender care you would give to somebody you loved.
Eat nice food – whatever tempts you. Keep eating sweets. Put a bar of chocolate in your pocket or handbag and munch it when the cravings trouble you. Don’t try to diet in the first few weeks of coming off. A few extra pounds of weight is a million times better than going back to using or drinking.
Hot sweet tea with two spoonfuls of sugar is the best thing if you have a hangover as part of stopping using drink or drugs. You may not like the sugar, but drink it. You need it.
Drink plenty of liquid, just as long as it doesn’t contain alcohol. If you have been using alcohol as well as drugs, make sure there is a large quantity of soft drink in the house. Most people find they crave sweet things during withdrawal.
Have fruit juice or cola in the fridge ready to drink, with ice in hot weather. Fruit juice mixed with soda makes a good sparkling drink. Try a hot drink of blackcurrant juice with boiling water last thing at night, or a traditional cosy nightcap such as malted milk.
If you are a cigarette smoker, this is not the moment to cut back on fags. Although smoking isn’t good for you, it may help you get through withdrawals. So don’t do anything foolish like giving it up when you are coming off drugs.
Finally, pamper your body with long hot baths, aftershave, cologne and scent. If you are female, have your hair done. Small morale-boosters are a help in these early days. If you are clean outside, it will help you feel clean inside.
*86\116\2*
Fixed proportion mixtures
These are mixtures of clear, soluble, fast-acting insulin and cloudy, isophane, medium-acting insulin made by the manufacturer. Mixtures (fast: medium) include 10:90, 20:80, 30:70, 40:60, 50:50. The advantages are that you do not need to mix them so it is quicker for you, there is less possibility of error in making up the mixture, and they are more convenient. There are sufficient variations to allow a different insulin morning and evening and adjustments to your life-style. The disadvantage is that you have no control over the proportions in the mixture on any one occasion. Thus you may be planning a football game one afternoon and would prefer to reduce the morning dose of isophane insulin. But you have to reduce the whole mixture and may find yourself sugary before lunch because you also reduced the dose of fast-acting insulin. Fixed proportion mixtures have grown in popularity and in practice many people find them satisfactory for most of the time. I would always start a person with new diabetes on a fixed proportion mixture to make it easier for them at first.
Fast and medium separately twice a day
This usually means soluble insulin (e.g. Actrapid, Humulin S or Velosulin) and an isophane insulin (e.g. Humulin I, Insulatard, Protaphane), but some people may inject a longer-acting insulin such as Monotard twice a day. The advantage of this regimen is that you have four insulin peaks to adjust – morning fast insulin working until lunch-time, morning medium insulin working during the afternoon, evening fast insulin working until bed-time, evening medium insulin working through the night to breakfast-time. This makes it very flexible. The disadvantage is that you have to draw up a precise mixture and there is more possibility of error than with a fixed proportion mixture.
Fast before meals and medium or long before bed
This is the most flexible regimen of all. It is usually used with an insulin pen but people who prefer needles and syringes can use it too. Fast-acting insulin is given before each meal in a dose calculated on the prevailing blood glucose, the amount and timing of the meal and any planned exercise. Medium (e.g. isophane) or very long-acting insulin (e.g. Ultratard) is given before bed to cover the night. Some people can miss meals or vary the times at which they eat; others find that they still need eat regularly. This regimen can improve blood glucose control, but only if you pay attention to your blood glucose results measured before each meal and before bed.
Once daily insulin
It is rarely possible to control a truly insulin-dependent diabetic’s blood glucose on once daily insulin. It may stabilize glucose control in someone with type II (maturity onset) diabetes who is still making a little insulin, but not enough for his oral hypoglycemic pills to work fully. Sadly, there are still people on once-daily insulin, often those who have diabetes for many years, who refuse to try twice daily insulin injections despite obviously poor glucose balance. They usually have diabetic tissue damage. In someone who is unable to give his or her own insulin injections and who is reliant on the district nurse or a carer who comes once a day, once daily insulin may be the only solution. In this situation one may be aiming for freedom from symptoms of unduly high or unduly low glucose rather than normoglycemia (a normal blood glucose).
*15/102/5*
* Include more oily fish, nuts, seeds and oils in your diet
The essential fatty acids in these foods are important for the prevention of heart disease. The fish oils help to lower cholesterol, thin the blood and lessen the risk of narrowing of the arteries. Walnuts have been shown to be helpful in preventing heart attacks, again due to the essential fatty acid content. A study of 26,500 members of a religious sect called Seventh Day Adventists, who do not drink or smoke, found that those who ate a handful of nuts at least five times a week had half the heart problems of those who rarely ate any nuts. This underlines the crucial importance of diet in preventing heart disease.
* Eat more fresh vegetables and fruit and also dried fruit
Fibre found in potatoes, carrots, apples, beans and oats binds up the cholesterol and carries it out of the body. Vitamin С found in fruit and vegetables is important because low levels of vitamin С have been linked to increased levels of cholesterol.
* Eat more soya
Soya beans have been found to help control cholesterol levels so should be included in the diet in the form of tofu, soya milk, miso, tempeh and tamari (wheat-free soy sauce made in the traditional way). Soya beans contain more protein than milk without the saturated fat or cholesterol. They are the only beans considered to be a complete protein because they contain all eight essential amino acids. Soya is also high in essential fatty acids. The role of soya in preventing and treating chronic disease has become so important that there is an annual four-day international conference devoted just to soya. The conference, hosted in Brussels in September 1996, with nearly eighty speakers from around the world, focused on the role of soya in reducing heart disease and cancer. And papers were presented on soya and hormones, the menopause and osteoporosis.
* Exercise regularly
Take brisk walks and get your heart beating fasting than it usually does. As well as keeping the cardiovascular system in good condition, exercise also seems to help raise HDL (the ‘good’ cholesterol) and lower LDL (the ‘bad’ cholesterol).
* Look at your vitamins
A very exciting confirmation of the link between good nutrition and heart disease came from a study published in The Lancet in March 1996. Scientists from Cambridge University and Papworth Hospital found that taking a daily dose of vitamin E reduced the risk of having a heart attack by an astonishing 75 per cent. An eighteen-month trial involved 2000 patients with coronary arteriosclerosis (fatty deposits in the arteries). Half of the patients were given the vitamin E supplement with their regular medication and half took the placebo with their regular medication.
The number of heart attacks in the group which took the vitamin E was a quarter of those taking the dummy pills. Those given the supplement appeared to be at no greater risk of having a heart attack than normal, healthy men and women of the same age with no heart problems.
According to Professor Morris Brown of Cambridge University, quoted in the Journal of the Institute for Optimum Nutrition: ‘This is even more exciting than aspirin. Most people in our study were already taking aspirin. The average benefit from taking aspirin is in the order of 25 to 40 per cent reduction. Vitamin E reduces the risk of heart attack by a massive 75 per cent.’
Professor Brown then goes on to say that he would not suggest that people should stop taking aspirin. Why not? He just suggests that they take the vitamin E as well. He added ‘It would be irresponsible for us to recommend it freely to those without heart disease.’ Is he actually suggesting you wait until you have narrowing of the arteries or a heart attack and then start the vitamin E?
With results like these on a large-scale double-blind controlled trial, doctors should be recommending what to eat and what to take to keep us well. But results like this and others before get stuck in the academic literature without being put to any practical use. Several other previous studies in fact have indicated that vitamin E is important for heart health – low blood levels of this vitamin have been linked to heart attack risk.
So increase your vitamin E intake from foods such as olives, olive oil, avocado and tuna and take it in a supplement form
* Make sure your mineral levels are good
It has been found that magnesium-rich foods seem to protect against coronary disease. A ten-year study of 2000 men showed that those who had heart attacks had significantly less magnesium in their blood than those who did not. Also analysis of three other trials has shown a significant reduction in deaths by treating heart disease patients with magnesium. Magnesium-rich foods are cereals such as wheat, oats and rye.
*5/101/5*
More than 90% of cases of prostatitis are chronic nonbacterial cases. Unfortunately, the cause and appropriate treatment remain elusive. In some cases, occult infection may be the cause. When nucleic acid testing is performed on prostate biopsy specimens, evidence of infection is found in up to 77% cases. These studies were not well controlled, and response to antibiotic treatment was found to be poor. Other possible causes include atypical infections (Chlamydia, Trichomonas, Mycoplasma, Ureaplasma), reflux secondary to urethral spasm, excessive ejaculation, infrequent ejaculation, prostate trauma (as with receptive anal intercourse), interstitial cystitis, allergy, and stress.
Symptoms and signs in patients with chronic nonbacterial prostatitis are the same as those for bacterial causes. Urine and prostatic fluid cultures are negative in nonbacterial cases. The NIH chronic prostatitis symptom scale can also be applied to nonbacterial cases.
Treatment of chronic nonbacterial prostatitis is generally disappointing, since the response rate is so poor. Many clinicians believe that a 1 -month trial of antibiotics to cover for occult infection is reasonable. Other treatments include sitz-baths, anti-inflammatory agents, Quercetin (a bioflavinoid), stress reduction, alpha-blockers, allopurinol, avoiding caffeine, and transurethral microwave thermatherapy. The number and variety of treatments reflect the confusion surrounding this illness. More research is needed to improve the quality of life in men suffering from this disease.
*6/348/5*
Cytomegalovirus (CMV) is similar to microbes like Pneumocystis carinii and Toxoplasma gondii, which infect people and then remain dormant in the body. Most people have antibodies to CMV in their blood, meaning they have been infected and continue to harbor small numbers of the virus. The initial infection is usually associated with either trivial symptoms or no symptoms at all. For most people the presence of the virus in the body continues to cause no symptoms, but when the immune defenses are lowered, the virus proliferates.
Because CMV resides in blood cells, it is widely distributed through out the body; in people with AIDS, it causes infections in many different organs. In the lungs it can cause pneumonia, in the eyes it can cause inflammation in the retina (retinitis), in the gastrointestinal tract it can cause diarrhea, in the liver it causes hepatitis, and in the brain it causes encephalitis.
Probably 90 percent of people with AIDS develop CMV infection at some time during their illness. Retinitis occurs in 5 to 10 percent of people with AIDS, and gastrointestinal disease in about 10 percent. Many people simply have fever, and tests of the blood and urine show the
presence of CMV. For many, the only symptoms of CMV infection are fever, fatigue, and weight loss, that is, the constitutional symptoms described previously.
CMV is difficult to treat and impossible to cure. Antibiotics are at least partially effective against some forms of the disease. One treatable form is CMV retinitis, an inflammation of the eye which may progress to blindness in one or both eyes if it is not treated promptly and properly.
CMV can be transmitted through sexual contact. Like so many of the microbes previously discussed, CMV is not readily transmitted from one person to another. Even if it were transmitted, it is unlikely that it would be of any consequence for most people. Because CMV can cause serious disease in an unborn infant, there has been concern that pregnant women not take care of someone with CMV infection. However, careful studies indicate that people with CMV infection are unlikely to transmit the virus to caregivers, pregnant or not.
*57\191\2*
The most severe allergic reaction to valproic acid is a severe, sometimes fatal liver failure. Such a reaction occurs in one out of 800 children younger than two years of age, in one out of 7,000 children ages two to ten, and in fewer than one in 100,000 children older than ten who are also taking multiple other drugs. The risk is lower when valproic acid is the only drug in use.
While valproic acid is, in general, a safe anticonvulsant drug, it should be used with great caution in children younger than two years of age, and then preferably as the only drug.
Valproic acid may also cause severe, persistent abdominal pain, accompanied by nausea and vomiting (pancreatitis). It may cause a decrease in the blood’s clotting cells (platelets) and thus in the body’s ability to form blood clots. Because frequent tests of blood counts, bloodclotting, and of liver function are expensive and painful, and, in addition, will not predict whether your child will incur one of these problems tomorrow or next week, we do not perform them on a frequent or routine basis.
In general, we counsel parents that if their child is taking valproic acid and is ill for several days or has changes in behavior or school performance, they should ask their doctor if this could be due to the anticonvulsant.
We caution parents that if their child who is taking valproic acid has persistent vomiting, yellow skin (jaundice), darkened urine, easy bruising, or a tendency to bleed from cuts, they should contact their physician immediately. Also, before any surgery, your surgeon should be informed that your child is taking valproic acid, so that the ability of his blood to clot can be evaluated and the surgeon can be prepared to prevent or stop excessive bleeding.
*127\208\8*
Sexual response is a physiological process that involves different stages. The biological goal of the response process is the reproduction of the species. Human psychological traits greatly influence sexual response and sexual desire. Thus, we may find relationships with one partner vastly different from those we might experience with other partners.
Sexual response generally follows a pattern. Laboratory research has delineated four stages within the response cycle, and researchers agree that each individual has a personal response pattern that may or may not conform to the stages observed in experimental research. Both males and females’ sexual responses are somewhat arbitrarily divided into four stages: excitement/arousal, plateau, orgasm, and resolution. Identification of these stages was primarily achieved by researchers William Masters and Virginia Johnson in laboratory situations in which genital responses were carefully measured, using specially designed instruments. Regardless of the type of sexual activity (stimulation by a partner or self-stimulation), the response stages are the same.
During the first stage, excitement/arousal, male and female genital responses are caused by vasocongestion, or increased blood flow in the genital region. Increased blood flow to these organs causes them to swell. The vagina begins to lubricate in preparation for penile penetration, and the penis becomes partially erect. Both sexes may exhibit a “sex flush,” or light blush all over their bodies. Excitement/arousal can be generated by touching other parts of the body, by kissing, through fantasy, by viewing films or videos, or by reading erotic literature.
The plateau phase is characterized by an intensification of the initial responses. Voluntary and involuntary muscle tensions increase. The female’s nipples and the male’s penis become erect. A few drops of fluid, which may contain sperm, are secreted from the penis at this time. This fluid is termed pre-ejaculatory fluid.
During the orgasmic phase, vasocongestion and muscle tensions reach their peak, and rhythmic contractions occur through the genital regions. In females, these contractions are centered in the uterus, the outer vagina, and the anal sphincter. In males, the contractions occur in two stages. First, contractions within the prostate gland begin propelling semen through the urethra. In the second stage, the muscles of the pelvic floor, the urethra, and the anal sphincter contract. Semen usually, but not always, is ejaculated from the penis. In both sexes, spasms in other major muscle groups also occur, particularly in the buttocks and abdomen. Feet and hands may also contract, and facial features often contort.
Muscle tension and congested blood subside in the resolution phase, as the genital organs return to their prearousal states. Both sexes usually experience deep feelings of well-being and profound relaxation. In some males, a refractory period occurs. Males experience a period of time in which their systems are incapable of subsequent arousal. This refractory period may last from a few minutes to several hours. The length of the refractory period increases with age.
Following orgasm and resolution, many females are capable of being aroused and brought to orgasm again. Males and females experience the same stages in the sexual response cycle; however, the length of time spent in any one stage is variable. Thus, one partner may be in the plateau phase while the other is in the excitement or orgasmic phase. Such variations in response rates are entirely normal. Some couples believe that simultaneous orgasm is desirable for sexual satisfaction. Although simultaneous orgasm is pleasant, so are orgasms achieved at different times.
Sexual pleasure and satisfaction are possible without orgasm or intercourse. Achieving sexual maturity includes learning that sex is not a contest with a real or imaginary opponent. The sexually mature person enjoys sexual activity whether or not orgasm occurs. Expressing love and sexual feelings for another person involves many pleasurable activities, of which intercourse and orgasm may only be a part.
*2/277/5*