Brucellosis: The fact sheet

Brucellosis is a contagious, costly disease of ruminant animals which also affects humans. Although brucellosis can attack other animals, its main threat is to swine, cattle, and bison. This disease is also known as contagious abortion or Bang’s disease.In humans, it's known as undulant fever ...
Brucellosis is a contagious, costly disease of ruminant animals which also affects humans. Although brucellosis can attack other animals, its main threat is to swine, cattle, and bison. This disease is also known as contagious abortion or Bang%26rsquo;s disease. In humans, it's known as undulant fever because of the severe intermittent fever it causes. This fever is accompanying human infection, also known as Malta fever because it was first recognized as a human disease on the island of Malta.

Should we be afraid of brucellosis?

Considering the damage done by the infections in animals, this must be considered as one of the most serious livestock diseases. In animals, brucellosis can cause a decreased milk production, weight loss, loss of young, infertility, and lameness. This disease can spread very rapidly, and is transmissible to humans. These facts make it all the more serious.

What can cause brucellosis?

Brucellosis is caused by a group of bacteria known scientifically as the genus Brucella. There are three species of Brucella that cause the most concern. Those are B. abortus, principally affecting cattle and bison, B. suis, principally affecting swine and reindeer but also cattle and bison, and B. melitensis, principally affecting goats. In cattle and bison, the disease currently localizes in the reproductive organs. Bacteria are shed in milk or via the aborted fetus, afterbirth, or other reproductive tract discharges of the affected animal.

Signs and symptoms of brucellosis

There is no effective way to detect infected animals by symptoms of brucellosis. The most obvious signs in pregnant animals are abortion or birth of weak calves. Milk production may be reduced from changes in the normal lactation period. This is caused by abortions and delayed conceptions. It is not true that all infected cows abort.
However, those that do abort, usually abort between the fifth and seventh month of pregnancy.





Infected cows usually abort once, but a percentage will abort during additional pregnancies too. Calves born from later pregnancies may be weak and unhealthy due to brucellosis. Even though their calves may appear healthy, infected cows continue to harbor and discharge infectious organisms. Those animals should be regarded as dangerous sources of the disease. Other symptoms of brucellosis include an apparent lowering of fertility with poor conception rates. It is retained after births with consequential uterine infections and occasionally enlarged, arthritic joints.

How does brucellosis spread?

Brucellosis is commonly transmitted onto susceptible animals by direct contact with infected animals. It can also transmit through an environment that has been contaminated with discharges from infected animals. Aborted fetuses, placental membranes or fluids, and other vaginal discharges present after an infected animal has aborted or calved are all highly contaminating as well. These discharges and fluids have a lot of Brucella organisms. Cows commonly lick those materials or the genital area of other cows. Cows could also ingest the disease-causing organisms with contaminated food or water. Despite occasional exceptions, the general rule is that brucellosis is carried from one herd to another by an infected animal. This mode of transmission occurs when a herd owner buys replacement cattle or bison that are infected. It could also happen when the owner%26rsquo;s animals were exposed to infection prior to purchase. The disease may also be spread when wild animals or animals from an affected herd mingle with brucellosis-free animals.

How to fight brucellosis?

In the past, brucellosis control was limited mainly to individual herds. These days there is a Cooperative State Federal Brucellosis Eradication Program working to eliminate the disease from the entire country. Like other animal disease-eradication efforts, the success of the program depends on the support and participation of each livestock producer. States are designated brucellosis-free when none of their cattle or bison is found to be infected for 12 consecutive months. The question is, how do epidemiologists help fight brucellosis? Epidemiologists are specially trained veterinarians who investigate disease sources and the means of eliminating infection in affected herds and areas. They are concerned with diseases in a group or population of animals, and evaluate circumstances connected with the occurrence of brucellosis. These veterinarians help eliminate brucellosis by identifying factors essential to its control and prevention in their region.

How does the brucellosis ring test surveillance work?

The BRT procedure, or brucellosis ring test procedure, makes it possible to perform surveillance on whole dairy herds quickly and economically. Milk or cream from each cow in the herd is pooled, and a sample is taken for testing for brucellosis. Then a suspension of stained, destroyed Brucella organisms is added to a small quantity of milk. If the milk from one or more infected animals is present in the sample, a bluish ring forms at the cream line as the cream rises, which is good sign the animals could have brucellosis. With certain exceptions, herd tests must include all cattle and bison over 6 months of age.

What is the incubation period of brucellosis?

An incubation period is the interval of time between exposure to an infectious dose of organism and the first appearance of disease signs for that animal. The incubation period of brucellosis in cattle, bison, and other animals is quite variable, ranging from about 2 weeks to a full year, and even longer in certain instances. When abortion is the first sign observed, the minimum incubation period is about 30 days in most animals. Some animals abort before developing a positive reaction to the brucellosis diagnostic test. Other infected animals may never abort. There are also infected animals that do not abort but develop a positive reaction to the diagnostic test within 30 to 60 days after infection. Some animals may not develop a positive reaction for several months to over a year after exposed to brucellosis.

Can brucellosis in animals be cured?

Put simply %26ndash; no, brucellosis cannot be cured. Repeated attempts to develop a cure for brucellosis in animals have failed. Occasionally, animals may recover after a period of time but it is more common that only the signs disappear and the animals remain diseased. Such animals are dangerous sources of infection for other animals with which they associate.

Can brucellosis be prevented?

The disease may be avoided by employing good sanitation and management practices for each animal. In fact, for cattle and bison in heavily infected areas or replacement animals added to such herds, officials recommend vaccinating heifers with an approved Brucella vaccine as the best prevention. The vaccine is a live product and must be administered only by an accredited veterinarian. It is important is that tattoo identifies the year in which vaccination took place. Brucella abortus vaccine produces a bodily response that increases the animal%26rsquo;s resistance to this disease. However, vaccination is not 100% effective in preventing brucellosis. The vaccine typically protects about 65% of the vaccinated cattle from becoming infected by an average exposure to Brucella.

How does brucellosis affect humans?

People infected with the brucellosis organism usually develop symptoms similar to a severe influenza. However, this disease (called undulant fever) persists for several weeks or months and may get progressively worse. Farmers, ranchers, veterinarians, and packing plant workers are infected most frequently, because they come into direct contact with infected animals. The initial symptoms of brucellosis are fatigue and headaches, followed by high fever, chills, drenching sweats, joint pains, backache, and loss of weight and appetite. Undulant fever usually does not kill its victims, but the disease is too serious to be dealt with lightly.

What are the main sources of human infection?

In years past, prior to pasteurization, raw milk was considered the prime source of brucellosis in humans, but today most humans contract the disease by coming in direct contact with infected material. Those are aborted fetuses, afterbirth, and uterine discharges of diseased animals, or infected carcasses at slaughter.

Can people get brucellosis by eating meat?

There is no danger from eating cooked meat products, because the disease-causing bacteria are not normally found in muscle tissue. Besides, these bacteria are killed by normal cooking temperatures. The disease could only be transmitted to humans while slaughtering infected animals or processing contaminated organs from freshly killed animals.

How to protect against brucellosis?

Ranchers, farmers, or animal managers should clean and disinfect calving areas and other places likely to become contaminated. Each individual should wear sturdy rubber or plastic gloves when assisting calving or aborting animals. They should also scrub hands well with soap and water afterward. Precautions against drinking raw milk or eating un-pasteurized milk products are also important. Ultimately, the best prevention for brucellosis is to eliminate brucellosis from all animals in the area.

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Wegener's Granulomatosis: Diagnosis & Treatment

Wegener’s granulomatosis is not a contagious disease as many people believe. There is no evidence suggesting that it is hereditary either. It is a very rare disease, affecting only 1 in every 30,000-50,000 people which is probably why most of us are not aware of this problem. About 500 new cas...
Wegener%26rsquo;s granulomatosis is not a contagious disease as many people believe. There is no evidence suggesting that it is hereditary either. It is a very rare disease, affecting only 1 in every 30,000-50,000 people which is probably why most of us are not aware of this problem. About 500 new cases are diagnosed each year, with the disease occurring at any age. However, it mostly affects individuals in their 30s and 40s. It affects males and females equally, but 97% of all patients are Caucasian, 2% are Negroid and 1% are of another race. With Wegener%26rsquo;s granulomatosis it is extremely important to know more about diagnosis and its treatment once it is diagnosed.

What is Wegener%26rsquo;s granulomatosis?

Wegener%26rsquo;s granulomatosis is a rare disorder that causes blood vessels in the upper respiratory tract (nose, sinuses, and ears), followed by lungs, and kidneys, to become swollen and inflamed. The eyes, skin, and joints may also be affected with arthritis occurring in about half the cases. Wegener's granulomatosis is thought to be an autoimmune disorder. This uncommon disease usually begins as a localized granulomatous inflammation of upper or lower respiratory tract mucosa, and may progress into generalized necrotizing granulomatous vasculitis and glomerulonephritis. The cause of Wegener%26rsquo;s granulomatosis is unknown. Although the disease resembles an infectious process, no causative agent has been isolated yet. Because of the characteristic histological changes, hypersensitivity has been postulated as the basis of the disease.

Symptoms of Wegener%26rsquo;s granulomatosis

Frequent sinusitis is the most common symptom for Wegener%26rsquo;s granulomatosis.






Other early symptoms include persistent fever without an obvious cause, night sweats, fatigue, and malaise (an %26ldquo;ill feeling%26rdquo;). Chronic ear infections may preclude a diagnosis of Wegener%26rsquo;s granulomatosis.







Other upper respiratory symptoms include nose bleeds, pain, and sores around the opening of the patient%26rsquo;s nose. Loss of appetite and weight loss are common as well. Skin lesions typically occur, but there is no one typical lesion associated with this disease. Symptoms of kidney disease may be present, but this does not always happen. The urine may be bloody, and usually it first appears as red or smoky urine. Eye problems develop in a significant number of patients, which may range from mild conjunctivitis to severe swelling of the eye. Other symptoms include weakness, cough, or coughing up blood, as well as bloody sputum. The patient commonly complains about shortness of breath, wheezing, chest pain, rashes, and joint pains.

Diagnosis of Wegener%26rsquo;s granulomatosis

Wegener's granulomatosis is diagnosed by characteristic clinical, serologic, and pathologic findings. Wegener%26rsquo;s granulomatosis must be diagnosed and treated early to prevent complications. Common complications include kidney disease, lung disease, heart attacks, and brain damage. A doctor can usually recognize the distinctive pattern of symptoms, although blood test results cannot specifically identify Wegener%26rsquo;s granulomatosis.





However, these blood tests can strongly support the diagnosis. A blood test can detect antineutrophil cytoplasmic antibodies in the blood, which suggest this disease. If the nose, throat, or skin is not affected, a diagnosis can be difficult. This is because the symptoms and x-rays can resemble those of several lung diseases. Chest x-ray may show cavities or dense areas in the lungs similar to cancer. To definitely diagnose Wegener%26rsquo;s granulomatosis a variety of tests may be performed, including a biopsy of abnormal tissue. The doctor could chose to have open lung biopsy, upper airway biopsy, nasal mucosal biopsy, bronchoscopy with transtracheal biopsy, or kidney biopsy. Urinalysis is helpful to look for signs of kidney disease such as protein and blood in the urine. In fact, the presence of kidney disease is necessary to make a definitive diagnosis of Wegener%26rsquo;s granulomatosis.

Treatment of Wegener%26rsquo;s granulomatosis

Corticosteroids may be used alone to treat the early symptoms. However, most people also need another immunosuppressive drug, such as cyclophosphamide to treat Wegener%26rsquo;s granulomatosis.





Imuran is a common choice. This drug is able to control the disease by reducing the body%26rsquo;s inappropriate immune reaction, which improves the prognosis significantly. Without treatment, this form of the disorder is fatal. Treatment is usually continued for at least a year after the symptoms for Wegener%26rsquo;s granulomatosis disappear.

Corticosteroids, given at the same time to suppress inflammation, can usually be tapered off and discontinued during other treatment still last. For people receiving immunosuppressive drugs, a doctor treats any suspected infection as early as possible. This is because of the body%26rsquo;s decreased ability to fight infections during this therapy. Pneumonia is particularly common when the lungs are affected by Wegener%26rsquo;s. Moreover, antibiotic may be used to prevent infections in people who have been taking immunosuppressive drugs for years. Treatment with corticosteroids, cyclophosphamide, methotrexate, or azathioprine produces a long-term remission in over 90% of patients afflicted by Wegener%26rsquo;s granulomatosis.







With treatment, most people recover within months although some may develop chronic renal failure. Without treatment, patients can die within a few months, which is why complications usually result from lack of treatment. Possible complications include chronic kidney failure, hemoptysis (coughing up blood), respiratory failure, or inflammation of the eyes. Common complications are also nasal septum perforation and rash. Moreover, medications used to treat the disease can cause side effects. These side effects may also lead to complications.

It is important to know when to call the health care provider. Anyone who experiences chest pain, coughing up blood, blood in the urine, or other symptoms of this disorder should call their health care provider. The problem is that no preventive measures are currently known.

Prognosis of Wegener%26rsquo;s granulomatosis

With proper treatment, most people diagnosed with Wegener%26rsquo;s granulomatosis recover within months. However, some may develop chronic renal failure. The complete syndrome usually progresses rapidly to renal failure once the diffuse vascular phase begins due to Wegener%26rsquo;s granulomatosis.







Patients with limited disease may have nasal and pulmonary lesions, with little or no systemic involvement, where pulmonary manifestations may improve or worsen spontaneously. A previously fatal prognosis can be been dramatically improved by treatment with immunosuppressive cytotoxic drugs. Early diagnosis and treatment are crucial, because a high remission rate is now possible. In fact, critical renal complications can be avoided or reduced. Cyclophosphamide, 1 to 2 mg/kg/day with oral hydration, or by initial rapid IV infusion as a single dose q 2 to 3 weeks is the drug of choice for Wegener%26rsquo;s granulomatosis.







Corticosteroids, which reduce the vasculitic edema, are given concurrently. It could be prednisone 1 mg/kg/day. After 2 to 3 mo, prednisone is tapered until the patient is maintained solely on cyclophosphamide. This means long-term IV dosing appears to be less efficacious.

In Wegener%26rsquo;s granulomatosis treatment, Azathioprine is less effective. However, this drug may be an alternative or adjunct to cyclophosphamide for patients who cannot tolerate cyclophosphamide. Pulse treatment with methotrexate seems to be a better alternative. Long-term prophylactic trimethoprim-sulfamethoxazole seems to be highly effective for upper respiratory tract lesions and may suffice as the sole long-term treatment once all systemic features have been ablated by cyclophosphamide and corticosteroids. Occasionally, the associated anemia may be so profound that blood transfusions are required due to this therapy.

Long-term complete remission can be achieved with proper therapy, even in the case of advanced disease. Kidney transplantation has been successful in renal failure, although a report of one patient who received a cadaver kidney implant showed that typical renal lesions of Wegener's granulomatosis developed at the end. An increased incidence of solid tumors after many years may reflect high-dose cyclophosphamide use as a therapy of choice. The high incidence of bladder cancer many years after treatment is an alarming consequence of the hemorrhagic cystitis associated with excreted cyclophosphamide breakdown products. It is often unmitigated by high fluid output during initial therapy. Kidney lesions cause glomerulonephritis, which may result in blood in the urine and kidney failure at the end as serious consequences of Wegener%26rsquo;s granulomatosis.







Kidney disease can quickly worsen, and if left untreated, kidney failure and death occur in more than 90% of patients. Wegener's granulomatosis is most common in middle-aged adults and some doctors think that men are affected twice as often as women. It is rare in children, but the disease has been seen in infants as young as 3 months of age.

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Biceps Tendinitis

Tendinitis is also known as tendonitis. This is an inflammation of a tendon, which is a band of fibrous tissue connecting muscle to bone. The inflammation causes pain, tenderness, and occasionally restricted movement of the muscle attached to the tendon. When we talk about biceps tendonitis, it is a...
Tendinitis is also known as tendonitis. This is an inflammation of a tendon, which is a band of fibrous tissue connecting muscle to bone. The inflammation causes pain, tenderness, and occasionally restricted movement of the muscle attached to the tendon. When we talk about biceps tendonitis, it is an inflammation of the biceps muscle tendon.

What is tendinitis?

Tendinitis can cause permanent damage to the tendons where a natural tendency to favor the painful area can also lead to stiffness. A vague discomfort at the age of 30, if overuse is continued for years, can lead to a loss of flexibility. Most commonly, this is due to scarring of the tissues. Sometimes the discomfort of tendinitis disappears within weeks, especially if you rest the affected area. In elderly people and those who continue to use the affected area, tendinitis often heals more slowly, and could even progresses to a chronic condition. Almost any tendon in the body can be affected. However, those located around the knee, foot, elbow and shoulder are most frequently affected.

Knee tendonitis is a common location for this inflammation type. Actually, there are three types of knee tendonitis %26ndash; patellar tendinitis, quadriceps tendinitis, and popliteus tendinitis. Patellar tendinitis is also called %26ldquo;jumper%26rsquo;s knee%26rdquo;. It affects the patellar tendon just below the patella (kneecap). The patient complains of pain during an activity such as landing from a jump and going downstairs, or during a lack of activity - for example sitting for long periods of time. Quadriceps tendinitis affects the patellar tendon just above the kneecap; this condition is likely to be found in athletes who do a lot of rapid acceleration and deceleration. Popliteus tendinitis affects the site of insertion of the popliteus tendon on the lateral epicondyle of the femur, so runners, particularly those who run down hills or along sloping surfaces, are likely to complain of this type of tendinitis.







Reducing the symptoms is the first step in alleviating the tendonitis and establishing a diagnosis. The doctor may tell you to use ice or heat, take certain medications, and limit physical activity. This might help control the pain and swelling along with self-massaging the area. Ice helps prevent swelling and reduces pain, so placing ice on the painful area for 10 minutes at a time, several times a day, may be a good idea. If you already have a swelling, heat may help; apply a heating pad or hot towels to the tendon for 30 minutes at a time, two or three times a day. Pain relievers and anti-inflammatory drugs are used to ease immediate symptoms. However, this is not going to cure the condition or keep it from recurring. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief. However, this relief only lasts for 24-72 hours. In rare cases, surgery is necessary to repair damage. Rest allows the tissues to heal after the surgery. On the other hand, returning to activity too soon may cause the symptoms to reoccur.

Self-massage using a heat-inducing cream or oil may also help with tendonitis. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day. You should continue with this process until healed.

Shoulder tendinitis has three types, which are rotator cuff tendinitis, calcific tendinitis and biceps tendinitis. The rotator cuff consists of four muscles around the shoulder joint that help control the shoulder%26rsquo;s position. This tendon keeps it stable. With rotator cuff tendinitis the pain is located about three inches below the top of the shoulder. This pain is felt when reaching overhead or behind the back. Rotator cuff tendinitis will usually resolve with rest, anti-inflammatory medications, or an injection of cortisone and a local anesthetic into the area surrounding the tendon. Patients with rotator cuff tendonitis should also exercise using light weights. If pain is not relieved with exercise and medication alone, an x-ray of the shoulder may reveal bony anatomy. This occurs between a bone at the top of the shoulder and the ball at the top of the arm bone. A procedure called an acromioplasty is performed to make more room for the rotator cuff tendons and relieve this problem. Using an arthroscope it is inserted into the shoulder and the surgeon is able to remove some of the bone from the acromion through two or three small 1/4%26quot; incisions.

Calcific tendinitis is caused by calcium deposits in the rotator cuff region, and symptoms include excruciating pain and severe restriction of shoulder motion. X-rays reveal calcium deposits within the rotator cuff or overlying the head of the humerus and treatment includes injection of cortisone and a local anesthetic into the area surrounding the tendon. Multiple needle punctures into the calcium deposit may break it up and relieve the symptoms of tendinitis. If conservative treatment is ineffective, arthroscopic calcium removal and subacromial bursectomy are viable alternatives.

Biceps tendinitis is an inflammation of the biceps tendons that attach to the shoulder, usually affecting individuals whose occupations involve repetitive biceps flexion against resistance, or whose activities include forceful throwing of a ball. Biceps tendinitis will resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic. All this is placed into the area surrounding the tendon, as well as a sling to immobilize the shoulder. With biceps tendinitis surgery is occasionally required to stabilize a displaced tendon.

More on biceps tendinitis

The biceps muscle is a large, strong muscle in the front of the upper arm. This muscle divides into two major sections. The larger section of the bicep, called the long head of the muscle, is connected to the shoulder by a long tendon that passes through a groove in the upper end of the arm bone, called the bicepital groove. That is the point where tendinitis strikes, and beyond the groove, the tendon enters the shoulder joint and attaches to the top of the shoulder socket. Biceps tendon is held in the groove of the upper arm bone by the inter-tubercular ligament. If this ligament is injured or stretched, the tendon slides in the groove causing problems. This is because sliding irritates the tendon, and the result is biceps tendinitis. A second cause of biceps tendinitis may be a deformity in the groove itself that can be too shallow or have rough edges. In any overhead position, the tendon is forced to curve, but the groove is fixed, so if the tendon is not firmly held down, it will slide out.

Signs and symptoms of biceps tendinitis

Injuries to the biceps tendons are commonly caused by repetitive overhead activity, so symptoms include pain when the arm is overhead or bent. It could also appear as localized tenderness as the tendon passes over the groove in the upper arm bone. Occasionally, a snapping sound or sensation in the shoulder area could also be a sign of biceps tendinitis. If you notice anything similar, it would be good to have doctor%26rsquo;s exam.

Diagnosis and treatment of biceps tendinitis

Like most shoulder ailments, biceps tendinitis is painful, especially in the throwing or serving position. The pain is focused on the front of patient%26rsquo;s shoulder, so for simple cases of biceps tendinitis, it is recommended to apply ice and rest. This means initial treatment is conservative. A patient should also start pendulum exercises as soon as the pain decreases.

Usually, the irritation disappears in a week, but you should know if you put too much pressure on the tendon too soon, the tendinitis will flare up again. For the more severe cases of biceps tendinitis, the doctor could prescribe oral anti-inflammatory medication and two weeks of rest. The icing should continue twice a day and patient should also perform pendulum exercises if they are not too painful. Very rarely does biceps tendinitis require surgery as the only treatment option that works. It only happens when the tendon will not stay in the bicipital groove and the irritation is chronic; the operation procedure involves surgically detaching the tendon from the shoulder joint. It is reattached to the coracoid process, a lip in the front of the shoulder, so this operation alleviates the pain and, almost unbelievably, there is very little loss of strength or mobility.

Surgical options for biceps tendinitis

If the pain results from shoulder instability or from pressure on the tendon from the shoulder bones, your orthopaedist may recommend arthroscopic surgery as the best treatment. Using fiber optic technology and miniature instruments inserted through a small incision, the surgeon can examine the shoulder joint. This way he will also be able to anchor the tendon properly. After surgery, your orthopaedist will prescribe a rehabilitation program. This program includes stretching and strengthening exercises. Early movement is important, but patient should wait for physician%26rsquo;s approval before doing any heavy lifting or returning to sports. However, once diagnosed with biceps tendonitis, the doctor will examine you and see which treatment options is the best choice in your case. Every patient might require different treatment, depending on many variable factors of this disease.

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Morton's Neuroma: Symptoms & Treatment

A neuroma is a thickening of nerve tissue. This problem may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma. It occurs at the base of the third and fourth toe. It is sometimes referred to as an inter-metatarsal neuroma, where inter-metatarsal des...

A neuroma is a thickening of nerve tissue. This problem may develop in various parts of the body. The most common neuroma in the foot is a Morton%26rsquo;s neuroma. It occurs at the base of the third and fourth toe. It is sometimes referred to as an inter-metatarsal neuroma, where inter-metatarsal describes its location (in the ball of the foot between the metatarsal bones, extending from the toes to mid-foot). Neuromas may also occur in other locations in the foot. The thickening or enlargement of the nerve that defines a neuroma is the result of nerve compression and irritation. This compression creates a swelling, eventually leading to permanent nerve damage as a serious consequence of Morton%26rsquo;s neuroma.

What is Morton%26rsquo;s neuroma?

Morton's neuroma is an enlarged nerve that usually occurs in the third inter-space. This inter-space is between the third and fourth toe. Problems often develop in this area because a part of the lateral plantar nerve combines with a part of the medial plantar nerve here. When the two nerves combine, they are typically larger in diameter than nerves going to the other toes. Moreover, the nerve lies in subcutaneous tissue, just above the fat pad of the foot, close to arteries and veins. Above the nerve, there is a structure called the deep transverse metatarsal ligament. This ligament is very strong, holding the metatarsal bones together. This ligament also creates the ceiling of the nerve compartment. With each step, the ground pushes up on the enlarged nerve and the deep transverse metatarsal ligament pushes down, which causes compression in a confined space. The reason the nerve enlarges has not been determined yet. Flat feet can cause the nerve to be pulled toward the middle more than normal. This could lead to irritation and possibly enlargement of the nerve. The syndrome is more common in women than men, possibly because women wear confining shoes more often.

High heels cause more weight to be transferred to the front of the foot, and tight toe boxes create lateral compression.





Because of this, more force is being applied in the area and the nerve compartment is squeezed from all sides. Under such conditions, even a minimal enlargement in the nerve can elicit pain as one of the symptoms.

Signs and symptoms of Morton%26rsquo;s neuroma

The most common symptom of Morton's neuroma is a localized pain in the inter-space between the third and fourth toe. The pain could be sharp or dull, and is worsened by wearing shoes and by walking. However, the pain is usually less severe when the foot is not bearing weight. Patient diagnosed with Morton%26rsquo;s neuroma will probably have one or more of these symptoms where the nerve damage occurs. These symptoms are tingling, burning, or numbness, pain, and a feeling that something is inside the ball of the foot, or that there is a rise in the shoe or a sock is bunched up. The progression of a Morton%26rsquo;s neuroma often follows the same pattern. The symptoms begin gradually, and at first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities. Symptoms may be suppressed temporarily by massaging the foot or by avoiding aggravating shoes or activities. Over time the symptoms progressively worsen and may persist for several days or weeks even when you avoid walking. The symptoms become more intense as the neuroma enlarges and the temporary changes in nerve become permanent.

What causes Morton%26rsquo;s neuroma?

Anything that causes compression or irritation of the nerve can lead to neuroma. One of the most common offenders is wearing shoes that have a tapered toe box. High-heeled shoes that cause the toes to be forced into the toe box could also cause Morton%26rsquo;s neuroma. People with certain foot deformities, such as bunions, hammertoes, flatfeet, or more flexible feet are at higher risk for developing Morton%26rsquo;s neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to Morton%26rsquo;s neuroma.

Diagnosing Morton%26rsquo;s neuroma

To diagnose Morton%26rsquo;s neuroma the podiatrist commonly palpates the area to elicit pain. He will try to diagnose you by squeezing the toes from the side. Next he or she may try to feel the neuroma by pressing a thumb into the third interspace of the foot. The podiatrist then tries to elicit Mulder%26rsquo;s sign. He or she will do this by holding the patient%26rsquo;s first, second, and third metatarsal heads with one hand and the fourth and fifth metatarsal heads in the other and pushing half the foot up and half the foot down slightly, where in many cases of Morton%26rsquo;s neuroma, this causes an audible click. This click is known as Mulder%26rsquo;s sign, which can help with Morton%26rsquo;s neuroma diagnosis. An x-ray should be taken to ensure that there is not a fracture of the foot. X-rays also can be used to examine the joints and bone density, ruling out arthritis and osteoarthritis. An MRI scan or magnetic resonance imaging is used to ensure that the compression is not caused by a tumor. An MRI also determines the size of the neuroma and how the syndrome should be treated - whether conservatively or aggressively. If surgery is indicated, the podiatrist can determine how much of nerve must be resected. This is important because there are different surgical techniques available, depending on the size and the position of the neuroma. However, MRIs are expensive, which is why some insurance companies are reluctant to pay for them. If the podiatrist believes an MRI is necessary, he or she can persuade the insurance company to pay for it. To establish a diagnosis, the foot and ankle surgeon will also need to obtain a thorough history of your symptoms and examine your foot. The best time to see a foot and ankle surgeon is early in the development of symptoms. This is because early diagnosis of a Morton%26rsquo;s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.

Treatment of Morton%26rsquo;s neuroma

In most cases, initial treatment consists of padding and taping. The goal is to disperse weight away from the neuroma. If the patient has flat feet, an arch support is incorporated so the patient will be instructed to wear shoes with wide toe boxes and avoid shoes with high heels. The doctor could recommend an injection of a local anesthetic to relieve pain and a corticosteroid to reduce inflammation. The patient is advised to return in a week or two sothat the progress of the disease could be monitored. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient%26rsquo;s foot and the type of the patient%26rsquo;s shoes. It can be relieved by a custom-fitted orthotic that helps keep the foot in a better position to prevent further damage. Conservative treatment does not work for most of patients and minor surgery usually is necessary to treat Morton%26rsquo;s neuroma.

There are two surgical procedures available in Morton%26rsquo;s neuroma treatment. The dorsal approach involves making an incision on the top of the foot, which permits the patient to walk soon after surgery. This is because the stitches are not on the weight-bearing side of the foot. The podiatrist maneuvers the instruments carefully through many structures and cuts the deep transverse metatarsal ligament. This ligament typically causes most of the nerve compression. This procedure can lead to instability in the forefoot that may require attention after treatment. The second procedure involves a plantar approach. In this procedure the incision is made on the sole of the foot. The patient must use crutches for about three weeks and the scar that forms can make walking uncomfortable as a side effect of this approach.

The advantage of the plantar approach is that the neuroma can be reached easily and resected without cutting any structures in the foot. However, before surgery, while developing a treatment plan, the foot and ankle surgeon will first determine how long the patient has had the neuroma. He will also need to evaluate its stage of development, because treatment approaches vary according to the severity of the problem. For mild to moderate cases of neuroma, treatment options include padding, which are techniques that provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking. Icing mean placing an icepack on the affected area helps reduce swelling. Orthotic devices issued by a foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve. Activity modifications are important to reduce especially those that put repetitive pressure on the neuroma. You should avoid these activities until the condition improves.

Changes in shoe wear could help, because it is important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels. Non-steroidal anti-inflammatory drugs such as Ibuprofen help reduce the pain and inflammation. If there is no significant improvement after the initial treatment, injection therapy may be tried as a treatment option for Morton%26rsquo;s neuroma. Surgery may be considered in patients who have not received adequate relief from other treatment options. The foot and ankle surgeon will determine which approach is optimal for your condition. The length of the recovery period after surgery will vary depending on the procedure or procedures performed. Regardless of whether you've undergone surgical or non-surgical treatment, your foot and ankle surgeon will recommend long-term measures, since it is important to help keep your symptoms from returning.

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Hashimoto's Disease & Hyperthyroidism

Hashimoto's is a disease, while hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Hashimoto’s disease is a problem with the thyroid gland located in the neck. The thyroid gland makes hormones that control ho...
Hashimoto's is a disease, while hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Hashimoto%26rsquo;s disease is a problem with the thyroid gland located in the neck. The thyroid gland makes hormones that control how the body uses energy. When someone has Hashimoto%26rsquo;s disease, their immune system begins to attack its own thyroid gland. This causes the thyroid gland to become swollen and irritated. When this happens, the thyroid cannot make hormones as it should. Hyperthyroidism is a condition when the thyroid gland produces more of its hormones then it should.

What is Hashimoto%26rsquo;s disease?

Hashimoto's disease is sometimes known as Hashimoto%26rsquo;s thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis. This is an autoimmune disease.
In Hashimoto's, antibodies react against the proteins in the thyroid, causing gradual destruction of the gland itself. It also affects its ability to produce the thyroid hormones the body needs. The thyroid gland is found low in the neck and is shaped like a butterfly. It produces two hormones, thyroxine (T4) and triiodothyronine (T3).
These hormones are released into the bloodstream, controlling the speed of all the body%26rsquo;s functions or metabolism. In hypothyroidism the output of these hormones is reduced, resulting in a decrease of metabolism. This causes various symptoms.
General muscle slow-down leads to tiredness, while reduced body metabolism causes dry skin, hair loss, constipation and weight gain. Joints commonly swell up, while shortage of breath may develop due to effects on the heart. In women, periods may become heavy and slower brain activity might result in memory loss or poor concentration. Youngsters may fail to grow and may not do well at school, although some people have no symptoms at all. However, the doctor may notice only a slow pulse or another minor change in appearance.







If the thyroid gland is enlarged, the doctor may identify the condition as Hashimoto%26rsquo;s disease, named after the Japanese physician who first described this combination of abnormalities.

How does Hashimoto%26rsquo;s disease occur?

The body sometimes produces substances called antibodies which are defense chemicals. Antibodies are usually made only to deal with foreign substances such as viruses, other germs, and things like pollen. In hypothyroidism, the antibodies and the cells that make them are directed against the bodies own cells, in this case the thyroid cells. This is called auto-immune destruction, and is almost impossible to prevent or reverse, so once thyroid cell damage occurs in this way, it is usually permanent.

Symptoms of Hashimoto%26rsquo;s disease

Symptoms that those afflicted with Hashimoto%26rsquo;s disease may have are varied. Because the thyroid gland may swell due to Hashimoto%26rsquo;s disease, patient may have a feeling of fullness or tightness in the throat. Trouble swallowing food or liquids is also common. A patient might notice a swelling or bump (goiter) in the front of the neck. Tiredness, forgetfulness, depression, coarse dry skin, slow heartbeat, weight gain, constipation and intolerance to cold are also symptoms of Hashimoto%26rsquo;s disease. Many people with this disease have no symptoms at all, where ordinary blood test may just show that the thyroid hormones are out of balance.

Who gets Hashimoto%26rsquo;s disease?

Although Hashimoto%26rsquo;s disease can affect people of all ages, it is most common in women between 30 and 50 years of age. If someone in your family has had thyroid disease, you may have an increased risk for Hashimoto%26rsquo;s disease, but no one is entirely sure why people get this disease.

Treatment of Hashimoto%26rsquo;s disease

There is no known cure for Hashimoto%26rsquo;s disease, but the doctor can treat low thyroid function, which is why a patient probably will not suffer any long-term effects. Thyroid medicine can replace the hormones that the thyroid gland usually makes. How long a patient needs to take the medicine will depend on the blood test results.
For most people, thyroid hormone medicine causes no problems at all. Taking thyroid medicine and having regular blood tests to see how the thyroid gland is working can help prevent symptoms like tiredness, weight gain, and constipation. Tablets of synthetic thyroxine (T4) are the usual treatment for Hashimoto%26rsquo;s disease, taken once daily. If you forget a dose once in a while no harm should follow. It is interesting that the body can make all the triiodothyronine (T3) which it needs from this T4, and it does not need to be given separately in most cases. However, because T3 works more rapidly, in some situations your doctor may decide to commence T3 out of preference. Moreover, thyroid extract is no longer recommended. Although it contains a mixture of T4 and T3, the content is not very consistent and giving mixtures of T4 and T3 at the same time has also not been shown to have any advantages. Thyroxine is often started in doses as low as 25 micrograms a day, and the dose is gradually built up every month or two to give the body a chance to adjust.

The doctor will use a regular examination, a blood test, and perhaps a heart examination to decide about the final thyroxine dose. Final dose is usually between 50 to 200 micrograms a day. You should always check the strength of thyroid tablets each time they are dispensed, since mistakes can happen. Some improvement usually occurs within 2 weeks of starting treatment but it takes 4 to 6 weeks of daily tablets to get the full benefit of a particular dose.
The older you are, the longer the doctor will take to build up the dose of thyroid hormones. Most symptoms will improve, but occasionally chest pain or shortness of breath develops. If this happens, the doctor needs to be told straight away. If your under-active thyroid was picked up by chance in a screening test, you may not feel much better after this treatment. If the thyroid gland was enlarged before treatment, it may get much smaller after the treatment of Hashimoto%26rsquo;s disease.
If too much thyroxine is taken, palpitations, trembling and sweating may appear. Even without these symptoms, mild over-dosage over several years may weaken the bones, making them more likely to be painful and to fracture. With the sensitive tests now available, it is possible for the doctor to be absolutely certain whether the dose being taken for treating this condition is correct or not.

Hashimoto%26rsquo;s disease and hyperthyroidism

A tendency to develop auto-immune thyroid disorders is commonly inherited. Some people develop an under-active thyroid following an overactive thyroid condition earlier in life. Overactive thyroid condition is called hyperthyroidism. About one person in l00 develops this quite common condition caused by hyperthyroidism. Both thyroid operations and the use of radioactive iodine for an overactive thyroid often result in an under-active thyroid state. That is why we could see the connection between Hashimoto%26rsquo;s disease and hyperthyroidism. In fact, sometimes certain foods and medicines (especially those containing iodine) can cause it. A particular type of under-active thyroid occurs 4 to 6 months after childbirth, approximately once in 15 pregnancies. This so-called post-partum thyroiditis may cause temporary or permanent thyroid under-activity, which is sometime preceded by a temporary overactive state. In many cases the onset of Hashimoto%26rsquo;s and the elevation of antibodies will be accompanied by a variety of symptoms. These symptoms are fatigue, weight changes, depression, hair loss, muscle/joint aches and pains, infertility, and recurrent miscarriages, among others.

Many conventional endocrinologists will not treat Hashimoto%26rsquo;s disease if the thyroid function tests are in the normal range, despite these symptoms. However, in some cases Hashimoto%26rsquo;s involves a slow but steady destruction of the gland that eventually results in the thyroid%26rsquo;s inability to produce sufficient thyroid hormone. This is the condition known as hypothyroidism. Along the way there can be periods where the thyroid sputters back to life, even causing temporary hyperthyroidism, and then a return to hypothyroidism. This cycling back and forth between hypothyroidism and hyperthyroidism is characteristic of Hashimoto%26rsquo;s disease. That is why we cannot say that Hashimoto%26rsquo;s disease is just refers to hypothyroidism. Ultimately, the thyroid slowly becomes less able to function, and when hypothyroidism itself can be measured by blood tests, many practitioners will finally treat it exclusively with thyroid hormone replacement drugs.

However, there are some endocrinologists, osteopaths and other practitioners, who believe that Hashimoto%26rsquo;s disease, as confirmed by the presence of thyroid antibodies, along with its symptoms, is enough to warrant treatment with small amounts of thyroid hormone. The practice of treating patients who have Hashimoto%26rsquo;s thyroiditis but a normal range of thyroid function tests is supported by study. In that study, German researchers reportedly used levothyroxine treatment for cases of Hashimoto%26rsquo;s autoimmune thyroiditis where TSH had not yet elevated beyond normal range. The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto%26rsquo;s disease reduced the various markers of autoimmune thyroiditis. They speculated that such treatment might even be able to stop the progression of Hashimoto%26rsquo;s disease, or perhaps even prevent the development of hypothyroidism.

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Smoking and lung cancer

Lung cancer is characterized by presence of malignant tumor cells which are destroying the healthy lung tissue. There are several types of lung cancer but the most common is bronchogenic carcinoma which accounts for about 90% of all lung cancers. A recent research indicated that inhaling carcinogen ...
Lung cancer is characterized by presence of malignant tumor cells which are destroying the healthy lung tissue. There are several types of lung cancer but the most common is bronchogenic carcinoma which accounts for about 90% of all lung cancers. A recent research indicated that inhaling carcinogen substances poses the biggest risk for lung cancer development and the most common mean of exposure to such substances is tobacco smoking. The risk of developing lung cancer increases sharply the more you smoke and the longer you smoke.

Incidence

Lung cancer is one of the most lethal of cancers worldwide, causing up to 3 million deaths annually. Only one in ten patients diagnosed with this disease will survive the next five years. Although lung cancer was previously an illness that mostly affected men, the lung cancer rate for women has been increasing in the last few decades, which has been attributed to the rising number of female smokers. Lung cancer is the number one cause of cancer deaths in both men and women in the United States. More than 154,000 Americans died from lung cancer in 2002. Still, more than 90% of lung cancers are preventable.

Signs and symptoms of lung cancer

Symptoms that suggest lung cancer include:

* dyspnea (shortness of breath)
* hemoptysis (coughing up blood)
* chronic cough or change in regular coughing pattern
* wheezing
* chest pain or pain in the abdomen
* cachexia (weight loss), fatigue and loss of appetite
* dysphonia (hoarse voice)
* clubbing of the fingernails (uncommon)
* difficulty swallowing

Possible causes of lung cancer

There are four major causes of lung cancer (and cancer in general):

* Carcinogens such as those in cigarette smoke

* Radiation exposure

* Genetic susceptibility

* Viral infection

Cigarette smoking

Lung cancer is directly related to smoking.







It is proven that there are over 40 carcinogens in the cigarette smoke including radioisotopes from the radon decay sequence, nitrosamine, and benzopyrene. Additionally, nicotine appears to depress the immune response to malignant growths in exposed tissue.

Unfortunately, the risk of getting cancer is not removed immediately after you stop smoking. In fact up to 40% of newly diagnosed lung cancer occurs in former smokers. In the United States, smoking is estimated to account for 87% of lung cancer cases.

Exposure to asbestos and certain chemicals

* Asbestos has been known to increase the risk of getting lung cancer.
* Uranium, chromium and nickel can all cause lung cancer too.

Exposure to radon gas

Radon gas is a naturally occurring radioactive gas that can seep out of the soil into buildings. It is thought that radon gas in very high concentrations may cause lung cancer.

Air pollution

Air pollution may cause lung cancer, although this has only been proven in people exposed to large amounts of diesel exhaust fumes for many years through their work. This type of long term occupational exposure may increase lung cancer risk by up to 47%.

Genetic susceptibility

Experts are still looking into the impact of family history on lung cancer. There is some evidence that there is at least one lung cancer gene because family history of lung cancer does have an impact on the risk. Families of smokers will all be exposed to cigarette smoke and so have an increased risk of lung cancer whether they carry the gene or not.

Passive smoking

Passive smoking refers to inhalation of the smoke coming from someone else%26rsquo;s cigarette. It has recently been identified as a much more possible cause of lung cancer in non-smokers than previously believed. Several researches have been conducted on this subject and they all came to the same conclusion- passive smoking causes lung cancer in non-smokers.

The study found that there was an estimated 16% increased risk of lung cancer among the non-smoking spouses of smokers. It is estimated that workplace exposure increases the risk for 17%.

Histological types of lung cancer

There are two major types of lung cancer:

* Non-small cell lung cancer %26ndash; This type of cancer is much more common. It usually spreads to different parts of the body more slowly than small cell lung cancer.
o squamous cell carcinoma
o adenocarcinoma,
o large cell carcinoma

* Small cell lung cancer- small cell lung cancer also called oat cell cancer, accounts for about 20% of all lung cancers.

Diagnosis of lung cancer

Unfortunately, lung cancer is usually diagnosed too late for treatment to be possible. In over half of people with lung cancer the disease has already spread at the time of the diagnosis.

Early diagnosis is difficult because many of the common symptoms of lung cancer are similar to those of chronic obstructive pulmonary disease.

* X-ray examination

The first investigation of lung cancer should be a chest X-ray. However, this method can't detect all tumors because it needs to be at least a centimeter in diameter to be detectable by an ordinary X-ray.

* Blood tests

Some simple blood tests and further examinations may also be carried out.

* Bronchoscopy

This is a very good diagnostic tool and it represents a direct inspection of the inside of the breathing tubes with a thin instrument called bronchoscope. It is all done using local anaesthetic and is the best method for the diagnosis of tumors in the bronchi in the centre of the chest.

* Biopsy

Depending on the site of the cancer, a biopsy will be obtained either by a bronchoscopy or a needle biopsy.

* Sample of sputum

A sample of sputum, the material coughed up from the respiratory tract, will also be examined for cancer cells.

* CT-scan

A CT scan provides more information about how much the tumor may have spread.

Metastatic lung cancer

The lung is a common place for metastasis from tumors in other parts of the body. These cancers, however, are identified by the site of origin, i.e., a breast cancer metastasis to the lung is still known as breast cancer. The adrenal glands, liver, brain, and bone are the most common sites of metastasis from primary lung cancer itself.

Treatment of lung cancer

Treatment of lung cancer can depend on the size, location and extent of the tumor, and general health of the patient. There are many treatments, which may be used alone or in combination. These include:

SURGERY

Surgery may cure lung cancer but it is used in limited stages of the disease. The type of surgery depends on where the tumor is located in the lung.

RADIATION THERAPY

Radiation therapy is a form of high energy X-ray that kills cancer cells. It is used:

* In combination with chemotherapy and sometimes with surgery.
* To offer relief from pain or blockage of the airways.

CHEMOTHERAPY

Chemotherapy is the use of drugs that are effective against cancer cells. Chemotherapy may be injected directly into a vein or given through a catheter, which is a thin tube that is placed into a large vein and kept there until it is no longer needed.

Chemotherapy may be used:

* In conjunction with surgery.
* In more advanced stages of the disease to relieve symptoms.
* In all stages of small cell cancer.

How come some smokers don%26rsquo;t develop lung cancer?

The fact is that not all smokers develop cancer but it is still not known why. Different people react differently to the 4,000 chemicals contained in cigarette smoke depending on their genetic and biological make-up. However, the fact is that the risk of developing lung cancer increases sharply the more you smoke and the longer you smoke. According to some researches, 1 in 11 men and 1 in 17 women will develop lung cancer in their lifetime.

Tobacco and other types of cancers

* Cancers of the mouth and throat

Several researches have tried to prove that smoking cigarettes is a risk factor for all cancers associated with the larynx, oral cavity and esophagus. It is proven that over 90% of patients with oral cancer use tobacco by either smoking or chewing it. The risk for these cancers increases with the number of cigarettes smoked and those who smoke pipes or cigars experience a risk similar to that of cigarette smokers.

* Bladder cancer

Tobacco smoking is the principal risk factor for bladder cancer in both men and women. It is estimated that current smokers are 2-5 time more likely to develop bladder cancer than non-smokers.

* Breast cancer

Some studies have proven that there is a link between smoking and breast cancer. Most epidemiological studies have found no association between active smoking and breast cancer but a new study found that among women who have smoked for 40 years or longer the risk of breast cancer was 60% higher that that of women who have never smoked.

* Cervical cancer

Cancer of the cervix has been found to be associated with cigarette smoking in many case-control studies. Smoking is the second most significant environmental factor after human papilloma virus.



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Hallucinations

Hallucinations are medically defined as apparent perception of an external object while the fact is that no such object is present. They are false or distorted sensory experiences that appear to be real perceptions to the person which is hallucinating. What is important about these sensory impressio...

Hallucinations are medically defined as apparent perception of an external object while the fact is that no such object is present. They are false or distorted sensory experiences that appear to be real perceptions to the person which is hallucinating. What is important about these sensory impressions? It is important to know that they are generated by the mind rather than by any external stimuli. Hallucinations could be seen, heard, felt, and even smelled or tasted by the person who is hallucinating. People may experience hallucinations as part of their normal developmental stages, especially during the preschool years, in the 2-5 year old range.

Possible causes of hallucinations

It is proven that the hallucinatory experience has a wide range of etiologies like:

%26middot; neurological insult,

%26middot; seizure and sleep disorders,

%26middot; substance abuse,

%26middot; grief,

%26middot; stress- It is proven that prolonged or extreme stress can impede thought processes and trigger hallucinations

%26middot; metabolic, endocrine and infectious diseases

%26middot; Electrical or neuro-chemical activity in the brain- It is proven that a hallucinatory sensation, often appears before, and gives warning of, a migraine. They are also reported as hallucinations!

%26middot; Mental illness- several researches done in the past have came to the conclusion that there is up to 75% of schizophrenic patients admitted for treatment which reported hallucinations.

%26middot; Brain damage or disease. Lesions or injuries to the brain may alter brain function and produce hallucinations.

The fact is that patients suffering from dementia and psychotic disorders such as schizophrenia frequently mostly experience hallucinations, but there is no rule because, hallucinations can also occur in patients who are not mentally.





In most cases we are talking about a result of stress overload, hypertension or exhaustion. It is also proven that sleep deprivation for a longer period can also lead to hallucinations.

Drug reactions %26ndash; Several researches done in the past have came to the conclusion that the use of psychotomimetics and many medication's side-effects could trigger hallucinations: ecstasy, LSD, mescaline, and psilocybin trigger hallucinations.

Top 10 drugs or classes associated with hallucinations.

• SSRIs



• tramadol



• bupropion



• venlafaxine



• quinolones



• proton pump inhibitors



• clarithromycin



• zopliclone



• ropinirole



• %26beta;-adrenoreceptor antagonists

Other drugs such as marijuana and PCP have hallucinatory effects. Hallucinogens can be classified by:

%26middot; quality of action,

%26middot; mechanisms of action,

%26middot; by chemical structure

Almost all hallucinogens contain nitrogen and are classified as alkaloids. THC and Salvinorin A are exceptions. Many hallucinogens often have chemical structures similar to those of human neurotransmitters, such as serotonin, and temporarily interfere with the action of neurotransmitters and/or receptor sites.

Beside these pathological causes- there are also some medical and psychiatric causes of hallucinations. Common causes include:

• Fever, which can occur with almost any infection,



• Intoxication or withdrawal from drugs



• Delirium or dementia



• Sensory deprivation such as blindness or deafness



• Severe medical illness including liver failure, kidney failure, and brain cancer



• Some psychiatric disorders, particularly schizophrenia, psychotic depression, and post-traumatic stress disorder

The mechanism of hallucination

Various theories have tried to explain the occurrence of hallucinations. Hallucinations were first seen as a projection of unconscious wishes and desires, but biological theories have claimed that hallucinations are more often thought of as being caused by functional deficits in the brain. Important thing to know is that the function of the neurotransmitter dopamine is thought to be particularly important. Hallucinations may result from biases in meta-cognitive abilities. These are abilities that allow us to monitor or draw inferences from our own internal psychological states.

Types of hallucinations

Hallucinations occur while a person is awake and conscious and some of the common hallucinations include:

• Hearing voices when no one has spoken (auditory-hallucinations)



• Seeing patterns, lights, beings or objects that aren't there (visual-hallucinations)



• Feeling a crawling sensation on the skin (tactile-hallucinations)



• Hallucinations related to smell or taste are rare, but possible

Visual Hallucination

• Hypnagogic Hallucination

These hallucinations occur just before falling asleep and can last from seconds to minutes; all the while the subject usually remains aware of the true nature of the images.

• Peduncular Hallucinosis

These hallucinations occur most often in the evenings but unlike the previous type-the subject is usually fully conscious.

• Delerium Tremens

The subject which suffers from delirium tremens is usually agitated and confused, especially in the later stages of this disease. It is also accompanied with sleep disorders!

• Parkinson's Disease and Lewy body Dementia

Parkinson disease is associated with Lewy body dementia because they produce similar hallucinatory symptoms. These hallucinations start with illusions and they typically last for several minutes. What is the cause? Well, it is a known fact that Parkinson's disease is usually associated with a degraded substantia nigra pars compacta.

• Migraine Coma

This type of hallucination is usually experienced during the recovery from a comatose state. Some researches have proven that these hallucinations occur during states of full consciousness.

• Charles Bonnet Syndrome

Symptoms characteristic to this syndrome are being felt by blind patients who experience visual hallucinations. The hallucinations usually occur during the morning or evening, but are not dependent on low light conditions.

• Focal Epilepsy

It is well known that some focal epilepsy could produce hallucinations which are characterized by being brief, and stereotyped.

Auditory Hallucinations

The definition is simple- they occur when people hear voices or other noises although nothing is there. It is also very important to rule out possible causes such as physical illness and the side-effects of medication. How to recognize? One sign that the person may be having hallucinations involving voices is when they talk to themselves although there are no rules!

Several researches has been conducted and the results are:

• 38% percent of subjects described the sound as stereophonic,



• 6% said it came from the right side,



• 4% said left.



• 10% ascribed the origin of sound as coming from behind them



• 9% percent said from the front



• 52% percent of subjects could not ascribe a gender to the voice, and considered it to be a mix,



• 24% considered the voice to be male and 5% female.

Auditory hallucinations are more common in psychotic conditions such as schizophrenia, although they may sometimes be associated with high doses of cocaine, amphetamine or other stimulants.

Hallucinations- a symptom of dementia

It is a proven fact that people with dementia often have hallucinations. It's still not clear if this is an indication that the dementia is getting worse, but the fact is that most dementia does worsen over time. When a person with dementia has hallucinations, it's important to rule out delirium as a cause.

Causes of delirium include:

• heart or lung disease,



• infections,



• poor nutrition,



• drug interactions



• hormone disorders

Hallucinations due to delirium usually go away with treatment of the underlying cause. When hallucinations occur as a symptom of dementia, treatment may include several medications.

Diagnosis

There is no doubt that every person should seek evaluation, if experienced hallucinations more then once and in unusual occasion!

Differential diagnosis

A general physician, psychologist, or psychiatrist will try to rule out possible organic, environmental, or psychological causes through a detailed medical examination and social history. If a psychological cause such as schizophrenia is suspected, a psychologist will typically conduct an interview with the patient and his family and administer one of several clinical inventories, or tests, to evaluate the mental status of the patient.

Occasionally, people who are in good mental health will experience a hallucination. If hallucinations are infrequent and transitory, and can be accounted for by short-term environmental factors such as sleep deprivation or meditation, no treatment may be necessary. However, if hallucinations are hampering an individual's ability to function, a general physician, psychologist, or psychiatrist should be consulted to pinpoint their source and recommend a treatment plan.

Treatment and prognosis

Every patient should know that hallucinations which are symptoms of a mental illness such as schizophrenia should be treated by a psychologist or psychiatrist.

• Medications

Antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperdal) may be prescribed.

• Psychosocial therapy

If hallucinations persist, psychosocial therapy can be helpful in teaching the patient the coping skills to deal with them. Hallucinations due to sleep deprivation or extreme stress generally stop after the cause is removed.

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Morton's Neuroma

A Morton's neuroma, also called an interdigital neuroma, intermetatarsal neuroma or a forefoot neuroma, is a benign swelling along a nerve in the foot that carries sensations from the toes. It is important to know that this isn't some cancerous growth and that the reason the nerve starts to swell i...

A Morton's neuroma, also called an interdigital neuroma, intermetatarsal neuroma or a forefoot neuroma, is a benign swelling along a nerve in the foot that carries sensations from the toes. It is important to know that this isn't some cancerous growth and that the reason the nerve starts to swell is unknown. Problem is that, once swelling begins, the nearby bones and ligaments put extra pressure on the nerve, causing more irritation and inflammation which is causing burning pain, numbness, tingling and other abnormal sensations in the toes. This swelling usually develops between the third and fourth toes and other locations are rare. Important thing to know is also that it is rare for a Morton's neuroma to develop in both feet at the same time.

Incidence of the condition

Several researches done in the past have came to the conclusion that the condition is much more common in women than men, probably as a result of wearing high-heeled and narrow-toed shoes. It is also much more common in obese people because being overweight also increases the risk of a Morton's neuroma. Highest prevalence of Morton's neuroma is found in patients aged 15-50 years, but the condition may occur at any age.

Symptoms of a Morton's Neuroma

When someone has a Morton%26rsquo;s neuroma, he or she will probably have one or more of these symptoms where the nerve damage in occurring:

• Tingling, burning, or numbness



• Pain



• A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.

The progression of a Morton's neuroma often follows this pattern:

• The symptoms begin gradually and at first- they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.



• The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.



• Over time the symptoms progressively worsen and may persist for several days or weeks.
  
  
  
  
  
  



• The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

Typically, the pain is relieved temporarily by taking off shoes, flexing toes and rubbing feet. Symptoms may be aggravated by standing for prolonged periods.

Possible causes of Morton%26rsquo;s neuroma

The fact is that experts don't understand exactly what causes Morton's neuroma. However- there are some theories that tried to explain the cause of the condition and most of them are considering injury to be the direct cause! The condition seems to occur in response to irritation, pressure or injury to one of the digital nerves that lead to toes. The growth of thickened nerve tissue is part of body's response to the irritation or injury. It is proven also that, in some cases, Morton's neuroma may result from abnormal mechanics of the foot. This includes the presence of different bunions, hammertoes, flatfeet or excessive flexibility. Certain activities carry increased risk of excessive toe deformities, such as prolonged walking, running, squatting, and ballet%26hellip;

Factors that appear to contribute to Morton's neuroma include:

• Wearing high-heeled shoes or shoes that are tight or ill-fitting, including those that box in feet and place pressure on toes



• High-impact athletic activities, such as jogging, that subject your feet to repetitive trauma



• Injury to your foot

Diagnosis of Morton%26rsquo;s neuroma

• Detailed patient%26rsquo;s history

Every doctor should suspect that a patient has a Morton's neuroma based on the nature and location of her or his foot pain. That%26rsquo;s why- doctor should ask questions about shoes %26mdash; what type of shoes a patient usually wears and whether these shoes have narrow toes or high heels. Differential diagnosis is easy! To rule out other causes of foot pain, doctor should ask questions about medical history, especially any history of arthritis, nerve and muscle problems or previous foot or leg injury.

• Physical examination

To confirm the diagnosis, every doctor should examine patient%26rsquo;s feet. He should look for areas of tenderness, swelling, calluses, numbness, muscle weakness and limited motion. It is very easy to confirm the diagnosis by squeezing the sides of patient%26rsquo;s foot. Squeezing should compress the neuroma and trigger patient%26rsquo;s typical pain. In some cases, doctor will find numbness in the area between the affected toes. It is also important to know one thing- pain in two or more locations on one foot more likely indicates that the toe joints are inflamed rather than a Morton' neuroma.

• X-ray and MRI imaging

Sometimes, a foot X-ray may be ordered to make sure that there isn't a stress fracture, but it will not show the actual neuroma. If the diagnosis is in doubt, doctor should request magnetic resonance imaging (MRI) of the foot.

Differential diagnosis

There are some condition that should be mixed with this Morton%26rsquo;s neuroma and these may include:

• Stress fracture of the neck of the metatarsal



• Rheumatoid arthritis and other systemic arthritis conditions



• Hammer toe



• Metatarsalgia



• Neoplasm



• Metatarsal head osteonecrosis



• Freiburg osteochondrosis



• Ganglion cysts



• Intermetatarsal bursal fluid collections



• True neuromas

Treatment of Morton%26rsquo;s neuroma

Every patient should know that in developing a treatment plan- foot and ankle surgeon will first determine how long does the condition last and evaluate its stage of development.

For mild to moderate cases of neuroma, treatment options include:

• Padding

It is proven that padding techniques provide support for the metatarsal arch, because it involves lessening the pressure on the nerve and decreasing the compression when walking. It could be very beneficial method!

• Icing

Placing an icepack on the affected area helps reduce swelling. Ice is also beneficial to decrease the associated inflammation.

• Orthotic devices

All patients will confirm- custom orthotic devices provided by foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve and sometimes %26ndash;relieve pain completely!

• Activity modifications

Activities that put repetitive pressure on the neuroma should be avoided until the condition improves. These include prolonged walking, running, squatting%26hellip;

• Changes in shoewear

It's important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels. This will significantly relieve pain and reduce risk for complications!

• Medications

Several patients have reported that some nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

• Injection therapy

If there is no significant improvement after initial treatment, injection therapy may be tried. Some simple analgesics or nonsteroidal anti-inflammatory medications may be used to relieve pain and inflammation! However, overuse of injected steroids can lead to a number of side effects, including weight gain and high blood pressure, so people usually receive only a limited number of injections.

Physical therapy

The physical therapist can help the physician in decisions regarding the modification of footwear, which is the first step to treatment. Every therapist should recommend soft-soled shoes with a wide toe box and low heel. High-heeled narrow non-padded shoes should not be worn; because it is proven that they aggravate the condition. A plantar pad is used most often for elevation. Other possible physical therapy treatment ideas for patients with Morton neuroma include:

• cryotherapy,



• ultrasound,



• deep tissue massage,



• stretching exercises

Surgical solutions

Most patients are confused because they don%26rsquo;t know when exactly is surgery needed? Well, it is simple- surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma:

%26middot; removing of the affected nerve

%26middot; releasing of the affected nerve

Recovery period

Every patient should know that the length of the recovery period will vary, depending on the procedure or procedures performed. Regardless the type of treatment, every foot and ankle surgeon should recommend long-term measures to help keep your symptoms from returning.

Possible surgical Complications

The surgical area contains very small blood vessels, nerves, and muscles and complications can occur.

• Haematoma

Once the neuroma is removed, the empty space may fill with blood, resulting in a painful haematoma.

• Infection

There is a risk for infection, necessitating careful monitoring by the podiatrist and patient. If the incision site becomes warm or red within a day or two after surgery, or if the patient runs a fever, the surgeon must be contacted immediately.

• Recurrence of the pain

Every patient should know that the recurrence is another very common possibility. Problem is that the stump of nerve remaining after resection can begin to grow again. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery.

Some useful tips for the patients

• Take anti-inflammatory medications.



• Try ice massage.



• Change your footwear and avoid high heels or tight shoes.



• Wear supports or pads



• Take a break for a few weeks and reduce activities such as jogging, aerobic exercise or dancing.

About 25% of patients will experience complete resolution of their symptoms by taking these steps.

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What is GHB?

Gamma hydroxybutyrate, or simply GHB, is a very powerful, rapidly acting central nervous system depressant. It was first synthesized in the 1920s and was used as a pain reliever. Some researches have proven that GHB is produced naturally by the body in small amounts but its physiological function is...
Gamma hydroxybutyrate, or simply GHB, is a very powerful, rapidly acting central nervous system depressant. It was first synthesized in the 1920s and was used as a pain reliever. Some researches have proven that GHB is produced naturally by the body in small amounts but its physiological function is unclear.

The law and abuse

GHB was sold in health food stores as a performance enhancing booster until the Food and Drug Administration banned it in 1990. It is currently marketed in some European countries as an adjunct to anesthesia.
GHB is abused for its ability to produce euphoric and hallucinogenic states and for its alleged function as a growth hormone that releases agents to stimulate muscle growth.

Common street-names of GHB

Blue nitro
Cherry fX bombs
Cherry meth
Easy lay
Everclear
Firewater
Gamma G
Georgia homeboy
GHB
G.H. revitalizer
Gib
Goops
Great hormones at bedtime
Grievous bodily harm
G-riffick
Growth hormone booster
Insom-X
Invigorate
Lemon fX drops
Liquid ecstasy
Liquid E
Liquid X
Longevity
Natural sleep-500
Nature's quaalude
Orange fX rush
Organic quaalude
Oxy-sleep
Poor man's heroin
Remforce
Revivarant
Salty water
Scoop
Soap
Somatomax PM
Somsanit
Vita-G
Water
Wolfies
Zonked

Incidence

GHB is often ingested with alcohol by young adults and teens at nightclubs and parties. It is used as a pleasure enhancer that depresses the central nervous system and induces intoxication.
Several researches have shown that annual GHB use by secondary school students in 2000 ranged from

%26bull; 1.1% among 10th graders
%26bull; 1.2% among 8th graders
%26bull; 1.9% among 12th graders

In 2001, estimates of annual GHB use ranged from 1.0% among 10th graders to 1.1% among 8th graders and 1.6% among 12th graders.

Production of GHB

GHB can be easily manufactured. In the United States, GHB is produced in laboratories with no guarantee of quality or purity, making its effects less predictable and more difficult to diagnose.






Abusers have figured out that this drug can be manufactured with inexpensive ingredients and using recipes on the Internet. There are some substances such as Gamma butyrolactone (GBL) and 1,4-butanediol which represent the analogs of GHB and can be substituted for it. Once ingested, these analogs convert to GHB and produce the identical effects. The FDA has issued warnings for both GBL and 1,4-butanediol, stating that the drugs have a potential for abuse and are a public health danger.

Medical used of GHB

From the date it was synthesized it has been used as a general anesthetic, and a hypnotic in the treatment of insomnia. GHB has also been used to treat clinical depression, and improve athletic performance. Food and Drug Administration have permitted the use of GHB under the trade name Xyrem in patients with narcolepsy, a form of sleep disorder. GHB is also used in the treatment of alcoholism. It is used to treat both, acute alcohol withdrawal and medium to long term detoxification.

The use and effects of GHB

%26bull; The appearance
GHB is usually taken orally, and in most cases it is sold as a light-colored powder that easily dissolves in liquids. It can also be found as a pure liquid packaged in vials or small bottles. In liquid form, it is clear, odorless, tasteless, and almost undetectable when mixed in a drink.

%26bull; The costs
GHB is typically consumed by the capful or teaspoonful at a cost of $5 to $10 per dose.

%26bull; The effects
Several studies have shown that the average dose is 1 to 5 grams. In most cases it produces effects in 15 to 30 minutes and the effects last from 3 to 6 hours. It is proven that consumption of:

o Less than 1 gram of this drug produce relaxing effects, causing a loss of muscle tone and reduced inhibitions.
o 1 to 2 grams causes a strong feeling of relaxation and slows the heart rate and respiration.
o 2 to 4 grams, pronounced interference with motor and speech control occurs. A coma-like sleep may be induced, requiring intubation to wake the user.

When mixed with alcohol, the depressant effects of GHB are enhanced. This can lead to respiratory depression, unconsciousness, coma, and overdose.

%26bull; Side effects

Side effects associated with GHB may include:

o nausea,
o vomiting,
o delusions,
o depression,
o vertigo,
o hallucinations,
o seizures,
o respiratory distress,
o loss of consciousness,
o slowed heart rate,
o lowered blood pressure,
o amnesia,
o coma

Mechanism of GHB action

Experts are still researching the exact mechanism of GHB effects because they are still not fully understood. GHB clearly has at least two sites of action, stimulating the:

%26bull; GHB receptor
%26bull; The GABAB.

Some researches tried to prove that GHB is nothing more then a neurotransmitter, which in high concentrations can also reach to the GABAB receptor causing the sedative effects.

GHB and cases of rape

The drug-facilitated rape is defined as a sexual assault made easier by the offender's use of an anesthetic-type drug that renders the victim physically incapacitated or helpless and unable to consent to sexual activity.

According to several researches, GHB is the most common substance used in drug-facilitated sexual assaults because it can mentally and physically paralyze an individual. Victims may not seek help until days after the assault, in part because the drug impairs their memory and in part because they may not identify signs of sexual assault. Even when they do seek help, GHB is only detectable in the system for a limited amount of time and the opportunity to detect the drug can quickly pass.

Dangers of usage

%26bull; Mixing GHB with alcohol is extremely dangerous and has caused many deaths due to respiratory failure.
%26bull; Passing out on GHB by itself is also dangerous and potentially life-threatening.
%26bull; Driving a car while on GHB could be extremely dangerous! It is proven that only one dose can impair motor coordination by as much as six drinks of alcohol.
%26bull; Regular, daily use of GHB can cause physical dependency with harsh withdrawal symptoms.
%26bull; GHB is illegal and possession can result in long prison terms.

Withdrawal from GHB

Patients with a history of around-the-clock use of GHB (every 2 to 4 hours) exhibit withdrawal symptoms including:

%26bull; anxiety,
%26bull; insomnia,
%26bull; tremors,
%26bull; episodes of tachycardia
%26bull; delirium
%26bull; agitation

Because GHB has a short duration of action and quickly leaves the user's system, withdrawal symptoms may occur within 1 to 6 hours of the last dose. These symptoms may last for many months.

Other signs and symptoms of acute GHB abstinence syndrome may include

%26bull; Anorexia, abdominal cramps
%26bull; Nightmares
%26bull; Impaired concentration, memory, and judgment
%26bull; Increased sensitivity to sounds and tactile sensations
%26bull; Delusions
%26bull; Tonic-clonic activity (it is unclear if actual seizures occur during GHB withdrawal)
%26bull; Elevated temperature
%26bull; Dehydration

Therapy of GHB dependence

Benzodiazepines
Benzodiazepines such as Lorazepam (Ativan%26reg;, Temesta%26reg;), chlordiazepoxide (Librium%26reg;, Mitran%26reg;, Poxi%26reg;), and diazepam (Valium%26reg;, T-Quil%26reg;), are useful in relieving some of the signs and symptoms of GHB withdrawal.
Big doses of oral or intravenous benzodiazepines do not decrease the likelihood of withdrawal delirium, but are important for controlling psychotic agitation. The big problem is that most patients in GHB withdrawal have an extremely high tolerance to the sedating effects of benzodiazepines and require large frequent doses similar to those required for the treatment of severe alcohol withdrawal. Such large benzodiazepine doses require close medical attention and the application of continuous pulse oximetry to monitor for oxygen desaturation.

Barbiturates
Barbiturates in combination with benzodiazepines have been used successfully to improve withdrawal symptoms. Pentobarbital, a short acting barbiturate, can be titrated intravenously in 100-200 mg increments to symptoms.

Sedating Agents
Propofol is an anesthetic agent used for sedation which has been reported to provide relief for the psychotic agitation in patients with severe GHB withdrawal symptoms.

Antihypertensive Medications
It is not uncommon for patients to request medications such as beta-blockers for the treatment of minor autonomic hyperactivity such as elevated heart rate, elevation of blood pressure, sweating, tremor, or panic attacks. Beta-blockers used to control vital sign abnormalities via peripheral beta-blockade, without central nervous system sedation, may be detrimental.

Haloperidol and Other Antipsychotic medications
Clinicians have reported using large doses of antipsychotic medication in an attempt to control GHB withdrawal psychosis and they provided limited control of symptoms. Neuroleptics may also increase the risk of neuroleptics malignant syndrome and malignant hyperthermia.


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