NasugnaM Health

New Study May Lead to Development of New Blood Pressure Treatments

2010-08-02T01:42:00.002+08:00

Nasugnam Health (August 2, 2010) — Researchers have found that increasing certain protein enzymes in the blood vessels of mice, relaxed the vessels, lowering the animal’s blood pressure. The study provides new avenues for research that may lead to new treatments for hypertension.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 3 adults in the United States has high blood pressure, which increases the risk for heart disease and stroke, the first and third leading causes of death in the United States.

"The paper demonstrates that cytochrome P450 plays an important role in the management of high blood pressure, a disease of enormous public health concern," said Darryl Zeldin, M.D., acting clinical director of the National Institute of Environmental Health Sciences (NIEHS) and senior author on the paper.

The study, published online in The FASEB Journal, was conducted by researchers at NIEHS who teamed with investigators at the University of North Carolina at Chapel Hill (UNC), Medical College of Wisconsin, Milwaukee, and Oregon Health and Science University, Portland.

The researchers created animal models that had a human cytochrome P450 (CYP450 or P450) in the cells that line their blood vessels. The mice with the P450 generated more substances called epoxyeicosatrienoic acids or EETs, known for their role in protecting the cardiovascular system. EETs relax and dilate the blood vessels and fight inflammation.

"We found that when the animals were exposed to substances known to increase blood pressure, the animals with the P450 had lower blood pressure and less damage to the kidneys compared to normal mice," said Craig R. Lee, Pharm.D., Ph.D., assistant professor at UNC and lead author on the paper. "We hope that these studies will advance the development of new treatments for high blood pressure."

"This is a great example of a basic finding that improves our understanding of a metabolic pathway that can be used to develop improved treatments for those suffering from a common disease like hypertension," said Linda Birnbaum, Ph.D., director of the NIEHS and the National Toxicology Program.

Source: The above story is reprinted from materials provided by the National Institutes of Health.

Journal Reference:

Lee CR, Imig JD, Edin ML, Foley J, DeGraff LM, Bradbury JA, et al. 2010. Endothelial expression of human cytochrome P450 epoxygenases lowers blood pressure and attenuates hypertension-induced renal injury in mice. FASEB J. Epub ahead of print 2010 May 21, doi:10.1096/fj.10-160119.

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Antibodies Protect the Body from Most HIV Strains

2010-08-01T23:06:00.001+08:00

Nasugnam Health (August 1, 2010) — Scientists have isolated 2 potent human antibodies that can stop more than 90% of known global HIV strains from infecting human cells in the laboratory. The finding may help researchers design more effective HIV vaccines. It may also help advance other strategies for preventing or treating HIV infection. The result of the study was published on the on July 8, 2010 online edition of Science.

Most vaccines work by triggering the immune system to produce antibodies that help beat back infections. This strategy hasn't been successful in defeating HIV. Proteins on the surface of HIV mutate rapidly and change shape continuously, preventing most antibodies from latching onto and neutralizing the virus.

Researchers have recently found antibodies that can neutralize multiple strains of HIV-1, the virus responsible for the HIV/AIDS pandemic. These antibodies bind to a specific, virtually unchanging region on HIV’s surface spikes—the structures that help the virus attach to and infect immune cells. Much attention has focused on a surface spike protein called gp120, which fastens onto the CD4 binding site on the surface of immune cells.

A team of scientists led by Drs. John R. Mascola and Gary J. Nabel of NIH's National Institute of Allergy and Infectious Diseases (NIAID) set out to isolate even more broadly neutralizing antibodies. Guided by recent insights into how HIV binds CD4, they used computer-assisted design to make protein probes that would react only with antibodies specific to the unchanging area where the virus binds CD4. The researchers then used the probes to isolate antibody-producing B cells from the serum of an HIV-1-infected donor.

The researchers reported finding 3 antibodies, called VRC01, VRC02 and VRC03. The first 2 of these antibodies are able to neutralize over 90% of circulating HIV-1 isolates. The antibodies are also more potent than previously identified HIV-neutralizing antibodies.

"The antibodies attach to a virtually unchanging part of the virus, and this explains why they can neutralize such an extraordinary range of HIV strains," Mascola explains.

In a companion paper, a collaborating group led by NIAID's Dr. Peter D. Kwong explored the atomic-level structure of VRC01 when attached to the CD4 binding site. Their analysis offered insights into how researchers might elicit VRC01-like antibodies through vaccination. "The discoveries we have made may overcome the limitations that have long stymied antibody-based HIV vaccine design," Kwong says.

“The discovery of these exceptionally broadly neutralizing antibodies to HIV and the structural analysis that explains how they work are exciting advances that will accelerate our efforts to find a preventive HIV vaccine for global use,” says NIAID director Dr. Anthony S. Fauci. “In addition, the technique the teams used to find the new antibodies represents a novel strategy that could be applied to vaccine design for many other infectious diseases.”

Source: The above story is reprinted from materials provided by the National Institutes of Health.

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Hyperthermia: Body Becoming Too Hot

2010-08-01T21:40:00.001+08:00

Heat-Related Illness Advice for Older People From the National Institute on Aging (NIA)

Hot summer weather can pose special health risks to older adults. The National Institute on Aging (NIA), part of the National Institutes of Health, has some advice for helping older people avoid heat-related illnesses, known as hyperthermia.

Hyperthermia is an abnormally high body temperature caused by a failure of the heat-regulating mechanisms of the body to deal with the heat coming from the environment. Heat fatigue, heat syncope (sudden dizziness after prolonged exposure to the heat), heat cramps, heat exhaustion and heat stroke are commonly known forms of hyperthermia. Risk for these conditions can increase with the combination of outside temperature, general health and individual lifestyle.

Lifestyle factors can include not drinking enough fluids, living in housing without air conditioning, lack of mobility and access to transportation, overdressing, visiting overcrowded places and not understanding how to respond to hot weather conditions.

Older people, particularly those with chronic medical conditions, should stay indoors on hot and humid days, especially when an air pollution alert is in effect. Also, people without air conditioners should go to places such as senior centers, shopping malls, movie theaters or libraries. Cooling centers, which may be set up by local public health agencies, religious groups and social service organizations in many communities, are another option.

Health-related factors that may increase risk include:

Being dehydrated.

Age-related changes to the skin such as poor blood circulation and inefficient sweat glands.

Heart, lung and kidney diseases, as well as any illness that causes general weakness or fever.

High blood pressure or other conditions that require changes in diet. For example, people on salt-restricted diets may increase their risk. However, salt pills should not be used without first consulting a doctor.

Reduced perspiration, caused by medications such as diuretics, sedatives, tranquilizers and certain heart and blood pressure drugs.

Taking several drugs for various conditions. It is important, however, to continue to take prescribed medication and discuss possible problems with a physician.

Being substantially overweight or underweight.

Drinking alcoholic beverages.

Heat stroke is a life-threatening form of hyperthermia. It occurs when the body is overwhelmed by heat and unable to control its temperature. Someone with a body temperature above 104 degrees Fahrenheit is likely suffering from heat stroke and may have symptoms of confusion, combativeness, strong rapid pulse, lack of sweating, dry flushed skin, faintness, staggering, possible delirium or coma. Seek immediate emergency medical attention for a person with any of these symptoms, especially an older adult.

If you suspect that someone is suffering from a heat-related illness:

Get the person out of the sun and into a shady, air-conditioned or other cool place. Urge them to lie down.

If you suspect heat stroke, call 911.

Encourage the individual to shower, bathe or sponge off with cool water.

Apply a cold, wet cloth to the wrists, neck, armpits, and/or groin, places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.

Offer fluids such as water, fruit and vegetable juices, but avoid alcohol and caffeine.

Source:
The above health article is reprinted from materials provided by the National Institutes of Health.

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Joint Replacement With New Regenerated Tissue Possible

2010-07-29T22:15:00.009+08:00

Nasugnam Health (July 29, 2010) — NIH-Funded Researchers Make Progress Toward Regenerating Tissue to Replace Joints

A team of NIH-funded researchers has successfully regenerated rabbit joints using a cutting edge process to form the joint inside the body, or in vivo. Regenerative in vivo procedures are performed by stimulating previously irreparable organs or tissues to heal themselves. In this study, bioscaffolds, or three-dimensional structures made of biocompatible and biodegradable materials in the shape of the tissue, were infused with a protein to promote growth of the rabbit joint.

The experiment demonstrated the feasibility of an approach to growing dissimilar tissues, such as cartilage and bone, derived entirely from the host’s own cells. Results of the study are in the July 29 issue of The Lancet.

Regeneration activity relied on the host's supply of cells to the joint, local tissue response, and functional stimulation to recreate the entire surface of the joint cartilage together with the bone. The approach sidesteps problems encountered in transplantation of cells grown ex vivo, such as immunological rejection, pathogen transmission, and potential formation of tumors.

The research team laser-scanned the surface contours of a rabbit forelimb joint and made a 3-D model that was used to create an anatomically dimensioned bioscaffold. Some rabbits in the study received a bioscaffold infused with a collagen gel loaded with the protein, called transforming growth factor beta 3 (TGFB3), while other rabbits received bioscaffolds without TGFB3.

Bioscaffolds infused with TGFB3 recruited 130 percent more cells and grew a whole layer of cartilage tissue with greater compressive and shear properties than those who received the bioscaffold without the TGFB3. Rabbits with TGFB3-infused bioscaffolds resumed weight-bearing activity and locomotion three to four weeks after joint replacement. At five to eight weeks after surgery, these rabbits moved nearly as well as the control rabbits. By contrast, rabbits whose bioscaffolds did not contain TGFB3 continued to limp.

The research team included Chang H. Lee, Avital Mendelson, Eduardo K. Moioli, and Jeremy J. Mao of Columbia University Medical Center Tissue Engineering and Regenerative Medicine Laboratory, New York City; James L. Cook, University of Missouri School of Veterinary Medicine, Columbia; and Hai Yao, Clemson University and Medical University of South Carolina Department of Bioengineering, Charleston.

"Cartilage is one of the most resistant tissues for regeneration. This is the first time an entire cartilage joint was regenerated. By successfully regenerating cartilage in this way, we hope that this approach would work with other tissues without cell transplantation," Dr. Mao said.

Future work could replace arthritic joints in pre-clinical animal models and ultimately in arthritis patients who need total joint replacement.

Osteoarthritis is the world's leading cause of chronic disabilities. The disease involves structural breakdown of cartilage and bone, and affects approximately 80 million people in the United States.

"The aging population with arthritis is expected to double by 2030, when the last of the baby boomers become seniors," adds Dr. Mao. Current joint replacements have only a 10–15 year lifespan which may not be long enough for the increasing numbers of arthritis patients who are 65 years old or younger.

"The potential for in vivo tissue regeneration is enormous," says Dr. Christine Kelley, director of the NIBIB Division of Discovery Science and Technology. "Dr. Mao's work with repairing damaged bone and cartilage by recruiting host cells within a living animal could help pave the way for advanced treatment of arthritis and other diseases in humans."

This work was supported by grants from the National Institute of Biomedical Imaging and Bioengineering (NIBIB) (National Institutes of Health grant R01EB002332) and New York State Stem Cell Science.

Source:
The above story is reprinted from materials provided by the National Institutes of Health and National Institute of Biomedical Imaging and Bioengineering (NIBIB).

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Researchers Found New Compound that Improves Obesity-Related Health Complications in NIH-Led Study

2010-07-27T22:04:00.014+08:00

Nasugnam Health (July 27, 2010) — An experimental compound appears to improve metabolic abnormalities associated with obesity, according to a preliminary study led by researchers at the National Institutes of Health. A report of the study, which was conducted with obese mice, appeared online yesterday, July 26, 2010 in the Journal of Clinical Investigation.

"This is a promising early step toward a treatment for some of the serious health consequences of obesity," says Kenneth R. Warren, Ph.D., acting director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the NIH.

"Our results suggest that this compound could perhaps provide clinical benefits for obese individuals without the liabilities seen thus far with similar compounds," adds senior author and NIAAA Scientific Director, George Kunos, M.D., Ph.D.

Previous studies have shown that similar compounds block the activity of endocannabinoids, natural messengers in the body that are chemically similar to the active compound in marijuana, and help regulate many biological functions. These compounds can help promote weight loss and improve metabolic complications of obesity, such as diabetes and insulin resistance, changes in blood lipid composition, and fatty liver. However, the clinical advancement of such compounds has been stymied by behavioral side effects associated with their use, such as anxiety, depression and suicidal thoughts.

Dr. Kunos and first author Joseph Tam, D.D.S., Ph.D., of the NIAAA Laboratory of Physiologic Studies, collaborated with a team of scientists within and outside NIH to investigate a compound designed to avoid those side effects while preserving the beneficial effects of blocking endocannabinoid activity.

"Endocannabinoid receptors are present in the brain, as well as in peripheral tissues including the liver, skeletal muscles, pancreas, and fatty tissues," explained Dr. Kunos. "Activation of peripheral endocannabinoid receptors contributes to obesity-related metabolic and hormonal abnormalities."

The researchers reasoned that a compound that is unable to penetrate into the brain would selectively block the activity of endocannabinoid receptors in peripheral tissues, and therefore might alleviate metabolic and hormonal problems related to obesity. All while avoiding the behavioral problems that result from blocking endocannabinoid receptors in the brain.

They developed such a compound, tested it in obese mice, and found that the mice showed improvements in glucose regulation, fatty liver, and plasma lipid profiles. They also found that the compound did not affect behavioral responses, such as cannabinoid-induced immobility and hypothermia, that are mediated by endocannabinoid receptors in the brain, and that it reduced weight in mice with diet-induced obesity by about 12 percent, but did not affect weight in mice with a genetic predisposition for obesity.

"These preliminary findings are very encouraging and warrant further testing of this compound as a potential pharmacotherapy for the metabolic syndrome associated with obesity," said Dr. Tam.

Sources:
The above story is reprinted from materials provided by the National Institutes of Health and National Institute on Alcohol Abuse and Alcoholism (NIAAA).

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HIV/AIDS Treatment Curbs Spread of HIV Among Drug Users, According to NIH Supported Study

2010-07-18T20:35:00.022+08:00

Nasugnam Health (July 18, 2010) — Highly active antiretroviral therapy (HAART), currently known for its therapeutic benefits against HIV, also reduced the spread of the virus among people with a history of injection drug use, according to a population-based study funded by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. The study was published today in the Lancet.

HAART, a combination of drugs that target HIV at different points in its lifecycle, stops the HIV virus from replicating. Though not a cure, HAART suppresses the virus, stopping disease progression and prolonging survival in people diagnosed with HIV/AIDS. In this study, Canadian researchers found that increasing levels of HAART coverage in British Columbia were strongly associated with decreases in viral load in the population and new HIV diagnoses.

Previous research had suggested that increased HAART coverage reduced the spread of HIV in the general population. The findings in this study applied not only to the general population, but also to the subset of individuals with a history of injection drug use.

“This study strengthens the evidence that maximizing HAART coverage within current medical guidelines will help to curb the spread of HIV,” said NIDA Director Dr. Nora D. Volkow. “These findings are especially important since new HIV cases have remained stubbornly steady in the United States at a rate of about 56,000 per year for the past 10 years.”

Researchers analyzed information from two databases that provide information on HAART use, looking at viral load, new HIV diagnoses, and HIV and viral load testing information in British Columbia, where residents are provided free access to HIV care. During three distinct time periods, researchers saw that the number of individuals actively receiving HAART had a strong impact on viral load and new diagnoses in the community. As HAART coverage increased sharply, new HIV diagnoses decreased sharply. As HAART coverage stabilized, so did viral load and new HIV diagnoses.

“Our results clearly demonstrate that there is a connection between treatment and prevention not just among the general population, but among injection drug users as well,” said Dr. Julio Montaner, the study’s lead author and director of the BC Centre for Excellence in HIV/AIDS. “Expanding HAART coverage within current medical guidelines will prevent disease progression and decrease new HIV infections.”

Worldwide, there were 2.7 million new HIV infections in 2008. In the United States, more than 1 million people live with diagnosed or undiagnosed HIV/AIDS. Statistics on the prevalence of HIV/AIDS in the United States can be found on the Centers for Disease Control and Prevention website: http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/index.htm.

The study can be found online at http://www.thelancet.com/. The research was supported by NIDA’s annual Avant-Garde Award to Dr. Montaner. The award was intended to stimulate high-impact research that may lead to groundbreaking opportunities for the prevention and treatment of HIV/AIDS in drug abusers. Information on NIDA’s Avant-Garde program can be found at http://www.drugabuse.gov/about/organization/arp/avgp.htm.

Source:
The above story is reprinted from materials provided by the National Institutes of Health (NIH) and National Institute on Drug Abuse (NIDA).

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Possible New Treatment for Severe Vasculitis Identified

2010-07-15T16:48:00.000+08:00

NAsugnam Health (July 15, 2010) - Investigators have made a major advance in treating people with a severe form of vasculitis, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, a rare but devastating disease of blood vessels. In a six-month study, a new treatment strategy provided the same benefits as the current standard of care used for more than 40 years but required less frequent treatments. Early results also suggest that patients with disease relapses-typically recurrences of fever, fatigue, kidney damage, or bleeding in the lungs-respond better to the new regimen.

The study, which appears online in the New England Journal of Medicine, was led by John Stone, M.D., M.P.H., of Massachusetts General Hospital, Boston, and Ulrich Specks, M.D., of the Mayo Clinic, Rochester, Minn. It was conducted by the Immune Tolerance Network (ITN). The ITN is an international consortium supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the Juvenile Diabetes Research Foundation International. Genentech Inc., of South San Francisco, Calif., and Biogen Idec Inc., of Weston, Mass., provided additional funding for the study.

Patients with ANCA-associated vasculitis make antibodies that attack immune cells called neutrophils, causing inflammation in small- to medium-sized blood vessels. This leads to organ damage, particularly in the airways, lungs and kidneys.

There are two main forms of this type of autoimmune vasculitis-microscopic polyangitis and Wegener's granulomatosis. These are rare, so-called orphan, diseases with approximately 6,000 newly diagnosed cases in the United States each year.

The current standard of care for ANCA-associated vasculitis combines a 3- to 6-month course of daily cyclophosphamide plus steroids, followed by long-term daily azathioprine (AZA) plus steroids. This regimen was originally developed by NIAID Director Anthony S. Fauci, M.D., and his colleagues in the early 1970s. Before this treatment regimen became available, about 80 percent of people died within two years of disease onset from kidney failure or bleeding in the lungs. The nearly 40-year-old therapy has been lifesaving for many patients.

"More than 90 percent of individuals with this once-devastating disease experience remission after they receive cyclophosphamide-based therapy," says Dr. Fauci. "Despite these gratifying results, there remains a high rate of relapse and a need for retreatment. Identifying more effective treatment options would be a welcome development."

Dr. Fauci's earlier research had shown that cyclophosphamide worked by suppressing the function of B cells, an immune cell that produces the self-destructive antibodies. However, long-term, repeated use of cyclophosphamide puts patients at increased risk of infection, cancer and infertility as well as other side effects.

In search of an alternative therapy for patients with ANCA-associated vasculitis, ITN investigators turned to rituximab, a synthetic antibody that selectively reduces the number of B cells circulating in the blood. Rituximab currently is licensed to treat some B-cell lymphomas, chronic lymphocytic leukemia and rheumatoid arthritis.

The goal of this study was twofold, says Dr. Stone. "First, we wanted to induce disease remission and reduce or eliminate maintenance steroid use. Second, we wanted to find a less toxic therapy that also will prolong remission."

In their study, the 197 participants-51 percent had been treated previously, 49 percent were newly diagnosed-were divided randomly into two groups. One group received intravenous rituximab therapy once a week for one month, plus steroids. The other group received 3 to 6 months of daily cyclophosphamide therapy plus steroids, followed by daily AZA. Neither the investigators nor the patients knew the treatment assignments. After a 6-month treatment period, the investigators found that 64 percent of participants in the rituximab group and 53 percent in the cyclophosphamide group had no disease activity and were able to completely discontinue the use of steroids. According to the ITN investigators, the study has successfully demonstrated that rituximab provided comparable benefits as standard therapy for ANCA-associated vasculitis.

Moreover, in patients with relapsing disease, the new treatment worked even better. The investigators found that 67 percent of participants with relapsing disease in the rituximab group had no disease activity and were able to discontinue all steroid use after therapy, compared with only 42 percent in the cyclophosphamide group.

"Although the two therapy regimens were equally effective in reducing patients' disease activity overall, our results indicate that rituximab is superior to cyclophosphamide in inducing remission for patients experiencing a disease flare," comments Dr. Specks.

The observation that rituximab offers similar benefits for patients with ANCA-associated vasculitis, while using a much shorter treatment regimen, is a major treatment advance, according to the investigators. Significantly, they also observed no major differences in the overall side effects in patients from the two treatment groups.

According to Drs. Stone and Specks, the ITN team plans to follow the participants until 18 months after treatment to determine if patients who received rituximab relapse and to evaluate the long-term safety of this regimen.

"The goal of the ITN is to develop tolerance-inducing therapies and bring them into clinical practice for immune-mediated diseases," says Daniel Rotrosen, M.D., director of NIAID's Division of Allergy, Immunology and Transplantation. "The results show that rituximab is a valid and long-awaited alternative to cyclophosphamide therapy. We eagerly await the results from the longer term study."

Additional NIH support for this research was provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Center for Research Resources' Clinical and Translational Science Awards.

Source: The above story is reprinted from materials provided by the National Institute of Allergy and Infectious Diseases (NIAID).

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How to Keep Your Bones Strong and Healthy

2010-05-22T14:14:00.002+08:00

Many people think that the bones of the body are just hard material that helps to protect body organs and keep the body upright when standing. While it is true that these are some of their functions, the bones have living cells that constantly work to keep it health and strong.

“Bone is living, growing tissue,” says Dr. Joan McGowan, a scientist at NIH. “It’s constantly breaking down and building up. It keeps refreshing itself.”

However, as people age, they may be at an increased risk of developing osteoporosis where the bones become weak and fragile. This can make the bones more easily to break.

According to the National Institutes of Health (NIH), it is estimated that about 10 million people in the United States have the condition and 34 million people have low bone mass. Having low levels of bone mass increases the risk of developing osteoporosis.

Osteoporosis is a “silent disease” much like having high blood pressure and diabetes. You never know that you have the condition until it is too late.

People who have osteoporosis may experience fracture even with a minor tumble, which may require surgery and hospitalization.

So how do we keep our bones strong and healthy?

An NIH funded research has shown that the best time to build up bone tissue is during childhood. Most bone is built by age 18 in girls and 20 in boys.

Things you can do prevent osteoporosis and low bone mass include:

Start with a well-balanced diet rich in calcium. Most of our bone is made of a rigid protein framework. Calcium (a mineral) adds strength and hardens that framework.

Calcium can be found in many foods including milk and other dairy products.

Get enough vitamin D. This vitamin helps the intestine absorb calcium. Most people can get the recommended vitamin D when they are exposed to the sun. Some people, however, may not get enough sunlight and may need to take vitamin D pills. A doctor can help you know how much of it you need.

Be physically active. Studies have shown that performing physically activity help the bones become stronger. Activities, such as jumping rope, running around and basketball can make a child’s bones stronger.

Even adults can perform physical activity to maintain bone strength, such as walking and jogging. Be sure to include foods rich in calcium and vitamin D.

Because our bones protect vital organs like the brain, lungs and heart, it is important that we maintain them, keeping them strong and healthy.

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Appendicitis Symptoms: Know the Signs of an Inflamed Appendix

2009-11-13T09:45:00.002+08:00

Appendicitis is the painful inflammation of the appendix usually due to a blockage to its opening to the large intestine. The appendix is a small pouch attached to the beginning of the large intestine. Appendicitis is a medical emergency because the appendix may burst and cause peritonitis—a potentially life threatening condition wherein infection can spread to other organs of the abdomen. Knowing the appendicitis symptoms and seeking immediate medical attention is important.

Appendicitis symptoms may differ from person to person, but the most common sign is abdominal pain. The pain may begin at the belly-button area and then moves toward the right lower part of the abdomen. Abdominal pain usually occurs before other symptoms. Other symptoms of appendicitis may include:

 loss of appetite

 nausea and vomiting

 constipation or diarrhea

 inability to pass gas

 low-grade fever (follows other symtoms) and

 abdominal swelling.

Other health problems in the digestive system may also have the same symptoms as appendicitis, such as intestinal adhesions, irritable bowel disease, constipation, and pelvic inflammatory disease

Appendicitis treatment almost always involves removing the appendix. The removal of the appendix is called appendectomy. According to experts, the removal of the appendix does not seem to affect any digestive process.

The Digestive System Disorders (DSD), a subdivision of Nasugnam Health, has more information about appendicitis and other digestive disorders.

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Treating Cocaine Addiction with Anti-Cocaine Vaccine

2009-11-07T17:25:00.001+08:00

An experimental anti-cocaine vaccine may cut cocaine use, researchers say.

In a recent clinical trial funded by the National institutes of Health (NIH), immunization with an experimental anti-cocaine vaccine resulted in a reduction in 38 percent of vaccinated patients.

"The results of this study represent a promising step toward an effective medical treatment for cocaine addiction," said NIDA Director Dr. Nora Volkow." Provided that larger follow-up studies confirm its safety and efficacy, this vaccine would offer a valuable new approach to treating cocaine addiction, for which no FDA-approved medication is currently available."

According to the NIH, the result of the clinical trial is the first successful demonstration of a vaccine against an illegal drug of abuse.

Like vaccines against infectious diseases, the anti-cocaine vaccine stimulates the immune system to produce antibodies. These attach to cocaine in the blood and prevent cocaine from passing into the brain.

Although, according to the researchers, the vaccine didn’t lead to complete abstinence, the results are meaningful. Reducing cocaine use can significantly improve an abusers’ quality of life.

The study, published in the October 2009 issue of the Archives of General Psychiatry, is the first successful, placebo-controlled demonstration of a vaccine against an illicit drug of abuse.

Source: National Institutes of Health (NIH) News (http://www.nih.gov/news/health/oct2009/nida-05.htm)

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Urinary System Disorders

2009-11-07T15:14:00.003+08:00

The urinary system is the body’s major eliminator of wastes. It acts to remove excess water and wastes from cells. These become parts of the urine, which is eliminated from the body through urination.

The urinary system include two kidneys, two ureters, a urinary bladder, a prostate (only in males), and a urethra. The kidneys are the actual organs that filter blood and remove excess water and waste products. The the urinary organs function to drain urine to the outside. The bladder stores urine until it is excreted from the body.

Urinary system disorders can occur when part of the urinary tract is blocked, damaged, or inflamed, such as that occurs during urinary tract infection.
Common urinary system disorders may include kidney stones, urinary tract infections, and kidney disease or kidney failure.

Symptoms of urinary system diseases may vary depending on the cause of the disorder. Some common symptoms may include difficulty or painful urination, unusual or foul smelling urine, pain on the back or sides, and sometimes fever or chills.
Treatment of urinary system disorders depend on the cause and extent of damage to the urinary organs.

For more topics about common and rare disorders affecting the urinary system, visit our Kidney Health Care website.

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Not All Drugs Have Generic Versions

2009-04-02T21:09:00.000+08:00

Generic drugs have the same active ingredients as their brand-name counterparts. However, not all brand-name drugs have generic versions. According to the U.S. Food and Drug Administration (FDA), a generic drug is a copy that is identical to a brand-name drug in dosage, safety, strength, how it is taken, quality, performance and intended use.

When a new drug is developed, the company who made the drug has the sole right to sell it. Just like other new products, new drugs are developed under patent protection. The patent protects the investment—including research, development, marketing and promotion—by giving the company the exclusive right to sell the drug while the patent is in effect. Brand-name or trade-name drugs are generally given patent protection for about 20 years. However, when the patent expires, other drug companies can introduce competitive generic versions, but only after they have been thoroughly tested by the manufacturer and approved by the FDA.

As generic versions of the brand-name drug are introduced, prices would likely go down because of competition. In addition, the "first" drug manufacturer can make their own generic version of their drug or other brand-name drugs but sell them without the brand name. According to the FDA, trade-name firms account for about 50 percent of generic drug production.

So the next time you buy your prescription drug, ask if there is a generic version. Or ask your doctor about generic versions of your prescription medicines. Generic drugs are less expensive, yet they are as effective as the brand-name drugs. Well, if it's a new drug, then we will not get a generic version some time very soon. Hmmm, we can't wait for 20 years just to get the generic version.

Generic Drugs Q and A

2009-04-02T16:03:00.000+08:00

Questions and Answers About Generic Drugs

What is a generic drug?

A generic drug is a copy of a brand-name drug. When a brand-name drug's patent protection expires, generic versions of the drug can be approved for sale. The generic version works the same way as the brand-name drug in dosage, safety, strength, how it is taken, quality, performance and intended use.

Are generic drugs as safe as brand-name drugs?

The answer is yes. The Food and Drug Administration (FDA) requires that drugs, generic or brand-name, be safe and effective. Since generics use the same active ingredients and are shown to work the same way in the body, they have the same risks and benefits as their brand-name counterparts.

Are generic drugs as effective as brand-name drugs?

Yes, they are as effective. Generic drugs have the same active ingredients as their brand-name counterparts. In addition, generic versions work in the same way and in the same amount of time as brand-name drugs. The only difference is the cost.

Why do generic drugs cost less?

Generic drugs are less expensive because manufacturers of the generic versions do not have the same development costs of the developer of a new drug. As a result, these generic manufacturers can sell the generic versions at substantial discounts. New drugs are developed under patent protection. The patent protects the investment—including research, development, marketing, and promotion—by giving the company the sole right to sell the drug while it is in effect. As patents near expiration, manufacturers can apply to the FDA to sell generic versions.

Once generic versions of certain brand-name drugs are approved, there is more competition, which keeps the price down.

Because generic drugs are less expensive, does that mean they are made in less modern facilities?

Generic manufacturers have facilities comparable to those of brand-name firms. All generic drug manufacturing facilities must meet the FDA’s standards of good manufacturing practices. FDA will not permit drugs to be made in substandard facilities. According to the U.S. FDA, brand-name firms are linked to an estimated 50 percent of generic drug production. They frequently make copies of their own or other brand-name drugs but sell them without the brand name.

If generic drugs and brand-name drugs have the same active ingredients, why do they look different?

Trademark laws do not allow a generic drug to look exactly like the brand-name drug already on the market. However, a generic drug must duplicate the active ingredient. Colors, flavors, and certain other inactive ingredients may be different. These ingredients do not affect the performance, safety or effectiveness of the generic drug.

Why don't they make generic counterparts for all brand-name drugs?

Fact is, brand-name drugs are generally given patent protection for 20 years from the date of submission of the patent. This provides protection for the innovator who laid out the initial costs (including research, development, and marketing expenses) to develop the new drug. However, when the patent expires, other drug companies can introduce competitive generic versions, but only after they have been thoroughly tested by the manufacturer and approved by the FDA.

Conclusion:

Ask your health care professional if there is a generic version of the medication you're taking. Using generic versions of brand-name drugs does not mean you are getting less. Generic drugs are as effective as their brand-name counterparts without the high price.

Reference: U.S. Food and Drug Administration (www.fda.gov)

How Bacteria Become Resistant To Antibiotics

2009-01-29T11:44:00.001+08:00

Bacteria are organisms that are invisible to the naked eye. They are found all around us, such as in drinking water, food, soil, plants, animals, and even inside our body.

Most of these bacteria are not harmful. In fact, some bacteria such as those found in the intestine, help in digesting food. However, many bacteria also are capable of causing severe infections.

The ability of antibiotics to stop an infection depends on killing or halting the growth of harmful bacteria. But some bacteria resist the effects of drugs and multiply and spread.

Some bacteria have developed resistance to antibiotics naturally, long before the development of commercial antibiotics.

After testing bacteria found in an arctic glacier and estimated to be over 2,000 years old, scientists found several of them to be resistant to antibiotics. This evidence most likely indicates a naturally occurring resistance.

If they are not naturally resistant, bacteria can become resistant to drugs. The more you use antibiotics, the more likely bacteria are to become resistant to the antibiotics. For instance, they may develop resistance to certain drugs spontaneously through mutation. Mutations are changes that occur in the genetic material, or DNA, of the bacteria. These changes allow the bacteria to fight or inactivate the antibiotic. Using antibiotics may kill normal bacteria, but the mutated versions can still live and multiply.

Related Topic: Misuse of Antibiotics: It Could Threaten Your Health

Source: Center for Devices and Radiological Health. FDA and You – Issue #2 – Winter 2004. U.S. Food and Drug Administration. Retrieved: January 29, 2009

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Misuse of Antibiotics: It Could Threaten Your Health

2009-01-29T11:10:00.004+08:00

Antibiotics, also called antimicrobial drugs, are medicines used to treat infections caused by bacteria. They can be available in several forms, such as ointments, pills, and liquid medicine.

These antibiotics have saved many lives. However, misuse and overuse of these medicines have contributed to a phenomenon called antibiotic resistance. In antibiotic resistance, the harmful bacteria change in a way that they reduce or eliminate the effectiveness of antibiotics.

Antibiotic Resistance: A Global Public Health Concern

This phenomenon of antibiotic resistance is becoming a public health concern worldwide. When a person is infected with an antibiotic-resistant bacterium, treatment of that patient may be more difficult. In addition, the antibiotic-resistant bacterium may spread to other people.

When antibiotics don’t work, the result can be

 longer illnesses

 more complicated illnesses

 more doctor visits

 the use of stronger and more expensive medicines

 more deaths caused by bacterial infections

Examples of the types of bacteria that have become resistant to antibiotics include the species that cause skin infections, meningitis, sexually transmitted diseases and respiratory tract infections such as pneumonia.

Antibiotics: Used to Fight Bacteria, Not Viruses

Antibiotics are meant to be used in infections caused by bacteria. For example, they are used to treat strep throat, which is caused by streptococcal (strep) bacteria, and skin infections caused by staphylococcal bacteria.

Although antibiotics kill bacteria, they are not effective against viruses or viral infections. Examples of viral infections include colds, most coughs, many types of sore throat, and influenza (flu).

Using antibiotics against viral infections

 will not cure the infection

 will not keep other individuals from catching the virus

 will not help a person feel better

 may cause unnecessary, harmful side effects

 may contribute to the development of antibiotic-resistant bacteria

Patients and health care professionals can all play an important role in combating antibiotic resistance. Patients should not demand antibiotics when a health care professional says they are not needed. Health care professionals should prescribe antibiotics only for infections they believe to be caused by bacteria.

As a patient, your best approach is to ask your health care professional whether an antibiotic is likely to be effective for your condition. Also, ask what else you can do to relieve your symptoms.

Things You Can Do To Prevent Antibiotic Resistance

The following are tips provide by the U.S. Food and Drug Administration to promote proper use of antibiotics.

 Do complete the full course of the medicine. It’s important to take all of the medication, even if you are feeling better. If treatment stops too soon, the medicine may not kill all the bacteria. You may become sick again, and the remaining bacteria may become resistant to the antibiotic that you’ve taken.

 Do not skip doses. Antibiotics are most effective when they are taken regularly.

 Do not save antibiotics. You might think that you can save an antibiotic for the next time you get sick, but an antibiotic is meant for your particular infection at the time. Never take leftover medicine. Taking the wrong medicine can delay getting the appropriate treatment and may allow your condition to worsen.

 Do not take antibiotics prescribed for someone else. These may not be appropriate for your illness, may delay correct treatment, and may allow your condition to worsen.

 Do talk with your health care professional about your treatment plan. Ask questions, especially if you are uncertain about when an antibiotic is appropriate or how to take it.

When prescribed an antibiotic to treat a bacterial infection, it’s important to take the medication exactly as directed. Let your health care professional know if your symptoms get worse or do not improve.

Related Topic: How Bacteria Become Resistant To Antibiotics

Source: Center for Devices and Radiological Health. FDA and You – Issue #16 – Winter 2008. U.S. Food and Drug Administration. Retrieved: January 29, 2009

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Hypothermia: Older People Are at Risk

2009-01-18T09:45:00.003+08:00

Almost everyone knows about winter dangers such as broken bones from falls on icy steps, sidewalks or streets. But cold weather also can cause an important, less obvious danger that can affect older people. Older adults are especially vulnerable to hypothermia, which can be deadly if not treated quickly. The National Institute on Aging (NIA), part of the National Institutes of Health (NIH), has some advice to help older people avoid hypothermia.

Hypothermia occurs when a person's body temperature drops below normal and stays low for a prolonged period of time. With advancing age, the body's ability to endure long periods of exposure to cold is lowered.

Older people also are at risk for hypothermia because their body's response to cold can be diminished by certain illnesses such as diabetes and some medicines, including over-the-counter cold remedies. In addition, older adults may be less active and generate less body heat. As a result, they can develop hypothermia even after exposure to relatively mild cold weather or a small drop in temperature.

The best way to identify someone with hypothermia is to look for confusion or sleepiness, slowed or slurred speech, shivering or stiffness in the arms and legs, weak pulse or low blood pressure, poor control over body movements or slow reactions. If you suspect that someone is suffering from the cold and you have a thermometer available, take his or her temperature. If it's 96 degrees or lower, call 911 for emergency help.

The NIA has information to help you prevent hypothermia. Here are a few tips:

-- Wear several layers of loose clothing when it is cold. The layers will trap warm air between them. Tight clothing can keep blood from flowing freely and lead to loss of body heat.

-- Wear a hat, scarf, gloves or mittens, and warm clothes when you go outside in cold weather. A significant amount of your body heat can be lost through your head, and hands and feet are the first body parts to get cold.

-- To keep warm at home, wear long underwear under your clothes, along with socks and slippers. Use a blanket or afghan to keep legs and shoulders warm and wear a hat or cap indoors.

-- Make sure your home is warm enough. Set your thermostat to at least 68 to 70 degrees. Even mildly cool homes with temperatures from 60 to 65 degrees can trigger hypothermia in older people.

-- Check with your doctor to see if any medications (prescription or over the counter) you are taking may increase your risk for hypothermia.

Source: NIH News. National Institutes of Health. Available at: http://www.nih.gov/news/health/jan2009/nia-16.htm. Accessed: January 17, 2009

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Contact NasugnaM

2008-12-23T07:36:00.003+08:00

Thank you for visiting the NasugnaM Health (NH) website.

Contacting the webmaster

Please be aware that we cannot reply to email questions about your specific health problems. We recommend that you direct your questions to your medical doctor.

The information in this website is meant to serve as an aid to understand general descriptions of health conditions and other health matters and not to replace a consultation with a qualified healthcare provider. You should not use the information in this website to formulate your own treatment plan. Your healthcare provider can determine which optimal medical and dietary plan is best for you.

To report any broken links, request for health topics to be featured in our website, or other concerns about our website, you can contact the webmaster at davidkm77(@)gmail(dot)com. View information about our privacy policy.Thank you very much.

[Top of Page]

About Nasugnam Health

2008-12-22T07:00:00.001+08:00

Privacy Statement

Of the information we learn about you from your visit to NasugnaM Health "nasugnam.blogspot.com," we store only the following: the domain name from which you access the Internet, the date and time you access our site, and the Internet address of the web site from which you direct-linked to our site. This information is used to measure the number of visitors to the various sections of our site and to help us make our site more useful to visitors.

Unless it is specifically stated otherwise, no additional information will be collected about you. When inquiries are emailed to us, we store the question and the email address information so that we can respond electronically. Unless otherwise required by statute, we do not identify publicly who sends questions or comments to our web site. We will not obtain information that will allow us to personally identify you when you visit our site, unless you chose to provide such information to us.

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These third-party ad servers or ad networks use technology to the advertisements and links that appear on www.nasugnam.blogspot.com send directly to your browsers. They automatically receive your IP address when this occurs. Other technologies ( such as cookies, JavaScript, or Web Beacons ) may also be used by the third-party ad networks to measure the effectiveness of their advertisements and / or to personalize the advertising content that you see.

www.nasugnam.blogspot.com has no access to or control over these cookies that are used by third-party advertisers. You should consult the respective privacy policies of these third-party ad servers for more detailed information on their practices as well as for instructions about how to opt-out of certain practices. www.nasugnam.blogspot.com's privacy policy does not apply to, and we cannot control the activities of, such other advertisers or web sites.

If you wish to disable cookies, you may do so through your individual browser options. More detailed information about cookie management with specific web browsers can be found at the browsers' respective websites.

Contacting the Webmaster

Nasugnam Health does not provide specific medical advice, diagnosis, or treatment. Your doctor can provide you with more information about your specific health problem or concerns.

For other concerns, you can contact the webmaster at: davidkm77 (at) gmail (dot) com.

Privacy Statement, Mission and Disclaimer, Advertisement Policy, Pop-Up Advertisements, Accreditation, and Site Maintenance
Published: December 22, 2008; Updated: March 18, 2008

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The Liver

2008-10-29T08:03:00.000+08:00

The liver, the largest organ inside the body, is located behind the ribs on the right side of the abdomen. It performs many vital functions to keep a person healthy. Some of its major functions include

storing the sugar that the body uses for energy
removing harmful substances from the blood
making enzymes and bile that help in the digestion of food
removing organisms such as bacteria from the blood
making proteins that aid in the blood clotting

The bile is the yellowish-green liquid produced by the liver cells is stored in the gallbladder. The gallbladder is a small pear-shaped organ located just under the liver. Bile produced by the liver is stored in the gallbladder until the body needs it.

Related Topic:

For More Information: (Links Open in a New Window)

Liver (National Digestive Diseases Information Clearinghouse)

Liver Diseases

2008-10-28T17:54:00.000+08:00

The liver is the largest organ inside the human body. It has many important functions including changing food into energy and cleaning alcohol and poisons from the blood. In addition, liver also makes bile, which is a yellowish-green liquid that helps with digestion.

There are many kinds of liver diseases, or hepatic diseases. Some liver diseases can be caused by viruses, such as hepatitis A, hepatitis B and hepatitis C. In some, liver disease can be the result of drugs, poisons or too much alcohol drinking. When scar tissue replaces normal liver cells because of an illness, the condition is called cirrhosis. Cancer can also affect the liver. Yellowing of the skin, a condition called jaundice, may be a sign of liver disease.

Some liver diseases may also be inherited such as hemochromatosis.

Related Topic:

The Liver

For More Information: (Links Open in a New Window)

Cirrhosis of the Liver (National Digestive Diseases Information Clearinghouse)
Hepatitis: What You Need to Know (National Digestive Diseases Information Clearinghouse)
Liver Problems: Common Problems and How to Avoid Them (Mayo Foundation for Medical Education and Research)

Graves' Disease

2008-10-28T14:44:00.000+08:00

Graves’ disease, also known as toxic diffuse goiter, is the most common cause of hyperthyroidism in the United States. Hyperthyroidism results from too much production of thyroid hormones by the thyroid gland.

In Graves’ disease, the immune system mistakenly produces antibodies, which stimulate the thyroid gland to make too much thyroid hormone.

Common symptoms of hyperthyroidism include

nervousness or irritability
heat intolerance
rapid and irregular heartbeat
frequent bowel movements or diarrhea
weight loss
goiter

People with Graves’ disease may also have bulging eyes, a condition called Graves’ ophthalmopathy or exophthalmos.

The condition is most often treated with radioiodine therapy, which gradually destroys the cells of the thyroid gland but does not affect other body cells. Other treatment options may include the use of antithyroid drugs and surgical procedure to remove the thyroid gland.

Additional treatment may be required for the eye problems associated with Graves' disease.

Related Topic:

For More Information: (Links Open in a New Window)

Graves' Disease (Endocrine Health)
Graves' Disease (National Institute of Diabetes and Digestive and Kidney Diseases)

Pancreas

2008-10-24T22:55:00.000+08:00

The pancreas is a large endocrine gland located behind the stomach and near the duodenum, which is the first part of the small intestine. It is considered a digestive system organ and an endocrine organ as well. A digestive organ because it makes and releases digestive juices, or enzymes that help in digestion of ingested food. It is also an endocrine system organ because certain cells in the pancreas produce hormones that help controlling blood sugar levels.

Related Topic:

For More Information: (Links Open in a New Window)

Your Digestive System and How it Works (National Institute of Diabetes and Digestive and Kidney Diseases)

Gallbladder

2008-10-24T20:52:00.000+08:00

The gallbladder is a small pear-shaped organ located just under the liver. It acts as a storage area for bile, which is made by the liver cells called hepatocytes. Bile produced by the liver is stored in the gallbladder until the body needs it.

The bile liquid is composed of water, cholesterol, fats, bile salts, proteins, and a waste product called bilirubin. Bile salts help in breaking up fats. The waste product bilirubin gives bile and stool a yellowish-brown color.

Related Topic:

For More Information: (Links Open in a New Window)

Your Digestive System and How it Works (National Institute of Diabetes and Digestive and Kidney Diseases)
Gallstones (National Institute of Diabetes and Digestive and Kidney Diseases)

Gallbladder Cancer

2008-10-24T18:53:00.000+08:00

Gallbladder cancer is a type of cancer that occurs in the gallbladder tissues. The gallbladder is a pear-shaped organ lying just under the liver. It stores the fluid called bile, which helps in the digestion of fats. Bile is produced by the liver cells.

Gallbladder cancer is a rare condition. Women and native Americans are at risk of developing the condition. Cancer of the gallbladder may cause symptoms such as:

Jaundice (yellowing of the skin and whites of the eyes)
Pain above the stomach
Fever
Nausea and vomiting
Lumps in the abdomen
bloating

These symptoms, however, may also be caused by other health problems. A doctor should be consulted if these problems occur.

Gallbladder cancer is difficult to detect and diagnose during its early stages. Sometimes the condition is found when doctors remove the gallbladder for another reason. People with gallstones rarely develop gallbladder cancer.

It may be hard to treat gallbladder cancer because, often, the condition is found late. However, gallbladder cancer can be cured if the condition is found before it has spread to nearby tissues. Treatment options may include surgery, chemotherapy, radiation, or a combination of these.

Related Topic:

Kidney Cancer (Cancer of the Kidney)
Pancreatic Cancer (Cancer of the Pancreas)
Thymus Cancer (Cancer of the Thymus Gland)
Thyroid Cancer (Cancer of the Thyroid Gland)

For More Information: (Links Open in a New Window)

Gallbladder Cancer (PDQ): Treatment (National Cancer Institute)
Gallbladder Cancer (American Society of Clinical Oncology)
What Is Gallbladder Cancer? (American Cancer Society

Thymus Cancer

2008-10-24T09:21:00.000+08:00

Thymus Cancer >>> May also be called: Thymic carcinoma, Thymoma

Thymus cancer is a general term for cancers or tumors that affect cells in the thymus gland. The thymus is a small organ lying in the upper chest under the breastbone. It is a part of the lymphatic system, which helps the body make a kind of white blood cell. These cells help protect the body from infections.

Cancer of the thymus is a rare condition. Other people are more likely to develop the condition if they have other diseases such as myasthenia gravis, polymyositis, lupus, rheumatoid arthritis, and thyroiditis. Sometimes thymus cancer does not cause symptoms. However, the following symptoms may be caused by a thymus cancer:

a cough that does not go away
pain in the chest
trouble breathing

The most common treatment for thymus cancer is to remove the tumor through surgery. Other treatment options may include radiation and hormone therapy.

Related Topic:

Gallbladder Cancer (Cancer of the Gallbladder)
Kidney Cancer (Cancer of the Kidney)
Pancreatic Cancer (Cancer of the Pancreas)
Thyroid Cancer (Cancer of the Thyroid Gland)

For More Information: (Links Open in a New Window)

Thymoma and Thymic Carcinoma (PDQ): Treatment (National Cancer Institute)
What Is Thymus Cancer? (American Cancer Society)
What You Need to Know About™ Cancer - An Overview (National Cancer Institute)

Gallstones

2008-10-23T16:39:00.000+08:00

Gallstones >>> Also Called: Cholelithiasis

Gallstones form when bile substances harden in the gallbladder. Bile is a liquid stored in the gallbladder, a small, pear-shaped structure under the liver. This liquid helps the body in digesting fats.

When gallstones travel from the gallbladder, they can block the flow of bile if they become stuck in any of the ducts that carry bile from the liver to the small intestine.

People at risk of developing gallstones include older adults; people who are overweight or obese; people who undergo rapid weight loss; people with diabetes; and those who are taking cholesterol-lowering drugs.

Gallstone attacks usually happen after eating a meal, especially fatty meals. Signs and symptoms of a gallstone attack include pain in the abdomen, back, or under the right shoulder, nausea, and vomiting. Because symptoms can be similar to those of other health problems, such as heart attack, an accurate diagnosis of gallstones is important.

If gallstones become trapped in any of the bile ducts, it can cause serious complications. The most common treatment is to remove the gallbladder through laparoscopic surgery. Although the gallbladder acts as a storage for bile, people can live normally if their gallbladder has been removed. Bile can still flow to the small intestine through another duct.

Related Topics:

Gallbladder (Normal)
Gallbladder Cancer (Overview)

For More Information: (Links Open in a New Window)

Gallstones (National Institute of Diabetes and Digestive and Kidney Diseases)
Gallstones (Mayo Foundation for Medical Education and Research)
Gallstones: What Are They and How Are They Treated? (American Academy of Family Physicians)

Kidney Cancer

2008-10-23T11:21:00.001+08:00

Kidney Cancer >>> Also called: Renal cell cancer, Hypernephroma, Renal adenocarcinoma

Kidney cancer is a type of cancer that forms in the lining of tiny tubes in the kidneys. Kidney cancer may spread to other organs, such as the lungs, liver, or bones. Also, cancer cells may spread from on kidney to the other. The spread of cancer is called mestastasis.

Kidney cancer happens most often in people over the age of 40. However, the reason for this not fully clear. Risk factors for kidney cancer include smoking, having certain genetic conditions such as Von Hippel-Lindau (VHL) syndrome, obesity, and long-term dialysis.

Common signs and symptoms of kidney cancer include:

blood in your urine(hematuria)
a lump or mass in the abdomen or side

unexplained weight loss

pain in the side that does not go away

loss of appetite

feeling very tired or having a general feeling of poor health

These signs and symptoms may also be caused by an infection, cysts, or other problems. A person who experience these symptoms should see a doctor immediately.Treatment of kidney cancer depends on the age, overall health, and the stage of the disease. Treatment of the condition may include surgery, arterial embolization, radiation, chemotherapy or biological therapy. In some cases a combination of these treatments may be necessary.

Related Topics:

Benign Tumors (Noncancerous Tumors) Cancers (General Description)Gallbladder Cancer (Cancer of the Gallbladder)Pancreatic Cancer (Cancer of the Pancreas)Thymus Cancer (Cancer of the Thymus)Thyroid Cancer (Cancer of the Thyroid)

For More Information: (Links Open in a New Window)

What You Need to Know about Kidney Cancer (National Cancer Institute)What Is Kidney Cancer (Renal Cell Carcinoma)? (American Cancer Society)Kidney Cancer in Children (American Urological Association)Your Kidneys and How They Work (National Institute of Diabetes and Digestive and Kidney Diseases)

Acute Renal Failure

2008-10-22T21:37:00.000+08:00

Acute Renal Failure >>> Also Called: Acute Kidney Failure

The kidneys are two bean-shaped organs located near the middle of the back just below the ribs. Each kidney is about the size of your fist. They perform vital functions such as keeping the blood clean and chemically balanced and controlling blood pressure.

Some kidney problems happen quickly, like an accident that injures the kidneys. Losing a lot of blood can cause sudden kidney failure. Some drugs or poisons can make your kidneys stop working. These sudden drops in kidney function are called acute renal failure (ARF).

ARF may lead to permanent loss of kidney function. But if your kidneys are not seriously damaged, acute renal failure may be reversed. Treatment of acute renal failure depends on the cause of the condition. For example, kidney failure caused by losing a lot of blood may be treated by replacing the lost blood through transfusion.

Related Topic:

Kidney Diseases (Overview)

For More Information:

Acute Kidney Failure (Kidney Health Care - KHC)
Kidney Failure in Children (Kidney Health Care - KHC)
Your Kidneys and How They Work (National Institute of Diabetes and Digestive and Kidney Diseases)

Kidney Diseases

2008-10-22T18:59:00.000+08:00

Kidney Diseases >>> Also called: Renal disease

Kidney disease occurs when the tiny filtering units in the kidneys, called nephrons, are damaged.

The kidneys are two bean-shaped organs, which are located near the middle of the back, just below the rib cage. Each kidney has about a million tiny structures called nephrons. The nephrons are the actual filtering units of the kidney, which remove wastes and extra water from the blood. Waste products and excess water comprises the urine. Urine flows from the kidneys to the urinary bladder through tubes called ureters. The bladder stores the urine until it is passed out of the body during urination.

When the nephrons are damaged, the kidneys will be unable to remove wastes and extra water. Kidney disease usually develops slowly over years, which can present no obvious symptoms.

Kidney disease can be caused by a variety of conditions. You are at risk of developing kidney disease if you have

diabetes
high blood pressure
a close family member with kidney disease

Doctors can order tests to find out if a person has kidney disease. If the kidneys fail completely, dialysis or kidney transplantation may be the only treatment options.

Related Topic:

Acute Renal Failure (ARF)

For More Information:

Kidney Disease Overview (National Kidney Disease Education Program)
Your Kidneys and How They Work (National Institute of Diabetes and Digestive and Kidney Diseases)

Kidney Stones

2008-10-22T17:46:00.000+08:00

Kidney Stones >>> Also called: Nephrolithiasis

Kidney stones are solid materials that form in the kidney from substances present in the urine. It may be as small as a grain of sand or as large as a pearl. The most common type of stone is composed of calcium in combination with oxalate or phosphate.

Most kidney stones pass out of the body through the urinary tract without causing any symptoms. However, larger stones can become stuck in the tract, block the flow of urine, and can cause great pain.

Signs and symptoms of kidney stones may include:

excruciating pain in the back or side that will not go away
blood in the urine (hematuria)
fever and chills
vomiting
urine that looks cloudy or has foul odor
burning feeling while urinating

Depending on the type and size of stone, treatment options may include lifestyle changes; medications; and extracorporeal shock wave lithotripsy (ESWL), which makes use of shock-waves to break the stones. Talk to your doctor about other treatment procedures that are available.
A good first step to prevent the formation of any type of stone is to drink plenty of liquids—water is best.

Related Topic:

Kidney Diseases (Overview)

For More Information:

Kidney Stones (Kidney Health Care - KHC)
Kidney Stones in Adults (National Institute of Diabetes and Digestive and Kidney Diseases)

Cushing's Syndrome

2008-10-22T13:26:00.000+08:00

Cushing's Syndrome is also called: Hypercortisolism

Cushing's syndrome is a rare adrenal gland disease in which the body's tissues are exposed to high levels of the hormone cortisol for a long time. Cortisol is made by the adrenal glands, which are endocrine glands located just above the kidneys.

Cushing’s syndrome can be caused by long-term exposure to glucocorticoids, which are used to treat inflammatory diseases. Some kinds of tumors, such as pituitary and adrenal gland tumors can also cause the adrenal glands to produce too much cortisol.

Typical signs and symptoms of Cushing’s syndrome include

upper body obesity

a rounded face

skin that bruises easily and heals poorly

weakened bones
severe fatigue and muscle weakness

excess body hair growth

menstrual irregularities in women and decreased fertility in men

Treatment of Cushing's syndrome depends on the specific cause. It may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs.

Related Topic:

Adrenal Gland Diseases (Web Health Start)

For More Information:

Cushing's Syndrome (Endocrine Health)
Cushing's Syndrome (National Institute of Diabetes and Digestive and Kidney Diseases)

Adrenal Gland Diseases

2008-10-22T12:25:00.000+08:00

Also called: Adrenal Gland Disorders, Suprarenal Gland Disorders

The adrenal, or suprarenal, glands are located just above the kidneys. They produce hormones such as cortisol, aldosterone, and sex hormones. The outer layer of these glands makes hormones that help the body to respond to stress, control blood pressure and water and salt balance, and other vital functions.

Adrenal diseases can cause the adrenal glands to produce too much or too little hormones. When too much cortisol is produced by the gland, it can cause a condition called Cushing's syndrome. A decline or not enough cortisol can lead to Addison's disease.

Some of the causes of adrenal gland diseases may include tumors in the pancreas, autoimmune diseases in which the body's immune system mistakenly attacks and damages the pancreas, and infections. Some people, at birth, are not able to make enough cortisol.

Treatment of adrenal diseases or disorders depends on the type and its cause. Many adrenal gland diseases can be treated with surgery or medications.

Related Topics:

Addison's Disease
Cushing's Syndrome

For More Information:

Adrenal Gland Disorders (National Institute of Child Health and Human Development)
Addison's Disease (National Diabetes and Digestive and Kidney Diseases)
Cushing's Syndrome (National Diabetes and Digestive and Kidney Diseases)

Addison's Disease

2008-10-22T10:18:00.000+08:00

Addison's Disease is also called: Hypocortisolism, Adrenal insufficiency, Adrenocortical hypofunction,

Addison's disease occurs when the adrenal glands don't make enough hormones. The adrenal glands are located just above the kidneys. The outer layer of these glands makes hormones that help the body in responding to stress and controlling blood pressure and water and salt balance.

An autoimmune disorder usually causes Addison's disease. An autoimmune disorder occurs when the body's immune system mistakenly attacks normal tissues. In Addison's disease, the immune system attacks and damages the adrenal glands.

Symptoms of the disease may include loss of appetite, weight loss, fatigue, muscle weakness, low blood pressure, and darkening of the skin (hyperpigmentation).

To confirm diagnosis of Addison's disease, the doctor will likely order lab tests. The condition can be fatal if left untreated. Treatment involves replacing the hormones that the adrenal glands are not making with synthetic hormones.

Related Topic:

Adrenal Gland Diseases (Web Health Start)

For More Information:

Addison's Disease (National Institute of Diabetes and Digestive and Kidney Diseases)

Benign Tumors

2008-10-21T21:10:00.000+08:00

Benign Tumors are also called: Benign cancer, Noncancerous tumors, Benign neoplasms

Tumors occur when new cells in the body are produced in an uncontrolled and unorderly manner. Normally, body cells grow and produce new cells to replace dead cells. However, sometimes, new cells are formed when they are not supposed to and old cells don't die when they should. When these extra cells aggregate to form a mass, it is called a tumor.

Tumors can be generally classified as either benign or malignant. Benign tumors are not cancerous while malignant tumors are cancerous, which means they can spread to nearby organs or even other body parts. In benign tumors, the tumor cells grow only in one place and do not invade nearby organs or other parts of the body. However, benign tumors can press on nearby vital organs. For example, a benign tumor that forms in the brain can press on other structures of the brain.

Treatment of benign tumors usually involves surgery. Once benign tumors are removed, they usually do not grow back.

Start Here:

What is Cancer? (National Cancer Institute)
Tumor Grade: Questions and Answers (National Cancer Institute)

Cancers

2008-10-21T19:05:00.000+08:00

Also called: Tumor, Malignancy, Carcinoma, Neoplasms

Cancer is the general term for diseases wherein cells in the body abnormally divide without control, which may invade other tissues. Cells are the building blocks of all organs of the body.

In normal processes, the body forms new cells as they are needed, which replace old cells that die. However, sometimes this process could go wrong. New cells form even when the body does not need them, and old cells don't die when they should. These extra cells can form a mass of tissue called a tumor. Not all tumors are considered cancerous. Tumors can be benign or malignant.

Benign tumors are not cancerous, which means they do not spread to other parts of the body.

Malignant tumors are cancerous, which means the cancer cells can invade nearby organs and other parts of the body. When cancer spread from one part of the body to another, it is called metastasis.

Symptoms and treatment of cancer depend on the type and stage of the cancer-how advanced it is. Treatment options may include surgery to remove the tumor, radiation and/or chemotherapy.

Related Topics:

Benign Tumors (Noncancerous Tumors)
Gallbladder Cancer (Cancer of the Gallbladder)
Kidney Cancer (Cancer of the Kidney)
Pancreatic Cancer (Cancer of the Pancreas)
Thymus Cancer (Cancer of the Thymus Gland)
Thyroid Cancer (Cancer of the Thyroid Gland)

For More Information:

What is Cancer? (National Cancer Institute)
Cancer: Questions and Answers (National Cancer Institute)
What You Need to Know about Cancer: An Overview (National Cancer Institute)

Pancreatic Cancer

2008-10-21T15:00:00.000+08:00

Pancreatic cancer is a type of cancer that forms in the pancreas. The pancreas is a large gland behind the stomach close to the duodenum, which is the first part of the small intestine. This endocrine gland helps in breaking down food by producing digestive juices or enzymes. In addition, the pancreas also produces hormones, which help to regulate levels of sugar in the blood.

According to the National Institutes of Health, pancreatic cancer or cancer of the pancreas is the fourth-leading cause of cancer death in the U.S.

People at risk for developing pancreatic cancer are those who

are smoking

have long-term diabetes

have chronic pancreatitis or long-term inflammation of the pancreas

have certain hereditary disorders

It is hard to detect early stages of pancreatic cancer. People with early stages of the disease may not experience symptoms, if they do get symotoms, they are often vague. When symptoms do occur, it may include pain in the abdomen and back, yellowing of the skin and eyes, loss of appetite, weight loss, and fatigue.

Pancreatic cancer is often found during its late stages when cancer spreads quickly. For this reason, pancreatic cancer can be hard to treat. However, when pancreatic cancer is found during its very early stage, it can be cured. Possible treatment options may include surgery, radiation, chemotherapy, or a combination of these treatments.

Related Topics:

Gallbladder Cancer (Cancer of the Gallbladder)
Kidney Cancer (Cancer of the Kidney)
Thymus Cancer (Cancer of the Thymus Gland)
Thyroid Cancer (Cancer of the Thyroid Gland)

For More Information:

What You Need to Know About Cancer of the Pancreas (National Cancer Institute)

Diseases of the Pancreas

2008-10-21T10:03:00.000+08:00

Also called: Pancreatic Diseases, Pancreatic Disorders

The pancreas is a large gland behind the stomach and close to the duodenum, the first part of the small intestine. This gland produces digestive juices, or enzymes that help in breaking down food. In addition, the pancreas also makes hormones that help regulate blood sugar levels.

Problems with the pancreas include

Inflammation of the pancreas, or pancreatitis: This occurs when digestive enzymes, which are normally inactive in the pancreas, start digesting the organ itself.

Cancer of the pancreas

Cystic fibrosis - An inherited disorder in which thick, sticky mucus can also block tubes in the pancreas.

Other problems or disorders of the pancreas are type I and type II diabetes. Type I diabetes occurs when cells in the pancreas, called beta cells, stop making insulin because the body's immune system has attacked them. In type II diabetes, the pancreas loses the ability to produce and release enough insulin in response to ingested foods.

Related Topics:

Pancreas (Normal)
Pancreatic Cancer (Cancer of the Pancreas)

For More Information: (Links Open in a New Window)

Your Digestive System and How it Works (National Institute of Diabetes and Digestive and Kidney Diseases)
Pancreatitis (National Institute of Diabetes and Digestive and Kidney Diseases)

Pituitary Disorders

2008-10-21T08:34:00.000+08:00

The pituitary gland is a tiny, pea-sized gland at the base of your brain. The pituitary is considered the "master control gland" because it controls the activity of most other glands in the body. It makes hormones that can affect metabolism, blood pressure, sexuality, reproduction, the stress response and other important body functions.

Although injuries can cause pituitary disorders, the most common cause is a tumor in the pituitary gland. About 1 in 10,000 people get them. A pituitary tumor is an abnormal growth of cells in the pituitary. Most pituitary tumors are non-cancerous, which means they do not spread to other parts of the body. However, the tumors can cause the pituitary to make too many hormones, which leads to imbalances of hormones in the body. This can cause endocrine disorders such as:

Cushing's syndrome

problems with growth and development

hyperthyroidism.

Symptoms of pituitary tumors include headaches, problems with vision, nausea and vomiting, and symptoms caused by the production of too many hormones.

Most cases of pituitary tumors are usually treatable. Treatment is often surgery to remove the tumor. Other options include medicines and radiation.

Sart Here:

Pituitary Tumors Information Page (National Institute of Neurological Disorders and Stroke)

Hyperthyroidism

2008-10-21T00:13:00.000+08:00

Hyperthyroidism is an endocrine gland disorder in which too much thyroid hormone is produced and released by the thyroid gland. The clinical term for too much thyroid hormone in the blood is thyrotoxicosis.

The thyroid gland is a butterfly-shaped organ in the neck just below the throat. It produces thyroid hormone, which helps the body in controlling heart rate, blood pressure, weight, and body temperature.

People with hyperthyroidism may have symptoms such as:

 Muscle weakness or fatigue

 Nervousness or irritability

 Trouble sleeping

 Intolerance to heat

 Weight loss

The condition can be caused by Graves’ disease—an autoimmune disease—which is the most common cause of hyperthyroidism; thyroid nodules, which are lumps in the thyroid gland; inflammation of the thyroid; taking too much iodine; and overmedicating with synthetic thyroid hormone.

To diagnose hyperthyroidism, the doctor will likely ask about your signs and symptoms and will perform a thorough physical examination. Your doctor will order tests to confirm the diagnosis and to find its cause.

Treatment of hyperthyroidism may include medications, radioiodine therapy or radioactive iodine, or thyroid surgery.

Related Topics:

Hypothyroidism
Thyroid Cancer
Thyroid Diseases

Related Sites:

Endocrine Health
American Association of Clinical Endocrinologists
American Thyroid Association
The Endocrine Society
The Hormone Foundation
National Graves’ Disease Foundation
National Institutes of Health

Content Reference:National Endocrine and Metabolic Diseases Information Service (April 2008). Hyperthyroidism (NIH Publication No. 08–5415). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://www.endocrine.niddk.nih.gov/pubs/Hyperthyroidism/index.htm. Accessed: October 21, 2008

Thyroid Cancer

2008-10-20T22:34:00.000+08:00

A thyroid cancer is a type of cancer that forms in the thyroid gland. The thyroid is a butterfly-shaped gland at the base of the throat. It makes hormones that help control heart rate, blood pressure, weight, and body temperature.

Although, anyone can get cancer of the thyroid gland, certain factors may increase the risk. You may be at risk if

you have a family member who has had thyroid disease

you are between the ages of 25 and 65

you are a female

you are Asian

you are having radiation treatments to your head or neck

If you observe a lump or have swelling in your neck, you should consult your healthcare provider. Your doctor will order laboratory tests to see if you have cancer and to find out which type you have.

Treatment of thyroid cancer depends on the type and how far the cancer has spread. Treatment may include surgery, radioactive iodine or radioiodine therapy, hormone treatment, radiation therapy or chemotherapy. In some cases, a combination of these treatments may be necessary.

Related Topics:

Benign Tumors (Noncancerous Tumors)
Cancers (Overview)
Gallbladder Cancer (Cancer of the Gallbladder)
Kidney Cancer (Cancer of the Kidney)
Pancreatic Cancer (Cancer of the Pancreas)
Thymus Cancer (Cancer of the Thymus Gland)

For More Information:

What is Cancer? (National Cancer Institute)
Cancer: Questions and Answers (National Cancer Institute)
What You Need to Know about Cancer: An Overview (National Cancer Institute)

Content References:

National Cancer Institute
National Cancer Institute Dictionary of Terms

Hypothyroidism

2008-10-20T21:14:00.000+08:00

Hypothyroidism is a thyroid disorder in which not enough hormone is produced by the thyroid gland. The condition can cause different body functions to slow down.

The thyroid gland is a butterfly-shaped gland located in the neck just below the adam’s apple. It produces the thyroid hormone, which regulates metabolism—the way the body uses energy. Thyroid hormone also affects brain development, heart and nervous system functions, and body temperature. Calcitonin is the other hormone produced by the thyroid, which affects blood calcium levels.

A variety of conditions can cause hypothyroidism including:

 Hashimoto’s disease, an autoimmune disorder that usually affects women.

 thyroiditis (inflammation of the thyroid)

 surgical removal of the thyroid

 treatments for hyperthyroidism—too much thyroid hormone—or other thyroid problems

 certain medications

Hypothyroidism has many symptoms including fatigue, weight gain, and intolerance to cold temperatures.

Most cases of hypothyroidism can be easily treated with synthetic thyroid hormone.

Reference:

National Endocrine and Metabolic Diseases Information Services (May 2008). Hypothyroidism (NIH Publication No. 08–6180). National Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD. Web URL: http://www.endocrine.niddk.nih.gov/pubs/Hypothyroidism/

Thyroid Diseases

2008-10-20T19:39:00.000+08:00

The thyroid gland is a butterfly-shaped organ in the neck. The thyroid produces thyroid hormone and calcitonin. The thyroid hormone regulates metabolism - how the body uses energy - that affects almost all parts of the body.

Thyroid diseases affect millions of people in the United States. Most of them are women. A thyroid disease can make the body use energy more slowly or quickly than it should. A thyroid gland that is not active enough causes a condition called hypothyroidism, which is the more common form of thyroid disease. The condition can make a person gain weight, feel fatigued, and intolerant to cold temperatures.

When the thyroid becomes overactive, it makes more thyroid hormones than the body needs. That condition is hyperthyroidism. Symptoms of hyperthyroidism include weight loss, elevated heart rate and intolerance to heat or hot temperatures.

Hypothyroidism and hyperthyroidism may be caused by other health problems. Treatment involves trying to reset the body's metabolism to a normal rate.

Reference:

Medline Plus: Health Topics (September 2008). Thyroid Diseases. National Library of Medicine, National Institutes of Health (NIH), Bethesda, MD. Web URL: www.nlm.nih.gov/medlineplus/thyroiddiseases.html. Accessed: October 16, 2008

Parathyroid Disorders

2008-10-20T15:55:00.000+08:00

The parathyroid glands are four pea-sized glands located at the back side of the thyroid gland in the neck. Though their names are similar, the thyroid and parathyroid glands are completely different. The parathyroid glands make parathyroid hormone, or PTH. The hormone helps in keeping the right balance of calcium and phosphorous in the body.

When the parathyroid glands make too much or too little parathyroid hormone, it can result in substance imbalances in the body. If they secrete extra PTH, it would lead to a condition called hyperparathyroidism, which raises blood calcium levels. In many cases, a benign tumor on a parathyroid gland makes it overactive. Or, the extra hormones can come from enlarged parathyroid glands. It is rarely caused by cancer.

When not enough PTH is produced, it could cause hypoparathyroidism. In this condition, blood calcium levels decline and blood phosphorus levels rise. Causes of hypothyroidism include injury to the glands, endocrine disorders or genetic conditions. Goal of treatment is to restore balance of calcium and phosphorous levels.

For More Information: (Links Open in a New Window)

Hyperparathyroidism (National Institute of Diabetes and Digestive and Kidney Diseases)

Page Last Revised: November 6, 2008

Related Topics

Content Source:

Courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Web Url: www.niddk.nih.gov

Adrenal Gland Disorders

2008-03-11T17:13:00.001+08:00

The adrenal glands are paired glands, one of which sits on top of each kidney. These glands are responsible for releasing three different classes of hormones. These hormones control many important bodily functions, such as:

Maintaining metabolic processes, such as managing blood sugar levels and regulating inflammation

Regulating the balance of salt and water

Controlling the "fight or flight" response to stress

Maintaining pregnancy

Initiating and controlling sexual maturation during childhood and puberty

The adrenal glands are also an important source of sex steroids, such as estrogen and testosterone.

What are adrenal gland disorders?

Adrenal gland disorders occur when the adrenal glands do not work properly. Sometimes, this may be caused by a problem in another gland that regulates the activity of the adrenal gland. In some cases, the adrenal gland itself may have the problem. Some of the adrenal gland disorders or diseases include:

Cushing's Syndrome - Cushing’s syndrome happens when a person’s body is exposed to too much of the hormone cortisol. In this syndrome, a person’s body makes more cortisol than it needs. For example, adrenal tumors can cause the body to produce too much cortisol. In some cases, children are born with a form of adrenal hyperplasia that leads to Cushing syndrome. Or, in some cases, certain medications can cause the body to make too much cortisol. (Learn more about the signs and symptoms, causes, and treatment options of Cushing's Syndrome)

Congenital Adrenal Hyperplasia - Congenital adrenal hyperplasia is a genetic disorder of adrenal gland deficiency. In this disorder, the body doesn’t make enough of the hormone cortisol. The bodies of people with congenital adrenal hyperplasia may also have other hormone imbalances, such as not making enough aldosterone, but making too much androgen.

Pituitary Tumors - The pituitary gland is located in the brain and helps to regulate the activity of most other glands in the body, including the adrenal glands. In rare cases, benign (non-cancerous) tumors may grow on the pituitary gland, which may restrict the hormones it releases.

In some cases, tumors on the pituitary can lead to Cushing’s syndrome – this is called Cushing disease. In other cases, the tumors reduce the adrenal gland’s release of hormones needed for the “fight or flight” response to stress. If the body is unable to handle physiological stress—a condition called Addison’s disease—it can be fatal.

What are the treatments for adrenal gland disorders?

The treatment for adrenal gland disorders depends on the specific disorder or the specific cause of the disorder. For example:

The treatment for Cushing’s syndrome depends on the cause. If the excess cortisol is caused by medication, your health care provider can change dosages or try a different medication to correct the problem. If the Cushing’s syndrome is caused by the body making too much cortisol, treatments may include oral medication, surgery, radiation, or a combination of these treatments.

Congenital adrenal hyperplasia can’t be cured, but it can be treated and controlled. People with congenital adrenal hyperplasia can take medication to help replace the hormones their bodies are not making. Some people with congenital adrenal hyperplasia only need these medications when they are sick, but others may need to take them every day.

Doctors can successfully treat most pituitary tumors with microsurgery, radiation therapy, surgery, drugs, or a combination of these treatments. Surgery is currently the treatment of choice for tumors that grow rapidly, especially if they threaten or affect vision. The treatment plan for other pituitary tumors differs according to the type and size of the tumor.

Source: National Institute of Child Health and Human Development (NICHD)(February, 2007). Adrenal Gland Disorders. Retrieved March 10, 2008, from NICHD, National Institutes of Health. Web site: http://www.nichd.nih.gov/health/topics/Adrenal_Gland_Disorders.cfm

Page Last Revised: February 12, 2010

Peripheral Arterial Disease

2008-03-01T12:32:00.001+08:00

According to the National Heart, Lung, and Blood Institute (NHLBI), one in every 20 Americans over the age of 50 has P.A.D., a condition that raises the risk for heart attack and stroke.

Peripheral Arterial Disease—also known as P.A.D.—is a common, yet serious, disease. It occurs when extra cholesterol and other fats circulating in the blood stick to the walls of the arteries that supply blood to your limbs. This buildup—called plaque—narrows your arteries, often reducing or blocking the flow of blood. P.A.D. most commonly occurs in the legs, but also can be present in the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. Nearly everyone who has P.A.D.—even those who do not have leg symptoms—suffers from an inability to walk as fast or as far as they could before P.A.D.

Just like clogged arteries in the heart, clogged arteries in the legs mean you are at risk for having a heart attack or stroke. Plaque buildup in the legs does not always cause symptoms, so many people can have P.A.D. and not know it. People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause. According to the NHLBI, P.A.D. affects 8 to 12 million people in the United States, especially those over 50.

Risk Factors:

The cause of plaque buildup in the limbs is unknown in most cases. Your risk of having P.A.D. increases if you:

 Are over the age of 50.
 Smoke or used to smoke. Those who smoke or have a history of smoking have up to four times greater risk of P.A.D.
 Have diabetes. One in every three people over the age of 50 with diabetes is likely to have P.A.D.
 Have high blood pressure. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries.
 Have high blood cholesterol. Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs.
 Have a personal history of vascular disease, heart attack, or stroke. If you have heart disease, you have a one in three chance of also having P.A.D.

Signs and Symptoms:

If they are present, the typical signs and symptoms of the disease include:

 Claudication—fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity such as walking or climbing stairs. This pain or discomfort goes away once the activity is stopped and during rest. Many people do not report this problem to their health care providers because they think it is a natural part of aging or due to some other cause.
 Pain in the legs and/or feet that disturbs sleep.
 Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all.
 Color changes in the skin of the feet, including paleness or blueness.
 A lower temperature in one leg compared to the other leg.
 Poor nail growth and decreased hair growth on toes and legs.

However, most people with P.A.D. do not experience symptoms. If you believe you are at risk for P.A.D., discuss this concern with your health care provider. Find out if you should be tested for P.A.D and what you can do to lower your risk.

I I Diagnosis >>>

Source: National Heart, Lung, and Blood Institute. Facts About Peripheral Arterial Disease. Retrieved March 1, 2008, from NHLBI, National Institutes of Health of the Department of Health and Human Services. Web site: http://www.nhlbi.nih.gov/health/public/heart/pad/materials/pad_extfctsht_general.html

Peripheral Arterial Disease: Diagnosis

2008-03-01T12:26:00.002+08:00

Your doctor first asks you about your risk for P.A.D. Your provider will take a medical and family history, perform a physical exam, and conduct diagnostic tests. In addition, there are many specialists who take care of patients with P.A.D., including: vascular medicine specialists, vascular surgeons, cardiologists, podiatrists, and interventional radiologists.

Medical and Family History

Your health care provider is likely to spend some time reviewing:

 Your medical history, including the presence of diabetes, high blood pressure, high cholesterol, and other important factors;
 Your status as a current or former smoker;
 Your personal and family history of cardiovascular disease;
 Any symptoms you may be experiencing in your legs while sitting, standing, walking, climbing, or participating in other physical activities; and
 Your current diet and medications.

Physical Exam

During the physical exam, your health care provider may check:

 Pulses in your legs and feet to determine if there is enough blood flowing to these areas;
 The color, temperature, and appearance of your legs and feet; and
 For signs of poor wound healing on the legs and feet.

Diagnostic Tests

When checking you for P.A.D., your health care provider may perform a simple noninvasive test called an ankle-brachial index (ABI). Painless and easy, the ABI compares the blood pressure readings in your ankles with the blood pressure readings in your arms. An ABI can help determine whether you have P.A.D., but it cannot identify which arteries are narrowed or blocked. Your health care provider may decide to do a Doppler ultrasound test to see whether a specific artery is open or blocked. This test uses sound waves to measure the blood flow in the veins and arteries in your arms and legs. Your health care provider may also perform blood tests to see if you have diabetes and check your cholesterol levels. Other tests are also used to help diagnose P.A.D. Talk with your health care provider for more information.

<<< Back I I Treatment >>>

Peripheral Arterial Disease: Treatment

2008-03-01T12:11:00.001+08:00

The overall goals for treating P.A.D. are to reduce any symptoms, improve quality of life and mobility, and prevent heart attack, stroke, and amputation.

There are three main approaches to treating P.A.D.: making lifestyle changes; taking medication; and in some cases, having a special procedure or surgery. Your health care provider will determine the best treatment options for you, based on your medical history and the severity of your condition.

Lifestyle Changes

P.A.D. treatment often includes making long-lasting lifestyle changes. If you have P.A.D., or are aiming to prevent it, your health care provider may prescribe one or more of the following:

 Quit smoking. Don't smoke, and if you do, quit. Consult with your health care provider to develop an effective cessation plan and stick to it.
 Lower your numbers. Work with your health care provider to correct any high blood pressure, cholesterol, and blood glucose levels.
 Follow a healthy eating plan. Choose foods that are low in saturated fat, trans fat, and cholesterol. Be sure to include whole grains, vegetables, and fruits.
 Get moving. Make a commitment to be more physically active. Aim for 30 minutes of moderate-intensity activity on most, preferably all, days of the week.
 Aim for a healthy weight. If you are overweight or obese, work with your health care provider to develop a supervised weight loss plan.

Medication

In addition to lifestyle changes, your health care provider may prescribe one or more medications. These medications are used to:

 Lower high blood pressure and cholesterol levels and treat diabetes;
 Prevent the formation of blood clots that could cause a heart attack or stroke; and
 Help reduce leg pain while walking or climbing stairs.

Special Procedures and Surgeries

If the blood flow in one of your limbs is completely or almost completely blocked, you may benefit from having a procedure or surgery in addition to medications and lifestyle changes. Procedures such as angioplasty and bypass graft surgery will not cure P.A.D., but they can improve the blood circulation to your legs and your ability to walk.

Timely detection and treatment of P.A.D. can improve the quality of your life; help you keep your independence and mobility; and reduce your risk of heart attack, stroke, leg amputation, and even death. Taking steps to learn about P.A.D., including asking your health care provider to check your risk, can help you stay in circulation longer to enjoy your life.

<<< Diagnosis

What is Aneurysm?

2008-02-01T14:32:00.001+08:00

An aneurysm (AN-u-rism) is an abnormal bulge or “ballooning” in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. An aneurysm that grows and becomes large enough can burst, causing dangerous, often fatal, bleeding inside the body.

Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle (VEN-trih-kul) of the heart and travels through the chest and abdomen. An aneurysm that occurs in the aorta in the chest is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm.

Aneurysms also can occur in arteries in the brain, heart, intestine, neck, spleen, back of the knees and thighs, and in other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.

About 15,000 Americans die each year from ruptured aortic aneurysms. Ruptured aortic aneurysm is the 10th leading cause of death in men over age 50 in the United States.

Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk. Experts recommend that men who are 65 to 75 years old and have ever smoked (at least 100 cigarettes in their lifetime) should be checked for abdominal aortic aneurysms.

When found in time, aneurysms can usually be treated successfully with medicines or surgery. If an aortic aneurysm is found, the doctor may prescribe medicine to reduce the heart rate and blood pressure. This can reduce the risk of rupture.

Large aortic aneurysms, if found in time, can often be repaired with surgery to replace the diseased portion of the aorta. The outlook is usually excellent.

Source:
National Heart Lung and Blood Institute (NHLBI) (August 2006). Aneurysm. Retrieved February 1, 2008, from NHLBI, National Institutes of Health. Web site: http://www.nhlbi.nih.gov/health/dci/Diseases/arm/arm_all.html

Aneurysm: Types

2008-02-01T14:24:00.000+08:00

The different types of aneurysm include aortic aneurysms, cerebral aneurysms, and peripheral aneurysms.

Aortic Aneurysm

Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. The two types of aortic aneurysm are thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA).

Thoracic Aortic Aneurysm

An aortic aneurysm that occurs in the part of the aorta running through the thorax (chest) is a thoracic aortic aneurysm. One in four aortic aneurysms is a TAA.

Most TAAs do not produce symptoms, even when they are large. Only half of all people with TAAs notice any symptoms. TAAs are identified more often now than in the past because of chest computed tomography (CT) scans performed for other medical problems.

In a common type of TAA, the walls of the aorta become weak and a section nearest to the heart enlarges. Then the valve between the heart and the aorta cannot close properly and blood leaks backward into the heart. Less commonly, a TAA can develop in the upper back away from the heart. A TAA in this location can result from and injury to the chest such as from an auto crash.

Abdominal Aortic Aneurysm

An aortic aneurysm that occurs in the part of the aorta running through the abdomen is an abdominal aortic aneurysm. Three in four aortic aneurysms are AAAs.

An AAA can grow very large without producing symptoms. About 1 in 5 AAAs rupture.

Cerebral Aneurysm

Aneurysms that occur in an artery in the brain are called cerebral aneurysms. They are sometimes called berry aneurysms because they are often the size of a small berry. Most cerebral aneurysms produce no symptoms until they become large, begin to leak blood, or rupture.

A ruptured cerebral aneurysm causes a stroke. Signs and symptoms can include a sudden, extremely severe headache, nausea, vomiting, stiff neck, sudden weakness in an area of the body, sudden difficulty speaking, and even loss of consciousness, coma, or death. The danger of a cerebral aneurysm depends on its size and location in the brain, whether it leaks or ruptures, and the person’s age and overall health.

Peripheral Aneurysm

Aneurysms that occur in arteries other than the aorta (and not in the brain) are called peripheral aneurysms. Common locations for peripheral aneurysms include the artery that runs down the back of the thigh behind the knee (popliteal artery), the main artery in the groin (femoral artery), and the main artery in the neck (carotid artery).

Peripheral aneurysms are not as likely to rupture as aortic aneurysms, but blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery. If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling.

<<<-What is Aneurysm? I I Causes->>>

Aneurysm: Causes

2008-02-01T14:20:00.001+08:00

What Causes an Aneurysm?

An aneurysm can result from atherosclerosis (hardening and narrowing of the inside of arteries). As atherosclerosis develops, the artery walls become thick and damaged and lose their normal inner lining. This damaged area of artery can stretch or “balloon” from the pressure of blood flow inside the artery, resulting in an aneurysm.

An aneurysm also can develop from constant high blood pressure inside an artery.

A thoracic aortic aneurysm can result from an injury to the chest (for example, an injury that occurs from an auto crash). Certain medical conditions, such as Marfan syndrome, that weaken the body’s connective tissues, also can cause aneurysms.

In rare cases, infections such as untreated syphilis (a sexually transmitted infection) can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that cause inflammation of blood vessels, such as vasculitis.

<<<- Types I I Risk Factors ->>>

Aneurysm: Risk Factors

2008-02-01T14:12:00.001+08:00

Who Is At Risk for an Aneurysm?

Populations Affected
Men are 5 to 10 times more likely than women to have an abdominal aortic aneurysm (AAA)—the most common type of aneurysm.

The risk of AAA increases as you get older, and it is more likely to occur in people between the ages of 60 to 80. A peripheral aneurysm also is more likely to affect people ages 60 to 80. Cerebral (brain) aneurysms, though rare, are more likely to occur in people ages 35 to 60.

Risk Factors

Factors that increase your risk for aneurysm include:

Atherosclerosis, a buildup of fatty deposits in the arteries.

Smoking. You are eight times more likely to develop an aneurysm if you smoke.

Overweight or obesity.

A family history of aortic aneurysm, heart disease, or other diseases of the arteries.

Certain diseases that can weaken the wall of the aorta, such as:

Marfan syndrome (an inherited disease in which tissues don’t develop normally)

Untreated syphilis (a very rare cause today)

Tuberculosis (also a very rare cause today)

Trauma such as a blow to the chest in a car accident.

Severe and persistent high blood pressure between the ages of 35 and 60. This increases the risk for a cerebral aneurysm.

Use of stimulant drugs such as cocaine.

<<<- Causes I I Signs ->>>

Aneurysm: Signs and Symptoms

2008-02-01T14:03:00.001+08:00

What Are the Signs and Symptoms of an Aneurysm?

The signs and symptoms of an aneurysm depend on its type, location, and whether it has ruptured or is interfering with other structures in the body. Aneurysms can develop and grow for years without causing any signs or symptoms. It is often not until an aneurysm ruptures or grows large enough to press on nearby parts of the body or block blood flow that it produces any signs or symptoms.

Abdominal Aortic Aneurysm

Most abdominal aortic aneurysms (AAAs) develop slowly over years and have no signs or symptoms until (or if) they rupture. Sometimes, a doctor can feel a pulsating mass while examining a patient's abdomen. When symptoms are present, they can include:

Deep penetrating pain in your back or the side of your abdomen
Steady gnawing pain in your abdomen that lasts for hours or days at a time
Coldness, numbness, or tingling in your feet due to blocked blood flow in your legs

If an AAA ruptures, symptoms can include sudden, severe pain in your lower abdomen and back; nausea and vomiting; clammy, sweaty skin; lightheadedness; and a rapid heart rate when standing up. Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which the organs of the body do not get enough blood flow.

Thoracic Aortic Aneurysm

A thoracic (chest) aortic aneurysm may have no symptoms until the aneurysm begins to leak or grow. Signs or symptoms may include:

Pain in your jaw, neck, upper back (or other part of your back), or chest
Coughing, hoarseness, or trouble breathing

Cerebral Aneurysm

If a cerebral (brain) aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include:

A droopy eyelid
Double vision or other changes in vision
Pain above or behind the eye
A dilated pupil
Numbness or weakness on one side of the face or body

If a cerebral aneurysm ruptures, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Signs of a stroke are similar to those listed above for cerebral aneurysm, but they usually come on suddenly and are more severe. Any of these symptoms require immediate medical attention.

Peripheral Aneurysm

Signs and symptoms of peripheral aneurysm may include:

A pulsating lump that can be felt in your neck, arm, or leg
Leg or arm pain, or cramping with exercise
Painful sores on toes or fingers
Gangrene (tissue death) from severely blocked blood flow in your limbs

An aneurysm in the popliteal artery (behind the knee) can compress nerves and cause pain, weakness, and numbness in your knee and leg.

Blood clots can form in peripheral aneurysms. If a clot breaks loose and travels through the bloodstream, it can lodge in your arm, leg, or brain and block the artery. An aneurysm in your neck can block the artery to the brain and cause a stroke.

<<<- Risk Factors I I Diagnosis ->>>

Aneurysm: Diagnosis

2008-02-01T13:38:00.001+08:00

An aneurysm may be found by chance during a routine physical exam. More often, an aneurysm is found by chance during an x ray, ultrasound, or computed tomography (CT) scan performed for another reason, such as chest or abdominal pain.

If you have an abdominal aortic aneurysm (AAA), the doctor may feel a pulsating mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. If you are overweight or obese, it may be difficult for your doctor to feel even a large abdominal aneurysm.

If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.

Specialists Involved

You may be referred to a cardiothoracic surgeon, vascular surgeon, or neurosurgeon for diagnosis and treatment of an aneurysm. A cardiothoracic surgeon performs surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon performs surgery on the abdominal aorta and on the peripheral arteries. A neurosurgeon performs surgery on the brain, including the arteries in the head, and on the spine and nerves.

Diagnostic Tests and Procedures

To diagnose and evaluate an aneurysm, one or more of the following tests or procedures may be performed:

Chest x ray. A chest x ray provides a picture of the organs and structures inside the chest, including the heart, lungs, and blood vessels.

Ultrasound. This simple and painless test uses sound waves to create a picture of the inside of the body. It shows the size of an aneurysm, if one is detected. The ultrasound scan may be repeated every few months to see how quickly an aneurysm is growing.

CT scan. A CT scan provides computer-generated, x-ray images of the internal organs. A CT scan may be performed if the doctor suspects a TAA or AAA. A liquid dye that can be seen on an x ray is injected into an arm vein to outline the aorta or artery on the CT scan. The CT scan images can be used to determine the size and shape of an abdominal aneurysm more accurately than an ultrasound.

MRI. MRI uses magnets and radio waves to create images of the inside of the body. It is very accurate in detecting aneurysms and determining their size and exact location.

Angiography. Angiography also uses a special dye injected into the blood stream to make the insides of arteries show up on x-ray pictures. An angiogram shows the amount of damage and blockage in blood vessels.

Aortogram. An aortogram is an angiogram of the aorta. It may show the location and size of an aortic aneurysm, and the arteries of the aorta that are involved.

<<<- Signs I I Treatment ->>>

Treatment of Aneurysm

2008-02-01T13:26:00.001+08:00

How Is an Aneurysm Treated?

Goals of Treatment

Some aneurysms, mainly small ones that are not causing pain, can be treated with “watchful waiting.” Others need to be treated to prevent growth and complications. The goals of treatment are to prevent the aneurysm from growing, prevent or reverse damage to other body structures, prevent or treat a rupture, and to allow you to continue to participate in normal daily activities.

Treatment Options

Medicine and surgery are the two types of treatment for an aneurysm. Medicines may be prescribed before surgery or instead of surgery. Medicines are used to reduce pressure, relax blood vessels, and reduce the risk of rupture. Beta blockers and calcium channel blockers are the medicines most commonly used.

Surgery may be recommended if an aneurysm is large and likely to rupture.

How Can an Aneurysm Be Prevented?

The best way to prevent an aneurysm is to avoid the risk factors that increase the changes of developing one. To do this, you can:

Quit smoking.
Eat a low-fat, low-cholesterol diet to reduce the buildup of plaque in the arteries.
Plaque is a fatty buildup that narrows the arteries.
Control high blood pressure (eating a low-salt diet helps).
Control high cholesterol.
Get regular physical activity.

<<<- Diagnosis I I Aneurysm Main ->>>

Angina

2008-01-05T15:44:00.000+08:00

Other Names: Angina pectoris, Acute coronary syndrome, Chest pain, Coronary artery spasms, Prinzmetal's angina, Stable or common angina, Unstable angina, Variant angina

Angina is a chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood.Angina is not considered as a disease but rather a symptom of an underlying heart problem. Angina is the usual symptom of coronary artery disease (CAD), the most common type of heart disease.

CAD occurs when a fatty material called plaque builds up on the inner walls of the coronary arteries. Plaque causes the coronary arteries to become narrow and stiff. The flow of oxygen-rich blood to the heart muscle is reduced.

Angina may feel like a pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.

Not all chest pain or discomfort is angina. A heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack also can cause chest pain or discomfort. All chest pain should be checked by a doctor.

The most common types of angina are stable angina and unstable angina. A rare type of angina is called variant angina.

Stable angina occurs when the heart is working harder than usual. Pain from stable angina goes away when you rest or take your angina medicine. Angina medicine, such as nitroglycerin, helps widen and relax the arteries so that more blood can flow to the heart.

Unstable angina is a very dangerous condition and needs emergency treatment. Unstable angina is a sign that a heart attack may happen soon. Unstable angina can occur with or without physical exertion. It isn't relieved by rest or medicine.

Variant (Prinzmetal's) angina is caused by a spasm (tightening) in a coronary artery. This narrowing of the artery slows or stops blood flow to the heart muscle. The pain may be severe. This type of angina is relieved by medicine.

Angina is a symptom of an underlying heart condition, usually coronary artery disease (CAD). So if you're at risk for CAD, you're also at risk for angina.

Risk factors for CAD include:
Unhealthy cholesterol levels.
High blood pressure.
Cigarette smoking.
Insulin resistance or diabetes.
Overweight or obesity.
Metabolic syndrome.
Lack of physical activity.
Age. (The risk increases for men after 45 years of age and for women after 55 years of age.)
Family history of early heart disease.

Symptoms of angina vary based on the type. Pain and discomfort are the main symptoms of angina. Nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur.

If you have chest pain, your doctor will want to find out whether it's angina. To diagnose angina, your doctor will do a physical exam and ask about your symptoms, risk factors, and family history of heart disease. He or she also may order tests to confirm the diagnosis.

Treatments for angina include lifestyle changes, medicines, medical procedures, and cardiac rehabilitation. Lifestyle changes include following a healthy eating plan, quitting smoking, being physically active, losing weight, and learning how to handle stress and relax.

Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. When lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.

You can prevent or lower your risk for angina and CAD by making lifestyle changes and treating related conditions.

If you have angina, it's important to know the pattern of your angina, what medicines you take (keep a list) and how often you should take then, how to control your angina, and the limits on your physical activity. You should know how and when to seek medical help.

Source: National Heart Lung and Blood Institute (November, 2007). What is Angina. Retrieved January 5, 2008, from National Institutes of Health. Web site: http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html

Heart Disease: Know the Risks, Signs and Symptoms and Prevention

2007-12-09T18:10:00.001+08:00

Heart disease is the leading cause of death in the United States and is a major cause of disability. Almost 700,000 people die of heart disease in the U.S. each year. That is about 29% of all U.S. deaths. Heart disease is a term that includes several more specific heart conditions. The most common heart disease in the United States is coronary heart disease, which can lead to heart attack.

The risk of coronary heart disease can be reduced by taking steps to prevent and control those adverse factors that put people at greater risk for heart disease and heart attack. Additionally, knowing the signs and symptoms of heart attack, calling 911 right away, and getting to a hospital are crucial to the most positive outcomes after having a heart attack. People who have had a heart attack can also work to reduce their risk of future events. (Centers for Disease Control and Prevention, November 2007)

Coronary Heart Disease
Heart Attack
Other Heart Diseases and Related Terms
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Coronary Heart Disease

2007-12-09T17:59:00.001+08:00

Coronary Heart Disease (CHD) is the most common type of heart disease. CHD occurs when the coronary arteries, that supply blood to the heart muscle, become hardened and narrowed due to the plaque buildup. The plaque buildup and the narrowing and hardening of the arteries is called atherosclerosis. Plaques are a mixture of fatty substances including cholesterol and other lipids. Blood flow and oxygen supply to the heart can be reduced or even fully blocked with a growing plaque. Plaques may also rupture and cause blood clots that block arteries.

CHD can lead to a heart attack. Angina can also occur. Angina is chest pain or discomfort that occurs when the heart muscle is not getting enough blood. Over time, CHD can weaken the heart muscle and lead to heart failure, a serious problem where the heart cannot pump blood the way that it should. Also, irregular heart beats, called arrhythmias, can develop.

The most common symptom of CHD is angina. In some people the first sign of CHD is a heart attack. Doctors can assess a patient’s risk status by checking several factors, including blood pressure, blood cholesterol and glucose, history of heart disease, and other factors. Doctors can perform several tests to assess CHD in patients who are at high risk or have symptoms. These may include one or more of these tests:

ECG or EKG (electrocardiogram), which measures the electrical function and the rate and regularity of your heartbeat.
Echocardiogram, which creates a picture of the heart.
Exercise stress test, to measure how well the heart pumps at greater than usual workloads when it needs more oxygen.
Chest x–ray, a picture of the organs and structures inside the chest.
Cardiac catheterization, a thin, flexible tube is passed through an artery in the groin or arm to reach the coronary arteries. The tube lets your doctor check the inside of your arteries to see if there is any blockage. Your doctor also can measure the pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x–ray.
Coronary angiography, which is usually performed along with cardiac catheterization. A dye is injected through the catheter into the coronary arteries. The doctor can then take an x–ray to see the flow of blood through the heart and check for blockages.

For persons with CHD, treatment will involve addressing those factors that put them at risk for CHD and heart attack. The doctor may recommend lifestyle changes to help reduce risk. Medicines and medical treatments may be needed. Medicines are available to treat high blood cholesterol, high blood pressure, irregular heart beats, blood flow, and other potential problems. Some advanced treatments and surgical procedures may be used to help restore blood flow to the heart muscle.

In principle, all people can take steps to lower their personal risk of heart disease and heart attack by addressing their risk factors. People who already have heart disease especially need to control their risk factors.

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Heart Attack

2007-12-09T17:45:00.001+08:00

A heart attack is also called a myocardial infarction. If the blood supply to the heart is severely reduced or completely blocked, heart muscle cells may not receive enough oxygen and begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart. This damage can cause irregular heart rhythms or even sudden cardiac arrest or stopping of the heart beat. Death can result. Coronary artery disease is the chief underlying cause of a heart attack. A less common cause of a heart attack is a severe spasm of a coronary artery that reduces the blood supply to the heart.

When a person is having a heart attack, emergency care is needed that may include cardiopulmonary resuscitation (CPR), electrical shock (called defibrillation), and other advanced emergency medical care. Emergency medical personnel and doctors can quickly perform emergency treatment and transport the person to the hospital. Bystanders might also be trained to perform CPR and to use an automated external defibrillator, if one is available, until emergency medical personnel arrive. Once at the hospital, doctors can perform several tests to quickly determine if the person is having or has had a heart attack and the best course of action to restore blood flow.

Because a heart attack is a medical emergency, it is important to recognize the signs and symptoms of a heart attack and to act immediately by calling 9–1–1 or your local medical emergency hotline. A person's chance of surviving a heart attack is increased the sooner emergency treatment is administered.

A heart attack survivor may have a damaged heart that affects the heart rhythm, pumping action, and blood circulation. This puts heart attack victims at greater risk of having another heart attack or other events such as a stroke, kidney problems, and peripheral arterial problems. Cardiac rehabilitation is usually recommended for heart attack survivors after the emergency event has stabilized. Cardiac rehabilitation guides the patient to make changes that can help improve cardiovascular fitness and quality of life. These changes may include dietary changes, physical activity, smoking cessation, and other issues such as medication schedules and stress management. Heart attack survivors should seek their doctor's advice about daily activities such as returning to work, driving, physical and sexual activity, and air travel.

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Other Heart Diseases and Related Terms

2007-12-09T17:27:00.001+08:00

Angina

Chest pain or discomfort that occurs when the heart muscle is not getting enough blood. Angina may feel like pressure or a squeezing pain in the chest. The pain may also occur in the shoulders, arms, neck, jaw, or back, and it may feel like indigestion. Angina is a symptom of coronary heart disease. Angina may be stable or unstable. Stable angina is chest pain that occurs on physical exertion or under mental or emotional stress. Unstable angina is chest pain that occurs even while at rest, without apparent reason.

Acute Coronary Syndrome

A term that is sometimes used to describe people who have either an acute myocardial infarction or unstable angina.

Aortic Aneurysm and Dissection

A condition where the aorta stretches or dilates (aneurysm) and ruptures (dissection). A ruptured aneurysm is an emergency situation.

Arrhythmias

Irregular, or abnormally fast or slow, beating of the heart. The heart beat is controlled by electrical impulses. When the timing or frequency of these electrical impulses are disrupted, arrhythmias develop. Some arrhythmias are quite serious. An example is ventricular fibrillation, a severely abnormal heart rhythm that causes death unless treated right away by providing an electrical shock to the heart (called defibrillation). Others are less severe but can develop into more serious conditions over time. A particular concern is atrial fibrillation. Atrial fibrillation is rapid, irregular beating of the upper chambers of the heart. The chambers can quiver instead of beating in a regular pattern. Blood is not fully pumped out of them and may pool and clot. For more information, see our atrial fibrillation fact sheet.

Cardiomyopathy

A weakening of the heart muscle or a change in heart muscle structure. It often results in inadequate heart pumping or other heart function abnormalities. These can result from various causes, including prior heart attacks, viral or bacterial infections, and others.

Congenital Heart Disease

Malformations of heart structures, present during pregnancy or at birth. These may be caused by genetic factors or by adverse exposures during pregnancy. Examples include holes in the walls that divide the heart chambers, abnormal heart valves, and others. Congenital heart defects can disrupt the normal flow of blood through the heart. Congenital heart defects are the most common type of major birth defect.

Heart Failure

This may also be called congestive heart failure or chronic heart failure. Heart failure is a condition where the heart cannot pump enough blood and oxygen to meet the needs of other body organs. Heart failure does not mean that the heart has stopped, but that it cannot pump blood the way that it should. Heart failure is a serious condition. There is no cure for heart failure at this time, except a heart transplant. Once diagnosed, medicines are needed for the rest of the person's life.

Peripheral Arterial Disease (PAD)

Hardening of the arteries that supply blood to the arms and legs. PAD is usually the result of atherosclerosis, the buildup of plaque and narrowing of the arteries. Blood flow and oxygen to the muscles in the arms and legs can be reduced or even fully blocked. Painful leg muscles, numbness, swelling in the ankles and feet, and weak pulse in the feet are some of the signs and symptoms of PAD.

Rheumatic Heart Disease

This condition is damage to the heart valves and other heart structures due to inflammation and scarring caused by rheumatic fever, which occurs from streptococcal infection.

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Preventing Heart Disease

2007-12-09T15:25:00.000+08:00

Steps That You Can Do To Lower Your Risk for Heart Disease.

Following these simple steps would greatly lower your risk of having heart diseases.

Prevent and control high blood cholesterol

High blood cholesterol is a major risk factor for heart disease. Preventing and treating high blood cholesterol includes eating a diet low in saturated fat and cholesterol and high in fiber, keeping a healthy weight, and getting regular exercise. All adults should have their cholesterol levels checked once every five years. If yours is high, your doctor may prescribe medicines to help lower it.

Prevent and control high blood pressure

Lifestyle actions such as healthy diet, regular physical activity, not smoking, and healthy weight will help you to keep normal blood pressure levels and all adults should have their blood pressure checked on a regular basis. Blood pressure is easily checked. If your blood pressure is high, you can work with your doctor to treat it and bring it down to the normal range. A high blood pressure can usually be controlled with lifestyle changes and with medicines when needed.

Prevent and control diabetes

People with diabetes have an increased risk of heart disease but can reduce their risk. Also, people can take steps to reduce their risk for diabetes in the first place, through weight loss and regular physical activity. For more information about diabetes, see Understanding Diabetes-Increasing Awareness website.

No tobacco

Smoking increases the risk of high blood pressure, heart disease, and stroke. Never smoking is one of the best things a person can do to lower their risk. And, quitting smoking will also help lower a person’s risk of heart disease. A person's risk of heart attack decreases soon after quitting. If you smoke, your doctor can suggest programs to help you quit smoking.

Moderate alcohol use

Excessive alcohol use increases the risk of high blood pressure, heart attack, and stroke. People who drink should do so only in moderation and always responsibly.

Maintain a healthy weight

Healthy weight status in adults is usually assessed by using weight and height to compute a number called the "body mass index" (BMI). BMI usually indicates the amount of body fat. An adult who has a BMI of 30 or higher is considered obese. Overweight is a BMI between 25 and 29.9. Normal weight is a BMI of 18 to 24.9. Proper diet and regular physical activity can help to maintain a healthy weight.

Regular physical activity

Adults should engage in moderate level physical activities for at least 30 minutes on most days of the week.

Diet and nutrition

Along with healthy weight and regular physical activity, an overall healthy diet can help to lower blood pressure and cholesterol levels and prevent obesity, diabetes, heart disease, and stroke. This includes eating lots of fresh fruits and vegetables, lowering or cutting out added salt or sodium, and eating less saturated fat and cholesterol to lower these risks.

Information provided by the Division for Heart Disease and Stroke Prevention. Centers for Disease Control and Prevention.

Ulcer

2007-05-07T19:36:00.000+08:00

What is an ulcer?

An ulcer is a sore or hole in the lining of the stomach or duodenum (the first part of the small intestine).Twenty-five million Americans suffer from ulcers. People of any age can get an ulcer and women are affected just as often as men.

Cause:

Helicobacter pylori (H. pylori) is a bacterium that lives on the lining of the stomach. Although we used to think that spicy food, acid, and stress were the major causes of ulcers, we now know that nine out of ten ulcers are caused by H. pylori. Medicines that reduce stomach acid may make you feel better, but your ulcer may come back. Here's the good news: Since most ulcers are caused by this bacterial infection, they can be cured with the right antibiotics.

Symptoms:

The most common ulcer symptom is gnawing or burning pain in the abdomen between the breastbone and the belly button. The pain often occurs when the stomach is empty, between meals and in the early morning hours, but it can occur at any other time. It may last from minutes to hours and may be relieved by eating food or taking antacids. Less common symptoms include nausea, vomiting, or loss of appetite. Sometimes ulcers bleed. If bleeding continues for a long time, it may lead to anemia with weakness and fatigue. If bleeding is heavy, blood may appear in vomit or bowel movements, which may appear dark red or black.

Diagnosis:

Your health care provider may choose to use any of the following tests to determine if your ulcer is caused by H. pylori.

Blood tests: A blood test can confirm if you have H. pylori. To perform this test, your health care provider sends your blood sample to a lab.
Breath tests: A breath test can determine if you are infected with H. pylori. In this test, you drink a harmless liquid and in less than 1 hour, a sample of your breath is tested for H. pylori.
Endoscopy: Your health care provider may decide to perform an endoscopy. This is a test in which a small tube with a camera inside is inserted through the mouth and into the stomach to look for ulcers. During the endoscopy, small samples of the stomach lining can be obtained and tested for H. pylori.

Treatment:

If you have an ulcer, you should be tested for H. pylori, and if found to be infected, you should be treated with antibiotics. Antibiotics are the new cure for ulcers; therapy is 1-2 weeks of one or two antibiotics and a medicine that will reduce the acid in the stomach. This treatment is a dramatic medical advance because eliminating H. pylori with antibiotics means that there is a greater than 90% chance that the ulcer can be cured for good. Remember, it is very important to continue taking all of this medicine until it is gone, even when you begin to feel better. If you are having side effects that make it hard to take your medicine, talk to your health care provider.

Ulcer Facts:

Most ulcers are caused by an infection, not spicy food, acid and stress.
The most common ulcer symptom is burning pain in the stomach.
Your doctor can test you for H. pylori.
Antibiotics are the new cure for ulcers.
Eliminating H. pylori infection with antibiotics means that your ulcer can be cured for good.

Content Source: Coordinating Center for Infectious Diseases / Division of Bacterial and Mycotic Diseases. Centers for Disease Control and Prevention. October 12, 2005

Page Last Modified: December 10, 2007

Pneumonia

2007-05-06T18:01:00.001+08:00

Pneumonia is a type of lung disease. Pneumococcal pneumonia can infect the upper respiratory tract and can spread to the blood, lungs, middle ear, or nervous system.

Pneumococcal pneumonia mainly causes illness in children younger than 2 years old and adults 65 years of age or older. The elderly are especially at risk of getting seriously ill and dying from this disease. In addition, people with certain medical conditions such as chronic heart, lung, or liver diseases or sickle cell anemia are also at increased risk for getting pneumococcal pneumonia.

People with HIV infection, AIDS, or people who have had organ transplants and are taking medicines that lower their resistance to infection are also at high risk of getting this disease.

Cause

Pneumonia can be caused by a variety of viruses, bacteria, and sometimes fungi. Pneumococcal pneumonia is caused by bacteria called Streptococcus pneumoniae. S. pneumoniae is also called pneumococcus.

Transmission

Pneumococcus is spread through contact between people who are ill or who carry the bacteria in their throat. You can get pneumococcal pneumonia from respiratory droplets from the nose or mouth of an infected person. It is common for people, especially children, to carry the bacteria in their throats without being sick.

Symptoms

Pneumococcal pneumonia may begin suddenly. You may first have a severe shaking chill which is usually followed by:

 High fever
 Cough
 Shortness of breath
 Rapid breathing
 Chest pains

Other symptoms may include

 Nausea
 Vomiting
 Headache
 Tiredness
 Muscle aches

Diagnosis

Your health care provider can diagnose pneumonia based on your

 Symptoms
 Physical exam
 Lab tests
 Chest x-ray

Other bacteria and germs also can cause pneumonia. Therefore, if you have any of the symptoms of pneumonia, you should get diagnosed early and start taking medicine, if appropriate.

Your health care provider can usually diagnose pneumococcal pneumonia by finding S. pneumoniae bacteria in your blood, saliva, or lung fluid.

Treatment

Your health care provider usually will prescribe antibiotics to treat this disease. The symptoms of pneumococcal pneumonia usually go away within 12 to 36 hours after you start taking medicine.

Some bacteria such as S. pneumoniae, however, are now capable of resisting and fighting off antibiotics. Such antibiotic resistance is increasing worldwide because these medicines have been overused or misused. Therefore, if you are at risk of getting pneumococcal pneumonia, you should talk with your health care provider about what you can do to prevent it.

Prevention

The pneumococcal vaccine is the only way to prevent getting pneumococcal pneumonia. Vaccines are available for children and adults.

The National Immunization Program (NIP) of the Centers for Disease Control and Prevention recommends that you get the pneumococcal pneumonia vaccine if you are in any of the following groups.

 You are 65 years old or older

 You have a serious long-term health problem such as heart disease, sickle cell disease, alcoholism, lung disease (not including asthma), diabetes, or liver cirrhosis

 Your resistance to infection is lowered due to

HIV infection or AIDS
Lymphoma, leukemia, or other cancers
Cancer treatment with x-rays or medicines
Treatment with long-term steroid medicines
Bone marrow or organ transplant
Kidney failure or kidney syndrome
Damaged spleen or no spleen
You are an Alaskan Native or from certain Native American populations

The NIP also recommends that all babies and children younger than 2 years old get the pneumococcal vaccine.

Contact your health care provider to find out whether you or your child should be vaccinated to prevent pneumococcal pneumonia.

Complications

In about 30 percent of people with pneumococcal pneumonia, the bacteria invade the bloodstream from the lungs. This causes bacteremia, a very serious complication of pneumococcal pneumonia that also can cause other lung problems and certain heart problems.

Topic Courtesy of the National Institute of Allergy and Infectious Diseases. January 31, 2006

Cushing's Syndrome

2007-05-05T18:23:00.001+08:00

Cushing's syndrome is caused by long-term exposure of the body's tissues to high levels of the hormone cortisol. Cortisol is one of the hormones produced by an endocrine gland called the adrenal gland. We have two adrenal glands, one of each sits on top of each kidney.

Cushing's syndrome also known as "hypercortisolism," is a relatively rare disease that commonly affects adults aged 20 to 50. An estimated 10 to 15 of every million people are affected by Cushing's syndrome each year. (Endocrine and Metabolic Diseases Information Service, 2002)

TOPICS about CUSHING'S Syndrome:

Content Source:
Cushing’s Syndrome. Endocrine and Metabolic Diseases Information Service. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health (NIH). NIH Publication No. 02–3007: June 2002

This Page Last Revised: April 8, 2010

Signs and Symptoms of Cushing's Syndrome

2007-05-05T18:19:00.001+08:00

What are the symptoms of Cushing's Syndrome?

Symptoms vary, but most people have upper body obesity, rounded face, increased fat around the neck, and thinning arms and legs. Children tend to be obese with slowed growth rates.

Other symptoms appear in the skin, which becomes fragile and thin. It bruises easily and heals poorly. Purplish pink stretch marks may appear on the abdomen, thighs, buttocks, arms and breasts. The bones are weakened, and routine activities such as bending, lifting or rising from a chair may lead to backaches, rib and spinal column fractures.

Most people have severe fatigue, weak muscles, high blood pressure and high blood sugar. Irritability, anxiety and depression are common.

Women usually have excess hair growth on their faces, necks, chests, abdomens, and thighs. Their menstrual periods may become irregular or stop. Men have decreased fertility with diminished or absent desire for sex.

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Causes of Cushing's Syndrome

2007-05-05T18:14:00.001+08:00

Cushing's syndrome occurs when the body's tissues are exposed to excessive levels of cortisol for long periods of time. Many people suffer the symptoms of Cushing's syndrome because they take glucocorticoid hormones such as prednisone for asthma, rheumatoid arthritis, lupus and other inflammatory diseases, or for immunosuppression after transplantation.

Others develop Cushing's syndrome because of overproduction of cortisol by the body. Normally, the production of cortisol follows a precise chain of events. First, the hypothalamus, a part of the brain which is about the size of a small sugar cube, sends corticotropin releasing hormone (CRH) to the pituitary gland. CRH causes the pituitary to secrete ACTH (adrenocorticotropin), a hormone that stimulates the adrenal glands. When the adrenals, which are located just above the kidneys, receive the ACTH, they respond by releasing cortisol into the bloodstream.

Cortisol performs vital tasks in the body. It helps maintain blood pressure and cardiovascular function, reduces the immune system's inflammatory response, balances the effects of insulin in breaking down sugar for energy, and regulates the metabolism of proteins, carbohydrates, and fats. One of cortisol's most important jobs is to help the body respond to stress. For this reason, women in their last 3 months of pregnancy and highly trained athletes normally have high levels of the hormone. People suffering from depression, alcoholism, malnutrition and panic disorders also have increased cortisol levels.

When the amount of cortisol in the blood is adequate, the hypothalamus and pituitary release less CRH and ACTH. This ensures that the amount of cortisol released by the adrenal glands is precisely balanced to meet the body's daily needs. However, if something goes wrong with the adrenals or their regulating switches in the pituitary gland or the hypothalamus, cortisol production can go awry.

Pituitary Adenomas

Pituitary adenomas cause most cases of Cushing's syndrome. They are benign, or non-cancerous, tumors of the pituitary gland which secrete increased amounts of ACTH. Most patients have a single adenoma. This form of the syndrome, known as "Cushing's disease," affects women five times more frequently than men.

Ectopic ACTH Syndrome

Some benign or malignant (cancerous) tumors that arise outside the pituitary can produce ACTH. This condition is known as ectopic ACTH syndrome. Lung tumors cause over 50 percent of these cases. Men are affected 3 times more frequently than women.

The most common forms of ACTH-producing tumors are oat cell, or small cell lung cancer, which accounts for about 25 percent of all lung cancer cases, and carcinoid tumors. Other less common types of tumors that can produce ACTH are thymomas, pancreatic islet cell tumors, and medullary carcinomas of the thyroid.

Adrenal Tumors

Sometimes, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing's syndrome. The average age of onset is about 40 years. Most of these cases involve non-cancerous tumors of adrenal tissue, called adrenal adenomas, which release excess cortisol into the blood.

Adrenocortical carcinomas, or adrenal cancers, are the least common cause of Cushing's syndrome. Cancer cells secrete excess levels of several adrenal cortical hormones, including cortisol and adrenal androgens. Adrenocortical carcinomas usually cause very high hormone levels and rapid development of symptoms.

Familial Cushing's Syndrome

Most cases of Cushing's syndrome are not inherited. Rarely, however, some individuals have special causes of Cushing's syndrome due to an inherited tendency to develop tumors of one or more endocrine glands. In Primary Pigmented Micronodular Adrenal Disease, children or young adults develop small cortisol-producing tumors of the adrenal glands. In Multiple Endocrine Neoplasia Type I (MEN I), hormone secreting tumors of the parathyroid glands, pancreas and pituitary occur. Cushing's syndrome in MEN I may be due to pituitary, ectopic or adrenal tumors.

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Diagnosis of Cushing’s Syndrome

2007-05-05T18:07:00.001+08:00

How is Cushing's Syndrome dignosed?

Diagnosis is based on a review of the patient's medical history, physical examination and laboratory tests. Often x-ray exams of the adrenal or pituitary glands are useful for locating tumors. These tests help to determine if excess levels of cortisol are present and why.

24-Hour Urinary Free Cortisol Level

This is the most specific diagnostic test. The patient's urine is collected over a 24-hour period and tested for the amount of cortisol. Levels higher than 50–100 micrograms a day for an adult suggest Cushing's syndrome. The normal upper limit varies in different laboratories, depending on which measurement technique is used.

Once Cushing's syndrome has been diagnosed, other tests are used to find the exact location of the abnormality that leads to excess cortisol production. The choice of test depends, in part, on the preference of the endocrinologist or the center where the test is performed.

Dexamethasone Suppression Test

This test helps to distinguish patients with excess production of ACTH due to pituitary adenomas from those with ectopic ACTH-producing tumors. Patients are given dexamethasone, a synthetic glucocorticoid, by mouth every 6 hours for 4 days. For the first 2 days, low doses of dexamethasone are given, and for the last 2 days, higher doses are given. Twenty-four hour urine collections are made before dexamethasone is administered and on each day of the test.

Since cortisol and other glucocorticoids signal the pituitary to lower secretion of ACTH, the normal response after taking dexamethasone is a drop in blood and urine cortisol levels. Different responses of cortisol to dexamethasone are obtained depending on whether the cause of Cushing's syndrome is a pituitary adenoma or an ectopic ACTH-producing tumor.

The dexamethasone suppression test can produce false-positive results in patients with depression, alcohol abuse, high estrogen levels, acute illness, and stress. Conversely, drugs such as phenytoin and phenobarbital may cause false-negative results in response to dexamethasone suppression. For this reason, patients are usually advised by their physicians to stop taking these drugs at least one week before the test.

CRH Stimulation Test

This test helps to distinguish between patients with pituitary adenomas and those with ectopic ACTH syndrome or cortisol-secreting adrenal tumors. Patients are given an injection of CRH, the corticotropin-releasing hormone which causes the pituitary to secrete ACTH. Patients with pituitary adenomas usually experience a rise in blood levels of ACTH and cortisol. This response is rarely seen in patients with ectopic ACTH syndrome and practically never in patients with cortisol-secreting adrenal tumors.

Direct Visualization of the Endocrine Glands (Radiologic Imaging)

Imaging tests reveal the size and shape of the pituitary and adrenal glands and help determine if a tumor is present. The most common are the CT (computerized tomography) scan and MRI (magnetic resonance imaging). A CT scan produces a series of x-ray pictures giving a cross-sectional image of a body part. MRI also produces images of the internal organs of the body but without exposing the patient to ionizing radiation.

Imaging procedures are used to find a tumor after a diagnosis has been established. Imaging is not used to make the diagnosis of Cushing's syndrome because benign tumors, sometimes called "incidentalomas," are commonly found in the pituitary and adrenal glands. These tumors do not produce hormones detrimental to health and are not removed unless blood tests show they are a cause of symptoms or they are unusually large. Conversely, pituitary tumors are not detected by imaging in almost 50 percent of patients who ultimately require pituitary surgery for Cushing's syndrome.

Petrosal Sinus Sampling

This test is not always required, but in many cases, it is the best way to separate pituitary from ectopic causes of Cushing's syndrome. Samples of blood are drawn from the petrosal sinuses, veins which drain the pituitary, by introducing catheters through a vein in the upper thigh/groin region, with local anesthesia and mild sedation. X-rays are used to confirm the correct position of the catheters. Often CRH, the hormone which causes the pituitary to secrete ACTH, is given during this test to improve diagnostic accuracy. Levels of ACTH in the petrosal sinuses are measured and compared with ACTH levels in a forearm vein. ACTH levels higher in the petrosal sinuses than in the forearm vein indicate the presence of a pituitary adenoma; similar levels suggest ectopic ACTH syndrome.

The Dexamethasone-CRH Test

Some individuals have high cortisol levels, but do not develop the progressive effects of Cushing's syndrome, such as muscle weakness, fractures and thinning of the skin. These individuals may have Pseudo Cushing's syndrome, which was originally described in people who were depressed or drank excess alcohol, but is now known to be more common.

Pseudo Cushing's does not have the same long-term effects on health as Cushing's syndrome and does not require treatment directed at the endocrine glands. Although observation over months to years will distinguish Pseudo Cushing's from Cushing's, the dexamethasone-CRH test was developed to distinguish between the conditions rapidly, so that Cushing's patients can receive prompt treatment. This test combines the dexamethasone suppression and the CRH stimulation tests. Elevations of cortisol during this test suggest Cushing's syndrome.

Some patients may have sustained high cortisol levels without the effects of Cushing's syndrome. These high cortisol levels may be compensating for the body's resistance to cortisol's effects. This rare syndrome of cortisol resistance is a genetic condition that causes hypertension and chronic androgen excess.

Sometimes other conditions may be associated with many of the symptoms of Cushing's syndrome. These include polycystic ovarian syndrome, which may cause menstrual disturbances, weight gain from adolescence, excess hair growth and sometimes impaired insulin action and diabetes. Commonly, weight gain, high blood pressure and abnormal levels of cholesterol and triglycerides in the blood are associated with resistance to insulin action and diabetes; this has been described as the "Metabolic Syndrome-X." Patients with these disorders do not have abnormally elevated cortisol levels.

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Treatment of Cushing’s Syndrome

2007-05-05T18:02:00.001+08:00

Treatment depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects.

Pituitary Adenomas

Several therapies are available to treat the ACTH-secreting pituitary adenomas of Cushing's disease. The most widely used treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and very fine instruments, the surgeon approaches the pituitary gland through a nostril or an opening made below the upper lip. Because this is an extremely delicate procedure, patients are often referred to centers specializing in this type of surgery. The success, or cure, rate of this procedure is over 80 percent when performed by a surgeon with extensive experience. If surgery fails, or only produces a temporary cure, surgery can be repeated, often with good results. After curative pituitary surgery, the production of ACTH drops two levels below normal. This is a natural, but temporary, drop in ACTH production, and patients are given a synthetic form of cortisol (such as hydrocortisone or prednisone). Most patients can stop this replacement therapy in less than a year.

For patients in whom transsphenoidal surgery has failed or who are not suitable candidates for surgery, radiotherapy is another possible treatment. Radiation to the pituitary gland is given over a 6-week period, with improvement occurring in 40 to 50 percent of adults and up to 80 percent of children. It may take several months or years before patients feel better from radiation treatment alone. However, the combination of radiation and the drug mitotane (Lysodren®) can help speed recovery. Mitotane suppresses cortisol production and lowers plasma and urine hormone levels. Treatment with mitotane alone can be successful in 30 to 40 percent of patients. Other drugs used alone or in combination to control the production of excess cortisol are aminoglutethimide, metyrapone, trilostane and ketoconazole. Each has its own side effects that doctors consider when prescribing therapy for individual patients.

Ectopic ACTH Syndrome

To cure the overproduction of cortisol caused by ectopic ACTH syndrome, it is necessary to eliminate all of the cancerous tissue that is secreting ACTH. The choice of cancer treatment—surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of these treatments—depends on the type of cancer and how far it has spread. Since ACTH-secreting tumors (for example, small cell lung cancer) may be very small or widespread at the time of diagnosis, cortisol-inhibiting drugs, like mitotane, are an important part of treatment. In some cases, if pituitary surgery is not successful, surgical removal of the adrenal glands (bilateral adrenalectomy) may take the place of drug therapy.

Adrenal Tumors

Surgery is the mainstay of treatment for benign as well as cancerous tumors of the adrenal glands. In Primary Pigmented Micronodular Adrenal Disease and the familial Carney's complex, surgical removal of the adrenal glands is required.

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Content Source:Cushing’s Syndrome. Endocrine and Metabolic Diseases Information Service. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health (NIH). NIH Publication No. 02–3007: June 2002

Gastroesophageal Reflux Disease (GERD)

2007-04-28T12:54:00.001+08:00

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES)* does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach.

*The Lower esophageal sphincter is a valve or sphincter between the esophagus and stomach.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

Symptoms:

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

Topics about GERD:

Causes of GERD
Treatment of GERD

Sources:
Digestive Diseases E -K. National Digestive Diseases Information Clearinghouse (NDDIC). National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH Publication No. 00-2750: February 2000

Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD). National Digestive Diseases Information Clearinghouse (NDDIC. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–0882: June 2003

Image Credit: NIDDK Image Library. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Post Updated: April 30, 2007

Causes of GERD

2007-04-28T12:51:00.001+08:00

No one knows why people get GERD. A hiatal hernia may contribute to the development of the condition. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest.

The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Hiatal Hernia (Hiatus Hernia)(hy-AY-tul HUR-nee-uh)
A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest.
Causes heartburn from stomach acid flowing back up through the opening.

Other factors that may contribute to GERD include

alcohol use
overweight
pregnancy
smoking

Also, certain foods can be associated with reflux events, including

citrus fruits
chocolate
drinks with caffeine
fatty and fried foods
garlic and onions
mint flavorings
spicy foods
tomato-based foods, like spaghetti sauce, chili, and pizza

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Treatment of GERD

2007-04-28T12:49:00.001+08:00

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

If you smoke, stop.
Do not drink alcohol.
Lose weight if needed.
Eat small meals.
Wear loose-fitting clothes.
Avoid lying down for 3 hours after a meal.
Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts—just using extra pillows will not help.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time. They are effective for about half of those who have GERD symptoms. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor.

Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD.

Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for GERD.

Surgery

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Implant
The FDA approved an implant that may help people with GERD who wish to avoid surgery. Enteryx is a solution that becomes spongy and reinforces the LES to keep stomach acid from flowing into the esophagus. It is injected during endoscopy. The implant is approved for people who have GERD and who require and respond to proton pump inhibitors. The long-term effects of the implant are unknown.

Back to GERD Home

Excerpts from: Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD). National Digestive Diseases Information Clearinghouse (NDDIC. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–0882: June 2003

Inguinal Hernia

2007-04-28T11:30:00.000+08:00

Inguinal Hernia (IN-gwuh-nul HUR-nee-uh)

A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery.

A hernia is a condition in which part of the intestine bulges through a weak area in muscles in the abdomen. An inguinal hernia occurs in the groin (the area between the abdomen and thigh). It is called "inguinal" because the intestines push through a weak spot in the inguinal canal, which is a triangle-shaped opening between layers of abdominal muscle near the groin. Obesity, pregnancy, heavy lifting, and straining to pass stool can cause the intestine to push against the inguinal canal.

Symptoms of inguinal hernia may include a lump in the groin near the thigh; pain in the groin; and, in severe cases, partial or complete blockage of the intestine. The doctor diagnoses hernia by doing a physical exam and by taking x rays and blood tests to check for blockage in the intestine.

The main treatment for inguinal hernia is surgery to repair the opening in the muscle wall. This surgery is called herniorrhaphy. Sometimes the weak area is reinforced with steel mesh or wire. This operation is called hernioplasty. If the protruding intestine becomes twisted or traps stool, part of the intestine might need to be removed. This surgery is called bowel resection. (Bowel is another word for intestine.)

Sources:
Digestive Diseases E -K. National Digestive Diseases Information Clearinghouse (NDDIC). National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH Publication No. 00-2750: February 2000

Inguinal Hernia. National Digestive Diseases Information Clearinghouse (NDDIC. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–3410: February 2006

Image Credit: NIDDK Image Library. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Amyloidosis and Kidney Disease

2007-04-27T11:22:00.000+08:00

Proteins are important building blocks for all body parts, including muscles, bones, hair, and nails. Proteins circulate throughout the body in the blood and are normally harmless. Occasionally, cells produce abnormal proteins that can settle in body tissue, forming deposits and causing disease. When these deposits of abnormal proteins were first discovered, they were called amyloid, and the disease process amyloidosis.

In recent years, researchers have discovered that different kinds of proteins can form amyloid deposits and have identified several types of amyloidosis. Two of these types are closely related to kidney disease. In primary amyloidosis, abnormal protein production occurs as a first step and can lead to kidney disease. Dialysis-related amyloidosis (DRA), on the other hand, is a result of kidney disease.

Primary Amyloidosis

Primary amyloidosis occurs when the body's antibody-producing cells do not function properly and produce abnormal protein fibers made of antibody fragments. Some people with primary amyloidosis have a condition called multiple myeloma. The antibody fragments come together to form amyloid deposits in different organs, including the kidneys, where they cause serious damage. Injured kidneys can't function effectively and may be unable to remove urea and other wastes from the blood. Elevated levels of these protein fibers can also damage the heart, lungs, brain, and digestive system.

One common sign of kidney amyloidosis is the presence of abnormally high levels of protein in the urine, a condition known as proteinuria. Healthy kidneys prevent protein from entering the urine, so the presence of protein may be a sign that the kidneys aren't working properly. A physician who finds large amounts of protein in the urine may also perform a biopsy—take a small sample of tissue for examination with a microscope—to confirm amyloidosis.

Current treatments are aimed at slowing the progression of amyloid build-up. Combination drug therapy with melphalan, a cancer drug, and prednisone, an anti-inflammatory steroid drug, may improve organ function and survival rates by interrupting the growth of the abnormal cells that produce amyloid protein. These are the same drugs used in chemotherapy to treat certain cancers, such as multiple myeloma, and they may have serious side effects, such as nausea and vomiting, hair loss, and fatigue.

Some clinics have reported promising results treating amyloidosis by transplanting the patient’s own blood stem cells to replace diseased or damaged bone marrow. The therapy also requires high doses of melphalan, so side effects can be serious. Patients with heart problems may not be considered for this treatment.

Dialysis-Related Amyloidosis

Normal kidneys filter and remove excess small proteins from the blood, thus keeping blood levels normal. When the kidneys don't work properly, as in patients receiving dialysis, one type of small protein calle beta-2-microglobulin builds up in the blood. When this occurs, beta-2-microglobulin molecules may join together, like the links of a chain, forming a few very large molecules from many smaller ones. These large molecules can form deposits and eventually damage the surrounding tissues and cause great discomfort. This condition is called dialysis-related amyloidosis (DRA).

DRA is relatively common in patients, especially older adults, who have been on hemodialysis for more than 5 years. Hemodialysis membranes that have been used for many years don't effectively remove the large, complex beta-2-microglobulin proteins from the bloodstream. Newer hemodialysis membranes, as well as peritoneal dialysis, remove beta-2-microglobulin more effectively, but not enough to keep blood levels normal. As a result, blood levels remain elevated, and deposits form in bone, joints, and tendons (the tissue that connects the muscle to the bone). DRA may result in pain, stiffness, and fluid in the joints. Patients with DRA may also develop hollow cavities, or cysts, in some of their bones; these may lead to unexpected bone fractures. Amyloid deposits may cause tears in ligaments and tendons. Most patients with these problems can be helped by surgical intervention.

Half of the people with DRA also develop a condition called carpal tunnel syndrome, which results from the unusual buildup of protein in the wrists. Patients with this condition may experience numbness or tingling, sometimes associated with muscle weakness, in their fingers and hands. This is a treatable condition.

Unfortunately, no cure for DRA has been found, although a successful kidney transplant may stop the disease from progressing. However, DRA has caught the attention of dialysis engineers, who are attempting to develop new dialysis membranes that can remove larger amounts of beta-2-microglobulin from the blood.

Sources:
Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Amyloidosis and Kidney Disease. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4694: May 2006

Renal Osteodystrophy

2007-04-27T11:01:00.000+08:00

The medical term "renal" describes things related to the kidneys. Renal osteodystrophy is a bone disease that occurs when your kidneys fail to maintain the proper levels of calcium and phosphorus in your blood. It's a common problem in people with kidney disease and affects 90 percent of dialysis patients.

Renal osteodystrophy is most serious in children because their bones are still growing. The condition slows bone growth and causes deformities. One such deformity occurs when the legs bend inward toward each other or outward away from each other; this deformity is referred to as "renal rickets." Another important consequence is short stature. Symptoms can be seen in growing children with renal disease even before they start dialysis.

The bone changes from renal osteodystrophy can begin many years before symptoms appear in adults with kidney disease. For this reason, it's called the "silent crippler." The symptoms of renal osteodystrophy aren't usually seen in adults until they have been on dialysis for several years. Older patients and women who have gone through menopause are at greater risk for this disease because they're already vulnerable to osteoporosis, another bone disease, even without kidney disease. If left untreated, the bones gradually become thin and weak, and a person with renal osteodystrophy may begin to feel bone and joint pain. There's also an increased risk of bone fractures.

Hormones and Minerals

In healthy adults, bone tissue is continually being remodeled and rebuilt. The kidneys play an important role in maintaining healthy bone mass and structure because one of their jobs is to balance calcium and phosphorus levels in the blood.

Calcium is a mineral that builds and strengthens bones. It's found in many foods, particularly milk and other dairy products. If calcium levels in the blood become too low, four small glands in the neck called the parathyroid glands release a hormone called parathyroid hormone (PTH). This hormone draws calcium from the bones to raise blood calcium levels. Too much PTH in the blood will remove too much calcium from the bones; over time, the constant removal of calcium weakens the bones.

Phosphorus, which is found in most foods, also helps regulate calcium levels in the bones. Healthy kidneys remove excess phosphorus from the blood. When the kidneys stop working normally, phosphorus levels in the blood can become too high, leading to lower levels of calcium in the blood and resulting in the loss of calcium from the bones.

Healthy kidneys produce calcitriol, a form of vitamin D, to help the body absorb dietary calcium into the blood and the bones. If calcitriol levels drop too low, PTH levels increase, and calcium is removed from the bones. Calcitriol and PTH work together to keep calcium balance normal and bones healthy. In a patient with kidney failure, the kidneys stop making calcitriol. The body then can't absorb calcium from food and starts removing it from the bones.

Diagnosis

To diagnose renal osteodystrophy, your doctor may take a sample of your blood to measure levels of calcium, phosphorus, PTH, and calcitriol. The doctor may perform a bone biopsy to see how dense your bones are. A bone biopsy is done under local anesthesia and involves removing a small sample of bone from the hip and analyzing it under a microscope. Determining the cause of renal osteodystrophy helps the doctor decide on a course of treatment.

Treatment

Controlling PTH levels prevents calcium from being withdrawn from the bones. Usually, overactive parathyroid glands are controllable with a change in diet, dialysis treatment, or medication. The drug cinacalcet hydrochloride (Sensipar), approved by the Food and Drug Administration in 2004, lowers PTH levels by imitating calcium. If PTH levels can't be controlled, the parathyroid glands may need to be removed surgically.

If your kidneys aren't making adequate amounts of calcitriol, you can take synthetic calcitriol as a pill or in an injectable form. Your doctor may prescribe a calcium supplement in addition to calcitriol.

Renal osteodystrophy can also be treated with changes in diet. Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease. Almost all foods contain phosphorus, but it's especially high in milk, cheese, dried beans, peas, nuts, and peanut butter. Limit drinks such as cocoa, dark sodas, and beer. Often, medications such as calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), or lanthanum carbonate (Fosrenol) are prescribed with meals and snacks to bind phosphorus in the bowel. These decrease the absorption of phosphorus into the blood. Be sure your phosphate binder is aluminum-free because aluminum can be toxic and cause anemia. A renal dietitian can help develop a dietary plan to control phosphorus levels in the blood.

Exercise has been found to increase bone strength in some patients. It's important, however, to consult a doctor or health care professional before beginning any exercise program.

A good treatment program, including proper attention to dialysis, diet, and medications, can improve your body's ability to repair bones damaged by renal osteodystrophy.

Sources:
Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Renal Osteodystrophy. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 05–4630: January 2005

Conditions Related to Kidney Failure and Their Treatments

2007-04-27T10:30:00.001+08:00

Your kidneys do much more than remove wastes and extra fluid. They also make hormones and balance chemicals in your system. When your kidneys stop working, you may have problems with anemia and conditions that affect your bones, nerves, and skin. Some of the more common conditions caused by kidney failure are extreme tiredness, bone problems, joint problems, itching, and "restless legs." Restless legs will keep you awake as you feel them twitching and jumping.

Anemia and Erythropoietin (EPO)

Anemia is a condition in which the volume of red blood cells is low. Red blood cells carry oxygen to cells throughout the body. Without oxygen, cells can’t use the energy from food, so someone with anemia may tire easily and look pale. Anemia can also contribute to heart problems.

Anemia is common in people with kidney disease because the kidneys produce the hormone erythropoietin, or EPO, which stimulates the bone marrow to produce red blood cells. Diseased kidneys often don’t make enough EPO, and so the bone marrow makes fewer red blood cells. EPO is available commercially and is commonly given to patients on dialysis.

Renal Osteodystrophy

The term "renal" describes things related to the kidneys. Renal osteodystrophy, or bone disease of kidney failure, affects 90 percent of dialysis patients. It causes bones to become thin and weak or formed incorrectly and affects both children and adults. Symptoms can be seen in growing children with kidney disease even before they start dialysis. Older patients and women who have gone through menopause are at greater risk for this disease.

For more information, see the fact sheet on Renal Osteodystrophy.

Itching (Pruritus)

Many people treated with hemodialysis complain of itchy skin, which is often worse during or just after treatment. Itching is common even in people who don’t have kidney disease; in kidney failure, however, itching can be made worse by wastes in the bloodstream that current dialyzer membranes can’t remove from the blood.

The problem can also be related to high levels of parathyroid hormone (PTH). Some people have found dramatic relief after having their parathyroid glands removed. The four parathyroid glands sit on the outer surface of the thyroid gland, which is located on the windpipe in the base of your neck, just above the collarbone. The parathyroid glands help control the levels of calcium and phosphorus in the blood.

But a cure for itching that works for everyone has not been found. Phosphate binders seem to help some people; these medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Others find relief after exposure to ultraviolet light. Still others improve with EPO shots. A few antihistamines (Benadryl, Atarax, Vistaril) have been found to help; also, capsaicin cream applied to the skin may relieve itching by deadening nerve impulses. In any case, taking care of dry skin is important. Applying creams with lanolin or camphor may help.

Sleep Disorders

Patients on dialysis often have insomnia, and some people have a specific problem called the sleep apnea syndrome, which is often signaled by snoring and breaks in snoring. Episodes of apnea are actually breaks in breathing during sleep. Over time, these sleep disturbances can lead to "day-night reversal" (insomnia at night, sleepiness during the day), headache, depression, and decreased alertness. The apnea may be related to the effects of advanced kidney failure on the control of breathing.

Treatments that work with people who have sleep apnea, whether they have kidney failure or not, include losing weight, changing sleeping position, and wearing a mask that gently pumps air continuously into the nose (nasal continuous positive airway pressure, or NCPAP).

Many people on dialysis have trouble sleeping at night because of aching, uncomfortable, jittery, or "restless" legs. You may feel a strong impulse to kick or thrash your legs. Kicking may occur during sleep and disturb a bed partner throughout the night. The causes of restless legs may include nerve damage or chemical imbalances.

Moderate exercise during the day may help, but exercising a few hours before bedtime can make it worse. People with restless leg syndrome should reduce or avoid caffeine, alcohol, and tobacco; some people also find relief with massages or warm baths. A class of drugs called benzodiazepines, often used to treat insomnia or anxiety, may help as well. These prescription drugs include Klonopin, Librium, Valium, and Halcion. A newer and sometimes more effective therapy is levodopa (Sinemet), a drug used to treat Parkinson’s disease.

Sleep disorders may seem unimportant, but they can impair your quality of life. Don’t hesitate to raise these problems with your nurse, doctor, or social worker.

Amyloidosis

Dialysis-related amyloidosis (DRA) is common in people who have been on dialysis for more than 5 years. DRA develops when proteins in the blood deposit on joints and tendons, causing pain, stiffness, and fluid in the joints, as is the case with arthritis. Working kidneys filter out these proteins, but dialysis filters are not as effective.

For more information, see the fact sheet on Amyloidosis and Kidney Disease.

The NasugnaM Health does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

Sources:Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Conditions Related to Kidney Failure and Their Treatments. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 07–4666: December 2006

High Blood Pressure and Kidney Disease

2007-04-24T11:26:00.001+08:00

Your kidneys play a key role in keeping your blood pressure in a healthy range, and blood pressure, in turn, can affect the health of your kidneys. High blood pressure, also called hypertension, can damage the kidneys.

What is high blood pressure? Blood pressure measures the force of blood against the walls of your blood vessels. Blood pressure that remains high over time is called hypertension.

Extra fluid in your body increases the amount of fluid in your blood vessels and makes your blood pressure higher. Narrow or clogged blood vessels also raise your blood pressure.

If you have high blood pressure, see your doctor regularly.

How does high blood pressure hurt my kidneys?

High blood pressure makes your heart work harder and, over time, can damage blood vessels throughout your body. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It's a dangerous cycle.

High blood pressure is one of the leading causes of kidney failure, also commonly called end-stage renal disease (ESRD). People with kidney failure must either receive a kidney transplant or go on dialysis. Every year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States.

How will I know whether I have high blood pressure?

Most people with high blood pressure have no symptoms. The only way to know whether your blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure when your heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when your heart is resting between beats.

Your blood pressure is considered normal if it stays below 120/80 (expressed as "120 over 80"). People with a systolic blood pressure of 120 to 139 or a diastolic blood pressure of 80 to 89 are considered prehypertensive and should adopt health-promoting lifestyle changes to prevent diseases of the heart and blood vessels. If your systolic blood pressure is consistently 140 or higher or your diastolic pressure is 90 or higher, you have high blood pressure and should talk with your doctor about the best ways to lower it.

How will I know whether I have kidney damage?

Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. Blood tests will show whether your kidneys are removing wastes efficiently. Your doctor should order tests to measure your serum creatinine. Having too much creatinine in your blood is a sign that you have kidney damage. The doctor should use the serum creatinine to estimate the main kidney function called glomerular filtration rate, or GFR.

Another sign is proteinuria, or protein in your urine. Proteinuria has also been shown to be associated with heart disease and damaged blood vessels.

How can I prevent high blood pressure from damaging my kidneys?

If you have kidney damage, you should keep your blood pressure below 130/80. The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health (NIH), recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.

How can I control my blood pressure?

NHLBI has found that five lifestyle changes can help control blood pressure:

Maintain your weight at a level close to normal. Choose fruits, vegetables, grains, and low-fat dairy foods.

Limit your daily sodium (salt) intake to 2,000 milligrams or lower if you already have high blood pressure. Read nutrition labels on packaged foods to learn how much sodium is in one serving. Keep a sodium diary.

Get plenty of exercise, which means at least 30 minutes of moderate activity, such as walking, most days of the week.

Avoid consuming too much alcohol. Men should limit consumption to two drinks (two 12-ounce servings of beer or two 5-ounce servings of wine or two 1.5-ounce servings of "hard" liquor) a day. Women should have no more than a single serving on a given day because metabolic differences make women more susceptible to the effects of alcohol.

Limit caffeine intake.

Are there medicines that can help?

Many people need medicine to control high blood pressure. Two groups of medications called ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) lower blood pressure and have an added protective effect on the kidney in people with diabetes. Additional studies have shown that ACE inhibitors and ARBs also reduce proteinuria and slow the progression of kidney damage in people who do not have diabetes.

You may need to take a combination of two or more blood pressure medicines to stay below 130/80. Your doctor may also prescribe a diuretic in addition to your ACE inhibitor or ARB. Diuretics are also called "water pills" because they help you urinate and get rid of excess fluid in your body.

What groups are at risk for kidney failure related to high blood pressure?

All racial groups have some risk of developing kidney failure from high blood pressure. African Americans, however, are more likely than Caucasians to have high blood pressure and to develop kidney problems from it—even when their blood pressure is only mildly elevated. In fact, African Americans are six times more likely than Caucasians to develop hypertension-related kidney failure.

People with diabetes also have a substantially increased risk for developing kidney failure. People who are at risk both because of their race and because of diabetes should have early management of high blood pressure.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), also part of NIH, sponsored the African American Study of Kidney Disease and Hypertension (AASK) to find effective ways to prevent high blood pressure and kidney failure in this population. The results, released in 2003, showed that an ACE inhibitor was better at slowing the progression of kidney disease in African Americans than either of two other drugs.

Content Source:High Blood Pressure and Kidney Disease. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 05–4572: August 2005

Page Last Revised: April 8, 2010

Hematuria: Blood in the Urine

2007-04-24T11:04:00.001+08:00

Hematuria is the presence of red blood cells (RBCs) in the urine. In microscopic hematuria, the urine appears normal to the naked eye, but examination with a microscope shows a high number of RBCs. Gross hematuria can be seen with the naked eye—the urine is red or the color of cola.

Causes:

Several conditions can cause hematuria, most of them not serious. For example, exercise may cause hematuria that goes away in 24 hours. Many people have hematuria without any other related problems. Often no specific cause can be found. But because hematuria may be the result of a tumor or other serious problem, a doctor should be consulted.

Diagnosis of Hematuria

To find the cause of hematuria, or to rule out certain causes, the doctor may order a series of tests, including urinalysis, blood tests, kidney imaging studies, and cystoscopic examination.

Urinalysis is the examination of urine for various cells and chemicals. In addition to finding RBCs, the doctor may find white blood cells that signal a urinary tract infection or casts, which are groups of cells molded together in the shape of the kidneys' tiny filtering tubes, that signal kidney disease. Excessive protein in the urine also signals kidney disease

Blood tests may reveal kidney disease if the blood contains high levels of wastes that the kidneys are supposed to remove.

Kidney imaging studies include ultrasound, computerized tomography (CT) scan, or intravenous pyelogram (IVP). An IVP is an x ray of the urinary tract. Imaging studies may reveal a tumor, a kidney or bladder stone, an enlarged prostate, or other blockage to the normal flow of urine.

A cystoscope can be used to take pictures of the inside of the bladder. It has a tiny camera at the end of a thin tube, which is inserted through the urethra. A cystoscope may provide a better view of a tumor or bladder stone than can be seen in an IVP.

Treatment of Hematuria

Treatment depends on the cause of hematuria. If no serious condition is causing the hematuria, no treatment is necessary.

Source:

Hematuria (Blood in the Urine). National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 07–4559: February 2007