Diseases Treatment

What do doctors call this condition?

Huntington’s chorea, hereditary chorea, chronic progressive chorea, adult chorea
What is this condition?

Huntington’s disease is a hereditary disease in which degeneration of the cerebral cortex and basal ganglia cause chronic progressive chorea (involuntary movements) and mental deterioration, ending in dementia. Huntington’s disease usually strikes persons between ages 25 and 55 (the average age is 35); however, 2% of cases occur in children, and 5% as late as age 60. Death usually results 10 to 15 years after onset, from suicide, congestive heart failure, or pneumonia.
What causes it?

The cause of Huntington’s disease is unknown. Because this disease is transmitted as a genetic trait common to men and women, either sex can transmit and inherit it. Each child of a parent with this disease has a 50% chance of inheriting it; however, the child who doesn’t inherit it can’t pass it on to his or her own children.
What are its symptoms?

Onset is insidious. The person eventually becomes totally dependent, emotionally and physically, through loss of musculoskeletal control. Gradually, the individual develops progressively severe choreic movements. Such movements are rapid, often violent, and purposeless. Initially, they appear on one side and are more prominent in the face and arms than in the legs. They progress from mild fidgeting to grimacing; tongue smacking; indistinct speech; slow, writhing movements (especially of the hands) related to emotional state; and contracted neck muscles.

Ultimately, the person with Huntington’s disease develops dementia, although the dementia doesn’t always progress at the same rate as the chorea. Dementia can be mild at first but eventually severely disrupts the personality. Such personality changes include obstinacy, carelessness, untidiness, moodiness, apathy, inappropriate behavior, loss of memory and concentration, and sometimes paranoia.
How is it diagnosed?

Huntington’s disease can be detected by positron emission tomography and DNA analysis. Diagnosis is based on a characteristic clinical history: progressive chorea and dementia, onset in early middle age (35 to 40), and confirmation of a genetic link. Computed tomography scan (commonly called a CAT scan) and magnetic resonance imaging (commonly called an MRI) demonstrate brain atrophy. Molecular genetics may detect the gene for Huntington’s disease in people at risk while they’re still symptom-free.
How is it treated?

Because a cure for Huntington’s disease has not yet been found, treatment is supportive, protective, and symptomatic. Tranquilizers, as well as anti psychotics such as Thorazine, Haldol, and Tofranil, help control choreic movements. They also relieve discomfort and depression, making the person easier to manage. However, tranquilizers increase rigidity and can’t stop mental deterioration. Institutionalization is often necessary because of mental deterioration.

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Techniques for studying the functions of the kidney and visualizing the structures and processes of the urinary tract have been highly developed in recent years. Very exact knowledge of urological conditions can be obtained with the assistance of highly refined instruments, chemical analyses, x-ray visualization, and tests of function.
Urinalysis

Diagnosis of disease by inspection of the urine is an ancient and honorable practice, pursued centuries ago by Babylonian magi and Chinese, Hindu, Greek and Roman physicians of the time. In medieval days, the flask of urine was held in high esteem by patients and by practitioners who made diagnoses merely by looking at the portentous fluid.

Today, a properly analyzed urine specimen can tell many precise tales about conditions of the body. A complete urinalysis is not always necessary; it depends on what the doctor wants to learn about a particular patient’s condition. The mere volume of urine passed in 24 hours may, for instance, be significant. Odor and color are gross qualities, and frightening color does not always have frightening significance, as when reddish urine is traced to eating too many beets. Tests for sugar, albumin, specific gravity and acid-alkaline reaction are more or less routine, but more sophisticated tests may be ordered to determine the presence of specific kinds of inorganic crystals, bile, pus, blood cells, bacteria, proteins and other elements. Cultures may be necessary to identify the particular germs responsible for a urinary tract infection, so that effective anti microbial drugs may be used against them. Urine tests alone of course do not tell the whole story about a patient’s condition.
Cystoscopy

From the catheter, the beginning of instrumentation of the urinary tract, it was a tremendous leap to the modern cystoscope. This remarkable instrument consists essentially of a hollow tube with a tiny electric light bulb at its tip, which can be passed into the bladder. Various systems of viewing lenses are then introduced. Thus the interior of the bladder, the tubes leading into it, and the urethra can be inspected visually.

Modern cystoscopes embodying refined improvements are exceedingly versatile instruments. Forms of the cystoscope can be used as operating instruments for destruction of tumors and removal of stones and foreign bodies from the bladder. Recent improvements in the light systems have made it possible to see in the ureter and kidney pelvis, and it is likely that excellent instruments for inspecting the urine-collecting chambers of the kidney’s interior will be developed.
X Rays

Developments in x-ray apparatus have tremendously improved the study of the urinary tract and kidney function. Plain films can now be made which show the outlines of urinary tract structures. Other details can be visualized by injecting radio-opaque substances and making an x-ray film an excretory pyelogram. This enables the entire urinary tract to be visualized and shows any distortions or disturbances associated with disease processes. It is also possible to introduce such substances into particular regions through cystoscopes and catheters. Recent developments in cinefluorography make it possible to take motion pictures of the urinary tract in action, following the introduction of opaque media.

Since the main function of the kidney is to clear certain substances -from the blood, its ability to do so is a measure of kidney function. Highly specialized studies of the chemical constituents of the blood and ability of the kidneys to clear dyes or other substances give important information about how well the organs are doing their job.

Infections of the kidney and its pelvis (pyelonephritis) are quite common. They are of extreme importance because chronic and recurring infections tend to induce changes which in time may interfere seriously with kidney function. In many ways the conditions seem to be related to high blood pressure. Some cases, particularly if untreated or neglected, progress to renal insufficiency­ incapacity of the kidneys to filter toxins adequately from the blood. Retention of these infectious wastes leads to uremia or “uremic poisoning.”

Infections can reach the kidney by various routes: direct ascent of infecting organisms from the bladder; spread from infections in surrounding tissues; and via the bloodstream and lymphatic channels. Acute infections manifest them­selves by pain in the kidney region, fever and chills, and changes in composition of the urine. Chronic and recurrent infections tend to manifest themselves more insidiously in symptoms such as head­ache, nausea or vomiting.

Symptoms Of Kidney Infections

The urine may contain pus (pyuria), colonies of micro-organisms, many white blood cells, and other products of inflammation. Identification of the infecting organisms enables effective antibiotics or other drugs to be given to destroy the organisms. Many acute and chronic infections respond to proper chemotherapy, rest, and general care in the form of fluids and other measures.

However, many kidney infections are complicated by obstructions and conditions which prevent free drainage of the urinary tract. Infected teeth and other foci may introduce infecting organisms into the bloodstream and thence the kidneys, in continuous supply. Extrarenal sources of infection must be recognized and cleared up, and there is need for urological investigation to recognize and correct abnormalities which impede good drainage and perpetuate low-grade infectious organisms. Early diagnosis and treatment is important and neglect may lead to kidney damage that is difficult if not impossible to reverse.

What is this condition?

In this disorder, the brain and the spinal cord meninges become inflamed, usually as a result of bacterial infection. Such inflammation may involve all three meningeal membranes: the dura mater, the arachnoid, and the pia mater. The prognosis is good and complications are rare, especially if the disease is recognized early and the infecting organism responds to antibiotics. However, the death rate in untreated disease is 70% to 100%. The prognosis is poorer for infants and elderly people.
What causes it?

Meningitis is almost always a complication of another bacterial infection: bacteremia (especially from pneumonia, pus in a body cavity, osteomyelitis, or endocarditis), sinus or middle ear infection, encephalitis, myelitis, or brain abscess.

This disorder may also follow skull fracture, a penetrating head wound, lumbar puncture, or ventricular shunt insertion. Aseptic inflammation of the brain and spinal cord membranes also may result from a virus or other organism. Sometimes, no causative organism can be found. Inflammation of the brain and spinal cord membranes may progress to congestion of adjacent tissues and destroy some nerve cells.
What are the symptoms of Meningitis?

The cardinal symptoms of this disorder are the same as those of infection (fever, chills, malaise) and of increased intracranial pressure (headache, vomiting and, rarely, swelling of the optic disk). Signs of meningeal irritation include rigidity at the nape of the neck, involuntary knee flexion when the neck is passively flexed, inability to extend the leg completely when sitting, exaggerated and symmetrical deeptendon reflexes, and backward arching of the back and extremities so that the body rests on the head and heels.

Other symptoms are irregular heartbeats, irritability, extreme sensitivity to light, double vision and other visual problems, and delirium, deep stupor, and coma.

An infant may show signs of infection and is often fretful and refuses to eat. Such an infant may vomit a great deal, leading to dehydration.

As this disease progresses, twitching, seizures (in 30% of infants), or coma may develop. Most older children have the same symptoms as adults. In the subacute form, onset may be gradual.
How is it diagnosed?

A lumbar puncture (spinal tap), showing typical cerebrospinal fluid findings, and certain physical exam findings usually establish this diagnosis. The fluid may appear cloudy or milky white, depending on the number of white blood cells present. Protein levels in cerebrospinal fluid tend to be high; sugar levels may be low. (In subacute disease, fluid findings may vary.) Cerebrospinal fluid culture and sensitivity tests usually identifY the infecting organism unless it’s a virus.

To help determine the major sites of infection, the doctor will take cultures of the blood, urine, and nose and throat secretions; a chest X-ray; and an electrocardiogram. An abnormally high level of white blood cells and electrolyte abnormalities also are common. Computed tomography (commonly called a CAT scan) can rule out brain hematoma, hemorrhage, or tumor.
How is it treated?

To treat this disorder, the person receives appropriate antibiotic therapy and vigorous supportive care. Usually, intravenous antibiotics are given for at least 2 weeks, followed by oral antibiotics. Such antibiotics include Bicillin, Omnipen, or Nafcil. However, if the person is allergic to penicillin, Chloromycetin or Kantrex may be given. Other drugs include a cardiac glycoside such as Lanoxin to control irregular heartbeats, Osmitrol to decrease brain swelling, an anti seizure drug (usually given intravenously) or a sedative to reduce restlessness, and aspirin or Tylenol (or another acetaminophen product) to relieve headache and fever.

Supportive measures include bed rest, reduction of body temperature, and measures to prevent dehydration. The person must be isolated if the nasal cultures are positive for certain organisms. Of course, treatment includes appropriate therapy for any coexisting conditions, such as pneumonia.

Some stones thrive in acid urine, others in alkaline. Medicines and special diets, such as an acid ash diet, may help to maintain desired balances and deter future stone formation. There are other medical measures which a doctor can institute from his special knowledge of the patient’s body chemistry and physical condition. It is of immediate importance to remove stones that are causing serious trouble, and this generally requires surgery . Sometimes it is desirable to remove the entire kidney, if its function has been markedly impaired by a large stone or stones, and if the remaining kidney is healthy and quite capable of continuing the labors that it has shouldered anyhow. Naturally, it is far more desirable for a person who is susceptible to stone formation to cooperate with his doctor in regular checkups, with x-rays and other measures, which may keep trouble from progressing and do everything possible to avert eventual surgical removal of a kidney.

Symptoms Of Kidney Stones

Some stones cause no symptoms, at least for a long time. Fine crystals, no larger than grains of sand, may pass down the ureter and to the outside world without the patient’s being aware of it. Some “silent” stones are too large to enter or obstruct the ureter, but they may move about in the kidney and do quiet injury to delicate tissues. Some stones may practically fill the kidney pelvis and take on the irregular shape of the cavity, like a cast. These are called “stag horn” calculi from their antler like appearance. person who experiences it. The agony is caused by a stone which enters the ureter and works its way down, gouging as it goes. The pain is not necessarily felt in the mid-back, in the area memorialized by old-time advertisements for kidney nostrums, but may be referred to the pelvic region. Indeed, pain is not invariably excruciating, and the immediate symptoms may be nausea, vomiting, chills and fever.

Kidney Stones Treatment

If the stone gets stuck in the ureter, and medical measures can do little more than relieve pain, surgery will probably be necessary to remove an obstruction which can cause urine to back up, distend, and injure the tract above it most gravely. Stone-harried kidneys generally are more prone to infections; modern antibacterial drugs afford potent measures of control.

Often a stone passes into the bladder and acute pain subsides. Bladder stones are relatively easy to remove with instruments which leave no operative scar. The surgical instrument is inserted through the urethra, the stone grasped and crushed, and the particles withdrawn. Occasionally, a stone will lodge in the urethra and prevent urination. Its removal is comparatively easy and always an immense relief to the patient.

Treatment of Vomiting

Simple vomiting from intestinal upsets can usually be arrested by the following steps:

Nothing by mouth for 3/2 hours after last vomiting spell.

Then start with one-half tablespoon of medium strength tea, ginger ale or a cola drink. Increase by a half table­spoon every 20 minutes until four tablespoons are reached. Then cereal, crackers, toast or apple sauce may be offered. Gradually increase the diet but only if the child desires it. Do not give undiluted milk or orange juice until the stomach is settled.

There are a number of medications which can be given by mouth, rectum or by injection which are very effective in arresting a vomiting attack. These are prescribed by the physician.

Treatment of Diarrhea

Most diarrhoeas treatment can be done with comparative ease if the cause is known. For instance, there are milk substitutes for infants who have a hypersensitivity to cow’s milk; there are medications that will soothe an irritation of the gastrointestinal tract; there are other medications that kill intestinal bacteria; the diet can be arranged to temporarily eliminate laxative foods such as spinach, prunes and apricots. Often a simple diarrhea may be eliminated quickly by bringing the child’s milk to a boil and letting it simmer for 15 to 20 minutes (at times boiled skim milk produces faster results). Gradually solids may be added. In many cases of diarrhea, paregoric may be given to slow down the rapid action of the intestines. The dosage depends on the age and weight of the child and should be used at the direction of the child’s doctor. Diarrhea associated with ulcerative colitis, cystic fibrosis or celiac disease requires careful and specific medical care.

Osteoporosis is a chronic disease in which the mineral content of the bones progressively decreases so that the bones become brittle and are easily broken. It is linked to more than 1 million fractures of the hip, spine, and other bones each year. Vertebral bones in the spine shrink and fracture, causing a deformed spine. Bones in the wrist are also common fracture’ sites. Some 25 million Americans are affected by osteoporosis, 80% of whom are postmenopausal women. Although postmenopausal white and Asian women are at highest risk, men and women of all ages and ethnicities can be affected.

Though bones may seem hard, they are made of living cells that require calcium and vitamin D (necessary for optimum absorption of calcium) to grow and stay strong. Almost all of the body’s calcium stores are located in bone. During growth and development, bones typically receive more calcium than they give up. By age 25, when bone density peaks, calcium absorption levels off; at age 30, the bone-building process is over. This is when bone mass maintenance and calcium are especially important. If blood levels of calcium drop, the body withdraws what it needs from its bones. With adequate dietary intake of calcium, bones are spared the effects of calcium depletion that may accelerate osteoporosis.

Calcium is not the only factor associated with bone loss. Estrogen depletion during menopause triggers bone loss up to 1 % a year. By the time a woman is 80, she may have lost 30% to 40% of her bone mass. When bone-mass loss becomes excessive, it may not take even a fall to fracture bones. Simply bending over and lifting 25 pounds-a heavy bag of groceries-could cause injury. During menopause, hormone-replacement therapy in the form of estrogen supplementation is recommended for many women as protection against osteoporosis.

Because nicotine is thought to decrease blood levels of estrogen, smoking also contributes to bone loss. Smokers go through menopause on average at least 2 years earlier than nonsmokers. Genetics may also play a role in osteoporosis. Researchers have identified an osteoporosis gene that determines how well vitamin D facilitates the absorption of calcium. People who have the gene are more resistant to absorbing available calcium. Caffeine and alcohol have also been implicated in bone loss. A recent study found that women who drank two or more cups of caffeinated coffee a day and drank no milk experienced significant loss of bone density after menopause. The effects of caffeine can be negated with consumption of milk. In the same study, coffee drinkers who drank at least one glass of milk per day had 6.5% higher bone density than the coffee only group.
Osteoporosis Treatment

The National Osteoporosis Foundation recommends several simple steps to reduce the risk of contracting this disease. First, consume adequate amounts of calcium, preferably from food. If this doesn’t work, calcium supplements are recommended. The Foundation suggests 1500 mg, which is almost double the amount given in the RDA. 25 Second, consume enough vitamin D (400 IU) to permit absorption of the calcium. Third, consider hormone-replacement therapy (estrogen) and discuss its use with your medical doctor, especially if there is a family history of osteoporosis. And fourth, participate in weight-bearing activities, such as walking, running, and weight training, to prevent bone loss. In one study, women who participated in a year-long exercise program and received daily doses of estrogen experienced a 7% increase in bone density and fared better than women on estrogen alone. Physical exercise forces bones to adapt to the stresses imposed on them, and they hypertrophy in response. Bones atrophy when they are unstressed.

People with osteoporosis can and should exercise, but the type of physical activity and the intensity of exercise must be carefully selected. Forceful contractions of muscles and high-impact activities should be avoided because they may stress the bones beyond their breaking point. Swimming, water aerobics, stationary cycling, walking, and light weight training are good starting activities for those with osteoporosis.

Kidney Tumors are not uncommon. They may be benign, or they may be malignant that is, cancerous, with ability to spread to other parts of the body (metastasize). The benign tumors are essentially cysts of the kidney, fluid­filled sacs. These may occur in one kidney or both, and may produce a large mass in the abdomen of the patient.

Malignant tumors practically always affect only one kidney. They arise in functioning tissue of the kidney. In general, kidney malignancies occur in two periods of life, in infancy, and in mid-adult life. Broadly speaking, there are two types: the so-called Wilms’ tumor of childhood, and the malignancy of the adult; the so­called hypernephroma, which occurs primarily in persons over the age of 40. There are other malignant tumors which need not be discussed, because they are extremely rare and their effects are quite similar to those of Wilms’ and hypernephroma tumors.
Kidney Tumor Symptoms

Evidences of such kidney tumors are primarily pain in one side or the other, bloody urine, or appearance of a mass in the abdomen in the region of the kidney. The symptom of bloody urine may not be accompanied by pain. There may be periods when there is no blood in the urine, and precious time may be lost in hope that the symptom will “go away.” It is always a symptom that calls for immediate investigation, although it may originate from quite another cause than cancer.
Kidney Tumor Cure

As with all cancers, the best hope of cure lies in early treatment.A mother is often the first to discover a Wilms’ tumor, as an abdominal mass, in the course of caring for her baby. The tumor usually occurs before the age of seven. A mass that can be felt in the abdomen is not necessarily a Wilms’ tumor. A very large hydronephrosis, which we will discuss later, can also produce a mass and is much more common than Wilms’ tumor. Congenital cysts of the kidney also may produce a large abdominal mass. Every child who has a palpable mass in the abdomen should be investigated promptly. The treatment for Wilms’ tumor and hypernephroma is removal.

What do doctors call this condition?

Parkinsonism, paralysis agitans, shaking palsy
What is this condition?

Named for James Parkinson, the English doctor who wrote the first accurate description of the disease in 1817, Parkinson’s disease is a slowly progressive movement disorder that characteristically produces muscle rigidity, loss or absence of voluntary motion (akinesia), and involuntary tremors.

One of the most common crippling diseases in the United States, Parkinson’s disease affects men more often than women, and strikes 1 in every 100 people over age 60. Because of increased longevity, this amounts to roughly 60,000 new cases diagnosed annually in the United States alone.
What causes it?

Although the cause of Parkinson’s disease in unknown, studies of the brain have established that a deficiency of a neurotransmitter, dopamine, prevents brain cells from performing their normal function within the central nervous system.
Parkinsons Disease symptoms?

The cardinal symptoms of Parkinson’s disease are muscle rigidity and akinesia and an insidious tremor that begins in the fingers (unilateral “pill-roll” tremor), increases during stress or anxiety, and decreases with purposeful movement and sleep. Muscle rigidity results in resistance to passive muscle stretching, which may be uniform or jerky.

Akinesia causes the person with Parkinson’s disease to walk with difficulty, either bent backward or falling forward.

Akinesia also produces a high-pitched, monotone voice; drooling; a masklike facial expression; loss of posture control; and difficulty swallowing or speaking (or both). Occasionally, the person’s eyes are fixed upward, with involuntary tonic movements, or the eyelids are completely closed. Parkinson’s disease itself doesn’t impair the intellect, but a coexisting disorder, such as arteriosclerosis, may do so.
How is it diagnosed?

Lab tests are not usually helpful in identifYing Parkinson’s disease, so the diagnosis is based on the person’s age and history, and the characteristic clinical picture of the disease. However, a urinalysis may support the diagnosis by revealing decreased dopamine levels. A conclusive diagnosis is possible only after ruling out involutional depression, cerebral arteriosclerosis, other causes of tremor and, in people under age 30, intracranial tumors, Wilson’s disease, or toxicity from phenothiazine or other drugs.
How is it treated?

Because there’s no cure for Parkinson’s disease, the primary aim of treatment is to relieve symptoms and keep the person functional as long as possible. Treatment consists of drugs, physical therapy and, in severe cases unresponsive to drugs, neurosurgery.

Drug therapy usually includes Larodopa, a dopamine replacement that’s most effective during early stages of the disease. It’s given in increasing doses until symptoms are relieved or side effects appear. Because side effects can be serious, a combination drug­Sinemet-is frequently given. When Larodopa proves unsuitable, alternative drug therapy includes anticholinergics, such as Artane; antihistamines, such as Benadryl; and Symmetrel, an antiviral agent. Eldepryl, an enzyme-inhibiting agent, allows conservation of dopamine and enhances the therapeutic effect of Larodopa.

When drug therapy fails, stereotactic neurosurgery may be an alternative. In this procedure, electrical coagulation, freezing, radioactivity, or ultrasound is used to inactivate a small, specific portion of the brain to prevent involuntary movement. This is most effective in young, otherwise healthy people with unilateral tremor or muscle rigidity. However, neurosurgery can only relieve symptoms.

Individually planned physical therapy complements drug treatment and neurosurgery to maintain normal muscle tone and function
What can a person with Parkinson’s disease do?

• If you have difficulty eating, eat frequent small meals to increase your caloric intake.

• To help establish a regular bowel elimination routine, drink plenty of fluids and eat high-fiber foods.

• If you have trouble moving from a standing to a sitting position, consider installing an elevated toilet seat.

• If you have excessive tremors, you may achieve partial control of your body by sitting on a chair and using its arms to steady yourself.

• Remember that fatigue may cause you to depend more on others.

• As instructed by your doctor, use proper positioning to help prevent bed sores and contractures .

• If you’re taking Larodopa, follow your doctor’s instructions on which foods to avoid (such as multivitamin preparations and fortified cereals) .

• Take household safety measures to prevent accidents.

• For more information, contact the National Parkinson Foundation or the United Parkinson Foundation.