Diseases Treatment

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.

Obstructions

The most common abnormalities involving the infections of urinary tract, and the most important from the point of view of kidney damage, are obstructions. Obstructions can occur in the area where the urine-collecting pelvis of the kidney merges with the narrow ureter, or they may occur anywhere along the ureter. For example, a stone or congenital stricture may obstruct the ureter any­where along its course. Or obstruction can occur within the bladder from a tumor which blocks the openings of both ureters into the bladder, or it can occur at the bladder neck from congenital lesions, tumors, stones, or strictures.

Obstruction anywhere along the line causes urine to back up, as a river backs up behind a dam. Back pressure produces hydronephrosis, a swelling of the kidney pelvis, and the ureter becomes distended and swollen above the level of obstruction. Hydraulic pressure squeezes kidney tissue which begins to atrophy. Functioning capacity is gradually lost and the inflated kidney is at risk of becoming totally useless. When destruction of any nature is discovered, it must be removed by appropriate therapy to prevent irreparable harm.
Ureters

Injuries which tear, puncture, or otherwise disrupt a ureter permit urine to seep into surrounding tissues like water from a burst pipe. Repair is surgical. Strictures and stones may cause obstruction. Tumors may produce obstruction and gross bleeding into the bladder. The most important single difference between lesions of the ureter and the kidney itself is that ureteral obstruction invariably produces pain, but lesions of the kidney frequently do not. The pain warning generally leads to early diagnosis and removal of an obstruction which can do untold harm to the kidney above it.

Cancer of the Bladder

It is extremely important that persons who have any difficulty or abnormality of urination be carefully examined to ascertain whether any lesions are present in the bladder.

Cancer of the bladder is one of the most common in this country. It is almost as common as cancer of the lungs, although it has not received as much publicity. At the University Hospitals in Iowa City, more than 75 new patients with cancer of the bladder are seen yearly.

The most common evidence of cancer of the bladder is grossly bloody urine, but frequency of urination and cloudy urine may also be important symptoms. When detected early, the outlook is good, when late, poor. Treatment consists of destruction of the tumor by a combination of surgical removal and irradiation therapy. Small tumors may be removed through the urethra with an instrument called the resectoscope. Larger lesions require more radical sur

What is this condition?

Uveitis is an inflammation of one uveal tract of the eye. (The uveal tract consists of the iris, choroid, and related tissue structures.) The disorder occurs as anterior uveitis, which affects the iris (iritis) or both the iris and the ciliary body (iridocyclitis); as posterior uveitis, which affects the choroid (choroiditis) or both the choroid and the retina (chorioretinitis); or as panuveitis, which affects the entire uveal tract.

Untreated anterior uveitis progresses to posterior uveitis, causing scarring, cataracts, and glaucoma. With immediate treatment, anterior uveitis usually subsides after a few days to several weeks; however, recurrence is likely. Posterior uveitis generally causes some residual vision loss and markedly blurred vision.
What causes it?

In most cases, the cause of uveitis is unknown. But it can result from allergy, bacteria, viruses, fungi, chemicals, traumatic injury, surgery, or systemic diseases, such as rheumatoid arthritis, ankylosing spondylitis, and toxoplasmosis.
What are its symptoms?

Anterior uveitis produces moderate to severe pain in one eye; severe ciliary congestion; sensitivity to light; tearing; a small, nonreactive pupil; and blurred vision. Posterior uveitis begins insidiously, with complaints of slightly decreased or blurred vision or floating spots. Pain and sensitivity to light may also occur.
How is it diagnosed?

In anterior and posterior uveitis, a slit-lamp exam shows a “flare and cell” pattern, which looks like light passing through smoke. It also shows an increased number of cells over the inflamed area. With a special lens, the doctor can also use slit-lamp and ophthalmoscopic exams to identifY active inflammatory fundus lesions involving the retina or choroid.

In posterior uveitis, serologic tests can reveal if toxoplasmosis is the cause.
How is it Treated?

Uveitis requires vigorous and prompt management, which includes treatment of any known underlying cause and application of eye­drops or ointment, such as 1 % Atropisol or steroids. For severe uveitis, therapy includes oral steroids. However, long-term steroid therapy can cause increased intraocular pressure and increased risk of cataracts.