29 Mei 2008
Diabetes
Diabetes means that your blood sugar is too high. Your blood always has some sugar in it because the body uses sugar for energy; it's the fuel that keeps you going. But too much sugar in the blood is not good for your health. Your body changes most of the food you eat into sugar. Your blood takes the sugar to the cells throughout your body. The sugar needs insulin to get into the body's cells. Insulin is a hormone made in the pancreas, an organ near the stomach. The pancreas releases insulin into the blood. Insulin helps the sugar from food get into body cells. If your body does not make enough insulin or the insulin does not work right, the sugar can't get into the cells, so it stays in the blood. This makes your blood sugar level high, causing you to have diabetes.
Diabetes can lead to blindness, heart disease, stroke, kidney failure, amputations (having a toe or foot removed, for example), and nerve damage. In women, diabetes can cause problems during pregnancy and make it more likely that your baby will be born with birth defects.
Pre-diabetes means your blood sugar is higher than normal but lower than the diabetes range. It also means you are at risk of getting type 2 diabetes and heart disease. The good news is: You can reduce the risk of getting diabetes and even return to normal blood sugar levels with modest weight loss and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose (sugar) checked again in 1 to 2 years.
The three main types of diabetes are:
Type 1 diabetes is commonly diagnosed in children and young adults, but it's a lifelong condition. If you have this type of diabetes, your body does not make insulin, so you must take insulin every day. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, eating healthy, exercising regularly, taking aspirin daily (for some), and controlling blood pressure and cholesterol.
Type 2 diabetes is the most common type of diabetes — about 9 out of 10 people with diabetes have type 2 diabetes. You can get type 2 diabetes at any age, even during childhood. In type 2 diabetes, your body makes insulin, but the insulin can't do its job, so sugar is not getting into the cells. Treatment includes taking medicine, eating healthy, exercising regularly, taking aspirin daily (for some), and controlling blood pressure and cholesterol.
Gestational (jess-TAY-shun-ul) diabetes occurs during pregnancy. This type of diabetes occurs in about 1 in 20 pregnancies. During pregnancy your body makes hormones that keep insulin from doing its job. To make up for this, your body makes extra insulin. But in some women this extra insulin is not enough, so they get gestational diabetes. Gestational diabetes usually goes away when the pregnancy is over. Women who have had gestational diabetes are more likely to develop type 2 diabetes later in life.
About 20 million Americans have diabetes, about half of whom are women. As many as one third do not know they have diabetes.
Type 1 diabetes occurs at about the same rate in men and women, but it is more common in Whites than in minorities.
Type 2 diabetes is more common in older people, mainly in people who are overweight. It is more common in African Americans, Hispanic Americans/Latinos, and American Indians.
Causes diabetes
Type 1 and type 2 diabetes — The exact causes of both types of diabetes are still not known. Type 1 diabetes tends to show up after a person is exposed to a trigger, such as a virus, which can start an attack on the cells in the pancreas that make insulin. There is no one cause for type 2 diabetes, but it seems to run in families, and most people who get type 2 diabetes are overweight.
Gestational diabetes — Changing hormones and weight gain are part of a healthy pregnancy, but these changes make it hard for your body to keep up with its need for insulin. When that happens, your body doesn't get the energy it needs from the foods you eat.
Things that can put you at risk for diabetes include:
Age (being older than 45); Overweight or obesity; Family history (having a mother, father, brother, or sister with diabetes)
Race/ethnicity — your family background is African American, American Indian/Alaska Native, Hispanic American/Latino, Asian American/Pacific Islander and Native Hawaiian
Having a baby with a birth weight more than 9 pounds
Having diabetes during pregnancy (gestational diabetes)
High blood pressure — 140/90 mm HG or higher. Both numbers are important. If one or both numbers are usually high, you have high blood pressure.
High cholesterol — total cholesterol over 240 mg/dL
Inactivity — exercising less than 3 times a week
Abnormal results in a prior diabetes test
Having other health conditions that are linked to problems using insulin, like Polycystic Ovarian Syndrome (PCOS)
Having a history of heart disease or stroke
Should I be tested for diabetes?
If you're at least 45-years-old, you should get tested for diabetes, and then you should be tested again every 3 years. If you're 45 or older and overweight (Calculate your Body Mass Index (BMI) you may want to get tested more often. If you're younger than 45, overweight, and have one or more of the risk factors listed in "Am I at Risk for Diabetes?" you should get tested now. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose (blood sugar), pre-diabetes, or diabetes.
Being very thirsty, urinating a lot, feeling very hungry, feeling very tired, losing weight without trying, having sores that are slow to heal, having dry and itchy skin, losing feeling in or having tingling in the hands or feet, having blurry vision and having more infections than usual
If you have one or more of these signs, contact your doctor
More information :
Contacting the National Women's Health Information Center at 1-800-994-9662 or the following organizations:
National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney DiseasesPhone Number(s): (800) 860-8747Internet Address: http://www.niddk.nih.gov/health/diabetes/diabetes.htm
National Diabetes Education ProgramPhone Number(s): (800) 438-5383 (publications ordering)Internet Address: http://ndep.nih.gov/
Centers for Disease Control and PreventionPhone Number(s): (800) 232-4636Internet Address: http://www.cdc.gov/diabetes/
INFECTION ADENOVIRUS
A group of viruses that infect the membranes (tissue linings) of the respiratory tract, the eyes, the intestines, the urinary tract, and are a frequent cause of diarrhea. Adenoviral infections affect infants and young children much more frequently than adults. Although these infections can occur at any time of the year, respiratory tract disease caused by adenovirus is more common in late winter, spring, and early summer.
However, conjunctivitis and pharyngoconjunctival fever caused by adenovirus tend to affect older children mostly in the summer.
Signs and Symptoms
1) Febrile respiratory disease, which is an infection of the respiratory tract that includes a fever, is the most common result of adenoviral infection in children. The illness often appears flu-like and can include symptoms of pharyngitis (inflammation of the pharynx, or sore throat), rhinitis (inflammation of nasal membranes, or a congested, runny nose), cough, and swollen lymph nodes (glands). Sometimes the respiratory infection leads to acute otitis media, an infection of the middle ear. Adenovirus often affects the lower respiratory tract as well, causing bronchiolitis, croup, or viral pneumonia, which is less common but can cause serious illness in infants. Adenovirus can also produce a dry, harsh cough that can resemble whooping cough (pertussis). 2) Gastroenteritis is an inflammation of the stomach and the small and large intestines. Symptoms include watery diarrhea, vomiting, headache, fever, and abdominal cramps.
4) Conjunctivitis (or pinkeye) is a mild inflammation of the conjunctiva (membranes that cover the eye and inner surfaces of the eyelids.
5) Pharyngoconjunctival fever, often seen in small outbreaks among school-age children, occurs when adenovirus affects both the lining of the eye and the respiratory tract. Symptoms include very red eyes and a severe sore throat, sometimes accompanied by low-grade fever, rhinitis, and swollen lymph nodes.
6) Keratoconjunctivitis is a more severe infection that involves both the conjunctiva and cornea (the transparent front part of the eye). This type of adenoviral infection is extremely contagious, and occurs most often in older children and young adults, who complain of red eyes, photophobia (discomfort of the eyes upon exposure to light), tearing, and pain.
ContagiousnessThe types of adenovirus that cause respiratory and intestinal infections spread from person to person through respiratory secretions (coughs or sneezes) or fecal contamination. Fecal material can be ingested through contamination of water supplies, poor hand washing between the bathroom and the kitchen, eating food contaminated by houseflies, or poor hygiene after handling diapers. Indirect transmission can occur through exposure to the contaminated surfaces of furniture and other objects. IncubationOnce a child is exposed to adenovirus, symptoms can develop from 2 days to 2 weeks later.TreatmentAdenoviral illnesses often resemble certain bacterial infections, which can be treated with antibiotics. But antibiotics don't work against viruses. To diagnose the true cause of the symptoms so that proper treatment can be prescribed, your child's doctor may want to test a sample of respiratory or conjunctival secretions, a stool specimen, or blood or urine sample - depending on what condition is being considered. The doctor will decide on a course of action based on your child's condition.
Adenoviral infections usually don't require hospitalization. However, infants and young children may not be able to drink enough fluids to replace what they lose during vomiting or diarrhea and may therefore need to be hospitalized to correct or prevent dehydration. Also, young - especially premature - infants with pneumonia usually need to be hospitalized.If your child has a respiratory infection or fever, getting plenty of rest and taking in extra fluids is essential. A cool-mist humidifier (vaporizer) may help loosen congestion and make your child more comfortable. Be sure to clean and dry the humidifier thoroughly each day to prevent bacterial or mold contamination. If your child is under 6 months old, you may need to clear his or her nose with a bulb syringe. Don't give any over-the-counter (OTC) cold remedies or cough medicines without checking with your child's doctor.
You can use acetaminophen to treat a fever; however, do not give aspirin because of the risk of Reye syndrome, a life-threatening illness.If your child has diarrhea or is vomiting, increase fluid intake and check with the doctor about giving an oral rehydration solution to prevent dehydration. To relieve the symptoms of conjunctivitis, use warm compresses and a topical eye ointment or drops if your child's doctor recommends them.DurationMost adenoviral infections last from a few days to a week. Severe respiratory infections may last longer and cause lingering symptoms, such as a cough. Pneumonia can last anywhere from 2 to 4 weeks. In cases of pharyngoconjunctival fever, sore throat and fever may disappear within a week, but conjunctivitis can persist for another several days to a week.
The more severe keratoconjunctivitis can even last for several weeks. Adenovirus can also cause diarrhea that lasts up to 2 weeks, which is longer than other viral diarrheas.PreventionThere's no way to completely prevent adenoviral infections in children. To reduce the risk of transmission, parents and other caregivers should encourage frequent hand washing, keep shared surfaces such as countertops and toys clean, and remove children with infections from group settings until symptoms subside.
When to Call Your Child's Doctor
1) A fever continues more than a few days 2) A symptoms seem to get worse after a week 3) Your child has breathing problems 4) Your child is under 3 months old 5) Any swelling and redness around the eye becomes more severe or painful 6) Your child shows signs of dehydration, such as appearing tired or lacking energy, producing less urine or tears, or having a dry mouth or sunken eyesRemember that you know your child best. If he or she appears to be severely ill, don't hesitate to call your child's doctor right away.From : Nemours Foundation Kids health
27 Mei 2008
Pharmacology of Coccaine
Cocaine in its purest form is a white, pearly product. Cocaine appearing in powder form is a salt, typically cocaine hydrochloride (CAS 53-21-4). Street market cocaine is frequently adulterated or “cut” with various powdery fillers to increase its weight; the substances most commonly used in this process are baking soda; sugars, such as lactose, dextrose, inositol, and mannitol; and local anesthetics, such as lidocaine or benzocaine, which mimic or add to cocaine's numbing effect on mucous membranes. Cocaine may also be "cut" with other stimulants such as methamphetamine.Adulterated cocaine is often a white, off-white or pinkish powder.
The color of “crack” cocaine depends upon several factors including the origin of the cocaine used, the method of preparation – with ammonia or baking soda – and the presence of impurities, but will generally range from white to a yellowish cream to a light brown. Its texture will also depend on the adulterants, origin and processing of the powdered cocaine, and the method of converting the base. It ranges from a crumbly texture, sometimes extremely oily, to a hard, almost crystalline nature.
From : Wikipedia
24 Mei 2008
Aspergillosis
Aspergillosis is a large spectrum of fungi infection diseases caused by members of the genus Aspergillus. The three principal entities are: allergic bronchopulmonary aspergillosis, pulmonary aspergilloma and invasive aspergillosis. Colonization of the respiratory tract is also common. The clinical manifestation and severity of the disease depends upon the immunologic state of the patient. Lowered host resistance due to such factors as underlying debilitating disease, neutropenia chemotherapy, disruption of normal flora, and an inflammatory response due to the use of antimicrobial agents and steroids can predispose the patient to colonization, invasive disease, or both. Aspergillus spp. are frequently secondary opportunistic pathogens in patients with bronchiectasis, carcinoma, other mycoses, sarcoid, and tuberculosis.
Aspergillosis also dangerous for our livestock. At 1960 in England happened the epidemic which caused big loss at turkey ranch over there. With study known the the epidemic caused of existence of mikotoksin at feed livestock yielded by mushroom of Aspergillus flavus. Start the moment that's emerging various research of concerning the micotoxin. At 1972 Wookey find in New Guinea of feed substance which is a lot of contaminated by aflatoxin are peanut, sorgum,dan maize with the rate until 500 ppb.In Thailand in the year 1982 found the fact that peanut and maize over there a lot of impure of aflatoxin that is each 77% and 60% with the rate 12,5 - 20 ppb Shotwell and Hasseltine 1983 in Virginia there are 25% impure maize of aflatoxin with the rate 21 - 137 ppb. Culvenor 1974 said expressing peaceful aflatoxin for chicken with the maximal rate 200 ppb, for human being maximal peaceful rate 30 ppb. Pursuant to various research of other;dissimilar contamination rate very depend on climate and weather; in moment of rain season contaminat rate can 2-3 times in drought season.
Forms of the disease Sites
Colonization, allergic bronchopulmonary aspergillosis and toxicoses involved sinuses, lungs
Pulmonary aspergilloma involved Pre-existing lung cavity
Invasive aspergillosis
Pulmonary aspergillosis, CNS aspergillosis, Sinonasal aspergillosis, Osteomyelitis Endophthalmitis, Endocarditis, Renal abscesses, Cutaneous (burns, post surgical wounds, IV insertion sites, etc).
Others : Otomycosis, Exogenous endophthalmitis, Allergic fungal sinusitis and Urinary tract fungus balls
Change of patologis organ for example hiperplasia bile tract, vacuoliszation of hepar cell, megalositosis, fibrosis at hepar tissue
Prognosis
Prognosis depends upon the type and severity of disease as well as the immunological status of the patient. Allergic aspergillosis is typically a chronic entity, but evolves from episodes of acute corticosteroid-responsive asthma to fibrotic end-stage lung disease. Allergic aspergillosis has been successfully treated with corticosteroids, and intraconazole. The prolonged use of steroids in cases of chronic aspergillosis should be approached with caution.
Treatment TheraphyAspergillomas may be treated by surgical resection. However, this approach may cause significant morbidity and mortality, therefore it should be reserved for patients at high risk to develop severe hemoptysis.Invasive aspergillosis may be treated with voriconazole, amphotericin B (deoxycholate and lipid preparations), and itraconazole. The ability of voriconazole to effectively treat invasive aspergillosis and to reduce associated mortality was recently demonstrated by a large well-conducted randomized trial and is particulary noteworthy. A large number of new investigational drugs (posaconazole, ravuconazole, caspofungin, FK463, and anidulafungin (LY303366)) have activity against Aspergillus spp. and are being extensively evaluated. Caspofungin was also recently licensed in the United States for treatment of invasive aspergillosis in patients who are refractory to, or intolerant of other therapies (i.e., amphotericin B, lipid formulations of amphotericin B, and/or itraconazole). However, despite these advances in therapy, the invasive forms of aspergillosis are often associated with significant morbidity and mortality.Selection of therapy also needs to consider the certainty of the diagnosis. Voriconazole, itraconazole, the investigational azoles with anti-mould activity, and amphotericin B all possess a reasonably broad-spectrum of activity against Aspergillus and the related hyaline moulds. Their activity does, however, vary for the agents of zygomycosis, with posaconazole being the azole with the most reliable activity against this class of fungi. The echinocandin glucan synthesis inhibitors (caspofungin, FK463, and anidulafungin) possess a narrower spectrum of activity and should only be used if the infection is known to be due to Aspergillus spp. Usage of hydrated of sodium of calcium alumunium silicate can prevent the absorbtion aflatoxin in digestion and degrade negativity effect.
Diagnosis of Mesothelioma
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos, or by home renovation using asbestos cement products. Unlike lung cancer, there is no association between mesothelioma and smoking.
Diagnosis
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells. The procedure could diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients.
Typical immunohistochemistry results Positive
EMA (epithelial membrane antigen) in a membranous distribution, WT1 (Wilms' tumour 1), Calretinin, Mesothelin-1, Cytokeratin 5/6, HBME-1 (human mesothelial cell 1)
Typical immunohistochemistry results Negative
CEA (carcinoembryonic antigen), B72.3, MOC-3 1, CD15, Ber-EP4, TTF-1 (thyroid transcription factor-1)
Screening
There is no universally agreed protocol for screening people who have been exposed to asbestos. However some research indicates that the serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.
Staging
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
Pathophysiology
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.
Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.
Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.
Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:
- Neurofibromatosis type 2 at 22q12
- P16INK4A
- P14ARF
Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:
- Inactivation of tumor suppressor genes
- Activation of oncogenes
- Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
- Activation of DNA repair enzymes, which may be prone to error
- Activation of telomerase
- Prevention of apoptosis
Asbestos fibres have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.
Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.
From Wikipedia
Diagnosis
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells. The procedure could diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients.
Typical immunohistochemistry results Positive
EMA (epithelial membrane antigen) in a membranous distribution, WT1 (Wilms' tumour 1), Calretinin, Mesothelin-1, Cytokeratin 5/6, HBME-1 (human mesothelial cell 1)
Typical immunohistochemistry results Negative
CEA (carcinoembryonic antigen), B72.3, MOC-3 1, CD15, Ber-EP4, TTF-1 (thyroid transcription factor-1)
Screening
There is no universally agreed protocol for screening people who have been exposed to asbestos. However some research indicates that the serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.
Staging
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
Pathophysiology
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.
Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.
Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.
Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:
- Neurofibromatosis type 2 at 22q12
- P16INK4A
- P14ARF
Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:
- Inactivation of tumor suppressor genes
- Activation of oncogenes
- Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
- Activation of DNA repair enzymes, which may be prone to error
- Activation of telomerase
- Prevention of apoptosis
Asbestos fibres have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.
Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.
From Wikipedia
19 Mei 2008
Androgen Insensitivity Syndrome
What is androgen insensitivity syndrome?
Androgen insensitivity syndrome is a condition that affects sexual development before birth and during puberty. People with this condition are genetically male, with one X and one Y chromosome. Because their bodies are unable to respond to certain hormones (called androgens), they may have mostly female sexual characteristics or signs of both male and female sexual development (hermaphroditism).
Complete androgen insensitivity syndrome occurs when the body cannot use androgens at all. Partial or mild androgen insensitivity syndrome results when tissues are partially sensitive to the effects of androgens. People with partial androgen insensitivity (also called Reifenstein syndrome) can have normal female sexual characteristics, both male and female sexual characteristics, or normal male sexual characteristics. People with mild androgen insensitivity appear male, but are often infertile and tend to develop female breasts at puberty.
How common is androgen insensitivity syndrome?
Complete androgen insensitivity syndrome affects 2 to 5 per 100,000 live male births. Partial androgen insensitivity is at least as common as complete androgen insensitivity. Mild androgen insensitivity is much less common.
What genes are related to androgen insensitivity syndrome?
Mutations in the AR gene cause androgen insensitivity syndrome.
The AR gene provides instructions to make a protein called an androgen receptor. This protein allows cells to respond to androgens, which are hormones (such as testosterone) that direct male sexual development. Androgens and androgen receptors also have other important functions in both males and females, such as regulating hair growth and sex drive. Mutations in the AR gene prevent the androgen receptor from working properly, which makes cells less responsive to androgens or prevents cells from using these hormones at all. Depending on the level of androgen insensitivity, an affected person's sexual characteristics can vary from mostly female to mostly male.
Read more about the AR gene.
How do people inherit androgen insensitivity syndrome?
This condition is inherited in an X-linked recessive pattern. A condition is considered X-linked if the mutated gene that causes the disorder is located on the X chromosome, one of the two sex chromosomes. In males (who have only one X chromosome) one altered copy of the gene in each cell is sufficient to cause the condition. Males are affected by X-linked recessive disorders much more frequently than females. A striking characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons.
About two-thirds of cases are inherited from mothers who carry an altered copy of the AR gene on one of their two X chromosomes. The remaining cases result from a new mutation in a mother's egg cell before the child is conceived.
17 Mei 2008
Cancer Center Research Mesothelioma
ILLINOIS
Robert H. Lurie Cancer CenterNorthwestern UniversityThe Robert H. Lurie Comprehensive Cancer Center of Northwestern University in conjunction with the Northwestern Medical Faculty Foundation recently opened a modern, outpatient clinical cancer center. The facility offers a full range of oncology services and provides access to specialized research, clinical trials and diagnostic services. RHL Cancer Center, Northwestern University 303 East Chicago AvenueOlson Pavilion, Room 8250 Chicago, IL 60611312-908-5250
MARYLAND
Sidney Kimmel Comprehensive Cancer CenterThe Johns Hopkins Comprehensive Care CenterThe Comprehensive Cancer Center at Johns Hopkins is dedicated to better understanding human cancers and finding more effective treatments. The center has active programs in clinical research, laboratory research, education, community outreach, and prevention, treatment and control. Sidney Kimmel Comprehensive Cancer Center is the only such NCI Comprehensive Cancer Center in the state of Maryland. The Center also offers complete family and patient services that include a Cancer Counseling Center, survivors and palliative care programs, and two residences for patients traveling from out-of-town to receive treatment. Sidney Kimmel Comprehensive Cancer Center Johns Hopkins University 600 North Wolfe StreetBaltimore, MD 21287-8943410-955-8822
MASSACHUSETTS
Dana-Farber Cancer Institute, BostonThe mission of Dana-Farber Cancer Institute is to provide expert, compassionate care to children and adults with cancer while advancing the understanding, diagnosis, treatment, cure, and prevention of cancer and related diseases. Dana-Farber Cancer Institute44 Binney StreetBoston, MA 02115617-632-2233
MICHIGAN
University of MichiganComprehensive Cancer CenterThe University of Michigan Comprehensive Cancer Center provides its patients comprehensive diagnostic, treatment and support services in an environment that reflects their mission: the conquest of cancer through innovation and collaboration. Drawing on the strengths of the U-M faculty, the Cancer Center has assembled a team of specialists who are leaders in their fields to unravel the threat of cancer and to provide care and comfort to those it afflicts. UMCCC102 ObservatoryAnn Arbor, MI 48109-0724313-936-1831
Barbara Ann Karmanos Cancer InstituteThe Barbara Ann Karmanos Cancer Institute, backed state-of-the-science cancer research, is the only cancer center in southeast Michigan where teams of cancer experts diagnose patients with world-class precision and compassionate care. Working with hundreds of doctors statewide, the Institute arranges for care convenient for patients and families. Cancer teams and doctors can recommend the best treatment options with the Institute’s immediate access to the latest cancer-fighting drugs and therapies. Karmanos Cancer Institute, Michigan 110 East Warren AvenueDetroit, MI 48201313-833-1146
MINNESOTA
Mayo Cancer CenterMayo FoundationMayo Clinic Cancer Center is the only NCI-designated cancer center with a national presence. It is located in three sites: Scottsdale, Ariz.; Jacksonville, Fla.; and Rochester, Minn. The three locations give Mayo Clinic Cancer Center a broad geographic reach to serve diverse patient populations and bring diverse perspectives to its research. Offers Clinical trials for the treatment of advanced lung cancer and malignant pleural mesothelioma, as just one of the center's many services. Mayo Clinic Cancer Center 200 First Street SWRoghester, MN 55905507-284-3753
NEW HAMPSHIRE
Norris Cotton Cancer CenterProvides a positive environment for treatment, cure, and recovery for patients with all forms of cancer. Patients receive technologically advanced cancer treatments and access to clinical trials of new treatments. Each patient is seen as an individual, and a specific treatment plan is developed by specialists who work directly with the patient, family, and referring physician. The Cancer Center is also a leader in improving the comfort and quality of life of patients. Norris Cotton Cancer Center Dartmouth-Hitchock Medical CenterOne Medical Center Drive Lebanon, NH 03756603-650-4141
NEW YORK
Roswell Park Cancer InstituteRoswell Park Cancer Institute is dedicated to providing total care to the cancer patient; to conducting research into the causes, treatment and prevention of cancer; and to educating the public and the next generation of those who study and treat cancer. Specializing in the diagnosis and treatment of mesothelioma and other forms of cancer. Roswell Park Cancer Institute Elm and Carlton Streets Buffalo, NY 14263800-767-9355213-845-5770
Columbia-Presbyterian Comprehensive Cancer CenterOngoing clinical trials for mesothelioma treatment among a full range of research, care, after-care and support in helping patients set on the goal of surviving cancer. Herbert Irving Comprehensive Cancer CenterCollege of Physicians and Surgeons701 West 168th Street New York, NY 10032212-305-6921
Memorial Sloan-Kettering Cancer CenterOne of the world's premier cancer centers, Memorial Sloan-Kettering Cancer Center is committed to exceptional patient care, leading-edge research, and superb educational programs. Provides comprehensive services in the field of mesothelioma treatment, as well as extensive support for those surviving from asbestos caused and other forms of cancer. Memorial Sloan-Kettering Cancer Center1275 York Avenue New York, NY 10021Physician Referral Service: 800-525-2225General Information & Appointment Scheduling: 212-639-2000
Robert H. Lurie Cancer CenterNorthwestern UniversityThe Robert H. Lurie Comprehensive Cancer Center of Northwestern University in conjunction with the Northwestern Medical Faculty Foundation recently opened a modern, outpatient clinical cancer center. The facility offers a full range of oncology services and provides access to specialized research, clinical trials and diagnostic services. RHL Cancer Center, Northwestern University 303 East Chicago AvenueOlson Pavilion, Room 8250 Chicago, IL 60611312-908-5250
MARYLAND
Sidney Kimmel Comprehensive Cancer CenterThe Johns Hopkins Comprehensive Care CenterThe Comprehensive Cancer Center at Johns Hopkins is dedicated to better understanding human cancers and finding more effective treatments. The center has active programs in clinical research, laboratory research, education, community outreach, and prevention, treatment and control. Sidney Kimmel Comprehensive Cancer Center is the only such NCI Comprehensive Cancer Center in the state of Maryland. The Center also offers complete family and patient services that include a Cancer Counseling Center, survivors and palliative care programs, and two residences for patients traveling from out-of-town to receive treatment. Sidney Kimmel Comprehensive Cancer Center Johns Hopkins University 600 North Wolfe StreetBaltimore, MD 21287-8943410-955-8822
MASSACHUSETTS
Dana-Farber Cancer Institute, BostonThe mission of Dana-Farber Cancer Institute is to provide expert, compassionate care to children and adults with cancer while advancing the understanding, diagnosis, treatment, cure, and prevention of cancer and related diseases. Dana-Farber Cancer Institute44 Binney StreetBoston, MA 02115617-632-2233
MICHIGAN
University of MichiganComprehensive Cancer CenterThe University of Michigan Comprehensive Cancer Center provides its patients comprehensive diagnostic, treatment and support services in an environment that reflects their mission: the conquest of cancer through innovation and collaboration. Drawing on the strengths of the U-M faculty, the Cancer Center has assembled a team of specialists who are leaders in their fields to unravel the threat of cancer and to provide care and comfort to those it afflicts. UMCCC102 ObservatoryAnn Arbor, MI 48109-0724313-936-1831
Barbara Ann Karmanos Cancer InstituteThe Barbara Ann Karmanos Cancer Institute, backed state-of-the-science cancer research, is the only cancer center in southeast Michigan where teams of cancer experts diagnose patients with world-class precision and compassionate care. Working with hundreds of doctors statewide, the Institute arranges for care convenient for patients and families. Cancer teams and doctors can recommend the best treatment options with the Institute’s immediate access to the latest cancer-fighting drugs and therapies. Karmanos Cancer Institute, Michigan 110 East Warren AvenueDetroit, MI 48201313-833-1146
MINNESOTA
Mayo Cancer CenterMayo FoundationMayo Clinic Cancer Center is the only NCI-designated cancer center with a national presence. It is located in three sites: Scottsdale, Ariz.; Jacksonville, Fla.; and Rochester, Minn. The three locations give Mayo Clinic Cancer Center a broad geographic reach to serve diverse patient populations and bring diverse perspectives to its research. Offers Clinical trials for the treatment of advanced lung cancer and malignant pleural mesothelioma, as just one of the center's many services. Mayo Clinic Cancer Center 200 First Street SWRoghester, MN 55905507-284-3753
NEW HAMPSHIRE
Norris Cotton Cancer CenterProvides a positive environment for treatment, cure, and recovery for patients with all forms of cancer. Patients receive technologically advanced cancer treatments and access to clinical trials of new treatments. Each patient is seen as an individual, and a specific treatment plan is developed by specialists who work directly with the patient, family, and referring physician. The Cancer Center is also a leader in improving the comfort and quality of life of patients. Norris Cotton Cancer Center Dartmouth-Hitchock Medical CenterOne Medical Center Drive Lebanon, NH 03756603-650-4141
NEW YORK
Roswell Park Cancer InstituteRoswell Park Cancer Institute is dedicated to providing total care to the cancer patient; to conducting research into the causes, treatment and prevention of cancer; and to educating the public and the next generation of those who study and treat cancer. Specializing in the diagnosis and treatment of mesothelioma and other forms of cancer. Roswell Park Cancer Institute Elm and Carlton Streets Buffalo, NY 14263800-767-9355213-845-5770
Columbia-Presbyterian Comprehensive Cancer CenterOngoing clinical trials for mesothelioma treatment among a full range of research, care, after-care and support in helping patients set on the goal of surviving cancer. Herbert Irving Comprehensive Cancer CenterCollege of Physicians and Surgeons701 West 168th Street New York, NY 10032212-305-6921
Memorial Sloan-Kettering Cancer CenterOne of the world's premier cancer centers, Memorial Sloan-Kettering Cancer Center is committed to exceptional patient care, leading-edge research, and superb educational programs. Provides comprehensive services in the field of mesothelioma treatment, as well as extensive support for those surviving from asbestos caused and other forms of cancer. Memorial Sloan-Kettering Cancer Center1275 York Avenue New York, NY 10021Physician Referral Service: 800-525-2225General Information & Appointment Scheduling: 212-639-2000
Cancer Center Research Mesothelioma (Alabama, Arizona, California, Connecticut, Washington and Florida)
ALABAMA
University of Alabama at BirminghamIt is the mission of the UAB Comprehensive Cancer Center to provide the most up-to-date and effective care to cancer patients; to advance the nation's scientific understanding of cancer; and to translate this new knowledge into improved diagnosis, treatment, and prevention for all types of cancer including mesothelioma. UAB Comprehensive Cancer CenterBasic Health Sciences Building1824 Sixth Avenue SouthBirmingham, AL 35294-3300205-934-5077
ARIZONA
University of Arizona Cancer CenterArizona's first comprehensive cancer center provides care for and treatment of those who have encountered all forms of cancer including mesothelioma (asbestos related cancer), as well as research into new techniques for prevention and cure, and through educational outreach programs that help people reduce their cancer risk. University of Arizona Cancer Center 1501 North Campbell Ave.Tucson, AZ 85724602-626-7925
CALIFORNIA
Jonsson Comprehensive Cancer Center
UCLA´s Jonsson Comprehensive Cancer Center (JCCC) has established an international reputation for developing new cancer therapies, providing the best in experimental and traditional treatments, and expertly guiding and training the next generation of medical researchers. With a membership of more than 230 physicians and scientists, the Jonsson Cancer Center handles more than 20,000 patient visits per year and conducts hundreds of clinical trials, providing the latest in experimental cancer treatments. Patients at the JCCC benefit from care provided by experts from different specialties who work together to help them contend with the immediate and long-term challenges of cancer. University of California at Los Angeles10833 Le Conte AvenueLos Angeles, CA 90095-1781800-825-2631310-825-5268
USC/Norris Comprehensive Cancer Center
The USC/Norris Comprehensive Cancer Center, located in Los Angeles, is a major regional and national resource for cancer research, treatment, prevention and education. More than 190 basic scientists, physicians and other Keck School of Medicine of USC faculty members who are members of the USC/Norris Cancer Center investigate the complex origins and progression of cancer, develop prevention strategies and search for cures. University of Southern California1441 Eastlake Avenue Los Angeles, CA 90033-0800213-764-0816
University of California San Francisco Comprehensive Cancer Center Housed within one of the nation's top biomedical research universities, the UCSF Comprehensive Cancer Center consolidates the work of researchers and clinicians who are dedicated to four fundamental pursuits: Laboratory research into the causes and events of cancer's progression; clinical research to translate new knowledge into viable treatments; sensitive, state-of-the-art patient care; and population research that can lead to effective prevention, early detection, and quality-of-life improvement for those living with cancer. Several physiciaans, oncologists, doctors and specialists providing mesothelioma treatment resources / information and research are affiliated with or work directly at the UCSF Comprehensive Cancer Center. University of California San Francisco 1600 Divisadero Street, San Francisco, CA 94115 1-800-888-8664
City Of Hope Comprehensive Cancer Center
Throughout its history, City of Hope has been committed to excellence in all areas of biomedical research, patient-centered medical care, and community outreach. StethIn recognition of our excellence in a broad range of new approaches to cancer research and treatment—and our outreach to the community—the
National Cancer Institute (NCI) has designated City of Hope a Comprehensive Cancer Center—one of just a handful of elite institutions nationwide. As a division of the National Institutes of Health, the NCI is the Federal Government's principal agency for cancer research and training. BB The NCI's Cancer Center program acknowledges institutions for their scientific excellence, and their ability to bring diverse research approaches to the problem of cancer. The "Comprehensive Cancer Center" designation indicates that City of Hope has undergone a rigorous peer review process, and has been found to be worthy of this highest level of recognition. City of Hope Comprehensive Cancer Center1500 East Duarte Road Duarte, CA 91010 626-256-HOPE (4673) 310-825-5268
CONNECTICUT
Yale Comprehensive Cancer Center
Yale Cancer Center combines innovative cancer treatment and quality care for patients. YCCC is the only comprehensive cancer center in Southern New England. Cancer treatment is available through multidisciplinary teams who work together to make sure that every aspect of a patient’s treatment plan is well managed. Among other cancer disciplines, YCCC has a team of doctors specializing in and dedicated to mesothelioma diagnosis and treatment. Yale University School of Medicine333 Cedar StreetNew Haven, CT 06520-8028203-785-4095
District of Columbia, WASHINGTON DC
Lombardi Cancer Research Center
Lombardi is the only NCI-designated Comprehensive Cancer Center in the Washington, DC area. LCRC's clinical team offers the latest treatments for virtually every type of cancer. LCRC also provides the Lombardi CancerLine - a free, confidential information and referral resource for questions about cancer prevention, symptoms, screenings, support services, and treatment, or to access any of LCRC's doctors. The CancerLine can be reached at (202) 444-4000 from 9 a.m. to 5 p.m. LCRC at Georgetown University Medical Center3800 Reservoir Road NW Washington, DC 20007202-687-2110
FLORIDA
Sylvester Comprehensive Cancer Center
SCCC is Southern Florida's univserity based cancer center, providing cancer-related research, diagnosis, and treatment at the University of Miami Leonard M. Miller School of Medicine. UM/Sylvester handles more than 1,400 inpatient admissions annually, performs 3,000 surgical procedures, and treats 3,000 new cancer patients each year. In addition, UM/Sylvester physicians and scientists are engaged in 200 clinical trials and receive more than $31 million annually in research grants. University of Miami Medical School1475 Northwest 12th Avenue Miami, FL 33136305-548-4918
University of Alabama at BirminghamIt is the mission of the UAB Comprehensive Cancer Center to provide the most up-to-date and effective care to cancer patients; to advance the nation's scientific understanding of cancer; and to translate this new knowledge into improved diagnosis, treatment, and prevention for all types of cancer including mesothelioma. UAB Comprehensive Cancer CenterBasic Health Sciences Building1824 Sixth Avenue SouthBirmingham, AL 35294-3300205-934-5077
ARIZONA
University of Arizona Cancer CenterArizona's first comprehensive cancer center provides care for and treatment of those who have encountered all forms of cancer including mesothelioma (asbestos related cancer), as well as research into new techniques for prevention and cure, and through educational outreach programs that help people reduce their cancer risk. University of Arizona Cancer Center 1501 North Campbell Ave.Tucson, AZ 85724602-626-7925
CALIFORNIA
Jonsson Comprehensive Cancer Center
UCLA´s Jonsson Comprehensive Cancer Center (JCCC) has established an international reputation for developing new cancer therapies, providing the best in experimental and traditional treatments, and expertly guiding and training the next generation of medical researchers. With a membership of more than 230 physicians and scientists, the Jonsson Cancer Center handles more than 20,000 patient visits per year and conducts hundreds of clinical trials, providing the latest in experimental cancer treatments. Patients at the JCCC benefit from care provided by experts from different specialties who work together to help them contend with the immediate and long-term challenges of cancer. University of California at Los Angeles10833 Le Conte AvenueLos Angeles, CA 90095-1781800-825-2631310-825-5268
USC/Norris Comprehensive Cancer Center
The USC/Norris Comprehensive Cancer Center, located in Los Angeles, is a major regional and national resource for cancer research, treatment, prevention and education. More than 190 basic scientists, physicians and other Keck School of Medicine of USC faculty members who are members of the USC/Norris Cancer Center investigate the complex origins and progression of cancer, develop prevention strategies and search for cures. University of Southern California1441 Eastlake Avenue Los Angeles, CA 90033-0800213-764-0816
University of California San Francisco Comprehensive Cancer Center Housed within one of the nation's top biomedical research universities, the UCSF Comprehensive Cancer Center consolidates the work of researchers and clinicians who are dedicated to four fundamental pursuits: Laboratory research into the causes and events of cancer's progression; clinical research to translate new knowledge into viable treatments; sensitive, state-of-the-art patient care; and population research that can lead to effective prevention, early detection, and quality-of-life improvement for those living with cancer. Several physiciaans, oncologists, doctors and specialists providing mesothelioma treatment resources / information and research are affiliated with or work directly at the UCSF Comprehensive Cancer Center. University of California San Francisco 1600 Divisadero Street, San Francisco, CA 94115 1-800-888-8664
City Of Hope Comprehensive Cancer Center
Throughout its history, City of Hope has been committed to excellence in all areas of biomedical research, patient-centered medical care, and community outreach. StethIn recognition of our excellence in a broad range of new approaches to cancer research and treatment—and our outreach to the community—the
National Cancer Institute (NCI) has designated City of Hope a Comprehensive Cancer Center—one of just a handful of elite institutions nationwide. As a division of the National Institutes of Health, the NCI is the Federal Government's principal agency for cancer research and training. BB The NCI's Cancer Center program acknowledges institutions for their scientific excellence, and their ability to bring diverse research approaches to the problem of cancer. The "Comprehensive Cancer Center" designation indicates that City of Hope has undergone a rigorous peer review process, and has been found to be worthy of this highest level of recognition. City of Hope Comprehensive Cancer Center1500 East Duarte Road Duarte, CA 91010 626-256-HOPE (4673) 310-825-5268
CONNECTICUT
Yale Comprehensive Cancer Center
Yale Cancer Center combines innovative cancer treatment and quality care for patients. YCCC is the only comprehensive cancer center in Southern New England. Cancer treatment is available through multidisciplinary teams who work together to make sure that every aspect of a patient’s treatment plan is well managed. Among other cancer disciplines, YCCC has a team of doctors specializing in and dedicated to mesothelioma diagnosis and treatment. Yale University School of Medicine333 Cedar StreetNew Haven, CT 06520-8028203-785-4095
District of Columbia, WASHINGTON DC
Lombardi Cancer Research Center
Lombardi is the only NCI-designated Comprehensive Cancer Center in the Washington, DC area. LCRC's clinical team offers the latest treatments for virtually every type of cancer. LCRC also provides the Lombardi CancerLine - a free, confidential information and referral resource for questions about cancer prevention, symptoms, screenings, support services, and treatment, or to access any of LCRC's doctors. The CancerLine can be reached at (202) 444-4000 from 9 a.m. to 5 p.m. LCRC at Georgetown University Medical Center3800 Reservoir Road NW Washington, DC 20007202-687-2110
FLORIDA
Sylvester Comprehensive Cancer Center
SCCC is Southern Florida's univserity based cancer center, providing cancer-related research, diagnosis, and treatment at the University of Miami Leonard M. Miller School of Medicine. UM/Sylvester handles more than 1,400 inpatient admissions annually, performs 3,000 surgical procedures, and treats 3,000 new cancer patients each year. In addition, UM/Sylvester physicians and scientists are engaged in 200 clinical trials and receive more than $31 million annually in research grants. University of Miami Medical School1475 Northwest 12th Avenue Miami, FL 33136305-548-4918
Asbestosis Litigation : How to Choose Asbestosis Lawyer
Choosing an Asbestos Lawyer
Choosing an asbestosis lawyer to represent you in court can be a very stressful, confusing, and trying task. Here are some tips that can help you to make the right decision:Does the lawyer have asbestosis lawsuit experience?Most lawyers specialize in a particular field of law. You want to make sure that the lawyer you choose is familiar with your issues and has relevant experience in mesothelioma law. A lawyer that regularly drafts wills may not be the best choice when the subject is an asbestos law.Do your research before selecting a mesothelioma lawyer.Ask the lawyer what experience he or his firm has in handling asbestos cases. Ask how many cases the firm has handled, how many cases the firm has tried, and how your case will be handled.Make sure you know the role of the asbestos lawyer.Once you've decided to hire an asbestos lawyer, be sure that you understand the terms of your agreement.
How often will the lawyer update you? What information will you have to provide for the lawsuit? Do you understand all of your options? What will the total cost be?
If you are not clear on exactly the lawyer is doing, ask for clarification. Even though your chances of success cannot be guaranteed, discuss the approaches to your case. You should be comfortable with your lawyer as you approach your case. Be up front on all the facts and circumstances that surround your asbestos lawsuit. You want to get the agreement you make with your lawyer in writing.Lawyer and asbestos lawsuit fees and costs.Ask what the cost will be for the asbestos lawyer service before any work begins. Also ask whether you will be responsible for other fees and charges. State ethics rule that lawyers are required to charge a reasonable fee. The American Bar Association recommends that lawyers explain their fees, preferably in writing, within a reasonable time after agreeing to represent you. Some state bars require that lawyers put their fees in writing before they take a case. Your lawyer may charge you extra for copying documents, court filing fees, courier service, or research services.
Make sure that you understand what you will be charged for and for how much.Asbestos lawyer and asbestos lawsuit payment arrangements.The most expensive lawyer is not always the best one, nor is a "bargain" rate always a great deal. You want to look for the best balance of experience and cost. To lower costs, you may want to ask your asbestos lawyer if a junior lawyer or paralegal can perform some of the work. You may also want to ask if there are some tasks that you can perform yourself to save time and money. You may be able to copy, pick up or deliver documents, or other menial tasks. An asbestos lawyer may charge a flat fee for a specific task or offer other methods of payment.
Contingency fees. A contingent fee arrangement is that your lawyer gets a percentage of the compensation money you receive as resolution of your asbestos lawsuit. If you do not receive compensation for the lawsuit then your lawyer collects no fees. However, you may owe charges for court fees, copying, and hiring expert witnesses. A contingency fee is a good option for those unable to pay hourly.
Mesothelioma lawsuit records.Your asbestos lawyer may ask you for documents that relate to your lawsuit. Keep copies if you give your lawyer the originals. Also ask for copies of all other important documents. When you get a bill from your lawyer, review it carefully and ask for clarification about any charges that are unclear to you.Asbestos lawsuit class actions.In a class action, a court decides that a group of people (a "class") may have been harmed in a similar way. You may receive a notice giving you the decision to take part in the asbestos lawsuit. Read the notice carefully. If you do not take any action, you most likely will become a member of the class by default. If that happens then you are bound by the outcome of the lawsuit class action, you can't bring your own asbestos lawsuit case, and you won't have direct control of the lawsuit. If you decide to not become a member of the class, you keep the right to bring your own suit and control it directly. You will have to hire and pay for your own asbestos lawyer and you will not share in any benefits that may be won in the asbestos lawsuit class action.Asbestos lawyer service.You may fire your asbestos lawyer at any time if you are not satisfied with the work he or she has performed on your behalf. In some cases you may need the permission of a judge to do this. Please keep in mind that the legal system can move slowly and that an asbestos case may take some time to resolve. Weigh the costs and benefits of starting over with a new lawyer. Your lawsuit might be delayed and that could cost more. Lawyers are subject to state ethics rules and are required to charge reasonable fees; if you think that your lawyer did not treat you fairly, represent you adequately, or charged you too much, communicate with him or her and try to work out a solution. If the attempt to resolve the matter directly with your lawyer is unsuccessful, you may consider filing a complaint with your state or local bar association. For some states, arbitration is available to mediate such problems. If you are satisfied with the work your lawyer has done for you, communicate that as well.
From Asbsestos Lawyer .com
Choosing an asbestosis lawyer to represent you in court can be a very stressful, confusing, and trying task. Here are some tips that can help you to make the right decision:Does the lawyer have asbestosis lawsuit experience?Most lawyers specialize in a particular field of law. You want to make sure that the lawyer you choose is familiar with your issues and has relevant experience in mesothelioma law. A lawyer that regularly drafts wills may not be the best choice when the subject is an asbestos law.Do your research before selecting a mesothelioma lawyer.Ask the lawyer what experience he or his firm has in handling asbestos cases. Ask how many cases the firm has handled, how many cases the firm has tried, and how your case will be handled.Make sure you know the role of the asbestos lawyer.Once you've decided to hire an asbestos lawyer, be sure that you understand the terms of your agreement.
How often will the lawyer update you? What information will you have to provide for the lawsuit? Do you understand all of your options? What will the total cost be?
If you are not clear on exactly the lawyer is doing, ask for clarification. Even though your chances of success cannot be guaranteed, discuss the approaches to your case. You should be comfortable with your lawyer as you approach your case. Be up front on all the facts and circumstances that surround your asbestos lawsuit. You want to get the agreement you make with your lawyer in writing.Lawyer and asbestos lawsuit fees and costs.Ask what the cost will be for the asbestos lawyer service before any work begins. Also ask whether you will be responsible for other fees and charges. State ethics rule that lawyers are required to charge a reasonable fee. The American Bar Association recommends that lawyers explain their fees, preferably in writing, within a reasonable time after agreeing to represent you. Some state bars require that lawyers put their fees in writing before they take a case. Your lawyer may charge you extra for copying documents, court filing fees, courier service, or research services.
Make sure that you understand what you will be charged for and for how much.Asbestos lawyer and asbestos lawsuit payment arrangements.The most expensive lawyer is not always the best one, nor is a "bargain" rate always a great deal. You want to look for the best balance of experience and cost. To lower costs, you may want to ask your asbestos lawyer if a junior lawyer or paralegal can perform some of the work. You may also want to ask if there are some tasks that you can perform yourself to save time and money. You may be able to copy, pick up or deliver documents, or other menial tasks. An asbestos lawyer may charge a flat fee for a specific task or offer other methods of payment.
Contingency fees. A contingent fee arrangement is that your lawyer gets a percentage of the compensation money you receive as resolution of your asbestos lawsuit. If you do not receive compensation for the lawsuit then your lawyer collects no fees. However, you may owe charges for court fees, copying, and hiring expert witnesses. A contingency fee is a good option for those unable to pay hourly.
Mesothelioma lawsuit records.Your asbestos lawyer may ask you for documents that relate to your lawsuit. Keep copies if you give your lawyer the originals. Also ask for copies of all other important documents. When you get a bill from your lawyer, review it carefully and ask for clarification about any charges that are unclear to you.Asbestos lawsuit class actions.In a class action, a court decides that a group of people (a "class") may have been harmed in a similar way. You may receive a notice giving you the decision to take part in the asbestos lawsuit. Read the notice carefully. If you do not take any action, you most likely will become a member of the class by default. If that happens then you are bound by the outcome of the lawsuit class action, you can't bring your own asbestos lawsuit case, and you won't have direct control of the lawsuit. If you decide to not become a member of the class, you keep the right to bring your own suit and control it directly. You will have to hire and pay for your own asbestos lawyer and you will not share in any benefits that may be won in the asbestos lawsuit class action.Asbestos lawyer service.You may fire your asbestos lawyer at any time if you are not satisfied with the work he or she has performed on your behalf. In some cases you may need the permission of a judge to do this. Please keep in mind that the legal system can move slowly and that an asbestos case may take some time to resolve. Weigh the costs and benefits of starting over with a new lawyer. Your lawsuit might be delayed and that could cost more. Lawyers are subject to state ethics rules and are required to charge reasonable fees; if you think that your lawyer did not treat you fairly, represent you adequately, or charged you too much, communicate with him or her and try to work out a solution. If the attempt to resolve the matter directly with your lawyer is unsuccessful, you may consider filing a complaint with your state or local bar association. For some states, arbitration is available to mediate such problems. If you are satisfied with the work your lawyer has done for you, communicate that as well.
From Asbsestos Lawyer .com
14 Mei 2008
Gentamicin│Antibiotic
Systematic (IUPAC) name
2-[4,6-diamino-3- [3-amino-6-(1-methylaminoethyl) tetrahydropyran-2-yl] oxy-2-hydroxy- cyclohexoxy]-5-methyl- 4-methylamino-tetrahydropyran-3,5-dio
Excretion renal
Half life 2 hours
Routes IV/IM
Protein binding 0-10%
Bioavailability limited oral bioavailability
Formula C21H43N5O7
Mol. mass 477.596 g/mol
Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative bacteria. However, this antibiotic is not used for Neisseria gonorrhoeae, Neisseria meningitidis or Legionella pneumophila bacterial infections.
This antibiotic is synthesized by Micromonospora, a genus of Gram-positive bacteria widely present in the environment (water and soil). To highlight their specific biological origins, gentamicin and other related antibiotics produced by this genus (verdamicin, mutamicin, sisomicin, netilmicin, retymicin) have generally their spellings ending in ~micin and not in ~mycin. This antibiotic is a bactericidal antibiotic that works by binding the 50S subunit of the bacterial ribosome, interrupting protein synthesis.
Like all aminoglycosides, when this antibiotic is given orally, it is not systemically active. This is because this antibiotic is not absorbed to any appreciable extent from the small intestine. It appears to be completely eliminated unchanged in the urine. Urine must be collected for many days to recover all of a given dose because the drug binds avidly to certain tissues. It is administered intravenously, intramuscularly or topically to treat infections.
E. coli has shown some resistance to this antibiotic, despite being Gram-negative. This antibiotic is one of the few heat-stable antibiotics that remain active even after autoclaving, which makes it particularly useful in the preparation of certain microbiological growth media.Treatment of susceptible bacterial infections, normally Gram-negative bacteria including Pseudomonas, Proteus, Serratia, and Gram-positive Staphylococcus.
Side effects
All aminoglycosides are toxic to the sensory cells of the ear, but they vary greatly in their relative effects on hearing versus balance. This antibiotic is a vestibulotoxin, and can cause permanent loss of equilibrioception, caused by damage to the vestibular apparatus of the inner ear if taken at high doses or for prolonged periods of time. This antibiotic has on occasion impaired or even wholly destroyed hearing. In most instances, the affected individual has undergone treatment for 2 weeks or more. A small number of affected individuals have a normally harmless mutation in their mitochondrial RNA, that allows the gentamicin to affect their cells. The cells of the ear are particularly sensitive to this. This antibiotic is sometimes used intentionally for this purpose in severe Ménière's disease, to disable the vestibular apparatus.
This antibiotic can also be highly nephrotoxic, particularly if multiple doses accumulate over a course of treatment. For this reason this antibiotic is usually dosed by body weight. Various formulae exist for calculating gentamicin dosage. Also trough and peak serum levels of gentamicin are monitored during treatment, generally before and after the third dose is infused. This antibiotic, like other aminoglycosides, causes nephrotoxicity by inhibiting protein synthesis in renal cells. This mechanism specifically causes necrosis of cells in the proximal tubule, resulting in acute tubular necrosis which can lead to acute renal failure.
From Wikipedia, the free encyclopedia
2-[4,6-diamino-3- [3-amino-6-(1-methylaminoethyl) tetrahydropyran-2-yl] oxy-2-hydroxy- cyclohexoxy]-5-methyl- 4-methylamino-tetrahydropyran-3,5-dio
Excretion renal
Half life 2 hours
Routes IV/IM
Protein binding 0-10%
Bioavailability limited oral bioavailability
Formula C21H43N5O7
Mol. mass 477.596 g/mol
Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative bacteria. However, this antibiotic is not used for Neisseria gonorrhoeae, Neisseria meningitidis or Legionella pneumophila bacterial infections.
This antibiotic is synthesized by Micromonospora, a genus of Gram-positive bacteria widely present in the environment (water and soil). To highlight their specific biological origins, gentamicin and other related antibiotics produced by this genus (verdamicin, mutamicin, sisomicin, netilmicin, retymicin) have generally their spellings ending in ~micin and not in ~mycin. This antibiotic is a bactericidal antibiotic that works by binding the 50S subunit of the bacterial ribosome, interrupting protein synthesis.
Like all aminoglycosides, when this antibiotic is given orally, it is not systemically active. This is because this antibiotic is not absorbed to any appreciable extent from the small intestine. It appears to be completely eliminated unchanged in the urine. Urine must be collected for many days to recover all of a given dose because the drug binds avidly to certain tissues. It is administered intravenously, intramuscularly or topically to treat infections.
E. coli has shown some resistance to this antibiotic, despite being Gram-negative. This antibiotic is one of the few heat-stable antibiotics that remain active even after autoclaving, which makes it particularly useful in the preparation of certain microbiological growth media.Treatment of susceptible bacterial infections, normally Gram-negative bacteria including Pseudomonas, Proteus, Serratia, and Gram-positive Staphylococcus.
Side effects
All aminoglycosides are toxic to the sensory cells of the ear, but they vary greatly in their relative effects on hearing versus balance. This antibiotic is a vestibulotoxin, and can cause permanent loss of equilibrioception, caused by damage to the vestibular apparatus of the inner ear if taken at high doses or for prolonged periods of time. This antibiotic has on occasion impaired or even wholly destroyed hearing. In most instances, the affected individual has undergone treatment for 2 weeks or more. A small number of affected individuals have a normally harmless mutation in their mitochondrial RNA, that allows the gentamicin to affect their cells. The cells of the ear are particularly sensitive to this. This antibiotic is sometimes used intentionally for this purpose in severe Ménière's disease, to disable the vestibular apparatus.
This antibiotic can also be highly nephrotoxic, particularly if multiple doses accumulate over a course of treatment. For this reason this antibiotic is usually dosed by body weight. Various formulae exist for calculating gentamicin dosage. Also trough and peak serum levels of gentamicin are monitored during treatment, generally before and after the third dose is infused. This antibiotic, like other aminoglycosides, causes nephrotoxicity by inhibiting protein synthesis in renal cells. This mechanism specifically causes necrosis of cells in the proximal tubule, resulting in acute tubular necrosis which can lead to acute renal failure.
From Wikipedia, the free encyclopedia
12 Mei 2008
Antidepressants
What are antidepressants?
Antidepressants are medicines used to help people who have depression. Most people with depression get better with treatment that includes these medicines.How do antidepressants work?Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters. Neurotransmitters are needed for normal brain function. Antidepressants help people with depression by making these natural chemicals more available to the brain.
How long will I have to take an antidepressant?
Antidepressants are typically taken for at least 4 to 6 months. In some cases, patients and their doctors may decide that antidepressants are needed for a longer time.
What are the different kinds of antidepressants?
Antidepressants are put into groups based on which chemicals in the brain they affect. There are many different kinds of antidepressants, including:Selective serotonin reuptake inhibitors (SSRIs)-italopram (brand name: Celexa)-escitalopram (brand name: Lexapro)-fluoxetine (brand name: Prozac)-paroxetine (brand names: Paxil, Pexeva)-sertraline (brand name: Zoloft)These medicines tend to have fewer side effects than other antidepressants. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, sexual problems and headache.Tricyclics-amitriptyline (brand name: Elavil)-desipramine (brand name: Norpramin)-imipramine (brand name: Tofranil)-nortriptyline (brand name: Aventyl, Pamelor)Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.Serotonin and norepinephrine reuptake inhibitors (SNRIs)-venlafaxine (brand name: Effexor)-duloxetine (brand name: Cymbalta)Some common side effects caused by these medicines include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased heart rate and increased cholesterol levels can also occur.Norepinephrine and dopamine reuptake inhibitors (NDRIs)bupropion (brand name: Wellbutrin)Some of the common side effects in people taking NDRIs include agitation, nausea, headache, loss of appetite and insomnia. It can also cause increase blood pressure in some people.
Combined reuptake inhibitors and receptor blockers-trazodone (brand name: Desyrel)-nefazodone (brand name: Serzone)-maprotiline-mirtazpine (brand name: Remeron)Common side effects of these medicines are drowsiness, dry mouth, nausea and dizziness. If you have liver problems, you should not take nefazodone. If you have seizures, you should not take maprotiline.
Monamine oxidase inhibitors (MAOIs)-isocarboxazid (brand name: Marplan)-phenelzine (brand name: Nardil)-tranlcypromine (brand name: Parnate)
MAOIs are used less commonly than the other antidepressants. They can have serious side effects, including weakness, dizziness, headaches and trembling. Taking an MAOI antidepressant while you're taking another antidepressant or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will also tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking an MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.Will antidepressants affect my other medicines?Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant.
by familydoctor.org editorial staff. American Academy of Family
Antidepressants are medicines used to help people who have depression. Most people with depression get better with treatment that includes these medicines.How do antidepressants work?Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters. Neurotransmitters are needed for normal brain function. Antidepressants help people with depression by making these natural chemicals more available to the brain.
How long will I have to take an antidepressant?
Antidepressants are typically taken for at least 4 to 6 months. In some cases, patients and their doctors may decide that antidepressants are needed for a longer time.
What are the different kinds of antidepressants?
Antidepressants are put into groups based on which chemicals in the brain they affect. There are many different kinds of antidepressants, including:Selective serotonin reuptake inhibitors (SSRIs)-italopram (brand name: Celexa)-escitalopram (brand name: Lexapro)-fluoxetine (brand name: Prozac)-paroxetine (brand names: Paxil, Pexeva)-sertraline (brand name: Zoloft)These medicines tend to have fewer side effects than other antidepressants. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, sexual problems and headache.Tricyclics-amitriptyline (brand name: Elavil)-desipramine (brand name: Norpramin)-imipramine (brand name: Tofranil)-nortriptyline (brand name: Aventyl, Pamelor)Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.Serotonin and norepinephrine reuptake inhibitors (SNRIs)-venlafaxine (brand name: Effexor)-duloxetine (brand name: Cymbalta)Some common side effects caused by these medicines include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased heart rate and increased cholesterol levels can also occur.Norepinephrine and dopamine reuptake inhibitors (NDRIs)bupropion (brand name: Wellbutrin)Some of the common side effects in people taking NDRIs include agitation, nausea, headache, loss of appetite and insomnia. It can also cause increase blood pressure in some people.
Combined reuptake inhibitors and receptor blockers-trazodone (brand name: Desyrel)-nefazodone (brand name: Serzone)-maprotiline-mirtazpine (brand name: Remeron)Common side effects of these medicines are drowsiness, dry mouth, nausea and dizziness. If you have liver problems, you should not take nefazodone. If you have seizures, you should not take maprotiline.
Monamine oxidase inhibitors (MAOIs)-isocarboxazid (brand name: Marplan)-phenelzine (brand name: Nardil)-tranlcypromine (brand name: Parnate)
MAOIs are used less commonly than the other antidepressants. They can have serious side effects, including weakness, dizziness, headaches and trembling. Taking an MAOI antidepressant while you're taking another antidepressant or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will also tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking an MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.Will antidepressants affect my other medicines?Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant.
by familydoctor.org editorial staff. American Academy of Family
10 Mei 2008
CIPROFLOXACIN (antibiotic) : Side efect
Ciprofloxacin may cause side effects.
Tell your doctor if any of these symptoms are severe or do not go away: Nausea, vomiting, stomach pain, indigestion, diarrhea, headache, nervousness, agitation, anxiety, difficulty falling asleep or staying asleep, nightmares or abnormal dreams, feelings of not trusting others or feelings that others want to hurt you and vaginal itching and/or discharge.
Some side effects can be serious. If you experience any of these symptoms, stop taking ciprofloxacin, and call your doctor immediately: rash or blisters, hives, itching, tingling or swelling ( the face, neck, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs ), difficulty breathing or swallowing, hoarseness, rapid, irregular, or pounding heartbeat, fainting, fever, joint or muscle pain, unusual bruising or bleeding, extreme tiredness, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the skin or eyes, flu-like symptoms, seizures, dizziness, double vision, pulsing sounds in the head or ringing in the ears, confusion, uncontrollable shaking of a part of the body, hallucinations (seeing things or hearing voices that do not exist), depression, thoughts about dying or killing yourself, pain, burning, tingling, numbness, and/or weakness in a part of the body, loss of ability to feel light touch, pain, heat or coldness, or vibration in a part of the body, loss of ability to know position of a part of the body, loss of muscle strength in a part of the body
Ciprofloxacin may cause joint damage in children. Ciprofloxacin should not normally be given to children younger than 18 years old unless they have certain serious infections that cannot be treated with other antibiotics or they have been exposed to anthrax in the air. If your doctor prescribes ciprofloxacin for your child, be sure to tell the doctor if your child has a history of joint-related problems. Call your doctor if your child develops joint problems while taking ciprofloxacin or after treatment with ciprofloxacin. Talk to your child's doctor about the risks of giving ciprofloxacin to your child. Ciprofloxacin may cause other side effects.
Call your doctor if you have any unusual problems while taking this medication.
From : MedlinePlus Drug Information Ciprofloxacin_files
Tell your doctor if any of these symptoms are severe or do not go away: Nausea, vomiting, stomach pain, indigestion, diarrhea, headache, nervousness, agitation, anxiety, difficulty falling asleep or staying asleep, nightmares or abnormal dreams, feelings of not trusting others or feelings that others want to hurt you and vaginal itching and/or discharge.
Some side effects can be serious. If you experience any of these symptoms, stop taking ciprofloxacin, and call your doctor immediately: rash or blisters, hives, itching, tingling or swelling ( the face, neck, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs ), difficulty breathing or swallowing, hoarseness, rapid, irregular, or pounding heartbeat, fainting, fever, joint or muscle pain, unusual bruising or bleeding, extreme tiredness, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the skin or eyes, flu-like symptoms, seizures, dizziness, double vision, pulsing sounds in the head or ringing in the ears, confusion, uncontrollable shaking of a part of the body, hallucinations (seeing things or hearing voices that do not exist), depression, thoughts about dying or killing yourself, pain, burning, tingling, numbness, and/or weakness in a part of the body, loss of ability to feel light touch, pain, heat or coldness, or vibration in a part of the body, loss of ability to know position of a part of the body, loss of muscle strength in a part of the body
Ciprofloxacin may cause joint damage in children. Ciprofloxacin should not normally be given to children younger than 18 years old unless they have certain serious infections that cannot be treated with other antibiotics or they have been exposed to anthrax in the air. If your doctor prescribes ciprofloxacin for your child, be sure to tell the doctor if your child has a history of joint-related problems. Call your doctor if your child develops joint problems while taking ciprofloxacin or after treatment with ciprofloxacin. Talk to your child's doctor about the risks of giving ciprofloxacin to your child. Ciprofloxacin may cause other side effects.
Call your doctor if you have any unusual problems while taking this medication.
From : MedlinePlus Drug Information Ciprofloxacin_files
Infection of Ancylostoma | Parasite infection
Infection of ancylostoma is the common parasite infection case met at human being.
Synonyms :
Hookworm infection, hookworm, hookworm disease
Etiology :
Hookworm is the common name for blood-sucking nematodes of the Ancylostomatidae family; the two species that most commonly infect humans and cause this parasite infection are Ancylostoma duodenale and Necator americanus.
Classic hookworm disease is a gastrointestinal (GI) infection with chronic blood loss leading to iron deficiency anemia and protein malnutrition. The disease is caused by A duodenale, the major anthropophilic hookworm, and, less commonly, by the zoonotic species Ancylostoma ceylanicum.
Cutaneous larva migrans is a parasite infection caused most commonly by larvae of Ancylostoma braziliense, whose definitive hosts include dogs and cats. The manifestations of cutaneous larva migrans are limited to the skin.
Eosinophilic enteritis is a gastro intestinal infection caused by the dog hookworm Ancylostoma caninum. This parasite infection disease is characterized by abdominal pain but no blood loss.
N americanus causes only "classic hookworm disease," as defined above.
In 1880, an epidemic called miners' anemia occurred among Italian laborers building the Saint Gotthard railway tunnel in the Swiss Alps. A duodenale was responsible for the epidemic.
Pathophysiology:
Some of this parasite infection pathophysiology are : Eggs deposited on warm, moist soil develop into infective larvae over 5-7 days. Infective larvae are developmentally arrested and nonfeeding. If unable to infect a new host, the larvae die when their metabolic reserves are exhausted, usually in about 6 weeks. Humans are the major reservoir, and infection is maintained by continual contamination of soil by human feces.
Internationally:
Hookworm infection with human-host species has an estimated global prevalence of 1 billion people (These parasites drain the equivalent of all the blood from approximately 1.5 million people every day.) This parasite infection Infection is most prevalent in tropical and subtropical zones, roughly between the latitudes of 45°N and 30°S. Hookworm infection occurs only in isolated temperate areas.
Infection is endemic in most developing countries. However, even in endemic regions parasite infection is usually confined to rural areas, especially where human feces are used for fertilizer or where sanitation is inadequate. In developed countries, infection is most commonly encountered in travelers, emigrants, and adoptees from developing countries.
A duodenale is the predominant species in the Mediterranean region, northern regions of India and China, and North Africa which cause this parasite infection. A ceylanicum is found in focally parasite infection endemic areas in southern Asia. N americanus is the predominant species in southern China, Southeast Asia, the Americas, most of Africa, and parts of Australia. This differential distribution is not absolute, and mixed infections with both species are common in individual patients.
In endemic areas, highest prevalence is among school-aged children and adolescents, which may be because of age-related changes in exposure and the acquisition of immunity. Once infected, children are more vulnerable to developing morbidity because dietary intake often fails to compensate for intestinal losses of iron and protein, especially in developing countries. A fulminant form of acute GI hemorrhage associated with acute ancylostoma infection has been described in newborns.
Other problem
Other problem of this parasite infection are : Once iron deficiency anemia from blood loss is diagnosed, keep in mind that rare causes of intestinal blood loss (eg, polyps, Meckel diverticulum) are far less common in developing countries.Respiratory symptoms with peripheral eosinophilia should suggest a parasitic etiology.Differentiation between scabies and cutaneous larva migrans is not always easy, especially if the latter occurs with atypical rash. Important distinguishing criteria for scabies are history of exposure, crusty lesions on the hands or feet, and generalized pruritus.
Form of infection
Classic hookworm infection
Humans acquire infection either by exposing skin to soil contaminated with A duodenale or N americanus larvae or by ingesting soil contaminated with A duodenale larvae. In this case parsite infection larval skin penetration requires contact with contaminated soil for 5-10 minutes.
The larvae elaborate a protease that helps the organisms bore through the skin. Larvae entering via the skin migrate through the venous and lymphatic circulation. After traversing pulmonary capillaries, larvae enter lung alveoli and ascend the airways, where they are coughed up and swallowed. Orally ingested larvae may undergo extraintestinal migration or remain in the GI tract.
During the migratory phase, larvae evoke an eosinophilic inflammatory response.
After passively reaching the proximal small intestine, larvae develop into adult, sexually mature male and female worms. Within the small intestine, the adult worm attaches with its mouth to the mucosa and begins to feed. Using its teeth or cutting plates, powerful esophageal muscles, and hydrolytic enzymes, the hookworm digests the plug of tissue within its buccal capsule. At the same time, the worm releases a potent anticoagulant, causing profound bleeding from eroded capillaries in the lamina propria. Worms change location every 4-8 hours, producing minute, bleeding, mucosal ulcerations.
Larvae require about 6-8 weeks from the time of skin penetration to develop into adults. Worms mate in the small intestine, and the females deposit fertilized eggs into the lumen. Eggs begin to appear in feces about 8-12 weeks after infection.
Some A duodenale larvae, however, may undergo a period of extraintestinal dormancy after penetrating the skin before resuming their migration to the gut for maturation. This dormancy period can last weeks or months. As a result of this dormant period, intestinal ancylostomiasis can occur up to a year after initial exposure to infective larvae. The repositories of these dormant larvae may be muscle tissue, or the dormant larvae may enter the mammary glands and breast milk, which may account for cases of infantile ancylostomiasis in Africa, China, and India.
Cutaneous larva migrans
The infective larvae of zoonotic species such as A braziliense do not elaborate sufficient concentrations of hydrolytic enzymes to penetrate the junction of the dermis and epidermis. These larvae remain trapped superficial to this layer, where they migrate laterally at a rate of 1-2 cm/d and create the pathognomonic serpiginous tunnels of cutaneous larva migrans. Larvae can survive in the skin for about 10 days before dying (even in untreated persons).
Eosinophilic enteritis
Larvae of A caninum typically enter a human host by skin penetration, although infection by oral ingestion is possible. In this parasite infection case larvae probably remain dormant in skeletal muscles and create no symptom.
In some individuals, larvae may reach the gut and mature into adult worms. Why some individuals sustain A caninum development and then respond with a severe localized allergic reaction is unknown.
Adult worms secrete various potential allergens into the intestinal mucosa. Some patients have been reported to have increasingly severe recurrent abdominal pain, which may be analogous to a response to repeated insect stings.
08 Mei 2008
Anthrax : Virus infection
What is Anthrax?
Anthrax, pronounced as anthraks, is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. This rod-shaped microbe grows in soil, where it can be ingested by sheep, cows, horses and goats. Anthrax most commonly occurs in warm-blooded animals, but can also infect humans. Anthrax spores can be produced in a dry form (for biological warfare) which may be stored and ground into particles. When inhaled by humans, these particles cause respiratory failure and death within a week.
Transmission to humans normally occurs through contact with infected animals but can also occur through breathing air laden with the spores of the bacilli. The disease is usually restricted to individuals who handle hides of animals (farmers, butchers, and veterinarians) or sort wool.
There are three main types of anthrax: cutaneous, respiratory, and intestinal.
Cutaneous: Most anthrax infections occur when the bacterium enters a cut or abrasion on the skin. Deaths are rare with appropriate antimicrobial therapy.
More on Cutaneous Anthrax
Respiratory: Anthrax infection in the respiratory system (contracted by breathing infected particles). Respiratory anthrax usually results in death in 1-2 days after onset of the acute symptoms.
More on Respiratory Anthrax
Intestinal: Anthrax infection of the intestinal tract. It ususally occurs following the consumption of contaminated meat. It is characterized by an acute inflammation of the intestinal tract.
Symptoms of Anthrax?
Symptoms of anthrax an individual may experience vary depending upon the type of exposure. Skin exposure: (Cutaneous Anthrax) a boil-like lesion appears on the hands, face, and neck. These lesions eventually forms a black center. A swelling of the lymph gland under the arm may occur. The cutaneous form of anthrax is not usually fatal to humans
Respiratory exposure: (Pulmonary Anthrax) symptoms might resemble the common cold and may progress to severe breathing problems and possibly death. Pulmonary anthrax causes lesions in the lungs and brain.
Symptoms of anthrax usually appear within 7 days of exposure.
What Causes Anthrax?
Anthrax is caused by a bacillus (Bacillus anthracis) that primarily affects sheep, horses, hogs, cattle, and goats. Since anthax largely affects sheep, horses, hogs, cattle and goats, it is labeled a veterinary disease. Anthrax is almost always fatal in animals.
How is Anthrax Spread?
Humans can become infected with anthrax by inhaling contaminated soil particles (anthrax can live in soil for years) or by handling wool or hair from diseased animals. Infection of the intestinal tract can occur by eating undercooked meat from diseased animals.
Effects of Anthrax
The inhaled form of anthrax (pulmonary anthrax) is rare and extremely deadly. Studies of previous cases indicate that a dose of 2,500 to 55,000 anthrax spores is lethal to about half of the people who inhale them. The first stage of anthrax infection, lasting from hours to a few days, involves flu-like symptoms, including fever, coughing, weakness and chest pains.
The second stage usually ends in death within days. Lung damage deprives the body of oxygen. The victim then goes into shock. Brain infection may also occur.
Antibiotics only prove helpful at the earliest stages of the disease because they fight bacteria, not the toxins the bacteria produce in abundance.
The cutaneous form of anthrax is caused by the same germ but is contracted through the skin. Three to five days after infection, a painless blister appears. A day or two later, this becomes a black, open sore. Cutaneous anthrax accounts for 95 percent of anthrax cases in the United States, and is easily treated with antibiotics. Left untreated, perhaps 5 percent of cases progress to a dangerous bloodstream infection, which is almost always fatal.
Anthrax Treatment?
Penicillin, tetracycline, erythromycin, or chloramphenicol and other antibiotics may be prescribed by your doctor. To be effective, treatment should be initiated early.
How is Anthrax diagnosed?
Anthrax is diagnosed by isolating the bacterium B. anthracis from the blood, skin lesions, or respiratory secretions. It is also diagnosed by measuring specific antibodies in the blood of persons with suspected cases.
Can Anthrax be prevented?
Anthrax vaccine is available for people in high-risk occupations. The spread of anthrax can be prevented by: carefully handle dead animals suspected of having anthrax; provide good ventilation when processing hides, fur, hair or wool; and vaccinate animals.
Lung Cancer Symptoms
Lung cancer symptoms are rarely felt until the disease has developed into an advanced stage. Even when symptoms are felt, people often tolerate them for some time before they seek medical assistance. For instance, it's easy to shrug off shortness of breath as being out of shape, or a chronic cough as a bad cold or allergies.
More obvious symptoms, such as coughing up blood or dyspnea (difficulty breathing), may occur before medical advice is asked for.Common lung cancer symptoms include:
Constant chest pain
Chronic cough that worsens over time
Coughing up blood (hemoptysis)
Dyspnea (difficulty breathing)
Fatigue
Lung infection (pneumonia, bronchitis)
Shortness of breath
Swollen lymph nodes
Loss of appetite and weight loss
Wheezing.
Wheezing, lung infection, chest pain, or other symptoms can indicate a number of medical conditions other than lung cancer and require professional diagnosis. Dyspnea and coughing up blood are alarming symptoms and require immediate medical attention.Swollen lymph nodes are a sign of infection. The lymphatic system is the primary response system to infections. Malignant cancer cells can also enter the lymphatic system, causing the nodes to swell, and travel to more distant parts of the body, causing the cancer to spread rapidly.There are other lung cancer symptoms in addition to the primary symptoms.
Some of the following may not appear to do much with the respiratory system but in combination with other symptoms can indicate lung cancer:
Bone pain and tenderness
Breast development in men
Weakness
Chills
Speech difficulties or changes (i.e., hoarsness)
Droopy eyelids
Swelling of the face and neck
Fever
Joint pain and swelling
Muscle weakness
Pale or bluish skin
Speech difficulties
The vague nature of many of these symptoms (wheezing, fatigue, shortness of breath, chest pain) shows the need for a reliable screening process for people in high-risk groups. Research has yet to develop a safe, effective screening tool, but clinical trials are making process.
From Asbestos Research Center
Breast Cancer in Pregnancy: Chemo OK
Facing a diagnosis of breast cancer is challenging enough, but facing breast cancer during pregnancy can be nothing short of devastating.
Can I have chemotherapy?
Will the treatment hurt my baby?
New research helps to answer these questions, and the findings should serve to reassure patients and their doctors.
In a German study examining outcomes among 122 pregnant breast cancer patients, researchers concluded that pregnant patients can often be treated as aggressively as non-pregnant patients, with little evidence of ill effects to their babies.
The findings were presented this week at the 6th European Breast Cancer Conference in Berlin.
Sibylle Loibl, MD, of the University of Frankfurt, tells WebMD that it is now clear that most pregnant breast cancer patients do have options.
"The evidence now shows that women who are pregnant are often good candidates for standard breast cancer treatments," she says.
Breast Cancer and Pregnancy
The patients in the study were enrolled in a registry of women diagnosed with breast cancer while pregnant.
All were diagnosed between April 2003 and December 2007. Their average age at diagnosis was 33 and the average gestational age of their babies was 21 weeks.
While a few women terminated their pregnancies, most did not, Loibl says. A total of 33% had surgery alone, 43% had surgery and chemotherapy, 5.4% had chemotherapy alone, and 2.7% had no treatment.
The health problems reported among the babies during their first month of life were generally minor and outcomes among babies born to mothers who had chemotherapy were similar to those of babies born to mothers who did not.
Loibl adds that some of the children in the registry have now been followed for five years, with little evidence of developmental delays or learning issues.
Chemotherapy During Pregnancy
Much of the pioneering research on breast cancer treatment during pregnancy has been done over the past two decades at Houston's University of Texas M.D. Anderson Cancer Center.
M.D. Anderson clinicians were among the first to treat pregnant women with standard chemotherapy protocols. Some of the children born to these women are now in their late teens, and oncologist Jennifer Litton, MD, tells WebMD they are doing quite well.
"There haven't been significant cardiac effects or learning disabilities," she says.
Chemotherapy is not given at M.D. Anderson during the first trimester of pregnancy, when vital organs are still forming and the risk of birth defects is highest.
"The birth defect rate is as high as 20% when chemotherapy is given in the first trimester, but that rate drops to around 1.3% when chemotherapy is given later," she says. "That is on par with the national average," she says.
Chemotherapy-treated patients usually get a combination of three drugs -- fluorouracil, doxorubicin, and cyclophosphamide.
The American Cancer Society estimates that about one in 3,000 pregnant women are diagnosed with breast cancer, and the number is expected to grow as more women have babies in their late 30s and 40s, says Litton.
Litton agrees that pregnant breast cancer patients usually do have options, but they may not hear about them unless they are treated at a major cancer center like M.D. Anderson.
"Studies like this one are getting the message out to community physicians, but it is slow," she says. "This is a case where seeking a second opinion may make a big difference."
FROM : WebMD
SOURCES:
6th European Breast Cancer Conference, Berlin, April 15-19, 2008.
Sibylle Loibl, MD, assistant professor in obstetrics and gynecology, University of Frankfurt, Germany.
Jennifer Litton, MD, assistant professor of breast medical oncology, University of Texas M.D. Anderson Cancer Center, Houston.
CancerWise.org: "Breast Cancer Is Treatable During Pregnancy."
American Cancer Society web site: "Treatment of Breast Cancer During Pregnancy."
Can I have chemotherapy?
Will the treatment hurt my baby?
New research helps to answer these questions, and the findings should serve to reassure patients and their doctors.
In a German study examining outcomes among 122 pregnant breast cancer patients, researchers concluded that pregnant patients can often be treated as aggressively as non-pregnant patients, with little evidence of ill effects to their babies.
The findings were presented this week at the 6th European Breast Cancer Conference in Berlin.
Sibylle Loibl, MD, of the University of Frankfurt, tells WebMD that it is now clear that most pregnant breast cancer patients do have options.
"The evidence now shows that women who are pregnant are often good candidates for standard breast cancer treatments," she says.
Breast Cancer and Pregnancy
The patients in the study were enrolled in a registry of women diagnosed with breast cancer while pregnant.
All were diagnosed between April 2003 and December 2007. Their average age at diagnosis was 33 and the average gestational age of their babies was 21 weeks.
While a few women terminated their pregnancies, most did not, Loibl says. A total of 33% had surgery alone, 43% had surgery and chemotherapy, 5.4% had chemotherapy alone, and 2.7% had no treatment.
The health problems reported among the babies during their first month of life were generally minor and outcomes among babies born to mothers who had chemotherapy were similar to those of babies born to mothers who did not.
Loibl adds that some of the children in the registry have now been followed for five years, with little evidence of developmental delays or learning issues.
Chemotherapy During Pregnancy
Much of the pioneering research on breast cancer treatment during pregnancy has been done over the past two decades at Houston's University of Texas M.D. Anderson Cancer Center.
M.D. Anderson clinicians were among the first to treat pregnant women with standard chemotherapy protocols. Some of the children born to these women are now in their late teens, and oncologist Jennifer Litton, MD, tells WebMD they are doing quite well.
"There haven't been significant cardiac effects or learning disabilities," she says.
Chemotherapy is not given at M.D. Anderson during the first trimester of pregnancy, when vital organs are still forming and the risk of birth defects is highest.
"The birth defect rate is as high as 20% when chemotherapy is given in the first trimester, but that rate drops to around 1.3% when chemotherapy is given later," she says. "That is on par with the national average," she says.
Chemotherapy-treated patients usually get a combination of three drugs -- fluorouracil, doxorubicin, and cyclophosphamide.
The American Cancer Society estimates that about one in 3,000 pregnant women are diagnosed with breast cancer, and the number is expected to grow as more women have babies in their late 30s and 40s, says Litton.
Litton agrees that pregnant breast cancer patients usually do have options, but they may not hear about them unless they are treated at a major cancer center like M.D. Anderson.
"Studies like this one are getting the message out to community physicians, but it is slow," she says. "This is a case where seeking a second opinion may make a big difference."
FROM : WebMD
SOURCES:
6th European Breast Cancer Conference, Berlin, April 15-19, 2008.
Sibylle Loibl, MD, assistant professor in obstetrics and gynecology, University of Frankfurt, Germany.
Jennifer Litton, MD, assistant professor of breast medical oncology, University of Texas M.D. Anderson Cancer Center, Houston.
CancerWise.org: "Breast Cancer Is Treatable During Pregnancy."
American Cancer Society web site: "Treatment of Breast Cancer During Pregnancy."
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