Normally the brain's cells communicate with other cells by firing tiny electrical signals. Sometimes something goes wrong, and the cells signal many times faster than normal. That abnormal signaling causes an attack called a seizure. Seizures usually include sudden, abnormal movements and behaviors. People who have had two or more seizures have a condition called epilepsy.
Symptoms
The main symptom, or sign, of epilepsy is the seizure. There are two types of seizures: generalized and partial. Generalized seizures result from abnormal signals in most of the brain. Partial seizures result from abnormal signals in part of the brain.
During a generalized seizure the person may fall down and lose consciousness. The muscles may jerk, turn stiff, or become limp for a few minutes. Breathing can stop temporarily. After a violent seizure the person feels confused and tired. In some cases a generalized seizure is hard to notice. The person may just lose consciousness for a few seconds and stare or blink.
During a partial seizure the person does not usually fall down. The person may have sudden emotions or see, taste, or smell things that are not real. The person may seem to be in a dream. The muscles on one side of the body may jerk, or the person may repeat strange movements.
Causes
Many different things can cause epilepsy. It may result from a brain injury, either before or after birth, or a brain tumor. Diseases that affect the brain, including meningitis and encephalitis, can also lead to epilepsy. Epilepsy can sometimes occur after a person has a stroke (a blot clot or bleeding in the brain). Some cases of epilepsy may be genetic, or passed down from parent to child. In about half the cases of epilepsy the actual cause is not known.
Prevention
Because the cause of epilepsy is often unknown, the condition is difficult to prevent. People can prevent some types of epilepsy by protecting the brain from injury. Wearing a seat belt in cars can protect the head during an accident. Wearing a helmet while skating, biking, or playing sports can also prevent brain injury. Treating diseases and health problems that affect the brain can also help to prevent epilepsy.
Treatment
There is no cure for epilepsy, but there are a number of drugs that help to control seizures. A special diet can also help. If medicine and diet do not work, doctors may perform surgery on the brain. They may also place a small machine under the patient's skin. The machine sends electricity to the brain, which helps to reduce the number of seizures a person has.
People can help a person having a seizure by doing several things. They should help the person roll onto his side and put a pillow under his head. They should loosen the person's collar if possible. They should not put anything in the person's mouth. It is also important to move sharp or hard objects out of the person's way.
Monday, May 26, 2008
Microdermabrasion
Microdermabrasion is a mini procedure that involves the skin being "sandblasted" by aluminum oxide crystals, baking soda, salt or corn cob granules to remove the stratum corneum (top) layer of the skin; dead skin cells.
Microdermabrasion also promotes the production of new cells in the basal (deepest) layer of the dermis. This procedure may not give everyone the same results but if you have the money it is a nice treat and requires no down time. It can clean your pores incredibly and hinder any future breaks outs if used on a regular basis.
Are You Suitable for Microdermabrasion?
If you have or have had acne, discolorations, superficial lines and wrinkles, uneven texture or sun damaged skin -- you may be a candidate for Microdermabrasion.
Is Microdermabrasion Painful?
Microdermabrasion does not hurt although it may sting a little around the eye area. The patient normally works up to a level as they go to increase the penetration to the skin.
Microdermabrasion also promotes the production of new cells in the basal (deepest) layer of the dermis. This procedure may not give everyone the same results but if you have the money it is a nice treat and requires no down time. It can clean your pores incredibly and hinder any future breaks outs if used on a regular basis.
Are You Suitable for Microdermabrasion?
If you have or have had acne, discolorations, superficial lines and wrinkles, uneven texture or sun damaged skin -- you may be a candidate for Microdermabrasion.
Is Microdermabrasion Painful?
Microdermabrasion does not hurt although it may sting a little around the eye area. The patient normally works up to a level as they go to increase the penetration to the skin.
Medifast Diet: Complete Review
The Medifast diet plan is popular.
Forbes recently placed the company at number 28 in their 200 best small companies list), and Medifast have even produced a book (What Physicians Have Always Known About Weight Loss).
But what is Medifast all about? One clue is the name - it contains the word fast...
The Basics
The Medifast brand has been around for a number of decades, and at one time was only available via physicians. Nowadays the products can be ordered on-line and through a number of distributors.
Medifast offer a stable of meal replacement products - all generally formulated to be low-calorie and low-fat, and containing the optimum levels of vitamins. The formula will generally take users into a mild state of ketosis.
The most popular plan is called 5 and 1. This plan (800-1000 calories daily) comprises 5 meal replacements and one "real" meal containing a lean protein and vegetables and salad. Medifast claim a weight loss of 2-5 pounds per week on this plan.
Proof?
What many people don't realize is that very few commercial weight loss programs have ever undergone any clinical studies. Medifast heavily promote the fact that a Johns Hopkins university study has shown that Medifast results in significant weight loss (67 pound average loss in males and 57 pound average loss in females). It's worth pointing out that this study looked at patients who attended Medifast clinics.
There is also an additional study that compared the Medifast program with diabetes medication. The study found Medifast more effective at controlling type 2 diabetes than an ADA-recommended program (see PR).
Both studies were led by Associate Professor Lawrence Cheskin of Johns Hopkins Bloomberg School of Public Health and were funded by Medifast.
Successes
Due to the popularity of the program, Medifast have a number of "success stories" - one of which is Nnedi Uzowihe-Igwe of Maryland, USA (currently featured on the Medifast site). She also appeared in People magazine in January 2006 describing a massive transformation that resulted in a 160lb weight loss between June 2004 and April 2005. Nnedi subsequently became pregnant and gave birth to her second daughter)
I was able to find out how Nnedi was going now, and she appears to have maintained her massive initial weight loss (and is aiming to lose the weight she put on with the second baby by the end of this year).
What you can expect
Drastic
Protein fasts and low-calorie meal replacements are a drastic solution, and in my opinion appropriate for drastic situations. Given the choice between gastric bypass surgery or Medifast, then Medifast must surely be a better answer.
The biggest test of a program such as Medifast is the long-term consequences - and in particular weaning off a program based around shakes and soups. The transition phase should be four to six weeks, and often starts off by introducing some oatmeal at breakfast, and some fruit for snacks. Also exercise must become a part of life (5 days a week). Exercise must be fairly low-key during the restrictive part of Medifast - but once transitioning - it becomes increasingly important.
Due to the level of energy intake and exercise levels - it is likely that some muscle loss will occur during the weight loss phase. Once again, the best course of action would be to gradually include strength training during the transition phase - and begin to build up muscle tone.
Costs
The Medifast 5 and 1 plan cost $275 for 4 weeks. However - that's the cost of the "5" - you will still need to buy your daily "lean and green" meal (lean protein plus salad/vegetables).
Men & Women
Different formulations are used for men and women. Some shakes are called Medifast 55 or Medifast 70. The latter has a higher soy protein content and is more suitable for men (or women who prefer higher protein).
Behavior Change Required
Behavioral changes are critical to the long-term success of Medifast. Unless these lifestyle changes are applied, then the weight could easily swing back on like a yo-yo. It's worth taking a look at the post 10 Questions To Ask Before Changing Your Diet.
Conclusion
I don't believe Medifast is for the person who wants to lose 20 pounds. This is a serious program for serious situations, and it may be advisable to follow the program while receiving regular support from a clinic, and even under medical advisement.
However ample proof exists that the program does work and can lead to significant weight loss provided the transition phase is followed correctly.
Forbes recently placed the company at number 28 in their 200 best small companies list), and Medifast have even produced a book (What Physicians Have Always Known About Weight Loss).
But what is Medifast all about? One clue is the name - it contains the word fast...
The Basics
The Medifast brand has been around for a number of decades, and at one time was only available via physicians. Nowadays the products can be ordered on-line and through a number of distributors.
Medifast offer a stable of meal replacement products - all generally formulated to be low-calorie and low-fat, and containing the optimum levels of vitamins. The formula will generally take users into a mild state of ketosis.
The most popular plan is called 5 and 1. This plan (800-1000 calories daily) comprises 5 meal replacements and one "real" meal containing a lean protein and vegetables and salad. Medifast claim a weight loss of 2-5 pounds per week on this plan.
Proof?
What many people don't realize is that very few commercial weight loss programs have ever undergone any clinical studies. Medifast heavily promote the fact that a Johns Hopkins university study has shown that Medifast results in significant weight loss (67 pound average loss in males and 57 pound average loss in females). It's worth pointing out that this study looked at patients who attended Medifast clinics.
There is also an additional study that compared the Medifast program with diabetes medication. The study found Medifast more effective at controlling type 2 diabetes than an ADA-recommended program (see PR).
Both studies were led by Associate Professor Lawrence Cheskin of Johns Hopkins Bloomberg School of Public Health and were funded by Medifast.
Successes
Due to the popularity of the program, Medifast have a number of "success stories" - one of which is Nnedi Uzowihe-Igwe of Maryland, USA (currently featured on the Medifast site). She also appeared in People magazine in January 2006 describing a massive transformation that resulted in a 160lb weight loss between June 2004 and April 2005. Nnedi subsequently became pregnant and gave birth to her second daughter)
I was able to find out how Nnedi was going now, and she appears to have maintained her massive initial weight loss (and is aiming to lose the weight she put on with the second baby by the end of this year).
What you can expect
Drastic
Protein fasts and low-calorie meal replacements are a drastic solution, and in my opinion appropriate for drastic situations. Given the choice between gastric bypass surgery or Medifast, then Medifast must surely be a better answer.
The biggest test of a program such as Medifast is the long-term consequences - and in particular weaning off a program based around shakes and soups. The transition phase should be four to six weeks, and often starts off by introducing some oatmeal at breakfast, and some fruit for snacks. Also exercise must become a part of life (5 days a week). Exercise must be fairly low-key during the restrictive part of Medifast - but once transitioning - it becomes increasingly important.
Due to the level of energy intake and exercise levels - it is likely that some muscle loss will occur during the weight loss phase. Once again, the best course of action would be to gradually include strength training during the transition phase - and begin to build up muscle tone.
Costs
The Medifast 5 and 1 plan cost $275 for 4 weeks. However - that's the cost of the "5" - you will still need to buy your daily "lean and green" meal (lean protein plus salad/vegetables).
Men & Women
Different formulations are used for men and women. Some shakes are called Medifast 55 or Medifast 70. The latter has a higher soy protein content and is more suitable for men (or women who prefer higher protein).
Behavior Change Required
Behavioral changes are critical to the long-term success of Medifast. Unless these lifestyle changes are applied, then the weight could easily swing back on like a yo-yo. It's worth taking a look at the post 10 Questions To Ask Before Changing Your Diet.
Conclusion
I don't believe Medifast is for the person who wants to lose 20 pounds. This is a serious program for serious situations, and it may be advisable to follow the program while receiving regular support from a clinic, and even under medical advisement.
However ample proof exists that the program does work and can lead to significant weight loss provided the transition phase is followed correctly.
The Best Acne Treatments
There are too many acne fighting products on the market to count, and the majority of them simply do not work. However, there are some that do work quite well. The problem is that many people who suffer from acne will spend quite a bit of time and money trying to find the best acne treatments. Teenagers often outgrow acne before they find a treatment that works.
One of the better acne treatments on the market today is ProActiv. ProActiv seems to be helping many people who could not find other solutions that worked. It has been featured on infomercials, news stories, magazine articles, and newspaper articles. Proactiv is a system that includes a renewing cleanser, revitalizing toner, and repairing lotion. Prescription grade benzoyl peroxide is the active ingredient in ProActiv. ProActiv does not require a prescription.
A treatment that is available by prescription is Accutane. Accutane is a very strong medication, that is only suitable for those who suffer from severe and persistent acne. The medication is taken internally, and there are possible side effects, including birth defects, dry and cracked lips, and liver dysfunction.
Another one of that is used topically is retin-a. Many people have had great success with retin-a, which is used to treat acne, acne scars, wrinkles, stretch marks, skin discoloration, and a variety of other skin afflictions. Retin-a is available by prescription, but some over the counter medications contain retin-a.
Not all treatments come in the form of chemicals. Certain essential oils are also beneficial in the treatment of acne. These essential oils can be applied topically for the treatment of mild to moderate acne. The best essential oils for acne treatment are: Tea Tree Oil, Bergamot Oil, Clove Oil, Lavender Oil, and Rosewood Oil. If the essential oil needs to be diluted, mix it with Grapeseed Oil for best results.
In order to find the best acne treatment for you, start with essential oils. If that doesn't work, go to the next step by trying ProActive. If ProActive doesn't work, then try a prescription alternative. You may also consider being tested for food allergies, as certain allergies can cause acne. In this case, the only treatment you need is to eliminate those certain foods from your diet.
One of the better acne treatments on the market today is ProActiv. ProActiv seems to be helping many people who could not find other solutions that worked. It has been featured on infomercials, news stories, magazine articles, and newspaper articles. Proactiv is a system that includes a renewing cleanser, revitalizing toner, and repairing lotion. Prescription grade benzoyl peroxide is the active ingredient in ProActiv. ProActiv does not require a prescription.
A treatment that is available by prescription is Accutane. Accutane is a very strong medication, that is only suitable for those who suffer from severe and persistent acne. The medication is taken internally, and there are possible side effects, including birth defects, dry and cracked lips, and liver dysfunction.
Another one of that is used topically is retin-a. Many people have had great success with retin-a, which is used to treat acne, acne scars, wrinkles, stretch marks, skin discoloration, and a variety of other skin afflictions. Retin-a is available by prescription, but some over the counter medications contain retin-a.
Not all treatments come in the form of chemicals. Certain essential oils are also beneficial in the treatment of acne. These essential oils can be applied topically for the treatment of mild to moderate acne. The best essential oils for acne treatment are: Tea Tree Oil, Bergamot Oil, Clove Oil, Lavender Oil, and Rosewood Oil. If the essential oil needs to be diluted, mix it with Grapeseed Oil for best results.
In order to find the best acne treatment for you, start with essential oils. If that doesn't work, go to the next step by trying ProActive. If ProActive doesn't work, then try a prescription alternative. You may also consider being tested for food allergies, as certain allergies can cause acne. In this case, the only treatment you need is to eliminate those certain foods from your diet.
Friday, May 23, 2008
Mesothelioma
Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos.[1] In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).
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.
Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
* chest wall pain
* pleural effusion, or fluid surrounding the lung
* shortness of breath
* fatigue or anemia
* wheezing, hoarseness, or cough
* blood in the sputum (fluid) coughed up
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
* abdominal pain
* ascites, or an abnormal buildup of fluid in the abdomen
* a mass in the abdomen
* problems with bowel function
* weight loss
In severe cases of the disease, the following signs and symptoms may be present:
* blood clots in the veins, which may cause thrombophlebitis
* disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* jaundice, or yellowing of the eyes and skin
* low blood sugar level
* pleural effusion
* pulmonary emboli, or blood clots in the arteries of the lungs
* severe ascites
A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
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
Treatment
Treatment of MM using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation[citation needed]. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies, has proved disappointing. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed. It is not possible to remove the entire mesothelium without killing the patient.
Radiation
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy
In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
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.
Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
* chest wall pain
* pleural effusion, or fluid surrounding the lung
* shortness of breath
* fatigue or anemia
* wheezing, hoarseness, or cough
* blood in the sputum (fluid) coughed up
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
* abdominal pain
* ascites, or an abnormal buildup of fluid in the abdomen
* a mass in the abdomen
* problems with bowel function
* weight loss
In severe cases of the disease, the following signs and symptoms may be present:
* blood clots in the veins, which may cause thrombophlebitis
* disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* jaundice, or yellowing of the eyes and skin
* low blood sugar level
* pleural effusion
* pulmonary emboli, or blood clots in the arteries of the lungs
* severe ascites
A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
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
Treatment
Treatment of MM using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation[citation needed]. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies, has proved disappointing. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed. It is not possible to remove the entire mesothelium without killing the patient.
Radiation
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy
In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
Alzheimer disease
degenerative brain disorder that develops in mid to late adulthood. It results in a progressive and irreversible decline in memory and a deterioration of various other cognitive abilities. The disease is characterized by the destruction of nerve cells and neural connections in the cerebral cortex of the brain and by a significant loss of brain mass. The disease was first described in 1906 by Alois Alzheimer, a German neuropathologist.
Alzheimer disease is the most common form of *dementia. The disease develops differently among individuals; this suggests that more than one pathologic process may lead to the same outcome. Typically, the first symptom to appear is forgetfulness. As the disease progresses, memory loss becomes more severe, and language, perceptual, and motor skills deteriorate. Mood becomes unstable, and the individual tends to become irritable and more sensitive to stress and may become intermittently angry, anxious, or depressed. In advanced stages, the individual becomes unresponsive and loses mobility and control of body functions; death ensues after a disease course lasting from 2 to 20 years.
About 10 percent of those who develop the disease are younger than 60 years of age. These cases, referred to as early-onset familial Alzheimer disease, result from an inherited genetic mutation. The majority of cases of Alzheimer disease, however, develop after age 60 (late-onset); they usually occur sporadically—i.e., in individuals with no family history of the disease—although a genetic factor has been identified that is thought to predispose these individuals to the disorder.
The presence of neuritic plaques and neurofibrillary tangles in the brain are used to diagnose Alzheimer disease in autopsy. Neuritic plaques—also called senile, dendritic, or amyloid plaques—consist of deteriorating neuronal material surrounding deposits of a sticky protein called beta amyloid. This protein is derived from a larger molecule called amyloid precursor protein, which is a normal component of nerve cells. Neurofibrillary tangles are twisted protein fibres located within nerve cells. These fibres consist of a protein, called tau, that normally occurs in neurons. When incorrectly processed, tau molecules clump together and form tangles. Both neuritic plaques and neurofibrillary tangles, which also may be found in smaller amounts in the brains of healthy elderly persons, are thought to interfere in some way with normal cellular functioning. However, it is not known whether the plaques and tangles are a cause or a consequence of the disease.
Other features have been noted in the brains of many persons with Alzheimer disease. One is a deficiency of the neurotransmitter acetylcholine; neurons containing acetylcholine play an important role in memory. Abnormal concentrations of aluminum also have been found in neurofibrillary tangles and neuritic plaques, but it is not known whether the element plays a causative role in the disease.
Underlying genetic defects have been identified for both late- and early-onset cases of Alzheimer disease. A defect in the gene that codes for amyloid precursor protein may increase the production or deposition of beta amyloid, which forms the core of neuritic plaques. This gene, however, is responsible for only 2 to 3 percent of all early-onset cases of the disease; the remainder are attributed to two other genes. A defect in the gene that directs production of apolipoprotein E (ApoE), which is involved in cholesterol transport, may be a factor in the majority of late-onset Alzheimer cases. There are three forms of this gene—ApoE2, ApoE3, and ApoE4—one of which, ApoE4, is associated with a higher risk of disease.
There is no cure for Alzheimer disease. The medication tacrine slightly slows the progression of the disease by slowing the breakdown of acetylcholine, but it is not effective in all patients and can become toxic to the liver. Most treatment aims to control the depression, behavioral problems, and insomnia that often accompany the disease.
*dementia
chronic, usually progressive deterioration of intellectual capacity associated with the widespread loss of nerve cells and the shrinkage of brain tissue. Dementia is most commonly seen in the elderly (senile dementia), though it is not part of the normal aging process and can affect persons of any age.
The most common irreversible dementia is Alzheimer disease. This condition begins with memory loss, which may first appear to be simple absentmindedness or forgetfulness. As dementia progresses, the loss of memory broadens in scope until the individual can no longer remember basic social and survival skills or function independently. Language, spatial or temporal orientation, judgment, or other cognitive capacities may decline, and personality changes may also occur. Dementia is also present in other degenerative brain diseases including Pick disease and Parkinson disease.
The second most common cause of dementia is hypertension (high blood pressure) or other vascular conditions. This type of dementia, called multi-infarct, or vascular, dementia results from a series of small strokes that progressively destroy the brain. Dementia can also be caused by Huntington disease, syphilis, multiple sclerosis, acquired immune deficiency syndrome (AIDS), and some types of encephalitis. Treatable dementias occur in hypothyroidism, other metabolic diseases, and some malignant tumours. Treatment of the underlying disease in these cases may inhibit the progress of dementia but usually does not reverse it.
Alzheimer disease is the most common form of *dementia. The disease develops differently among individuals; this suggests that more than one pathologic process may lead to the same outcome. Typically, the first symptom to appear is forgetfulness. As the disease progresses, memory loss becomes more severe, and language, perceptual, and motor skills deteriorate. Mood becomes unstable, and the individual tends to become irritable and more sensitive to stress and may become intermittently angry, anxious, or depressed. In advanced stages, the individual becomes unresponsive and loses mobility and control of body functions; death ensues after a disease course lasting from 2 to 20 years.
About 10 percent of those who develop the disease are younger than 60 years of age. These cases, referred to as early-onset familial Alzheimer disease, result from an inherited genetic mutation. The majority of cases of Alzheimer disease, however, develop after age 60 (late-onset); they usually occur sporadically—i.e., in individuals with no family history of the disease—although a genetic factor has been identified that is thought to predispose these individuals to the disorder.
The presence of neuritic plaques and neurofibrillary tangles in the brain are used to diagnose Alzheimer disease in autopsy. Neuritic plaques—also called senile, dendritic, or amyloid plaques—consist of deteriorating neuronal material surrounding deposits of a sticky protein called beta amyloid. This protein is derived from a larger molecule called amyloid precursor protein, which is a normal component of nerve cells. Neurofibrillary tangles are twisted protein fibres located within nerve cells. These fibres consist of a protein, called tau, that normally occurs in neurons. When incorrectly processed, tau molecules clump together and form tangles. Both neuritic plaques and neurofibrillary tangles, which also may be found in smaller amounts in the brains of healthy elderly persons, are thought to interfere in some way with normal cellular functioning. However, it is not known whether the plaques and tangles are a cause or a consequence of the disease.
Other features have been noted in the brains of many persons with Alzheimer disease. One is a deficiency of the neurotransmitter acetylcholine; neurons containing acetylcholine play an important role in memory. Abnormal concentrations of aluminum also have been found in neurofibrillary tangles and neuritic plaques, but it is not known whether the element plays a causative role in the disease.
Underlying genetic defects have been identified for both late- and early-onset cases of Alzheimer disease. A defect in the gene that codes for amyloid precursor protein may increase the production or deposition of beta amyloid, which forms the core of neuritic plaques. This gene, however, is responsible for only 2 to 3 percent of all early-onset cases of the disease; the remainder are attributed to two other genes. A defect in the gene that directs production of apolipoprotein E (ApoE), which is involved in cholesterol transport, may be a factor in the majority of late-onset Alzheimer cases. There are three forms of this gene—ApoE2, ApoE3, and ApoE4—one of which, ApoE4, is associated with a higher risk of disease.
There is no cure for Alzheimer disease. The medication tacrine slightly slows the progression of the disease by slowing the breakdown of acetylcholine, but it is not effective in all patients and can become toxic to the liver. Most treatment aims to control the depression, behavioral problems, and insomnia that often accompany the disease.
*dementia
chronic, usually progressive deterioration of intellectual capacity associated with the widespread loss of nerve cells and the shrinkage of brain tissue. Dementia is most commonly seen in the elderly (senile dementia), though it is not part of the normal aging process and can affect persons of any age.
The most common irreversible dementia is Alzheimer disease. This condition begins with memory loss, which may first appear to be simple absentmindedness or forgetfulness. As dementia progresses, the loss of memory broadens in scope until the individual can no longer remember basic social and survival skills or function independently. Language, spatial or temporal orientation, judgment, or other cognitive capacities may decline, and personality changes may also occur. Dementia is also present in other degenerative brain diseases including Pick disease and Parkinson disease.
The second most common cause of dementia is hypertension (high blood pressure) or other vascular conditions. This type of dementia, called multi-infarct, or vascular, dementia results from a series of small strokes that progressively destroy the brain. Dementia can also be caused by Huntington disease, syphilis, multiple sclerosis, acquired immune deficiency syndrome (AIDS), and some types of encephalitis. Treatable dementias occur in hypothyroidism, other metabolic diseases, and some malignant tumours. Treatment of the underlying disease in these cases may inhibit the progress of dementia but usually does not reverse it.
Hodgkin disease
an uncommon cancer of the lymphatic system (malignant lymphoma) that usually strikes young adults and people 55 years of age or older. Most patients can be cured if the disease is detected in its early stages, but even those with advanced Hodgkin disease have a significant chance of recovery. The overall cure rate is approximately 75 percent.
In its early stages the disease is characterized by local, painless swelling of one or more lymph nodes and sometimes by swelling of the spleen, liver, or other organs. In addition to swollen lymph nodes, symptoms may include fever and itching followed later by weight loss and fatigue. A microscopic examination of affected tissue, usually obtained from a lymph node, is required to confirm diagnosis.
The cause of Hodgkin disease remains unknown, but numerous infectious agents, including bacteria, protozoa, and viruses, have been suggested. Previous infection with the Epstein-Barr virus, the causative agent of mononucleosis, has been linked to many cases of Hodgkin disease. Hodgkin disease tumours develop from B lymphocytes. Treatment consists of chemotherapy, radiation, or a combination of both, depending on the stage of development of the disease.
The disease is named after Thomas Hodgkin, who first described it in 1832.
In its early stages the disease is characterized by local, painless swelling of one or more lymph nodes and sometimes by swelling of the spleen, liver, or other organs. In addition to swollen lymph nodes, symptoms may include fever and itching followed later by weight loss and fatigue. A microscopic examination of affected tissue, usually obtained from a lymph node, is required to confirm diagnosis.
The cause of Hodgkin disease remains unknown, but numerous infectious agents, including bacteria, protozoa, and viruses, have been suggested. Previous infection with the Epstein-Barr virus, the causative agent of mononucleosis, has been linked to many cases of Hodgkin disease. Hodgkin disease tumours develop from B lymphocytes. Treatment consists of chemotherapy, radiation, or a combination of both, depending on the stage of development of the disease.
The disease is named after Thomas Hodgkin, who first described it in 1832.
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