DIVERTICULITIS

December 21st, 2010
Diverticulitis occurs as a result of impaction of diverticula with fecaliths, which create an inflammatory process, sometimes leading to erosion and perforation of the colonic wall. Simple diverticulitis, which occurs in the majority of patients, is not associated with complications; these patients usually respond to medical therapy. Complicated diverticulitis involves perforation, obstruction, abscess, or fistula. This occurs in a quarter of patients with the first episode and requires surgery.
Most patients with acute sigmoid diverticulitis have left lower quadrant pain, fever, and leukocytosis. A mass may be palpated on pelvic and rectal examination. CT scanning is the diagnostic technique of choice and typically reveals thickening of the bowel wall, streaky mesenteric fat and associated abscess.
Patients with mild symptoms in the absence of systemic signs and symptoms may be treated on an outpatient basis with a low-residue diet and broad-spectrum oral antibiotics for 7 to 10 days. Hospitalization is required for significant fever, more severe signs and symptoms, or inability to tolerate an oral diet. Treatment consists of bowel rest, intravenous antibiotics, and intravenous fluids. Persistent fever and leukocytosis after 48 hours suggest an unresolving abscess. Up to one third of patients will go on to have a second episode of diverticulitis, and elective surgery should be considered in these patients.
Surgery is mandatory for patients with complications of diverticulitis. Percutaneous drainage of an abscess may be used preoperatively to simplify a subsequent surgery, or in some cases eliminate the need for surgery. The antibiotic regimens recommended for secondary peritonitis are also appropriate for antimicrobial management of diverticular complications.
*100/348/5*

DIVERTICULITISDiverticulitis occurs as a result of impaction of diverticula with fecaliths, which create an inflammatory process, sometimes leading to erosion and perforation of the colonic wall. Simple diverticulitis, which occurs in the majority of patients, is not associated with complications; these patients usually respond to medical therapy. Complicated diverticulitis involves perforation, obstruction, abscess, or fistula. This occurs in a quarter of patients with the first episode and requires surgery.Most patients with acute sigmoid diverticulitis have left lower quadrant pain, fever, and leukocytosis. A mass may be palpated on pelvic and rectal examination. CT scanning is the diagnostic technique of choice and typically reveals thickening of the bowel wall, streaky mesenteric fat and associated abscess.Patients with mild symptoms in the absence of systemic signs and symptoms may be treated on an outpatient basis with a low-residue diet and broad-spectrum oral antibiotics for 7 to 10 days. Hospitalization is required for significant fever, more severe signs and symptoms, or inability to tolerate an oral diet. Treatment consists of bowel rest, intravenous antibiotics, and intravenous fluids. Persistent fever and leukocytosis after 48 hours suggest an unresolving abscess. Up to one third of patients will go on to have a second episode of diverticulitis, and elective surgery should be considered in these patients.Surgery is mandatory for patients with complications of diverticulitis. Percutaneous drainage of an abscess may be used preoperatively to simplify a subsequent surgery, or in some cases eliminate the need for surgery. The antibiotic regimens recommended for secondary peritonitis are also appropriate for antimicrobial management of diverticular complications.*100/348/5*

ADOLESCENCE AND REBELLION

December 16th, 2010
Rebellion can be seen in such things as manner of dress and appearance. It is usually the opposite of what the parents’ generation accepts. Little ways of testing out crop up in being late from a date, buying something without permission, arguing with the parents over just anything. The kids are aware of their dependency, and they don’t like it. There is even some shame over being in such a position. It is important that the parents recognize the rebellion and respond to it. In this era of “Be friends with your kids,” some well-meaning parents have accepted any behavior from their kids. For example, if the kids, for the sake of rebellion, brought home some grass to smoke, their parents might light up, too. Often the kids will do whatever they can, just to get their parents angry. They are so often reminded by others of how much they look or act like their father or mother. They don’t want that. Adolescents want to be themselves. They do not want to be carbon copies of their parents, whom they probably don’t much like at the moment. Going out and doing some drinking with the gang, doing something weird to their hair that Mom and Dad will hate, not cleaning their rooms, helping the neighbors but not their parents, are all fairly common ways of testing out and attempting to assert independence.
Destructive rebellion can occur when the parents either do not recognize the rebellion or do not respond to it. It can take many forms, such as running out of the house after an argument and driving off at 80 or 90 miles per hour, getting really drunk, running away, or, for girls, getting pregnant despite frequent warnings from their overrestrictive parents to avoid all sexual activities.
There are many roadblocks to completion of these four basic tasks. One results from a social paradox. Adolescents are physically ready for adult roles long before our society allows it. Studies of other societies and cultures point this out. In some societies adolescence doesn’t cover a decade or more. It is about a 1-hour trip! Light a fire, beat a gong, send the boy into the woods to pray to the moon; when he returns, hand him a spear and a wife, and he’s in business. Our society dictates instead that people stay in an adolescent position for a frightfully long time: junior high school, senior high school, college, graduate school. Another social paradox comes from the mixed messages. On the one hand, it’s “Be heterosexual, get a date,” “Get a job,” “Be grown up.” On the other, it’s “Be back by 1 AM,” “Save the money for college,” “Don’t argue with me.” The confusion of “Grow up, but stay under my control” can introduce tensions. Another roadblock can be posed by alcohol and drug use. It should be pointed out that of all groups, adolescents are those most likely to be involved with drugs other than alcohol. In considering adolescents it is imperative to think broadly, in terms of substance use and abuse, or chemical dependency, not just in terms of alcohol and alcoholism.
This has been a very brief overview of adolescence. There are many excellent books on the subject should you want a more in-depth study. For our purposes here, it will suffice as a context in which to consider alcohol use.
*146\331\2*

ADOLESCENCE AND REBELLIONRebellion can be seen in such things as manner of dress and appearance. It is usually the opposite of what the parents’ generation accepts. Little ways of testing out crop up in being late from a date, buying something without permission, arguing with the parents over just anything. The kids are aware of their dependency, and they don’t like it. There is even some shame over being in such a position. It is important that the parents recognize the rebellion and respond to it. In this era of “Be friends with your kids,” some well-meaning parents have accepted any behavior from their kids. For example, if the kids, for the sake of rebellion, brought home some grass to smoke, their parents might light up, too. Often the kids will do whatever they can, just to get their parents angry. They are so often reminded by others of how much they look or act like their father or mother. They don’t want that. Adolescents want to be themselves. They do not want to be carbon copies of their parents, whom they probably don’t much like at the moment. Going out and doing some drinking with the gang, doing something weird to their hair that Mom and Dad will hate, not cleaning their rooms, helping the neighbors but not their parents, are all fairly common ways of testing out and attempting to assert independence.Destructive rebellion can occur when the parents either do not recognize the rebellion or do not respond to it. It can take many forms, such as running out of the house after an argument and driving off at 80 or 90 miles per hour, getting really drunk, running away, or, for girls, getting pregnant despite frequent warnings from their overrestrictive parents to avoid all sexual activities.There are many roadblocks to completion of these four basic tasks. One results from a social paradox. Adolescents are physically ready for adult roles long before our society allows it. Studies of other societies and cultures point this out. In some societies adolescence doesn’t cover a decade or more. It is about a 1-hour trip! Light a fire, beat a gong, send the boy into the woods to pray to the moon; when he returns, hand him a spear and a wife, and he’s in business. Our society dictates instead that people stay in an adolescent position for a frightfully long time: junior high school, senior high school, college, graduate school. Another social paradox comes from the mixed messages. On the one hand, it’s “Be heterosexual, get a date,” “Get a job,” “Be grown up.” On the other, it’s “Be back by 1 AM,” “Save the money for college,” “Don’t argue with me.” The confusion of “Grow up, but stay under my control” can introduce tensions. Another roadblock can be posed by alcohol and drug use. It should be pointed out that of all groups, adolescents are those most likely to be involved with drugs other than alcohol. In considering adolescents it is imperative to think broadly, in terms of substance use and abuse, or chemical dependency, not just in terms of alcohol and alcoholism.This has been a very brief overview of adolescence. There are many excellent books on the subject should you want a more in-depth study. For our purposes here, it will suffice as a context in which to consider alcohol use.*146\331\2*

HOW ASTHMA MEDICATIONS CAN BE EFFECTIVELY DELIVERED? IHHALATION METHOD – SPACE INHALERS

December 10th, 2010
Space inhaler device is an aid that makes using an inhaler easier. It is essentially a chamber like aid that attaches to the inhaler, or the MDI, and holds the aerosol produced by a metred-dose inhaler (MDI) before it is inhaled into the lungs.
This chamber performs two major functions:
1. The aerosol remains inside the space chamber for some time, therefore, the larger particles from the MDI settle down on the walls of the chamber and do not unnecessarily go into the mouth or the throat;
2. It increases the distance between the MDI emission nozzle and the mouth of the patient, because of which the finer particles of the mist penetrate into the distal airways.
Many type of space inhaler devices are available. Spacehaler is perhaps the most scientifically designed spacer device. It has been seen that larger pear-shaped spacers generally give better results than the smaller spacers.
Generally, one brand of space inhaler can be attached with inhaler of another company. But in some cases the nozzle of the spacer device is shaped in such a manner that it fits only to a particular brand of MDI. Hence, while purchasing a space inhaler, one should ensure that the MDI and the spacer device fit properly.
For infants and children who are under five years of age, there is often a problem of hand-mouth-lung coordination. Even then it has been seen that space inhalers improve the bronchodilator response in children who are unable to use MDIs effectively.
Other benefits of using a space inhaler include:
1. Space inhaler is easy to hold in the right position. It allows children to inhale the medicine without coordinating a puff with a breath.
2. It helps, more medicine to get to the small airways where it works more effectively.
3. It reduces the after taste of the medicine.
4. It reduces the possible adverse effects of the medicine.
*73\260\8*

HOW ASTHMA MEDICATIONS CAN BE EFFECTIVELY DELIVERED? IHHALATION METHOD – SPACE INHALERSSpace inhaler device is an aid that makes using an inhaler easier. It is essentially a chamber like aid that attaches to the inhaler, or the MDI, and holds the aerosol produced by a metred-dose inhaler (MDI) before it is inhaled into the lungs.This chamber performs two major functions:1. The aerosol remains inside the space chamber for some time, therefore, the larger particles from the MDI settle down on the walls of the chamber and do not unnecessarily go into the mouth or the throat;2. It increases the distance between the MDI emission nozzle and the mouth of the patient, because of which the finer particles of the mist penetrate into the distal airways.Many type of space inhaler devices are available. Spacehaler is perhaps the most scientifically designed spacer device. It has been seen that larger pear-shaped spacers generally give better results than the smaller spacers.Generally, one brand of space inhaler can be attached with inhaler of another company. But in some cases the nozzle of the spacer device is shaped in such a manner that it fits only to a particular brand of MDI. Hence, while purchasing a space inhaler, one should ensure that the MDI and the spacer device fit properly.For infants and children who are under five years of age, there is often a problem of hand-mouth-lung coordination. Even then it has been seen that space inhalers improve the bronchodilator response in children who are unable to use MDIs effectively.Other benefits of using a space inhaler include: 1. Space inhaler is easy to hold in the right position. It allows children to inhale the medicine without coordinating a puff with a breath. 2. It helps, more medicine to get to the small airways where it works more effectively.3. It reduces the after taste of the medicine. 4. It reduces the possible adverse effects of the medicine.*73\260\8*

PID A MAJOR PROBLEM; TROPICAL STDS ARE UNCOMMON

October 7th, 2010

The importance of pelvic inflammatory disease and its relationship to sexually transmitted infections, particularly gonorrhoea and chlamydia, are more clearly recognised.

STDs such as donovanosis, chancroid and lymphogranuloma venereum mainly occur in tropical countries. Donovanosis is commonly seen in Papua New Guinea and is a common cause of ulcerative genital lesions in Aborigines in northern and central Australia. These conditions are occasionally seen in people who have had sexual contacts in third world countries.

Genital infections not usually sexually transmitted, such as candidiasis, are included in the Handbook for convenience. Also included are scabies, pubic pediculosis and molluscum contagiosum which are spread by close personal contact, and gastrointestinal infections which may be sexually transmitted.
*5/56/1*
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AGE GROUPS; RISK GROUPS; MAJOR STDS IN AUSTRALIA

October 7th, 2010

In Western society most patients with STD are in the 15 to 30 year age group. There has been increased recognition of sexual abuse of children, and practitioners should be alert to the existence and significance of STD particularly in young children.

People with multiple sexual partners (including prostitutes) are at higher risk of STDs than are members of the general community. AIDS has had a considerable impact on the sexual behaviour of homosexual men among whom STDs had been common.

In Australia, the most important STDs are chlamydial infection, gonorrhoea, genital herpes, HIV infection, human papilloma virus infection, syphilis and hepatitis B. Penicillin resistant gonococcal infection is an increasing problem.
*4/56/1*
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IMMUNE SYSTEM: HOW INFECTIONS MAY END INFECTIONS

June 16th, 2010
No more infections. No more hepatitis. No more pneumonia and influenza. No more venereal disease. No more children’s contagions. Good-bye to malaria, meningitis, and maybe, one day, the common cold.
Before the 20th century ends, science may bid good riddance to most, if not all, diseases caused by viruses and bacteria. Spurred by the successes of vaccine treatments over the past decades, biologists and chemists are creating amazing new vaccines that stop those germs invading and growing in our bodies.
What exactly is a vaccine? Simply put, a vaccine is a dose of just enough of a particular germ to trigger your immune system but not make you sick. Into each vaccine scientists put all or part of the particular germ against which they want to protect you, but first they weaken, dismember, or kill that germ in the laboratory. Once you swallow or take shots of this altered germ, the pieces tell your body to make anti-germ proteins called antibodies. The antibodies stave off the deadly germs from getting a foothold in your body.
Keep in mind that vaccines prevent infectious disease; they do not cure it. Scientists are using new technology to improve old vaccines, such as those in whooping cough and influenza, making them safer and more powerful. And they are fashioning new vaccines for diseases against which we have no protection. Vaccines for genital herpes and chicken pox, for example, are two of a dozen under development.
Elena Jenkins, 10, of Nutley, New Jersey, owes her life to the new, experimental chicken pox vaccine from Japan. Five years ago, she came down with leukemia, which doctors stopped with drugs and radiation. But, like all leukemia victims, Elena became acutely susceptible to chicken pox. In normal children, only a mild rash covers the skin; when the disease attacks a person who has had leukemia, it can kill horribly by peeling away all the skin and invading the brain.
Elena’s parents, Linda and Bob Jenkins, lived in dread that Elena would catch chicken pox. “We were afraid her brother would bring the disease home from school,” recalls Mrs. Jenkins.
In May 1981, Dr. Ann Gershon, then of New York University Medical Center in Manhattan injected Elena with the new vaccine, which is made from live, weakened viruses. A year later, Elena broke out in a mild case of chicken pox and survived.
Dr. Jonas Salk, who in 1955 invented the first vaccine that cut down the crippling polio virus, said that modern technology opens the way “to control more and more of the major infections and parasitic diseases.” That technology includes these developments:
•   Growing viruses and bacteria in test tubes to produce the raw material of vaccines
•   Altering the genes of viruses and bacteria so that they cannot produce disease but can stimulate antibodies
•   Isolating pieces of germs that can trigger immunity against the whole germ.
Before he died, Dr. Salk told me, “If there is a will to do so, there will be a way to develop vaccines.”
This scientific know-how was slow in coming. In 1796, Edward Jenner, an English doctor, observed that milkmaids who caught cowpox from cows did not catch the deadly smallpox. Dr. Jenner got the idea that rubbing pus from the cow’s pox into people’s skin might somehow protect them from smallpox. Thus began vaccination, which comes from the Latin word for cow, vacca.
Dr. Jenner didn’t know it, but the pus contained the cowpox virus, now called vaccinia. (Like all viruses, vaccinia is a tiny germ, so small that 100,000 of them can fit onto the period at the end of this sentence.) And because this cowpox virus is a weak “cousin” to the smallpox virus, the cowpox antibodies stopped the smallpox germ.
Much of vaccine technology today is based on Dr. Jenner’s principle – that is, using weak “relatives” or altered germs to fight more powerful viruses and bacteria.
However, most infections do not have such close “relatives” as do cowpox and smallpox, so scientists have to weaken strong viruses in the laboratory.
*137/266/5*

DIET THERAPY: METHOD FOR DIETARY CALCULATIONS

June 16th, 2010
The physician, and in some situations the dietitian, prescribes the amounts of carbohydrate, protein, and fat that are to be used in measured diets. Using the values for the exchange lists, the dietitian, dietetic technician, or nurse calculates the number of exchanges to be furnished by the diet.
The steps in diet planning are listed below.
1.   Become familiar with the patient’s usual pattern of meals, the food likes and dislikes, and so on. Whether the patient eats at home, carries lunches, or eats in a restaurant will affect the planning. The amount of money that can be spent, the preparation facilities, and the cultural patterns must be considered.
2.   Include basic foods to ensure adequate levels of minerals and vitamins: 2 cups milk (3 or more for children and pregnant or lactating women); two servings vegetables; two servings fruit, including a good source of ascorbic acid; four to five exchanges meat; wholegrain or enriched bread and cereal.
3.   List the carbohydrate, protein, and fat values for the milk, vegetables, and fruit.
4.   Subtract the carbohydrate value of these foods (74 in the example) from the carbohydrate level prescribed (150 gm). Divide the difference by 15 to determine the number of bread exchanges (5 in the example).
5.   Total the protein values of the milk, vegetables, and bread exchanges (30 in the example). Subtract from the protein prescribed (70). Divide the difference by 7 to determine the number of meat exchanges (6 in the example).
6.   Total the fat values for milk and meat (18 in the example) and subtract from the total fat prescribed (70). Divide the difference by 5 to determine the number of fat exchanges (10 in the example).
7.   Check the calculations to be certain that they are correct. It is not a good idea to split the bread, fruit, and meat exchanges into half.
8.   Divide the total exchanges for the day into meal patterns according to the physician’s diet order and the patient’s preference.
*137/234/5*

CHILDCARE: TOYS

May 19th, 2009

Toys are an important part of childhood. Children (and adults) can choose from a bewildering array of toys, simple or incredibly complex, cheap or expensive. It is often said that play is the work of childhood, and children use toys to play, to learn, and to fertilise their imagination.

There is pressure on both children and parents to purchase certain types of toys. Many parents at some level feel better if they are able to provide a large quantity and variety of toys for their children. There is peer and advertising pressure on children to have certain toys — just look at the saturation advertising on afternoon television which is directed at children. This pressure is often difficult to resist.

Expensive toys are not necessarily better than cheap ones, and there is nothing wrong with toys that are hand-me-downs, provided they are sturdy and still in reasonable condition. It is often a very old soft toy that a child becomes most attached to. Children have very vivid imaginations and rich fantasy lives, and they improvise readily. Anything can be a toy — not necessarily something that is bought from a toy shop. Improvised toys (such as the lid of a saucepan or empty containers) stimulate the child’s creativity.

Let the child choose the toys if possible — they should not be a realisation of parents’ fantasies. However, it is important that you set clear limits in advance on such issues as cost and safety. Toys and play are an important way that parents and children can communicate with each other. They create the opportunity to share quality time together and stimulate the child’s learning and creativity.

*114\90\8*

THE SEXUAL HEALTH EXAM: CAN YOU BE INVOLVED IN A MUTUALLY PLEASING AND FULFILLING SEXUAL EXPERIENCE?

May 18th, 2009

“Ever since the heart attack, he seems to be trying too hard. 1 mean, he wants to please me, prove something, I think.” The wife described her feelings about the impact of a life-threatening disease on her husband and her marital sex. “He used to really enjoy me, but now he seems to be worried that I will see or think that he is fragile or something.” With catastrophic illnesses, some patients adopt styles that prevent a mutually pleasing sexual interaction. Here are some of the styles, based on my interviews.

The Accepter: This person acts as if the disease is deserved, another negative in a disappointing life. There is little effort to fight back, to change, to adapt, to protect sexuality. Rather, there is surrender and sacrifice of sexuality to the disease process. “The doctor told me that diabetes could cause impotence. He said it, and he was right. So I don’t know why you are asking me about our sex life. I can’t have one,” said the husband. When I asked how his wife felt about that, he responded, “She has no more choice than I do. It is just in the cards. A bad deal, a rotten deal. ” When I suggested that there was no erection at all, the man responded, “Look, you learn to live with what you are given.” To paraphrase T.S. Eliot, if you fail to look inside for the strength to grow at times of crisis, then you must accept whatever life gives you. As this chapter continues, remember one basic principle: No disease prevents sexuality. The Accepter has forgotten this fact.

The Denier: This patients minimizes all illness, indeed all negative events, and in the process sexuality leaves the marriage. This minimizing interferes with sex because the maintenance of intimacy depends first on acknowledging any blocks to that intimacy. “No stroke is going to bother me. It didn’t even faze me, really. We just keep going,” reported the husband. “No way that’s true, Dave,” said his wife. “Can’t you see that we haven’t had sex in months?” The husband could not believe his ears. “It could not have been that long. I’m just as sexy as ever.” He laughed and pinched his wife’s thigh. She slapped his hand and he continued to laugh. “It’s not funny.” She began to cry. “You’re either a liar or a fool. I cannot live this way.”

*265\97\8*

SUPER LOVE FOR SUPER SEX/LOVE-MAP LANDMARKS: WHAT IS YOUR PRIMARY MODE

May 18th, 2009

OF EXPRESSION?

Are you a talker, a toucher, a shower, a feeler, a senser, a listener? How do you best express yourself?

One husband said, “I’m a man of few words. My wife has all merest.”

The wife responded, “Oh really? Your few words are worth hundreds of mine, because you never listen anyway. I have to send ten for one to be heard.”

Styles of communication are as different as the people who use them. Try now to identify your basic style: quiet, reflective, passive, active—how do you send your signals?

“I don’t talk about love,” said the man. “I show it, I give it, I demonstrate it.”

“Then I must be blind,” answered the wife. “So try talking a little more. I listen better then I see.”

When you really want to be heard and understood, how do you send your message? How do you communicate, show the road signs along your love map?

*91\97\8*

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