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Buerger’s Disease

Alternative Nane:Thromboangiitis obliterans

Definition:
Buerger’s disease is a rare disease of the arteries and veins in the arms and legs.In this disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger’s disease usually first shows in the hands and feet and may eventually affect larger areas of your arms and legs.

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Buerger’s disease is rare in the United States, but is more common in the Middle East and Far East. Buerger’s disease usually affects men younger than 40 years of age, though it’s becoming more common in women.

Virtually everyone diagnosed with Buerger’s disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger’s disease. For those who don’t quit, amputation of all or part of a limb may be necess

Symptoms:
The following are the symptoms of Buerger’s:
•Intermittent leg pains
•Leg numbness
•Leg tingling
•Leg burning
•Leg paresthesias
•Foot pains
•Leg pain worse with exertion
•Foot pain worse with exertion
•Foot paresthesias
•Foot numbness
•Foot tingling
•Foot burning
•Cold feet
•Foot discoloration
•Poor leg circulation
•Poor hand circulation – in some less common cases
•Severe pain in extremities at rest
•Insomnia
•Sensation of cold at extremities
•Cold hypersensibility
•Sudden sweating
•Dyshidrosis
•Ulceration of extremities
•Gangrene of extremities
•Blood vessel inflammation
•Blood vessel thrombosis
•Rest pain
•Unremitting ischemic ulcerations
•Gangrene of the digits of hands and feet

The lack of sufficient blood flow to the hands and feet leads to the development of tissue ischemia and sores or lesions. This can eventually lead to the death (necrosis) of affected tissues and gangrene, which may require removal of the dead tissues or amputation in the most severe cases.

Buerger’s disease can mimic or occur in conjunction with a condition called Raynaud’s phenomenon. Symptoms of Raynaud’s phenomenon include a change in color of the affected fingers and toes. The fingers and toes may appear pale, grey or bluish (cyanosis). The hands and feet may feel very cold and there may also be pain, throbbing, burning or numbness….more about Buerger’s disease »

Causes:
The precise cause of Buerger’s disease is unknown.
It’s believed that in genetically susceptible individuals, smoking triggers an autoimmune response that causes the inflammation. The symptoms occur as a result of inadequate blood supply to the tissues.

Diagnosis:
Patient history and physical examination strongly suggest Buerger’s disease.
The condition is characterized by swelling in the arteries and veins of the arms and legs. The cells that cause the inflammation and swelling — and eventually blood clots — form in the vessels leading to your hands and feet and block the blood flow to those parts of your body.

Reduced blood flow means that the skin tissue in your hands and feet doesn’t get adequate oxygen and nutrients. This leads to the signs and symptoms of Buerger’s disease, beginning with pain and weakness in your fingers and toes and spreading to other parts of your arms and legs.

While no tests can confirm whether you have Buerger’s disease, your doctor will likely order tests to rule out other more common conditions or confirm suspicion of Buerger’s disease brought on by your signs and symptoms.

Tests may include:

Blood tests
Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood-clotting disorders and diabetes, along with other diseases and conditions.

The Allen’s test
Your doctor may perform a simple test called the Allen’s test to check blood flow through the arteries carrying blood to your hands. In the Allen’s test, you make a tight fist, which forces the blood out of your hand. Your doctor presses on the arteries at each side of your wrist to slow the flow of blood back into your hand, making your hand lose its normal color. Next, you open your hand and your doctor releases the pressure on one artery, then the other. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger’s disease.

Angiogram
An angiogram, also called an arteriogram, helps doctors see the condition of your arteries. A special dye is injected into an artery, after which you undergo

X-rays or other imaging tests. The dye helps to delineate any artery blockages that show up on the images. Your doctor may order angiograms of both your arms and your legs — even if you don’t have signs and symptoms of Buerger’s disease in all of your limbs. Buerger’s disease almost always affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.

* Doppler ultrasonography to show diminished circulation in the peripheral vessels

* plethysmography to help detect decreased circulation in the peripheral vessels

Risk Factors:

Tobacco use
Cigarette smoking greatly increases your risk of Buerger’s disease. Heavy cigarette smokers (people who smoke one and a half packs a day or more) are most likely to develop Buerger’s disease, though it can occur in people who use any form of tobacco, including cigars and chewing tobacco. People who smoke hand-rolled cigarettes using raw tobacco may have the greatest risk of Buerger’s disease.

It isn’t clear how tobacco use increases your risk of Buerger’s disease, but virtually everyone diagnosed with Buerger’s disease uses tobacco. It’s thought that chemicals in tobacco may irritate the lining of your blood vessels, causing them to swell. Rates of Buerger’s disease are highest in areas of the Middle

East and Far East where heavy smoking is most common.

Although secondhand smoke isn’t thought to be a major risk factor for Buerger’s disease, if you’re diagnosed, you should stay away from people who are

Smoking. Secondhand smoke could worsen your condition.

Chronic gum disease :Long-term infection of the gums is also associated with the development of Buerger’s disease.

Treatment:
The only effective treatment for Buerger’s disease is to quit smoking (smoking cessation) and to abstain from the use of all tobacco products, such as chewing tobacco. At this time, there are no medications that are effective in treating Buerger’s disease.

If an affected individual continues to smoke, they’re likely to have toes and/or fingers amputated. Infections should be treated promptly.

Smoking cessation is a challenging process and requires a multifaceted approach to be successful. For optimal results with smoking cessation, it is recommended that a smoker consults with a health care provider prior to quitting. Smoking cessation can include a combination of nicotine replacement therapy to minimize the nicotine cravings associated with nicotine withdrawal, and participation in a smoking cessation support group, such as Freedom From Smoking (http://www.ffsonline.org/ ) or Nicotine Anonymous (http://www.nicotine-anonymous.org).

Lifestyle & Home Remedies:
Take care of your fingers and toes if you have Buerger’s disease. Check the skin on your arms and legs daily for cuts and scrapes, keeping in mind that if you’ve lost feeling to a finger or toe you may not feel, for example, a cut when it happens. Keep your fingers and toes protected and avoid exposing them to cold.

Low blood flow to your extremities means your body can’t resist infection as easily. Small cuts and scrapes can easily turn into serious infections. Clean any cut with water, apply antibiotic ointment and cover it with a clean bandage. Keep an eye on any cuts or scrapes to make sure they’re healing. If they get worse or heal slowly, see your doctor promptly.

Visit your dentist regularly to keep your gums and teeth in good health and avoid gum disease, which in its chronic form is associated with Buerger’s disease.
Prognosis: The disease is progressive in patients who do not stop smoking. Areas with gangrene must be removed surgically.

Prevention:
Quit using tobacco in any form
Virtually everyone who has Buerger’s disease has used tobacco in some form, most prominently cigarettes. To prevent Buerger’s disease, it’s important to not use tobacco.

Quitting smoking can be hard. If you’re like most people who smoke, you’ve probably tried to quit in the past, but haven’t been successful. It’s never too late to try again. Talk to your doctor about strategies to help you quit.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.wrongdiagnosis.com/b/buergers_disease/intro.htm
http://edition.cnn.com/HEALTH/library/buergers-disease/DS00807.html
http://www.mayoclinic.com/health/buergers-disease/DS00807
http://www.bbc.co.uk/health/physical_health/conditions/buergher1.shtml

Buerger’s Disease

http://modernmedicalguide.com/buergers-disease/

http://indiahealthtour.com/treatments/vascular/buerger-disease-thromboangiitis-obliterans-treatment-india.html

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Some Health Quaries & Answers

Protection during breast-feeding
Q: I am breast-feeding my nine-month old baby. I have not had my periods and am not using any contraception. I was told that if you are breast-feeding, you will not get pregnant. Is it true?


A:
It’s a myth, an old wife’s tale. You can become pregnant as soon as you have intercourse, even if you are breast feeding and have not had your periods. You need to check with your gynaecologist and ask for a reliable method of contraception which you can use until you are ready to have your next baby.

There are several options: your husband can use condoms, or you can have an intra-uterine contraceptive device (IUD) inserted, take progesterone-only pills daily or take an injection of a long-acting form of progesterone once in three months.

Familial cancer :-
Q: One of my maternal uncles had lung cancer and another had stomach cancer that spread to the brain. What precautions should I take so that I do not develop cancer?

A: Some cancers can be genetic or hereditary. But in your case, your uncles seem to have had different types of cancer. To reduce your risk of developing the disease, in general, lead a healthy life with one hour of exercise daily. Maintain your BMI (weight divided by height in metre squared) at 23. Eat four to five helpings of fruits and vegetables everyday. After the age of 50, do a PSA (prostate specific antigen) test. The PSA level rises in prostrate cancer which is very common in men.

Still no baby
Q: We have no children even after seven years of marriage. My wife became pregnant four times, but each time the pregnancy ended in an abortion. We also tried to have a test tube baby but that too was unsuccessful.

A: Your wife seems to have no problem conceiving since she become pregnant naturally four times. The difficulty seems to lie in retaining the pregnancy and carrying it to term. This may be due to congenital malformations or tumours (like fibroids) in the uterus, or diseases such as kidney problems, diabetes and hormonal imbalance. There are several reasons which need to be investigated by an obstetrician. Investing in a test tube baby is not a solution unless you also plan to use a surrogate mother.

Sweaty palms
Q: I sweat excessively on my palms because of which am unable to shake hands with people or use a keyboard. I have tried several creams and lotions but to no avail.


A:
Sweating excessively on the palms is due to overdrive of the sympathetic nervous system and is independent of the temperature regulatory sweating that occurs on other parts of the body. You need basic blood tests to rule out thyroid and other endocrine malfunctions. These can be treated.

To begin with, try soaking your hands in boric acid solution twice a day. Then apply an anti perspirant roll or deodorant. Wipe your palms frequently. Also, you could use a “plastic skin” on the keyboard to type.

Some doctors prescribe anti cholinergergic tablets, beta blockers or sedatives. However, these have side effects — such as dry mouth and sleepiness — which are usually more distressing than the disease. Surgery can be done to remove the nerve ganglia responsible for the problem. But this should be the last resort.

Migraine attack
Q: I suffer from migraine. The headaches are incapacitating and I lose several working days every month. I do not want to keep on taking tablets.


A:
Migraine can be treated in one of two ways. Some patients are able to accurately predict the onset of an attack. They do very well with stemetil, phenergan, codeine or sumatryptan, which have to be taken before the headache is well-established and vomiting starts.

In others, the headaches are frequent and unpredictable. They need preventive medication like propanalol or amitryptiline, which must be taken daily. Sometimes regular physical exercise combined with relaxation techniques in yoga reduces the frequency and severity of the attacks. Accupressure applied to specific sites at the onset of the headache may help.

Right weight
Q: I am 38 years old and have two children. I am a little plump, not fat. What should my correct weight be?

A: After the age of two, a person’s ideal weight is determined not by age but by calculating the BMI. It is a good indicator of the body fat. Ideally, the BMI should be 23.

Based on this calculation, figure out how many kilograms you need to lose. Exercising one hour everyday should work off about 350 calories. You can tailor your diet so that every day you have a calorific deficit of 500 calories. A 3,500-calorie negative balance will result in a kilogram of weight loss.

Source
: The Telegraph ( Kolkata, India)

Drug Cuts the Risk of Prostate Cancer

Two-panel drawing shows normal male reproducti...

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Men at an above-normal risk of prostate cancer may be able to reduce their risk of developing the disease by taking a drug already on the market.

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In research reported yesterday, the drug dutasteride, currently used to shrink enlarged prostates, was found to reduce the risk of prostate cancer by about a quarter in high-risk men.

The drug apparently caused small tumors to stop growing or even to shrink, a research team reported in the New England Journal of Medicine.

The medication is sold under the brand name Avodart.

A previous study had found that a similar drug, finasteride, could also lower the risk of prostate tumors, but the new research – conducted at 250 sites in 42 countries – suggests that dutasteride is slightly more effective.

The new study “is further evidence that there is a role for these drugs in risk reduction,” said Dr. Jack Jacoub, a medical oncologist at Orange Coast Memorial Medical Center in Fountain Valley, Calif., who was not involved in the study. “If a patient understands all the issues [associated with the drug], I think it would be appropriate to provide it.”
Dr. Howard M. Sandler, an oncologist at the Cedars-Sinai Medical Center in Los Angeles, was even more emphatic.

“The question might be, why isn’t every man taking one of these drugs?” he said. “They help people urinate better by shrinking the prostate, they probably reduce baldness, and they reduce the risk of prostate cancer. There seems to be very little downside to them.”

GlaxoSmithKline, which manufactures Avodart, said on Monday that it would apply to the Food and Drug Administration for permission to market the drug for risk reduction in men with high PSA levels, a measure of prostate cancer risk; a family history of the disease, or other risk factors such as ethnicity.

But because the drug is already available, doctors do not need to wait for such permission to prescribe it as a preventive.

Considering the low risk of the drug, that might be a safe option, experts said. Insurance companies are not likely to pay for it for that purpose, however, until the FDA approves it.

Both dutasteride and finasteride are already approved for treating benign prostatic hyperplasia, or BPH, an enlargement of the prostate gland that causes urinary and other problems.

Finasteride is sold by Merck & Co. Inc. under the brand name Proscar.

In the study, researchers enrolled 8,231 men, ages 50 to 75, who had elevated levels of PSA but no evidence of prostate tumors on a biopsy.

Half received dutasteride daily for four years; half received a placebo.

All the men received biopsies two years after enrollment and again two years later.

Overall, 659 men taking dutasteride were diagnosed with prostate cancer (19.9 percent), compared to 858 men (25.1 percent) taking a placebo – a 23 percent reduction.

Among men with a family history of prostate cancer, the drug reduced risk by 31.4 percent.

Price may be a problem. According to GlaxoSmithKline, the wholesale cost of Avodart is $3.23 per pill. Finasteride is available in a generic form and is thus cheaper.

Prostate cancer is the most common cancer in men after skin cancer. It affects 192,000 men a year and kills 27,000.

Source : The Blade : April ’01. 2010

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Breasts Like a Woman

Both men and women have breasts. In women they are well developed while in men they are rudimentary. Yet 60 per cent of men, at some point in their life, develop aesthetically unacceptable “gynaecomastia “ , a term which in Greek means “breasts like a woman”.
……..Gynecom_img_17
Male babies may develop enlargement of one or both breasts. Sometimes, the affected breasts may also secrete a watery milk-like secretion. This is normal and occurs because the baby’s breast has been influenced by the mother’s hormones. It disappears if left alone. Pressing it to remove the milk can result in infection and abscess formation.

Thirty to 50 per cent boys in the age group 11 to 14 years suddenly develop breasts. It occurs because during this time the levels of the sex hormones, both estrogen (female hormone) and testosterone (male hormone), start to increase. Testosterone controls male traits such as muscle mass and body hair, while estrogen controls female traits, including the growth of breasts. A perfect ratio has to be maintained, or else it might lead to the development of breasts in boys. In 75 per cent of them, the breasts regress spontaneously within three years.

Breast enlargement in boys may persist because of hypogonadism (inadequate development of the male sex organs). This may be genetic — in people whose genetic profile is XXY instead of XY, owing to the failure of the testes to develop at all, or a result of artificial removal of the testes (castration). It may occur in adults as a result of kidney and thyroid diseases. Liver damage can also result in low testosterone levels and enlarged breasts.

Enzymes belonging to the cytochrome P450 group, found in fat tissue, convert testosterones to estrogens. As the fat tissue increases gynaecomastia can occur. Weight loss and exercises, like the bench press and push-ups, can correct this type of breast enlargement along with overall weight reduction.

These enzymes can be affected by medications for ulcers, anti psychotic drugs, sedatives, diuretics and some antibiotics. Long-term use of medications belonging to these groups can cause gynaecomastia. Several illicit drugs are available on the streets today. Some, such as the amphetamines, are touted as a “safe” adjuvant to long hours of studying as they prevent drowsiness. But long-term use of these not only damages the psyche but also promotes breast development.

“Nutritional supplements” are used by many bodybuilders. Many do not contain all the ingredients listed. Some are sold secretly “under the counter” or via the Internet. Many preparations are not legal or may have expired. They may not conform to safety standards. Moreover, they may contain steroids. Sometimes, they contain creatinine, natural ingredients found in the human body. However, they may be dangerous to health, and cause enlarged and sometimes lumpy breasts.

There is no short cut to a “Mr World” physique. At least two hours of workout is needed with a healthy high-protein, low-fat diet.

Gynaecomastia is not always harmless. It needs to be reviewed with all previous medical documents, and investigated with blood tests and scans. Very rarely, gynaecomastia confined to one side may be due to cancer.

Diagnosis and treatment of the underlying cause of gynaecomastia may lead to improvement. Changing the offending medication, avoiding alcohol and exercising regularly may be all that is required. Some medications which are anti estrogen, or testosterone derivatives can sometimes be used on a short-term basis under medical supervision. These medications are for treating other diseases and are not universally approved for the treatment of gynaecomastia.

Medical treatment or “waiting and watching” can be tried for two to three years. After that, the breast tissue tends to harden and then surgery is the only alternative. There are several options — liposuction, gland excision, skin sculpture, reduction mammoplasty or a combination of these techniques. Reduction surgery is a cosmetic procedure and is usually performed by plastic surgeons.

In 25 per cent of men with persistent gynaecomastia, there is no correctable cause, nor is the condition dangerous. If they do not wish to have surgery or try medications and just wish to live with the condition, the breasts can often be compressed. An elastic girdle worn by women around their abdomens can be used and works quite well. Or else, a loose thick shirt may be sufficient to hide the offending bulges.

Source: The Telegraph (Kolkata, India)

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Some Health Quaries & Answers

Q: My one-year-old son developed watery diarrhoea. We went to several doctors who first prescribed tests and then gave him antibiotics. Eventually I was told he had developed “milk intolerance” and was switched to soya milk. Can I give him goat or buffalo milk? Can I use a tinned product like Nan or Lactogen instead?


A:
Your son has developed an inability to digest lactose, the sugar in milk, probably as a consequence of gastroenteritis. Since he is a year old, and you do not want to give him soya milk, try keeping him on other foods (no milk) for 72 hours. Very often the intestine recovers its ability to digest milk in that time. Nan, Lactogen, goat and buffalo milk all contain lactose. Switching him to these products will not solve the problem.

Lung cancer
Q: My daughter is 24 years old and has been diagnosed with lung cancer. How is it possible? She does not smoke.

A: The factors that contribute to the development of lung cancer in non-smoking women are postulated to be exposure to second hand smoke, high levels of the hormone estrogen, genetic factors, or abnormal embryonic remnants in the lung that mutate. None of these (except exposure to second hand smoke) can be changed.

Sugar or honey?
Q: I am diabetic, but my blood sugar level is well under control. I use Equal in my tea and coffee. Recently I read that it is bad for health. Can I use honey instead?

 

A: Honey contains fructose, glucose and sucrose. All these are sugars, so substituting honey for sugar will not help. The main constituent of Equal is aspartame (L-aspartyl-L-phenylalanyl-methyl-ester) which is about 200 times as sweet as sugar with virtually no calories. This compound breaks down in the system to:

1) Phenylalanine (50 per cent), which can be neurotoxic and in some susceptible people cause seizures

2) Aspartic acid (40 per cent), which can cause brain damage in the developing brain

3) Methanol (10 per cent), which turns into formaldehyde

The quantities taken by diabetic patients in tea and coffee are small and probably insufficient to cause these adverse reactions. People who drink large quantities of diet cola or such drinks are more likely to be affected. The reactions are idiosyncratic and vary from individual to individual.

Weight gain
Q: I gained 4 kg after I got married. This now makes me 75 kg. Also, I have not been able to conceive.


A: Y
our lifestyle may have changed after marriage. The best thing to do is to stop snacking, cut out chocolates and puddings, and always refuse a second helping. You also need to exercise. An hour a day is sufficient, but you need to vigorously cross train. Run one day, swim the next and cycle the third. Combine this with yoga if you want that hourglass figure.

Bed wetting
Q: My nine-year-old son still wets his bed. This is an embarrassment to us.

A: Bed wetting is said to be primary when bladder control has never been achieved and secondary when there is a reversion to it after six dry months. Most children achieve night time bladder control by the age of three. But around 30 per cent of children continue to wet their bed. Even without treatment, this percentage falls to 20 per cent by the age of six. However, one per cent of adolescents continue to wet their bed. Bed wetting may be familial and is commoner in boys. If urine and blood test results are normal, and there is no structural abnormality, then the outlook for such children is good. About 15 per cent gets spontaneously cured. Berating the child, punishment or humiliation is not an answer to the problem.

A few simple measures may help:

* Limit fluid intake after 7pm

* Avoid caffeinated drinks (colas, tea and coffee)

* Encourage the child to go to the toilet before bedtime

* Avoid punishment

* Encourage success

* Leave a light on in the bathroom

* Make the child wear simple underclothes without complicated bows and zippers so that they can be easily pulled up or down if required.

Gasping for air
Q: I have been diagnosed with emphysema. I am breathless most of the time. How did I get this?


A:
Emphysema usually follows lung damage as a result of long-term cigarette smoking, air pollution or occupational exposure to dust as in the case of coal miners. It runs in some families where many members have a genetically determined deficiency of an enzyme called Alpha-1-antitrypsin. It can occur in poorly controlled asthmatics. Lung function decreases with age so it can occur in older people without any of these risk factors. It is also commoner in men.

It can be treated with inhalers, nebulisers, oxygen, bronchodilators and appropriate antibiotics whenever an infection flares up. In the case of smokers, treatment will not succeed unless smoking is stopped.

Source: The Telegraph (Kolkata, India)

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