Category: Ailmemts & Remedies

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Banish Back Pain

Most back pain can be treated without surgery……CLICK & SEE

Your spine truly is a marvel of engineering, a strong yet flexible column that supports your head and pro­tects the delicate cord carrying nerves from the brain to the rest of your body.

The spine’s complexity is also the reason back problems are so common. Eight out of 10 Americans will experience lower-back pain at some point, and back pain is the single largest cause of workers’ compensation claims. The costs—in medical treatment and time lost—add up to more than $50 billion annually.

Most back pain will ease with proper diagnosis and treatment. Experts estimate that less than 2 percent of patients with chronic back pain need surgery. That option should be used only as a last resort.

Back pain falls into two categories: acute and chronic. Acute back injuries include tears to the capsule of the discs that cushion the upper vertebrae; hernias, which affect the gelatinous center of the discs; and sprains, which stretch the ligaments connecting the vertebrae. Avoid activities that involve lifting, bending, or twisting. Gentle activities like walking can help speed healing and reduce swelling around an injury. Analgesic medications such as acetaminophen are safe for short-term use. Acute back pain almost always disappears within several weeks.

Chronic back pain is the kind that lasts longer than three months. Most cases are caused by improper alignment of the vertebrae or pelvis, which puts pressure on the nerves. This may cause stiffness or pain in the lower back or pain that radiates into the buttocks or back of the legs (sciatica).

Here are some common causes of chronic pain, and simple strategies to help.

Obesity, especially abdominal fat, which pulls the pelvis and lumbar spine forward and downward. The obvious solution: Lose weight.

Poor posture, especially during prolonged sitting, such as working at a desk or driving. To correct the problem, stay conscious of your posture. Change the way you stand, sit, or walk. You may need guidance from a physical therapist or exercise physiologist.
Degeneration of normal structures such as ligaments, discs, and bones of the spine. This is common among smokers but also can occur as a result of chronic inflammation from arthritis. If you smoke, quitting is critical for your overall health and can go far in preventing long-term degeneration of the back.
For many conditions, it’s helpful to do daily back exercises that stretch key muscles and strengthen the abdominal core.

You may click to see->Natural Cure For Back Pain

Written by Dr. Mark Liponis, PARADE Magazine

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.

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Esophagitis

Alternative Names: Inflammation – esophagus

Definition:
Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach.

YOU MAY CLICK TO SEE THE PICTURE.……..Eosinophilic esophagitis

Herpes esophagitis

Endoscopic image of peptic stricture showing n...
Endoscopic image of peptic stricture showing narrowing of the esophagus near the junction with the stomach due to chronic gastroesophageal reflux in the setting of scleroderma. (Photo credit: Wikipedia)

Esophagus is  the tube that carries food from the throat to the stomach. If left untreated, this condition can become very uncomfortable, causing problems with swallowing, ulcers and scarring of the esophagus. In rare instances, a condition known as “Barrett’s esophagus” may develop, which is a risk factor for cancer of the esophagus.

Causes:
Esophagitis is frequently caused by the backflow of acid-containing fluid from the stomach to the esophagus (gastroesophageal reflux). You have a higher risk for esophagitis if you have had excessive vomiting, surgery or radiation to the chest (such as in lung cancer), or if you take medications such as aspirin, ibuprofen, potassium, alendronate, and doxycycline.

Persons with weakened immune systems due to HIV and certain medications (such as corticosteroids) may develop infections that lead to esophagitis. Esophageal infection may be due to viruses such as herpes or cytomegalovirus, and fungi or yeast (especially Candida infections).

The infection or irritation may cause the tissues to become inflamed and occasionally form ulcers. You may have difficulty when swallowing and a burning sensation in the esophagus.

Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi or diseases that weaken the immune system. Infections that cause esophagitis include:

*  Candida. This is a yeast infection of the esophagus caused by the same fungus that causes vaginal yeast infections. The infection develops in the esophagus when the body’s immune system is weak (such as in people with diabetes or HIV). It is usually very treatable with antifungal drugs.

* Herpes. Like Candida, this viral infection can develop in the esophagus when the body’s immune system is weak. It is treatable with antiviral drugs.

Irritation causing esophagitis may be caused by any of the following:

* GERD
* Vomiting
* Surgery
* Medications such as aspirin and anti-inflammatories
* Taking a large pill with too little water or just before bedtime
* Swallowing a toxic substance
* Hernias
* Radiation injury (after receiving radiation for cancer treatment)

You may click to see the related topics below:
Gastroesophageal reflux disease
Esophagitis Candida
Esophagitis CMV
Esophagitis herpes
Symptoms:
Symptoms of esophagitis include:

* Difficult and/or painful swallowing
* Heartburn (acid reflux)
* Mouth sores
* A feeling of something of being stuck in the throat
* Nausea
* Vomiting
*Oral lesions (herps)
If you have any of these symptoms, you should contact your health care provider as soon as possible.

Diagnosis:
Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:

* Upper endoscopy . A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus.

* Biopsy. During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope.

* Upper GI series (or barium swallow). During this procedure, x-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and shows up white on an x-ray. This characteristic enables doctors to view certain abnormalities of the esophagus.

Treatment:
Treatment depends on the specific cause. Reflux disease may require medications to reduce acid. Infections will require antibiotics. Possible treatments include:

* Medications that block acid production, like heartburn drugs
* Antibiotics, antifungals or antivirals to treat an infection
* Pain medications that can be gargled or swallowed
* Corticosteroid medication to reduce inflammation
* Intravenous (by vein) nutrition to allow the esophagus to heal, to reduce the likelihood of malnourishment or dehydration
* Endoscopy to remove any lodged pill fragments
* Surgery to remove the damaged part of the esophagus

While being treated for esophagitis, there are certain steps you can take to help limit discomfort.

* Avoid spicy foods such as those with pepper, chili powder, curry and nutmeg.
* Avoid hard foods such as nuts, crackers and raw vegetables.
* Avoid acidic foods and beverages such as tomatoes, oranges, grapefruits and their juices. Instead, try imitation fruit drinks with vitamin C.
* Add more soft foods such as applesauce, cooked cereals, mashed potatoes, custards, puddings and high protein shakes to your diet.
* Take small bites and chew food thoroughly.
* If swallowing becomes increasingly difficult, try tilting your head upward so the food flows to the back of the throat before swallowing.
* Drink liquids through a straw to make swallowing easier.
* Avoid alcohol and tobacco.

Click for Herbal and Alternative Treatment…:->.(1).…..(2)…..(3)……(4)

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Prognosis:-
The disorders that cause esophagitis usually respond to treatment.

Possible Complications :-
If untreated, esophagitis may cause severe discomfort, swallowing difficulty to the extent of causing malnutrition or dehydration, and eventual scarring of the esophagus. This scarring may lead to a stricture of the esophagus, and food or medications may not be able to pass through to the stomach.

A condition called Barrett’s esophagus can develop after years of gastroesophageal reflux. Rarely, Barrett’s esophagus may lead to cancer of the esophagus.

When to Contact a Medical Professional
Call your health care provider if you have symptoms that suggest esophagitis.

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.medicinenet.com/esophagitis/article.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001153.htm

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Varicose veins

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Definition:
Varicose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins of your lower body.

Varicose veins affect 1 out of 2 people over age 50. They are more common in women than men. Hemorrhoids are a type of varicose vein. Spider veins are like varicose veins, but they are smaller.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems. Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins.

Symptoms:
Varicose veins usually don’t cause any pain. Signs you may have varicose veins include:

*Veins that are dark purple or blue in color
*Veins that appear twisted and bulging; often like cords on your legs
*Varicose veins may also form in other places on your legs, from your groin to your ankle.

CLICK & SEE THE PICTURES
When painful signs and symptoms occur, they may include:

*An achy or heavy feeling in your legs
*Burning, throbbing, muscle cramping and swelling in your lower legs
*Worsened pain after sitting or standing for a long time
*Itching around one or more of your veins
Skin ulcers near your ankle, which can mean you have a severe form of vascular disease that requires medical attention . Spider veins are similar to varicose veins, but they’re smaller. Spider veins are found closer to the skin’s surface and are often red or blue. They occur on the legs, but can also be found on the face. Spider veins vary in size and often look like a spider’s web.

Diagnosis:Ultrasound – Venous (Extremities)

When to call health care provider
Self-care — such as exercise, elevating your legs or wearing compression stockings — can help you ease the pain of varicose veins and may prevent them from getting worse. But if you’re concerned about how your veins look and feel and self-care measures haven’t stopped your condition from getting worse, see your doctor.


Causes:–
Arteries carry blood from your heart to the rest of your tissues. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Muscle contractions in your lower legs act as pumps, and elastic vein walls help blood return to your heart. Tiny valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.

Causes of varicose veins can include:

*Age. As you get older, your veins can lose elasticity causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Blood pools in your veins, and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated through the lungs.

*Pregnancy. Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Changes in your hormones during pregnancy also may play a role. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.

Risk factors:
These factors increase your risk of developing varicose veins:

*Your age. Varicose veins occur most often in people ages 30 to 70, with your risk increasing as you age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to allow blood to flow back into your veins where it collects instead of flowing up to your heart.

*Your sex. Women are more likely to develop the condition. Hormonal changes during pregnancy, premenstruation or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins.

*Genetics. If other family members had varicose veins, there’s a greater chance you will too.

*Obesity. Being overweight puts added pressure on your veins.

*Standing for long periods of time. Your blood doesn’t flow as well if you’re in the same
position for long periods.

Complications:-
Complications of varicose veins, although rare, can include:
Ulcers. Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are caused by long-term fluid buildup in these tissues, caused by increased pressure of blood within affected veins. A brown colored spot on the skin usually begins before an ulcer forms. See your doctor immediately if you suspect you’ve developed an ulcer.

Blood clots. Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may swell considerably. Any sudden leg swelling warrants urgent medical attention because it may indicate a blood clot — a condition known medically as
thrombophlebitis.

Treatment :
*Ambulatory Phlebectomy(American Society for Dermatologic Surgery)

*Sclerotherapy(American Society of Plastic Surgeons)

*Varicose Vein Treatment (Endovenous Ablation of Varicose Veins)(Radiological Society of North America)

*Vain Treatment: What to Expect Before, During, and After(American Academy of Dermatology)

Alternative Therapy :-
*Bilberry(National Center for Complementary and Alternative Medicine)
*Horse Chestnut(National Center for Complementary and Alternative Medicine)

Click to learn more about Varicose veins

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.mayoclinic.com/health/varicose-veins/DS00256

http://www.nlm.nih.gov/medlineplus/varicoseveins.html

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Cholangiocarcinoma

Alternative Names: Bile duct cancer

Definition: Cholangiocarcinoma is a cancerous (malignant) growth in the bile duct which drain bile from the liver into the small intestine. Other biliary tract cancers include pancreatic cancer, gall bladder cancer, and cancer of the ampulla of Vater. Cholangiocarcinoma is a relatively rare adenocarcinoma, with an annual incidence of 1–2 cases per 100,000 in the Western world, but rates of cholangiocarcinoma have been rising worldwide over the past several decades.

CLICK  & SEE THE PICTURES

Causes
Cancerous tumors of the bile ducts are usually slow-growing and do not spread (metastasize) quickly. However, many of these tumors are already advanced by the time they are found.

A cholangiocarcinoma may start anywhere along the bile ducts. These tumors block off the bile ducts.

They affect both men and women. Most patients are older than 65.

Risk Factors:
Although most patients present without any known risk factors evident, a number of risk factors for the development of cholangiocarcinoma have been described; in the Western world, the most common of these is primary sclerosing cholangitis (PSC), an inflammatory disease of the bile ducts which is in turn closely associated with ulcerative colitis (UC). Epidemiologic studies have suggested that the lifetime risk of developing cholangiocarcinoma for a person with PSC is 10%–15%,  although autopsy series have found rates as high as 30% in this population. The mechanism by which PSC increases the risk of cholangiocarcinoma is not well-understood.
Certain parasitic liver diseases may be risk factors as well. Colonization with the liver flukes Opisthorchis viverrini (found in Thailand, Laos, and Malaysia) or Clonorchis sinensis (found in Japan, Korea, and Vietnam) has been associated with the development of cholangiocarcinoma. Patients with chronic liver disease, whether in the form of viral hepatitis (e.g. hepatitis B or C), alcoholic liver disease, or cirrhosis from other causes, are at increased risk of cholangiocarcinoma. HIV infection was also identified in one study as a potential risk factor for cholangiocarcinoma, although it was unclear whether HIV itself or correlated factors (e.g. hepatitis C infection) were responsible for the association.

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Congenital liver abnormalities, such as Caroli’s syndrome or choledochal cysts, have been associated with an approximately 15% lifetime risk of developing cholangiocarcinoma. The rare inherited disorders Lynch syndrome II and biliary papillomatosis are associated with cholangiocarcinoma. The presence of gallstones (cholelithiasis) is not clearly associated with cholangiocarcinoma. However, intrahepatic stones (so-called hepatolithiasis), which are rare in the West but common in parts of Asia, have been strongly associated with cholangiocarcinoma. Exposure to Thorotrast, a form of thorium dioxide which was used as a radiologic contrast medium, has been linked to the development of cholangiocarcinoma as late as 30–40 years after exposure; Thorotrast was banned in the United States in the 1950s due to its carcinogenicity.

Ricks for this condition include:

* Bile duct (choledochal) cysts
* Chronic biliary irritation
* History of infection with the parasitic worm, liver flukes
* Primary sclerosing cholangitis

Cholangiocarcinoma is rare. It occurs in approximately 2 out of 100,000 people.

Symptoms
* Chills
* Clay-colored stools
* Fever
* Itching
* Loss of appetite
* Pain in the upper right abdomen that may radiate to the back
* Weight loss
* Yellowing of the skin (jaundice)

The most common physical indications of cholangiocarcinoma are abnormal liver function tests, jaundice (yellowing of the eyes and skin), which occurs only when bile ducts are blocked by the tumor, abdominal pain (30%–50%), generalized itching (66%), weight loss (30%–50%), fever (up to 20%), or changes in stool or urine color.To some extent, the symptoms depend upon the location of the tumor: Patients with cholangiocarcinoma in the extrahepatic bile ducts (outside the liver) are more likely to have jaundice, while those with tumors of the bile ducts within the liver often have pain without jaundice.
.Yellowing of the skin and eyes (jaundice)->     CLICK & SEE
Blood tests of liver function in patients with cholangiocarcinoma often reveal a so-called “obstructive picture,” with elevated bilirubin, alkaline phosphatase, and gamma glutamyl transferase levels, and relatively normal transaminase levels. Such laboratory findings suggest obstruction of the bile ducts, rather than inflammation or infection of the liver, as the primary cause of the jaundice.  CA19-9 is elevated in most cases

Diagnosis:–
Cholangiocarcinoma is definitively diagnosed from tissue, i.e. it is proven by biopsy or examination of the tissue excised at surgery. It may be suspected in a patient with obstructive jaundice. Considering it as the working-diagnosis may be challenging in patients with primary sclerosing cholangitis (PSC); such patients are at high risk of developing cholangiocarcinoma, but the symptoms may be difficult to distinguish from those of PSC. Furthermore, in patients with PSC, such diagnostic clues as a visible mass on imaging or biliary ductal dilatation may not be evident.

Exams and Tests:-
Blood tests
Blood tests that show abnormal function.
There are no specific blood tests that can diagnose cholangiocarcinoma by themselves. Serum levels of carcinoembryonic antigen (CEA) and CA19-9 are often elevated, but are not sensitive or specific enough to be used as a general screening tool. However, they may be useful in conjunction with imaging methods in supporting a suspected diagnosis of cholangiocarcinoma.
:

Abdominal imaging
CT scan showing cholangiocarcinomaUltrasound of the liver and biliary tree is often used as the initial imaging modality in patients with suspected obstructive jaundice. Ultrasound can identify obstruction and ductal dilatation and, in some cases, may be sufficient to diagnose cholangiocarcinoma.  Computed tomography (CT) scanning may also play an important role in the diagnosis of cholangiocarcinoma.

Tests that show a tumor or blockage in the bile duct:
*Abdominal CT scan
*Abdominal ultrasound
*CT scan-directed biopsy
*Cytology
*Endoscopic retrograde cholangiopancreatography (ERCP)
*Percutaneous transhepatic cholangiogram (PTCA)

Liver function tests (especially bilirubin)

Treatment  :-
The goal is to treat the cancer and the blockage it causes. When possible, surgery to remove the tumor is the treatment of choice and may result in a cure. However, often the cancer has already spread by the time it is diagnosed.

Chemotherapy or radiation may be given after surgery to decrease the risk of the cancer returning. However, the benefit of this treatment is not certain.

Endoscopic therapy or surgery can clear blockages in the biliary ducts and relieve jaundice in patients when the tumor cannot be removed.

For patients with cancer that cannot be removed, radiation therapy may be beneficial. Chemotherapy may be added to radiation therapy or used when the tumor has spread. However, this is rarely effective.

Support Groups:-
You can ease the stress of illness by joining a support group with members who share common experiences and problems (see cancer – support group).

Hospice is often a good resource for patients with cholangiocarcinoma that cannot be cured.

Prognosis:
Surgical resection offers the only potential chance of cure in cholangiocarcinoma. For non-resectable cases, the 5-year survival rate is 0% where the disease is inoperable because distal lymph nodes show metastases[63], and less than 5% in general. Overall median duration of survival is less than 6 months in inoperable, untreated, otherwise healthy patients with tumors involving the liver by way of the intrahepatic bile ducts and hepatic portal vein.

For surgical cases, the odds of cure vary depending on the tumor location and whether the tumor can be completely, or only partially, removed. Distal cholangiocarcinomas (those arising from the common bile duct) are generally treated surgically with a Whipple procedure; long-term survival rates range from 15%–25%, although one series reported a five year survival of 54% for patients with no involvement of the lymph nodes. Intrahepatic cholangiocarcinomas (those arising from the bile ducts within the liver) are usually treated with partial hepatectomy. Various series have reported survival estimates after surgery ranging from 22%–66%; the outcome may depend on involvement of lymph nodes and completeness of the surgery. Perihilar cholangiocarcinomas (those occurring near where the bile ducts exit the liver) are least likely to be operable. When surgery is possible, they are generally treated with an aggressive approach often including removal of the gallbladder and potentially part of the liver. In patients with operable perihilar tumors, reported 5-year survival rates range from 20%–50%.

The prognosis may be worse for patients with primary sclerosing cholangitis who develop cholangiocarcinoma, likely because the cancer is not detected until it is advanced. Some evidence suggests that outcomes may be improving with more aggressive surgical approaches and adjuvant therapy.

Possible Complications :-
*Infection
*Liver failure
*Spread (metastasis) of tumor to other organs.

When to Contact a Medical Professional :-
Call your health care provider if you have jaundice or other symptoms of cholangiocarcinoma.

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://en.wikipedia.org/wiki/Cholangiocarcinoma
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000291.htm

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Bilateral Hydronephrosis

Alternative Names: Hydronephrosis – bilateral

Definition
Bilateral hydronephrosis is the enlargement (distention) of the urine collecting structures and pelvis of both kidneys. Bilateral means both sides.

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Click to See : Unilateral hydronephrosis

Causes
Bilateral hydronephrosis occurs when urine is unable to drain from the kidney down the ureters into the bladder. Hydronephrosis is not itself a disease, but rather a physical result of whatever disease is keeping urine from draining out of the kidneys, ureters, and bladder.

Disorders associated with bilateral hydronephrosis include:
*Acute bilateral obstructive uropathy
*Bladder outlet obstruction
*Chronic bilateral obstructive uropathy
*Neurogenic bladder
*Posterior ureteral valves
*Prune belly syndrome

*Uteropelvic junction obstruction

*Vesicoureteric reflux

Symptoms
Signs of hydronephrosis are generally seen during pregnancy ultrasound studies. There are no symptoms in the fetus.In the newborn, any urinary tract infection is reason to suspect some type of obstructive problem in the kidney. An older child who gets repeat urinary tract infections should be evaluated for possible obstruction.

Urinary tract obstruction usually has no other symptoms beyond an increased number of urinary tract infections.

Diagnosis:

Exams and Tests
Bilateral hydronephrosis may be seen on:

*CT scan of the abdomen or kidneys
*IVP
*Pregnancy (fetal) ultrasound
*Renal scan
*Ultrasound of the abdomen or kidneys

Treatment
Placing a Foley catheter may relieve the obstruction. Other treatment options include draining the bladder or relieving pressure with nephrostomy tubes placed through the skin (percutaneous) or stents placed in the ureters to allow urine to flow from the kidney to the bladder.

Once the blockage is treated, the underlying cause (such as an enlarged prostate) must be identified and treated.

Prognosis:
Advances in fetal ultrasound have given specialists the ability to diagnose problems caused by bilateral obstruction of the urinary tract in the developing fetus. If an obstruction is detected in a fetus, intrauterine surgery (performed while the fetus is still inside the mother’s uterus), or shortly after birth, will improve kidney function.

Newborns diagnosed with obstruction while still in the uterus can receive prompt surgical correction of the defects, often with good results.

Possible Complications :-
Renal insufficiency or failure may develop as a complication of many of the disorders associated with hydronephrosis.

When to Contact a Medical Professional
This disorder is usually discovered by the health care provider.

Prevention
A fetal ultrasound can reveal an obstruction of the urinary tract and allow for early surgery with better outcomes in the newborn. Other causes of obstruction, such as kidney stones, can be diagnosed early if individuals recognize early warning signs of obstruction and kidney disease.

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.nlm.nih.gov/medlineplus/ency/article/000474.htm

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