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Herbs & Plants

Robinia pseudacacia

Botanical Name: Robinia pseudacacia
Family: Fabaceae
Subfamily: Faboideae
Tribe: Robinieae
Genus: Robinia
Species: R. pseudoacacia
Kingdom: Plantae
Order: Fabales

Synonyms: Locust Tree

Common Names: Black Locust, Yellow Locust, False acacia

Habitat:Robinia pseudacacia is native to Eastern N. America – Appalachian and Ozark mountain ranges. Naturalized in Britain . It grows in woods and thickets, especially in deep well-drained calcareous soils.

Description:
Robinia pseudoacacia is a deciduous Tree growing to 25 m (82ft) by 15 m (49ft) at a fast rate. Exceptionally, it may grow up to 52 metres (171 ft) tall and 1.6 metres (5.2 ft) diameter in very old trees. It is a very upright tree with a straight trunk and narrow crown which grows scraggly with age. The dark blue-green compound leaves with a contrasting lighter underside give this tree a beautiful appearance in the wind and contribute to its grace.

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Black locust is a shade intolerant species and therefore is typical of young woodlands disturbed areas where sunlight is plentiful and soil is dry, in this sense, black locust can often grow as a weed tree. It also often spreads by underground shoots or suckers which contribute to the weedy character of this species. Young trees are often spiny, however, mature trees often lack spines. In the early summer black locust flowers; the flowers are large and appear in large, intensely fragrant (reminiscent of orange blossoms), clusters. The leaflets fold together in wet weather and at night (nyctinasty) as some change of position at night is a habit of the entire leguminous family.

Description in detail:
*Bark: The bark is dark gray brown and tinged with red or orange in the grooves. It is deeply furrowed into grooves and ridges which run up and down the trunk and often cross and form diamond shapes.

*Root: The roots of black locust contain nodules which allow it to fix nitrogen as is common within the pea family.
The branches are typically zig-zagy and may have ridges and grooves or may be round. When young, they are at first coated with white silvery down, this soon disappears and they become pale green and afterward reddish or greenish brown.

Prickles: :Prickles may or may not be present on young trees, root suckers, and branches near the ground; typically, branches high above the ground rarely contain prickles. R. psuedoacacia is quite variable in the quantity and amount of prickles present as some trees are densely prickly and other trees have no prickles at all. The prickles typically remain on the tree until the young thin bark to which they are attached is replaced by the thicker mature bark. They develop from stipules[14] (small leaf like structures which grow at the base of leaves) and since stipules are paired at the base of leaves, the prickles will be paired at the bases of leaves. They range from .25–.8 inches (0.64–2.03 cm) in length and are somewhat triangular with a flared base and sharp point. Their color is of a dark purple and they adhere only to the bark.

*Wood: Pale yellowish brown; heavy, hard, strong, close-grained and very durable in contact with the ground. The wood has a specific gravity of 0.7333, and a weight of approximately 45.7 pounds per cubic foot.

* Leaves: The leaves are compound, meaning that each leaf contains many smaller leaf like structures called leaflets, the leaflets are roughly paired on either side of the stem which runs through the leaf (rachis) and there is typically one leaflet at the tip of the leaf (odd pinnate). The leaves are alternately arranged on the stem. Each leaf is 6–14 inches (15–36 cm) long and contains 9-19 leaflets, each being 1–2 inches (2.5–5.1 cm)long, and .25–.75 inches (0.64–1.91 cm) wide. The leaflets are rounded or slightly indented at the tip and typically rounded at the base. The leaves come out of the bud folded in half, yellow green, covered with silvery down which soon disappears. Each leaflet initially has a minute stipel, which quickly falls, and is connected to the (rachis) by a short stem or petiolule. The leaves are attached to the branch with slender hairy petioles which is grooved and swollen at the base. The stipules are linear, downy, membranous at first and occasionally develop into prickles. The leaves appear relatively late in spring.
The leave color of the fully grown leaves is a dull dark green above and paler beneath. In the fall the leaves turn a clear pale yellow.

*Flower: The flowers open in May or June for 7–10 days, after the leaves have developed. They are arranged in loose drooping clumps (racemes) which are typically 4–8 inches (10–20 cm) long.[5] The flowers themselves are cream-white (rarely pink or purple) with a pale yellow blotch in the center and imperfectly papilionaceous in shape. They are about 1 inch (2.5 cm) wide, very fragrant, and produce large amounts of nectar. Each flower is perfect, having both stamens and a pistil (male and female parts). There are 10 stamens enclosed within the petals; these are fused together in a diadelphous configuration, where the filaments of 9 are all joined to form a tube and one stamen is separate and above the joined stamens. The single ovary is superior and contains several ovules. Below each flower is a calyx which looks like leafy tube between the flower and the stem. It is made from fused sepals and is dark green and may be blotched with red. The pedicels (stems which connect the flower to the branch) are slender, .5 inches (1.3 cm), dark red or reddish green.

*Fruit: The fruit is a typical legume fruit, being a flat and smooth pea-like pod 2–4 inches (5.1–10.2 cm) long and .5 inches (1.3 cm) broad. The fruit usually contains 4-8 seeds. The seeds are dark orange brown with irregular markings. They ripen late in autumn and hang on the branches until early spring. There are typically 25500 seeds per pound.

*Winter buds: Minute, naked (having no scales covering them), three or four together, protected in a depression by a scale-like covering lined on the inner surface with a thick coat of tomentum and opening in early spring. When the buds are forming they are covered by the swollen base of the petiole.

*Cotyledons are oval in shape and fleshy.

Cultivation:
Landscape Uses:Erosion control, Firewood, Aggressive surface roots possible. Succeeds in any well-drained soil, preferring one that is not too rich. Succeeds in dry barren sites, tolerating drought and atmospheric pollution. Succeeds in a hot dry position. The plant is reported to tolerate an annual precipitation in the range of 61 to 191cm, an annual temperature in the range of 7.6 to 20.3°C and a pH of 6.0 to 7.0. A fast-growing tree for the first 30 years of its life, it can begin to flower when only 6 years old, though 10 – 12 years is more normal. The flowers are a rich source of nectar and are very fragrant with a vanilla-like scent. The branches are brittle and very liable to wind damage. When plants are grown in rich soils they produce coarse and rank growth which is even more liable to wind damage. The plants sucker freely and often form dense thickets, the suckers have vicious thorns. There are some named varieties selected for their ornamental value[188], some of these are thornless. Any pruning should be done in late summer in order to reduce the risk of bleeding. The leaves are rich in tannin and other substances which inhibit the growth of other plants. A very greedy tree, tending to impoverish the soil. (Although a legume, I believe it does not fix atmospheric nitrogen. A very good bee plant. This species is notably resistant to honey fungus. Special Features: North American native, Invasive, Naturalizing, All or parts of this plant are poisonous, Attracts butterflies, Fragrant flowers, Blooms are very showy.

Propagation :
Seed – pre-soak for 48 hours in warm water and sow the seed in late winter in a cold frame. A short stratification improves germination rates and time. Prick out the seedlings into individual pots when they are large enough to handle and grow them on in the greenhouse for their first winter. Plant them out into their permanent positions in the following summer. Other reports say that the seed can be sown in an outdoor seedbed in spring. The seed stores for over 10 years. Suckers taken during the dormant season.

.
Edible Uses: Condiment; Drink; Oil.

Seed – cooked. Oily. They are boiled and used like peas. After boiling the seeds lose their acid taste. The seed is about 4mm long and is produced in pods up to 10cm long that contain 4 – 8 seeds. A nutritional analysis is available. Young seedpods – cooked. The pods contain a sweetish pulp that is safe to eat and is relished by small children. (This report is quite probably mistaken, having been confused with the honey locust, Gleditsia spp.) A strong, narcotic and intoxicating drink is made from the skin of the fruit. Piperonal is extracted from the plant, it is used as a vanilla substitute. No further details. All the above entries should be treated with some caution, see the notes at the top of the page regarding toxicity. Flowers – cooked. A fragrant aroma, they are used in making jams and pancakes. They can also be made into a pleasant drink.

Composition:
Figures in grams (g) or miligrams (mg) per 100g of food.
Seed (Dry weight)

*0 Calories per 100g
*Water : 0%
*Protein: 21g; Fat: 3g; Carbohydrate: 0g; Fibre: 28g; Ash: 6.8g;
*Minerals – Calcium: 1400mg; Phosphorus: 0.3mg; Iron: 0mg; Magnesium: 0mg; Sodium: 0mg; Potassium: 0mg; Zinc: 0mg;
*Vitamins – A: 0mg; Thiamine (B1): 0mg; Riboflavin (B2): 0mg; Niacin: 0mg; B6: 0mg;

Medicinal Uses:
Febrifuge. The flowers are antispasmodic, aromatic, diuretic, emollient and laxative. They are cooked and eaten for the treatment of eye ailments. The flower is said to contain the antitumor compound benzoaldehyde. The inner bark and the root bark are emetic, purgative and tonic. The root bark has been chewed to induce vomiting, or held in the mouth to allay toothache, though it is rarely if ever prescribed as a therapeutic agent in Britain. The fruit is narcotic. This probably refers to the seedpod. The leaves are cholagogue and emetic. The leaf juice inhibits viruses.
Tonic, emetic and purgative properties have been ascribed to the root and bark, but the locust tree is rarely, if ever, prescribed as a therapeutic agent.

Occasional cases of poisoning are on record in which boys have chewed the bark and swallowed the juice: the principal symptoms being dryness of the throat, burning pain in the abdomen, dilatation of the pupils, vertigo and muscular twitches; excessive quantities causing also weak and irregular heart action.

Though the leaves of Robinia have also been stated to produce poisonous effects careful examination has failed to detect the presence of any soluble proteid or of alkaloids, and by some the leaves have been recorded as even affording wholesome food for cattle.

The flowers contain a glucoside, Robinin, which, on being boiled with acids, is resolved into sugar and quercetin.

Other Uses:
Dye; Essential; Fibre; Fuel; Oil; Soil stabilization; Wood.

A drying oil is obtained from the seed. An essential oil is obtained from the flowers. Highly valued, it is used in perfumery. A yellow dye is obtained from the bark. Robinetin is a strong dyestuff yielding with different mordants different shades similar to those obtained with fisetin, quercetin, and myricetin; with aluminum mordant, it dyes cotton to a brown-orange shade. The bark contains tannin, but not in sufficient quantity for utilization. On a 10% moisture basis, the bark contains 7.2% tannin and the heartwood of young trees 5.7%. The bark is used to make paper and is a substitute for silk and wool. Trees sucker freely, especially if coppiced, and they can be used for stabilizing banks etc. Wood – close-grained, exceedingly hard, heavy, very strong, resists shock and is very durable in contact with the soil. It weighs 45lb per cubic foot and is used in shipbuilding and for making fence posts, treenails, floors etc. A very good fuel, but it should be used with caution because it flares up and projects sparks. The wood of Robinia pseudoacacia var. rectissima, the so called ‘Long Island’ or ‘Shipmast’ locust, has a greater resistance to decay and wood borers, outlasting other locust posts and stakes by 50 – 100% .
Known Hazards: All parts of the plant (except the flowers) and especially the bark, should be considered to be toxic. The toxins are destroyed by heat. The inner bark contains a poisonous proteid substance, Robin, which possesses strong emetic and purgative properties. It is capable of coagulating the casein of milk and of clotting the red corpuscles of certain animals.
Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.

Resources:
https://en.wikipedia.org/wiki/Robinia_pseudoacacia
http://www.pfaf.org/user/Plant.aspx?LatinName=Robinia+pseudoacacia
http://www.botanical.com/botanical/mgmh/a/acaci005.html

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Herbs & Plants

Rhus ovata

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Botanical Name : Rhus ovata
Family: Anacardiaceae
Genus: Rhus
Species: R. ovata
Kingdom: Plantae
Order: Sapindales

Common Names: Sugar Bush, Sugar sumac

Habitat : Rhus ovata is native to South-western N. America – California, Arizona and Mexico. It grows on dry rocky slopes below 800 metres, usually away from the coast, in California. Grows in oak woodlands and chaparral.

Description:
Rhus ovata is an evergreen Shrub ranging from 2–10 m (6.6–32.8 ft), tall and it has a rounded appearance. The twigs are thick and reddish in color. Its foliage consists of dark green, leathery, ovate leaves that are folded along the midrib. The leaf arrangement is alternate.

Its inflorescences which occur at the ends of branches consist of small, 5-petaled, flowers that appear to be pink, but upon closer examination actually have white to pink petals with red sepals. Additionally, the flowers may be either bisexual or pistillate. The fruit is a reddish, sticky drupe, and is small, about 6 – 8 mm in diameter.

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It is frost tender. It is in leaf 12-Jan. The flowers are dioecious (individual flowers are either male or female, but only one sex is to be found on any one plant so both male and female plants must be grown if seed is required) and are pollinated by Bees.The plant is not self-fertile.

Suitable for: light (sandy) and medium (loamy) soils, prefers well-drained soil and can grow in nutritionally poor soil. Suitable pH: acid, neutral and basic (alkaline) soils. It cannot grow in the shade. It prefers dry or moist soil and can tolerate drought.
Cultivation:
Succeeds in a well-drained fertile soil in full sun. Succeeds in a hot dry position. Plants are usually found in poor dry soils in the wild. This species is not very hardy in Britain, it may not succeed outdoors even in the mildest areas of the country. One report says that it can tolerate temperatures down to about -5°c. The young growth in spring can be damaged by late frosts. Plants have brittle branches and these can be broken off in strong winds. Plants are also susceptible to coral spot fungus. Plants in this genus are notably resistant to honey fungus. Many of the species in this genus are highly toxic and can also cause severe irritation to the skin of some people, whilst other species such as this one are not poisonous. It is relatively simple to distinguish which is which, the poisonous species have axillary panicles and smooth fruits whilst non-poisonous species have compound terminal panicles and fruits covered with acid crimson hairs. The toxic species are sometimes separated into their own genus, Toxicodendron, by some botanists. Dioecious. Male and female plants must be grown if seed is required.

Propagation:
Seed – best sown in a cold frame as soon as it is ripe. Pre-soak the seed for 24 hours in hot water (starting at a temperature of 80 – 90c and allowing it to cool) prior to sowing in order to leach out any germination inhibitors. This soak water can be drunk and has a delicious lemon-flavour. The stored seed also needs hot water treatment and can be sown in early spring in a cold frame. When they are large enough to handle, prick the seedlings out into individual pots and grow them on in the greenhouse for their first winter. Plant them out into their permanent positions in late spring or early summer, after the last expected frosts. Cuttings of half-ripe wood, 10cm with a heel, July/August in a frame. Root cuttings 4cm long taken in December and potted up vertically in a greenhouse. Good percentage. Suckers in late autumn to winter

Edible Uses:
Fruit is eaten raw or cooked. Slightly acid to sweet tasting. The fruit is only 6 – 8mm in diameter with very little flesh, but it is produced in dense racemes and so is easily harvested. When soaked for 10 – 30 minutes in hot or cold water it makes a very refreshing lemonade-like drink (without any fizz of course). The fruit can also be sucked for the tart juice that forms on its surface. A sweetish white sap exudes from the fruit and can be used as an acid flavouring or a sugar substitute. The leaves are boiled to make a tea.

Medicinal Uses:
An infusion of the leaves has been used in the treatment of chest pains, coughs and colds. An infusion has also been taken just before giving birth to facilitate an easy delivery. Some caution is advised in the use of the leaves and stems of this plant, see the notes above on toxicity.

Other Uses :
Dye; Mordant; Oil; Soil stabilization.

The leaves are rich in tannin. They can be collected as they fall in the autumn and used as a brown dye or as a mordant. An oil is extracted from the seeds. It attains a tallow-like consistency on standing and is used to make candles. These burn brilliantly, though they emit a pungent smoke. Often planted in poor dry soils in America, where its extensive root system helps to prevent erosion.

Known Hazards : There are some suggestions that the sap of this species can cause a skin rash in susceptible people, but this has not been substantiated.
Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.

Resources:
https://en.wikipedia.org/wiki/Rhus_ovata
http://www.pfaf.org/user/Plant.aspx?LatinName=Rhus+ovata

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Psychiatry

How to stop being furiously angry

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Isabel Clarke, a clinical psychologist who runs an anger-management clinic, explains why bad temper is a growing problem — and how to keep it in check.

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Imagine a pill you could take that instantly calms your temper when it’s about to burst into a Herculean mess. That’s what researchers might be on the brink of formulating after experiments helped them to identify the brain’s anger centre. Scientists at New York University found that chemical changes in the brain’s lateral septum made the mice attack other animals. It’s a discovery that could lead to a calming drug.

Meanwhile, we remain a nation of quiet seethers. Research by PruHealth found that nearly half of us admit to snapping at colleagues, 28 per cent to shouting at people at work and one in four to slamming down phones and banging fists on desks. On social media, it takes far less than a Katie Hopkins soundbite to enrage the digital British public into attack mode. But until the anger pill is a reality, our only option is self-management…

Why are we all so angry?
The more stress someone is under, the more likely they are to have an anger problem. Because we are working harder than ever, more chronically stressed people are presenting to their GPs and mental health clinics with anger issues.

Add to this, disinhibition — there is a greater level of acceptance of anger, swearing and even violent behaviour than there was 50 years ago — and the increased speed of our reactions, thanks to social media and email (as opposed to writing letters) and the root of our anger problem is clear.

Anger manifests itself in different ways. One person might turn their anger against themselves, which can manifest as depression, addiction or self-harm. Another might explode. But anger has a necessary function: to protect, by alerting us to threat and giving us the courage to meet challenges.

That “threat system” is part of our evolution and changes your body from a calm state into one that is ready to attack or run away. A shot of the stress hormone adrenaline is released, which leads to tense muscles, increased blood circulation, short breathing and alertness.

People who are under chronic stress exist in a constant state of attack mode, which can have a detrimental effect on their health. It is like driving in second gear on the motorway — you’re using the car’s resources to tackle a problem that isn’t there, which means that your car is likely to be damaged, burn out or even explode. The other problem is that the buzz from adrenaline can be addictive. Likewise, when a person gets what they want as a result of showing their anger, they can get caught in an anger trap, where outbursts seem like the only way to express their needs. So controlling excess anger is essential.

Look out for warning signs:….CLICK & SEE
Notice when your body is moving into threat mode — this might be during a conversation, while driving or when commuting — and pay attention to your early-warning signs of anger. Everyone’s signs will be different but they might include a tenseness across the shoulders or an uncomfortable feeling in the stomach. Ask yourself: What’s the matter? Then do something about it. This might be having a constructive conversation or using a simple breathing technique. For example, making your out breath longer than your in breath can be instantly relaxing. Paying attention to the physical reality around you and taking in the bigger picture, rather than the thoughts in your head, can also help. This allows you to instantly distance yourself from your own threat system and get the mental space to ask yourself whether you need to take some time out (see below).

Escape wind-up thinking:
The language we use in our thoughts and conversations can alert the body to a threat, priming it to react with anger. Characteristic wind-up thoughts include “shoulds”, “musts” or “oughts” as well as phrases beginning with “You never”, “You always” or “It’s not fair”. These are definite, accusatory and inflexible, and can keep you fixed in threat mode where you’re more likely to blow up. It can be hard to change your thought patterns. Instead, recognise wind-up thinking and acknowledge that it’s not in your best interest to continue it.

Object without losing it:
Angry people often try to project an attitude of “I’m cool, nothing gets to me”. As a result, they may allow resentments to build up until they eventually explode. Learning to communicate assertively is essential. The key is to state what you want firmly and calmly with words such as: “Excuse me, I can’t let this go.” It’s also important to put yourself in the other person’s shoes — this is something people with anger issues often have a hard time with, as they tend to be wound up in their own position.

Call time:
It can be difficult to have a constructive conversation if one or both parties have switched into attack mode. Take a couple having an argument. If one of them notices their own, or the other person’s, anger building up with physical signs, such as increased breathing and a raised voice, they might say they need to go out for a walk to clear their head. Often, this is the point where the other partner won’t let them, desperate to get one last point across. But it’s also the point where arguments can escalate to emotional or physical violence.

An expart councelor has worked with couples on negotiating this space and ensuring the other person respects it. Having such an agreement is essential for dealing with anger, especially at home. Don’t continue the discussion if you observe in someone’s behaviour or speech — or your own — that the body has gone into action mode. Take time out. Go for a walk outside, write in a journal or call a friend — set aside some alone time…...CLICK & SEE

Let go:
When your body is in threat mode, anything — from being told you might lose your job to someone jumping in front of you in a queue — can feel equally outrageous and worthy of an outburst. By taking a step back with the simple breathing practices mentioned above, you can see the bigger picture and work out whether it really is outrageous and worth fighting for. Ask yourself if it will matter in five minutes. If the answer is no, let it go.

Source: The Telegraph (Kolkata, India)

Best way to get rid from sudden anger  is to practice Yoga  with  Medition & Pranayama.

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Health Quaries

Some Health Quaries & Answers

Mum’s milk, please   :-
Q: I had a caesarian for my first pregnancy. I plan such a delivery for my current pregnancy too. Last time I was unable to breast-feed the baby. I do not want that to happen again.

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A: If you are committed to breast-feeding, you will surely succeed. It does, however, take a little longer for the milk flow to become established after a caesarian. Ask for the baby and hold him or her as soon as possible after birth. Establish skin-to-skin contact and give the baby a chance to nuzzle at your breast. Try to breast-feed early and often. Take only non-sedating painkillers for the postoperative pain, because if you are drowsy you will not be able to hold the baby properly.

Violent child:-
Q: My 12-year-old son develops a blank stare and then starts to attack everyone around, beating and biting. Later he seems to have no recollection of what happened.

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A: Your son may be having seizures (epilepsy). Unfortunately, people associate seizures with violent movements of all four limbs and loss of consciousness. This is not the case. Seizures may take many forms and manifest themselves as repetitive, incomprehensible, unrecollected actions. Consult a neurologist who may advise an EEG to record the electrical signals from the brain. Seizures can be treated and controlled with proper medication.

Nodes in neck :-
Q: I developed swellings on the right side of my neck around two years ago. It was diagnosed as tuberculosis (TB). I underwent treatment as prescribed for four months. The swellings have reappeared. They are not painful. I am scared it might be cancer.

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A: TB is very common in India. Any part of the body can be affected. The nodes in the neck are frequently infected. The diagnosis is made with fine needle aspiration cytology, by taking a little fluid from the swelling with a syringe. The appearance of TB is fairly typical and very different from cancer. The infection usually requires short-term intensive chemotherapy for six months. In the first two months isoniazid, rifampicin, pyrazinamide and ethambutol or streptomycin is given, followed by isoniazid and rifampicin for the next four months. The rifamicin has to be taken first thing in the morning on an empty stomach. Not a single dose of medication can be missed. Some patients need to have the nodes removed surgically despite adequate medication. Also, you seem to have taken the medication only for four months instead of six. That may explain the recurrence.

Pain in scrotum :-
Q: I am 25 years old. I have pain in my scrotum on one side. I went to the doctor and he said it is “epididymitis”. He also asked a lot of questions about my sex life. Since I am not married I was embarrassed and did not go back.

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A: Epididymitis is common in young men between 20 and 40. It is caused by bacterial infections, TB or STDs (sexually transmitted diseases). It can occur after a urinary tract infection. That is the reason for the queries on your sex life. Depending on your answers, he needs to make a selection of antibiotics for treatment. The important thing is to take the entire course of antibiotic in the dosage prescribed.

Fit but fat :-
Q: I am very fit but everyone says I am fat. My weight is 88 kg. My height is 1.54m.

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A: Weight divided by height in metre squared should ideally be 23. Yours seems to be around 37. Though you may be fit and energetic, technically, you are obese. Unless you lose the extra weight, you are in danger of eventually developing other illnesses like diabetes, heart disease and arthritis.

Loosing weight is an uphill task. The important thing is persistence. You need to have a negative calorific balance to lose weight. Eat a diet of 1,500 calories. Exercise by walking for two hours a day. Do some yoga and other core strengthening exercises. This way, you will lose around 700 calories a day. To lose 1 kilo, you need a negative balance of 7,000 calories.

Anal fissure :-
Q: I developed recurrent painful swellings near my anal opening. They burst and now discharge pus. The doctor said it is a fissure and that I need surgery. Please advise.

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A: Fissures tend to recur because the drainage of the pus from the initial lesion is never complete unless the entire area is laid open surgically. Medicines (allopathy or homeopathy) will not cure the problem. Until a date is fixed for surgery, take sitz baths morning and evening. Make sure you are not constipated — eat four to five helpings of fruit and vegetables every day. Also take isabgol husk — two teaspoons dissolved in a glass of water — every night.

Source: Tne Telegraph  (Kolkata, India)

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Ailmemts & Remedies

Emphysema

Definition:-

Emphysema is a type of chronic obstructive pulmonary disease (COPD) involving damage to the air sacs (alveoli) in the lungs. As a result, your body does not get the oxygen it needs. Emphysema makes it hard to catch your breath. You may also have a chronic cough and have trouble breathing during exercise.

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The most common cause is cigarette smoking. If you smoke, quitting can help prevent you from getting the disease. If you already have emphysema, not smoking might keep it from getting worse.

It is  characterized by an abnormal, permanent enlargement of air spaces distal to the terminal bronchioles. The disease is coupled with the destruction of walls, but without obvious fibrosis.  It is often caused by exposure to toxic chemicals, including long-term exposure to tobacco smoke.

As it worsens, emphysema turns the spherical air sacs — clustered like bunches of grapes — into large, irregular pockets with gaping holes in their inner walls. This reduces the number of air sacs and keeps some of the oxygen entering your lungs from reaching your bloodstream. In addition, the elastic fibers that hold open the small airways leading to the air sacs are slowly destroyed, so that they collapse when you breathe out, not letting the air in your lungs escape.

Airway obstruction, another feature of COPD, contributes to emphysema. The combination of emphysema and obstructed airways makes breathing increasingly difficult. Treatment often slows, but doesn’t reverse, the process.

Emphysema is characterized by loss of elasticity (increased pulmonary compliance) of the lung tissue caused by destruction of structures feeding the alveoli, in some cases owing to the action of alpha 1-antitrypsin deficiency.

Classification:-
Emphysema can be classified into primary and secondary. However, it is more commonly classified by location.

Emphysema can be subdivided into panacinary and centroacinary (or panacinar and centriacinar, or centrilobular and panlobular).

Panacinary (or panlobular) emphysema is related to the destruction of alveoli, because of an inflammation or deficiency of alpha 1-antitrypsin. It is found more in young adults who do not have chronic bronchitis.

Centroacinary (or centrilobular) emphysema is due to destruction of terminal bronchioli muchosis, due to chronic bronchitis. This is found mostly in elderly people with a long history of smoking or extreme cases of passive smoking.
Other types include distal acinar and irregular.

A special type is congenital lobar emphysema (CLE).

Congenital lobar emphysema:-
CLE is results in overexpansion of a pulmonary lobe and resultant compression of the remaining lobes of the ipsilateral lung, and possibly also the contralateral lung. There is bronchial narrowing because of weakened or absent bronchial cartilage.

There may be congenital extrinsic compression, commonly by an abnormally large pulmonary artery. This causes malformation of bronchial cartilage, making them soft and collapsible.

CLE is potentially reversible, yet possibly life-threatening, causing respiratory distress in the neonate

Symptoms:
Emphysema symptoms are mild to begin with but steadily get worse as the disease progresses. The main emphysema symptoms are:

*Shortness of breath
*Wheezing
*Chest tightness
*Reduced capacity for physical activity
*Chronic coughing, which could also indicate chronic bronchitis
*Loss of appetite and weight
*Fatigue
When to see a doctor

*You tire quickly, or you can’t easily do the things you used to do
*You can’t breathe well enough to tolerate even moderate exercise
*Your breathing difficulty worsens when you have a cold
*Your lips or fingernails are blue or gray, indicating low oxygen in your blood
*You frequently cough up yellow or greenish sputum
*You note that bending over to tie your shoes makes you short of breath
*You are losing weight.

These signs and symptoms don’t necessarily mean you have emphysema, but they do indicate that your lungs aren’t working properly and should be evaluated by your doctor as soon as possible.

Causes:
The causes of emphysema include:

1.Smoking. Cigarette smoke is by far the most common cause of emphysema. There are more than 4,000 chemicals in tobacco smoke, including secondhand smoke. These chemical irritants slowly destroy the small peripheral airways, the elastic air sacs and their supporting elastic fibers.

2.Protein deficiency. Approximately 1 to 2 percent of people with emphysema have an inherited deficiency of a protein called AAt, which protects the elastic structures in the lungs. Without this protein, enzymes can cause progressive lung damage, eventually resulting in emphysema. If you’re a smoker with a lack of AAt, emphysema can begin in your 30s and 40s. The progression and severity of the disease are greatly accelerated by smoking.

Risk Factors:

Risk factors for emphysema include:

*Smoking. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible, and the risk for all types of smokers increases with the number of years and amount of tobacco smoked.

*Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

*Exposure to secondhand smoke. Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else’s cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema.

*Occupational exposure to fumes or dust. If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you’re more likely to develop emphysema. This risk is even greater if you smoke.

*Exposure to indoor and outdoor pollution. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants — car exhaust, for instance — increases your risk of emphysema.

*HIV infection. Smokers living with HIV are at greater risk of emphysema than are smokers who don’t have HIV infection.

*Connective tissue disorders. Some conditions that affect connective tissue — the fibers that provide the framework and support for your body — are associated with emphysema. These conditions include cutis laxa, a rare disease that causes premature aging, and Marfan syndrome, a disorder that affects many different organs, especially the heart, eyes, skeleton and lungs.

Complications:-
Emphysema can increase the severity of other chronic conditions, such as diabetes and heart failure. If you have emphysema, air pollution or a respiratory infection can lead to an acute COPD exacerbation, with extreme shortness of breath and dangerously low oxygen levels. You may need admission to an intensive care unit and temporary support from an artificial breathing machine (ventilator) until the infection clears.

Pathophysiology:-
In normal breathing, air is drawn in through the bronchi and into the alveoli, which are tiny sacs surrounded by capillaries. Alveoli absorb oxygen and then transfer it into the blood. When toxicants, such as cigarette smoke, are breathed into the lungs, the harmful particles become trapped in the alveoli, causing a localized inflammatory response. Chemicals released during the inflammatory response (e.g., elastase) can eventually cause the alveolar septum to disintegrate. This condition, known as septal rupture, leads to significant deformation of the lung architecture. These deformations result in a large decrease of alveoli surface area used for gas exchange. This results in a decreased Transfer Factor of the Lung for Carbon Monoxide (TLCO). To accommodate the decreased surface area, thoracic cage expansion (barrel chest) and diaphragm contraction (flattening) take place. Expiration increasingly depends on the thoracic cage and abdominal muscle action, particularly in the end expiratory phase. Due to decreased ventilation, the ability to exude carbon dioxide is significantly impaired. In the more serious cases, oxygen uptake is also impaired.

As the alveoli continue to break down, hyperventilation is unable to compensate for the progressively shrinking surface area, and the body is not able to maintain high enough oxygen levels in the blood. The body’s last resort is vasoconstricting appropriate vessels. This leads to pulmonary hypertension, which places increased strain on the right side of the heart, the side responsible for pumping deoxygenated blood to the lungs. The heart muscle thickens in order to pump more blood. This condition is often accompanied by the appearance of jugular venous distension. Eventually, as the heart continues to fail, it becomes larger and blood backs up in the liver.

Patients with alpha 1-antitrypsin deficiency (A1AD) are more likely to suffer from emphysema. A1AD allows inflammatory enzymes (such as elastase) to destroy the alveolar tissue. Most A1AD patients do not develop clinically significant emphysema, but smoking and severely decreased A1AT levels (10-15%) can cause emphysema at a young age. The type of emphysema caused by A1AD is known as panacinar emphysema (involving the entire acinus) as opposed to centrilobular emphysema, which is caused by smoking. Panacinar emphysema typically affects the lower lungs, while centrilobular emphysema affects the upper lungs. A1AD causes about 2% of all emphysema. Smokers with A1AD are at the greatest risk for emphysema. Mild emphysema can often develop into a severe case over a short period of time (1–2 weeks).

Pathogenesis
Severe emphysemaWhile A1AD provides some insight into the pathogenesis of the disease, hereditary A1AT deficiency only accounts for a small proportion of the disease. Studies for the better part of the past century have focused mainly upon the putative role of leukocyte elastase (also neutrophil elastase), a serine protease found in neutrophils, as a primary contributor to the connective tissue damage seen in the disease. This hypothesis, a result of the observation that neutrophil elastase is the primary substrate for A1AT, and A1AT is the primary inhibitor of neutrophil elastase, together have been known as the “protease-antiprotease” theory, implicating neutrophils as an important mediator of the disease. However, more recent studies have brought into light the possibility that one of the many other numerous proteases, especially matrix metalloproteases might be equally or more relevant than neutrophil elastase in the development of non-hereditary emphysema.

The better part of the past few decades of research into the pathogenesis of emphysema involved animal experiments where various proteases were instilled into the trachea of various species of animals. These animals developed connective tissue damage, which was taken as support for the protease-antiprotease theory. However, just because these substances can destroy connective tissue in the lung, as anyone would be able to predict, doesn’t establish causality. More recent experiments have focused on more technologically advanced approaches, such as ones involving genetic manipulation. One particular development with respect to our understanding of the disease involves the production of protease “knock-out” animals, which are genetically deficient in one or more proteases, and the assessment of whether they would be less susceptible to the development of the disease. Often individuals who are unfortunate enough to contract this disease have a very short life expectancy, often 0–3 years at most.

Prognosis and treatment
Emphysema is an irreversible degenerative condition. The most important measure to slow its progression is for the patient to stop smoking and avoid all exposure to cigarette smoke and lung irritants. Pulmonary rehabilitation can be very helpful to optimize the patient’s quality of life and teach the patient how to actively manage his or her care. Patients with emphysema and chronic bronchitis can do more for themselves than patients with any other disabling disease.

Emphysema is also treated by supporting the breathing with anticholinergics, bronchodilators, steroid medication (inhaled or oral), and supplemental oxygen as required. Treating the patient’s other conditions including gastric reflux and allergies may improve lung function. Supplemental oxygen used as prescribed (usually more than 20 hours per day) is the only non-surgical treatment which has been shown to prolong life in emphysema patients. There are lightweight portable oxygen systems which allow patients increased mobility. Patients can fly, cruise, and work while using supplemental oxygen. Other medications are being researched, and herbal organic remedies are being offered by companies.

Lung volume reduction surgery (LVRS) can improve the quality of life for certain carefully selected patients. It can be done by different methods, some of which are minimally invasive. In July 2006 a new treatment, placing tiny valves in passages leading to diseased lung areas, was announced to have good results, but 7% of patients suffered partial lung collapse. The only known “cure” for emphysema is lung transplant, but few patients are strong enough physically to survive the surgery. The combination of a patient’s age, oxygen deprivation and the side-effects of the medications used to treat emphysema cause damage to the kidneys, heart and other organs. Transplants also require the patient to take an anti-rejection drug regimen which suppresses the immune system, and so can lead to microbial infection of the patient. Patients who think they may have contracted the disease are recommended to seek medical attention as soon as possible.

A study published by the European Respiratory Journal suggests that tretinoin (an anti-acne drug commercially available as Retin-A) derived from vitamin A can reverse the effects of emphysema in mice by returning elasticity (and regenerating lung tissue through gene mediation) to the alveoli.

While vitamin A consumption is not known to be an effective treatment or prevention for the disease, this research could in the future lead to a cure. A follow-up study done in 2006 found inconclusive results (“no definitive clinical benefits”) using Vitamin A (retinoic acid) in treatment of emphysema in humans and stated that further research is needed to reach conclusions on this treatment…..click & see

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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/Emphysema
http://www.mayoclinic.com/health/emphysema/DS00296

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