Uses The main use of iron is in the treatment of iron-de?ciency anaemias (See ANAEMIA.) Iron preparations sometimes cause irritation of the gastrointestinal tract, and should therefore always be taken after meals. They sometimes produce a tendency towards constipation. Whenever possible, iron preparations should be given by mouth; if PARENTERAL administration is clinically necessary because of malabsorption, a suitable preparation is iron sorbitol injection given intramuscularly. Most patients respond successfully to oral iron preparations.... iron
Symptoms: Influenza-like fever, breathlessness, cough.
Prognosis: Chronic lung damage and progressive disability.
Indicated: antifungals, antibiotics.
Alternatives. Teas. Marigold, Ground Ivy, Scarlet Pimpernel, Yarrow. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.
Tablets/capsules. Garlic, Echinacea, Goldenseal, Thuja.
Powders. Combine, parts, Echinacea 3; Goldenseal 1; Thuja 1. Dose: 500mg, (two 00 capsules or one- third teaspoon) thrice daily.
Decoction. Irish Moss, to promote expectoration and eliminate debris.
Tinctures. Alternatives. (1) Echinacea 2; Lobelia 1; Liquorice 1. (2) Equal parts: Wild Indigo, Thuja and Pleurisy root. (3) Echinacea 2; Marigold 1; Thuja half; Liquorice half. Dosage: two 5ml teaspoons in water thrice daily. Acute cases: every 2 hours.
Topical. Inhalation of Eucalyptus or Tea Tree oils.
Diet. See: DIET – GENERAL. Yoghurt in place of milk.
Note: Bronchodilators of little value. Those at risk should have an X-ray at regular intervals. ... farmer’s lung
The first and most common symptom is a cough. Other symptoms include coughing up blood, shortness of breath, and chest pain. Lung cancer can spread to other parts of the body, especially the liver, brain, and bones. In most cases, the cancer is revealed in a chest X-ray. To confirm the diagnosis, tissue must be examined microscopically for the presence of cancerous cells (see cytology). If lung cancer is diagnosed at an early stage, pneumonectomy (removal of the lung) or lobectomy (removal of part of the lung) may be possible. Anticancer drugs and radiotherapy may also be used. lung, collapse of See atelectasis; pneumothorax.... lung
Most lung disorders can be detected by chest X-ray.
CT scanning and MRI play an important role in detecting the presence and spread of lung tumours.
Ultrasound scanning is sometimes used to reveal pleural effusion.
Radioisotope scanning is used to detect evidence of pulmonary embolism.... lung imaging
Noncancerous tumours occur less frequently than cancers.
The most common form of noncancerous tumour is a bronchial adenoma, which arises in the lining of a bronchus.
Adenomas often cause bronchial obstruction; affected people may also cough up blood.
Treatment involves surgical removal of the tumour.
Other rare noncancerous tumours include fibromas (which consist of fibrous tissue) and lipomas (which consist of fatty tissue).
No treatment is necessary unless the tumours are causing problems.... lung tumours
Symptoms These depend upon whether the anaemia is sudden in onset, as in severe haemorrhage, or gradual. In all cases, however, the striking sign is pallor, the depth of which depends upon the severity of the anaemia. The colour of the skin may be misleading, except in cases due to severe haemorrhage, as the skin of many Caucasian people is normally pale. The best guide is the colour of the internal lining of the eyelid. When the onset of the anaemia is sudden, the patient complains of weakness and giddiness, and loses consciousness if he or she tries to stand or sit up. The breathing is rapid and distressed, the pulse is rapid and the blood pressure is low. In chronic cases the tongue is often sore (GLOSSITIS), and the nails of the ?ngers may be brittle and concave instead of convex (koilonychia). In some cases, particularly in women, the Plummer-Vinson syndrome is present: this consists of di?culty in swallowing and may be accompanied by huskiness; in these cases glossitis is also present. There may be slight enlargement of the SPLEEN, and there is usually some diminution in gastric acidity.
CHANGES IN THE BLOOD The characteristic change is a diminution in both the haemoglobin and the red cell content of the blood. There is a relatively greater fall in the haemoglobin than in the red cell count. If the blood is examined under a microscope, the red cells are seen to be paler and smaller than normal. These small red cells are known as microcytes.
Treatment consists primarily of giving suf?cient iron by mouth to restore, and then maintain, a normal blood picture. The main iron preparation now used is ferrous sulphate, 200 mg, thrice daily after meals. When the blood picture has become normal, the dosage is gradually reduced. A preparation of iron is available which can be given intravenously, but this is only used in cases which do not respond to iron given by mouth, or in cases in which it is essential to obtain a quick response.
If, of course, there is haemorrhage, this must be arrested, and if the loss of blood has been severe it may be necessary to give a blood transfusion (see TRANSFUSION – Transfusion of blood). Care must be taken to ensure that the patient is having an adequate diet. If there is any underlying metabolic, oncological, toxic or infective condition, this, of course, must be adequately treated after appropriate investigations.
Megaloblastic hyperchromic anaemia There are various forms of anaemia of this type, such as those due to nutritional de?ciencies, but the most important is that known as pernicious anaemia.
PERNICIOUS ANAEMIA An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the PARIETAL cells of the stomach. These cells normally produce INTRINSIC FACTOR, the carrier protein for vitamin B12 (see APPENDIX 5: VITAMINS) that permits its absorption in the terminal part of the ILEUM. Lack of the factor prevents vitamin B12 absorption and this causes macrocytic (or megaloblastic) anaemia. The disorder can affect men and women, usually those over the age of 40; onset is insidious so it may be well advanced before medical advice is sought. The skin and MUCOSA become pale, the tongue is smooth and atrophic and is accompanied by CHEILOSIS. Peripheral NEUROPATHY is often present, resulting in PARAESTHESIA and numbness and sometimes ATAXIA. A rare complication is subacute combined degeneration of the SPINAL CORD.
In 1926 two Americans, G R Minot and W P Murphy, discovered that pernicious anaemia, a previously fatal condition, responded to treatment with liver which provides the absent intrinsic factor. Normal development requires a substance known as extrinsic factor, and this depends on the presence of intrinsic factor for its absorption from the gut. The disease is characterised in the blood by abnormally large red cells (macrocytes) which vary in shape and size, while the number of white cells (LEUCOCYTES) diminishes. A key diagnostic ?nd is the presence of cells in the BONE MARROW.
Treatment consists of injections of vitamin B12 in the form of hydroxocobalamin which must be continued for life.
Aplastic anaemia is a disease in which the red blood corpuscles are very greatly reduced, and in which no attempt appears to be made in the bone marrow towards their regeneration. It is more accurately called hypoplastic anaemia as the degree of impairment of bone-marrow function is rarely complete. The cause in many cases is not known, but in rather less than half the cases the condition is due to some toxic substance, such as benzol or certain drugs, or ionising radiations. The patient becomes very pale, with a tendency to haemorrhages under the skin and mucous membranes, and the temperature may at times be raised. The red blood corpuscles diminish steadily in numbers. Treatment consists primarily of regular blood transfusions. Although the disease is often fatal, the outlook has improved in recent years: around 25 per cent of patients recover when adequately treated, and others survive for several years. In severe cases promising results are being reported from the use of bone-marrow transplantation.
Haemolytic anaemia results from the excessive destruction, or HAEMOLYSIS, of the red blood cells. This may be the result of undue fragility of the red blood cells, when the condition is known as congenital haemolytic anaemia, or of acholuric JAUNDICE.
Sickle-cell anaemia A form of anaemia characteristically found in people of African descent, so-called because of the sickle shape of the red blood cells. It is caused by the presence of the abnormal HAEMOGLOBIN, haemoglobin S, due to AMINO ACID substitutions in their polypeptide chains, re?ecting a genetic mutation. Deoxygenation of haemoglobin S leads to sickling, which increases the blood viscosity and tends to obstruct ?ow, thereby increasing the sickling of other cells. THROMBOSIS and areas of tissue INFARCTION may follow, causing severe pain, swelling and tenderness. The resulting sickle cells are more fragile than normal red blood cells, and have a shorter life span, hence the anaemia. Advice is obtainable from the Sickle Cell Society.... inadequate intake of iron
Normal values for a 60 kg man are (in ml):
Total lung capacity (TLC) The volume of air that can be held in the lungs at maximum inspiration.
Tidal volume (TV) The volume of air taken into and expelled from the lungs with each breath.
Inspiratory reserve volume (IRV) The volume of air that can still be inspired at the end of a normal quiet inspiration.
Expiratory reserve volume (ERV) The volume of air that can still be expired at the end of a normal quiet expiration.
Residual volume (RV) The volume of air remaining in the lungs after a maximal expiration.
Vital capacity (VC) The maximum amount of air that can be expired after a maximal inspiration.
Functional residual capacity (FRC) The volume of air left in the lungs at the end of a normal quiet expiration.... lung volumes
Form and position Each lung is a sponge-like cone, pink in children and grey in adults. Its apex projects into the neck, with the base resting on the DIAPHRAGM. Each lung is enveloped by a closed cavity, the pleural cavity, consisting of two layers of pleural membrane separated by a thin layer of ?uid. In healthy states this allows expansion and retraction as breathing occurs.
Heart/lung connections The HEART lies in contact with the two lungs, so that changes in lung volume inevitably affect the pumping action of the heart. Furthermore, both lungs are connected by blood vessels to the heart. The pulmonary artery passes from the right ventricle and divides into two branches, one of which runs straight outwards to each lung, entering its substance along with the bronchial tube at the hilum or root of the lung. From this point also emerge the pulmonary veins, which carry the blood oxygenated in the lungs back to the left atrium.
Fine structure of lungs Each main bronchial tube, entering the lung at the root, divides into branches. These subdivide again and again, to be distributed all through the substance of the lung until the ?nest tubes, known as respiratory bronchioles, have a width of only 0·25 mm (1/100 inch). All these tubes consist of a mucous membrane surrounded by a ?brous sheath. The surface of the mucous membrane comprises columnar cells provided with cilia (hair-like structures) which sweep mucus and unwanted matter such as bacteria to the exterior.
The smallest divisions of the bronchial tubes, or bronchioles, divide into a number of tortuous tubes known as alveolar ducts terminating eventually in minute sacs, known as alveoli, of which there are around 300 million.
The branches of the pulmonary artery accompany the bronchial tubes to the furthest recesses of the lung, dividing like the latter into ?ner and ?ner branches, and ending in a dense network of capillaries. The air in the air-vesicles is separated therefore from the blood only by two delicate membranes: the wall of the air-vesicle, and the capillary wall, through which exchange of gases (oxygen and carbon dioxide) readily takes place. The essential oxygenated blood from the capillaries is collected by the pulmonary veins, which also accompany the bronchi to the root of the lung.
The lungs also contain an important system of lymph vessels, which start in spaces situated between the air-vesicles and eventually leave the lung along with the blood vessels, and are connected with a chain of bronchial glands lying near the end of the TRACHEA.... lungs
In?ammation of the lungs is generally known as PNEUMONIA, when it is due to infection; as ALVEOLITIS when the in?ammation is immunological; and as PNEUMONITIS when it is due to physical or chemical agents.
Abscess of the lung consists of a collection of PUS within the lung tissue. Causes include inadequate treatment of pneumonia, inhalation of vomit, obstruction of the bronchial tubes by tumours and foreign bodies, pulmonary emboli (see EMBOLISM) and septic emboli. The patient becomes generally unwell with cough and fever. BRONCHOSCOPY is frequently performed to detect any obstruction to the bronchi. Treatment is with a prolonged course of antibiotics. Rarely, surgery is necessary.
Pulmonary oedema is the accumulation of ?uid in the pulmonary tissues and air spaces. This may be caused by cardiac disease (heart failure or disease of heart valves – see below, and HEART, DISEASES OF) or by an increase in the permeability of the pulmonary capillaries allowing leakage of ?uid into the lung tissue (see ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)).
Heart failure (left ventricular failure) can be caused by a weakness in the pumping action of the HEART leading to an increase in back pressure which forces ?uid out of the blood vessels into the lung tissue. Causes include heart attacks and HYPERTENSION (high blood pressure). Narrowed or leaking heart valves hinder the ?ow of blood through the heart; again, this produces an increase in back pressure which raises the capillary pressure in the pulmonary vessels and causes ?ooding of ?uid into the interstitial spaces and alveoli. Accumulation of ?uid in lung tissue produces breathlessness. Treatments include DIURETICS and other drugs to aid the pumping action of the heart. Surgical valve replacement may help when heart failure is due to valvular heart disease.
Acute respiratory distress syndrome Formerly known as adult respiratory distress syndrome (ARDS), this produces pulmonary congestion because of leakage of ?uid through pulmonary capillaries. It complicates a variety of illnesses such as sepsis, trauma, aspiration of gastric contents and di?use pneumonia. Treatment involves treating the cause and supporting the patient by providing oxygen.
Collapse of the lung may occur due to blockage of a bronchial tube by tumour, foreign body or a plug of mucus which may occur in bronchitis or pneumonia. Air beyond the blockage is absorbed into the circulation, causing the affected area of lung to collapse. Collapse may also occur when air is allowed into the pleural space – the space between the lining of the lung and the lining of the inside of the chest wall. This is called a pneumothorax and may occur following trauma, or spontaneously
– for example, when there is a rupture of a subpleural air pocket (such as a cyst) allowing a communication between the airways and the pleural space. Lung collapse by compression may occur when ?uid collects in the pleural space (pleural e?usion): when this ?uid is blood, it is known as a haemothorax; if it is due to pus it is known as an empyema. Collections of air, blood, pus or other ?uid can be removed from the pleural space by insertion of a chest drain, thus allowing the lung to re-expand.
Tumours of the lung are the most common cause of cancer in men and, along with breast cancer, are a major cause of cancer in women. Several types of lung cancer occur, the most common being squamous cell carcinoma, small- (or oat-) cell carcinoma, adenocarcinoma, and large-cell carcinoma. All but the adenocarcinoma have a strong link with smoking. Each type has a di?erent pattern of growth and responds di?erently to treatment. More than 30,000 men and women die of cancer of the trachea, bronchus and lung annually in England and Wales.
The most common presenting symptom is cough; others include haemoptisis (coughing up blood), breathlessness, chest pain, wheezing and weight loss. As well as spreading locally in the lung – the rate of spread varies – lung cancer commonly spawns secondary growths in the liver, bones or brain. Diagnosis is con?rmed by X-rays and bronchoscopy with biopsy.
Treatment Treatment for the two main categories of lung cancer – small-cell and nonsmall-cell cancer – is di?erent. Surgery is the only curative treatment for the latter and should be considered in all cases, even though fewer than half undergoing surgery will survive ?ve years. In those patients unsuitable for surgery, radical RADIOTHERAPY should be considered. For other patients the aim should be the control of symptoms and the maintenance of quality of life, with palliative radiotherapy one of the options.
Small-cell lung cancer progresses rapidly, and untreated patients survive for only a few months. Because the disease is often widespread by the time of diagnosis, surgery is rarely an option. All patients should be considered for CHEMOTHERAPY which improves symptoms and prolongs survival.
Wounds of the lung may cause damage to the lung and, by admitting air into the pleural cavity, cause the lung to collapse with air in the pleural space (pneumothorax). This may require the insertion of a chest drain to remove the air from the pleural space and allow the lung to re-expand. The lung may be wounded by the end of a fractured rib or by some sharp object such as a knife pushed between the ribs.... lungs, diseases of
Aetiology: heavy menstrual loss, feeble constitution from hereditary weakness, poor diet, hidden or known blood loss from gastric ulcer, pregnancy, bleeding piles or insufficient food minerals: iron, copper, calcium, etc, chronic liver or kidney disease, worms, anorexia nervosa, rheumatoid arthritis, tuberculosis. Symptoms. Tiredness, dizziness, breathlessness, palpitations, pale face and mucous membranes. White of eyes may be blue. Enlarged flabby tongue often bears impression of teeth marks. Hair lifeless, fingernails brittle and ridged. There may be angina, tinnitus and general reduced efficiency.
Treatment. The object is to achieve absorption of iron to raise normal haemoglobin levels and increase red cells. Echinacea has a reputation for regeneration of red cells. Herbs used with success: Echinacea, Gentian, Motherwort, Mugwort, Barberry, Hops, Nettles, Saw Palmetto, Chaparral, Red Clover, Dandelion.
Bitter herbs stimulate absorption of vital nutrients from the stomach, toning liver and pancreas, increasing the appetite; usually given half hour before meals. See: BITTERS.
Gentian. 1 teaspoon fine-cut chips to 2 cups cold water steeped 8 hours (overnight). Dose: Half-1 cup thrice daily before meals.
Tea. Formula. Combine: Agrimony 1; Barberry bark 1; Nettles 2; White Poplar bark half. Place 1oz (30g) in 1 pint (500ml) cold water and bring to boil. Simmer 10 minutes. Drink cold: Half-1 cup thrice daily, before meals.
Powders. Formula. Echinacea 2; Gentian 1; Kelp 1; pinch Red Pepper. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.
Liquid extracts. Formula: Echinacea 1; Queen’s Delight 1; Ginseng 1; Ginger quarter. Dose: 30-60 drops in water, thrice daily, before meals.
Infusion Gentian Co Conc BP (1949). Dose: 30-60 drops.
Diet. Dandelion coffee, as desired. Molasses. Desiccated liver.
Floradix. A pre-digested iron preparation. Readily assimilable by the body. Compounded by Dr Otto Greither (Salus Haus). Iron is fed onto yeast which breaks down the metal and absorbs its cells. Other tonic ingredients include extracts of nettles, carrots, spinach, fennel, Vitamin C plus supplements;
Angelica root, Mallow, Horsetail, Yarrow, Juniper and Rosehips. Not chemically preserved.
Avoid chocolate, egg yolk, tea, coffee, wheat bran.
Supplements. Daily. Vitamin C (1g morning and evening). Vitamin B12, Folic acid 400mcg. Vitamin C is the most potent enhancer of iron absorption. Multivitamin containing iron.
Note: Iron absorption is decreased by antacids, tetracyclines, phosphates, phytates (phytic acid from excessive intake of wholewheat bread), and excessive calcium supplements. Lack of stomach hydrochloric acid impairs iron absorption, especially in the elderly. ... anaemia: iron deficiency
Symptoms: dry cough, difficult breathing usually at night. Loss of weight, tiredness, feverishness with rise of temperature. (Clinical Allergy, 1984. 14,429)
Tea. Yarrow, Elderflowers, Comfrey herb: equal parts.
Tablets/capsules. Garlic. Lobelia. Iceland Moss.
Powders. Formula. Pleurisy root 2; Hyssop 1; Iceland Moss 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Liquid Extracts. Formula. Pleurisy root 2; Liquorice 1; Hyssop 1. 1 teaspoon in water thrice daily, and when necessary. ... canary fancier’s lung
Tablets/capsules. Iceland Moss.
Decoction. Irish Moss.
Tea. Combine equal parts, Comfrey, White Horehound, Liquorice. 1 heaped teaspoon to each cup water simmered gently 1 minute. Dose: half-1 cup morning and evening. Pinch Cayenne improves.
Potential benefits of Comfrey for this condition outweigh risk. ... lung weakness
Constituents: palmitic acid, linoleic acid, tannins, ergosterol, saponin.
Action: expectorant, demulcent astringent, haemostatic, orexigenic, antibiotic (mild).
Uses: asthma, laryngitis, sore throat, children’s dry cough, whooping cough, haemoptysis, nasal catarrh, bronchitis.
External: open wounds – to avoid infection.
Combinations. With Coltsfoot and White Horehound for TB cough. With Ephedra for difficult breathing. Preparations. Average dose: 2-4g. Thrice daily. Tea: 1 teaspoon to each cup boiling water; infuse 15 minutes; dose: one-third-1 cup. Or may be boiled in milk.
Liquid Extract BHP (1983): 1:1 in 25 per cent alcohol. Dose: 2-4ml.
Balm of Gilead Cough Mixture. ... lungwort
Iron deficiency may also be caused or worsened by lack of iron in, or its poor absorption from, the diet.
The symptoms are those of the underlying cause, along with a sore mouth or tongue, and those common to all forms of anaemia, such as fatigue and breathlessness. The diagnosis is made from blood tests and tests to look for an underlying cause. Treatment is given for the cause, along with a course of iron tablets or, very rarely, injections.... anaemia, iron-deficiency
A heart–lung machine consists of a pump (to replace the heart’s function) and an oxygenator (to replace the lung’s function). It bypasses the heart and lungs, and the heart can be stopped.
Use of a heart–lung machine tends to damage red blood cells and to cause blood clotting. These problems can be minimized, however, by the administration of heparin, an anticoagulant drug, beforehand.heart–lung transplant A procedure in which the heart and lungs of a patient are removed, and replaced with donor organs. This surgery is used to treat diseases in which the lung damage has affected the heart, or vice versa. Such diseases include cystic fibrosis, fibrosing alveolitis, and some severe congenital heart defects (see heart disease, congenital). A heart–lung machine is used to take over the function of the patient’s heart and lungs during the operation, which is no more dangerous than a heart transplant.
heart-rate The rate at which the heart contracts to pump blood around the body. Most people have a heart-rate of between 60 and 100 beats per minute at rest. This rate tends to be faster in childhood and to slow slightly with age. Very fit people may have a resting rate below 60 beats per minute.
The heart muscle responds automatically to any increase in the amount of blood returned to it from active muscles by increasing its output. During extreme exercise, heart-rate may increase to 200 contractions per minute and the output to almost 250 ml per beat.
The heart-rate is also regulated by the autonomic nervous system. The parts of this system concerned with heart action are a nucleus of nerve cells, called the cardiac centre, in the brainstem, and 2 sets of nerves (the parasympathetic and sympathetic).
At rest, the parasympathetic nerves – particularly the vagus nerve – act on the sinoatrial node to maintain a slow heart-rate. During or in anticipation of muscular activity, this inhibition lessens and the heart-rate speeds up.
Sympathetic nerves release noradrenaline, which further increases the heart-rate and force of contraction. Sympathetic activity can be triggered by fear or anger, low blood pressure, or a reduction of oxygen in the blood.
Release of adrenaline and noradrenaline by the adrenal glands also acts to increase heart-rate.
The rate and rhythm of the heart can be measured by feeling the pulse or by listening with a stethoscope; a more accurate record is provided by an ECG.
A resting heart-rate above 100 beats per minute is termed a tachycardia, and a rate below 60 beats per minute a bradycardia. (See also arrhythmia, cardiac.)... heart–lung machine
cystic fibrosis. The lungs can also be affected by allergic disorders. The most important of these is asthma. Another such disorder is allergic alveolitis, which is usually a reaction to dust of plant or animal origin. Irritation of the airways, usually by tobacco-smoking, can cause diseases characterized by damage to lung tissue and narrowing of the airways (see pulmonary disease, chronic obstructive). The lungs can also be affected by cancerous tumours; lung cancer is one of the most common cancers. Noncancerous lung tumours are uncommon.
Injury to a lung, usually resulting from penetration of the chest wall, can cause the lung to collapse (see pneumothorax; haemothorax). Damage to the interior of the lungs can be caused by inhalation of toxic substances (see asbestosis; silicosis). Blood supply to the lungs may be reduced by pulmonary embolism.
Lung disorders can be investigated in various ways, such as chest X-ray, bronchoscopy, and pulmonary function tests.... lung, disorders of