Necessity Health Dictionary

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Necessity: From 1 Different Sources

n. the ethical and legal doctrine that provides justification for doing something that might otherwise be seen as blameworthy when the consequences of not doing so would be worse. For example, doctors have no right to touch a patient without consent, yet might be considered lacking in duty of care if they did not restrain patients who were about to kill themselves. See also paternalism.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Endoscopy

Examination of a body cavity – for example, PLEURAL CAVITY, GASTROINTESTINAL TRACT, BILE DUCT and URINARY BLADDER – using an ENDOSCOPE in order to diagnose or treat a disorder in the cavity. The development of endoscopy has reduced the need for major surgery, as many diagnostic procedures can be performed with an endoscope (as can MINIMALLY INVASIVE SURGERY (MIS)). The development of ?bre optics (the transmission of light along bundles of glass or plastic ?bres) has greatly advanced the practice of endoscopy and hospitals now routinely run endoscopy clinics on an out-patient basis, often without the necessity for a general anaesthetic.... endoscopy

Pre-admission Certification

A review of the medical necessity and appropriateness of a person’s admission to a hospital or other health care organization, conducted before, at or shortly after admission and to authorise a length of stay consistent with norms for the evaluation.... pre-admission certification

Tinospora

Tinospora cordifolia

Menispermaceae

San: Amrita, Guduchi;

Hin,

Ben: Giloe;

Mal: Amritu, Chittamritu;

Tam: Amridavalli

Kan: Amritaballi;

Tel: Tivantika, Tippatige; Pun: Batindu Ori: Gulochi

Importance: Tinospora is a common climbing shrub which is used in medicine, usually in the fresh state, though it is commercially available in the dried state. It is probably the most useful preparation acting as a tonic and aphrodisiac. As a tonic it is best given in infusion with or without milk. It is a popular remedy for snake-bite and leprosy. It is generally prescribed in general debility, diabetes, fever, jaundice, skin diseases, rheumatism, urinary diseases, dyspepsia, gout, gonorrhoea and leucorrhoea. It is a constituent of several preparations like guduchayado churna, gududyadi kwath, guduchilouha, amritarista, sanjivanivati, guduchi taila, amiritastak kwath, etc. The juice mixed with the pulp of long pepper and honey is a house hold remedy for gonorrhoea. Several oils for external applications are prepared with amrita and applied to skin diseases, rheumatic affections and other nervous complaints. A small quantity of bruised stem soaked for three hours in half a litre of water and strained combined with ammonium acetate is administered in intermittent and milder forms of fevers. It is rendered more agreeable with cinnamon, cloves and other aromatics. (Viswanathan, 1997).

Distribution: The plant is widely seen in tropical countries like India, Myanmar, Sri Lanka and in Andaman Islands. It is mostly found trailing on forest trees, fences and hedges along the boundaries.

Botany: Tinospora cordifolia (Willd) Miers ex Hk. f & Thoms. syn. Menispermum cordifolium Willd, Cocculus cordifolius (Willd) DC. belongs to the family Menispermaceae. It is a climbing shrub with rough corky bark. Leaves are glabrous, cordate 5-10cm broad, acute or accuminate. The plant is dioecious. Male flowers are in fascicles; sepals oval; petals half the length of sepals. Female flowers are usually solitary, having ovary on the fleshy receptacle. Fruits are red when ripe.

Agrotechnology: Giloe requires a warm humid tropical climate. It thrives well in deep fertile soils which are rich in organic matter. It is propagated vegetatively by stem cuttings. About 10-15cm long stem cuttings having at least 2 nodes are planted in the field or polybags. Treatment of cut ends with hormones gives better results. The usual planting time is with the onset of monsoon in May-June. Usually it is planted along boundaries or nearby tall trees and allowed to trail on the trees or hedges and hence regular spacing is not followed. While planting, adequate amounts of organic manure are applied. Once the plant is established no much management is needed. The stem is the most economic part. Harvesting can be commenced after one year and usually partial harvesting is followed depending on the necessity. The stem and root should be collected in hot season when the concentration of the bitter principle is the highest. A full grown well ramified plant may give 2-3kg vines, which are cut into smaller pieces and traded either fresh or after drying.

Properties and activity: The plant contains cordifol, tinosporidine, tinosporide, perberilin, heptacosanol, - sitosterol, cordifolone, tinosporon, tinosporic acid, tinosporol, cordifolide, tinosporine, magnoflorine and tembetarine (Husain et al,1992).

The plant is antigonorrhoric, stomachic, antispasmodic, antiinflammatory, stimulant, diuretic, emetic, antidiabetic, aphrodisiac, antiperiodic, antileprotic antirheumantic and tonic. The root is an emetic in large doses. The tincture and extract are alterative and tonic and in a less degree antiperiodic and diuretic. (Dey,1980).... tinospora

Utilization Review

Evaluation of the necessity, appropriateness and efficiency of the use of health care services, procedures and facilities. In a hospital, this includes review of the appropriateness of admissions, services ordered and provided, length of a stay, and discharge practices, both on a concurrent and retrospective basis. Utilization review can be done by a peer review group or a public agency.... utilization review

Nerve Block

a method of producing *anaesthesia in part of the body by blocking the passage of pain impulses in the sensory nerves supplying it. A local anaesthetic, such as lidocaine, is injected into the tissues in the region of a nerve. In this way anaesthesia can be localized, so that minor operations can be performed without the necessity of giving a general anaesthetic. A *ring block is a common technique used for anaesthetizing a digit.... nerve block

Cancer – Stomach And Intestines

Fibroma, myoma, lipoma, polyp, etc. When any of these breakdown bleeding can cause anaemia and melaena. Rarely painful. May obstruct intestinal canal causing vomiting. Periodic vomiting of over one year suspect.

Symptoms (non-specific). Loss of appetite, anaemia, weight loss; pain in abdomen, especially stomach area. Vomit appears as coffee grounds. Occult blood (tarry stools).

Causes. Alcohol, smoking cigarettes, low intake of fruits and vegetables. Foods rich in salt and nitrites including bacon, pickles, ham and dried fish. (Cancer Researchers in Digestive Diseases and Sciences) Long term therapy with drugs that inhibit gastric acid secretion increase risk of stomach cancer.

Of possible value. Alternatives:– Tea. Mixture. Equal parts: Red Clover, Gotu Kola, Yarrow. Strong infusion (2 or more teaspoons to each cup boiling water; infuse 15 minutes. As many cups daily as tolerated.

Formula. Condurango 2; Bayberry 1; Liquorice 1; Goldenseal quarter. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Thrice daily in water or honey.

Traditional. Rosebay Willowherb. Star of Bethlehem.

Chinese green tea. Anti-cancer effects have been found in the use of Chinese green tea extracts. Clinical trials on the therapeutic effects against early stomach cancer were promising. (Chinese Journal Preventative Medicines 1990. 24 (2) 80-2)

Chinese Herbalism. Combination. Oldenlandia diffusa 2 liang; Roots of Lu (Phragmites communis) 1 liang; Blackened Ginger 1 ch’ien; Pan-chih-lien (Scutellaria barbarta 5 ch’ein; Chih-tzu (gardenia jasminoides) 3 ch’ien. One concoction/dose daily. Follow with roots of Bulrush tea.

William H. Cook, MD. “Mullein greatly relieves pain, and may be used with Wild Yam and a little Water- Pepper (Polygonum Hydropiper).” The addition of Water-Pepper (or Cayenne) ensures diffusive stimulation and increased arterial force. Burns Lingard, MNIMH. Inoperable cancer of the stomach. Prescribed: Liquid Extract Violet leaves and Red Clover, each 4 drachms; Liquid Extract Cactus grand., 2 drops. Dose every 4 hours. Woman lived 30 years after treatment attaining age of 70.

Arthur Barker, FNIMH. Mullein sometimes helpful for pain.

Wm Boericke MD. American Cranesbill.

George Burford MD. Goldenseal.

Maria Treben. “After returning from a prison camp in 1947 I had stomach cancer. Three doctors told me it was incurable. From sheer necessity I turned to Nature’s herbs and gathered Nettle, Yarrow, Dandelion and Plantain; the juice of which I took hourly. Already after several hours I felt better. In particular I was able to keep down a little food. This was my salvation.” (Health Through God’s Pharmacy – 1981) Essiac: Old Ontario Cancer Remedy. Sheila Snow explored the controversy surrounding the famous cancer formula ‘Essiac’. This was developed by Rene Caisse, a Canadian nurse born in Bracebridge, Ontario, in 1888. Rene noticed that an elderly patient had cured herself of breast cancer with an Indian herbal tea. She asked for the recipe and later modified it. Rene’s aunt, after using the remedy for 2 years, fully recovered from an inoperable stomach cancer with liver involvement, and other terminal patients began to improve.

Rene’s request to be given the opportunity to treat cancer patients in a larger way was turned down by Ottawa’s Department of Health and Welfare. She eventually handed over the recipe to the Resperin Corporation in 1977, for the sum of one dollar, from whom cancer patients may obtain the mixture if their doctors submit a written request. However, records have not been kept up.

In 1988 Dr Gary Glum, a chiropractor in Los Angeles, published a book called ‘Calling of an Angel’: the true story of Rene Caisse. He gives the formula, which consists of 11b of powdered Rumex acetosella

(Sorrel), 1 and a half pounds cut Arctium lappa (Burdock), 4oz powdered Ulmus fulva (Slippery Elm bark), and 1oz Rheum palmatum (Turkey Rhubarb). The dosage Rene recommended was one ounce of Essiac with two ounces of hot water every other day at bedtime; on an empty stomach, 2-3 hours after supper. The treatment should be continued for 32 days, then taken every 3 days. (Canadian Journal of Herbalism, July 1991 Vol XII, No. III)

Diet. See: DIET – CANCER. Slippery Elm gruel.

Note: Anyone over 40 who has recurrent indigestion for more than three weeks should visit his family doctor. Persistent pain and indigestion after eating can be a sign of gastric cancer and no-one over 40 should ignore the symptoms. A patient should be referred to hospital for examination by endoscope which allows the physician to see into the stomach.

Study. Evidence to support the belief that the high incidence of gastric cancer in Japan is due to excessive intake of salt.

Note: A substance found in fish oil has been shown experimentally to prevent cancer of the stomach. Mackerel, herring and sardines are among the fish with the ingredient.

Treatment by or in liaison with hospital oncologist or general medical practitioner. ... cancer – stomach and intestines

Eczema

The most common skin disease; recognised by minute blisters (vesicles) which fill with colourless fluid and burst leaving the skin cracked, scaly and weepy with possible bleeding. Successful treatment depends upon recognising the type and distribution. Partly a metabolic imbalance.

Atopic eczema. Allergic eczema. May run in families together with hay fever, asthma or inflamed nasal membrane. May appear anywhere but prefers elbows, knees (flexures), ankles or face. Often seen in infants. May return again and again throughout adult life. Scratching exacerbates.

As regards babies, some paediatricians believe breast-feeding to be protective. A stronger case follows investigation into pollutants from the atmosphere or as additives in food. Industrial chemicals find their way into breast milk that may not be easily excreted but stored in fat.

Cow’s milk is particularly suspect because of exposure of the animal to herbicides and pesticides. For this reason, goat’s milk has met with some success in treatment of this condition, as has Soya milk. Now known that food plays an important part in effective treatment. Chief allergy-stimulators: dairy produce, eggs, cow’s milk. Each individual case must identify those foods that are responsible.

Seborrhoeic eczema leads to scaling of the scalp and redness of the ears, eyebrows, side of the nose and possibly armpits and groin.

Stasis eczema (or varicose eczema) may arise from varicose vein problems, usually limited to the lower third of the leg.

Discoid eczema has coin-shaped patches preferring extensor surfaces of arms and legs.

Contact eczema may be caused by washing-up detergents, etc. See: CONTACT DERMATITIS.

While emotional or psychic disturbance may worsen, eczema is seldom a psychosomatic disorder arising from stressful situations. Contact with water may worsen. Hairdressers and those allergic to dyes may require patch tests.

Eczema patients, especially atopic, have a metabolic deficiency of linoleic acid (a dietary fatty acid) to y-linolenic acid, which is found in Evening Primrose oil. Eczema may develop in bottle-fed babies due to absence of GLA (gamma-linolenic acid) in commercial powdered milk. GLA is present in Evening Primrose.

A cross-over trial in 99 patients (adults and children) by Bristol (England) dermatologists found Evening Primrose oil (Efamol capsules) produced an overall 43 per cent improvement in eczema severity: doses – 4 to 6 capsules twice daily (adults); 2 capsules twice daily (children). Lower doses were not effective.

Alternatives. Barberry, Bladderwrack, Blood root, Blue Flag root, Bogbean, Burdock, Clivers, Devil’s Claw, Echinacea, Figwort, Fringe Tree, Fumitory, Garlic, Guaiacum, Goldenseal, Mountain Grape, Gotu Kola, Nettles, Plantain, Poke root, Queen’s Delight, Red Clover, Sarsaparilla, Sassafras, Wild Indigo, Heartsease, Yellow Dock.

Tea. Combine herbs: equal parts: Gotu Kola, Clivers, Red Clover. 1-2 teaspoons to each cup boiling water; infuse 5-10 minutes; 1 cup thrice daily, before meals (Dry eczema).

Formula: equal parts, Burdock root, Yellow Dock root, Valerian root. Dose. Liquid Extracts, 1 teaspoon. Tinctures, 1-2 teaspoons. Powders, two 00 capsules or one-third teaspoon. Thrice daily, before meals. Practitioner: specific medication.

Dry eczema. Equal parts, tinctures: Yarrow, Dandelion, Calendula, Echinacea.

Weeping eczema. Combine tinctures: Barberry 1; Clivers 2; Echinacea 2.

Seborrhoeic eczema. Combine tinctures: Blue Flag root 1; Meadowsweet 2; Boneset 1.

Discoid eczema. Combine tinctures: Yellow Dock 2; Mountain Grape 1; Echinacea 1.

Varicose eczema. Combine tinctures: Echinacea 2; Calendula (Marigold) 1; Hawthorn 1.

Dosage for the above: One to two 5ml teaspoons in water thrice daily before meals.

Skin Care. May reduce necessity for steroid creams. It is best to avoid: lanolin and Coconut oil compounds that may contain coal tar. Wash in soft water (rain water) or water not containing chemical softeners.

Indicated: soothing softening herbal lotions, ointments or creams: Marshmallow, Chickweed, Comfrey, Witch Hazel, Aloe Vera gel, Jojoba oil, Evening Primrose oil. For seborrhoeic eczema: Bran Bath or Bran Wash, twice weekly, soapless, followed by Rosemary shampoo. Vitamin E lotion or cream.

Note: A study carried out at the University of Manchester, England, found that children with eczema had significantly low levels of serum zinc than control-cases. (British Journal of Dermatology, 1984, 111, 597)

Evening Primrose oil. For Omega 6 fatty acids.

Diet. Gluten-free. Oily fish: see entry. Avoid cow’s milk, wheat products.

Supplements. Daily. Vitamins: A (7500iu). C (500mg). E (400iu). Bioflavonoids (500mg). Zinc (15mg). Betaine hydrochloride.

Note: The disorder may be due to a deficiency of essential fatty acids (EFAs) brought about by a deficiency of zinc which is necessary for EFA metabolism.

Chinese herbs. A study has shown herbal treatment to be far superior to placebo in clinical trials. British children with (dry) atopic eczema responded favourably to treatment which included the following herbs known as Formula PSE101.

Ledebouriella sesloides, Potentilla chinesis, Anebia clematidis, Rehmannia glutinosa, Peonia lactiflora, Lophatherum gracile, Dictamnus dasycarpus, Tribulus terrestris, Glycyrrhiza uralensis, Schizonepta tenuifolia. Non-toxicity confirms their safety. (Sheeham M et al. “A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic dermatitis”, British Journal of Dermatology, 126: 179-184 1992)

When 10 Chinese herbs were analysed by a team at the Great Ormond Street Hospital, London, it was revealed that no single active ingredient or herb was responsible for success. “It was a combination of all 10 herbs that gave the medicine its healing properties.” This is an example of the synergistic effect of combined plant remedies and supports the herbalist’s belief in use of the whole plant. ... eczema

Liver – Cirrhosis

A disease of the liver with hardened and fibrotic patches. Scar tissue obstructs the flow of blood through the liver, back pressure causing damage. As they wear out liver cells are not renewed.

Causes: damage from gall-stones, aftermath of infections, drugs; the commonest is alcohol. Usually made up of three factors: toxaemia (self-poisoning), poor nutrition, infective bacteria or virus.

Symptoms. Loss of appetite, dyspepsia, low grade fever, nosebleeds, lethargy, spidery blood vessels on face, muscular weakness, jaundice, loss of sex urge, redness of palms of hands, unable to lie on left side. Mechanical pressure may cause dropsy and ascites. Alcohol-induced cirrhosis correlates with low phospholipid levels.

Treatment. Bitter herbs are a daily necessity to keep the bile fluid and flowing. Among other agents, peripheral vaso-dilators are indicated. Regulate bowels.

Teas. Balmony, Milk Thistle, Boldo, Bogbean. Dandelion coffee. Barberry tea (cold water). Tablets/capsules. Calamus, Blue Flag, Wild Yam.

Formula. Wahoo 2; Wild Yam 1; Blue Flag root 1. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Milk Thistle (Silybum marianum). Based on its silymarin contents: 70-210mg, thrice daily.

Practitioner. For pain. Tincture Gelsemium: 5-10 drops in water when necessary.

Enema. Constipation may be severe for which warm water injection should be medicated with few drops Tincture Myrrh.

Diet. High protein, high starch, low fat. Reject alcohol. Accept: Dandelion coffee, artichokes, raw onion juice, turmeric as a table spice.

Lecithin. Soy-derived lecithin to antidote alcohol-induced cirrhosis. (Study: Bronx Veterans Affairs Medical Center & Mount Sinai Hospital School of Medicine, New York City)

Supplements. B-complex, B12, C (1g), K, Magnesium, Zinc.

Treatment by or in liaison with a general medical practitioner or gastro-enterologist. ... liver – cirrhosis

Depot Injection

An intramuscular injection of a drug that gives a slow, steady release of its active chemicals into the bloodstream. Release of the drug is slowed by the inclusion of substances such as oil or wax. The release of the active drug can be made to last for hours, days, or weeks.

A depot injection is useful for patients who may not take their medication correctly.

It also prevents the necessity of giving a series of injections over a short period.

Hormonal contraceptives (see contraception, hormonal methods of), corticosteroid drugs, and antipsychotic drugs may be given by depot injection.

Side effects may arise due to the uneven release of the drug into the bloodstream.... depot injection

Medicolegal

Relating to aspects of medicine and law that overlap. Among the matters on which medicolegal experts advise are the laws concerning damages for injuries due to medical negligence or malpractice, evidence concerning the extent of injury in a civil action, the use of paternity tests, the mental competence of people who have drawn up wills, and restrictions on the mentally ill.

Medicolegal issues also include an individual’s right to die (see brain death; euthanasia; living will); the necessity for informed consent to any surgical procedure; the legal aspects of artificial insemination, in vitro fertilization, sterilization, and surrogacy; and a patient’s right to confidentiality concerning his or her illness. (For the medical aspects of criminal law, see forensic medicine.)... medicolegal


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