Numbness Health Dictionary

This is neuralgia of the sciatic nerve. These are the two largest nerves in the body, composed of the tibial and common perineal nerves, bound together and containing elements of the lowest two lumbar and upper three sacral spinal cord nerves. Sciatica is felt as severe pain from the buttocks, down the back of the thighs, often radiating to the inside of the leg, even to the point of parasthesia or prickly numbness. Although tumors can cause the problem, far and away the most common causes are a lower back subluxation (responding to adjustment) or pelvic congestion and edema (responding to laxatives, exercise, and decreasing portal vein and lymphatic congestion).... sciatica

Diabetes mellitus is a condition characterised by a raised concentration of glucose in the blood due to a de?ciency in the production and/or action of INSULIN, a pancreatic hormone made in special cells called the islet cells of Langerhans.

Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.

Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.

Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.

A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.

Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production

– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).

Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.

Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.

Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.

Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).

Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;

(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.

Complications The risks of complications increase with duration of disease.

Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.

Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.

Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.

Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).

Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.

Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.

Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.

Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.

Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;

(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.

Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.

Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.

However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.

Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.

Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.

Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.

A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.

Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.... diabetes mellitus

A chemical substance that harms nervous tissue, causing symptoms of numbness or weakness of the body part supplied by the damaged NERVE. The venom of some snakes contains neurotoxic substances, and bacteria may produce neurotoxins: examples are those that cause DIPHTHERIA and TETANUS. Arsenic and lead are examples of inorganic neurotoxins.... neurotoxin

A major NERVE in the arm, it runs from the brachial plexus to the hand. The nerve controls the muscles that move the ?ngers and thumb and conveys sensation from the ?fth and part of the fourth and from the adjacent palm. Muscle weakness and numbness in the areas supplied by the nerve is usually caused by pressure from an abnormal outgrowth from the epicondyle at the bottom of the humerus (upper-arm bone).... ulnar nerve

Disease or inflammation of, or damage to, the peripheral nerves, which connect the central nervous system (brain and spinal cord), to the muscles, glands, sense organs, and internal organs. The term neuritis is now used more or less interchangeably with neuropathy. Most nerve cell axons (the conducting fibres that make up nerves) are insulated by a sheath of the fatty substance myelin. Most neuropathies arise from damage to, or irritation of, either the axons or their myelin sheaths, which may cause slowing or a complete block of the passage of electrical signals. Polyneuropathy (or polyneuritis) means damage to several nerves; mononeuropathy (or mononeuritis) indicates damage to a single nerve; neuralgia describes pain caused by irritation or inflammation of a nerve.

Some cases of neuropathy have no obvious cause. Among specific causes are diabetes mellitus, dietary deficiencies, excessive alcohol consumption, and metabolic upsets such as uraemia.

Nerves may become acutely inflamed after a viral infection, and neuropathies may also result from autoimmune disorders, such as rheumatoid arthritis. Neuropathies may occur secondarily to cancerous tumours, or with lymphomas and leukaemias. There is also a group of inherited neuropathies, the most common being peroneal muscular atrophy.

The symptoms of neuropathy depend on whether it affects mainly sensory nerve fibres or mainly motor nerve fibres. Damage to sensory nerve fibres may cause numbness, tingling, sensations of cold, and pain. Damage to motor fibres may cause muscle weakness and muscle wasting. Damage to autonomic nerves may lead to blurred vision, impaired or absent sweating, faintness, and disturbance of gastric, intestinal, bladder, and sexual functioning.

To determine the extent of the damage, nerve conduction studies are carried out together with EMG tests, which record the electrical activity in muscles.

Diagnostic tests such as blood tests, MRI scans, and nerve or muscle biopsy may also be required.

When possible, treatment is aimed at the underlying cause.

If the cell bodies of the damaged nerve cells have not been destroyed, full recovery from neuropathy is possible.... neuropathy

A disorder of the blood vessels in which exposure to cold causes the small arteries supplying the fingers and toes to contract suddenly. This cuts off blood flow to the digits, which become pale. The fingers are more often affected than the toes. The cause is unknown, but young women are most commonly affected.

On exposure to cold, the digits turn white due to lack of blood. As sluggish blood flow returns, the digits become blue; when they are warmed and normal blood flow returns, they turn red. During an attack, there is often tingling, numbness, or a burning feeling in the affected fingers or toes. In rare cases, the artery walls gradually thicken, permanently reducing blood flow. Eventually painful ulceration or even gangrene may develop at the tips of the affected digits.

Diagnosis is made from the patient’s history. Treatment involves keeping the hands and feet as warm as possible. Vasodilator drugs or calcium channel blockers may be helpful in severe cases. (See also Raynaud’s phenomenon.)... raynaud’s disease

A slow-growing, benign tumour in the auditory canal arising from the Schwann cells of the acoustic cranial nerve. The neuroma, which accounts for about 7 per cent of all tumours inside the CRANIUM, may cause facial numbness, hearing loss, unsteady balance, headache, and TINNITUS. It can usually be removed surgically, sometimes with microsurgical techniques that preserve the facial nerve.... acoustic neuroma

A disorder occurring predominantly in middle-aged women in which there is numbness and tingling of the ?ngers.... acroparaesthesia

As spinal chord nerves branch out into the body, some segments fan out across the skin; these are the nerves that monitor the surface and are the source of senses of touch, pain, hot, cold and distension. All this information is funneled back in and up to the brain, which learned early on to correlate WHAT information comes from WHERE. Think of the brain as the CPU, with the spinal chord nerves uploading raw binary data; the brain has to make a running program out of this. It must form a three-dimensional hologram or homunculus from the linear input, and retranslate it outwards as binary data. The surface of the forearm, as an example, has sensory input gathered from several different and very separate spinal chord nerves. The brain will origami-fold these separate data streams into FOREARM. If you were to inject novacaine into the base of the left first sacral nerve (LS1), you would find that a whole section of skin became numb. So well defined a section that you could outline in charcoal the demarcation between sensation and numbness. This section would be a long oval of of numbness around the left buttock, under to the groin, perhaps part of the thigh...and the left heel. That spinal nerve is solely responsible for carrying sensation from that zone of skin...that dermatome; your brain mixes all the dermatomes together to get a working hologram of your total skin surface. That particular nerve also brings and sends information about the uterus, abdominal wall and pelvic floor. If you are a woman suffering pelvic heaviness and suppressed menses, a hot footbath might be enough S1 (heel dermatome) stimulation to cross-talk over to the referred S1 pelvic functions...and heat up the stuck uterus. Much of acupuncture, Jinshinjitsu, and zone and reflex therapy (not to mention Rolfing) uses various aspects of this dermatome crossover phenomena (by whatever name) and zone counterirritation was widely used in American standard medicine up until...penicillin. It was still being described in clinical manuals as late as 1956, although with the mention that it was only used infrequently and a “mechanism not understood” disclaimer.... dermatomes

A disease of the peripheral nerves causing weakness and numbness in the limbs. It customarily occurs up to three weeks after an infection – for example, CAMPYLOBACTER infection of the gastrointestinal tract provoking an allergic response in the nerves. It may begin with weakness of the legs and gradually spread up the body. In the worst cases the patient may become totally paralysed and require to be arti?cially ventilated. Despite this, recovery is the rule.... guillain-barré syndrome

An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the parietal cells of the STOMACH. These cells normally produce intrinsic factor, which is the carrier protein for vitamin B12 that permits its absorption in the terminal ileum. Without intrinsic factor, vitamin B12 cannot be absorbed and this gives rise to a macrocytic ANAEMIA. The skin and mucosa become pale and the tongue smooth and atrophic. A peripheral NEUROPATHY is often present, causing paraesthesiae (see under TOUCH), numbness and even ATAXIA. The more severe neurological complication of sub-acute combined degeneration of the cord is fortunately more rare. The anaemia gets its name from the fact that before the discovery of vitamin B12 it was uniformly fatal. Now a monthly injection of vitamin B12 is all that is required to keep the patient healthy.... pernicious anaemia

Stevia Tea is made from a green plant native to Paraguay with nutritious leaves up to 30 times sweeter than cane sugar. Stevia Tea contains numerous vitamins and nutrients and it has no calories, but its sweet taste reduces the craving for sweets and aids in the weight loss process. It does not adversely affect the blood sugar level and it can be enjoyed by both diabetics and obese people. Stevia Tea Brewing Stevia Tea can be added to other teas as a replacement for artificial sweetners. Pour one cup of unboiled hot water or other type of beverage over the Stevia Tea bag and let it steep for about three to five minutes. You can serve it hot or iced. If you use Stevia leaves to prepare your Stevia Tea cup, all you need to do is pour hot water over a couple of leaves and it will be ready in only a few minutes. There is no need to add sugar or honey because of its natural sweetness which serves as the perfect substitute. Stevia Tea Health Benefits Stevia, also called “honeyleaf” or “sweet herb”, is considered a miracle plant due to its health restoring benefits. Its leaves contain numerous beneficial minerals which include calcium, zinc, potassium and carbohydrates, as well as A and C vitamins. Stevia Tea can be used as an aid in the treatment of diabetes, high blood pressure and heartburn. Other health benefits of Stevia Tea include the improvement of digestion, oral health and hygene. The water based stevia concentrate has alo been used for treating skin conditions such as acnea. It is beneficial in skin care, having a smoothing and softening effect. Stevia Tea Side Effects The reportedside effects of Stevia Tea include dizziness, nausea and bloating, numbness and mild muscle pain, but none of them were long-lasting. Stevia may interfere with the blood sugar level, potentially lowering it, but caution is advisable among people with diabetes. Patients who already have a low blood pressure should avoid it because another effect of Stevia Tea is lowering the blood pressure. Although there are no long-term side effects, it is recommended that pregnant and nursing women avoid it also until more conclusive research is conducted. Sweetening your tea with stevia will bring your cup a delighful taste, without any unpleasant aftertaste. Enjoy a nice sweet cup of Stevia Tea and benefit from its nutritional value and extraordinarily valuable health effects!... stevia tea information

A common disorder of the spine, in which an intervertebral disc ruptures and part of its pulpy core protrudes. It causes painful and at times disabling pressure on a nerve root or, less commonly, on the spinal cord. The lower back is most commonly affected. A prolapsed disc may sometimes be caused by a sudden strenuous action, but it usually develops gradually as a result of degeneration of the discs with age. If the sciatic nerve root is compressed, it causes sciatica, which may be accompanied by numbness and tingling, and, eventually, weakness in the muscles of the leg. A prolapsed disc in the neck causes neck pain and weakness in the arm and hand.

Symptoms improve with time and analgesic drugs. However, in severe cases, surgical techniques, such as decompression of the spinal canal or removal of the protruding material and repair of the disc, may be necessary.... disc prolapse

A rare condition affecting the peripheral nerves (see peripheral nervous system) that causes weakness, usually in the limbs. The cause is believed to be an allergic reaction to an infection, usually viral; the nerves are damaged by antibodies produced by the body to eliminate the infection. In most cases, the disease develops 2 or 3 weeks after the onset of infection. Weakness, often accompanied by numbness and tingling, usually starts in the legs and spreads to the arms. The weakness may become progressively worse, resulting in paralysis. The muscles of the face and those controlling speech, swallowing, and breathing may also be affected.

Diagnosis of Guillain–Barré syndrome is confirmed by electrical tests to measure how fast nerve impulses are being conducted, or by a lumbar puncture. Most people recover fully with only supportive treatment. However, in severe cases, treatment with plasmapheresis or immunoglobulin may be given. Mechanical ventilation may be needed to aid breathing if the respiratory muscles and diaphragm are severely affected. Some people are left with permanent weakness in affected areas and/or suffer from further attacks of the disease.... guillain–barré syndrome

Toxic effects of mercury on the body. The most common cause of mercury poisoning is breathing in vapour given off by liquid mercury, usually as a result of industrial exposure. Swallowing a small amount of liquid mercury is unlikely to lead to poisoning. Mercury compounds may cause poisoning by absorption through the intestines (causing nausea, vomiting, diarrhoea, and abdominal pain) or the skin (causing severe inflammation).

After entering the body, mercury accumulates in organs, principally the brain and kidneys. Mercury deposits in the brain cause tiredness, incoordination, excitability, tremors, and numbness in the limbs. In severe cases, there may be impaired vision and dementia. Deposits of mercury in the kidneys may lead to kidney failure.

Treatment may involve chelating agents, which help the body to excrete the mercury quickly; haemodialysis (see dialysis); and induced vomiting or pumping out the stomach, if mercury has been swallowed within the previous few hours.... mercury poisoning

A severe headache, typically lasting 4–72 hours, accompanied by visual disturbances and/or nausea and vomiting. Migraine attacks may be isolated or may recur at varying intervals.

There is no single cause of migraine, although it tends to run in families. Stress-related, food-related, or sensoryrelated factors may trigger an attack. Menstruation and oral contraceptives may also trigger migraine.

There are 2 types: migraine with aura (an impression of flashing lights and/or numbness and tingling), and migraine without aura. In migraine without aura, there is a slowly worsening headache, often on one side of the head, with nausea and sometimes vomiting.

In migraine with aura, there may be visual disturbances for up to an hour, followed by a severe one-sided headache, nausea, vomiting and light-sensitivity. Other temporary neurological symptoms, such as weakness in one half of the body, may occur.

Diagnosis is usually made from the history and a physical examination. Treatment for an attack is an analgesic drug such as aspirin or paracetamol, plus an antiemetic drug, if needed. If this is not effective, treatment with serotonin agonists such as sumatriptan may be prescribed. Ergotamine may prevent an attack if taken before the headache begins, but is now rarely used. Sleeping in a darkened room may hasten recovery. For frequent attacks, preventive treatment may be needed. Keeping a diary can help pinpoint trigger factors, and prophylactic drugs may be prescribed.(See also cluster headaches.) ... migraine

A noncancerous tumour of nerve tissue. In most cases, the cause is unknown; rarely, a neuroma develops as a result of damage to a nerve.A neuroma may affect any nerve in the body. Symptoms vary, but there is often intermittent pain and sometimes weakness and numbness in the areas that are supplied by the affected nerve.

If symptoms are troublesome, the tumour may be surgically removed. (See also acoustic neuroma.)... neuroma

An antibacterial drug that is used in the treatment of urinary tract infection. Nitrofurantoin should be taken with food to reduce the risk of stomach irritation, abdominal pain, and nausea. More rarely, breathing difficulty, numbness, and jaundice occur.... nitrofurantoin

A tingling or prickly feeling in an area of skin that is usually

associated with numbness and, sometimes, a burning feeling. The medical term is paraesthesia. Transient pins-andneedles is due to a temporary disturbance in the conduction of nerve signals from the skin. Persistent pins-and-needles may be caused by neuropathy.... pins-and-needles

A potassium-sparing diuretic drug, which is given to treat heart failure.

Spironolactone may cause numbness, weakness, and nausea.

Less common side effects include diarrhoea, lethargy, impotence, rash, and irregular menstruation.

High doses may cause abnormal breast enlargement in men.... spironolactone

An antibiotic drug used to treat a number of uncommon infections, including tularaemia, plague, brucellosis, and glanders.

It may damage nerves in the inner ear, disturbing balance and causing dizziness, tinnitus, or deafness.

Other side effects are facial numbness, tingling in the hands, and headache.... streptomycin

The daily requirement of iron for an adult is 12 mg, and 15–20 mg for an adult woman during pregnancy. This is well covered by an ordinary diet, so that by itself it is not a common cause. But if there is a steady loss of blood, as a result of heavy menstrual loss or ‘bleeding piles’, the intake of iron in the diet may not be su?cient to maintain adequate formation of haemoglobin.

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

Piper longum

Piperaceae: San: Pippali;

Hin, Ben, Pun: Piplamul; Kan, Mal:Thippali ;

Tam: Thippili; Mar: Pimpli;

Tel: Pipppaloo; Ass: Piplu.

Introduction: Long pepper is a slender aromatic climber whose spike is widely used in ayurvedic and unani systems of medicine particularly for diseases of respiratory tract. Pipalarishta, Pippalyasava, Panchakola, Pippalayadilauha, and Lavana bhaskar churan are common ayurvedic preparations made out of the dry spikes of female types. Ittrifal fauladi, Angaruya-i-kabir and Majun khadar are well known unani preparations of long pepper. Its roots also have several medicinal uses. The root is useful in bronchitis, stomach ache, diseases of spleen and tumours. Fruit is useful in vata and kapha, asthma, bronchitis, abdominal complaints, fever, leucoderma, urinary discharges, tumours, piles, insomnia and tuberculosis. Root and fruit are used in gout and lumbago. The infusion of root is prescribed after parturition to induce the expulsion of placenta. The root and fruit decoction are used in acute and chronic bronchitis and cough. It contains the alkaloid piperine which has diverse pharmacological activities, including nerve depressant and antagonistic effect on electro- shock and chemo -shock seizures as well as muscular incoordination.

Distribution: The plant is a native of Indo-Malaya region. It was very early introduced to Europe and was highly regarded as a flavour ingredient by the Romans. The Greek name “Peperi”, the Latin “Piper” and the English “Pepper” were derived from the Sanskrit name “Pippali”. It grows wild in the tropical rain forests of India, Nepal, Indonesia, Malaysia, Sri lanka, Rhio, Timor and the Philippines. In India, it is seen in Assam, West Bengal, Uttar Pradesh, Madhya Pradesh, Maharashtra, Kerala, Karnataka.and Tamil Nadu. It is also cultivated in Bengal, Chirapunchi area of Assam, Akola-Amravati region of Maharashtra, Anamalai hills of Tamil Nadu, Orissa, Uduppi and Mangalore regions of Karnataka. Bulk of Indian long pepper comes from its wild growth in Assam, Shillong and West Bengal, supplemented by imports from Sri Lanka and Indonesia (Viswanathan,1995)

Botany: Piper longum Linn. is a member of Piperaceae family. The plant is a glabrous perennial under-shrub with erect or sub-scandent nodose stem and slender branches, the latter are often creeping or trailing and rooting below or rarely scandent reaching a few metres height. Leaves are simple, alternate, stipulate, and petiolate or nearly sessile; lower ones broadly ovate, cordate; upper ones oblong, oval, all entire, smooth, thin with reticulate venation; veins raised beneath. It flowers nearly throughout the year. Inflorescence is spike with unisexual small achlamydeous densely packed flowers and form very close clusters of small greyish green or darker grey berries. Female spikes with short thick stalk varying from 1.5 to2.5 cm in length and 0.5 to 0.7 cm in thickness.

A number of geographical races are available in different agroclimatic regions of India; the most popular being Assam, West Bengal and Nepal races. Piper officinarum DC; syn. Chavica officinarum Miquel, Piper pepuloides and Piper chaba Hunter are the other related species of importance.

Agrotechnology: Long pepper is a tropical plant adapted to high rainfall areas with high humidity. An elevation of 100-1000 m is ideal. It needs partial shade to the tune of 20-30% for best growth. The natural habitat of the plant is on the borders of streams. It is successfully cultivated in well drained forest soils rich in organic matter. Laterite soils with high organic matter content and moisture holding capacity are also suitable for cultivation.

Long pepper is propagated by suckers or rooted vine cuttings.15-20 cm long 3-5 nodded rooted vine cuttings establishes very well in polybags. The best time for raising nursery is March-April. Normal irrigation is given on alternate days. The rooted cuttings will be ready for transplanting in 2 months time. With the onset of monsoon in June the field is ploughed well and brought to good tilth. 15-20 cm raised beds of convenient length and breadth are taken. On these beds, pits are dug at 60 x 60 cm spacing and well decomposed organic manure at 100 g/pit is applied and mixed with the soil. Rooted vine cuttings from polybags are transplanted to these pits. Gap filling can be done after one month of planting.The crop needs heavy manuring at the rate of 20 t FYM/ha every year. Application of heavy dose organic matter and mulching increase water retention in the soil and control weeds. Small doses of chemical fertilisers can also be used. The crop needs irrigation once a week. Sprinkler irrigation is ideal. With irrigation the crop continues to produce spikes and off-season produce will be available. However, it is reported that unirrigated crop after the onset of monsoon grows vigorously and shows much hardiness than the irrigated crop.

Crop losses can be heavy due to pests and diseases. Mealy bugs and root grubs, attack the plant particularly during summer. Infested plants show yellowing and stunted growth. Application of systemic insecticides like nuvacron or dimecron will control the pests. Adults and nymphs of Helopeltis theivora severely feeds on the foliage which can be controlled by 0.25% neem kernel suspension. Rotting of leaves and vines during monsoon season is caused by Colletotrichum glorosporiodes and necrotic lesions and blights on the leaves during summer is caused by Colletotrichum and Cercospora spp. These diseases can be controlled by spraying of 1% Bordeaux mixture repeatedly. A virus like disease characterised by yellowing and crinkling of leaves, stunted growth and production of spikes of smaller size and inferior quality was also recently reported.

The vines start flowering six months after planting and flowers are produced almost throughout the year. The spikes mature in 2 months time. The optimum stage of harvest is when the spikes are blackish green. The pungency is highest at this stage. Spikes are hand picked when they become mature and then dried. The yield of dry spike is 400 kg /ha during first year, increases to 1000kg during third year and thereafter it decreases. Therefore, after 3 years the whole plant is harvested. The stem is cut close to the ground and roots are dug up. Average yield is 500 kg dry roots/ha (Viswanathan,1995).

Piper longum can also be cultivated as an intercrop in plantations of coconut, subabul and eucalyptus.

Post harvest technology: The harvested spikes are dried in sun for 4-5 days until they are perfectly dry. The green to dry spike ratio is 10:1.5 by weight. The dried spikes have to be stored in moisture proof containers. Stem and roots are cleaned, cut into pieces of 2.5-5 cm length, dried in shade and marketed as piplamool. There are three grades of piplamool, based on the thickness. The commercial drug consists 0.5-2.5 cm long ,0.5-2.5 mm thick, cylindrical pieces dirty light brown in colour and peculiar odour with a pungent bitter taste, producing numbness to the tongue.

Properties and activity: The spike of long pepper contains 4-5% piperine, piplartin, piperolactam, N-isobutyl deca trans-2-trans-4-dienamide and piporadione alkaloides, besides 0.7 % essential oil. Roots gave the alkaloids piperine, piperlongumine (piplartine) and piperlonguminine; sesamine, methyl 3, 4, 5-trimethoxy cinnamate. Stem gave triacoutane 22, 23 - dihydrostigmasterol. Fruit essential oil contains piperidine, caryophyllene and sesquiterpene alcohol (Atal et al, 1975).

The root is plungent, hot, stomachic, laxative, anthelmintic and carminative. The fruit is sweetish, pungent, hot, stomachic, aphrodisiac, alterative, laxative, antidysenteric, emmenagogue, abortifacient, diuretic and tonic. The essential oil is antimicrobial and anthelmintic.

N-isobutyl-deca-trans-2-trans-4-dienamide is antitubercular.

Piperine is hypotensive, antipyretic, analeptic, and nerve stimulant (Warrier et al, 1995).... long pepper

Occupational health The e?ect of work on human health, and the impact of workers’ health on their work. Although the term encompasses the identi?cation and treatment of speci?c occupational diseases, occupational health is also an applied and multidisciplinary subject concerned with the prevention of occupational ill-health caused by chemical, biological, physical and psychosocial factors, and the promotion of a healthy and productive workforce.

Occupational health includes both mental and physical health. It is about compliance with health-and-safety-at-work legislation (and common law duties) and about best practice in providing work environments that reduce risks to health and safety to lowest practicable levels. It includes workers’ ?tness to work, as well as the management of the work environment to accommodate people with disabilities, and procedures to facilitate the return to work of those absent with long-term illness. Occupational health incorporates several professional groups, including occupational physicians, occupational health nurses, occupational hygienists, ergonomists, disability managers, workplace counsellors, health-and-safety practitioners, and workplace physiotherapists.

In the UK, two key statutes provide a framework for occupational health: the Health and Safety at Work, etc. Act 1974 (HSW Act); and the Disability Discrimination Act 1995 (DDA). The HSW Act states that employers have a duty to protect the health, safety and welfare of their employees and to conduct their business in a way that does not expose others to risks to their health and safety. Employees and self-employed people also have duties under the Act. Modern health-and-safety legislation focuses on assessing and controlling risk rather than prescribing speci?c actions in di?erent industrial settings. Various regulations made under the HSW Act, such as the Control of Substances Hazardous to Health Regulations, the Manual Handling Operations Regulations and the Noise at Work Regulations, set out duties with regard to di?erent risks, but apply to all employers and follow the general principles of risk assessment and control. Risks should be controlled principally by removing or reducing the hazard at source (for example, by substituting chemicals with safer alternatives, replacing noisy machinery, or automating tasks to avoid heavy lifting). Personal protective equipment, such as gloves and ear defenders, should be seen as a last line of defence after other control measures have been put in place.

The employment provisions of the DDA require employers to avoid discriminatory practice towards disabled people and to make reasonable adjustments to working arrangements where a disabled person is placed at a substantial disadvantage to a non-disabled person. Although the DDA does not require employers to provide access to rehabilitation services – even for those injured or made ill at work – occupational-health practitioners may become involved in programmes to help people get back to work after injury or long-term illness, and many businesses see the retention of valuable sta? as an attractive alternative to medical retirement or dismissal on health grounds.

Although a major part of occupational-health practice is concerned with statutory compliance, the workplace is also an important venue for health promotion. Many working people rarely see their general practitioner and, even when they do, there is little time to discuss wider health issues. Occupational-health advisers can ?ll in this gap by providing, for example, workplace initiatives on stopping smoking, cardiovascular health, diet and self-examination for breast and testicular cancers. Such initiatives are encouraged because of the perceived bene?ts to sta?, to the employing organisation and to the wider public-health agenda. Occupational psychologists recognise the need for the working population to achieve a ‘work-life balance’ and the promotion of this is an increasing part of occupational health strategies.

The law requires employers to consult with their sta? on health-and-safety matters. However, there is also a growing understanding that successful occupational-health management involves workers directly in the identi?cation of risks and in developing solutions in the workplace. Trade unions play an active role in promoting occupational health through local and national campaigns and by training and advising elected workplace safety representatives.

Occupational medicine The branch of medicine that deals with the control, prevention, diagnosis, treatment and management of ill-health and injuries caused or made worse by work, and with ensuring that workers are ?t for the work they do.

Occupational medicine includes: statutory surveillance of workers’ exposure to hazardous agents; advice to employers and employees on eliminating or reducing risks to health and safety at work; diagnosis and treatment/management of occupational illness; advice on adapting the working environment to suit the worker, particularly those with disabilities or long-term health problems; and advice on the return to work and, if necessary, rehabilitation of workers absent through illness. Occupational physicians may play a wider role in monitoring the health of workplace populations and in advising employers on controlling health hazards where ill-health trends are observed. They may also conduct epidemiological research (see EPIDEMIOLOGY) on workplace diseases.

Because of the occupational physician’s dual role as adviser to both employer and employee, he or she is required to be particularly diligent with regards to the individual worker’s medical CONFIDENTIALITY. Occupational physicians need to recognise in any given situation the context they are working in, and to make sure that all parties are aware of this.

Occupational medicine is a medical discipline and thus is only part of the broader ?eld of occupational health. Although there are some speci?c clinical duties associated with occupational medicine, such as diagnosis of occupational disease and medical screening, occupational physicians are frequently part of a multidisciplinary team that might include, for example, occupational-health nurses, healthand-safety advisers, ergonomists, counsellors and hygienists. Occupational physicians are medical practitioners with a post-registration quali?cation in occupational medicine. They will have completed a period of supervised in-post training. In the UK, the Faculty of Occupational Medicine of the Royal College of Physicians has three categories of membership, depending on quali?cations and experience: associateship (AFOM); membership (MFOM); and fellowship (FFOM).

Occupational diseases Occupational diseases are illnesses that are caused or made worse by work. In their widest sense, they include physical and mental ill-health conditions.

In diagnosing an occupational disease, the clinician will need to examine not just the signs and symptoms of ill-health, but also the occupational history of the patient. This is important not only in discovering the cause, or causes, of the disease (work may be one of a number of factors), but also in making recommendations on how the work should be modi?ed to prevent a recurrence – or, if necessary, in deciding whether or not the worker is able to return to that type of work. The occupational history will help in deciding whether or not other workers are also at risk of developing the condition. It will include information on:

the nature of the work.

how the tasks are performed in practice.

the likelihood of exposure to hazardous agents (physical, chemical, biological and psychosocial).

what control measures are in place and the extent to which these are adhered to.

previous occupational and non-occupational exposures.

whether or not others have reported similar symptoms in relation to the work. Some conditions – certain skin conditions,

for example – may show a close relationship to work, with symptoms appearing directly only after exposure to particular agents or possibly disappearing at weekends or with time away from work. Others, however, may be chronic and can have serious long-term implications for a person’s future health and employment.

Statistical information on the prevalence of occupational disease in the UK comes from a variety of sources, including o?cial ?gures from the Industrial Injuries Scheme (see below) and statutory reporting of occupational disease (also below). Neither of these o?cial schemes provides a representative picture, because the former is restricted to certain prescribed conditions and occupations, and the latter suffers from gross under-reporting. More useful are data from the various schemes that make up the Occupational Diseases Intelligence Network (ODIN) and from the Labour Force Survey (LFS). ODIN data is generated by the systematic reporting of work-related conditions by clinicians and includes several schemes. Under one scheme, more than 80 per cent of all reported diseases by occupational-health physicians fall into just six of the 42 clinical disease categories: upper-limb disorders; anxiety, depression and stress disorders; contact DERMATITIS; lower-back problems; hearing loss (see DEAFNESS); and ASTHMA. Information from the LFS yields a similar pattern in terms of disease frequency. Its most recent survey found that over 2 million people believed that, in the previous 12 months, they had suffered from an illness caused or made worse by work and that

19.5 million working days were lost as a result. The ten most frequently reported disease categories were:

stress and mental ill-health (see MENTAL ILLNESS): 515,000 cases.

back injuries: 508,000.

upper-limb and neck disorders: 375,000.

lower respiratory disease: 202,000.

deafness, TINNITUS or other ear conditions: 170,000.

lower-limb musculoskeletal conditions: 100,000.

skin disease: 66,000.

headache or ‘eyestrain’: 50,000.

traumatic injury (includes wounds and fractures from violent attacks at work): 34,000.

vibration white ?nger (hand-arm vibration syndrome): 36,000. A person who develops a chronic occu

pational disease may be able to sue his or her employer for damages if it can be shown that the employer was negligent in failing to take reasonable care of its employees, or had failed to provide a system of work that would have prevented harmful exposure to a known health hazard. There have been numerous successful claims (either awarded in court, or settled out of court) for damages for back and other musculoskeletal injuries, hand-arm vibration syndrome, noise-induced deafness, asthma, dermatitis, MESOTHELIOMA and ASBESTOSIS. Employers’ liability (workers’ compensation) insurers are predicting that the biggest future rise in damages claims will be for stress-related illness. In a recent study, funded by the Health and Safety Executive, about 20 per cent of all workers – more than 5 million people in the UK – claimed to be ‘very’ or ‘extremely’ stressed at work – a statistic that is likely to have a major impact on the long-term health of the working population.

While victims of occupational disease have the right to sue their employers for damages, many countries also operate a system of no-fault compensation for the victims of prescribed occupational diseases. In the UK, more than 60 diseases are prescribed under the Industrial Injuries Scheme and a person will automatically be entitled to state compensation for disability connected to one of these conditions, provided that he or she works in one of the occupations for which they are prescribed. The following short list gives an indication of the types of diseases and occupations prescribed under the scheme:

CARPAL TUNNEL SYNDROME connected to the use of hand-held vibrating tools.

hearing loss from (amongst others) use of pneumatic percussive tools and chainsaws, working in the vicinity of textile manufacturing or woodworking machines, and work in ships’ engine rooms.

LEPTOSPIROSIS – infection with Leptospira (various listed occupations).

viral HEPATITIS from contact with human blood, blood products or other sources of viral hepatitis.

LEAD POISONING, from any occupation causing exposure to fumes, dust and vapour from lead or lead products.

asthma caused by exposure to, among other listed substances, isocyanates, curing agents, solder ?ux fumes and insects reared for research.

mesothelioma from exposure to asbestos.

In the UK, employers and the self-employed have a duty to report all occupational injuries (if the employee is o? work for three days or more as a result), diseases or dangerous incidents to the relevant enforcing authority (the Health and Safety Executive or local-authority environmental-health department) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). Despite this statutory duty, comparatively few diseases are reported so that ?gures generated from RIDDOR reports do not give a useful indication of the scale of occupational diseases in the UK. The statutory reporting of injuries is much better, presumably because of the clear and acute relationship between a workplace accident and the resultant injury. More than 160,000 injuries are reported under RIDDOR every year compared with just 2,500 or so occupational diseases, a gross underestimate of the true ?gure.

There are no precise ?gures for the number of people who die prematurely because of work-related ill-health, and it would be impossible to gauge the exact contribution that work has on, for example, cardiovascular disease and cancers where the causes are multifactorial. The toll would, however, dwarf the number of deaths caused by accidents at work. Around 250 people are killed by accidents at work in the UK each year – mesothelioma, from exposure to asbestos at work, alone kills more than 1,300 people annually.

The following is a sample list of occupational diseases, with brief descriptions of their aetiologies.

Inhaled materials

PNEUMOCONIOSIS covers a group of diseases which cause ?brotic lung disease following the inhalation of dust. Around 250–300 new cases receive bene?t each year – mostly due to coal dust with or without silica contamination. SILICOSIS is the more severe disease. The contraction in the size of the coal-mining industry as well as improved dust suppression in the mines have diminished the importance of this disease, whereas asbestos-related diseases now exceed 1,000 per year. Asbestos ?bres cause a restrictive lung disease but also are responsible for certain malignant conditions such as pleural and peritoneal mesothelioma and lung cancer. The lung-cancer risk is exacerbated by cigarette-smoking.

Even though the use of asbestos is virtually banned in the UK, many workers remain at risk of exposure because of the vast quantities present in buildings (much of which is not listed in building plans). Carpenters, electricians, plumbers, builders and demolition workers are all liable to exposure from work that disturbs existing asbestos. OCCUPATIONAL ASTHMA is of increasing importance – not only because of the recognition of new allergic agents (see ALLERGY), but also in the number of reported cases. The following eight substances are most frequently linked to occupational asthma (key occupations in brackets): isocyanates (spray painters, electrical processors); ?our and grain (bakers and farmers); wood dust (wood workers); glutaraldehyde (nurses, darkroom technicians); solder/colophony (welders, electronic assembly workers); laboratory animals (technicians, scientists); resins and glues (metal and electrical workers, construction, chemical processors); and latex (nurses, auxiliaries, laboratory technicians).

The disease develops after a short, symptomless period of exposure; symptoms are temporally related to work exposures and relieved by absences from work. Removal of the worker from exposure does not necessarily lead to complete cessation of symptoms. For many agents, there is no relationship with a previous history of ATOPY. Occupational asthma accounts for about 10 per cent of all asthma cases. DERMATITIS The risk of dermatitis caused by an allergic or irritant reaction to substances used or handled at work is present in a wide variety of jobs. About three-quarters of cases are irritant contact dermatitis due to such agents as acids, alkalis and solvents. Allergic contact dermatitis is a more speci?c response by susceptible individuals to a range of allergens (see ALLERGEN). The main occupational contact allergens include chromates, nickel, epoxy resins, rubber additives, germicidal agents, dyes, topical anaesthetics and antibiotics as well as certain plants and woods. Latex gloves are a particular cause of occupational dermatitis among health-care and laboratory sta? and have resulted in many workers being forced to leave their profession through ill-health. (See also SKIN, DISEASES OF.)

Musculoskeletal disorders Musculoskeletal injuries are by far the most common conditions related to work (see LFS ?gures, above) and the biggest cause of disability. Although not all work-related, musculoskeletal disorders account for 36.5 per cent of all disabilities among working-age people (compared with less than 4 per cent for sight and hearing impairment). Back pain (all causes – see BACKACHE) has been estimated to cause more than 50 million days lost every year in sickness absence and costs the UK economy up to £5 billion annually as a result of incapacity or disability. Back pain is a particular problem in the health-care sector because of the risk of injury from lifting and moving patients. While the emphasis should be on preventing injuries from occurring, it is now well established that the best way to manage most lower-back injuries is to encourage the patient to continue as normally as possible and to remain at work, or to return as soon as possible even if the patient has some residual back pain. Those who remain o? work on long-term sick leave are far less likely ever to return to work.

Aside from back injuries, there are a whole range of conditions affecting the upper limbs, neck and lower limbs. Some have clear aetiologies and clinical signs, while others are less well de?ned and have multiple causation. Some conditions, such as carpal tunnel syndrome, are prescribed diseases in certain occupations; however, they are not always caused by work (pregnant and older women are more likely to report carpal tunnel syndrome irrespective of work) and clinicians need to be careful when assigning work as the cause without ?rst considering the evidence. Other conditions may be revealed or made worse by work – such as OSTEOARTHRITIS in the hand. Much attention has focused on injuries caused by repeated movement, excessive force, and awkward postures and these include tenosynovitis (in?ammation of a tendon) and epicondylitis. The greatest controversy surrounds upper-limb disorders that do not present obvious tissue or nerve damage but nevertheless give signi?cant pain and discomfort to the individual. These are sometimes referred to as ‘repetitive strain injury’ or ‘di?use RSI’. The diagnosis of such conditions is controversial, making it di?cult for sufferers to pursue claims for compensation through the courts. Psychosocial factors, such as high demands of the job, lack of control and poor social support at work, have been implicated in the development of many upper-limb disorders, and in prevention and management it is important to deal with the psychological as well as the physical risk factors. Occupations known to be at particular risk of work-related upper-limb disorders include poultry processors, packers, electronic assembly workers, data processors, supermarket check-out operators and telephonists. These jobs often contain a number of the relevant exposures of dynamic load, static load, a full or excessive range of movements and awkward postures. (See UPPER LIMB DISORDERS.)

Physical agents A number of physical agents cause occupational ill-health of which the most important is occupational deafness. Workplace noise exposures in excess of 85 decibels for a working day are likely to cause damage to hearing which is initially restricted to the vital frequencies associated with speech – around 3–4 kHz. Protection from such noise is imperative as hearing aids do nothing to ameliorate the neural damage once it has occurred.

Hand-arm vibration syndrome is a disorder of the vascular and/or neural endings in the hands leading to episodic blanching (‘white ?nger’) and numbness which is exacerbated by low temperature. The condition, which is caused by vibrating tools such as chain saws and pneumatic hammers, is akin to RAYNAUD’S DISEASE and can be disabling.

Decompression sickness is caused by a rapid change in ambient pressure and is a disease associated with deep-sea divers, tunnel workers and high-?ying aviators. Apart from the direct effects of pressure change such as ruptured tympanic membrane or sinus pain, the more serious damage is indirectly due to nitrogen bubbles appearing in the blood and blocking small vessels. Central and peripheral nervous-system damage and bone necrosis are the most dangerous sequelae.

Radiation Non-ionising radiation from lasers or microwaves can cause severe localised heating leading to tissue damage of which cataracts (see under EYE, DISORDERS OF) are a particular variety. Ionising radiation from radioactive sources can cause similar acute tissue damage to the eyes as well as cell damage to rapidly dividing cells in the gut and bone marrow. Longer-term effects include genetic damage and various malignant disorders of which LEUKAEMIA and aplastic ANAEMIA are notable. Particular radioactive isotopes may destroy or induce malignant change in target organs, for example, 131I (thyroid), 90Sr (bone). Outdoor workers may also be at risk of sunburn and skin cancers. OTHER OCCUPATIONAL CANCERS Occupation is directly responsible for about 5 per cent of all cancers and contributes to a further 5 per cent. Apart from the cancers caused by asbestos and ionising radiation, a number of other occupational exposures can cause human cancer. The International Agency for Research on Cancer regularly reviews the evidence for carcinogenicity of compounds and industrial processes, and its published list of carcinogens is widely accepted as the current state of knowledge. More than 50 agents and processes are listed as class 1 carcinogens. Important occupational carcinogens include asbestos (mesothelioma, lung cancer); polynuclear aromatic hydrocarbons such as mineral oils, soots, tars (skin and lung cancer); the aromatic amines in dyestu?s (bladder cancer); certain hexavalent chromates, arsenic and nickel re?ning (lung cancer); wood and leather dust (nasal sinus cancer); benzene (leukaemia); and vinyl chloride monomer (angiosarcoma of the liver). It has been estimated that elimination of all known occupational carcinogens, if possible, would lead to an annual saving of 5,000 premature deaths in Britain.

Infections Two broad categories of job carry an occupational risk. These are workers in contact with animals (farmers, veterinary surgeons and slaughtermen) and those in contact with human sources of infection (health-care sta? and sewage workers).

Occupational infections include various zoonoses (pathogens transmissible from animals to humans), such as ANTHRAX, Borrelia burgdorferi (LYME DISEASE), bovine TUBERCULOSIS, BRUCELLOSIS, Chlamydia psittaci, leptospirosis, ORF virus, Q fever, RINGWORM and Streptococcus suis. Human pathogens that may be transmissible at work include tuberculosis, and blood-borne pathogens such as viral hepatitis (B and C) and HIV (see AIDS/HIV). Health-care workers at risk of exposure to infected blood and body ?uids should be immunised against hapatitis B.

Poisoning The incidence of occupational poisonings has diminished with the substitution of noxious chemicals with safer alternatives, and with the advent of improved containment. However, poisonings owing to accidents at work are still reported, sometimes with fatal consequences. Workers involved in the application of pesticides are particularly at risk if safe procedures are not followed or if equipment is faulty. Exposure to organophosphate pesticides, for example, can lead to breathing diffculties, vomiting, diarrhoea and abdominal cramps, and to other neurological effects including confusion and dizziness. Severe poisonings can lead to death. Exposure can be through ingestion, inhalation and dermal (skin) contact.

Stress and mental health Stress is an adverse reaction to excessive pressures or demands and, in occupational-health terms, is di?erent from the motivational impact often associated with challenging work (some refer to this as ‘positive stress’). Stress at work is often linked to increasing demands on workers, although coping can often prevent the development of stress. The causes of occupational stress are multivariate and encompass job characteristics (e.g. long or unsocial working hours, high work demands, imbalance between e?ort and reward, poorly managed organisational change, lack of control over work, poor social support at work, fear of redundancy and bullying), as well as individual factors (such as personality type, personal circumstances, coping strategies, and availability of psychosocial support outside work). Stress may in?uence behaviours such as smoking, alcohol consumption, sleep and diet, which may in turn affect people’s health. Stress may also have direct effects on the immune system (see IMMUNITY) and lead to a decline in health. Stress may also alter the course and response to treatment of conditions such as cardiovascular disease. As well as these general effects of stress, speci?c types of disorder may be observed.

Exposure to extremely traumatic incidents at work – such as dealing with a major accident involving multiple loss of life and serious injury

(e.g. paramedics at the scene of an explosion or rail crash) – may result in a chronic condition known as post-traumatic stress disorder (PTSD). PTSD is an abnormal psychological reaction to a traumatic event and is characterised by extreme psychological discomfort, such as anxiety or panic when reminded of the causative event; sufferers may be plagued with uncontrollable memories and can feel as if they are going through the trauma again. PTSD is a clinically de?ned condition in terms of its symptoms and causes and should not be used to include normal short-term reactions to trauma.... occupational health, medicine and diseases

Multiple sclerosis is a progressive disease of the BRAIN and SPINAL CORD, which, although slow in its onset, in time may produce marked symptoms such as PARALYSIS and tremors (see TREMOR), and may ultimately result in a severely disabled invalid. The disorder consists of hardened patches, from the size of a pin-head to that of a pea or larger, scattered here and there irregularly through the brain and spinal cord. Each patch is made up of a mass of the CONNECTIVE TISSUE (neuroglia), which should be present only in su?cient amount to bind the nerve-cells and ?bres together. In the earliest stage, the insulating sheaths (MYELIN) of the nerve-?bres in the hardened patches break up, are absorbed, and leave the nerve-?bres bare, the connective tissue being later formed between these.

Cause Although this is one of the most common diseases of the central nervous system in Europe – there are around 50,000 affected individuals in Britain alone – the cause is still not known. The disease comes on in young people (onset being rare after the age of 40), apparently without previous illness. The ratio of women-to-men victims is 3:2. It is more common in ?rst and second children than in those later in birth order, and in small rather than big families. There may be a hereditary factor for MS, which could be an autoimmune disorder: the body’s defence system attacks the myelin in the central nervous system as if it were a ‘foreign’ tissue.

Symptoms These depend greatly upon the part of the brain and cord affected by the sclerotic patches. Temporary paralysis of a limb, or of an eye muscle, causing double vision, and tremors upon exertion, ?rst in the affected parts, and later in all parts of the body, are early symptoms. Sti?ness of the lower limbs causing the toes to catch on small irregularities in the ground and trip the person in walking, is often an annoying symptom and one of the ?rst to be noticed. Great activity is shown in the re?ex movements obtained by striking the tendons and by stroking the soles of the feet. The latter re?ex shows a characteristic sign (Babinski sign) in which the great toe bends upwards and the other toes spread apart as the sole is stroked, instead of the toes collectively bending downwards as in the normal person. Tremor of the eye movements (nystagmus) is usually found. Trembling handwriting, interference with the functions of the bladder, giddiness, and a peculiar ‘staccato’ or ‘scanning’ speech are common symptoms at a later stage. Numbness and tingling in the extremities occur commonly, particularly in the early stages of the disease. As the disease progresses, the paralyses, which were transitory at ?rst, now become con?rmed, often with great rigidity in the limbs. In many patients the disease progresses very slowly.

People with multiple sclerosis, and their relatives, can obtain help and guidance from the Multiple Sclerosis Society. Another helpful organisation is the Multiple Sclerosis Resources Centre. Those with sexual or marital problems arising out of the illness can obtain information from SPOD (Association to Aid the Sexual and Personal Relationships of People with a Disability). (See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)

Treatment is di?cult, because the most that can be done is to lead a life as free from strain as possible, to check the progress of the disease. The use of INTERFERON beta seems to slow the progress of MS and this drug is licensed for use in the UK for patients with relapsing, remitting MS over two years, provided they can walk unaided – a controversial restriction on this (expensive) treatment. CORTICOSTEROIDS may be of help to some patients.

The NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) ruled in 2001 that the use of the drugs interferon beta and glatiramer acetate for patients with multiple sclerosis was not cost-e?ective but recommended that the Department of Health, the National Assembly for Wales and the drug manufacturers should consider ways of making the drugs available in a cost-e?ective way. Subsequently the government said that it would consider funding a ‘risk-sharing’ scheme in which supply of drugs to patients would be funded only if treatment trials in individuals with MS showed that they were e?ective.

The Department of Health has asked NICE to assess two CANNABIS derivatives as possible treatments for multiple sclerosis and the relief of post-operative pain. Trials of an under-thetongue spray and a tablet could, if successsful, lead to the two drugs being available around 2005.

It is important to keep the nerves and muscles functioning, and therefore the patient should remain at work as long as he or she is capable of doing it, and in any case should exercise regularly.... multiple sclerosis (ms)

A term applied to unusual feelings, apart from mere increase, or loss, of sensation, experienced by a patient without any external cause: for example, hot ?ushes, numbness, tingling, itching. Various paraesthesiae form a common symptom in some nervous diseases.... paraesthesia

Numbness, prickly sensations without point specificity, or abnormal hypersensitivities, all local to one part of the body, and without an obvious cause. Your foot falling asleep is paresthetic, but not paresthesia...the cause is you sat funny.... paresthesia

Radiculopathy is damage to the roots of nerves where they enter or leave the SPINAL CORD. Causes include ARTHRITIS of the spine, thickening of the MENINGES, and DIABETES MELLITUS. Symptoms include pain, PARAESTHESIA, numbness and wasting of muscles supplied by the nerves. Treatment is of the underlying cause.... radiculopathy

A term applied to symptoms, and sensations, perceived only by the affected individual. For example, numbness is a purely subjective sensation, whilst the jerk given by the leg on tapping the tendon of the knee is an objective sign.... subjective

Scoliosis A condition where the spine is curved to one side (the spine is normally straight when seen from behind). The deformity may be mobile and reversible, or ?xed; if ?xed it is accompanied by vertebral rotation and does not disappear with changes in posture. Fixed scoliosis is idiopathic (of unknown cause) in 65–80 per cent of cases. There are three main types: the infantile type occurs in boys under three and in 90 per cent of cases resolves spontaneously; the juvenile type affects 4–9 year olds and tends to be progressive. The most common type is adolescent idiopathic scoliosis; girls are affected in 90 per cent of cases and the incidence is 4 per cent. Treatment may be conservative with a ?xed brace, or surgical fusion may be needed if the curve is greater than 45 degrees. Scoliosis can occur as a congenital condition and in neuromuscular diseases where there is muscle imbalance, such as in FRIEDREICH’S ATAXIA.

Kyphosis is a backward curvature of the spine causing a hump back. It may be postural and reversible in obese people and tall adolescent girls who stoop, but it may also be ?xed. Scheuermann’s disease is the term applied to adolescent kyphosis. It is more common in girls. Senile kyphosis occurs in elderly people who probably have osteoporosis (bone weakening) and vertebral collapse.

Disc degeneration is a normal consequence of AGEING. The disc loses its resiliance and becomes unable to withstand pressure. Rupture (prolapse) of the disc may occur with physical stress. The disc between the fourth and ?fth lumbar vertebrae is most commonly involved. The jelly-like central nucleus pulposus is usually pushed out backwards, forcing the annulus ?brosus to put pressure on the nerves as they leave the spinal canal. (See PROLAPSED INTERVERTEBRAL DISC.)

Ankylosing spondylitis is an arthritic disorder of the spine in young adults, mostly men. It is a familial condition which starts with lumbar pain and sti?ness which progresses to involve the whole spine. The discs and ligaments are replaced by ?brous tissue, making the spine rigid. Treatment is physiotherapy and anti-in?ammatory drugs to try to keep the spine supple for as long as possible.

A National Association for Ankylosing Spondylitis has been formed which is open to those with the disease, their families, friends and doctors.

Spondylosis is a term which covers disc degeneration and joint degeneration in the back. OSTEOARTHRITIS is usually implicated. Pain is commonly felt in the neck and lumbar regions and in these areas the joints may become unstable. This may put pressure on the nerves leaving the spinal canal, and in the lumbar region, pain is generally felt in the distribution of the sciatic nerve – down the back of the leg. In the neck the pain may be felt down the arm. Treatment is physiotherapy; often a neck collar or lumbar support helps. Rarely surgery is needed to remove the pressure from the nerves.

Spondylolisthesis means that the spine is shifted forward. This is nearly always in the lower lumbar region and may be familial, or due to degeneration in the joints. Pressure may be put on the cauda equina. The usual complaint is of pain after exercise. Treatment is bed rest in a bad attack with surgery indicated only if there are worrying signs of cord compression.

Spinal stenosis is due to a narrowing of the spinal canal which means that the nerves become squashed together. This causes numbness with pins and needles (paraesthia) in the legs. COMPUTED TOMOGRAPHY and nuclear magnetic resonance imaging scans can show the amount of cord compression. If improving posture does not help, surgical decompression may be needed.

Whiplash injuries occur to the neck, usually as the result of a car accident when the head and neck are thrown backwards and then forwards rapidly. This causes pain and sti?ness in the neck; the arm and shoulder may feel numb. Often a support collar relieves the pain but recovery commonly takes between 18 months to three years.

Transection of the cord occurs usually as a result of trauma when the vertebral column protecting the spinal cord is fractured and becomes unstable. The cord may be concussed or it may have become sheared by the trauma and not recover (transected). Spinal concussion usually recovers after 12 hours. If the cord is transected the patient remains paralysed. (See PARALYSIS.)... spine and spinal cord, diseases and injuries of

A form of anaemia following a deficiency of Vitamin B12. Usually occurs middle life, 45-60.

Symptoms. Skin of yellow tinge, failing eyesight, swollen ankles, feeble heart action, numbness of feet and legs, dyspepsia, tingling in limbs, diarrhoea, red beefy sore tongue, patches of bleeding under skin, unsteadiness and depression.

Treatment. Hospitalisation. Intramuscular injections of Vitamin B12. Herbs known to contain the vitamin – Comfrey, Iceland Moss. Segments of fresh Comfrey root and Garlic passed through a blender produce a puree – good results reported.

Alternatives:– Teas: Milk Thistle, Hops, Wormwood, Betony, White Horehound, Motherwort, Parsley, Nettles, Centuary.

Formula. Combine Centuary 2; Hyssop 1; White Horehound 1; Red Clover flower 1; Liquorice quarter. 1-2 teaspoons to each cup boiling water, infuse 15 minutes. 1 cup thrice daily.

Decoction. Combine Yellow Dock 1; Peruvian bark quarter; Blue Flag root quarter; Sarsaparilla 1; Bogbean half. 1 teaspoon to each cup of water, or 4oz (30 grams) to 1 pint (half litre) water. Simmer gently 10-15 minutes in covered vessel. Dose: Half-1 cup, thrice daily.

Decoction. Combine Yellow Dock 1; Peruvian bark quarter; Blue Flag root quarter; Sarsaparilla 1; Bogbean half. 1 teaspoon to each cup of water, or 4oz (30 grams) to 1 pint (one-half litre) water. Simmer gently 10-15 minutes in covered vessel. Dose: Half-1 cup, thrice daily.

Tablets/capsules. Echinacea, Dandelion, Kelp.

Powders. Formula. Equal parts: Gentian, Balm of Gilead, Yellow Dock. Dose: 500mg (two 00 capsules or one-third teaspoon), thrice daily before meals.

Liquid Extracts. Combine, Echinacea 2; Gentian 1; Dandelion 1; Ginger quarter. Dose: 15-30 drops in water thrice daily.

Gentian decoction. 1 teaspoon dried root to each cup cold water.

Diet. Dandelion coffee. Calves’ liver. Absorption of nutritious food may be poor through stomach’s inability to produce sufficient acid to break down food into its elements. Indicated: 2-3 teaspoons Cider vinegar in water between meals. Contraindicated – vegetarian diet.

Supplements. Vitamin B12, (in absence of injections). Iron – Floradix. Desiccated liver. Vitamin C 1g thrice daily at meals. Folic acid. 400mcg thrice daily. ... anaemia: pernicious

Pain or stiffness in the arm that is often accompanied by pain, tingling and/or numbness of the hands or fingers, and weak hand grip. It may be a symptom of underlying disorders such as frozen shoulder or nerve compression from cervical osteoarthritis.... brachialgia

Stroke, or cerebrovascular accident (CVA), is sudden damage to BRAIN tissue caused either by a lack of blood supply or rupture of a blood vessel (see ISCHAEMIC STROKE). The affected brain cells die and the parts of the body they control or receive sensory messages from cease to function.

Causes Blood supply to the brain may be interrupted by arteries furring up with ATHEROSCLEROSIS (which is accelerated by HYPERTENSION and DIABETES MELLITUS, both of which are associated with a higher incidence of strokes) or being occluded by blood clots arising from distant organs such as infected heart valves or larger clots in the heart (see BLOOD CLOT; THROMBOSIS). Hearts with an irregular rhythm are especially prone to develop clots. Patients with thick or viscous blood, clotting disorders or those with in?amed arteries – for example, in SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) – are particularly in danger of having strokes. Bleeding into the brain arises from areas of weakened blood vessels, many of which may be congenital.

Symptoms Minor episodes due to temporary lack of blood supply and oxygen (called TRANSIENT ISCHAEMIC ATTACKS OR EPISODES (TIA, TIE)) are manifested by short-lived weakness or numbness in an arm or leg and may precede a major stroke. Strokes cause sudden weakness or complete paralysis of the muscles controlled by the part of the brain affected, as well as sensory changes (e.g. numbness or tingling). In the worst cases these symptoms and signs may be accompanied by loss of consciousness. If the stroke affects the area of the brain controlling the larynx and throat, the patient may suffer slurring or loss of speech with di?culty in initiating swallowing. When the face is involved, the mouth may droop and the patient dribble. Strokes caused by haemorrhage may be preceded by headaches. Rarely, CVAs are complicated by epileptic ?ts (see EPILEPSY). If, on the other hand, numerous small clots develop in the brain rather than one major event, this may manifest itself as a gradual deterioration in the patient’s mental function, leading to DEMENTIA.

Investigations Tests on the heart or COMPUTED TOMOGRAPHY or ultrasonic scans (see ULTRASOUND) on arteries in the neck may indicate the original sites of distantly arising clots. Blood tests may show increased thickness or tendency to clotting, and the diagnosis of general medical conditions can explain the presence of in?amed arteries which are prone to block. Special brain X-rays show the position and size of the damaged brain tissue and can usually distinguish between a clot or infarct and a rupture of and haemorrhage from a blood vessel in the brain.

Management It is better to prevent a stroke than try to cure it. The control of a person’s diabetes or high blood pressure will reduce the risk of a stroke. Treatment with ANTICOAGULANTS prevents the formation of clots; regular small doses of aspirin stop platelets clumping together to form plugs in blood vessels. Both treatments reduce the likelihood of minor transient ischaemic episodes proceeding to a major stroke.

Once the latter has occurred, there is no e?ective treatment to reduce the damage to brain tissue. Function will return to the affected part of the body only if and when the brain recovers and messages are again sent down the appropriate nerves. Simple movements are more likely to recover than delicate ones, and sophisticated functions have the worst outlook. Thus, movement of the thigh may improve more easily than ?ne movements of ?ngers, and any speech impairment is more likely to be permanent. A rehabilitation team can help to compensate for any disabilities the subject may have. Physiotherapists maintain muscle tone and joint ?exibility, whilst waiting for power to return; occupational therapists advise about functional problems and supply equipment to help patients overcome their disabilities; and speech therapists help with diffculties in swallowing, improve the clarity of remaining speech or o?er alternative methods of communication. District nurses or home helps can provide support to those caring for victims of stroke at home. Advice about strokes may be obtained from the Stroke Association.... stroke

Selenicereus grandiflorus. Night-blooming cereus. German: Kaktus. French: Cactier. Spanish: Cactus. Italian: Cacto. Dried or fresh flowers.

Constituents: alkaloids, flavonoids.

Action: cardiac stimulant, increasing force of the heart beat. Central nervous system stimulant. Tonic to sympathetic nervous system. Increases size of the heart-beat and reduces its frequency. Not an emergency agent such as Digitalis; requires time for action. Not a depressant.

Uses: Heart weakness with low blood pressure and valvular insufficiency. Rapid pulse with loss of body strength. “Chest held in a vice”. Unstable angina or coronary disease. Numbness of left arm. Relieves difficult breathing or congestion of the lungs of heart causation. As it has no known side-effects it enables heart sufferers to face the world with renewed confidence. Aneurism. Cholesterolised arteries, arteritis (temporal), heart murmur. Sexual neurasthenia, masturbation palpitation. Secondary prophylaxis following myocardial infarction.

Preparations: Thrice daily.

Tea. 2-3 flowers to each cup boiling water; infuse 15 minutes. Dose, one-third to half a cup. Liquid Extract: 1-8 drops.

Combination: Action is enhanced by addition of Motherwort and Oatstraw (equal parts). Tincture of Cereus, BPC 1934: dose 0.12 to 2ml (2-30 drops) in water. ... cactus

A congenital abnormality in which the lowest of the 7 cervical vertebrae (neck bones) has overdeveloped to form an extra rib parallel to and above the 1st normal rib.

Symptoms may occur if the rib begins to press on the lower brachial plexus (the group of nerves passing from the spinal cord into the arm), causing pain, numbness, and pinsand-needles in the forearm and hand.

Exercises to strengthen the shoulder muscles and improve posture may bring relief.

Severe or persistent symptoms may require surgery to remove the rib.... cervical rib

A collection of localized symptoms such numbness, tingling, discomfort, and muscle weakness caused by pressure on a nerve.... compression syndrome

A condition, such as carpal tunnel syndrome, in which local pressure on a nerve causes muscle pain, numbness, and weakness in the area that the nerve supplies.... entrapment neuropathy

Damage to tissues caused by extremely cold temperatures.

Frostbite can affect any part of the body, but the extremities (the nose, ears, fingers, and toes) are most susceptible.

The first symptoms of frostbite are a pins-andneedles sensation, followed by complete numbness.

The skin appears white, cold, and hard and then becomes red and swollen.

If damage is restricted to the skin and immediately underlying tissues, recovery may be complete.

If blood vessels are affected, gangrene may follow.

In such cases, amputation of the affected part may be necessary.... frostbite

Acorus calamus

Araceae

San: Vaca, Ugragandha, Bhadra;

Hin: Bacc, Gorbacc;

Ben: Bach; Mal:Vayampu;

Tam: Vasampu;

Kan: Bajai;

Tel: Vasa Vadaja

Importance: The sweet flag is an important medhya drug, capable of improving memory power and intellect. It is used in vitiated conditions of vata and kapha, stomatopathy, hoarseness, colic, flatulence, dyspepsia, helminthiasis, amenorrhoea, dismenorrhoea, nephropathy, calculi, strangury, cough, bronchitis, odontalgia, pectoralgia, hepatodynia, otalgia, inflammations, gout, epilepsy, delirium, amentia, convulsions, depression and other mental disorders, tumours, dysentery, hyperdipsia, haemorrhoids, intermittent fevers, skin diseases, numbness and general debility. It is reportedly useful in improving digestion, clearing speech and curing diarrhoea, dysentery, abdominal obstruction and colic. It is also useful in infantile fever, cough bronchitis and asthma. The drug is reported to cure hysteria, insanity and chronic rheumatic complaints. The rhizome is an ingredient of preparations like Vacaditaila, Ayaskrti, Kompancadi gulika, Valiya rasnadi kashaya, etc.

Distribution: The plant is a native of Europe. It is distributed throughout the tropics and subtropics, especially in India and Sri Lanka. It is found in marshes, wild or cultivated, ascending the Himalayas upto 1800m in Sikkim. It is plentiful in marshy tracts of Kashmir and Sirmoor, in Manipur and Naga Hills.

Botany: Acorus calamus Linn. belonging to the family Araceae is a semi -aquatic rhizomatous perennial herb. Rhizome is creeping, much branched, cylindrical or slightly compressed, light brown or pinkish brown externally, white and spongy within. Leaves are bright green, distichous, ensiform, base equitant, thickened in the middle and with wavy margins. Flowers are light brown and densely packed in sessile cylindric spadix. Fruits are oblong, turbinate berries with a pyramidal top. Seeds are few and pendant from the apex of the cells (Warrier et al, 1993).

Another species belonging to the genus Acorus is A. gramineus Soland, the roots of which are used in tonic, antiseptics and insecticidal preparations (Chopra et al, 1956).

Agrotechnology: Acorus is a hardy plant found growing from tropical to subtropical climates. It needs a good and well distributed rainfall throughout the year. It needs ample sunlight during the growth period as well as after harvest for drying the rhizomes. It may be cultivated in any good but fairly moist soil. It is usually grown in areas where paddy can be grown. It comes up well in clayey soils and light alluvial soils of river bank. The field is laid out and prepared exactly as for rice, irrigated sufficiently and after ploughing twice, watered heavily and again ploughed in the puddle. Sprouted rhizome pieces are used for planting and pressed into the mud at a depth of about 5cm at a spacing of 30x30cm. The rhizomes are planted in such a way that the plants in the second row comes in between the plants of the first row and not opposite to them. FYM is to be applied at 25t/ha. Fertilisers are applied at 25:50:60 kg N:P2O5:K2O/ha/yr. Whole of FYM and 1/3 of N, P2O5 and K2O are to be added in the field during March - April as a basal dose. The remaining 2/3 of nutrients is to be given in two equal split doses at 4 months and 8 months after planting. The field is to be regularly irrigated. About 5 cm of standing water is to be maintained in the field in the beginning. Later, it is to be increased to 10 cm as the plant grows. The field is to be regularly weeded. About 8 weedings are to be carried out in all. At each weeding the plants are pressed into the soil. The plant is attacked by mealy bugs. Both shoot and root mealy bugs can be controlled by spraying the shoot and drenching the roots of grown up plants with 10 ml Methyl parathion or 15ml Oxydemeton methyl or 20ml Quinalphos in 10 litres of water. The crop is ready for harvest at the end of first year. The field is to be dried partially so that sufficient moisture is left in the soil to facilitate deep digging. The leaves start turning yellow and dry, indicating maturity. The rhizome will be at a depth of 60cm and having about 30-60cm spread. Therefore, harvesting is to be done carefully. The rhizomes are to be cut into 5-7.5cm long pieces and all the fibrous roots are to be removed. Yield of rhizome is about 10t/ha (Farooqi et al, 1991).

Properties and Activity:Rhizomes, roots and leaves yield essential oil. The important constituents of the Indian oil are asarone and its -isomer. Other constituents are and -pinene, myrcene, camphene, p-cymene, camphor and linalool, sesquiterpenic ketones like asarone, calamone, calacone, acolamone, iso-acolamone, acoragermacrone, epishyobunone, shyobunone and iso- shyobunone. Alcohol present is preisocalamendiol. Sesquiterpene hydrocarbons like elemene, elemane and calarene are also present. Tricyclic sesquiterpenes present are caryophyllene, humulene, guaiene, S-guaizulene, arcurcumene, -cadinene, cadinane, calamenene, calacorene, dihydrocalacorene(calamenene), cadalene and selinene. Roots yield acoric acid as a main constituent in addition to choline. Plant also yields a flavone diglycoside- luteolin 6,8-C-diglucoside.

-asarone is the ma jor constituent of essential oil from rhizome (Dandiya et al, 1958,1959; Raquibuddoula, 1967).

Rhizome is insecticidal, pisicidal, spasmolytic, hypothermic, CNS active and analgesic. Essential oil is anticonvulsant. Rhizome is acrid, bitter, thermogenic, aromatic, intellect promoting, emetic, laxative, carminative, stomachic, anthelmintic, emmenagogue, diuretic, alexeteric, expectorant, anodyne, antispasmodic, aphrodisiac, antiinflammatory, sudorific, antipyretic, sialagogue, insecticidal, tranquillizer, sedative, analgesic, antithermic, antiasthmatic, hypotensive, respiratory depressant, aperitive and tonic.... sweet flag

A popular term for the small area at the back of the elbow where the ulnar nerve passes over a prominence of the humerus (upper-arm bone). A blow to the nerve causes acute pain, numbness, and a tingling sensation in the forearm and hand.... funny-bone

Pain and numbness in the hand and arm due to prolonged use of vibrating tools. Symptoms often also include blue or white coloration of the fingers and a tingling sensation in affected areas. Hand–arm vibration syndrome tends to develop slowly over years and is the result of repeated damage to blood vessels and nerves. Exposure to cold tends to aggravate the condition. There is no specific treatment, but avoiding vibrating tools is essential to prevent the disease progressing. In some cases, calcium channel blockers may help relieve some symptoms.... hand–arm vibration syndrome

Abnormally deep or rapid breathing that is usually caused by anxiety. Hyperventilation may also occur as a result of uncontrolled diabetes mellitus, oxygen deficiency, kidney failure, and some lung disorders.

Hyperventilation causes an abnormal loss of carbon dioxide from the blood, which can lead to an increase in blood alkalinity. Symptoms include numbness of the extremities, faintness, tetany, and a sensation of not being able to take a full breath. Breathing into a paper bag may help to reduce the symptoms in people with anxiety.... hyperventilation

The sense that enables an individual to assess the physical characteristics of objects – for example, their size, shape, temperature and texture. The sense of touch is considered here along with other senses associated with the skin and muscles. The cutaneous senses comprise:

Touch sense proper, by which we perceive a touch or stroke and estimate the size and shape of bodies with which we come into contact, but which we do not see.

Pressure sense, by which we judge the heaviness of weights laid upon the skin, or appreciate the hardness of objects by pressing against them.

Heat sense, by which we perceive that an object is warmer than the skin.

Cold sense, by which we perceive that an object touching the skin is cold.

Pain sense, by which we appreciate pricks, pinches and other painful impressions.

Muscular sensitiveness, by which the painfulness of a squeeze is perceived. It is produced probably by direct pressure upon the nerve-?bres in the muscles.

Muscular sense, by which we test the weight of an object held in the hand, or gauge the amount of energy expended on an e?ort.

Sense of locality, by which we can, without looking, tell the position and attitude of any part of the body.

Common sensation, which is a vague term used to mean composite sensations produced by several of the foregoing, like tickling, or creeping, and the vague sense of well-being or the reverse that the mind receives from internal organs. (See the entry on PAIN.)

The structure of the end-organs situated in the skin, which receive impressions from the outer world, and of the nerve-?bres which conduct these impressions to the central nervous system, have been described under NERVOUS SYSTEM. (See also SKIN.)

Touch affects the Meissner’s or touch corpuscles placed beneath the epidermis; as these di?er in closeness in di?erent parts of the skin, the delicacy of the sense of touch varies greatly. Thus the points of a pair of compasses can be felt as two on the tip of the tongue when separated by only 1 mm; on the tips of the ?ngers they must be separated to twice that distance, whilst on the arm or leg they cannot be felt as two points unless separated by over 25 mm, and on the back they must be separated by more than 50 mm. On the parts covered by hair, the nerves ending around the roots of the hairs also take up impressions of touch.

Pressure is estimated probably through the same nerve-endings and nerves that have to do with touch, but it depends upon a di?erence in the sensations of parts pressed on and those of surrounding parts. Heat-sense, cold-sense and pain-sense all depend upon di?erent nerve-endings in the skin; by using various tests, the skin may be mapped out into a mosaic of little areas where the di?erent kinds of impressions are registered. Whilst the tongue and ?nger-tips are the parts most sensitive to touch, they are comparatively insensitive to heat, and can easily bear temperatures which the cheek or elbow could not tolerate. The muscular sense depends upon the sensory organs known as muscle-spindles, which are scattered through the substance of the muscles, and the sense of locality is dependent partly upon these and partly upon the nerves which end in tendons, ligaments and joints.

Disorders of the sense of touch occur in various diseases. HYPERAESTHESIA is a condition in which there is excessive sensitiveness to any stimulus, such as touch. When this reaches the stage when a mere touch or gentle handling causes acute pain, it is known as hyperalgesia. It is found in various diseases of the SPINAL CORD immediately above the level of the disease, combined often with loss of sensation below the diseased part. It is also present in NEURALGIA, the skin of the neuralgic area becoming excessively tender to touch, heat or cold. Heightened sensibility to temperature is a common symptom of NEURITIS. ANAESTHESIA, or diminution of the sense of touch, causing often a feeling of numbness, is present in many diseases affecting the nerves of sensation or their continuations up the posterior part of the spinal cord. The condition of dissociated analgesia, in which a touch is quite well felt, although there is complete insensibility to pain, is present in the disease of the spinal cord known as SYRINGOMYELIA, and a?ords a proof that the nerve-?bres for pain and those for touch are quite separate. In tabes dorsalis (see SYPHILIS) there is sometimes loss of the sense of touch on feet or arms; but in other cases of this disease there is no loss of the sense of touch, although there is a complete loss of the sense of locality in the lower limbs, thus proving that these two senses are quite distinct. PARAESTHESIAE are abnormal sensations such as creeping, tingling, pricking or hot ?ushes.... touch

Compression of the median nerve between the transverse carpal ligament and the carpal bone. May cause damage to the sensory and motor nerves and manifest as teno-synovitis or ganglion. Affects chiefly middle-aged women.

Symptoms. Numbness or tingling in first three fingers which feel ‘clumsy’. Worse at night. Muscle wasting of palm of the hand.

Diagnostic sign: the ‘flick’ sign – shaking or ‘flicking’ of the wrist when pain is worse and which is believed to mechanically untether the nerve and promote return of venous blood. (J. Neural Neurosurgery and Psychiatry, 1984, 47, 873)

Differential diagnosis: compression of seventh cervical spinal nerve root (osteopathic lesion) has tingling of the hands when standing or from exaggerated neck movements.

Treatment. Reduction of spasm with peripheral relaxants (antispasmodics). Also: local injection of corticosteroid or surgical division of the transverse carpal ligament.

Alternatives:– Tea. Equal parts. Chamomile, Hops, Valerian. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 2-3 times daily.

Tablets/capsules. Cramp bark. St John’s Wort. Wild Yam. Lobelia. Prickly Ash. Passion flower. Black Cohosh. Hawthorn.

Powders. Formula. Cramp bark 1; Guaiacum half; Black Cohosh half; Pinch Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Bromelain, quarter to half a teaspoon between meals.

Turmeric. Quarter to half a teaspoon between meals.

Tinctures. Formula: Cramp bark 1; Lobelia half; Black Cohosh half. Few drops Tincture Capsicum. Mix. 1 teaspoon in water when necessary. To reduce blood pressure, add half part Mistletoe.

Practitioner. For pain. Tincture Gelsemium BPC 1963 5-15 drops when necessary.

Topical. Rhus tox ointment. Camphorated oil.

Lotion: Tincture Lobelia 20; Tincture Capsicum 1.

Supplements. Condition responsive to Vitamin B6 and B-complex. Some authorities conclude that CTS is a primary deficiency of Vitamin B6, dose: 50-200mg daily.

General. Yoga, to control pain. Attention to kidneys. Diuretics may be required. Cold packs or packet of peas from the refrigerator to site of pain for 15 minutes daily. ... carpal tunnel syndrome (cts)

Paralysis of the lower arm, with wasting of the small muscles in the hand, and numbness of the fingers (excluding the thumb) and of the inside of the forearm.

Klumpke’s paralysis is caused by injury to the 1st thoracic nerve (one of the spinal nerves) in the brachial plexus, which is usually the result of dislocation of the shoulder.... klumpke’s paralysis

Oenothera biennis L. German: Echte Nachtkerze. French: Onagre. Italian: Stella di sera. Keynote: Prostaglandin precursor. Unrefined oil is expressed from the seeds that yield gamma linolenic acid and an essential fatty acid. Whole plant is edible.

Action. Anticoagulant, nutritive, demulcent, anti-eczema. Reduces blood clotting time, which is of value for thrombosis. A precursor of Prostaglandin E1 which inhibits abnormal cell proliferation and reduces blood pressure. Reduces serum cholesterol levels. Externally: to protect moisture balance of the skin.

Use s. Stops platelet-clumping. Dilates coronary arteries and removes obstructions. Intermittent claudication. Raynaud’s disease. Said to slow down the progress of multiple sclerosis. Pre-menstrual tension and breast pain. Said to arrest rheumatoid arthritis in moderate cases. Prevention of liver damage. Dry scaly skin disorders; eczema, acne (with zinc). Soft brittle finger nails. Abnormal tear production. Hyperactive children. Mental depression. Diabetic retinitis. To allay the ageing process. Alleviates hangovers. Alcohol habit. Pruritus. Combined with Vitamin E which acts as a protective antioxidant. Trials have shown that the oil has significantly improved sensory function: muscle weakness, arm tendon reflex and numbness – which signs may be reversed in diabetes.

Preparations: “Efamol” 500: comprising 500mg Evening Primrose oil; 10mg natural Vitamin E. 4-6 capsules daily depending on requirement, for 6-8 weeks.

To maintain EFA and GLA levels. “Efamol” 250: comprising 250mg Evening Primrose oil; 200mg Safflower oil; 50mg Linseed oil; 10mg Vitamin E. 3-4 capsules daily, regularly.

Vitamins B6 and C; and minerals Magnesium and Zinc assist its action. Features in a wide range of cosmetic products as a moisturiser.

Poultice: leaves and flowers for abscesses, boils, etc.

Not given in epilepsy. ... evening primrose

Leprosy. Progressive infection by Mycobacterium leprae. Two forms: (1) tuberculoid; infection of the nerve endings and membranes of the nose, with loss of feeling and pale patches on the body. (2) Lepromatous; with inflamed thickened painful red skin exacerbated by ulceration, fever, neuritis and orchitis. Distorted lips and loss of nasal bone as infection progresses.

Symptoms: numbness, nerves may swell like iron rods. Infected nerves kill all sensation. In endemic areas, pins and needles in hands may call attention to it. A disease of nerves rather than skin. NOTIFIABLE DISEASE.

Many laymen and practitioners will never have seen a case. In the absence of modern medicine some good can be achieved by traditional remedies. Ancient Hindu and Chinese records refer to the use of Gotu Kola (internally and externally). Dr C.D. de Granpre? (1888) refers. (Martindale 27; p.441)

Oil of Chaulmoogra was used up to one hundred years ago before introduction of modern drugs. It fell into dis-use until discovered by a Director of Health in the Philippine Islands during World War I when he used it successfully in combination with camphor. In South America, where the disease is still active, Sarsaparilla has a long traditional reputation. Walnut oil is used as a dressing, in China. An anti- staphylococcal fraction has been isolated from the seeds of Psoralea corylifolia for use in leprosy. (Indian Journal of Pharmacy 26: 141, 1964)

Tea. Gotu Kola. Half a teaspoon to each cup boiling water; infuse 15 minutes. Drink freely. Stronger infusions may be used externally to cleanse ulceration.

Decoction. Combine: Sarsaparilla 1; Gotu Kola 1; Echinacea 2. Half an ounce to 1 pint water gently simmered 20 minutes. Dose: Half a cup 3 times daily.

Formula. Echinacea 2; Sarsaparilla 1; Gotu Kola 2. Dose. Powders 500mg. Liquid Extracts 3-5ml. Tinctures 5-10ml. Thrice daily.

Note: Antibody-positive cases of AIDS are vulnerable to leprosy, both diseases being caused by a similar bacterium.

To be treated by infectious diseases specialist. ... hansen’s disease

An illness characterized by habitual, compulsive, longterm, heavy consumption of alcohol and the development of withdrawal symptoms when drinking is suddenly stopped.

Three causative factors interact in the development of the illness: personality, environment, and the addictive nature of alcohol. Inadequate, insecure, or immature personalities are more at risk. Environmental factors are important, especially the ready availability, affordability, and social acceptance of alcohol. Genetic factors may play a part in causing dependence in some cases, but it is now widely believed that anyone, irrespective of personality, environment, or genetic background, can become an alcoholic. Stress is often a major factor in precipitating heavy drinking.

Alcohol dependence usually develops in 4 main stages that occur over a number of years. In the 1st phase, tolerance to alcohol develops in the heavy social drinker. In the 2nd phase, the drinker experiences memory lapses relating to events during the drinking episodes. In the 3rd phase, there is loss of control over alcohol consumption. The final phase is characterized by prolonged binges of intoxication and mental or physical complications.

Behavioural symptoms are varied and can include furtive, aggressive, or grandiose behaviour; personality changes (such as irritability, jealousy, or uncontrolled anger); neglect of food intake and personal appearance; and lengthy periods of intoxication.

Physical symptoms may include nausea, vomiting, or shaking in the morning; abdominal pain; cramps; numbness or tingling; weakness in the legs and hands; irregular pulse; enlarged blood vessels in the face; unsteadiness; confusion; memory lapses; and incontinence. After sudden withdrawal from alcohol, delirium tremens may occur.

Alcohol-dependent persons are more susceptible than others to a variety of physical and mental disorders (see alcohol-related disorders).

Many alcoholics require detoxification followed by long-term treatment. Different methods of treatment may be combined. Psychological treatments involve psychotherapy and are commonly carried out as group therapy. Social treatments may offer practical help and tend to include family members in the process. Physical treatment generally includes the use of disulfiram, a drug that sensitizes the drinker to alcohol so that he or she experiences unpleasant side effects when drinking. Alcoholics Anonymous and other self-help organizations can provide support and advice.... alcohol dependence

One of the main nerves of the arm. It is a branch of the brachial plexus and runs down the arm from the shoulder into the hand. The median nerve controls the muscles that carry out bending movements of the wrist, fingers, and thumb, and that rotate the forearm palm-inwards. The nerve also conveys sensations from the thumb and first 3 fingers, and from the region of the palm at their base.

Damage to the nerve may result from injury to the shoulder, a Colles’ fracture just above the wrist, or pressure on the nerve where it passes through the wrist (carpal tunnel syndrome).

Symptoms of damage include numbness and weakness in areas controlled by the nerve.... median nerve

A wide variety of physical and mental disorders associated with heavy, prolonged consumption of alcohol.

High alcohol consumption increases the risk of cancers of the mouth, tongue, pharynx (throat), larynx (voice box), and oesophagus, especially if combined with smoking. Incidence of liver cancer, as well as the liver diseases alcoholic hepatitis and cirrhosis, is higher among alcoholics. High alcohol consumption increases the risk of cardiomyopathy, hypertension, and stroke. Alcohol irritates the digestive tract and may cause gastritis. Heavy drinking in pregnancy increases the risk of miscarriage and fetal alcohol syndrome. Alcoholics are more likely to suffer from anxiety and depression and to develop dementia.

Many alcoholics have a poor diet and are prone to diseases caused by nutritional deficiency, particularly of thiamine (see vitamin B complex). Severe thiamine deficiency, called beriberi, disturbs nerve function, causing cramps, numbness, and weakness in the legs and hands. Its effects on the brain can cause confusion, disturbances of speech and gait, and eventual coma (see Wernicke– Korsakoff syndrome). Severe thiamine deficiency can also cause heart failure.

A prolonged high level of alcohol in the blood and tissues can disturb body chemistry, resulting in hypoglycaemia (reduced glucose in the blood) and hyperlipidaemia (increased fat in the blood).

These may damage the heart, liver, blood vessels, and brain; irreversible damage may cause premature death.... alcohol-related disorders

An important type of anaemia caused by a deficiency of vitamin B12 or another vitamin, folic acid. Either of these deficiencies seriously interferes with production of red blood cells in the bone marrow. An excess of cells called megaloblasts appears in the marrow. Megaloblasts give rise to enlarged and deformed red blood cells known as macrocytes.

Vitamin B12 is found only in foods of animal origin, such as meat and dairy products. It is absorbed from the small intestine after first combining with intrinsic factor, a chemical produced by the stomach lining. The most common cause of vitamin B12 deficiency is failure of the stomach lining to produce intrinsic factor, usually due to an autoimmune disorder; this is called pernicious anaemia. Total gastrectomy (removal of the stomach) prevents production of intrinsic factor, and removal of part of the small intestine prevents B12 absorption, as does the intestinal disorder Crohn’s disease. In a minority of cases, vitamin B12 deficiency is due to a vegan diet.

Folic acid is found mainly in green vegetables and liver. The usual cause of deficiency is a poor diet. Deficiency can also be caused by anything that interferes with the absorption of folic acid from the small intestine (for example Crohn’s disease or coeliac disease). Folic acid requirements are greater than normal in pregnancy.

Many people with mild megaloblastic anaemia have no symptoms. Others may experience tiredness, headaches, a sore mouth and tongue, and mild jaundice. If B12 deficiency continues for a long time, additional symptoms due to nerve damage, including numbness and tingling in the feet, may develop.

Megaloblastic anaemia is diagnosed by blood tests and a bone marrow biopsy. Megaloblastic anaemia due to poor diet can be remedied with a short course of vitamin B12 injections or folic acid tablets and the introduction of a normal diet. A lifelong course of vitamin B12 injections or folic acid tablets is required if the underlying cause of malabsorption is untreatable.... anaemia, megaloblastic

Inflammation of an artery wall, causing narrowing or complete blockage of the affected artery, reduced blood flow, and, in some cases, thrombosis and tissue damage. There are several types, including Buerger’s disease, an arteritis that affects the limbs, causing pain, numbness, and, in severe cases, gangrene.

Polyarteritis nodosa, a serious autoimmune disorder, can affect arteries in any part of the body, especially the heart and kidneys.

Temporal arteritis affects arteries in the scalp and may affect the eyes.

A rare type of arteritis is Takayasu’s arteritis, which is thought to be an autoimmune disorder.

This usually affects young women and involves the arteries that branch from the aorta into the neck and arms.... arteritis

A peculiar “warning” sensation that precedes or marks the onset of a migraine attack or of a seizure in epilepsy.

A migraine attack may be preceded by a feeling of elation, excessive energy, or drowsiness.

Thirst or a craving for sweet foods may develop.

Migraine may be heralded by flashing light before the eyes, blurred or tunnel vision, or difficulty in speaking.

There may also be weakness, numbness, or tingling in 1 half of the body.

An epileptic aura may be a distorted perception, such as a hallucinatory smell or sound.

One type of attack (in people with temporal lobe epilepsy) is often preceded by a vague feeling of discomfort in the upper abdomen and followed by a sensation of fullness in the head.... aura

n. a *carbonic anhydrase inhibitor used mainly in the treatment of glaucoma to reduce the pressure inside the eyeball and also as a preventative for epileptic seizures and altitude sickness. Side-effects include drowsiness and numbness and tingling of the hands and feet.... acetazolamide

n. an inflammatory process causing thickening and scarring (fibrosis) of the membranous linings (*meninges) of the spinal canal. The resulting entrapment of nerve roots may result in weakness, pain, and numbness in the affected area. The condition may result from infection or inflammation of the meninges, surgery, or as a response to the oil-based dyes previously used in *myelography. The reaction to myelography is prevented by the current use of water-soluble dyes.... arachnoiditis

bleeding from a cerebral blood vessel into the tissue of the brain. It is commonly caused by degenerative disease of the arteries and high blood pressure but it may result from bleeding from congenital abnormalities of blood vessels. The extent and severity of the symptoms depend upon the site and volume of the haemorrhage; they vary from a transient weakness or numbness to profound coma and death. See also atheroma; hypertension; stroke.... cerebral haemorrhage

The emotional reaction following the death of a loved relative or friend. The expression of grief is individual to each person, but there are recognized stages of bereavement, each characterized by a particular attitude. In the first stage, which may last from 3 days to 3 months, there is numbness and an unwillingness to recognize the death. Hallucinations, in which the dead person is seen, are a common experience. Once the numbness wears off, the person may be overwhelmed by feelings of anxiety, anger, and despair that can develop into a depressive illness (see depression).

Insomnia, malaise, agitation, and tearfulness are also common. Gradually, but usually within 2 years, the bereaved person adjusts to the loss.

Family and friends can often provide support. Outside help may be required and may be given by a social worker, health visitor, member of the clergy, or self-help group. For some people, when depression, apathy, and lethargy impede any chance of recovery, specialized counselling or psychotherapy is necessary. (See also stillbirth.)... bereavement

A nutritional disorder resulting from a lack of thiamine (vitamin B1) in the diet. Without thiamine, the brain, nerves, and muscles (including the heart muscle) are unable to function properly. In developed countries, the illness is seen only in people who are starving or on an extremely restricted diet, such as alcoholics. There are 2 forms of the illness. In dry beriberi, thiamine deficiency mainly affects the nerves and skeletal muscles. Symptoms include numbness, a burning sensation in the legs, and muscle wasting. In severe cases, the patient becomes virtually paralysed, emaciated, and bedridden. In wet beriberi, the main problem is heart failure, which leads to oedema (swelling caused by fluid accumulation) in the legs, and sometimes also in the trunk and face. Other symptoms of wet beriberi include poor appetite, rapid pulse, and breathlessness.

Beriberi is treated with thiamine, given orally or by injection.... beriberi

Any of the main arteries of the neck and head. There are 2 common carotid arteries (left and right), each of which divides into 2 main branches (internal and external).

The left carotid arises from the aorta and runs up the neck on the left side of the trachea (windpipe). The right carotid arises from the subclavian artery (which branches off the aorta) and follows a similar route on the right side of the

neck. Just above the level of the larynx (voice-box), each carotid artery divides to form an external carotid artery and an internal carotid artery. The external arteries have multiple branches that supply most tissues in the face, scalp, mouth, and jaws; the internal arteries enter the skull to supply the brain and eyes. At the base of the brain, branches of the 2 internal carotids and the basilar artery join to form a ring of vessels called the circle of Willis. Narrowing of these vessels may be associated with transient ischaemic attack (TIA); obstruction of them causes a stroke. carpal tunnel syndrome Numbness, tingling, and pain in the thumb, index finger, and middle fingers caused by compression of the median nerve at the wrist. Symptoms may be worse at night. The condition results from pressure on the nerve where it passes into the hand via a gap (the “carpal tunnel’’) under a ligament at the front of the wrist. It is common among keyboard users. It also occurs without obvious cause in middleaged women, and is associated with pregnancy, initial use of oral contraceptives, premenstrual syndrome, rheumatoid arthritis, myxoedema, and acromegaly.

The condition often disappears without treatment.

Persistent symptoms may be treated with a corticosteroid drug injected under the ligament, or the ligament may be cut to relieve pressure on the nerve.... carotid artery

A degenerative disorder, also known as cervical spondylitis, that affects the joints between the cervical vertebrae (bones in the neck). Cervical osteoarthritis mainly affects middle-aged and elderly people, but occasionally the degeneration begins earlier due to an injury.

Symptoms of cervical osteoarthritis may include pain and stiffness in the neck, pain in the arms and shoulders, numbness and tingling in the hands, and a weak grip. Other symptoms such as dizziness, unsteadiness, and double vision when turning the head may also occur. Rarely, pressure on the spinal cord can cause weakness or paralysis in the legs and loss of bladder control.

Treatments include heat treatment and analgesics.

Physiotherapy may improve neck posture and movement.

Pressure on the spinal cord may be relieved by surgery (see decompression, spinal canal).... cervical osteoarthritis

progressive damage to the peripheral nerves seen in some people with long-standing diabetes. It most commonly affects the legs, causing pain or numbness working up from the feet. There is no cure but drugs can sometimes be used to control the discomfort experienced, and good blood glucose control may prevent deterioration over time. See also diabetic holiday foot syndrome.... diabetic neuropathy

n. a disorder characterized by pain in the fibrous tissue components of muscles without any inflammation (compare fibromyositis). Widespread aching and stiffness with specific tender points are accompanied by extreme fatigue and often associated with headache, numbness and tingling, and various other symptoms. Fibromyalgia is frequently triggered by anxiety, stress, sleep deprivation, and straining or overuse of muscles; it appears to be closely related to *CFS/ME/PVF.... fibromyalgia

n. no longer having some valued aspect of one’s life, such as a relationship, a job, or a home, that one has previously enjoyed. This may have health consequences: shock, disbelief, and emotional numbness may be followed by anger, guilt, anxiety, or profound sadness. Such emotions may lead to behavioural changes or symptoms that bring people to health care. Encouraging the patient to talk about the loss will require *empathy, sensitivity, and *judgment from the professional, both to obtain the history of the events and to provide helpful advice and direction to assist in adjustment. See also bereavement.... loss

painful tingling and numbness felt over the lateral surface of the thigh when the lateral cutaneous nerve is trapped as it passes through the fibrous and muscular tissues of the groin. It is usually found in pregnant women.... meralgia paraesthetica

Also called myelomatosis, multiple myeloma is a rare, cancerous condition in which plasma cells in the bone marrow proliferate uncontrollably and function incorrectly. It occurs in middle- to old age.

Plasma cells are a type of B-lymphocyte that produce immunoglobulins, which help protect against infection. In multiple myeloma, the proliferating plasma cells produce excessive amounts of one type of immunoglobulin, while production of other types is impaired. This makes infection more likely.Proliferation of the abnormal cells causes pain and destroys bone tissue.

Affected vertebrae may collapse and compress nerves, causing numbness or paralysis. Blood calcium levels increase as bone is destroyed, as may the level of one or more immunoglobulins. These changes in the blood may damage the kidneys, leading to kidney failure. There may also be anaemia and a tendency for abnormal bleeding.

The disease is diagnosed by a bone marrow biopsy, by blood tests or urinalysis, and by X-rays. Treatment includes the use of anticancer drugs, radiotherapy, and supportive measures, including blood transfusions, antibiotic drugs, and analgesic drugs.... multiple myeloma

A progressive disease of the central nervous system in which patches of myelin in the brain and spinal cord are destroyed. Multiple sclerosis (or ) is an autoimmune disorder, in which the immune system attacks the myelin sheath that covers some nerves in the brain and spinal cord. Affected nerves cannot conduct nerve impulses, so functions such as movement and sensation may be lost. Any area of the body can be affected. Symptoms range from numbness and tingling to paralysis and incontinence.

Attacks of symptoms are followed by a variable period of remission, in which dramatic improvements may be made.

Women are more likely to develop than men, and there may be a genetic factor, as the disease sometimes runs in families. There may also be an environmental factor, as is more common in temperate zones than in the tropics.

Symptoms usually develop early in adulthood. Spinal cord damage may cause tingling, numbness, weakness in the extremities, spasticity, paralysis, and incontinence. Damage to white matter (myelinated nerves) in the brain may cause fatigue, vertigo, clumsiness, muscle weakness, slurred speech, blurred vision, numbness, weakness, or facial pain.

Attacks may last several months. After a variable remission period, a relapse occurs, which may be precipitated by injury, infection, or stress. Some people have mild relapses and long periods of remission, with few permanent effects. Some people become gradually more disabled from the first attack. A few suffer gross disability within the 1st year.

There is no single diagnostic test, but MRI may show damage to white matter in the brain. Evoked response tests on the eyes also provide strong evidence.

There is no specific treatment.

Some people claim that dietary modifications such as sunflower or evening primrose oils are beneficial.

In some cases, interferon beta can extend the time between attacks and reduce the rate of decline.... multiple sclerosis

Compression or stretching of a nerve, causing numbness, tingling, weakness, and, sometimes, pain. Common examples of a trapped nerve include carpal tunnel syndrome, in which pressure on the median nerve as it passes through the wrist causes symptoms in the thumb, index, and middle fingers; a disc prolapse, in which pressure on the nerve root leading from the spinal cord produces symptoms in the back and legs; and crutch palsy, in which the radial nerve presses against the humerus (upper-arm bone), producing symptoms in the wrist and hand.

A damaged nerve may take some time to heal. In severe cases, surgical decompression to relieve pressure on the nerve may be necessary.... nerve, trapped

The body system that gathers and stores information and is in overall control of the body.

The brain and spinal cord form the central nervous system (CNS), which consists of billions of interconnected neurons (nerve cells). Input of information to the CNS comes from the sense organs. Motor instructions are sent out to skeletal muscles, the muscles controlling speech, internal organs and glands, and the sweat glands in the skin. This information is carried along nerves that fan out from the CNS to the entire body. Each nerve is a bundle consisting of the axons (filamentous projections) of many individual neurons.

In addition to the nervous system’s anatomical divisions, there are various functional divisions. Two of the most important are the autonomic nervous system, concerned with the automatic (unconscious) regulation of internal body functioning, and the somatic nervous system, which controls the muscles responsible for voluntary movement.

The overall function of the nervous system is to gather and analyse information about the external environment and the body’s internal state, and to initiate appropriate responses, such as avoiding physical danger.

The nervous system functions largely through automatic responses to stimuli (see reflex), although voluntary actions can also be initiated through the activity of higher, conscious areas of the brain.

Disorders of the nervous system may result from damage to or dysfunction of its component parts (see brain; spinal cord; neuropathy; nerve injury). They may also be due to impairment of sensory, analytical, or memory functions (see vision, disorders of; deafness; numbness; anosmia; agnosia; amnesia), or of motor functions (see aphasia; dysarthria; ataxia). ... nervous system

a form of mercury poisoning (from ingesting methyl mercury in contaminated fish) that caused 43 deaths in the Japanese coastal town of Minamata during 1953–56. The source of mercury was traced to an effluent containing mercuric sulphate from a local PVC factory. Symptoms include numbness, difficulty in controlling the limbs, and impaired speech and hearing.... minamata disease

n. 1. an inflammatory disease of the spinal cord. The most usual kind (transverse myelitis) most often occurs during the development of multiple sclerosis, but it is sometimes a manifestation of *encephalomyelitis, when it can occur as an isolated attack. The inflammation spreads more or less completely across the tissue of the spinal cord, resulting in a loss of its normal function to transmit nerve impulses up and down. It is as though the spinal cord had been severed: paralysis and numbness affects the legs and trunk below the level of the diseased tissue. 2. inflammation of the bone marrow. See osteomyelitis.... myelitis

A rare disease of unknown cause in which there is inflammation of tissues throughout the body, especially the lymph nodes, lungs, skin, eyes, and liver. It occurs mainly in young adults.

Symptoms do not always occur, but when they do, they include fever, generalized aches, painful joints, and painful, bloodshot eyes. Sarcoidosis may also cause enlargement of the lymph nodes, breathlessness, erythema nodosum, a purplish facial rash, and areas of numbness. Possible complications include hypercalcaemia, which may damage the kidneys, and pulmonary fibrosis.

Treatment of sarcoidosis is not always needed.

Most people recover completely within 2 years, with or without treatment, but some develop a persistent, chronic form of the disease.

Corticosteroids are given to treat persistent fever or erythema nodosum, to prevent blindness in an affected eye, and to reduce the risk of lung damage.... sarcoidosis

Dulled, unpleasant, or otherwise altered sensations in the absence of an obvious stimulus.

Numbness and pins-and-needles are common abnormal sensations. The special senses can be impaired by damage to the relevant sensory apparatus (see vision, disorders of; smell; deafness; tinnitus). Other causes of abnormal sensation include peripheral nerve damage caused by diabetes mellitus, herpes zoster infection, or pressure from a tumour, and disruption of nerve pathways in the brain or spinal cord due to spinal injury, head injury, stroke, and multiple sclerosis.

Pressure on or damage to nerves can sometimes be relieved by surgery or by treatments for the cause.

In other cases, distressing abnormal sensation can be relieved only by cutting the relevant nerve fibres or by giving injections to block the transmission of signals.... sensation, abnormal

n. temporary loss of nerve function resulting in tingling, numbness, and weakness. It is usually caused by compression of the nerve and there is no structural damage involved. Complete recovery occurs. Compare axonotmesis; neurotmesis.... neurapraxia

(Devic’s disease) a condition that resembles multiple sclerosis. The diagnosis is confirmed by the finding of the antiaquaparin-4 antibody (NMO IgG antibody). Typically there is a transverse *myelitis, producing paralysis and numbness of the legs and trunk below the inflamed spinal cord, and *retrobulbar (optic) neuritis affecting both optic nerves. The attacks of myelitis and optic neuritis may coincide or they may be separated by days or weeks. Recovery from the initial attack is often incomplete and severe relapses occur commonly unless treatment with immunosuppressive therapies is started.... neuromyelitis optica

(hand–foot syndrome) a skin reaction marked by redness, numbness, and desquamation of the palms of the hands and soles of the feet. It can be caused by many chemotherapy drugs, particularly fluorouracil and capecitabine, and tyrosine kinase inhibitors. Treatment requires cessation of the drug.... palmoplantar erythrodysaesthesia

a diagnostic sign for *carpal tunnel syndrome. The patient is asked to hold his or her wrists in full flexion with the dorsal surfaces of both hands pushing against each other with fingers pointing downwards for 30–60 seconds. This manoeuvre increases pressure on the median nerve: tingling and numbness or pain in the thumb, index, middle, and ring fingers suggests carpal tunnel syndrome. See also Tinel’s sign. [G. S. Phalen (1911–98), US orthopaedist]... phalen’s sign

Displacement of the head of the humerus out of the shoulder joint. The main symptom is pain in the shoulder and upper arm, made worse by movement. A forward dislocation often produces obvious deformity; a backward dislocation usually does not.

Diagnosis is by X-rays. The head of the humerus is repositioned in the joint socket. The shoulder is then immobilized in a sling for about 3 weeks.

Complications of shoulder dislocation include damage to nerves, causing temporary weakness and numbness in the shoulder; damage to an artery in the upper arm, causing pain and discoloration of the arm and hand; and damage to muscles that support the shoulder.... shoulder, dislocation of

A water-soluble vitamin that plays a vital role in the activities of several enzymes in the body. Vitamin B12 is important in the production of the genetic material of cells (and thus in growth and development), in the production of red blood cells in bone marrow, in the utilization of folic acid and carbohydrates in the diet, and in the functioning of the nervous system. Foods rich in vitamin B12 include liver, kidney, chicken, beef, pork, fish, eggs, and dairy products.Deficiency is almost always due to the inability of the intestine to absorb the vitamin, usually as a result of pernicious anaemia (see anaemia, megaloblastic). Less commonly, deficiency may result from gastrectomy, malabsorption, or veganism. The effects of vitamin B12 deficiency are megaloblastic anaemia, a sore mouth and tongue, and symptoms caused by damage to the spinal cord, such as numbness and tingling in the limbs. There may also be depression and memory loss. A high intake of vitamin B12 has no known harmful effects.... vitamin b12

a combination of *paraesthesia (pins and needles), numbness, and pain in the hand, usually affecting the thumb, index, and middle fingers and sometimes extending to the medial aspect of the fourth finger. The symptoms are usually worse at night, and in longstanding cases there may be weakness of grip due to wasting of the *thenar eminence of the thumb. It is caused by pressure on the median nerve as it passes through the wrist (see carpal tunnel), which may result from any continuous repetitive movements of the hand, such as keyboarding, or any condition causing local swelling. It is common in rheumatoid arthritis, myxoedema, pregnancy, and at the menopause, when it is more likely to be bilateral. Treatment is by splinting of the wrist, *NSAIDs, injection of a steroid, or – in severe cases – by surgical release of the nerve under local anaesthesia.... carpal tunnel syndrome

(postinfective polyneuropathy) a disease of the peripheral nerves in which there is numbness and weakness in the limbs. It usually develops 1–28 days after a respiratory or gastrointestinal infection (commonly with Campylobacter): antibodies directed against the pathogen’s cell-surface antigens attack similar antigens on the myelin sheaths of the host’s peripheral nerves. Involvement of the respiratory muscles may require mechanical ventilation. Recovery is variable and often prolonged (there is a 10% mortality rate). Treatment with immunoglobulins (intravenous) or with plasma exchange may speed recovery and reduce long-term disability. See polyradiculitis. [G. Guillain (1876–1961) and A. Barré (1880–1967), French neurologists]... guillain–barré syndrome

(Hansen’s disease) n. a chronic disease, caused by the bacterium Mycobacterium leprae, that affects the skin, mucous membranes, and nerves. It is confined mainly to the tropics and is transmitted by direct contact. After an incubation period of 1–30 years, symptoms develop gradually and mainly involve the skin and nerves. Lepromatous (multibacillary) leprosy is a contagious steadily progressive form of the disease characterized by the development of widely distributed lumps on the skin, thickening of the skin and nerves, and in serious cases by severe numbness of the skin, muscle weakness, and paralysis, which leads to disfigurement and deformity. Tuberculosis is a common complication. Tuberculoid leprosy is a benign, often self-limiting, form of leprosy causing discoloration and disfiguration of patches of skin (sparsely distributed) associated with localized numbness. Indeterminate leprosy is a form of the disease in which skin manifestations represent a combination of the two main types; tuberculoid and indeterminate leprosy are known as paucibacillary leprosy.

Like tuberculosis, leprosy should be treated with a combination of antibacterial drugs, to overcome the problem of resistance developing to a single drug; the WHO advocates a combination of rifampicin and dapsone for six months to treat paucibacillary leprosy and these drugs with the addition of clofazimine for multibacillary leprosy, this multidrug therapy (MDT) to be continued for two years. Reconstructive surgery can repair some of the damage caused by the disease. A vaccine is being developed and tested.... leprosy

insidious numbness in muscles that develops 15–20 years after an attack of *poliomyelitis; the muscles may or may not have been previously affected. It may be caused by loss of nerve cells that have been under greater strain than normal as a result of the polio; there is no evidence of reactivation of the poliovirus. The syndrome also includes other symptoms, such as fatigue and pain, which may be due to secondary mechanical causes.... post-polio syndrome

(TIA) the result of temporary disruption of the circulation to part of the brain due to *embolism, *thrombosis to brain arteries, or spasm of the vessel walls (see stroke). The most common symptoms are transient loss of vision in one eye and weakness or numbness in one limb or part of a limb. Patients recover within 24 hours.... transient ischaemic attack

A group of watersoluble vitamins comprising thiamine (vitamin B1), riboflavin (vitamin B2), niacin, pantothenic acid, pyridoxine (vitamin B6), biotin (vitamin H), and folic acid. Vitamin B12 is discussed above.

Thiamine plays a role in the activities of various enzymes involved in the utilization of carbohydrates and thus in the functioning of nerves, muscles, and the heart. Sources include whole-grain cereals, wholemeal breads, brown rice, pasta, liver, kidney, pork, fish, beans, nuts, and eggs.

Those susceptible to deficiency include elderly people on a poor diet, and people who have hyperthyroidism, malabsorption, or severe alcohol dependence. Deficiency may also occur as a result of severe illness, surgery, or injury.

Mild deficiency may cause tiredness, irritability, and loss of appetite. Severe deficiency may cause abdominal pain, constipation, depression, memory impairment, and beriberi; in alcoholics, it may cause Wernicke–Korsakoff syndrome. Excessive intake is not known to cause harmful effects.

Riboflavin is necessary for the activities of various enzymes involved in the breakdown and utilization of carbohydrates, fats, and proteins; the production of energy in cells; the utilization of other B vitamins; and hormone production by the adrenal glands. Liver, whole grains, milk, eggs, and brewer’s yeast are good sources. People who are susceptible to riboflavin deficiency include those taking phenothiazine antipsychotic drugs, tricyclic antidepressant drugs, or oestrogen-containing oral contraceptives, and those with malabsorption or severe alcohol dependence. Riboflavin deficiency may also occur as a result of serious illness, surgery, or injury.

Prolonged deficiency may cause soreness of the tongue and the corners of the mouth, and eye disorders such as amblyopia and photophobia.

Excessive intake of riboflavin is not known to have any harmful effects.

Niacin plays an essential role in the activities of various enzymes involved in the metabolism of carbohydrates and fats, the functioning of the nervous and digestive systems, the manufacture of sex hormones, and the maintenance of healthy skin. The main dietary sources are liver, lean meat, fish, nuts, and dried beans. Niacin can be made in the body from tryptophan (an amino acid). Most cases of deficiency are due to malabsorption disorders or to severe alcohol dependence. Prolonged niacin deficiency causes pellagra. Excessive intake is not known to cause harmful effects.

Pantothenic acid is essential for the activities of various enzymes involved in the metabolism of carbohydrates and fats, the manufacture of corticosteroids and sex hormones, the utilization of other vitamins, the functioning of the nervous system and adrenal glands, and growth and development. It is present in almost all vegetables, cereals, and animal foods. Deficiency of pantothenic acid usually occurs as a result of malabsorption or alcoholism, but may also occur after severe illness, surgery, or injury. The effects include fatigue, headache, nausea, abdominal pain, numbness and tingling, muscle cramps, and susceptibility to respiratory infections. In severe cases, a peptic ulcer may develop. Excessive intake has no known harmful effects.Pyridoxine aids the activities of various enzymes and hormones involved in the utilization of carbohydrates, fats, and proteins, in the manufacture of red blood cells and antibodies, in the functioning of the digestive and nervous systems, and in the maintenance of healthy skin. Dietary sources are liver, chicken, pork, fish, whole grains, wheatgerm, bananas, potatoes, and dried beans. Pyridoxine is also manufactured by intestinal bacteria. People who are susceptible to pyridoxine deficiency include elderly people who have a poor diet, those with malabsorption or severe alcohol dependence, or those who are taking certain drugs (including penicillamine and isoniazid). Deficiency may cause weakness, irritability, depression, skin disorders, inflammation of the mouth and tongue, anaemia, and, in infants, seizures. In very large amounts, pyridoxine may cause neuritis.

Biotin is essential for the activities of various enzymes involved in the breakdown of fatty acids and carbohydrates and for the excretion of the waste products of protein breakdown. It is present in many foods, especially liver, peanuts, dried beans, egg yolk, mushrooms, bananas, grapefruit, and watermelon. Biotin is also manufactured by bacteria in the intestines. Deficiency may occur during prolonged treatment with antibiotics or sulphonamide drugs. Symptoms are weakness, tiredness, poor appetite, hair loss, depression, inflammation of the tongue, and eczema. Excessive intake has no known harmful effects.

Folic acid is vital for various enzymes involved in the manufacture of nucleic acids and consequently for growth and reproduction, the production of red blood cells, and the functioning of the nervous system. Sources include green vegetables, mushrooms, liver, nuts, dried beans, peas, egg yolk, and wholemeal bread. Mild deficiency is common, but can usually be corrected by increasing dietary intake. More severe deficiency may occur during pregnancy or breastfeeding, in premature or low-birthweight infants, in people undergoing dialysis, in people with certain blood disorders, psoriasis, malabsorption, or alcohol dependence, and in people taking certain drugs. The main effects include anaemia, sores around the mouth, and, in children, poor growth. Folic acid supplements taken just before conception, and for the first 12 weeks of pregnancy, have been shown to reduce the risk of a neural tube defect.... vitamin b complex

a group of congenital abnormalities caused by failure of the *neural tube to form normally. In *spina bifida the bony arches of the spine, which protect the spinal cord and its coverings (the meninges), fail to close. More severe defects of fusion of these bones will result in increasingly serious neurological conditions. A meningocele is the protrusion of the meninges through the gap in the spine, the skin covering being vestigial. There is a constant risk of damage to the meninges, with resulting infection. Urgent surgical treatment to protect the meninges is therefore required. In a meningomyelocele (myelomeningocele, myelocele) the spinal cord and the nerve roots are exposed, often adhering to the fine membrane that overlies them. There is a constant risk of infection and this condition is accompanied by paralysis and numbness of the legs and urinary incontinence. *Hydrocephalus and an *Arnold–Chiari malformation are usually present. A failure of fusion at the cranial end of the neural tube (cranium bifidum) gives rise to comparable disorders. The bone defect is most often in the occipital region of the skull but it may occur in the frontal or basal regions. A protrusion of the meninges alone is known as a cranial meningocele. The terms meningoencephalocele, encephalocele, and cephalocele are used for the protrusion of brain tissue through the skull defect. This is accompanied by severe mental and physical disorders.... neural tube defects

(polyneuropathy, peripheral neuritis) any of a group of disorders affecting the sensory and/or motor nerves in the peripheral nervous system. They tend to start distally, in the fingers and toes, and progress proximally. Symptoms include pins and needles, stabbing pains and a numbness on the sensory side, and weakness of the muscles. The most common causes of peripheral neuropathy are diabetes, alcohol, certain drugs, and such infections as HIV; genetic causes of peripheral neuropathy include amyloidosis and *Charcot-Marie-Tooth disease. The diagnosis may be established by neurophysiological tests, blood tests, and occasionally a nerve biopsy.... peripheral neuropathy

n. a spinal condition resulting from degeneration and flattening of the intervertebral discs in the cervical, thoracic, or lumbar regions. Symptoms include pain and restriction of movement, and in advanced cases tingling, numbness, and weakness may develop due to pressure on nerve roots. Spondylosis produces a characteristic appearance on X-ray, including narrowing of the space occupied by the disc and the presence of *osteophytes; these features of the disease (radiological spondylosis) may not be accompanied by any signs and symptoms. Pain is relieved by analgesics, NSAIDs, and physiotherapy; painful movements are prevented by wearing a neck orthosis (when the neck region is affected) or a lumbosacral corset (for the lower spine). Very severe cases sometimes require surgical fusion.... spondylosis