Raynauds either syndrome or disease Health Dictionary

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Raynauds Either Syndrome Or Disease: From 1 Different Sources

The first is less severe, characterized by blanching spasms of blood vessels leading to the hands and feet, initiated by cold, moisture, even emotional stress and low blood sugar. Sort of a finger migraine. After the spasm relaxes, the tissue distal becomes red, hot, even painful. R. Disease is more serious and perhaps deriving from different causes as well. The spasms may not subside, the effected tissues can become purplish, and in extreme cases, gangrenous.

Health Source: Herbal Medical
Author: Health Dictionary

Disease

A failure of the adaptive mechanisms of an organism to counteract adequately, normally or appropriately to stimuli and stresses to which the organism is subjected, resulting in a disturbance in the function or structure of some part of the organism. This definition emphasizes that disease is multifactorial and may be prevented or treated by changing any or a combination of the factors. Disease is a very elusive and difficult concept to define, being largely socially defined. Thus, criminality and drug dependence are presently seen by some as diseases, when they were previously considered to be moral or legal problems.... disease

Lyme Disease

A zoonotic disease caused by the spirochaete Borrelia burgdorferi and other species of the genus. Common in Europe and the USA and transmi tted by Ixodid ticks.... lyme disease

Chronic Fatigue Syndrome

(CFS) is a recently designated semi-disease, often attributed to EBV (the Epstein-Barr virus) or CMV (Cytomegalovirus) infections, characterized by FUOs (Fevers of Unknown Origin) and resulting in the patient suffering FLS (Feels Like Shit). In most of us, the microorganisms involved in CFS usually provoke nothing more than a head cold; in some individuals, however, they induce a long, grinding, and debilitating disorder, characterized by exhaustion, depression, periodic fevers...a crazy-quilt of symptoms that frustrates both the sufferer and the sometimes skeptical physician. MCS (Multiple Chemical Sensitivities) are another syndrome that is often lumped with CFS, and they may often be two faces of the same condition. I am not using all these acronyms to mock the conditions, but as an irony. There is too much (Acronym Safety Syndrome) in medicine, reducing complex and frustrating conditions to insider’s techno-babble, somehow therein trivializing otherwise complex, painful and crazy-making problems. The widest use of acronyms (AIDS, HIV, CFS, MCS, MS etc.) seems to be for diseases hardest to treat, least responsive to procedural medicine, and most depressing to discuss with patients or survivors.... chronic fatigue syndrome

Communicable Disease

An illness due to a specific infectious agent or its toxic products which arises through transmission of that agent or its products from a reservoir to a susceptible host - either directly, through the agencyof an intermediate plant or animal host, vector, or the inanimate environment.... communicable disease

Coeliac Disease

Around one in 100 people suffers from coeliac disease, a condition in which the small INTESTINE fails to digest and absorb food, but many have no or few symptoms and remain undiagnosed. The intestinal lining is permanently sensitive to the protein gliadin (an insoluble and potentially toxic PEPTIDE protein) which is contained in GLUTEN, a constituent of the germ of wheat, barley and rye. As bread or other grain-based foods are a regular part of most people’s diet, the constant presence of gluten in the intestine of sufferers of coeliac disease causes atrophy of the digestive and absorptive cells of the intestine. Children are usually diagnosed when they develop symptoms such as vomiting, diarrhoea, lethargy, ANAEMIA, swollen abdomen and pale, frothy, foul-smelling faeces with failure to thrive. The diagnosis is usually made by a positive blood antibody test such as antiendomysial antibodies. However, because there may be an occasional false positive result, the ‘gold standard’ is to obtain a biopsy of the JEJUNUM through a tiny metal capsule that can be swallowed, a specimen taken, and the capsule retrieved. Though coeliac disease was long thought to occur in childhood, a second peak of the disorder has recently been identi?ed among people in their 50s.

Not all sufferers from coeliac disease present with gastrointestinal symptoms: doctors, using screening techniques, have increasingly identi?ed large numbers of such people. This is important because researchers have recently discovered that untreated overt and silent coeliac disease increases the risk of sufferers developing osteoporosis (brittle bone disease – see BONE, DISORDERS OF) and cancer. The osteoporosis develops because the bowel fails to absorb the CALCIUM essential for normal bone growth. Because those with coeliac disease lack the enzyme LACTASE, which is essential for digesting milk, they avoid milk – a rich source of calcium.

The key treatment is a strict, lifelong diet free of gluten. As well as returning the bowel lining to normal, this diet results in a return to normal bone density. People with coeliac disease, or parents or guardians of affected children, can obtain help and guidance from the Coeliac Society of the United Kingdom. (See also MALABSORPTION SYNDROME; SPRUE.)... coeliac disease

Dumping Syndrome

A sensation of weakness and sweating after a meal in patients who have undergone GASTRECTOMY. Rapid emptying of the stomach and the drawing of ?uid from the blood into the intestine has been blamed, but the exact cause is unclear.... dumping syndrome

Marburg Disease

A serious African viral haemorrhagic fever harboured by monkeys. Named after the city of Marburg in Germany where a serious outbreak occurred amongst laboratory workers handling the tissues of African Green (Vervet) monkeys.... marburg disease

Syndrome

A pattern of symptoms and signs, appearing one by one or simultaneously, that together characterise a particular disease or disorder.... syndrome

Blind Loop Syndrome

A disorder in which abnormal FAECES occur as a result of a redundant loop in the small INTESTINE. The loop obstructs the normal ?ow of the contents of the bowel, causing stagnation. The syndrome is characterised by light-yellow, smelly, fatty, bulky faeces. The patient suffers from tiredness, malaise and loss of weight. Previous abdominal surgery is sometimes the cause, but the condition can be inherited. Blockage of intestinal contents upsets the bowel’s normal bacterial balance and hinders the normal absorption of nutrients. Treatment is either with antibiotics or, if that fails, surgery.... blind loop syndrome

Bornholm Disease

Bornholm disease, also known as devil’s grip, and epidemic myalgia, is an acute infective disease due to COXSACKIE VIRUSES. It is characterised by the abrupt onset of pain around the lower margin of the ribs, headache, and fever; it occurs in epidemics, usually during warm weather, and is more common in young people than in old. The illness usually lasts seven to ten days. It is practically never fatal. The disease is named after the island of Bornholm in the Baltic, where several epidemics have been described.... bornholm disease

Brittle Bone Disease

Brittle Bone Disease is another name for OSTEOGENESIS IMPERFECTA.... brittle bone disease

Caisson Disease

See COMPRESSED AIR ILLNESS.... caisson disease

Chagas’ Disease

A zoonotic protozoan disease endemic to parts of Latin America and caused by Trypanosmoma cruzi with reduviid (Triatomid or assassin) bugs as the vectors.... chagas’ disease

Adrenogenital Syndrome

An inherited condition, the adrenogenital syndrome – also known as congenital adrenal hyperplasia – is an uncommon disorder affecting about 1 baby in 7,500. The condition is present from birth and causes various ENZYME defects as well as blocking the production of HYDROCORTISONE and ALDOSTERONE by the ADRENAL GLANDS. In girls the syndrome often produces VIRILISATION of the genital tract, often with gross enlargement of the clitoris and fusion of the labia so that the genitalia may be mistaken for a malformed penis. The metabolism of salt and water may be disturbed, causing dehydration, low blood pressure and weight loss; this can produce collapse at a few days or weeks of age. Enlargement of the adrenal glands occurs and the affected individual may also develop excessive pigmentation in the skin.

When virilisation is noted at birth, great care must be taken to determine genetic sex by karyotyping: parents should be reassured as to the baby’s sex (never ‘in between’). Blood levels of adrenal hormones are measured to obtain a precise diagnosis. Traditionally, doctors have advised parents to ‘choose’ their child’s gender on the basis of discussing the likely condition of the genitalia after puberty. Thus, where the phallus is likely to be inadequate as a male organ, it may be preferred to rear the child as female. Surgery is usually advised in the ?rst two years to deal with clitoromegaly but parent/ patient pressure groups, especially in the US, have declared it wrong to consider surgery until the children are competent to make their own decision.

Other treatment requires replacement of the missing hormones which, if started early, may lead to normal sexual development. There is still controversy surrounding the ethics of gender reassignment.

See www.baps.org.uk... adrenogenital syndrome

Christmas Disease

A hereditary disorder of blood coagulation which can only be distinguished from HAEMOPHILIA by laboratory tests. It is so-called after the surname of the ?rst case reported in this country. About one in every ten patients clinically diagnosed as haemophiliac has in fact Christmas disease. It is due to lack in the blood of Factor IX (see COAGULATION).... christmas disease

Collagen Diseases

A group of diseases affecting CONNECTIVE TISSUE. The term is really outdated since there is no evidence that collagen is primarily involved. Fibrinoid NECROSIS and VASCULITIS are two ‘characteristics’, and autoimmunity reaction may occur in the connective tissue. The latter affects blood vessels and causes secondary damage in the connective tissue. Such conditions are sometimes described as collagen vascular diseases, examples being RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS (SLE), and SCLERODERMA.... collagen diseases

Crush Syndrome

A condition in which kidney failure occurs in patients who have been the victims of severe crushing accidents (see also KIDNEYS). The fundamental injury is damage to muscle. The limb swells. The blood volume falls. Blood UREA rises; there is also a rise in the POTASSIUM content of the blood. Urgent treatment in an intensive therapy unit is required and renal dialysis may well be necessary. The patient may survive; or die with renal failure. Post-mortem examination shows degeneration of the tubules of the kidney, and the presence in them of pigment casts.... crush syndrome

Diverticular Disease

The presence of numerous diverticula (sacs or pouches) in the lining of the COLON accompanied by spasmodic lower abdominal pain and erratic bowel movements. The sacs may become in?amed causing pain (see DIVERTICULITIS).... diverticular disease

Guillain-barré Syndrome

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

Gulf War Syndrome

A collection of varying symptoms, such as persistent tiredness, headaches, muscle pain and poor concentration, reported by members of the Coalition Armed Forces who served in the 1991 Gulf War. Whilst there is strong evidence for a health e?ect related to service, there is no evidence of a particular set of signs and symptoms (the de?nition of a ‘syndrome’) unique to those who served in the Gulf War. Symptoms have been blamed on multiple possible hazards, such as exposure to depleted uranium munitions, smoke from oil-well ?res and use of pesticides. However, the only clearly demonstrated association is with the particular pattern of vaccinations used to protect against biological weapons. Many con?icts in the past have generated their own ‘syndromes’, given names such as e?ort syndrome and shell-shock, suggesting a link to the psychological stress of being in the midst of warfare.... gulf war syndrome

Hand, Foot And Mouth Disease

A contagious disease due to infection with coxsackie A16 virus (see COXSACKIE VIRUSES). Most common in children, the incubation period is 3–5 days. It is characterised by an eruption of blisters on the palms and the feet (often the toes), and in the mouth. The disease

has no connection with foot and mouth disease in cattle, deer, pigs and sheep.... hand, foot and mouth disease

Haemolytic Disease Of The Newborn

A potentially serious disease of the newborn, characterised by haemolytic ANAEMIA (excessive destruction of red blood cells) and JAUNDICE. If severe, it may be obvious before birth because the baby becomes very oedematous (see OEDEMA) and develops heart failure – so-called hydrops fetalis. It may ?rst present on the ?rst day of life as jaundice and anaemia. The disease is due to blood-group incompatibility between the mother and baby, the commoneset being rhesus incompatibility (see BLOOD GROUPS). In this condition a rhesus-negative mother has been previously sensitised to produce rhesus antibodies, either by the delivery of a rhesus-positive baby, a miscarriage or a mismatched blood transfusion. These antibodies cross over into the fetal circulation and attack red blood cells which cause HAEMOLYSIS.

Treatment In severely affected fetuses, a fetal blood transfusion may be required and/or the baby may be delivered early for further treatment. Mild cases may need observation only, or the reduction of jaundice by phototherapy alone (treatment with light, involving the use of sunlight, non-visible ULTRAVIOLET light, visible blue light, or LASER).

Whatever the case, the infant’s serum BILIRUBIN – the bilirubin present in the blood – and its HAEMOGLOBIN concentration are plotted regularly so that treatment can be given before levels likely to cause brain damage occur. Safe bilirubin concentrations depend on the maturity and age of the baby, so reference charts are used.

High bilirubin concentrations may be treated with phototherapy; extra ?uid is given to prevent dehydration and to improve bilirubin excretion by shortening the gut transit time. Severe jaundice and anaemia may require exchange TRANSFUSION by removing the baby’s blood (usually 10 millilitres at a time) and replacing it with rhesus-negative fresh bank blood. Haemolytic disease of the newborn secondary to rhesus incompatibility has become less common since the introduction of anti-D (Rho) immunoglobulin. This antibody should be given to all rhesus-negative women at any risk of a fetomaternal transfusion, to prevent them from mounting an antibody response. Anti-D is given routinely to rhesus-negative mothers after the birth of a rhesus-positive baby, but doctors should also give it after threatened abortions, antepartum haemorrhages, miscarriages, and terminations of pregnancy.

Occasionally haemolytic disease is caused by ABO incompatibility or that of rarer blood groups.... haemolytic disease of the newborn

Infectious Disease

A disease of humans or animals resulting from an infection.... infectious disease

Irritable Bowel Syndrome

(IBS) This is a common and generally benign condition of the colon, taking different forms but usually characterized by alternating constipation and diarrhea. There is often some pain accompanying the diarrhea phase. The bowel equivalent of spasmodic asthma, its main cause is stress, often accompanied by a history of GI infections. Adrenalin stress slows the colon and causes constipation, followed by a cholinergic rebound overstimulation of the colon. It is also called spastic colon, colon syndrome, mucous colitis, even chronic colitis. True colitis is a potentially or actually serious pathology.... irritable bowel syndrome

Kawasaki Disease

Also called mucocutaneous lymph node syndrome, this disorder of unknown origin occurs mainly in children under ?ve and was ?rst described in Japan. It is characterised by high fever, conjunctivitis (see under EYE, DISORDERS OF), skin rashes and swelling of the neck glands. After about two weeks the skin from ?ngertips and toes may peel. The disease may last for several weeks before spontaneously resolving. It is possible that it is caused by an unusual immune response to INFECTION (see IMMUNITY).

Arteritis is a common complication and can result in the development of coronary artery aneurysms (see ANEURYSM) in up to 60 per cent of those affected. These aneurysms and even myocardial infarction (see HEART, DISEASES OF – Coronary thrombosis) are often detected after the second week of illness. The disease can be hard to diagnose as it mimics many childhood viral illnesses, especially in its early stages. The incidence in the UK is over 3 per 100,000 children under ?ve years of age.

Treatment Because of the danger of coronary artery disease, prompt treatment is important. This is with intravenous IMMUNOGLOBULINS and low-dose aspirin. To be e?ective, treatment must start in the ?rst week or so of the illness – a time when it is most di?cult to diagnose.... kawasaki disease

Legionnaire’s Disease

Infection by the Gram negative rod, Legionella pneumophila and other species of the Genus. Often presents as an atypical pneumonia. Outbreaks have been reported from various countries.... legionnaire’s disease

Nephrotic Syndrome

Nephrotic syndrome is one of PROTEINURIA, hypo-albuminaemia and gross OEDEMA. The primary cause is the leak of albumin (see ALBUMINS) through the GLOMERULUS. When this exceeds the liver’s ability to synthesise albumin, the plasma level falls and oedema results. The nephrotic syndrome is commonly the result of primary renal glomerular disease (see KIDNEYS, DISEASES OF – Glomerulonephritis). It may also be a result of metabolic diseases such as diabetic glomerular sclerosis and AMYLOIDOSIS. It may be the result of systemic autoimmune diseases such as SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and POLYARTERITIS NODOSA. It may complicate malignant diseases such as MYELOMATOSIS and Hodgkin’s disease (see LYMPHOMA). It is sometimes caused by nephrotoxins such as gold or mercury and certain drugs, and it may be the result of certain infections such as MALARIA and CROHN’S DISEASE.... nephrotic syndrome

Slapped Cheek Syndrome

See ERYTHEMA – Erythema infectiosum.... slapped cheek syndrome

Pelvic Inflammatory Disease

(PID) Also called salpingitis, the term is applied to infections of the fallopian tubes that follow or are concurrent with uterine and cervical infections. Gonorrhea and Chlamydia are the most common organisms, and the infection is usually begun through sexual contact, although metabolic imbalances, subtler systemic infections like a slow virus, the local insult of herpes or candidiasis, the sequela of medication or recreational drugs, birth control pills, even an IUD...all can alter the vaginal flora and induce inflammation sufficient to allow an endogenous organism to start the infection. PID after birth, on the other hand, is usually the result of staph or strep infections infecting injured membranes.... pelvic inflammatory disease

Premenstrual Syndrome

This has been de?ned as ‘any combination of emotional or physical features which occur cyclically in a woman before MENSTRUATION, and which regress or disappear during menstruation’. It is characterised by mood-changes, discomfort, swelling and tenderness in the breasts, swelling of the legs, a bloated feeling in the abdomen, headache, fatigue and constipation. The mood-changes range from irritability and mild depression to outbursts of violence. It may last for 3–14 days. How common it is is not known, as only the more severe cases are seen by doctors, but it has been estimated that one in ten of all menstruating women suffer from it severely enough to require treatment. The cause is not known, but it is probably due to some upset of the hormonal balance of the body. In view of the multiplicity of causes that have been put forward, it is not surprising that there is an equal multiplicity of treatments. Among these, one of the most widely used is PROGESTERONE. Others include pyridoxine, danazol, and gamma linolenic acid available in the form of oil of evening primrose. Whatever drug may be prescribed, counselling is equally essential and, in many cases, is all that is required.... premenstrual syndrome

Toxic Shock Syndrome

First described in 1978, this disorder is characterised by high fever, diarrhoea, SHOCK and a rash. It is frequently associated with the use of tampons (see TAMPON), but has occasionally been reported in men. The syndrome may also be linked to the use of contraceptives such as the diaphragm, cap and sponge (see under CONTRACEPTION), and skin wounds or infections may also be a cause. The disease is due to a staphylococcal toxin (see STAPHYLOCOCCUS; TOXINS). Treatment consists of supportive measures to combat shock and eradication of the staphylococcus by ANTIBIOTICS. The design of tampons has been improved. Recurrence of the disorder has been reported and women who have had an episode should stop using tampons and vaginal contraceptives.... toxic shock syndrome

Addison’s Disease

A disease causing failure of adrenal gland function, in particular deficiency of adrenal cortical hormones, mainly cortisol and aldosterone. Commonest causes are tuberculosis and auto- immune disease.

Symptoms: (acute) abdominal pain, muscle weakness, vomiting, low blood pressure due to dehydration, tiredness, mental confusion, loss of weight and appetite. Vomiting, dizzy spells. Increased dark pigmentation around genitals, nipples, palms and inside mouth. Persistent low blood pressure with occasional low blood sugar. Crisis is treated by increased salt intake. Research project revealed a craving for liquorice sweets in twenty five per cent of patients.

Herbs with an affinity for the adrenal glands: Parsley, Sarsaparilla, Wild Yam, Borage, Liquorice, Ginseng, Chaparral. Where steroid therapy is unavoidable, supplementation with Liquorice and Ginseng is believed to sustain function of the glands. Ginseng is supportive when glands are exhausted by prolonged stress. BHP (1983) recommends: Liquorice, Dandelion leaf.

Alternatives. Teas. Gotu Kola, Parsley, Liquorice root, Borage, Ginseng, Balm.

Tea formula. Combine equal parts: Balm and Gotu Kola. Preparation of teas and tea mixture: 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes; 1 cup 2 to 3 times daily.

Tablets/capsules. Ginseng, Seaweed and Sarsaparilla, Wild Yam, Liquorice. Dosage as on bottle. Formula. Combine: Gotu Kola 3; Sarsaparilla 2; Ginseng 1; Liquorice quarter. Doses. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 30-60 drops. Tinctures: 1-2 teaspoons 2 to 3 times daily.

Formula. Alternative. Tinctures 1:5. Echinacea 20ml; Yellow Dock 10ml; Barberry 10ml; Sarsaparilla 10ml; Liquorice (liquid extract) 5ml. Dose: 1-2 teaspoons thrice daily.

Supplementation. Cod liver oil. Extra salt. B-Vitamins. Folic acid. ... addison’s disease

Alzheimer’s Disease

A progressive brain deterioration first described by the German Neurologist, Alois Alzheimer in 1906. Dementia. Not an inevitable consequence of ageing. A disease in which cells of the brain undergo change, the outer layer (cerebral cortex) leading to tangles of nerve fibres due to reduced oxygen and blood supply to the brain.

The patient lives in an unreal world in which relatives have no sense of belonging. A loving gentle wife they once knew is no longer aware of their presence. Simple tasks, such as switching on an electrical appliance are fudged. There is distressing memory loss, inability to think and learn, speech disturbance – death of the mind. Damage by free radicals implicated.

Symptoms: Confusion, restlessness, tremor. Finally: loss of control of body functions and bone loss.

A striking similarity exists between the disease and aluminium toxicity. Aluminium causes the brain to become more permeable to that metal and other nerve-toxins. (Tulane University School of Medicine, New Orleans). High levels of aluminium are found concentrated in the neurofibrillary tangles of the brain in Alzheimer’s disease. Entry into the body is by processed foods, cookware, (pots and pans) and drugs (antacids).

“Reduction of aluminium levels from dietary and medicinal sources has led to a decline in the incidence of dementia.” (The Lancet, Nov 26, 1983).

“Those who smoke more than one packet of cigarettes a day are 4.5 times more likely to develop Alzheimer’s disease than non-smokers.” (Stuart Shalat, epidemiologist, Harvard University).

Researchers from the University of Washington, Seattle, USA, claim to have found a link between the disease and head injuries with damage to the blood/brain barrier.

Also said to be associated with Down’s syndrome, thyroid disease and immune dysfunction. Other contributory factors are believed to be exposure to mercury from dental amalgam fillings. Animal studies show Ginkgo to increase local blood flow of the brain and to improve peripheral circulation. Alternatives. Teas: Alfalfa, Agrimony, Lemon Balm, Basil, Chaparral, Ginkgo, Chamomile, Coriander (crushed seeds), Ginseng, Holy Thistle, Gotu Kola, Horsetail, Rosemary, Liquorice root (shredded), Red Clover flowers, Skullcap, Ladies Slipper.

Tea. Formula. Combine, equal parts: German Chamomile, Ginkgo, Lemon Balm. 1 heaped teaspoon to cup boiling water; infuse 5-15 minutes. 1 cup freely.

Decoction. Equal parts: Black Cohosh, Blue Flag root, Hawthorn berries. 1 teaspoon in each cupful water; bring to boil and simmer 20 minutes. Dose: half-1 cup thrice daily.

Powders. Formula. Hawthorn 1; Ginkgo 1; Ginger half; Fringe Tree half. Add pinch Cayenne pepper. 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Liquid extracts. Formula. Hawthorn 1; Ephedra half; Ginkgo 1. Dose: 30-60 drops, thrice daily, before meals.

Topical. Paint forehead and nape of neck with Tincture Arnica.

Diet: 2 day fluid-only fast once monthly for 6 months. Low fat, high fibre, lecithin. Lacto-vegetarian. Low salt.

Supplements. Vitamin B-complex, B6, B12, Folic acid, A, C, E, Zinc. Research has shown that elderly patients at high risk of developing dementia have lower levels of Vitamins A, E and the carotenes. Zinc and Vitamin B12 are both vital cofactors for brain enzymes.

Alzheimer’s Disease linked with zinc. Zinc is believed to halt cerebral damage. Senile plaques in the brain produce amyloid, damaging the blood-brain barrier. Toxic metals then cross into the brain, displacing zinc. This then produces abnormal tissue. (Alzheimer Disease and Associated Disorders, researchers, University of Geneva).

Japanese study. Combination of coenzyme Q10, Vitamin B6 and iron. Showed improved mental function. Abram Hoffer MD, PhD. Niacin 500mg tid, Vitamin C 500mg tid, Folic acid 5mg daily, Aspirin 300mg daily, Ginkgo herb 40mg daily. (International Journal of Alternative and Complementary Medicine, Feb 1994 p11)

Alzheimer’s Disease Society. 2nd Floor, Gordon House, 10 Greencoat Place, London SW1P 1PH, UK. Offers support to families and carers through membership. Practical help and information. Send SAE. ... alzheimer’s disease

Crohn’s Disease

Chronic inflammation and ulceration of the gut, especially the terminal ileum from changes in the gut blood vessels. Commences with ulceration which deepens, becomes fibrotic and leads to stricture. Defective immune system. Resistance low. May be associated with eye conditions and Vitamin B12 deficiency.

Symptoms: malaise, bloody alternating diarrhoea and constipation; right side colicky abdominal pain worse after meals; flatulence, loss of weight and appetite. Intestinal obstruction can usually be palpated. Blood count. A blood count high in whites indicates an abscess – a serious condition which may require surgical repair during which segments of the gut may have to be removed. Malignant change rare. Differential diagnosis. Ulcerative colitis, appendicitis, appendix abscess, irritable bowel syndrome.

Cracks or ulcers at corners of the mouth may be a good marker of Crohn’s Disease.

Treatment. Select one of the following. Herbal treatment offers a safe alternative to steroids by inducing remission in acute exacerbation. Good responses have been observed from the anti-bacterials Wild Yam and Goldenseal. Fenugreek seeds are of special value. Comfrey (tissue regeneration). Irish Moss.

Teas: Chamomile, Comfrey leaves, Hops, Marshmallow leaves, Meadowsweet, Shepherd’s Purse (Dr A. Vogel), Lobelia. Silverweed and Cranesbill are excellent for internal bleeding; Poke root for intestinal ulceration.

Decoction. Fenugreek seeds: 2 teaspoons to large cup water simmered gently 10 minutes. 1 cup freely. The seeds also should be consumed.

Tablets/capsules. Wild Yam, Fenugreek, Ginger, Goldenseal, Lobelia, Slippery Elm.

Powders. Formula. Wild Yam 2; Meadowsweet 2; Goldenseal 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Liquid Extracts. (1) Formula. Wild Yam 1, Echinacea 2. 30-60 drops in water thrice daily. Or, (2) Formula: Turkey Rhubarb 2, Goldenseal 1, Caraway half. 20-30 drops in water thrice daily.

Tinctures. Formula. Bayberry 2, Goldenseal 1, Cardamoms 1. Dose: One to two 5ml teaspoons thrice daily.

Ispaghula seeds. 2-4 teaspoons thrice daily.

Tea Tree oil Suppositories. Insertion at night.

Diet. Bland, little fibre, Slippery Elm gruel. Irish Moss preparations. Increase fluid intake. Reject: broccoli, tomatoes, lima, Soya, Brussels sprouts, pinto beans, cocoa, chocolate, cow’s milk, peas, onions, turnips, radishes. Accept fish oils.

Addenbrookes Hospital, Cambridge. Reject foods containing wheat and all dairy produce.

Supplements. Vitamins A, B12, C, Calcium, Iron, Magnesium, Potassium, Zinc.

Study. In a study carried out by UK researchers (1993) food allergies were found to be the most common cause of the disease. Results suggested that dietary changes may be as effective as corticosteroids in easing symptoms. The most common allergens were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats, chocolate. An elemental diet with a formula of nutrients (E028, produced by Hospital Supplies, Liverpool) was used in trials. (The Lancet, 6.11.1993)

Notes. Crohn’s Disease is associated with Erythema nodosum, more frequently recognised in childhood. A frequent cause is cow’s milk intolerance. Smoking adds to the risk of Crohn’s disease.

In susceptible people, the food additives titanium dioxide and aluminosilicates may evoke a latent inflammatory response resulting in Crohn’s disease, ulcerative colitis or bowel cancer. These chemicals may be found in the intestinal lymphoid aggregations in gut mucosa. (Jonathan Powell, Gastro-intestinal Laboratory, St Thomas’s Hospital, London) (Titanium dioxide rarely occurs naturally but is added to confectionery, drinking water and anti-caking agents.) ... crohn’s disease

Cushing’s Syndrome

A glandular disorder occurring mostly in females, aged 30 to 50.

Causes: a tumour on the adrenal glands or excessive medication with large doses of corticosteroid drugs to make up for adrenal insufficiency. There is diminished resistance to infection. (Echinacea)

Symptoms. Fat plethoric ‘moon’ face. Limbs thin, trunk obese. Skin easily bruises (Arnica). Fatigue, weakness, pink streaks on skin. Cessation of menstruation. Loss of sex drive in men. High blood pressure and sugar in the urine are common. Bone softening leads to pain. Acne (Agnus Castus). Excess body hair. Personality change.

Treatment. Adrenal stimulants may obviate surgery or irradiation to the adrenal glands: they include Ginseng, Liquorice, Sarsaparilla, Holy Thistle (Hyde), Samphire (Hyde).

Men. Tinctures. Formula. Ginseng 3; Sarsaparilla 2; Liquorice 1. One to two teaspoons in water thrice daily.

Women. Tinctures. Formula. Agnus Castus 2; Helonias 2; Pulsatilla 1. One to two teaspoons in water thrice daily.

Good responses have been observed from Pulsatilla and Black Cohosh. ... cushing’s syndrome

Down’s Syndrome

Mongolism. Trisomy 21. Not a disease but a defect in mental and physical development. In the normal human being there are 46 chromosomes; in Down’s there are 47 – one extra No 21 chromosome. The syndrome increases with the age of the mother after the age of 35. Over the age of 40 the chances of a mother having such a child are 1-2 per cent. Children with the defect have low levels of zinc.

Cases of Down’s have followed use of nonoxynol-9 (vaginal contraceptive device) such as the polyurethane sponge. The sponge. when left in situ for a long time, may cause Down’s to follow.

Certain physical characteristics are present. The most important feature is impaired mental development. Almost all are coeliacs.

Symptoms. Low IQ, short fingers, small flat head, flattened nose, low-set ears. May be subject to umbilical hernia, and heart disease. No treatment can cure, but certain herb teas rich in minerals (Alfalfa, Red Clover) together with Kelp (either in tablet or powder form) may help children, with possible improvements in IQ. Vitamin supplements – A, D, Thiamine, Riboflavin, B6, B12, C and E improve a child’s physical and mental health – as do also the minerals: Magnesium, Calcium, Zinc, Manganese, Copper, Iron and Iodine.

Children with Down’s syndrome run an increased risk of coeliac disease, due to disturbed immunity. A substantial evidence is held in America that links a low level of Selenium in the mother. Unnecessary X- rays should be avoided. Ensure fitness before conception by gentle exercise and nutrients: Folic Acid, Selenium and Zinc.

Children with the condition are noted for their happy disposition and warmth of feeling towards others. ... down’s syndrome

Hansen’s Disease

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

Hodgkin’s Disease

(Lymphadenoma. Lymphogranulomatosis). Chronic enlargement of the lymph nodes often together with that of the liver, spleen and bone marrow. Affects more males than females, 30- 40 years. High white blood cell count. Cancer of the lymph vessels. Follows a typical clinical course with anaemia until necrosis supervenes. The disease is suspected by a combination of enlargement of lymph nodes (especially the neck), severe itching and unexplained fever. Symptoms vary according to part of the body affected.

Symptoms. Hard rubbery glands are general, chiefly detected under the arm and groin. Enlarged nodes may compress nearby structures to produce nerve pains. Weight loss. Accumulation of fluid in lungs and abdomen. Obstruction of bile duct leads to jaundice. Patient may be prone to shingles. High fever heralds approaching fatality. Blood count, bone marrow aspiration and node biopsy confirm. Tubercula glands may simulate Hodgkin’s disease.

Some success reported by the use of the Periwinkle plant. (vinca rosea – Vinchristine) Wm Boericke, M.D. refers to Figwort as a powerful agent in Hodgkin’s disease.

Alternatives. Although there is no known cure, emphasis on the cortex of the adrenal gland may reduce skin irritation and pain in the later stages (Gotu Kola, Liquorice, Sarsaparilla). To arrest wasting and constitutional weakness: Echinacea. Anti-pruritics, alteratives and lymphatics are indicated.

Tea. Formula. Equal parts, Nettles, Gotu Kola, Red Clover. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 or more times daily.

Decoction. Formula. Equal parts – Yellow Dock, Queen’s Delight, Echinacea. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup 3 or more times daily.

Tablets/capsules. Poke root. Blue Flag root. Echinacea. Mistletoe.

Powders. Formula. Echinacea 2; Poke root 1; Bladderwrack 1. Dose: 500mg (two 00 capsules or one- third teaspoon) 3 or more times daily.

Tinctures. Mixture. Parts: Echinacea 2; Goldenseal quarter; Thuja quarter; Poke root half; Periwinkle 1. Dose: 1-2 teaspoons, 3 or more times daily. Where active inflammation is present – add Wild Yam 1. External. Castor oil packs to abdomen.

Treatment by a general medical practitioner or hospital specialist.

HOLISTIC MEDICINE. A school of thought which regards disease as a manifestation of an inner disturbance of the vital force, and not merely abnormality of certain groups of nerves, muscles, veins, or even the mind itself. Article 43 of Dr Samuel Hahnemann’s Organon of the Healing Art describes it:

“No organ, no tissue, no cell, no molecule is independent of the activities of the others but the life of each one of these elements is merged into the life of the whole. The unit of human life cannot be the organ, the tissue, the cell, the molecule, the atom, but the whole organism, the whole man.”

Holistic medicine relates disease to a patient’s personality, posture, diet, emotional life, and lifestyle. Treatment will be related to body, mind and spirit. It encourages a positive psychological response to the disease from which a patient suffers. For instance, its gentle approach to cancer embraces stress control, meditation, forms of visualisation and other life-enhancing skills.

Diet may be vegetarian, even vegan.... hodgkin’s disease

Hydatid Disease

An infection caused by a tapeworm Echinococcus granulosis, which infests cattle, foxes, sheep and especially dogs from which it finds its way into humans by contaminated food. Eggs pass through the wall of the gut to develop in body tissue as a hydatid cyst. Many years may pass before symptoms reveal its presence. Surgical operation is the only effective cure although certain vermifuges, taken from time to time, create in the intestine an inhospitable environment for the parasite: Wormwood, Malefern, Fennel, Pumpkin seeds; given in capsule or powder form. Such worms deplete reserves of Vitamin B12 and may cause megaloblastic anaemia.

Supplementation. Vitamin B12.

HYDRAGOGUE. A herbal cathartic that causes watery evacuation and drastic purgation. White Bryony, American Mandrake. (Practitioner use only) ... hydatid disease

Marfan’s Syndrome

A collagen disease in infants (hereditary) with lax joints permitting easy dislocation and strain.

Features: long fingers and arm span, high palate, kyphosis, etc.

Symptoms. Backache, pain in joints, dislocations.

Alternatives. Alfalfa, Fenugreek, Irish Moss, Kelp, Horsetail, Marshmallow, Bamboo gum.

Teas. Alfalfa, Comfrey leaves, Horsetail, Plantain, Silverweed. Any one: 1 heaped teaspoon to each cup boiling water; infuse 10-15 minutes. 1 cup thrice daily.

Decoction. Fenugreek seeds 2; Horsetail 1; Bladderwrack 1; Liquorice half. Prepare: 3 heaped teaspoons to 1 pint (500ml) water gently simmered 10 to 20 minutes. 1 wineglass thrice daily. Fenugreek seeds decoction.

Diet. High protein, oily fish.

Supplements. Calcium, Dolomite, Zinc. ... marfan’s syndrome

Meniere’s Disease

Inner ear disorder. Constriction of cerebral blood vessels (vasospasm) increases pressure of fluids in the balancing mechanism. Ages 40-60; more in men.

Etiology. Obscure; though cases may be traced to auto-toxaemia, Vitamin B deficiency, menstruation, malaria drugs (chloroquine).

Symptoms: dizziness, nausea, vomiting, tinnitus, sound distortions, heavy sweating, loss of hearing; usually in one ear only. Early diagnosis essential for effective treatment. This may mean reference to a department of otolaryngology or otoneurology.

Treatment. Antispasmodics. Nervines. Sometimes a timely diuretic reduces severity – Uva Ursi, Dandelion root, Wild Carrot.

Alternatives. Current European practice: Betony, German Chamomile, Passion flower, Hawthorn, Hops, Feverfew, White Willow.

Tea. Combine, equal parts: Valerian, Wild Carrot, Agrimony. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup every 2 hours during attack; thrice daily thereafter.

Decoction. Mistletoe: 2 teaspoons to each cup cold water steeped overnight. Bring to boil. Allow to cool. Half-1 cup, as above.

Tablets/capsules. Feverfew, Mistletoe, Prickly Ash.

Formula. Ginkgo 2; Dandelion 1; Black Cohosh 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Feverfew tincture. See: FEVERFEW.

Dr J. Christopher: inject into ears, at night, few drops oil of Garlic (or contents of Garlic capsule).

Cider vinegar. 2 teaspoons to glass water: as desired.

Aromatherapy. Inhalants: Eucalyptus or Rosemary oils.

Diet: gluten-free, low salt; good responses observed. High fibre. Avoid dairy products and chocolate. Vitamins: B-complex, B1; B2; B6; E; F. Brewer’s yeast, Niacin.

Minerals: Calcium. Magnesium. Phosphorus. Dolomite. ... meniere’s disease

Paget’s Disease

(Sir James Paget, 1814-99) Osteitis deformans. Chronic inflammation of bone at focal points (Pagetic sites), often widespread. Chronic. Progressive softening followed by thickening with distortion. Renewal of new bone outstrips absorption of old bone. Enlargement of the skull (‘Big head’) and of the long bones. Broadened pelvis, distorted spine (kyphosis) from flattened vertebra. Male predominence. Over 40 years. Spontaneous fractures possible. Paget’s disease and diabetes may be associated in the same family.

Some authorities believe cause is vitamin and mineral deficiency – those which promote bone health being calcium and magnesium (dolomite). Supplementation helps cases but evidence confirms that some pet-owners are at risk – a virus from cats and dogs possibly responsible. The prime candidate is one exposed to canine distemper. Dogs are involved twice as much as cats. The virus is closely related to the measles virus in humans.

Symptoms. Limbs deformed, hot during inflammatory stage. Headaches. Dull aching pain in bones. Deafness from temporal bone involvement. Loss of bone rigidity. Bowing of legs.

Surgical procedures may be necessary. Appears to be a case for immunisation of dogs against distemper.

Alternatives. Black Cohosh, Boneset, Cramp bark, Bladderwrack, German Chamomile, Devil’s Claw, Helonias, Oat husks, Prickly Ash, Sage, Wild Yam.

Tea. Oats (mineral nutrient for wasting diseases) 2; Boneset (anti-inflammatory) 1; Valerian (mild analgesic) 1; Liquorice quarter. Mix. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Decoction. Cramp bark 1; White Willow 2. Mix. 4 heaped teaspoons to 1 pint (500ml) water gently simmered 20 minutes. Dose: half-1 cup thrice daily.

Tablets/capsules. Cramp bark, Devil’s Claw, Echinacea, Helonias, Prickly Ash, Wild Yam.

Formula. Devil’s Claw 1; Black Cohosh 1; Valerian 1; Liquorice quarter. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action enhanced when taken in cup of Fenugreek tea. Thrice daily. Every 2 hours acute cases.

Practitioner’s analgesic. Tincture Gelsemium: 10 drops in 100ml water. Dose: 1 teaspoon every 2 hours (inflammatory stage).

Topical. Comfrey root poultice.

Diet. High protein, low salt, low fat. Oily fish.

Supplements. Daily. Vitamin C (500mg); Vitamin D (1000mg); Calcium citrate (1 gram); Dolomite (1 gram); Beta-Carotene (7500iu). Kelp. ... paget’s disease

Carpal Tunnel Syndrome

A condition characterised by attacks of pain and tingling in the ?rst three or four ?ngers of one or both hands. The attacks usually occur at night. Carpal tunnel syndrome is caused by pressure on the median nerve as it passes under the strong ligament that lies across the front of the wrist. The condition may respond to use of a night splint on the hand; otherwise a corticosteroid injection under the ligament may help. If not, pressure is relieved by surgical division of the compressing ligament.... carpal tunnel syndrome

Compression Syndrome

See MUSCLES, DISORDERS OF.... compression syndrome

Crohn’s Disease

Also called regional enteritis or regional ileitis, this is a nonspecific inflammatory disease of the upper and lower intestine that forms granulated lesions. It is usually a chronic condition, with acute episodes of diarrhea, abdominal pain, loss of appetite, and loss of weight. It may affect the stomach or colon, but the most common sites are the duodenum and the lowest part of the small intestine, the lower ileum. The standard treatment is, initially, anti-inflammatory drugs, with surgical resectioning often necessary. The disease is autoimmune, and sufferers share the same tissue type (HLA-B27) as those who acquire ankylosing spondylitis.... crohn’s disease

Fibrocystic Disease Of The Pancreas

See CYSTIC FIBROSIS.... fibrocystic disease of the pancreas

Graves’ Disease

See THYROID GLAND, DISEASES OF.... graves’ disease

Haemolytic Uraemic Syndrome

A disease of children resulting in acute RENAL failure. A febrile illness of the gastrointestinal or respiratory tracts is followed by intravascular COAGULATION of blood which results in HAEMOLYSIS, ANAEMIA, THROMBOCYTOPAENIA and renal failure (resulting from ?brin deposition in renal arterioles and glomerular capillaries).

The death rate is 2–10 per cent and the majority of patients survive without renal failure. The longer the period of OLIGURIA, the greater the risk of chronic renal failure.

Treatment is supportive, with replacement of blood and clotting factors, control of HYPERTENSION, and careful observation of ?uid balance.... haemolytic uraemic syndrome

Hellp Syndrome

A type of severe PRE-ECLAMPSIA (a disorder affecting some pregnant women) that affects various systems in the body. HAEMOLYSIS, raised concentration of the enzymes in the LIVER, and a low blood platelet count are among the characteristics (and explain the name HELLP); patients are acutely ill and immediate termination of pregnancy is necessary. (See also PREGNANCY AND LABOUR.)... hellp syndrome

Iatrogenic Disease

Disease induced by a physician: most commonly a drug-induced disease.... iatrogenic disease

Hyaline Membrane Disease

A form of ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) found in premature infants and some of those born by CAESAREAN SECTION, characterised by the onset of di?culty in breathing a few hours after birth. Most require extra oxygen and many need mechanical ventilation for a few days or even weeks. Recovery is the rule, although the most severely affected may die or suffer damage from oxygen lack. In this condition the ALVEOLITIS and the ?ner BRONCHIOLES of the lungs are lined with a dense membrane. The cause of the condition is a de?ciency of SURFACTANT in the lung passages which adversely affects gas exchanges in the alveoli.

Treatment includes the full gamut of neonatal intensive care, as well as speci?c therapy with PULMONARY SURFACTANT.... hyaline membrane disease

Irritable Bowel Syndrome (ibs)

A disorder of the intestinal tract that affects its motility and causes abdominal distension and irregular defaecation. Traditional, but now discarded, names have been spastic or irritable colon. The disease affects around 20 per cent of the general population but in most it is no more than a minor nuisance. The causes are not fully understood, but it is generally believed that symptoms develop in response to psychological factors, changed gastrointestinal motility, or altered visceral sensation. About 50 per cent of patients meet criteria for a psychiatric diagnosis. Anxiety, depression, neurosis, panic attacks, acute disease are among possible triggering factors. Some patients have diarrhoea, others are constipated, and some alternate between the two. Many have increased sensitivity to distension of the intestine. Dietary factors such as intolerance to dairy products and wheat are apparent in certain patients.

Common features of IBS include:

abdominal distension.

altered bowel habit.

colicky lower abdominal pain, eased by defaecation.

mucous discharge from rectum.

feelings of incomplete defaecation.

Investigations usually produce normal results. Positive diagnosis in people under 40 is usually straightforward. In older patients, however, barium ENEMA, X-rays and COLONOSCOPY should be done to exclude colorectal cancer.

Reassurance is the initial and often e?ective treatment. If this fails, treatment should be directed at the major symptoms. Several months of the antidepressant amitriptyline (see ANTIDEPRESSANT DRUGS) may bene?t patients with intractable symptoms, given at a dose lower than that used to treat depression. The majority of patients follow a relapsing/remitting course, with episodes provoked by stressful events in their daily lives. (See also INTESTINE, DISEASES OF.)... irritable bowel syndrome (ibs)

Locked-in Syndrome

This describes a condition in which a patient is awake and retains the power of sense perception, but is unable to communicate except by limited eye movements because the motor nervous system is paralysed. Several diseases can cause this syndrome, which results from interruption of some of the nerve tracts between the mid brain and the pons (see BRAIN). Sometimes the syndrome is caused by severe damage to muscles or the nerves enervating them. Locked-in syndrome may sometimes be confused with a PERSISTENT VEGETATIVE STATE (PVS).... locked-in syndrome

Malabsorption Syndrome

This term includes a multiplicity of diseases, all of which are characterised by faulty absorption from the INTESTINE of essential foodstu?s such as fat, vitamins and mineral salts. Among the conditions in this syndrome are COELIAC DISEASE, SPRUE, CYSTIC FIBROSIS and pancreatitis (see PANCREAS, DISORDERS OF). Surgical removal of the small intestine also causes the syndrome. Symptoms include ANAEMIA, diarrhoea, OEDEMA, vitamin de?ciencies, weight loss and, in severe cases, MALNUTRITION.... malabsorption syndrome

Notifiable Disease

An infectious or other disease required to be notified to the relevant State Government Authorityfor entry onto the Notifiable Diseases Register.... notifiable disease

Organic Disease

A disease that started as, or became, impairment of structure or tissue. The smoker may have coughing and shortness of breath for years, and suffer from functional disorders; when the smoker gets emphysema, it is an organic disease.... organic disease

Motor Neurone Disease (mnd)

A group of disorders of unknown origin. Certain cells in the neurological system’s MOTOR nerves degenerate and die. Upper and lower motor neurones may be affected but sensory cells retain their normal functions. Three types of MND are identi?ed: amyotrophic lateral sclerosis (AML – 50 per cent of patients); progressive muscular atrophy (25 per cent), in which the prognosis is better than for AML; and bulbar palsy (25 per cent). Men are affected more than women, and the disorder affects about seven people in every 100,000. Those affected develop progressive weakness and wasting of their muscles. The diagnosis is con?rmed with various tests including the measurement of electrical activity in muscles, electromyography, muscle BIOPSY, blood tests and X-ray examination of the spine. There is no medical treatment: patients need physical and psychological support with aids to help them overcome disabilities. The Motor Neurone Disease Association provides excellent advice and help for sufferers and their relatives. (See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP.)... motor neurone disease (mnd)

Parrot Disease

See PSITTACOSIS.... parrot disease

Plummer-vinson Syndrome

Hypochromic ANAEMIA and di?culty in swallowing due to an oesophageal web.... plummer-vinson syndrome

Post-viral Fatigue Syndrome

See MYALGIC ENCEPHALOMYELITIS (ME).... post-viral fatigue syndrome

Mendelson Syndrome

Inhalation of regurgitated stomach contents, usually as a complication of general ANAESTHESIA. It may cause death from ANOXIA or result in extensive lung damage.... mendelson syndrome

Prescribed Diseases

A collection of industrial diseases which provide those with a disease legal entitlement to welfare bene?ts. Examples are DEAFNESS from excessive noise in the workplace; ANTHRAX from farming; PNEUMOCONIOSIS from industrially generated dust (coal mining); and LEAD POISONING from the handling of chemicals. (See also OCCUPATIONAL HEALTH, MEDICINE AND DISEASES.)... prescribed diseases

Restless Legs Syndrome

A condition in which the patient experiences unpleasant sensations, and occasionally involuntary movements, in the legs when at rest, especially at night. No pathological changes have been identi?ed. It is sometimes indicative of iron-de?ciency ANAEMIA, but in many cases the cause remains a mystery and the variety of cures o?ered are a testimony to this. Some anti-epileptic drugs are said to help (see EPILEPSY).... restless legs syndrome

Seasonal Affective Disorder Syndrome

Known colloquially as SADS, this is a disorder in which an affected individual’s mood changes with the seasons. He or she is commonly depressed in winter, picking up again in the spring. The diagnosis is controversial and its prevalence is not known. The mood-change is probably related to light, with MELATONIN playing a key role. (See also MENTAL ILLNESS.)... seasonal affective disorder syndrome

Simmonds’ Disease

A rare condition in which wasting of the skin and the bones, IMPOTENCE, and loss of hair (ALOPECIA) occur as a result of destruction of the PITUITARY GLAND.... simmonds’ disease

Stokes-adams Syndrome

A term applied to a condition in which slowness of the PULSE is associated with attacks of unconsciousness, and which is due to ARRHYTHMIA of the cardiac muscle or even complete heart block. Usually the heart returns to normal rhythm after a short period, but patients who suffer from the condition are commonly provided with a PACEMAKER to maintain normal cardiac function (see also CARDIAC PACEMAKER).... stokes-adams syndrome

Tay Sachs Disease

An inherited recessive condition in which there is abnormal accumulation of lipids (see LIPID) in the BRAIN. The result is blindness, mental retardation and death in early childhood. The disease can usually be prevented by genetic counselling in those communities in which the disease is known to occur.... tay sachs disease

Peripheral Vascular Disease

The narrowing of the blood vessels in the legs and, less commonly, in the arms. Blood ?ow is restricted, with pain occurring in the affected area. If the blood supply is seriously reduced, GANGRENE of the tissues supplied by the affected vessel(s) may occur and the limb may need to be amputated. The common cause is ATHEROSCLEROSIS which may be brought on by HYPERTENSION, excessively fatty diet, poorly controlled DIABETES MELLITUS or smoking – the latter being the biggest risk factor, with 90 per cent of affected patients having been moderate to heavy smokers. Stopping smoking is essential; adequate exercise and a low-fat diet are important measures. Surgery may be required.... peripheral vascular disease

Perthes’ Disease

A condition of the hip in children, due to death and fragmentation of the epiphysis (or spongy extremity) of the head of the femur. The cause is not known. The disease occurs in the 4–10 year age-group, with a peak between the ages of six and eight; it is ten times more common in boys than girls, and is bilateral in 10 per cent of cases. The initial sign is a lurching gait with a limp, accompanied by pain. Treatment consists of limiting aggressive sporting activity which may cause intact overlying CARTILAGE to loosen. Where there are no mechanical symptoms and MRI scanning shows that the cartilage is intact, only minor activity modi?cation may be necesssary – but for several months or even years. Any breach in the cartilage is dealt with at ARTHROSCOPY by ?xing or trimming any loose ?aps. Eventually the disease burns itself out.... perthes’ disease

Polycystic Ovary Syndrome

Characterised by scanty (or absent) MENSTRUATION, INFERTILITY, hirsutism (excessive hairiness) and OBESITY and the sufferers often have multiple cysts in their OVARIES.

The condition is caused by an imbalance between LUTEINISING HORMONE (LH) and FOLLICLE-STIMULATING HORMONE (FSH); this imbalance stops OVULATION and varies the TESTOSTERONE output of the ovaries. The treatment may be with CLOMIPHENE; with a PROGESTOGEN drug; with LUTEINISING HORMONE-RELEASING HORMONE (LHRH); or with oral contraceptives (see under CONTRACEPTION – Non-barrier methods). The treatment chosen depends on the severity of the disease and whether the woman wants to conceive. Rarely a section of ovarian tissue is surgically removed.... polycystic ovary syndrome

Venereal Diseases

See SEXUALLY TRANSMITTED DISEASES (STDS).... venereal diseases

Weil’s Disease

Epidemic jaundice. A severe form of leptospirosis caused by such serovars as Leptospira icterrohaemorrhagiae.... weil’s disease

Respiratory Distress Syndrome

This may occur in adults as ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS), or in newborn children, when it is also known as HYALINE MEMBRANE DISEASE. The adult syndrome consists of PULMONARY OEDEMA of non-cardiac origin. The process begins when tissue damage stimulates the autonomic nervous system, releases vasoactive substances, precipitates complement activation, and produces abnormalities of the clotting cascade – the serial process that leads to clotting of the blood (see COAGULATION). The activation of complement causes white cells to lodge in the pulmonary capillaries where they release substances which damage the pulmonary endothelium.

Respiratory distress syndrome is a complication of SHOCK, systemic SEPSIS and viral respiratory infections. It was ?rst described in 1967, and – despite advances with assisted ventilation

– remains a serious disease with a mortality of more than 50 per cent. The maintenance of adequate circulating blood volume, peripheral PERFUSION, acid-base balance and arterial oxygenation is important, and assisted ventilation should be instituted early.

In newborns the mechanism is diferent, being provoked by an inability of the lungs to manufacture SURFACTANT.... respiratory distress syndrome

Zollinger-ellison Syndrome

A rare disorder in which severe peptic ulcers recur in the stomach and duodenum (see DUODENAL ULCER; STOMACH, DISEASES OF). It is caused by a tumour in the PANCREAS that produces a hormone, GASTRIN, which stimulates the stomach and duodenum to produce excess acid: this causes ulceration. Treatment is by surgery.... zollinger-ellison syndrome

Gastro-oesophageal Reflux Disease

See: REFLUX. ... gastro-oesophageal reflux disease

Osgood Schlatter Disease

Degenerative changes in the growth centres of bones in children due to calcium or other mineral deficiency. Herbs rich in calcium, iron, and magnesium are indicated. (Horsetail, Chamomile, Plantain, Silverweed, Nettles, Mullein, etc)

Selenium 50mcg and Vitamin E 400iu are recommended by Jonathan Wright MD, for decreasing the pain of disease, decreasing over 3 months. (Health Update USA, June 1990) ... osgood schlatter disease

Asperger’s Syndrome

A rare developmental disorder that is usually first recognized in childhood because of difficulties with social interactions, stilted speech, and very specialized interests.

Intelligence is normal or high.

Asperger’s syndrome is considered to be an autistic spectrum disorder and is also known as pervasive developmental disorder.

Special educational support may be needed, often within mainstream education.

The condition is lifelong.... asperger’s syndrome

Behçet’s Syndrome

A rare, multisystem disorder with recurrent mouth ulcers and genital ulcers and inflammation of the eyes, skin joints, blood vessels, brain, and intestines. The cause of Behçet’s syndrome is unknown, but it is strongly associated with a genetically determined histocompatability antigen, -B51. Treatment is difficult and may require corticosteroid and immunosuppressant drugs. The condition often becomes long-term.... behçet’s syndrome

Bowen’s Disease

A rare skin disorder that sometimes becomes cancerous. A flat, regular-shaped, patch of red, scaly skin forms, most commonly on the face or hands. The diseased skin is removed surgically or destroyed by freezing or cauterization.... bowen’s disease

Tropical Diseases

Technically, those diseases occurring in the area of the globe situated between the Tropic of Cancer and the Tropic of Capricorn: pertaining to the sun. They include many ‘exotic’ infections – many of them parasitic in origin – which fall under the umbrella of ‘TROPICAL MEDICINE’. However, disease in the tropics is far broader than this and includes numerous other infections, many of them with a viral or bacterial basis: for example, the viral hepatidises, streptococcal and pneumococcal infections, and tuberculosis. The prevalence of other diseases, such as rheumatic cardiac disease, cirrhosis, heptocellular carcinoma (‘hepatoma’), and various nutrition-related problems, is also much increased in most areas of the tropics. With people from developed countries increasingly travelling to worldwide destinations for business and holiday, the ‘importation’ of tropical diseases to temperate climates should be borne in mind when people fall ill.

The following diseases and conditions are treated under their separate dictionary entries: ANCYLOSTOMIASIS; BERIBERI; BLACKWATER FEVER; CHOLERA; DENGUE; DRACONTIASIS; DYSENTERY; ELEPHANTIASIS; FILARIASIS; HEAT STROKE; LEISHMANIASIS; LEPROSY; LIVER, DISEASES OF; MALARIA; ORIENTAL SORE; PLAGUE; PRICKLY HEAT; SCHISTOSOMIASIS; SLEEPING SICKNESS; STRONGYLOIDIASIS; SUNBURN; YAWS; YELLOW FEVER.... tropical diseases

Bright’s Disease

Another name for glomerulonephritis.... bright’s disease

Cerebrovascular Disease

Any disease affecting an artery in, and supplying blood to, the brain: for example, atherosclerosis (narrowing of the arteries) or defects or weaknesses in arterial walls causing aneurysm (a balloon-like swelling in an artery).

The disease may eventually cause a cerebrovascular accident, which commonly leads to a stroke.

Extensive narrowing of blood vessels throughout the brain can be a cause of dementia.... cerebrovascular disease

Chronic Obstructive Pulmonary Disease

See pulmonary disease, chronic obstructive.... chronic obstructive pulmonary disease

Compartment Syndrome

A painful cramp due to compression of a group of muscles within a confined space. It may occur when muscles are enlarged due to intensive training or injury such as shin splints. Cramps induced by exercise usually disappear when exercise is stopped. Severe cases may require fasciotomy to improve blood flow and prevent development of a permanent contracture.... compartment syndrome

Conn’s Syndrome

A disorder caused by the secretion of excessive amounts of the hormone aldosterone by a noncancerous tumour of one of the adrenal glands. (See also aldosteronism.)... conn’s syndrome

Cri Du Chat Syndrome

A rare, congenital condition of severe mental handicap, abnormal facial appearance, low birth weight, and short stature, which is characterized by a cat-like cry in infancy. The syndrome is caused by a chromosomal abnormality. There is no treatment. (See also genetic counselling.)... cri du chat syndrome

Buerger’s Disease

(Thromboangiitis obliterans). An inflammatory condition of blood vessels of the legs, tobacco said to be the causative factor. Confined to men, especially Jews.

Symptoms. Intermittent claudication. Affected parts of the leg are much paler than others, the condition regressing to ulceration and possible gangrene. Inflammation of nerves, veins and arteries may lead to clot formation (thrombosis).

Treatment. Stop smoking. Vasodilator herbs.

Alternatives. Cayenne (minute doses), Bayberry, Lime flowers, Lobelia, Prickly Ash, Wahoo bark, Mistletoe, Skullcap, Cactus.

BHP (1983) recommends: Angelica root, Hawthorn berry, Wild Yam.

Decoction. Formula. Equal parts: Hawthorn, Mistletoe, Valerian. 2 teaspoons to two cups water gently simmered 10 minutes. Dose half-1 cup thrice daily, and when necessary.

Tablets/capsules. Alternatives. Prickly Ash 100mg. Hawthorn 200mg. Wild Yam 200mg. Dosage as on bottles.

Powders. Formula. Equal parts: Hawthorn, Wild Yam, Prickly Ash. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Bayberry, Hawthorn, Prickly Ash. Dose: 1-2 teaspoons thrice daily. Practitioner. Tincture Gelsemium BPC (1973). 0.3ml (5 drops) when necessary for relief of pain.

Diet. Low fat, low salt, high fibre.

Supplements. Daily. Vitamin E 1000-1500iu. Vitamin B-complex. Magnesium, Calcium.

Exercise. Physiotherapy exercise. From the sitting position raise legs to horizontal; rest for a few minutes. Lie down and raise legs to 45 degrees; rest for a few minutes. Reverse movements resting each time to equalise the circulation. (Brenda Cooke FNIMH) ... buerger’s disease

Fanconi’s Syndrome

A rare kidney disorder that occurs most commonly in childhood. Various important chemicals, such as amino acids, phosphate, calcium, and potassium, are lost in the urine, leading to failure to thrive, stunting of growth, and bone disorders such as rickets. Possible causes of the syndrome include several rare inherited abnormalities of body chemistry and an adverse reaction to certain drugs.

The child may resume normal growth if an underlying chemical abnormality can be corrected. Alternatively, a kidney transplant may be possible.... fanconi’s syndrome

Carcinoid Syndrome

Flushing of the face and neck caused by an active malignant tumour in the stomach or intestines with secondary growths in the liver. Often accompanied by an explosive diarrhoea. The lesion is usually found in the ileum yet it may also appear in the bile duct, ovaries or bronchi. Other symptoms include low blood pressure, drastic reduction in weight due to loss of body fluids.

Symptoms: flushing of face and neck, diarrhoea, low blood pressure, weight loss.

Treatment: relief of symptoms only. Diarrhoea – Fenugreek seed tea. Flushing: Chamomile tea.

Vitamin and Mineral Supplementation: Because of severe drain on these food elements Multivitamins should be taken daily together with additional 1000ius Vitamin E for the disturbed circulatory system. The heart should be sustained with a preparation of the Hawthorn berry.

To be treated by or in liaison with a qualified medical practitioner. ... carcinoid syndrome

Fragile X Syndrome

An inherited defect of the X chromosome that causes learning difficulties.

The disorder occurs within families according to an X-linked recessive pattern of inheritance (see genetic disorders).

Although mainly males are affected, women can become carriers of the genetic defect.

In addition to having learning difficulties, affected males tend to be tall and physically strong, with large testes, a prominent nose and jaw, increased ear length, and are prone to epileptic seizures.

About a third of female carriers show some intellectual impairment.

The condition cannot be treated.... fragile x syndrome

Coronary Heart Disease

The cause of: coronary occlusion, coronary blockage, coronary thrombosis. A heart attack occurs when a coronary artery becomes blocked by swellings composed, among other things, of cholesterol. Such swellings may obstruct the flow of blood leading to a blood clot (thrombus). Cholesterol is a major cause of CHD.

Coronary thrombosis is more common in the West because of its preference for animal fats; whereas in the East fats usually take the form of vegetable oils – corn, sunflower seed, sesame, etc. Fatty deposits (atheroma) form in the wall of the coronary artery, obstructing blood-flow. Vessels narrowed by atheroma and by contact with calcium and other salts become hard and brittle (arterio-sclerosis) and are easily blocked. Robbed of oxygen and nutrients heart muscle dies and is replaced by inelastic fibrous (scar) tissue which robs the heart of its maximum performance.

Severe pain and collapse follow a blockage. Where only a small branch of the coronary arterial tree is affected recovery is possible. Cause of the pain is lack of oxygen (Vitamin E). Incidence is highest among women over 40 who smoke excessively and who take The Pill.

The first warning sign is breathlessness and anginal pain behind the breastbone which radiates to arms and neck. Sensation as if the chest is held in a vice. First-line agent to improve flow of blood – Cactus.

For cholesterol control target the liver. Coffee is a minor risk factor.

Measuring hair calcium levels is said to predict those at risk of coronary heart disease. Low hair concentrations may be linked with poor calcium metabolism, high aortic calcium build-up and the formation of plagues. (Dr Allan MacPherson, nutritionist, Scottish Agricultural College, Ayr, Scotland)

Evidence has been advanced that a diagonal ear lobe crease may be a predictor for coronary heart disease. (American Journal of Cardiology, Dec. 1992)

Tooth decay is linked to an increased risk of coronary heart disease and mortality, particularly in young men. (Dr Frank De Stefano, Marshfield Medical Research Foundation, Wisconsin, USA) Treatment. Urgency. Send for doctor or suitably qualified practitioner. Absolute bedrest for 3 weeks followed by 3 months convalescence. Thereafter: adapt lifestyle to slower tempo and avoid undue exertion. Stop smoking. Adequate exercise. Watch weight.

Cardiotonics: Motherwort, Hawthorn, Mistletoe, Rosemary. Ephedra, Lily of the Valley, Broom.

Cardiac vasodilators relax tension on the vessels by increasing capacity of the arteries to carry more blood. Others contain complex glycosides that stimulate or relax the heart at its work. Garlic is strongly recommended as a preventative of CHD.

Hawthorn, vasodilator and anti-hypertensive, is reputed to dissolve deposits in thickened and sclerotic arteries BHP (1983). It is believed to regulate the balance of lipids (body fats) one of which is cholesterol.

Serenity tea. Equal parts: Motherwort, Lemon Balm, Hawthorn leaves or flowers. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.

Decoction. Combine equal parts: Broom, Lily of the Valley, Hawthorn. 1-2 teaspoons to each cup water gently simmered 20 minutes. Half-1 cup freely.

Tablets/capsules. Hawthorn, Motherwort, Cactus, Mistletoe, Garlic.

Practitioner. Formula. Hawthorn 20ml; Lily of the Valley 10ml; Pulsatilla 5ml; Stone root 5ml; Barberry 5ml. Tincture Capsicum 1ml. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.

Prevention: Vitamin E – 400iu daily.

Diet. See: DIET – HEART AND CIRCULATION.

Supplements. Daily. Vitamin C, 2g. Vitamin E possesses anti-clotting properties, 400iu. Broad spectrum multivitamin and mineral including chromium, magnesium selenium, zinc, copper.

Acute condition. Strict bed-rest; regulate bowels; avoid excessive physical and mental exertion. Meditation and relaxation techniques dramatically reduce coronary risk. ... coronary heart disease

Ganser’s Syndrome

A rare factitious disorder in which a person seeks, consciously or unconsciously, to mislead others about his or her mental state and may simulate symptoms of psychosis.... ganser’s syndrome

Gaucher’s Disease

A genetic disorder in which the lack of the enzyme glucocerebrosidase leads to accumulation of a fatty substance, glucosylceramide, in the liver, spleen, bone marrow, and, sometimes, in the brain.

It is treated by regular injections of the missing enzyme.... gaucher’s disease

Gilles De La Tourette’s Syndrome

A rare, inherited neurological disorder.

It starts in childhood with repetitive grimaces and tics.

Involuntary barks, grunts, or other noises may appear as the disease progresses.

In some cases, the sufferer has episodes of issuing foul language.

The syndrome is more common in males.

It is usually of lifelong duration, but antipsychotic drugs can help in some cases.... gilles de la tourette’s syndrome

Goodpasture’s Syndrome

A rare autoimmune disorder causing inflammation of the glomeruli in the kidney (see glomerulus) and the alveoli in the lungs, and anaemia. It is a serious disease; unless treated early it may lead to lifethreatening bleeding into the lungs and progressive kidney failure. The disease is most common in young men, but can develop at any age and in women. Sometimes, it responds to treatment with immunosuppressant drugs and plasmapheresis. People who have severe or repeated attacks require dialysis and, eventually, a kidney transplant.... goodpasture’s syndrome

Graft-versus-host Disease

A complication of a bone marrow transplant in which immune system cells in the transplanted marrow attack the recipient’s tissues. Graft-versus-host (GVH) disease may occur soon after transplantation or appear some months later. The first sign is usually a skin rash. This may be followed by diarrhoea, abdominal pain, jaundice, inflammation of the eyes and mouth, and breathlessness.

GVH disease can usually be prevented by administration of immunosuppressant drugs. If the disease develops, it can be treated with corticosteroid drugs and immunosuppressant drugs such as ciclosporin In some cases, however, it can be difficult to control.... graft-versus-host disease

Horner’s Syndrome

A group of physical signs (narrowing of the eye pupil, drooping of the eyelid, and absence of sweating) affecting 1 side of the face that indicates damage to part of the sympathetic nervous system (see autonomic nervous system).... horner’s syndrome

Huntington’s Disease

An uncommon disease in which degeneration of the basal ganglia results in chorea and dementia. Symptoms of Huntington’s disease do not usually appear until age 35–50. The disease is due to a defective gene and is inherited in an autosomal dominant manner (see genetic disorders).

The chorea usually affects the face, arms, and trunk, resulting in random grimaces and twitches, and clumsiness. Dementia takes the form of irritability, personality and behavioural changes, memory loss, and apathy.

At present, there is no cure for Huntington’s disease, and treatment is aimed at reducing symptoms with drugs.... huntington’s disease

Hurler’s Syndrome

A rare, inherited condition caused by an enzyme defect. The syndrome is a type of inborn error of metabolism (see metabolism, inborn errors of) in which there is an abnormal accumulation of substances known as mucopolysaccharides in the tissues.

Affected children may appear normal at birth but, at 6–12 months of age, they develop cardiac abnormalities, umbilical hernia, skeletal deformities, and enlargement of the tongue, liver, and spleen.

Growth is limited and mental development slows.

If the condition is diagnosed in early infancy, a bone marrow transplant may be curative.... hurler’s syndrome

Inflammatory Bowel Disease

A collective term for chronic disorders affecting the small and/or large intestine that cause abdominal pain, bleeding, and diarrhoea. Crohn’s disease and ulcerative colitis are the most common types of inflammatory bowel disease.... inflammatory bowel disease

Lou Gehrig’s Disease

The most common type of motor neuron disease; also known as amyotrophic lateral sclerosis.... lou gehrig’s disease

Hashimoto’s Disease

Hashimoto’s thyroiditis. Inflammation of the Thyroid gland with increase of fibrous tissue and intrusion of excess white blood cells. Forerunner of myxoedema. It is an auto-immune disorder resulting in thyroid damage. Middle-aged women prone. Painless swelling.

Alternatives. Treatment. Echinacea is the key remedy.

Others indicated: Red Clover flower, Blue Flag root, Horsetail, Poke root, Bladderwrack. May be taken singly, as available.

Tea: Combine Bladderwrack 2; Echinacea 2; Horsetail 1. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup thrice daily.

Tinctures. Combine: Bladderwrack 2; Echinacea 2; Horsetail 1. Dose: one to two 5ml teaspoons in water thrice daily.

Diet. Iodised salt. Avoid cabbage which contains a factor which depresses the thyroid gland. Supplementation. Vitamin A. B-complex. Kelp. ... hashimoto’s disease

Marble Bone Disease

See osteopetrosis.... marble bone disease

Mcardle’s Disease

A rare genetic disorder characterized by muscle stiffness and painful cramps that increase during exertion and afterwards. The cause is a deficiency of an enzyme in muscle cells that stimulates breakdown of the carbohydrate glycogen into the simple sugar glucose. The result is a build-up of glycogen and low levels of glucose in the muscles. Damage to the muscles occurs, causing myoglobinuria (muscle-cell pigment in the urine), which may lead to kidney failure. There is no treatment, but symptoms may be relieved by eating glucose or fructose before exercise.... mcardle’s disease

Heart Disease – Congenital

Heart disease arising from abnormal development. Some cases are hereditary, others due to drugs taken during pregnancy. Many owe their origin to illnesses of the mother such as German measles. Structural abnormalities of the heart take different forms but whatever the case, when under abnormal pressure and stress, all may derive some small benefit from the sustaining properties of Hawthorn berry and other phytomedicines.

Alternatives. To sustain.

Teas. Lime flowers, Motherwort, Buckwheat, Hawthorn.

Tablets/capsules. Hawthorn, Mistletoe, Motherwort.

Formula. Hawthorn 2; Lily of the Valley 1; Selenicereus grandiflorus 1. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water morning and evening. ... heart disease – congenital

Minamata Disease

The name given to a severe form of mercury poisoning that occurred in the mid-1950s, in people who had eaten polluted fish from Minamata Bay, Japan.

Many people suffered severe nerve damage and some died.... minamata disease

Munchausen’s Syndrome

A chronic factitious disorder in which the sufferer complains of physical symptoms that are pretended or self-induced in order to play the role of patient. Most afflicted people are repeatedly hospitalized.

The usual complaints are abdominal pain, bleeding, neurological symptoms, rashes, and fever. Sufferers typically invent dramatic histories and behave disruptively in hospital. Many have detailed medical knowledge and scars from self-injury or previous treatment. In Munchausen’s syndrome by proxy, parents cause factitious disorders in their children.

Treatment consists of protecting sufferers from unnecessary operations and drug treatments.... munchausen’s syndrome

Nelson’s Syndrome

A rare disorder of the endocrine system that causes increased skin pigmentation. Nelson’s syndrome results from enlargement of the pituitary gland, which can follow removal of the adrenal glands (a treatment for Cushing’s syndrome).

Nelson’s syndrome is treated by hypophysectomy (removal or destruction of the pituitary gland).... nelson’s syndrome

Obstructive Airways Disease

See pulmonary disease, chronic obstructive.... obstructive airways disease

Notifiable Diseases

Notifiable diseases under the Public Health (Control of Disease Act, 1984) are:–

Acute encephalitis, acute meningitis, acute poliomyelitis, anthrax, cholera, diphtheria, dysentery (amoebic and bacillary), food poisoning, infective jaundice, leprosy, leptospirosis, lassa fever, mumps, malaria, marburg disease, measles, German measles, ophthalmia neonatorum, paratyphoid fever, plague, rabies, relapsing fever, scarlet fever, smallpox, tetanus, tuberculosis, typhoid fever, typhus, viral haemorrhagic fever, whooping cough and yellow fever.

Six communicable diseases are internationally notifiable to the World Health Organisation: yellow fever, plague, cholera, smallpox, louse-borne relapsing fever, louse-borne typhus.

Notification has to be made to local and central Government authorities. Certain occupational diseases and all cases of cancer must be registered and notified.

It is required that the above diseases and certain others receive modern medical therapy in a hospital or treatment under the supervision of a qualified physician. Failure to conform may expose a practitioner, registered or unregistered, to a charge of negligence. ... notifiable diseases

Periodontal Disease

Any disorder of the periodontium (the tissues that surround and support the teeth).... periodontal disease

Peyronie’s Disease

A disorder of the penis in which part of the sheath of fibrous connective tissue thickens, causing the penis to bend during erection. This commonly makes intercourse difficult and painful. Eventually, some of the penile erectile tissue may also thicken. Men over 40 are most often affected. The cause is unknown. The disease may improve without treatment. Otherwise, local injections of corticosteroid drugs or surgical removal of the thickened area and replacement with normal tissue may be carried out.... peyronie’s disease

Coronary Artery Disease

Narrowing of the coronary arteries, which supply blood to the heart, leading to damage or malfunction of the heart. The most common heart disorders due to coronary artery disease are angina pectoris and myocardial infarction (heart attack). The usual cause of narrowing of the arteries is atherosclerosis, in which fatty plaques develop on the artery linings. The vessel can become totally blocked if a blood clot forms or lodges in the narrowed area. Atherosclerosis has many interrelated causes including smoking, a high-fat diet, lack of exercise, being overweight, and raised blood cholesterol levels. Other factors include a genetic predisposition and diseases such as diabetes mellitus and hypertension.

The first symptom of coronary artery disease is frequently the chest pain of angina. Treatment is with drugs such as glyceryl trinitrate and other nitrate drugs, beta-blockers, calcium channel blockers, potassium channel activators, and vasodilator drugs. If drug treatment fails to relieve the symptoms, or there is extensive narrowing of the coronary

arteries, blood flow may be improved by balloon angioplasty or coronary artery bypass surgery.... coronary artery disease

Rett’s Syndrome

A brain disorder, thought to be a genetic disorder, that only affects girls. Symptoms usually occur when the child is 12–18 months old. Acquired skills, such as walking and communication skills, disappear and the girl becomes progressively handicapped, perhaps with signs of autism. There are repetitive writhing movements of the hands and limbs, and inappropriate outbursts of crying or laughter. There is no cure for Rett’s syndrome and sufferers need constant care and attention. Parents of an affected child should receive genetic counselling.... rett’s syndrome

Sézary Syndrome

A rare condition in which there is an abnormal overgrowth of lymphocytes in the skin, liver, spleen, and lymph nodes. It mainly affects middleaged and elderly people. The first symptom is the appearance of red, scaly patches on the skin that spread to form an itchy, flaking rash. There may also be accumulation of fluid under the skin, baldness, and distorted nail growth. Sézary syndrome is sometimes associated with leukaemia. Treatment includes anticancer drugs and radiotherapy.... sézary syndrome

Fifth Disease

An infectious disease that causes a widespread rash. Also known as slapped cheek disease or erythema infectiosum, fifth disease mainly affects children and is caused by a virus called parvovirus. The rash starts on the cheeks as separate, rose-red, raised spots, which subsequently converge to give the characteristic appearance. Within a few days, the rash spreads in a lacy pattern over the limbs but only sparsely on the trunk. It is often accompanied by mild fever. The rash usually clears after about 10 days. Adults, who contract the disease only rarely, may have joint pain and swelling lasting for up to 2 years. The incubation period is 7 to 14 days, and the only treatment is drugs to reduce the fever.... fifth disease

Hirschsprung’s Disease

A congenital disorder in which the rectum, and sometimes the lower part of the colon, lack the ganglion cells that control the intestine’s rhythmic contractions. The affected area becomes narrowed and blocks the movement of faecal material.

The disease is rare and tends to run in families. It occurs about 4 times more often in boys. Symptoms, which include constipation and bloating, usually develop in the first few weeks of life, but may become evident in infancy or early childhood. The child usually has a poor appetite and may fail to grow properly.

A barium X-ray examination can show the narrowed segment of the intestine.

A biopsy may be taken.

Treatment of Hirschsprung’s disease involves removing the narrowed segment and rejoining the normal intestine to the anus.... hirschsprung’s disease

Sjögren’s Syndrome

A condition in which the eyes and mouth are excessively dry.

The nasal cavity, throat, and vagina may also be affected.

The syndrome tends to occur with certain autoimmune disorders, such as rheumatoid arthritis and systemic lupus erythematosus.

Most sufferers are middle-aged women.... sjögren’s syndrome

Klinefelter’s Syndrome

A chromosomal abnormality in which a male has 1, or occasionally more, extra X chromosomes in his cells, giving a complement of instead of. The risk of a baby having the condition increases with maternal age. Features of the syndrome vary in severity and may not become apparent until puberty, when gynaecomastia (breast enlargement) occurs and the testes remain small. Affected males are usually infertile (see infertility). They tend to be tall and thin with a female body shape and absence of body hair. Incidence of learning difficulties is higher in people with Klinefelter’s syndrome than in the general population. There is no cure for the disorder, but hormonal treatment can induce secondary sexual characteristics, and mastectomy may be used to treat gynaecomastia.... klinefelter’s syndrome

Motor Neuron Disease

A group of disorders in which there is degeneration of the nerves in the central nervous system that control muscular activity. This causes weakness and wasting of the muscles. The cause is unknown.

The most common type of motor neuron disease is amyotrophic lateral sclerosis ( or Lou Gehrig’s disease). It usually affects people over the age of 50 and is more common in men. Some cases run in families. Usually, symptoms start with weakness in the hands and arms or legs, and muscle wasting. There may be irregular muscle contractions, and muscle cramps or stiffness. All four extremities are soon affected.

Progressive muscular atrophy and progressive bulbar palsy both start with patterns of muscle weakness different from but usually develop into.There are 2 types of motor neuron disease that first appear in childhood or adolescence. In most cases, these conditions are inherited. Werdnig–Hoffman disease affects infants at birth or soon afterwards. In almost all cases, progressive muscle weakness leads to death within several years. Chronic spinal muscular atrophy begins in childhood or adolescence, causing progressive weakness but not always serious disability.

There are no specific tests for motor neuron disease. Diagnosis is based on careful clinical examination by a neurologist. Tests including EMG, muscle biopsy, blood tests, myelography, CT scanning, or MRI may be performed.

The disease typically goes on to affect the muscles involved in breathing and swallowing, leading to death within 2–4 years. However, about 10 per cent of sufferers survive for 10 years.

Nerve degeneration cannot be slowed down, but physiotherapy and the use of various aids may help to reduce disability. The drug riluzole is used to extend life (or the time until mechanical ventilation is required).... motor neuron disease

Stein-leventhal Syndrome

See ovary, polycystic.... stein-leventhal syndrome

Still’s Disease

See rheumatoid arthritis, juvenile.... still’s disease

Raynaud’s Disease

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

Reiter’s Syndrome

A condition in which there is a combination of urethritis, reactive arthritis, and conjunctivitis. There may also be uveitis. Reiter’s syndrome is more common in men.

The syndrome is caused by an immune response and usually develops only in people with a genetic predisposition. Most patients have the -B27 tissue type (see histocompatability antigens). The syndrome’s development is induced by infection: usually nongonococcal urethritis, but sometimes bacillary dysentery. Reiter’s syndrome usually starts with a urethral discharge, which is followed by conjunctivitis and then arthritis. The arthritis usually affects 1 or 2 joints (usually the knee and/or ankle) and is often associated with fever and malaise. Attacks can last for several months. Tendons, ligaments, and tissue in the soles of the feet may also become inflamed. Skin rashes are common.

Diagnosis is made from the symptoms.

Analgesic drugs and nonsteroidal antiinflammatory drugs relieve symptoms but may have to be taken for a long period.

Relapses occur in about 1 in 3 cases.... reiter’s syndrome

Subclavian Steal Syndrome

Recurrent attacks of blurred or double vision, loss of coordination, or dizziness caused by reduced blood flow to the base of the brain when one arm (usually the left) is moved.

The cause is narrowing of the arteries that carry blood to the arms, usually due to atherosclerosis.

Treatment is by arterial reconstructive surgery.... subclavian steal syndrome

Sudden Infant Death Syndrome

The sudden, unexpected death of an infant that cannot be explained.

Possible risk factors include: laying the baby face-down to sleep; overheating; parental smoking after the birth; prematurity and low birth weight; and poor socioeconomic background.

Preventive measures include: ensuring that the baby sleeps on its back at the foot of the cot; regulating the baby’s temperature (using the same amount of clothing and blankets that an adult would need); and stopping smoking.... sudden infant death syndrome

Reye’s Syndrome

A rare disorder in which brain and liver damage follow a viral infection. Children over 15 are rarely affected. The cause is unknown, but aspirin seems to be a predisposing factor to developing the condition and is therefore not recommended for children.

The disorder starts as the child recovers from the infection. Symptoms include uncontrollable vomiting, lethargy, memory loss, and disorientation. Swelling of the brain may cause seizures, disturbances in heart rhythm, coma, and cessation of breathing.

Brain swelling may be controlled by corticosteroid drugs and by intravenous infusions of mannitol. Dialysis or blood transfusions may be needed. If breathing stops, a ventilator is used.

The death rate is around 10 per cent, and higher for those who have seizures, lapse into deep coma, and stop breathing.

Permanent brain damage may occur.... reye’s syndrome

Temporomandibular Joint Syndrome

Pain and other symptoms affecting the head, jaw, and face, thought to result when the temporomandibular joints and the muscles and ligaments attached to them do not work together correctly. Causes include spasm of the chewing muscles, an incorrect bite (see malocclusion), jaw, head, or neck injuries, or osteoarthritis. Common symptoms include headaches, tenderness of the jaw muscles, and aching facial pain. Treatment involves correction of any underlying abnormality, analgesic drugs, and, in some cases, injection of corticosteroid drugs into the joint.... temporomandibular joint syndrome

Testicular Feminization Syndrome

A rare inherited condition in which a genetic male with internal testes has the external appearance of a female. The syndrome is a form of intersex and is the most common form of male pseudohermaphroditism.

The cause is a defective response of the body tissues to testosterone.

The causative genes are carried on the X chromosome, and so females can be carriers. Affected individuals appear to be girls throughout childhood, and most develop female secondary sexual characteristics at puberty; but amenorrhoea occurs, and a diagnosis is usually made during investigations to find its cause. Chromosome analysis shows the presence of male chromosomes and blood tests show male levels of testosterone. Treatment of testicular feminization syndrome involves surgical removal of the testes, to prevent cancerous change in later life, and therapy with oestrogen drugs. An affected person is not fertile but can live a normal life as a woman.... testicular feminization syndrome

Tietze’s Syndrome

Chest pain localized to an area on the front of the chest wall, usually made worse by movement of the arms or trunk or by pressure on the chest wall. The syndrome is caused by inflammation of 1 or several rib cartilages and symptoms may persist for months. Treatment is with analgesics, nonsteroidal anti-inflammatory drugs, or local injections of corticosteroid drugs into the cartilage.... tietze’s syndrome

Tourette’s Syndrome

See Gilles de la Tourette’s syndrome.... tourette’s syndrome

Von Recklinghausen’s Disease

Another name for neurofibromatosis.... von recklinghausen’s disease

Weil’s Disease

Another name for leptospirosis.... weil’s disease

Turner’s Syndrome

A disorder caused by a chromosomal abnormality that only affects females. The abnormality may arise in 1 of 3 ways: affected females may have only 1 X chromosome instead of 2; they may have 1 normal and 1 defective X chromosome; or they may have a mixture of cells (see mosaicism), in which some of the cells are missing an X chromosome, some have extra chromosomes, and others have the normal complement of chromosomes. Turner’s syndrome causes short stature; webbing of the skin of the neck; absence or retarded development of sexual characteristics; amenorrhea, coarctation of the aorta, and abnormalities of the eyes and bones.

Treatment with growth hormone from infancy helps girls with Turner’s syndrome to achieve near normal height. Coarctation of the aorta is treated surgically. Treatment with oestrogen drugs induces menstruation, but it does not make affected girls fertile.... turner’s syndrome

Von Willebrand’s Disease

An inherited lifelong bleeding disorder similar to haemophilia. People with the condition have a reduced concentration in their blood of a substance called von Willebrand factor, which helps platelets in the blood to plug injured blood vessel walls and forms part of factor VIII (a substance vital to blood coagulation). Symptoms of deficiency of this factor include excessive bleeding from the gums and from cuts and nosebleeds. Women may have heavy menstrual bleeding. In severe cases, bleeding into joints and muscles may occur.

The disease is diagnosed by bloodclotting tests and measurement of blood levels of von Willebrand factor. Bleeding episodes can be prevented or controlled by desmopressin (a substance resembling ADH). Factor or concentrated von Willebrand factor may also be used to treat bleeding.... von willebrand’s disease

Whipple’s Disease

A rare disorder, also called intestinal lipodystrophy, that can affect many organs. Symptoms include steatorrhoea as a result of malabsorption, abdominal pain, joint pains, progressive weight loss, swollen lymph nodes, anaemia, and fever. The heart, lungs, and brain can also be affected. The condition is most common in middle-aged men.

The cause is thought to be bacterial; affected tissues are found to contain macrophages (a type of scavenging cell) containing rod-shaped bacteria. Treatment is with antibiotic drugs for at least 1 year. Dietary supplements are used to correct nutritional deficiencies occurring as a result of malabsorption.... whipple’s disease

Wilson’s Disease

A rare, inherited disorder in which copper accumulates in the liver, resulting in conditions such as hepatitis and cirrhosis. Copper is slowly released into other body parts, damaging the brain, causing mild intellectual impairment, and leading to debilitating rigidity, tremor, and dementia. Symptoms usually appear in adolescence but can occur much earlier or later. Lifelong treatment with penicillamine is needed and, if begun soon enough, can sometimes produce some improvement. If the disease is discovered before the onset of symptoms, the drug may prevent them from developing.... wilson’s disease

Contagious Disease

originally, a disease transmitted only by direct physical contact: now usually taken to mean any *communicable disease.... contagious disease

Abdomen, Diseases Of

See under STOMACH, DISEASES OF; INTESTINE, DISEASES OF; DIARRHOEA; LIVER, DISEASES OF; PANCREAS, DISEASES OF; GALL-BLADDER, DISEASES OF; KIDNEYS, DISEASES OF; URINARY BLADDER, DISEASES OF; HERNIA; PERITONITIS; APPENDICITIS; TUMOUR.

Various processes that can occur include in?ammation, ulceration, infection or tumour. Abdominal disease may be of rapid onset, described as acute, or more long-term when it is termed chronic.

An ‘acute abdomen’ is most commonly caused by peritonitis – in?ammation of the membrane that lines the abdomen. If any structure in the abdomen gets in?amed, peritonitis may result. Causes include injury, in?ammation of the Fallopian tubes (SALPINGITIS), and intestinal disorders such as APPENDICITIS, CROHN’S DISEASE, DIVERTICULITIS or a perforated PEPTIC ULCER. Disorders of the GALLBLADDER or URINARY TRACT may also result in acute abdominal pain.

General symptoms of abdominal disease include:

Pain This is usually ill-de?ned but can be very unpleasant, and is termed visceral pain. Pain is initially felt near the mid line of the abdomen. Generally, abdominal pain felt high up in the mid line originates from the stomach and duodenum. Pain that is felt around the umbilicus arises from the small intestine, appendix and ?rst part of the large bowel, and low mid-line pain comes from the rest of the large bowel. If the diseased organ secondarily in?ames or infects the lining of the abdominal wall – the PERITONEUM – peritonitis occurs and the pain becomes more de?ned and quite severe, with local tenderness over the site of the diseased organ itself. Hence the pain of appendicitis begins as a vague mid-line pain, and only later moves over to the right iliac fossa, when the in?amed appendix has caused localised peritonitis. PERFORATION of one of the hollow organs in the abdomen – for example, a ruptured appendix or a gastric or duodenal ulcer (see STOMACH, DISEASES OF) eroding the wall of the gut – usually causes peritonitis with resulting severe pain.

The character of the pain is also important. It may be constant, as occurs in in?ammatory diseases and infections, or colicky (intermittent) as in intestinal obstruction.

Swelling The commonest cause of abdominal swelling in women is pregnancy. In disease, swelling may be due to the accumulation of trapped intestinal contents within the bowel, the presence of free ?uid (ascites) within the abdomen, or enlargement of one or more of the abdominal organs due to benign causes or tumour.

Constipation is the infrequent or incomplete passage of FAECES; sometimes only ?atus can be passed and, rarely, no bowel movements occur (see main entry for CONSTIPATION). It is often associated with abdominal swelling. In intestinal obstruction, the onset of symptoms is usually rapid with complete constipation and severe, colicky pain. In chronic constipation, the symptoms occur more gradually.

Nausea and vomiting may be due to irritation of the stomach, or to intestinal obstruction when it may be particularly foul and persistent. There are also important non-abdominal causes, such as in response to severe pain or motion sickness.

Diarrhoea is most commonly due to simple and self-limiting infection, such as food poisoning, but may also indicate serious disease, especially if it is persistent or contains blood (see main entry for DIARRHOEA).

Jaundice is a yellow discoloration of the skin and eyes, and may be due to disease in the liver or bile ducts (see main entry for JAUNDICE).

Diagnosis and treatment Abdominal diseases are often di?cult to diagnose because of the multiplicity of the organs contained within the abdomen, their inconstant position and the vagueness of some of the symptoms. Correct diagnosis usually requires experience, often supplemented by specialised investigations such as ULTRASOUND. For this reason sufferers should obtain medical advice at an early stage, particularly if the symptoms are severe, persistent, recurrent, or resistant to simple remedies.... abdomen, diseases of

Acquired Immune Deficiency Syndrome (aids)

A severe manifestation of infection with the Human immunodeficiency virus (HIV).... acquired immune deficiency syndrome (aids)

Acute Disease / Illness

A disease which is characterized by a single or repeated episode of relatively rapid onset and short duration from which the patient usually returns to his/her normal or previous state or level of activity. An acute episode of a chronic disease (for example, an episode of diabetic coma in a patient with diabetes) is often treated as an acute disease.... acute disease / illness

Agent (of Disease)

A factor, such as a micro-organism, chemical substance, form of radiation, or excessive cold or heat, which is essential for the occurrence of a disease. A disease may be caused by more than one agent acting together or, in the case of deficiency diseases, by the absence of an agent.... agent (of disease)

Anterior Tibial Syndrome

See under MUSCLES, DISORDERS OF – Compression syndrome.... anterior tibial syndrome

Anus, Diseases Of

See under RECTUM, DISEASES OF.... anus, diseases of

Behçet’s Syndrome

This is a syndrome characterised by oral and genital ulceration, UVEITIS and ARTHROPATHY. THROMBOPHLEBITIS is a common complication, and involvement of the central nervous system may occur.... behçet’s syndrome

Bladder, Diseases Of

See URINARY BLADDER, DISEASES OF and GALLBLADDER, DISEASES OF; see also URINE.... bladder, diseases of

Blood, Diseases Of

See ANAEMIA; LEUKAEMIA; LYMPHOMA; MYELOMATOSIS; THROMBOSIS.... blood, diseases of

Acute Respiratory Distress Syndrome (ards)

Formerly known as adult respiratory distress syndrome. A form of acute respiratory failure in which a variety of di?erent disorders give rise to lung injury by what is thought to be a common pathway. The condition has a high mortality rate (about 70 per cent); it is a complex clinical problem in which a disproportionate immunological response plays a major role. (See IMMUNITY.)

The exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.

The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.

Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)

Addison’s Disease

The cause of Addison’s disease (also called chronic adrenal insu?ciency and hypocortisolism) is a de?ciency of the adrenocortical hormones CORTISOL, ALDOSTERONE and androgens (see ANDROGEN) due to destruction of the adrenal cortex (see ADRENAL GLANDS). It occurs in about 1 in 25,000 of the population. In the past, destruction of the adrenal cortex was due to TUBERCULOSIS (TB), but nowadays fewer than 20 per cent of patients have TB while 70 per cent suffer from autoimmune damage. Rare causes of Addison’s disease include metastases (see METASTASIS) from CARCINOMA, usually of the bronchus; granulomata (see GRANULOMA); and HAEMOCHROMATOSIS. It can also occur as a result of surgery for cancer of the PITUITARY GLAND destroying the cells which produce ACTH (ADRENOCORTICOTROPHIC HORMONE)

– the hormone which provokes the adrenal cortex into action.

Symptoms The clinical symptoms appear slowly and depend upon the severity of the underlying disease process. The patient usually complains of appetite and weight loss, nausea, weakness and fatigue. The skin becomes pigmented due to the increased production of ACTH. Faintness, especially on standing, is due to postural HYPOTENSION secondary to aldosterone de?ciency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as DEPRESSION. Acute episodes – Addisonian crises – may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring. ANOREXIA, nausea and vomiting are common and the sufferer may feel cold.

Diagnosis This depends on demonstrating impaired serum levels of cortisol and inability of these levels to rise after an injection of ACTH.

Treatment consists in replacement of the de?cient hormones. HYDROCORTISONE tablets are commonly used; some patients also require the salt-retaining hormone, ?udrocortisone. Treatment enables them to lead a completely normal life and to enjoy a normal life expectancy. Before surgery, or if the patient is pregnant and unable to take tablets, injectable hydrocortisone may be needed. Rarely, treated patients may have a crisis, perhaps because they have not been taking their medication or have been vomiting it. Emergency resuscitation is needed with ?uids, salt and sugar. Because of this, all patients should carry a card detailing their condition and necessary management. Treatment of any complicating infections such as tuberculosis is essential. Sometimes DIABETES MELLITUS coexists with Addison’s disease and must be treated.

Secondary adrenal insu?ciency may occur in panhypopituitarism (see PITUITARY GLAND), in patients treated with CORTICOSTEROIDS or after such patients have stopped treatment.... addison’s disease

Bowen’s Disease

An uncommon chronic localised skin disease, presenting as a solitary chronic ?xed irregular plaque mimicking eczema or psoriasis. It is a fairly benign form of CARCINOMA in situ in the EPIDERMIS but can occasionally become invasive. It is curable by CRYOTHERAPY or surgical excision.... bowen’s disease

Bright’s Disease

See KIDNEYS, DISEASES OF – Glomerulonephritis.... bright’s disease

Buerger’s Disease

See THROMBOANGIITIS OBLITERANS.... buerger’s disease

Burden Of Disease

The total significance of disease for society beyond the immediate cost of treatment. It measures years of life lost to ill-health as the difference between total life expectancy and disability-adjusted life expectancy.... burden of disease

Carriers Of Disease

See INFECTION.... carriers of disease

Alzheimer’s Disease

Alzheimer’s disease is a progressive degenerating process of neural tissue affecting mainly the frontal and temporal lobes of the BRAIN in middle and late life. There is probably a genetic component to Alzheimer’s disease, but early-onset Alzheimer’s is linked to certain mutations, or changes, in three particular GENES. Examination of affected brains shows ‘senile plaques’ containing an amyloid-like material distributed throughout an atrophied cortex (see AMYLOID PLAQUES). Many remaining neurons, or nerve cells, show changes in their NEUROFIBRILS which thicken and twist into ‘neuro?brillary tangles’. First symptoms are psychological with insidious impairment of recent memory and disorientation in time and space. This becomes increasingly associated with diffculties in judgement, comprehension and abstract reasoning. After very few years, progressive neurological deterioration produces poor gait, immobility and death. When assessment has found no other organic cause for an affected individual’s symptoms, treatment is primarily palliative. The essential part of treatment is the provision of appropriate nursing and social care, with strong support being given to the relatives or other carers for whom looking after sufferers is a prolonged and onerous burden. Proper diet and exercise are helpful, as is keeping the individual occupied. If possible, sufferers should stay in familiar surroundings with day-care and short-stay institutional facilities a useful way of maintaining them at home for as long as possible.

TRANQUILLISERS can help control di?cult behaviour and sleeplessness but should be used with care. Recently drugs such as DONEPEZIL and RIVASTIGMINE, which retard the breakdown of ACETYLCHOLINE, may check

– but not cure – this distressing condition. About 40 per cent of those with DEMENTIA improve.

Research is in progress to transplant healthy nerve cells (developed from stem cells) into the brain tissue of patients with Alzheimer’s disease with the aim of improving brain function.

The rising proportion of elderly people in the population is resulting in a rising incidence of Alzheimer’s, which is rare before the age of 60 but increases steadily thereafter so that 30 per cent of people over the age of 84 are affected.... alzheimer’s disease

Arteries, Diseases Of

ARTERIES are the blood vessels that convey blood away from the heart to the tissues. The commonest cause of arterial disease is a degenerative condition known as atherosclerosis. Less commonly, in?ammation of the arteries occurs; this in?ammation is known as arteritis and occurs in a variety of conditions.

Atherosclerosis is due to the deposition of CHOLESTEROL into the walls of arteries. The process starts in childhood with the development of fatty streaks lining the arteries. In adulthood these progress, scarring and calcifying to form irregular narrowings within the arteries and eventually leading to blockage of the vessel. The consequence of the narrowing or blockage depends on which vessels are involved

– diseased cerebral vessels cause strokes; coronary vessels cause angina and heart attacks; renal vessels cause renal failure; and peripheral arteries cause limb ischaemia (localised bloodlessness).

Risk factors predisposing individuals to atherosclerosis include age, male gender, raised plasma cholesterol concentration, high blood pressure, smoking, a family history of atherosclerosis, diabetes and obesity.

Arteritis occurs in a variety of conditions that produce in?ammation in the arteries. Examples include syphilis – now rare in Britain

– which produces in?ammation of the aorta with subsequent dilatation (aneurysm formation) and risk of rupture; giant cell arteritis (temporal arteritis), a condition usually affecting the elderly, which involves the cranial arteries and leads to headache, tenderness over the temporal arteries and the risk of sudden blindness; Takayasu’s syndrome, predominantly affecting young females, which involves the aortic arch and its major branches, leading to the absence of pulse in affected vessels; and polyarteritis nodosa, a condition causing multiple small nodules to form on the smaller arteries. General symptoms such as fever, malaise, weakness, anorexia and weight loss are accompanied by local manifestations of ischaemia (bloodlessness) in di?erent parts of the body.... arteries, diseases of

Chronic Condition / Disease

A disease which has one or more of the following characteristics: is permanent; leaves residual disability; is caused by nonreversible pathological alternation; requires special training of the patient for rehabilitation; or may be expected to require a long period of supervision, observation or care.... chronic condition / disease

Asperger’s Syndrome

A lifelong personality disorder, evident from childhood and regarded as a mild form of AUTISM. Persons with the syndrome tend to have great di?culty with personal relationships. They tend to take what is said to them as literal fact and have great di?culty in understanding irony, metaphors or even jokes. They appear shy with a distant and aloof character, emotional rigidity and inability to adapt to new situations. They are often mocked and ill-treated at school by their fellows because they appear unusual. Many people with Asperger’s seem to take refuge in intense interests or hobbies, often conducted to an obsessional degree. Many become skilled in mathematics and particularly information technology. Frustration with the outside world which is so hard to comprehend may provoke aggressive outbursts when stressed.... asperger’s syndrome

Attention Deficit Disorder (hyperactivity Syndrome)

A lifelong disorder characterised by overactive behaviour, short attention span and poor concentration. It is thought to be caused by a minor abnormality that affects the part of the brain that allows us to concentrate and focus on tasks. Some scientists have suggested that it may be caused by particular foods, particularly processed foods containing arti?cial additives, and recommend special diets. In some countries, attention de?cit disorder is diagnosed in up to a tenth of all children; this may re?ect di?erences in paediatric practice and diagnosis rather than a real variation in prevalence of the disorder. Behaviour therapy is the main treatment. Those children with very severe symptoms of restlessness, short attention span and disturbed behaviour may respond to additional treatment with methylphenidate (Ritalin®). This is an amphetamine-like drug that is thought to stimulate the part of the brain that is not working properly. Use of this drug has, however, been controversial.... attention deficit disorder (hyperactivity syndrome)

Chronic Fatigue Syndrome (cfs)

See also MYALGIC ENCEPHALOMYELITIS (ME). A condition characterised by severe, disabling mental and physical fatigue brought on by mental or physical activity and associated with a range of symptoms including muscle pain, headaches, poor sleep, disturbed moods and impaired concentration. The prevalence of the condition is between 0.2 and 2.6 per cent of the population (depending on how investigators de?ne CFS/ME). Despite the stereotype of ‘yuppie ?u’, epidemiological research has shown that the condition occurs in all socioeconomic and ethnic groups. It is commoner in women and can also occur in children.

In the 19th century CFS was called neurasthenia. In the UK, myalgic encephalomyelitis (ME) is often used, a term originally introduced to describe a speci?c outbreak such as the one at the Royal Free Hospital, London in 1955. The term is inaccurate as there is no evidence of in?ammation of the brain and spinal cord (the meaning of encephalomyelitis). Doctors prefer the term CFS, but many patients see this as derogatory, perceiving it to imply that they are merely ‘tired all the time’ rather than having a disabling illness.

The cause (or causes) are unknown, so the condition is classi?ed alongside other ‘medically unexplained syndromes’ such as IRRITABLE BOWEL SYNDROME (IBS) and multiple chemical sensitivity – all of which overlap with CFS. In many patients the illness seems to start immediately after a documented infection, such as that caused by EPSTEIN BARR VIRUS, or after viral MENINGITIS, Q FEVER and TOXOPLASMOSIS. These infections seem to be a trigger rather than a cause: mild immune activation is found in patients, but it is not known if this is cause or e?ect. The body’s endocrine system is disturbed, particularly the hypothalamopituitary-adrenal axis, and levels of cortisol are often a little lower than normal – the opposite of what is found in severe depression. Psychiatric disorder, usually depression and/or anxiety, is associated with CFS, with rates too high to be explained solely as a reaction to the disability experienced.

Because we do not know the cause, the underlying problem cannot be dealt with e?ectively and treatments are directed at the factors leading to symptoms persisting. For example, a slow increase in physical activity can help many, as can COGNITIVE BEHAVIOUR THERAPY. Too much rest can be harmful, as muscles are rapidly weakened, but aggressive attempts at coercing patients into exercising can be counter-productive as their symptoms may worsen. Outcome is in?uenced by the presence of any pre-existing psychiatric disorder and the sufferer’s beliefs about its causes and treatment. Research continues.... chronic fatigue syndrome (cfs)

Classification Of Disease

Arrangement of diseases into groups having common characteristics. Useful in efforts to achieve standardization in the methods of presenting mortality and morbidity data from different sources and, therefore, in comparability. May include a systematic numerical notation for each disease entry. Examples include the International Statistical Classification of Diseases, Injuries and Causes of Death.... classification of disease

Brain, Diseases Of

These consist either of expanding masses (lumps or tumours), or of areas of shrinkage (atrophy) due to degeneration, or to loss of blood supply, usually from blockage of an artery.

Tumours All masses cause varying combinations of headache and vomiting – symptoms of raised pressure within the inexpansible bony box formed by the skull; general or localised epileptic ?ts; weakness of limbs or disordered speech; and varied mental changes. Tumours may be primary, arising in the brain, or secondary deposits from tumours arising in the lung, breast or other organs. Some brain tumours are benign and curable by surgery: examples include meningiomas and pituitary tumours. The symptoms depend on the size and situation of the mass. Abscesses or blood clots (see HAEMATOMA) on the surface or within the brain may resemble tumours; some are removable. Gliomas ( see GLIOMA) are primary malignant tumours arising in the glial tissue (see GLIA) which despite surgery, chemotherapy and radiotherapy usually have a bad prognosis, though some astrocytomas and oligodendronogliomas are of low-grade malignancy. A promising line of research in the US (in the animal-testing stage in 2000) suggests that the ability of stem cells from normal brain tissue to ‘home in’ on gliomal cells can be turned to advantage. The stem cells were chemically manipulated to carry a poisonous compound (5-?uorouracil) to the gliomal cells and kill them, without damaging normal cells. Around 80 per cent of the cancerous cells in the experiments were destroyed in this way.

Clinical examination and brain scanning (CT, or COMPUTED TOMOGRAPHY; magnetic resonance imaging (MRI) and functional MRI) are safe, accurate methods of demonstrating the tumour, its size, position and treatability.

Strokes When a blood vessel, usually an artery, is blocked by a clot, thrombus or embolism, the local area of the brain fed by that artery is damaged (see STROKE). The resulting infarct (softening) causes a stroke. The cells die and a patch of brain tissue shrinks. The obstruction in the blood vessel may be in a small artery in the brain, or in a larger artery in the neck. Aspirin and other anti-clotting drugs reduce recurrent attacks, and a small number of people bene?t if a narrowed neck artery is cleaned out by an operation – endarterectomy. Similar symptoms develop abruptly if a blood vessel bursts, causing a cerebral haemorrhage. The symptoms of a stroke are sudden weakness or paralysis of the arm and leg of the opposite side to the damaged area of brain (HEMIPARESIS), and sometimes loss of half of the ?eld of vision to one side (HEMIANOPIA). The speech area is in the left side of the brain controlling language in right-handed people. In 60 per cent of lefthanders the speech area is on the left side, and in 40 per cent on the right side. If the speech area is damaged, diffculties both in understanding words, and in saying them, develops (see DYSPHASIA).

Degenerations (atrophy) For reasons often unknown, various groups of nerve cells degenerate prematurely. The illness resulting is determined by which groups of nerve cells are affected. If those in the deep basal ganglia are affected, a movement disorder occurs, such as Parkinson’s disease, hereditary Huntington’s chorea, or, in children with birth defects of the brain, athetosis and dystonias. Modern drugs, such as DOPAMINE drugs in PARKINSONISM, and other treatments can improve the symptoms and reduce the disabilities of some of these diseases.

Drugs and injury Alcohol in excess, the abuse of many sedative drugs and arti?cial brain stimulants – such as cocaine, LSD and heroin (see DEPENDENCE) – can damage the brain; the effects can be reversible in early cases. Severe head injury can cause localised or di?use brain damage (see HEAD INJURY).

Cerebral palsy Damage to the brain in children can occur in the uterus during pregnancy, or can result from rare hereditary and genetic diseases, or can occur during labour and delivery. Severe neurological illness in the early months of life can also cause this condition in which sti? spastic limbs, movement disorders and speech defects are common. Some of these children are learning-disabled.

Dementias In older people a di?use loss of cells, mainly at the front of the brain, causes ALZHEIMER’S DISEASE – the main feature being loss of memory, attention and reasoned judgement (dementia). This affects about 5 per cent of the over-80s, but is not simply due to ageing processes. Most patients require routine tests and brain scanning to indicate other, treatable causes of dementia.

Response to current treatments is poor, but promising lines of treatment are under development. Like Parkinsonism, Alzheimer’s disease progresses slowly over many years. It is uncommon for these diseases to run in families. Multiple strokes can cause dementia, as can some organic disorders such as cirrhosis of the liver.

Infections in the brain are uncommon. Viruses such as measles, mumps, herpes, human immunode?ciency virus and enteroviruses may cause ENCEPHALITIS – a di?use in?ammation (see also AIDS/HIV).

Bacteria or viruses may infect the membrane covering the brain, causing MENINGITIS. Viral meningitis is normally a mild, self-limiting infection lasting only a few days; however, bacterial meningitis – caused by meningococcal groups B and C, pneumococcus, and (now rarely) haemophilus – is a life-threatening condition. Antibiotics have allowed a cure or good control of symptoms in most cases of meningitis, but early diagnosis is essential. Severe headaches, fever, vomiting and increasing sleepiness are the principal symptoms which demand urgent advice from the doctor, and usually admission to hospital. Group B meningococcus is the commonest of the bacterial infections, but Group C causes more deaths. A vaccine against the latter has been developed and has reduced the incidence of cases by 75 per cent.

If infection spreads from an unusually serious sinusitis or from a chronically infected middle ear, or from a penetrating injury of the skull, an abscess may slowly develop. Brain abscesses cause insidious drowsiness, headaches, and at a late stage, weakness of the limbs or loss of speech; a high temperature is seldom present. Early diagnosis, con?rmed by brain scanning, is followed by antibiotics and surgery in hospital, but the outcome is good in only half of affected patients.

Cerebral oedema Swelling of the brain can occur after injury, due to engorgement of blood vessels or an increase in the volume of the extravascular brain tissue due to abnormal uptake of water by the damaged grey (neurons) matter and white (nerve ?bres) matter. This latter phenomenon is called cerebral oedema and can seriously affect the functioning of the brain. It is a particularly dangerous complication following injury because sometimes an unconscious person whose brain is damaged may seem to be recovering after a few hours, only to have a major relapse. This may be the result of a slow haemorrhage from damaged blood vessels raising intracranial pressure, or because of oedema of the brain tissue in the area surrounding the injury. Such a development is potentially lethal and requires urgent specialist treatment to alleviate the rising intracranial pressure: osmotic agents (see OSMOSIS) such as mannitol or frusemide are given intravenously to remove the excess water from the brain and to lower intracranial pressure, buying time for de?nitive investigation of the cranial damage.... brain, diseases of

Breasts, Diseases Of

The female breasts may be expected to undergo hormone-controlled enlargement at puberty, and later in pregnancy, and the glandular part of the breast undergoes evolution (shrinkage) after the menopause. The breast can also be affected by many di?erent diseases, with common symptoms being pain, nipple discharge or retraction, and the formation of a lump within the breast.

Benign disease is much more common than cancer, particularly in young women, and includes acute in?ammation of the breast (mastitis); abscess formation; and benign breast lumps, which may be ?broadenosis – di?use lumpiness also called chronic mastitis or ?brocystic disease – in which one or more ?uid-?lled sacs (cysts) develop.

Women who are breast feeding are particularly prone to mastitis, as infection may enter the breast via the nipple. The process may be arrested before a breast abscess forms by prompt treatment with antibiotics. Non-bacterial in?ammation may result from mammary duct ectasia (dilatation), in which abnormal or

blocked ducts may over?ow. Initial treatments should be with antibiotics, but if an abscess does form it should be surgically drained.

Duct ectasia, with or without local mastitis, is the usual benign cause of various nipple complaints, with common symptoms being nipple retraction, discharge and skin change.

Breast lumps form the chief potential danger and may be either solid or cystic. Simple examination may fail to distinguish the two types, but aspiration of a benign cyst usually results in its disappearance. If the ?uid is bloodstained, or if a lump still remains, malignancy is possible, and all solid lumps need histological (tissue examination) or cytological (cell examination) assessment. As well as having their medical and family history taken, any women with a breast lump should undergo triple assessment: a combination of clinical examination, imaging

– mammography for the over-35s and ultrasonagraphy for the under-35s – and ?ne-needle aspiration. The medical history should include details of any previous lumps, family history (up to 10 per cent of breast cancer in western countries is due to genetic disposition), pain, nipple discharge, change in size related to menstrual cycle and parous state, and any drugs being taken by the patient. Breasts should be inspected with the arms up and down, noting position, size, consistency, mobility, ?xity, and local lymphadenopathy (glandular swelling). Nipples should be examined for the presence of inversion or discharge. Skin involvement (peau d’orange) should be noted, and, in particular, how long changes have been present. Fine-needle aspiration and cytological examination of the ?uid are essential with ULTRASOUND, MAMMOGRAPHY and possible BIOPSY being considered, depending on the patient’s age and the extent of clinical suspicion that cancer may be present.

The commonest solid benign lump is a ?broadenoma, particularly in women of childbearing age, and is a painless, mobile lump. If small, it is usually safe to leave it alone, provided that the patient is warned to seek medical advice if its size or character changes or if the lump becomes painful. Fibroadenosis (di?use lumpiness often in the upper, outer quadrant) is a common (benign) lump. Others include periductal mastitis, fat NECROSIS, GALACTOCELE, ABSCESS, and non-breast-tissue lumps – for example, a LIPOMA (fatty tissue) or SEBACEOUS CYST. A woman with breast discharge should have a mammograph, ductograph, or total duct excision until the cause of any underlying duct ectasia is known. Appropriate treatment should then be given.

Malignant disease most commonly – but not exclusively – occurs in post-menopausal women, classically presenting as a slowly growing, painless, ?rm lump. A bloodstained nipple discharge or eczematous skin change may also be suggestive of cancer.

The most commonly used classi?cation of invasive cancers has split them into two types, ductal and lobular, but this is no longer suitable. There are also weaknesses in the tumour node metastases (TNM) system and the International Union Against Cancer (UICC) classi?cation.

The TNM system – which classi?es the lump by size, ?xity and presence of affected axillary glands and wider metastatic spread – is best combined with a pathological classi?cation, when assessing the seriousness of a possibly cancerous lump. Risk factors for cancer include nulliparity (see NULLIPARA), ?rst pregnancy over the age of 30 years, early MENARCHE, late MENOPAUSE and positive family history. The danger should be considered in women who are not breast feeding or with previous breast cancer, and must be carefully excluded if the woman is taking any contraceptive steroids or is on hormone-replacement therapy (see under MENOPAUSE).

Screening programmes involving mammography are well established, the aim being to detect more tumours at an early and curable stage. Pick-up rate is ?ve per 1,000 healthy women over 50 years. Yearly two-view mammograms could reduce mortality by 40 per cent but may cause alarm because there are ten false positive mammograms for each true positive result. In premenopausal women, breasts are denser, making mammograms harder to interpret, and screening appears not to save lives. About a quarter of women with a palpable breast lump turn out to have cancer.

Treatment This remains controversial, and all options should be carefully discussed with the patient and, where appropriate, with her partner. Locally contained disease may be treated by local excision of the lump, but sampling of the glands of the armpit of the same side should be performed to check for additional spread of the disease, and hence the need for CHEMOTHERAPY or RADIOTHERAPY. Depending on the extent of spread, simple mastectomy or modi?ed radical mastectomy (which removes the lymph nodes draining the breast) may be required. Follow-up chemotherapy, for example, with TAMOXIFEN (an oestrogen antagonist), much improves survival (it saves 12 lives over 100 women treated), though it may occasionally cause endometrial carcinoma. Analysis in the mid-1990s of large-scale international studies of breast-cancer treatments showed wide variations in their e?ectiveness. As a result the NHS has encouraged hospitals to set up breast-treatment teams containing all the relevant health professional experts and to use those treatments shown to be most e?ective.

As well as the physical treatments provided, women with suspected or proven breast cancer should be o?ered psychological support because up to 30 per cent of affected women develop an anxiety state or depressive illness within a year of diagnosis. Problems over body image and sexual diffculties occur in and around one-quarter of patients. Breast conservation and reconstructive surgery can improve the physical effects of mastectomy, and women should be advised on the prostheses and specially designed brassieres that are available. Specialist nurses and self-help groups are invaluable in supporting affected women and their partners with the problems caused by breast cancer and its treatment. Breast Cancer Care, British Association of Cancer United Patients (BACUP), Cancerlink, and Cancer Relief Macmillan Fund are among voluntary organisations providing support.... breasts, diseases of

Chronic Obstructive Pulmonary Disease (copd)

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

Communicable Diseases Control

The control of disease caused by infectious agents or their toxic products. Successes in the 19th and 20th centuries in the treatment and control of communicable diseases such as SMALLPOX, CHOLERA, TUBERCULOSIS, gastrointestinal infections, POLIOMYELITIS and SEXUALLY TRANSMITTED DISEASES (STDS) resulted in an erroneous conception that they no longer posed a serious threat to public health, and certainly not in developed countries. As a consequence, the maintenance of e?ective public health strategies steadily lost out in the competition for resources to the more ‘glamorous’ developments in medicine, such as improved CANCER treatments, HEART surgery, kidney DIALYSIS and organ TRANSPLANTATION. However, in recent decades the dangers of this approach have become increasingly apparent. Rapidly expanding urban populations, more complex lifestyles, new and resurgent infections (some linked to a spread of antibiotic resistance) such as AIDS/HIV and variant CREUTZFELDT-JAKOB DISEASE (CJD), and the ease with which infection can be spread by the enormous growth of long-distance travel and population migrations are severely straining existing public health measures. The supply of clean water, e?ective waste- and sewage-disposal measures, the hygienic production and delivery of food and early detection and subsequent prevention of infectious diseases can no longer be taken for granted. Governments will need to strengthen the provision of workable, properly resourced public health facilities, and developing countries will need ?nancial support and expert help from developed nations to achieve this objective. Timely recognition of new and resurgent infectious diseases requires national and international early-warning mechanisms to ensure rapid investigation and implementation of e?ective control measures. Otherwise, serious breakdowns in public health will occur, and international co-operation is vital to provide and support control measures. (See also COMMUNICABLE DISEASE; NOTIFIABLE DISEASES.)... communicable diseases control

Creutzfeldt-jakob Disease (cjd)

A rapidly progressive, fatal, degenerative disease in humans caused by an abnormal PRION protein. There are three aetiological forms of CJD: sporadic, IATROGENIC, and inherited. Sporadic CJD occurs randomly in all countries and has an annual incidence of one per million. Iatrogenic CJD is caused by accidental exposure to human prions through medical and surgical procedures (and cannibalism in the case of the human prion disease known as kuru that occurs in a tribe in New Guinea, where it is called the trembling disease). Inherited or familial CJD accounts for 15 per cent of human prion disease and is caused by a MUTATION in the prion protein gene. In recent years a new variant of CJD has been identi?ed that is caused by BOVINE SPONGIFORM ENCEPHALOPATHY (BSE), called variant CJD. The incubation period for the acquired varieties ranges from four years to 40 years, with an average of 10–15 years. The symptoms of CJD are dementia, seizures, focal signs in the central nervous system, MYOCLONUS, and visual disturbances.

Abnormal prion proteins accumulate in the brain and the spinal cord, damaging neurones (see NEURON(E)) and producing small cavities. Diagnosis can be made by tonsil (see TONSILS) biopsy, although work is under way to develop a diagnostic blood test. Abnormal prion proteins are unusually resistant to inactivation by chemicals, heat, X-RAYS or ULTRAVIOLET RAYS (UVR). They are resistant to cellular degradation and can convert normal prion proteins into abnormal forms. Human prion diseases, along with scrapie in sheep and BSE in cattle, belong to a group of disorders known as transmissible spongiform encephalopathies. Abnormal prion proteins can transfer from one animal species to another, and variant CJD has occurred as a result of consumption of meat from cattle infected with BSE.

From 1995 to 1999, a scienti?c study of tonsils and appendixes removed at operation suggested that the prevalence of prion carriage may be as high as 120 per million. It is not known what percentage of these might go on to develop disease.

One precaution is that, since 2003, all surgical instruments used in brain biopsies have had to be quarantined and disposable instruments are now used in tonsillectomy.

Measures have also been introduced to reduce the risk of transmission of CJD from transfusion of blood products.

In the past, CJD has also been acquired from intramuscular injections of human cadaveric pituitary-derived growth hormone and corneal transplantation.

The most common form of CJD remains the sporadic variety, although the eventual incidence of variant CJD may not be known for many years.... creutzfeldt-jakob disease (cjd)

Cushing’s Syndrome

Described in 1932 by Harvey Cushing, the American neurosurgeon, Cushing’s syndrome is due to an excess production of CORTISOL. It can thus result from a tumour of the ADRENAL GLANDS secreting cortisol, or from a PITUITARY GLAND tumour secreting ACTH and stimulating both adrenal cortexes to hypertrophy and secrete excess cortisol. It is sometimes the result of ectopic production of ACTH from non-endocrine tumours in the LUNGS and PANCREAS.

The patient gains weight and the obesity tends to have a characteristic distribution over the face, neck, and shoulder and pelvic girdles. Purple striae develop over the abdomen and there is often increased hairiness or hirsutism. The blood pressure is commonly raised and the bone softens as a result of osteoporosis. The best test to establish the diagnosis is to measure the amount of cortisol in a 24-hourly specimen of urine. Once the diagnosis has been established, it is then necessary to undertake further tests to determine the cause.... cushing’s syndrome

Da Costa’s Syndrome

See EFFORT SYNDROME.... da costa’s syndrome

Deficiency Disease

Any disease resulting from the absence from the diet of any substance essential to good health: for example, one of the vitamins.... deficiency disease

Disease Control

All the measures designed to prevent or reduce as much as possible the incidence, prevalence and consequences of disease, such as the control of disease vectors, the removal or reduction of the influence of predisposing factors in the environment, immunization and curative care.... disease control

Disease Management

The process of identifying and delivering, within selected populations (e.g. people with asthma or diabetes), the most efficient, effective combination of resources, interventions or pharmaceuticals for the treatment or prevention of a disease. Disease management could include team-based care, where medical practitioners and/or other health professionals participate in the delivery and management of care. It also includes the appropriate use of pharmaceuticals.... disease management

Disease Prevention

See “prevention”.... disease prevention

Down’s (down) Syndrome

A genetic disorder in which the affected person usually carries an extra chromosome – 47 instead of the usual 46. The extra chromosome occurs in the no. 21 group, hence the disorder is described as trisomy 21. The condition was named after Dr J L H Down, the London doctor who ?rst described it in 1866. The incidence is around one in 600 births. The disorder is characterised by a particular physical appearance and learning diffculties, with the affected individuals having an INTELLIGENCE QUOTIENT (IQ) ranging from 30 to 80 (normal is 100). Most people with the syndrome have eyes that slope up at the outer corners with skin folds that cover the inner ones. The face and features are smaller than normal, while the tongue is larger; the back of the head is ?attened and the hands are usually short and broad. The facial features led to the syndrome being described as ‘mongolism’, a term that is no longer used.

Children with Down’s syndrome are usually friendly and ?t in well with the family. Despite their learning disabilities, some learn to read and, if they have appropriate educational and environmental stimulation, can make the most of their abilities.

A heart defect is present in around 25 per cent of the children at birth, and deafness and acute LEUKAEMIA occur more frequently than in unaffected youngsters. Those with the syndrome are particularly prone to developing ear infections. ATHEROSCLEROSIS often develops early in adults and ALZHEIMER’S DISEASE tends to occur as early as 40 years of age. A friendly home environment helps them to enjoy life, but a few individuals with the syndrome may eventually require institutional care. Improved social and medical care means that many now live until their 60s.

Routine screening tests early in pregnancy, starting with blood analysis but going on if necessary to AMNIOCENTESIS and chorionic villus sampling (see PRENATAL SCREENING OR DIAGNOSIS), can identify fetuses likely to develop the disorder. If a sample of fetal cells con?rms the chromosome defect (triple marker test – see PREGNANCY AND LABOUR), the parents may consider termination of the pregnancy. In the UK, screening is normally o?ered to women over 35 because of their increased risk. When younger parents have a child with Down’s syndrome, the chances of a subsequent child with the disorder are relatively high as it is probable that both parents carry a chromosome abnormality insu?cient to cause ill-health until combined. So they may wish to discuss with their medical advisers the question of further pregnancies.

Parents who have a child with Down’s syndrome will understandably feel a combination of strong emotions, including anger and guilt, and constructive counselling can be valuable. Among societies o?ering advice and support is the Down’s Syndrome Association.... down’s (down) syndrome

Ear, Diseases Of

Diseases may affect the EAR alone or as part of a more generalised condition. The disease may affect the outer, middle or inner ear or a combination of these.

Examination of the ear includes inspection of the external ear. An auriscope is used to examine the external ear canal and the ear drum. If a more detailed inspection is required, a microscope may be used to improve illumination and magni?cation.

Tuning-fork or Rinne tests are performed to identify the presence of DEAFNESS. The examiner tests whether the vibrating fork is audible at the meatus, and then the foot of the fork is placed on the mastoid bone of the ear to discover at which of the two sites the patient can hear the vibrations for the longest time. This can help to di?erentiate between conductive and nerve deafness.

Hearing tests are carried out to determine the level of hearing. An audiometer is used to deliver a series of short tones of varying frequency to the ear, either through a pair of headphones or via a sound transducer applied directly to the skull. The intensity of the sound is gradually reduced until it is no longer heard and this represents the threshold of hearing, at that frequency, through air and bone respectively. It may be necessary to play a masking noise into the opposite ear to prevent that ear from hearing the tones, enabling each ear to be tested independently.

General symptoms The following are some of the chief symptoms of ear disease: DEAFNESS (see DEAFNESS). EARACHE is most commonly due to acute in?ammation of the middle ear. Perceived pain in this region may be referred from other areas, such as the earache commonly experienced after tonsillectomy (removal of the TONSILS) or that caused by carious teeth (see TEETH, DISORDERS OF). The treatment will depend on the underlying cause. TINNITUS or ringing in the ear often accompanies deafness, but is sometimes the only symptom of ear disease. Even normal people sometimes experience tinnitus, particularly if put in soundproofed surroundings. It may be described as hissing, buzzing, the sound of the sea, or of bells. The intensity of the tinnitis usually ?uctuates, sometimes disappearing altogether. It may occur in almost any form of ear disease, but is particularly troublesome in nerve deafness due to ageing and in noise-induced deafness. The symptom seems to originate in the brain’s subcortical regions, high in the central nervous system. It may be a symptom of general diseases such as ANAEMIA, high blood pressure and arterial disease, in which cases it is often synchronous with the pulse, and may also be caused by drugs such as QUININE, salicylates (SALICYLIC ACID and its salts, for example, ASPIRIN) and certain ANTIBIOTICS. Treatment of any underlying ear disorder or systemic disease, including DEPRESSION, may reduce or even cure the tinnitis, but unfortunately in many cases the noises persist. Management involves psychological techniques and initially an explanation of the mechanism and reassurance that tinnitus does not signify brain disease, or an impending STROKE, may help the person. Tinnitus maskers – which look like hearing aids – have long been used with a suitably pitched sound helping to ‘mask’ the condition.

Diseases of the external ear

WAX (cerumen) is produced by specialised glands in the outer part of the ear canal only. Impacted wax within the ear canal can cause deafness, tinnitis and sometimes disturbance of balance. Wax can sometimes be softened with olive oil, 5-per-cent bicarbonate of soda or commercially prepared drops, and it will gradually liquefy and ‘remove itself’. If this is ineffective, syringing by a doctor or nurse will usually remove the wax but sometimes it is necessary for a specialist (otologist) to remove it manually with instruments. Syringing should not be done if perforation of the tympanic membrane (eardrum) is suspected. FOREIGN BODIES such as peas, beads or buttons may be found in the external ear canal, especially in children who have usually introduced them themselves. Live insects may also be trapped in the external canal causing intense irritation and noise, and in such cases spirit drops are ?rst instilled into the ear to kill the insect. Except in foreign bodies of vegetable origin, where swelling and pain may occur, syringing may be used to remove some foreign bodies, but often removal by a specialist using suitable instrumentation and an operating microscope is required. In children, a general anaesthetic may be needed. ACUTE OTITIS EXTERNA may be a di?use in?ammation or a boil (furuncle) occurring in the outer ear canal. The pinna is usually tender on movement (unlike acute otitis media – see below) and a discharge may be present. Initially treatment should be local, using magnesium sulphate paste or glycerine and 10-per-cent ichthaminol. Topical antibiotic drops can be used and sometimes antibiotics by mouth are necessary, especially if infection is acute. Clotrimazole drops are a useful antifungal treatment. Analgesics and locally applied warmth should relieve the pain.

CHRONIC OTITIS EXTERNA producing pain and discharge, can be caused by eczema, seborrhoeic DERMATITIS or PSORIASIS. Hair lotions and cosmetic preparations may trigger local allergic reactions in the external ear, and the chronic disorder may be the result of swimming or use of dirty towels. Careful cleaning of the ear by an ENT (Ear, Nose & Throat) surgeon and topical antibiotic or antifungal agents – along with removal of any precipitating cause – are the usual treatments. TUMOURS of the ear can arise in the skin of the auricle, often as a result of exposure to sunlight, and can be benign or malignant. Within the ear canal itself, the commonest tumours are benign outgrowths from the surrounding bone, said to occur in swimmers as a result of repeated exposure to cold water. Polyps may result from chronic infection of the ear canal and drum, particularly in the presence of a perforation. These polyps are soft and may be large enough to ?ll the ear canal, but may shrink considerably after treatment of the associated infection.

Diseases of the middle ear

OTITIS MEDIA or infection of the middle ear, usually occurs as a result of infection spreading up the Eustachian tubes from the nose, throat or sinuses. It may follow a cold, tonsillitis or sinusitis, and may also be caused by swimming and diving where water and infected secretions are forced up the Eustachian tube into the middle ear. Primarily it is a disease of children, with as many as 1.5 million cases occurring in Britain every year. Pain may be intense and throbbing or sharp in character. The condition is accompanied by deafness, fever and often TINNITUS.

In infants, crying may be the only sign that something is wrong – though this is usually accompanied by some localising manifestation such as rubbing or pulling at the ear. Examination of the ear usually reveals redness, and sometimes bulging, of the ear drum. In the early stages there is no discharge, but in the later stages there may be a discharge from perforation of the ear drum as a result of the pressure created in the middle ear by the accumulated pus. This is usually accompanied by an immediate reduction in pain.

Treatment consists of the immediate administration of an antibiotic, usually one of the penicillins (e.g. amoxicillin). In the majority of cases no further treatment is required, but if this does not quickly bring relief then it may be necessary to perform a myringotomy, or incision of the ear drum, to drain pus from the middle ear. When otitis media is treated immediately with su?cient dosage of the appropriate antibiotic, the chances of any permanent damage to the ear or to hearing are reduced to a negligible degree, as is the risk of any complications such as mastoiditis (discussed later in this section). CHRONIC OTITIS MEDIA WITH EFFUSION or glue ear, is the most common in?ammatory condition of the middle ear in children, to the extent that one in four children in the UK entering school has had an episode of ‘glue ear’. It is characterised by a persistent sticky ?uid in the middle ear (hence the name); this causes a conductive-type deafness. It may be associated with enlarged adenoids (see NOSE, DISORDERS OF) which impair the function of the Eustachian tube. If the hearing impairment is persistent and causes problems, drainage of the ?uid, along with antibiotic treatment, may be needed – possibly in conjunction with removal of the adenoids. The insertion of grommets (ventilation tubes) was for a time standard treatment, but while hearing is often restored, there may be no long-term gain and even a risk of damage to the tympanic membrane, so the operation is less popular than it was a decade or so ago. MASTOIDITIS is a serious complication of in?ammation of the middle ear, the incidence of which has been dramatically reduced by the introduction of antibiotics. In?ammation in this cavity usually arises by direct spread of acute or chronic in?ammation from the middle ear. The signs of this condition include swelling and tenderness of the skin behind the ear, redness and swelling inside the ear, pain in the side of the head, high fever, and a discharge from the ear. The management of this condition in the ?rst instance is with antibiotics, usually given intravenously; however, if the condition fails to improve, surgical treatment is necessary. This involves draining any pus from the middle ear and mastoid, and removing diseased lining and bone from the mastoid.

Diseases of the inner ear

MENIÈRE’S DISEASE is a common idiopathic disorder of ENDOLYMPH control in the semicircular canals (see EAR), characterised by the triad of episodic VERTIGO with deafness and tinnitus. The cause is unknown and usually one ear only is affected at ?rst, but eventually the opposite ear is affected in approximately 50 per cent of cases. The onset of dizziness is often sudden and lasts for up to 24 hours. The hearing loss is temporary in the early stages, but with each attack there may be a progressive nerve deafness. Nausea and vomiting often occur. Treatment during the attacks includes rest and drugs to control sickness. Vasodilator drugs such as betahistine hydrochloride may be helpful. Surgical treatment is sometimes required if crippling attacks of dizziness persist despite these measures. OTOSCLEROSIS A disorder of the middle ear that results in progressive deafness. Often running in families, otosclerosis affects about one person in 200; it customarily occurs early in adult life. An overgrowth of bone ?xes the stapes (the innermost bone of the middle ear) and stops sound vibrations from being transmitted to the inner ear. The result is conductive deafness. The disorder usually affects both ears. Those affected tend to talk quietly and deafness increases over a 10–15 year period. Tinnitus often occurs, and occasionally vertigo.

Abnormal hearing tests point to the diagnosis; the deafness may be partially overcome with a hearing aid but surgery is eventually needed. This involves replacing the stapes bone with a synthetic substitute (stapedectomy). (See also OTIC BAROTRAUMA.)... ear, diseases of

Effort Syndrome

Also known as Da Costa’s syndrome, this is a condition in which symptoms occur, such as palpitations and shortness of breath, which are attributed by the patient to disorder of the heart. There is no evidence, however, of heart disease, and psychological factors are thought to be of importance. (See PSYCHOSOMATIC DISEASES.)... effort syndrome

Ebola Virus Disease

Ebola virus disease is another name for VIRAL HAEMORRHAGIC FEVER. The ebola virus is one of the most virulent micro-organisms known. Like the marburg virus (see MARBURG DISEASE), it belongs to the ?lovirus group which originates in Africa. Increased population mobility and wars have meant that the infection occasionally occurs elsewhere, with air travellers developing symptoms on returning home.

Treatment As the disease can be neither prevented nor cured, treatment is supportive, with strict anti-infection procedures essential as human-to-human transmission can occur via skin and mucous-membrane contacts. Incubation period is 5–10 days. Fever with MYALGIA and headache occur initially, often accompanied by abdominal and chest symptoms. Haemorrhagic symptoms soon develop and the victim either starts to improve in the second week or develops multi-organ failure and lapses into a coma. Mortality ranges from 25 to 90 per cent.... ebola virus disease

Eisenmenger Syndrome

A condition in which the subject suffers from a defect in one of the dividing walls (septum) of the HEART and this is accompanied by PULMONARY HYPERTENSION. The defect allows blood low in oxygen to ?ow from the right to the left side of the heart and be pumped into the aorta, which normally carries oxygenated blood to the body. The patient has a dusky blue appearance, becomes breathless and has a severely restricted exercise tolerance. There is an increase in red blood cells as the body attempts to compensate for the lowered oxygen delivery. The condition may be avoided by early surgical repair of the septal defect, but once it is evident, surgery may not be possible.... eisenmenger syndrome

False-memory Syndrome

See REPRESSED MEMORY THERAPY.... false-memory syndrome

Fetal Alcohol Syndrome

A disorder of newborn infants that is caused by the toxic effects on the growing FETUS of excessive amounts of alcohol taken by the mother. Low birth-weight and retarded growth are the main consequences, but affected babies may have hand and facial deformities and are sometimes mentally retarded.... fetal alcohol syndrome

Fibromyalgia Syndrome

Symptoms These vary, with pain and fatigue generally prominent, sometimes causing considerable disability. Patients can usually dress and wash independently but cannot cope with a job or household activities. Pain is mainly axial, but may affect any region. ANALGESICS, NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) and local physical treatments are generally ine?ective.

Patients often have a poor sleep pattern, waking exhausted. Unexplained headache, urinary frequency and abdominal symptoms are common, but no cause has been found. Patients generally score highly on measures of anxiety and DEPRESSION. Fibromyalgia is not an ideal description; idiopathic di?use-pain syndrome and non-restorative sleep disorder are increasingly preferred terms.

Clinical ?ndings are generally unremarkable; most important is the presence of multiple hyperalgesic tender sites (e.g. low cervical spine, low lumbar spine, suboccipital muscle, mid upper trapezius, tennis-elbow sites, upper outer quadrants of buttocks, medial fat pad of knees). In ?bromyalgia, hyperalgesia (excessive discomfort) is widespread and symmetrical, but absent at sites normally non-tender. Claims by patients to be tender all over are more likely to be due to fabrication or psychiatric disturbance. OSTEOARTHRITIS and periarticular syndrome are much more common and should be excluded, together with other conditions, such as hypothyroidism (see THYROID GLAND, DISEASES OF), SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and in?ammatory myopathy (see MUSCLES, DISORDERS OF), which may present with similar symptoms.

Cause There is no investigational evidence of in?ammatory, metabolic or structural abnormality, and the problem seems functional rather than pathological. SEROTONIN de?ciency has a signi?cant role in ?bromyalgia syndrome.

Management Controlled trials have con?rmed the usefulness of low-dose AMITRIPTYLINE or DOTHIEPIN together with a graded exercise programme to increase aerobic ?tness. How this works is still unclear; its e?cacy may be due to its normalising effects on the sleep centre or ‘pain gating’ (reduction of pain sensation) at the spinal-cord level. Prognosis is often poor. Nevertheless, suitable advice and training can help most patients to learn to cope better with their condition and avoid unnecessary investigations and drug treatments.... fibromyalgia syndrome

Fröhlich’s Syndrome

A condition in children characterised by obesity, physical sluggishness, and retarded sexual development. It is the result of disturbed PITUITARY GLAND function.... fröhlich’s syndrome

Functional Diseases

See PSYCHOSOMATIC DISEASES.... functional diseases

Gaucher’s Disease

A disease characterised by abnormal storage of LIPID, particularly in the SPLEEN, central nervous system, BONE MARROW, and LIVER. This results in enlargement of the spleen and the liver – particularly of the former – and ANAEMIA. It runs a chronic course. Diagnosis is usually by skin ?broblast glucocerebrosidase assay. Death often results from PNEUMONIA or bleeding. Infantile Gaucher’s often presents with marked neurological signs of rigid neck DYSPHAGIA, CATATONIA, hyper-re?exia and low IQ. The disease can now be treated with enzyme replacement using alglucerase. The annual cost per patient is substantial – several thousand pounds.... gaucher’s disease

Graft Versus Host Disease (gvhd)

A condition that is a common complication of BONE MARROW transplant (see TRANSPLANTATION). It results from certain LYMPHOCYTES in the transplanted marrow attacking the transplant recipient’s tissues, which they identify as ‘foreign’. GVHD may appear soon after a transplant or develop several months later. The condition, which is fatal in about a third of victims, may be prevented by immunosuppressant drugs such as ciclosporin.... graft versus host disease (gvhd)

Gall-bladder, Diseases Of

The gall-bladder rests on the underside of the LIVER and joins the common hepatic duct via the cystic duct to form the common BILE DUCT. The gall-bladder acts as a reservoir and concentrator of BILE, alterations in the composition of which may result in the formation of gallstones, the most common disease of the gallbladder.

Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.

Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.

Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of

Gilles De La Tourette’s Syndrome

Also known as Tourette’s syndrome, this is a hereditary condition of severe and multiple tics (see TIC) of motor or vocal origin. It usually starts in childhood and becomes chronic (with remissions). With a prevalance of one in 2,000, a dominant gene (see GENES) with variable expression may be responsible. The disorder is associated with explosive vocal tics and grunts, occasionally obscene (see COPROLALIA). The patient may also involuntarily repeat the words or imitate the actions of others (see PALILALIA). HALOPERIDOL, pimozide (an oral antipsychotic drug similar to CHLORPROMAZINE hydrochloride) and clonidine are among drugs that may help to control this distressing, but fortunately rare, disorder.... gilles de la tourette’s syndrome

Gums, Diseases Of

See MOUTH, DISEASES OF; TEETH, DISEASES OF.... gums, diseases of

Hansen’s Disease

See LEPROSY.... hansen’s disease

Hashimoto’s Disease

A condition in which the whole of the THYROID GLAND is di?usely enlarged and ?rm. It is one of the diseases produced by AUTOIMMUNITY. The enlargement is due to di?use in?ltration of lymphocytes and increase of ?brous tissue. This form of GOITRE appears in middle-aged women, does not give rise to symptoms of thyrotoxicosis (see THYROID GLAND, DISEASES OF – Thyrotoxicosis), and tends to produce myxoedema (see THYROID GLAND, DISEASES OF – Hypothyroidism).... hashimoto’s disease

Heart, Diseases Of

Heart disease can affect any of the structures of the HEART and may affect more than one at a time. Heart attack is an imprecise term and may refer to ANGINA PECTORIS (a symptom of pain originating in the heart) or to coronary artery thrombosis, also called myocardial infarction.

Arrhythmias An abnormal rate or rhythm of the heartbeat. The reason is a disturbance in the electrical impulses within the heart. Sometimes a person may have an occasional irregular heartbeat: this is called an ECTOPIC beat (or an extrasystole) and does not necessarily mean that an abnormality exists. There are two main types of arrhythmia: bradycardias, where the rate is slow – fewer than 60 beats a minute and sometimes so slow and unpredictable (heartblock) as to cause blackouts or heart failure; and tachycardia, where the rate is fast – more than 100 beats a minute. A common cause of arrhythmia is coronary artery disease, when vessels carrying blood to the heart are narrowed by fatty deposits (ATHEROMA), thus reducing the blood supply and damaging the heart tissue. This condition often causes myocardial infarction after which arrhythmias are quite common and may need correcting by DEFIBRILLATION (application of a short electric shock to the heart). Some tachycardias result from a defect in the electrical conduction system of the heart that is commonly congenital. Various drugs can be used to treat arrhythmias (see ANTIARRHYTHMIC DRUGS). If attacks constantly recur, the arrhythmia may be corrected by electrical removal of dead or diseased tissue that is the cause of the disorder. Heartblock is most e?ectively treated with an arti?cial CARDIAC PACEMAKER, a battery-activated control unit implanted in the chest.

Cardiomyopathy Any disease of the heart muscle that results in weakening of its contractions. The consequence is a fall in the e?ciency of the circulation of blood through the lungs and remainder of the body structures. The myopathy may be due to infection, disordered metabolism, nutritional excess or de?ciency, toxic agents, autoimmune processes, degeneration, or inheritance. Often, however, the cause is not identi?ed. Cardiomyopathies are less common than other types of heart diseases, and the incidence of di?erent types of myopathy (see below) is not known because patients or doctors are sometimes unaware of the presence of the condition.

The three recognised groups of cardiomyopathies are hypertrophic, dilated and restrictive.

•Hypertrophic myopathy, a familial condition, is characterised by great enlargement of the muscle of the heart ventricles. This reduces the muscle’s e?ciency, the ventricles fail to relax properly and do not ?ll suf?ciently during DIASTOLE.

In the dilated type of cardiomyopathy, both ventricles overdilate, impairing the e?ciency of contraction and causing congestion of the lungs.

In the restrictive variety, proper ?lling of the ventricles does not occur because the muscle walls are less elastic than normal. The result is raised pressure in the two atria (upper cavities) of the heart: these dilate and develop FIBRILLATION. Diagnosis can be di?cult and treatment is symptomatic, with a poor prognosis. In suitable patients, heart TRANSPLANTATION may be considered. Disorders of the heart muscle may also be

caused by poisoning – for example, heavy consumption of alcohol. Symptoms include tiredness, palpitations (quicker and sometimes irregular heartbeat), chest pain, di?culty in breathing, and swelling of the legs and hands due to accumulation of ?uid (OEDEMA). The heart is enlarged (as shown on chest X-ray) and ECHOCARDIOGRAPHY shows thickening of the heart muscle. A BIOPSY of heart muscle will show abnormalities in the cells of the heart muscle.

Where the cause of cardiomyopathy is unknown, as is the case with most patients, treatment is symptomatic using DIURETICS to control heart failure and drugs such as DIGOXIN to return the heart rhythm to normal. Patients should stop drinking alcohol. If, as often happens, the patient’s condition slowly deteriorates, heart transplantation should be considered.

Congenital heart disease accounts for 1–2 per cent of all cases of organic heart disease. It may be genetically determined and so inherited; present at birth for no obvious reason; or, in rare cases, related to RUBELLA in the mother. The most common forms are holes in the heart (atrial septal defect, ventricular septal defect – see SEPTAL DEFECT), a patent DUCTUS ARTERIOSUS, and COARCTATION OF THE AORTA. Many complex forms also exist and can be diagnosed in the womb by fetal echocardiography which can lead to elective termination of pregnancy. Surgery to correct many of these abnormalities is feasible, even for the most severe abnormalities, but may only be palliative giving rise to major diffculties of management as the children become older. Heart transplantation is now increasingly employed for the uncorrectable lesions.

Coronary artery disease Also known as ischaemic heart disease, this is a common cause of symptoms and death in the adult population. It may present for the ?rst time as sudden death, but more usually causes ANGINA PECTORIS, myocardial infarction (heart attack) or heart failure. It can also lead to a disturbance of heart rhythm. Factors associated with an increased risk of developing coronary artery disease include diabetes, cigarette smoking, high blood pressure, obesity, and a raised concentration of cholesterol in the blood. Older males are most affected.

Coronary thrombosis or acute myocardial infarction is the acute, dramatic manifestation of coronary-artery ischaemic heart disease – one of the major killing diseases of western civilisation. In 1999, ischaemic heart disease was responsible for about 115,000 deaths in England and Wales, compared with 153,000 deaths in 1988. In 1999 more than 55,600 people died of coronary thrombosis. The underlying cause is disease of the coronary arteries which carry the blood supply to the heart muscle (or myocardium). This results in narrowing of the arteries until ?nally they are unable to transport su?cient blood for the myocardium to function e?ciently. One of three things may happen. If the narrowing of the coronary arteries occurs gradually, then the individual concerned will develop either angina pectoris or signs of a failing heart: irregular rhythm, breathlessness, CYANOSIS and oedema.

If the narrowing occurs suddenly or leads to complete blockage (occlusion) of a major branch of one of the coronary arteries, then the victim collapses with acute pain and distress. This is the condition commonly referred to as a coronary thrombosis because it is usually due to the affected artery suddenly becoming completely blocked by THROMBOSIS. More correctly, it should be described as coronary occlusion, because the ?nal occluding factor need not necessarily be thrombosis.

Causes The precise cause is not known, but a wide range of factors play a part in inducing coronary artery disease. Heredity is an important factor. The condition is more common in men than in women; it is also more common in those in sedentary occupations than in those who lead a more physically active life, and more likely to occur in those with high blood pressure than in those with normal blood pressure (see HYPERTENSION). Obesity is a contributory factor. The disease is more common among smokers than non-smokers; it is also often associated with a high level of CHOLESTEROL in the blood, which in turn has been linked with an excessive consumption of animal, as opposed to vegetable, fats. In this connection the important factors seem to be the saturated fatty acids (low-density and very low-density lipoproteins [LDLs and VLDLs] – see CHOLESTEROL) of animal fats which would appear to be more likely to lead to a high level of cholesterol in the blood than the unsaturated fatty acids of vegetable fats. As more research on the subject is carried out, the arguments continue about the relative in?uence of the di?erent factors. (For advice on prevention of the disease, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)

Symptoms The presenting symptom is the sudden onset, often at rest, of acute, agonising pain in the front of the chest. This rapidly radiates all over the front of the chest and often down over the abdomen. The pain is frequently accompanied by nausea and vomiting, so that suspicion may be aroused of some acute abdominal condition such as biliary colic (see GALLBLADDER, DISEASES OF) or a perforated PEPTIC ULCER. The victim soon goes into SHOCK, with a pale, cold, sweating skin, rapid pulse and dif?culty in breathing. There is usually some rise in temperature.

Treatment is immediate relief of the pain by injections of diamorphine. Thrombolytic drugs should be given as soon as possible (‘rapid door to needle time’) and ARRHYTHMIA corrected. OXYGEN is essential and oral ASPIRIN is valuable. Treatment within the ?rst hour makes a great di?erence to recovery. Subsequent treatment includes the continued administration of drugs to relieve the pain; the administration of ANTIARRHYTHMIC DRUGS that may be necessary to deal with the heart failure that commonly develops, and the irregular action of the heart that quite often develops; and the continued administration of oxygen. Patients are usually admitted to coronary care units, where they receive constant supervision. Such units maintain an emergency, skilled, round-the-clock sta? of doctors and nurses, as well as all the necessary resuscitation facilities that may be required.

The outcome varies considerably. The ?rst (golden) hour is when the patient is at greatest risk of death: if he or she is treated, then there is a 50 per cent reduction in mortality compared with waiting until hospital admission. As each day passes the prognosis improves with a ?rst coronary thrombosis, provided that the patient does not have a high blood pressure and is not overweight. Following recovery, there should be a gradual return to work, care being taken to avoid any increase in weight, unnecessary stress and strain, and to observe moderation in all things. Smoking must stop. In uncomplicated cases patients get up and about as soon as possible, most being in hospital for a week to ten days and back at work in three months or sooner.

Valvular heart disease primarily affects the mitral and aortic valves which can become narrowed (stenosis) or leaking (incompetence). Pulmonary valve problems are usually congenital (stenosis) and the tricuspid valve is sometimes involved when rheumatic heart disease primarily affects the mitral or aortic valves. RHEUMATIC FEVER, usually in childhood, remains a common cause of chronic valvular heart disease causing stenosis, incompetence or both of the aortic and mitral valves, but each valve has other separate causes for malfunction.

Aortic valve disease is more common with increasing age. When the valve is narrowed, the heart hypertrophies and may later fail. Symptoms of angina or breathlessness are common and dizziness or blackouts (syncope) also occur. Replacing the valve is a very e?ective treatment, even with advancing age. Aortic stenosis may be caused by degeneration (senile calci?c), by the inheritance of two valvular leaflets instead of the usual three (bicuspid valve), or by rheumatic fever. Aortic incompetence again leads to hypertrophy, but dilatation is more common as blood leaks back into the ventricle. Breathlessness is the more common complaint. The causes are the same as stenosis but also include in?ammatory conditions such as SYPHILIS or ANKYLOSING SPONDYLITIS and other disorders of connective tissue. The valve may also leak if the aorta dilates, stretching the valve ring as with HYPERTENSION, aortic ANEURYSM and MARFAN’S SYNDROME – an inherited disorder of connective tissue that causes heart defects. Infection (endocarditis) can worsen acutely or chronically destroy the valve and sometimes lead to abnormal outgrowths on the valve (vegetations) which may break free and cause devastating damage such as a stroke or blocked circulation to the bowel or leg.

Mitral valve disease leading to stenosis is rheumatic in origin. Mitral incompetence may be rheumatic but in the absence of stenosis can be due to ISCHAEMIA, INFARCTION, in?ammation, infection and a congenital weakness (prolapse). The valve may also leak if stretched by a dilating ventricle (functional incompetence). Infection (endocarditis) may affect the valve in a similar way to aortic disease. Mitral symptoms are predominantly breathlessness which may lead to wheezing or waking at night breathless and needing to sit up or stand for relief. They are made worse when the heart rhythm changes (atrial ?brillation) which is frequent as the disease becomes more severe. This leads to a loss of e?ciency of up to 25 per cent and a predisposition to clot formation as blood stagnates rather than leaves the heart e?ciently. Mitral incompetence may remain mild and be of no trouble for many years, but infection must be guarded against (endocarditis prophylaxis).

Endocarditis is an infection of the heart which may acutely destroy a valve or may lead to chronic destruction. Bacteria settle usually on a mild lesion. Antibiotics taken at vulnerable times can prevent this (antibiotic prophylaxis) – for example, before tooth extraction. If established, lengthy intravenous antibiotic therapy is needed and surgery is often necessary. The mortality is 30 per cent but may be higher if the infection settles on a replaced valve (prosthetic endocarditis). Complications include heart failure, shock, embolisation (generation of small clots in the blood), and cerebral (mental) confusion.

PERICARDITIS is an in?ammation of the sac covering the outside of the heart. The sac becomes roughened and pain occurs as the heart and sac rub together. This is heard by stethoscope as a scratching noise (pericardial rub). Fever is often present and a virus the main cause. It may also occur with rheumatic fever, kidney failure, TUBERCULOSIS or from an adjacent lung problem such as PNEUMONIA or cancer. The in?ammation may cause ?uid to accumulate between the sac and the heart (e?usion) which may compress the heart causing a fall in blood pressure, a weak pulse and circulatory failure (tamponade). This can be relieved by aspirating the ?uid. The treatment is then directed at the underlying cause.... heart, diseases of

Hirschsprung’s Disease

Hirschsprung’s disease, or MEGACOLON, is a rare congenital disorder characterised by great hypertrophy and dilatation of the colon (see INTESTINE). The RECTUM and lower colon have failed to develop a normal nerve network, thus disturbing normal contraction and expansion of these structures. Treatment is surgical removal of the affected sections, with the remaining colon being joined to the anus.... hirschsprung’s disease

Hodgkin’s Disease

See LYMPHOMA.... hodgkin’s disease

Horner’s Syndrome

This is the description given to a combination of changes resulting from paralysis of the sympathetic nerve in the neck. They are: a small pupil; a drooping upper lid; and an apparently (though not actually) sunken eye.... horner’s syndrome

Hurler’s Syndrome

See GARGOYLISM.... hurler’s syndrome

Hyperkinetic Syndrome

See HYPERACTIVITY.... hyperkinetic syndrome

Industrial Diseases

See OCCUPATIONAL HEALTH, MEDICINE AND DISEASES.... industrial diseases

International Classification Of Disease (icd)

A World Health Organisation classi?cation of all known diseases and syndromes. The diseases are divided according to system (respiratory, renal, cardiac, etc.) or type (accidents, malignant growth, etc.). Each of them is given a three-digit number to facilitate computerisation. This classi?cation allows mortality and morbidity rates to be compared nationally and regionally. A revised ICD is published every ten years; a similar classi?cation is being developed for impairments, disabilities and handicaps.... international classification of disease (icd)

International Statistical Classification Of Diseases And Related Health Problems, Tenth Revision (icd-10)

A list of diagnoses and identifying codes used by medical practitioners and other health care providers. The coding and terminology provide a uniform language that permits consistent communication on claim forms. Data from earlier time periods were coded using the appropriate revision of the ICD for that time period. Changes in classification of causes of death in successive revisions of the ICD may introduce discontinuities in cause of death statistics over time.... international statistical classification of diseases and related health problems, tenth revision (icd-10)

Inflammatory Bowel Disease (ibd)

CROHN’S DISEASE and ULCERATIVE COLITIS are chronic in?ammatory diseases characterised by relapsing and remitting episodes over many years. The diseases are similar and are both classi?ed as IBD, but a signi?cant distinction is that Crohn’s disease can affect any part of the GASTROINTESTINAL TRACT from mouth to anus, whereas ulcerative colitis affects only the COLON. The incidence of IBD varies widely between countries, being rare in the developing world but much more common in westernised nations, where the incidence of Crohn’s disease is around 5–7 per 100,000 (and rising) and that of ulcerative colitis at a broadly stable 10 per 100,000. It is common for both disorders to develop in young adults, but there is a second spike of incidence in people in their 70s. Details about the two disorders are given under the individual entries elsewhere in the dictionary. In?ammatory bowel disease should not be confused with IRRITABLE BOWEL SYNDROME (IBS) which has some of the same symptoms of IBD but a di?erent cause and outcome.... inflammatory bowel disease (ibd)

Intestine, Diseases Of

The principal signs of trouble which has its origin in the intestine consist of pain somewhere about the abdomen, sometimes vomiting, and irregular bowel movements: constipation, diarrhoea or alternating bouts of these.

Several diseases and conditions are treated under separate headings. (See APPENDICITIS; CHOLERA; COLITIS; CONSTIPATION; CROHN’S DISEASE; DIARRHOEA; DYSENTERY; ENTERIC FEVER; HAEMORRHOIDS; HERNIA; INFLAMMATORY BOWEL DISEASE (IBD); ILEITIS; INTUSSUSCEPTION; IRRITABLE BOWEL SYNDROME (IBS); PERITONITIS; RECTUM, DISEASES OF; ULCERATIVE COLITIS.)

In?ammation of the outer surface is called peritonitis, a serious disease. That of the inner surface is known generally as enteritis, in?ammation of special parts receiving the names of colitis, appendicitis, irritable bowel syndrome (IBS) and in?ammatory bowel disease (IBD). Enteritis may form the chief symptom of certain infective diseases: for example in typhoid fever (see ENTERIC FEVER), cholera and dysentery. It may be acute, although not connected with any de?nite organism, when, if severe, it is a very serious condition, particularly in young children. Or it may be chronic, especially as the result of dysentery, and then constitutes a less serious if very troublesome complaint.

Perforation of the bowel may take place as the result either of injury or of disease. Stabs and other wounds which penetrate the abdomen may damage the bowel, and severe blows or crushes may tear it without any external wound. Ulceration, as in typhoid fever, or, more rarely, in TUBERCULOSIS, may cause an opening in the bowel-wall also. Again, when the bowel is greatly distended above an obstruction, faecal material may accumulate and produce ulcers, which rupture with the ordinary movements of the bowels. Whatever the cause, the symptoms are much the same.

Symptoms The contents of the bowel pass out through the perforation into the peritoneal cavity, and set up a general peritonitis. In consequence, the abdomen is painful, and after a few hours becomes extremely tender to the touch. The abdomen swells, particularly in its upper part, owing to gas having passed also into the cavity. Fever and vomiting develop and the person passes into a state of circulatory collapse or SHOCK. Such a condition may be fatal if not properly treated.

Treatment All food should be withheld and the patient given intravenous ?uids to resuscitate them and then to maintain their hydration and electrolyte balance. An operation is urgently necessary, the abdomen being opened in the middle line, the perforated portion of bowel found, the perforation stitched up, and appropriate antibiotics given.

Obstruction means a stoppage to the passage down the intestine of partially digested food. Obstruction may be acute, when it comes on suddenly with intense symptoms; or it may be chronic, when the obstructing cause gradually increases and the bowel becomes slowly more narrow until it closes altogether; or subacute, when obstruction comes and goes until it ends in an acute attack. In chronic cases the symptoms are milder in degree and more prolonged.

Causes Obstruction may be due to causes outside the bowel altogether, for example, the pressure of tumours in neighbouring organs, the twisting around the bowel of bands produced by former peritonitis, or even the twisting of a coil of intestine around itself so as to cause a kink in its wall. Chronic causes of the obstruction may exist in the wall of the bowel itself: for example, a tumour, or the contracting scar of an old ulcer. The condition of INTUSSUSCEPTION, where part of the bowel passes inside of the part beneath it, in the same way as one turns the ?nger of a glove outside in, causes obstruction and other symptoms. Bowel within a hernia may become obstructed when the hernia strangulates. Finally some body, such as a concretion, or the stone of some large fruit, or even a mass of hardened faeces, may become jammed within the bowel and stop up its passage.

Symptoms There are four chief symptoms: pain, vomiting, constipation and swelling of the abdomen.

Treatment As a rule the surgeon opens the abdomen, ?nds the obstruction and relieves it or if possible removes it altogether. It may be necessary to form a COLOSTOMY or ILEOSTOMY as a temporary or permanent measure in severe cases.

Tumours are rare in the small intestine and usually benign. They are relatively common in the large intestine and are usually cancerous. The most common site is the rectum. Cancer of the intestine is a disease of older people; it is the second most common cancer (after breast cancer) in women in the United Kingdom, and the third most common (after lung and prostate) in men. Around 25,000 cases of cancer of the large intestine occur in the UK annually, about 65 per cent of which are in the colon. A history of altered bowel habit, in the form of increasing constipation or diarrhoea, or an alternation of these, or of bleeding from the anus, in a middle-aged person is an indication for taking medical advice. If the condition is cancer, then the sooner it is investigated and treated, the better the result.... intestine, diseases of

Ischaemic Heart Disease

See HEART, DISEASES OF.... ischaemic heart disease

Joints, Diseases Of

‘Rheumatism’ is the colloquial term for nonspeci?c musculoskeletal symptoms arising in the joints, ligaments, tendons and muscles. ‘Arthritis’ describes a pathological musculoskeletal disorder. Most common are sprains of ligaments, strains of tendons and muscles,

BURSITIS, TENDINITIS and non-speci?c back pain (see BACKACHE).

Osteoarthritis (OA) rarely starts before 40, but by the age of 80 affects 80 per cent of the population. There are structural and functional changes in the articular cartilage, as well as changes in the collagenous matrix of tendons and ligaments. OA is not purely ‘wear and tear’; various sub-groups have a genetic component. Early OA may be precipitated by localised alteration in anatomy, such as a fracture or infection of a joint. Reactive new bone growth typically occurs, causing sclerosis (hardening) beneath the joint, and osteophytes – outgrowths of bone – are characteristic at the margins of the joint. The most common sites are the ?rst metatarsal (great toe), spinal facet joints, the knee, the base of the thumb and the terminal ?nger joints (Heberden’s nodes).

OA has a slow but variable course, with periods of pain and low-grade in?ammation. Acute in?ammation, common in the knee, may result from release of pyrophosphate crystals, causing pseudo-gout.

Urate gout results from crystallisation of URIC ACID in joints, against a background of hyperuricaemia. This high concentration of uric acid in the blood may result from genetic and environmental factors, such as excess dietary purines, alcohol or diuretic drugs.

In?ammatory arthritis is less common than OA, but potentially much more serious. Several types exist, including: SPONDYLARTHRITIS This affects younger men, chie?y involving spinal and leg joints. This may lead to in?ammation and eventual ossi?cation of the enthesis – that is, where the ligaments and tendons are inserted into the bone around joints. This may be associated with disorders in other parts of the body: skin in?ammation (PSORIASIS), bowel and genito-urinary in?ammation, sometimes resulting in infection of the organs (such as dysentery). The syndromes most clearly delineated are ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF), psoriatic or colitic spondylitis, and REITER’S SYNDROME. The diagnosis is made clinically and radiologically; no association has been found with autoantibodies (see AUTOANTIBODY). A particularly clear gene locus, HLA B27, has been identi?ed in ankylosing spondylitis. Psoriasis can be associated with a characteristic peripheral arthritis.

Systemic autoimmune rheumatic diseases (see AUTOIMMUNE DISORDERS). RHEUMATOID ARTHRITIS (RA) – see also main entry. The most common of these diseases. Acute in?ammation causes lymphoid synovitis, leading to erosion of the cartilage, associated joints and soft tissues. Fibrosis follows, causing deformity. Autoantibodies are common, particularly Rheumatoid Factor. A common complication of RA is Sjögren’s syndrome, when in?ammation of the mucosal glands may result in a dry mouth and eyes. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and various overlap syndromes occur, such as systemic sclerosis and dermatomyositis. Autoantibodies against nuclear proteins such as DNA lead to deposits of immune complexes and VASCULITIS in various tissues, such as kidney, brain, skin and lungs. This may lead to various symptoms, and sometimes even to organ failure.

Infective arthritis includes: SEPTIC ARTHRITIS An uncommon but potentially fatal disease if not diagnosed and treated early with approriate antibiotics. Common causes are TUBERCLE bacilli and staphylococci (see STAPHYLOCOCCUS). Particularly at risk are the elderly and the immunologically vulnerable, such as those under treatment for cancer, or on CORTICOSTEROIDS or IMMUNOSUPPRESSANT drugs. RHEUMATIC FEVER Now rare in western countries. Resulting from an immunological reaction to a streptococcal infection, it is characterised by migratory arthritis, rash and cardiac involvement.

Other infections which may be associated with arthritis include rubella (German measles), parvovirus and LYME DISEASE.

Treatment Septic arthritis is the only type that can be cured using antibiotics, while the principles of treatment for the others are similar: to reduce risk factors (such as hyperuricaemia); to suppress in?ammation; to improve function with physiotherapy; and, in the event of joint failure, to perform surgical arthroplasty. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) include aspirin, paracetamol and many recently developed ones, such as the proprionic acid derivatives IBUPROFEN and naproxen, along with other drugs that have similar properties such as PIROXICAM. They all carry a risk of toxicity, such as renal dysfunction, or gastrointestinal irritation with haemorrhage. Stronger suppression of in?ammation requires corticosteroids and CYTOTOXIC drugs such as azathioprine or cyclophosphamide. Recent research promises more speci?c and less toxic anti-in?ammatory drugs, such as the monoclonal antibodies like in?iximab. An important treatment for some osteoarthritic joints is surgical replacement of the joints.... joints, diseases of

Katayama Syndrome

A syndrome characterised by allergic symptoms and involving the respiratory tract (i.e. fever, cough, rash and marked eosinophilia) sometimes seen in patients who have had exposure to a large number of schistosome cercariae, especially Schistosoma japonicum, sometimes S. mansoni, rarely S. haematobium. Sydrome occurs during the invasive stage of schistosomiasis from the time of cercarial penetration of the skin to the time of early egg laying in the veins.... katayama syndrome

Kidneys, Diseases Of

Diseases affecting the kidneys can be broadly classi?ed into congenital and genetic disorders; autoimmune disorders; malfunctions caused by impaired blood supply; infections; metabolic disorders; and tumours of the kidney. Outside factors may cause functional disturbances – for example, obstruction in the urinary tract preventing normal urinary ?ow may result in hydronephrosis (see below), and the CRUSH SYNDROME, which releases proteins into the blood as a result of seriously damaged muscles (rhabdomyolosis), can result in impaired kidney function. Another outside factor, medicinal drugs, can also be hazardous to the kidney. Large quantities of ANALGESICS taken over a long time damage the kidneys and acute tubular NECROSIS can result from certain antibiotics.

K

Diagram of glomerulus (Malpighian corpuscle).

Fortunately the body has two kidneys and, as most people can survive on one, there is a good ‘functional reserve’ of kidney tissue.

Symptoms Many patients with kidney disorders do not have any symptoms, even when the condition is quite advanced. However,

others experience loin pain associated with obstruction (renal colic) or due to infection; fevers; swelling (oedema), usually of the legs but occasionally including the face and arms; blood in the urine (haematuria); and excess quantities of urine (polyuria), including at night (nocturia), due to failure of normal mechanisms in the kidney for concentrating urine. Patients with chronic renal failure often have very di?use symptoms including nausea and vomiting, tiredness due to ANAEMIA, shortness of breath, skin irritation, pins and needles (paraesthesia) due to damage of the peripheral nerves (peripheral neuropathy), and eventually (rarely seen nowadays) clouding of consciousness and death.

Signs of kidney disease include loin tenderness, enlarged kidneys, signs of ?uid retention, high blood pressure and, in patients with end-stage renal failure, pallor, pigmentation and a variety of neurological signs including absent re?exes, reduced sensation, and a coarse ?apping tremor (asterixis) due to severe disturbance of the body’s normal metabolism.

Renal failure Serious kidney disease may lead to impairment or failure of the kidney’s ability to ?lter waste products from the blood and excrete them in the urine – a process that controls the body’s water and salt balance and helps to maintain a stable blood pressure. Failure of this process causes URAEMIA – an increase in urea and other metabolic waste products – as well as other metabolic upsets in the blood and tissues, all of which produce varying symptoms. Failure can be sudden or develop more slowly (chronic). In the former, function usually returns to normal once the underlying cause has been treated. Chronic failure, however, usually irreparably reduces or stops normal function.

Acute failure commonly results from physiological shock following a bad injury or major illness. Serious bleeding or burns can reduce blood volume and pressure to the point where blood-supply to the kidney is greatly reduced. Acute myocardial infarction (see HEART, DISEASES OF) or pancreatitis (see PANCREAS, DISORDERS OF) may produce a similar result. A mismatched blood transfusion can produce acute failure. Obstruction to the urine-?ow by a stone (calculus) in the urinary tract, a bladder tumour or an enlarged prostate can also cause acute renal failure, as can glomerulonephritis (see below) and the haemolytic-uraemia syndrome.

HYPERTENSION, DIABETES MELLITUS, polycystic kidney disease (see below) or AMYLOIDOSIS are among conditions that cause chronic renal failure. Others include stone, tumour, prostatic enlargement and overuse of analgesic drugs. Chronic failure may eventually lead to end-stage renal failure, a life-threatening situation that will need DIALYSIS or a renal transplant (see TRANSPLANTATION).

Familial renal disorders include autosomal dominant inherited polycystic kidney disease and sex-linked familial nephropathy. Polycystic kidney disease is an important cause of renal failure in the UK. Patients, usually aged 30–50, present with HAEMATURIA, loin or abdominal discomfort or, rarely, urinary-tract infection, hypertension and enlarged kidneys. Diagnosis is based on ultrasound examination of the abdomen. Complications include renal failure, hepatic cysts and, rarely, SUBARACHNOID HAEMORRHAGE. No speci?c treatment is available. Familial nephropathy occurs more often in boys than in girls and commonly presents as Alport’s syndrome (familial nephritis with nerve DEAFNESS) with PROTEINURIA, haematuria, progressing to renal failure and deafness. The cause of the disease lies in an absence of a speci?c ANTIGEN in a part of the glomerulus. The treatment is conservative, with most patients eventually requiring dialysis or transplantation.

Acute glomerulonephritis is an immune-complex disorder due to entrapment within glomerular capillaries of ANTIGEN (usually derived from B haemolytic streptococci – see STREPTOCOCCUS) antibody complexes initiating an acute in?ammatory response (see IMMUNITY). The disease affects children and young adults, and classically presents with a sore throat followed two weeks later by a fall in urine output (oliguria), haematuria, hypertension and mildly abnormal renal function. The disease is self-limiting with 90 per cent of patients spontaneously recovering. Treatment consists of control of blood pressure, reduced ?uid and salt intake, and occasional DIURETICS and ANTIBIOTICS.

Chronic glomerulonephritis is also due to immunological renal problems and is also classi?ed by taking a renal biopsy. It may be subdivided into various histological varieties as determined by renal biospy. Proteinuria of various degrees is present in all these conditions but the clinical presentations vary, as do their treatments. Some resolve spontaneously; others are treated with steroids or even the cytotoxic drug CYCLOPHOSPHAMIDE or the immunosuppressant cyclosporin. Prognoses are generally satisfactory but some patients may require renal dialysis or kidney transplantation – an operation with a good success rate.

Hydronephrosis A chronic disease in which the kidney becomes greatly distended with ?uid. It is caused by obstruction to the ?ow of urine at the pelvi-ureteric junction (see KIDNEYS – Structure). If the ureter is obstructed, the ureter proximal to the obstruction will dilate and pressure will be transmitted back to the kidney to cause hydronephrosis. Obstruction may occur at the bladder neck or in the urethra itself. Enlargement of the prostate is a common cause of bladder-neck obstruction; this would give rise to hypertrophy of the bladder muscle and both dilatation of the ureter and hydronephrosis. If the obstruction is not relieved, progressive destruction of renal tissue will occur. As a result of the stagnation of the urine, infection is probable and CYSTITIS and PYELONEPHRITIS may occur.

Impaired blood supply may be the outcome of diabetes mellitus and physiological shock, which lowers the blood pressure, also affecting the blood supply. The result can be acute tubular necrosis. POLYARTERITIS NODOSA and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) may damage the large blood vessels in the kidney. Treatment is of the underlying condition.

Infection of the kidney is called pyelonephritis, a key predisposing factor being obstruction of urine ?ow through the urinary tract. This causes stagnation and provides a fertile ground for bacterial growth. Acute pyelonephritis is more common in women, especially during pregnancy when bladder infection (CYSTITIS) spreads up the ureters to the kidney. Symptoms are fever, malaise and backache. Antibiotics and high ?uid intake are the most e?ective treatment. Chronic pyelonephritis may start in childhood as a result of congenital deformities that permit urine to ?ow up from the bladder to the kidney (re?ux). Persistent re?ux leads to recurrent infections causing permanent damage to the kidney. Specialist investigations are usually required as possible complications include hypertension and kidney failure.

Tumours of the kidney are fortunately rare. Non-malignant ones commonly do not cause symptoms, and even malignant tumours (renal cell carcinoma) may be asymptomatic for many years. As soon as symptoms appear – haematuria, back pain, nausea, malaise, sometimes secondary growths in the lungs, bones or liver, and weight loss – urgent treatment including surgery, radiotherapy and chemotherapy is necessary. This cancer occurs mostly in adults over 40 and has a hereditary element. The prognosis is not good unless diagnosed early. In young children a rare cancer called nephroblastoma (Wilm’s tumour) can occur; treatment is with surgery, radiotherapy and chemotherapy. It may grow to a substantial size before being diagnosed.

Cystinuria is an inherited metabolic defect in the renal tubular reabsorption of cystine, ornithine, lysine and arginine. Cystine precipitates in an alkaline urine to form cystine stones. Triple phosphate stones are associated with infection and may develop into a very large branching calculi (staghorn calculi). Stones present as renal or ureteric pain, or as an infection. Treatment has undergone considerable change with the introduction of MINIMALLY INVASIVE SURGERY (MIS) and the destruction of stone by sound waves (LITHOTRIPSY).... kidneys, diseases of

Klinefelter’s Syndrome

The original syndrome described by Klinefelter consisted of GYNAECOMASTIA, testicular ATROPHY and INFERTILITY. Intelligence was unimpaired. Patients have been described who have associated mental defects and striking tallness of stature, but the only constant feature of the syndrome is testicular atrophy with resulting azoospermia and infertility.

The atrophy of the testis is the result of ?brosis, which begins to appear in childhood and progresses until all the seminiferous tubules are replaced by ?brous tissue. Gynaecomastia, mental retardation and eunuchoidism (see EUNUCH; loss of male secondary sexual characteristics – small penis, loss of body hair and a high-pitched voice) may be present. Most patients with Klinefelter’s syndrome have 47 chromosomes instead of the normal 46. The extra chromosome is an X chromosome, so that the sex chromosome constitution is XXY instead of XY. Klinefelter’s syndrome is one of the most common chromosome abnormalities and occurs in 1 in 300 of the male population. Patients with this syndrome show that the Y chromosome is strongly sex-determining: thus, a patient who has an XXY chromosome constitution may have the appearance of a normal male, with infertility the only incapacity, while the loss of a Y chromosome leads to the development of a bodily form which is essentially feminine (see TURNER’S SYNDROME).... klinefelter’s syndrome

Korsakoff’s Syndrome

A form of mental disturbance occurring in chronic alcoholism and other toxic states, such as URAEMIA, lead poisoning and cerebral SYPHILIS. Its special features are talkativeness with delusions in regard to time and place – the patient, although clear in other matters, imagining that he or she has recently made journeys.... korsakoff’s syndrome

Leber’s Disease

A hereditary disease in which blindness comes on at about the age of 20.... leber’s disease

Little’s Disease

A form of CEREBRAL PALSY.... little’s disease

Marfan’s Syndrome

An inherited disorder affecting about one person in 50,000 in which the CONNECTIVE TISSUE is abnormal. The result is defects of the heart valves, the arteries arising from the heart, the skeleton and the eyes. The victims are unusually tall and thin with a particular facial appearance (the US President Abraham Lincoln was said to have Marfan’s) and deformities of the chest and spine. They have spider-like ?ngers and toes and their joints and ligaments are weak. Orthopaedic intervention may help, as will drugs to control the heart problems. As affected individuals have a 50 per cent chance of passing on the disease to their children, they should receive genetic counselling.... marfan’s syndrome

Liver Disease In The Tropics

ACUTE LIVER DISEASE The hepatitis viruses (A– F) are of paramount importance. Hepatitis E (HEV) often produces acute hepatic failure in pregnant women; extensive epidemics – transmitted by contaminated drinking-water supplies – have been documented. HBV, especially in association with HDV, also causes acute liver failure in infected patients in several tropical countries: however, the major importance of HBV is that the infection leads to chronic liver disease (see below). Other hepatotoxic viruses include the EPSTEIN BARR VIRUS, CYTOMEGALOVIRUS (CMV), the ?avivirus causing YELLOW FEVER, Marburg/Ebola viruses, etc. Acute liver disease also occurs in the presence of several acute bacterial infections, including Salmonella typhi, brucellosis, leptospirosis, syphilis, etc. The complex type of jaundice associated with acute systemic bacterial infection – especially pneumococcal PNEUMONIA and pyomiositis – assumes a major importance in many tropical countries, especially those in Africa and in Papua New Guinea. Of protozoan infections, plasmodium falciparum malaria, LEISHMANIASIS, and TOXOPLASMOSIS should be considered. Ascaris lumbricoides (the roundworm) can produce obstruction to the biliary system. CHRONIC LIVER DISEASE Long-term disease is dominated by sequelae of HBV and HCV infections (often acquired during the neonatal period), both of which can cause chronic active hepatitis, cirrhosis, and hepatocellular carcinoma (‘hepatoma’) – one of the world’s most common malignancies. Chronic liver disease is also caused by SCHISTOSOMIASIS (usually Schistosoma mansoni and S. japonicum), and acute and chronic alcohol ingestion. Furthermore, many local herbal remedies and also orthodox chemotherapeutic compounds (e.g. those used in tuberculosis and leprosy) can result in chronic liver disease. HAEMOSIDEROSIS is a major problem in southern Africa. Hepatocytes contain excessive iron – derived primarily from an excessive intake, often present in locally brewed beer; however, a genetic predisposition seems likely. Indian childhood cirrhosis – associated with an excess of copper – is a major problem in India and surrounding countries. Epidemiological evidence shows that much of the copper is derived from copper vessels used to store milk after weaning. Veno-occlusive disease was ?rst described in Jamaica and is caused by pyrrolyzidine alkaloids (present in bush-tea). Several HIV-associated ‘opportunistic’ infections can give rise to hepatic disease (see AIDS/HIV).

A localised (focal) form of liver disease in all tropical/subtropical countries results from invasive Entamoeba histolytica infection (amoebic liver ‘abscess’); serology and imaging techniques assist in diagnosis. Hydatidosis also causes localised liver disease; one or more cysts usually involve the right lobe of the liver. Serological tests and imaging techniques are of value in diagnosis. Whilst surgery formerly constituted the sole method of management, prolonged courses of albendazole and/or praziquantel have now been shown to be e?ective; however, surgical intervention is still required in some cases.

Hepato-biliary disease is also a problem in many tropical/subtropical countries. In southeast Asia, Clonorchis sinensis and Opisthorchis viverini infections cause chronic biliary-tract infection, complicated by adenocarcinoma of the biliary system. Praziquantel is e?ective chemotherapy before advanced disease ensues. Fasciola hepatica (the liver ?uke) is a further hepato-biliary helminthic infection; treatment is with bithionol or triclabendazole, praziquantel being relatively ine?ective.... liver disease in the tropics

Medial Tibial Syndrome

The term applied by athletes to a condition characterised by pain over the inner border of the shin, which occurs in most runners and sometimes in joggers. The syndrome, also known as shin splints, is due to muscular swelling resulting in inadequate blood supply in the muscle: hence the pain. The disorder may be the result of compartment syndrome (build-up of pressure in the muscles), TENDINITIS, muscle or bone in?ammation, or damage to the muscle. It usually disappears within a few weeks, responding to rest and PHYSIOTHERAPY, with or without injections. In some cases, however, it becomes chronic and so severe that it occurs even at rest. If the cause is the compartment syndrome, relief is usually obtained by a simple operation to relieve the pressure in the affected muscles.... medial tibial syndrome

Menière’s Disease

Named after the Frenchman, Prosper Menière, who ?rst described it in 1861, the disease is characterised by TINNITUS, deafness and intermittent attacks of VERTIGO. The ?rst manifestation is usually deafness on one side; then – as a rule, many months later – there is a sudden attack, without any warning, of intense vertigo. The acute giddiness usually lasts for two or three hours with some unsteadiness persisting for a few days. The time interval between attacks varies from a week to a few months. When they do recur, they tend to do so in clusters. The tinnitus, which tends to be low-pitched, comes on at about the same time as the deafness; it is often described as being like rushing water or escaping steam. The deafness becomes gradually worse until it is complete. The condition is due to excessive ?uid in the labyrinth of the ears (see EAR). The cause of this accumulation is not known, although it has been suggested that it might be a form of ALLERGY, or might be due to spasm of small blood vessels. The disorder is diagnosed from AUDIOMETRY, the CALORIC TEST and other investigations.

Treatment Acute vertigo symptoms can sometimes be alleviated with drugs such as CYCLIZINE HYDROCHLORIDE and NICOTINIC ACID, but the disorder is notoriously di?cult to treat and no certain cure is available. Surgical decompression of the ?uid in the ear’s balancing mechanism may relieve vertigo and prevent the disease from worsening. The vestibular nerve to the ear can also be cut to relieve vertigo while preserving hearing.... menière’s disease

Nipples, Diseases Of

See BREASTS, DISEASES OF.... nipples, diseases of

Occupational Health, Medicine And Diseases

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

Osgood-schlatter’s Disease

The form of OSTEOCHONDROSIS involving the tibial tubercle – the growing point of the TIBIA. It occurs around PUBERTY, mainly in boys, and ?rst manifests itself by a painful swelling over the tibial tubercle at the upper end of the tibia. The pain is worst during and after exercise. A limp with increasing limitation of movement of the knee-joint develops. The disease usually clears up without treatment. If pain is troublesome, physiotherapy or immobilisation of the knee-joint in a plaster cast for up to eight weeks may be necessary.... osgood-schlatter’s disease

Liver, Diseases Of

The LIVER may be extensively diseased without any obviously serious symptoms, unless the circulation through it is impeded, the out?ow of BILE checked, or neighbouring organs implicated. JAUNDICE is a symptom of several liver disorders, and is discussed under its separate heading. ASCITES, which may be caused by interference with the circulation through the portal vein of the liver, as well as by other reasons, is also considered separately. The presence of gallstones is a complication of some diseases connected with the liver, and is treated under GALLBLADDER, DISEASES OF. For hydatid cyst of the liver, see TAENIASIS. Liver diseases in a tropical environment are dealt with later in this section.

In?ammation of the liver, or HEPATITIS, may occur as part of a generalised infection or may be a localised condition. Infectious hepatitis, which is the result of infection with a virus, is one of the most common forms. Many di?erent viruses can cause hepatitis, including that responsible for glandular fever (see MONONUCLEOSIS). Certain spirochaetes may also be the cause, particularly that responsible for LEPTOSPIROSIS, as can many drugs. Hepatitis may also occur if there is obstruction of the BILE DUCT, as by a gall-stone.

Cirrhosis of the liver A disorder caused by chronic damage to liver cells. The liver develops areas of ?brosis or scarring; in response, the remaining normal liver cells increase and form regeneration nodules. Those islands of normality, however, suffer from inadequate blood supply, thus adversely affecting liver function. Alcohol is the most common cause of cirrhosis in the United Kingdom and the USA, and the incidence of the disorder among women in the UK has recently risen sharply as a consequence of greater consumption of alcohol by young women in the latter decades of the 20th century. In Africa and many parts of Asia, infection with hepatitis B virus is a common cause. Certain drugs – for example, PARACETAMOL – may damage the liver if taken in excess. Unusual causes of cirrhosis include defects of the bile ducts, HAEMOCHROMATOSIS (raised iron absorption from the gut), CYSTIC FIBROSIS, cardiac cirrhosis (the result of heart failure causing circulatory congestion in the liver), and WILSON’S DISEASE (raised copper absorption).

Symptoms Some people with cirrhosis have no signs or symptoms and the disease may be diagnosed at a routine medical examination. Others may develop jaundice, OEDEMA (including ascites – ?uid in the abdomen), fever, confusion, HAEMATEMESIS (vomiting blood), loss of appetite and lethargy. On examination, cirrhotic patients often have an enlarged liver and/ or SPLEEN, and HYPERTENSION. Liver function tests, cholangiography (X-ray examination of the bile ducts) and biopsy of liver tissue will help to reach a diagnosis.

Treatment Nothing can be done to repair a cirrhosed organ, but the cause, if known, must be removed and further advance of the process thus prevented. In the case of the liver, a high-protein, high-carbohydrate, low-fat diet is given, supplemented by liver extract and vitamins B and K. The consumption of alcohol should be banned. In patients with liver failure and a poor prognosis, liver TRANSPLANTATION is worthwhile but only after careful consideration.

Abscess of the liver When an ABSCESS develops in the liver, it is usually a result of amoebic DYSENTERY, appearing sometimes late in the disease – even after the diarrhoea is cured (see below). It may also follow upon in?ammation of the liver due to other causes. In the case of an amoebic abscess, treatment consists of oral metronidazole.

Acute hepatic necrosis is a destructive and often fatal disease of the liver which is very rare. It may be due to chemical poisons, such as carbontetrachloride, chloroform, phosphorus and industrial solvents derived from benzene. It may also be the cause of death in cases of poisoning with fungi. Very occasionally, it may be a complication of acute infectious hepatitis.

Cancer of the liver is not uncommon, although it is rare for the disease to begin in the liver – the involvement of this organ being usually secondary to disease situated somewhere in the stomach or bowels. Cancer originating in the liver is more common in Asia and Africa. It usually arises in a ?brotic (or cirrhotic) liver and in carriers of the hepatitis B virus. There is great emaciation, which increases as the disease progresses. The liver is much enlarged, and its margin and surface are rough, being studded with hard cancer masses of varying size, which can often be felt through the abdominal wall. Pain may be present. Jaundice and oedema often appear.... liver, diseases of

Peyronie’s Disease

Painful and deformed erection of the PENIS caused by the formation of ?brous tissue. The cause is unknown but it may be associated with DUPUYTREN’S CONTRACTURE. The condition may be improved by surgery.... peyronie’s disease

Polycystic Disease Of The Kidney

An inherited disease in which the KIDNEYS contain many cysts. These grow in size until normal kidney tissue is largely destroyed. Cysts may also occur in other organs such as the liver. In adults, the disease will cause HYPERTENSION and kidney failure. There is also a juvenile form. There is no e?ective treatment, although symptoms can be alleviated by DIALYSIS and sometimes kidney transplant (see TRANSPLANTATION).... polycystic disease of the kidney

Lungs, Diseases Of

Various conditions affecting the LUNGS are dealt with under the following headings: ASTHMA; BRONCHIECTASIS; CHEST, DEFORMITIES OF; CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD); COLD, COMMON; EMPHYSEMA; EXPECTORATION; HAEMOPTYSIS; HAEMORRHAGE; OCCUPATIONAL HEALTH, MEDICINE AND DISEASES; PLEURISY; PNEUMONIA; PULMONARY EMBOLISM; TUBERCULOSIS.

In?ammation of the lungs is generally known as PNEUMONIA, when it is due to infection; as ALVEOLITIS when the in?ammation is immunological; and as PNEUMONITIS when it is due to physical or chemical agents.

Abscess of the lung consists of a collection of PUS within the lung tissue. Causes include inadequate treatment of pneumonia, inhalation of vomit, obstruction of the bronchial tubes by tumours and foreign bodies, pulmonary emboli (see EMBOLISM) and septic emboli. The patient becomes generally unwell with cough and fever. BRONCHOSCOPY is frequently performed to detect any obstruction to the bronchi. Treatment is with a prolonged course of antibiotics. Rarely, surgery is necessary.

Pulmonary oedema is the accumulation of ?uid in the pulmonary tissues and air spaces. This may be caused by cardiac disease (heart failure or disease of heart valves – see below, and HEART, DISEASES OF) or by an increase in the permeability of the pulmonary capillaries allowing leakage of ?uid into the lung tissue (see ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)).

Heart failure (left ventricular failure) can be caused by a weakness in the pumping action of the HEART leading to an increase in back pressure which forces ?uid out of the blood vessels into the lung tissue. Causes include heart attacks and HYPERTENSION (high blood pressure). Narrowed or leaking heart valves hinder the ?ow of blood through the heart; again, this produces an increase in back pressure which raises the capillary pressure in the pulmonary vessels and causes ?ooding of ?uid into the interstitial spaces and alveoli. Accumulation of ?uid in lung tissue produces breathlessness. Treatments include DIURETICS and other drugs to aid the pumping action of the heart. Surgical valve replacement may help when heart failure is due to valvular heart disease.

Acute respiratory distress syndrome Formerly known as adult respiratory distress syndrome (ARDS), this produces pulmonary congestion because of leakage of ?uid through pulmonary capillaries. It complicates a variety of illnesses such as sepsis, trauma, aspiration of gastric contents and di?use pneumonia. Treatment involves treating the cause and supporting the patient by providing oxygen.

Collapse of the lung may occur due to blockage of a bronchial tube by tumour, foreign body or a plug of mucus which may occur in bronchitis or pneumonia. Air beyond the blockage is absorbed into the circulation, causing the affected area of lung to collapse. Collapse may also occur when air is allowed into the pleural space – the space between the lining of the lung and the lining of the inside of the chest wall. This is called a pneumothorax and may occur following trauma, or spontaneously

– for example, when there is a rupture of a subpleural air pocket (such as a cyst) allowing a communication between the airways and the pleural space. Lung collapse by compression may occur when ?uid collects in the pleural space (pleural e?usion): when this ?uid is blood, it is known as a haemothorax; if it is due to pus it is known as an empyema. Collections of air, blood, pus or other ?uid can be removed from the pleural space by insertion of a chest drain, thus allowing the lung to re-expand.

Tumours of the lung are the most common cause of cancer in men and, along with breast cancer, are a major cause of cancer in women. Several types of lung cancer occur, the most common being squamous cell carcinoma, small- (or oat-) cell carcinoma, adenocarcinoma, and large-cell carcinoma. All but the adenocarcinoma have a strong link with smoking. Each type has a di?erent pattern of growth and responds di?erently to treatment. More than 30,000 men and women die of cancer of the trachea, bronchus and lung annually in England and Wales.

The most common presenting symptom is cough; others include haemoptisis (coughing up blood), breathlessness, chest pain, wheezing and weight loss. As well as spreading locally in the lung – the rate of spread varies – lung cancer commonly spawns secondary growths in the liver, bones or brain. Diagnosis is con?rmed by X-rays and bronchoscopy with biopsy.

Treatment Treatment for the two main categories of lung cancer – small-cell and nonsmall-cell cancer – is di?erent. Surgery is the only curative treatment for the latter and should be considered in all cases, even though fewer than half undergoing surgery will survive ?ve years. In those patients unsuitable for surgery, radical RADIOTHERAPY should be considered. For other patients the aim should be the control of symptoms and the maintenance of quality of life, with palliative radiotherapy one of the options.

Small-cell lung cancer progresses rapidly, and untreated patients survive for only a few months. Because the disease is often widespread by the time of diagnosis, surgery is rarely an option. All patients should be considered for CHEMOTHERAPY which improves symptoms and prolongs survival.

Wounds of the lung may cause damage to the lung and, by admitting air into the pleural cavity, cause the lung to collapse with air in the pleural space (pneumothorax). This may require the insertion of a chest drain to remove the air from the pleural space and allow the lung to re-expand. The lung may be wounded by the end of a fractured rib or by some sharp object such as a knife pushed between the ribs.... lungs, diseases of

Pott’s Disease

A traditional name often applied to the angular curvature of the spine which results from tuberculous disease. (See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.) The disease is named after Percivall Pott, an English surgeon (1714–88), who ?rst described the condition.... pott’s disease

Pulmonary Diseases

See LUNGS, DISEASES OF.... pulmonary diseases

Recovered Memory Syndrome

See REPRESSED MEMORY THERAPY.... recovered memory syndrome

Mouth, Diseases Of

The mucous membrane of the mouth can indicate the health of the individual and internal organs. For example, pallor or pigmentation may indicate ANAEMIA, JAUNDICE or ADDISON’S DISEASE.

Thrush is characterised by the presence of white patches on the mucous membrane which bleeds if the patch is gently removed. It is caused by the growth of a parasitic mould known as Candida albicans. Antifungal agents usually suppress the growth of candida. Candidal in?ltration of the mucosa is often found in cancerous lesions.

Leukoplakia literally means a white patch. In the mouth it is often due to an area of thickened cells from the horny layer of the epithelium. It appears as a white patch of varying density and is often grooved by dense ?ssures. There are many causes, most of them of minor importance. It may be associated with smoking, SYPHILIS, chronic SEPSIS or trauma from a sharp tooth. Cancer must be excluded.

Stomatitis (in?ammation of the mouth) arises from the same causes as in?ammation elsewhere, but among the main causes are the cutting of teeth in children, sharp or broken teeth, excess alcohol, tobacco smoking and general ill-health. The mucous membrane becomes red, swollen and tender and ulcers may appear. Treatment consists mainly of preventing secondary infection supervening before the stomatitis has resolved. Antiseptic mouthwashes are usually su?cient.

Gingivitis (see TEETH, DISEASES OF) is in?ammation of the gum where it touches the tooth. It is caused by poor oral hygiene and is often associated with the production of calculus or tartar on the teeth. If it is neglected it will proceed to periodontal disease.

Ulcers of the mouth These are usually small and arise from a variety of causes. Aphthous ulcers are the most common; they last about ten days and usually heal without scarring. They may be associated with STRESS or DYSPEPSIA. There is no ideal treatment.

Herpetic ulcers (see HERPES SIMPLEX) are similar but usually there are many ulcers and the patient appears feverish and unwell. This condition is more common in children.

Calculus (a) Salivary: a calculus (stone) may develop in one of the major salivary-gland ducts. This may result in a blockage which will cause the gland to swell and be painful. It usually swells before a meal and then slowly subsides. The stone may be passed but often has to be removed in a minor operation. If the gland behind the calculus becomes infected, then an ABSCESS forms and, if this persists, the removal of the gland may be indicated. (b) Dental, also called TARTAR: this is a calci?ed material which adheres to the teeth; it often starts as the soft debris found on teeth which have not been well cleaned and is called plaque. If not removed, it will gradually destroy the periodontal membrane and result in the loss of the tooth. (See TEETH, DISORDERS OF.)

Ranula This is a cyst-like swelling found in the ?oor of the mouth. It is often caused by mild trauma to the salivary glands with the result that saliva collects in the cyst instead of discharging into the mouth. Surgery may be required.

Mumps is an acute infective disorder of the major salivary glands. It causes painful enlargement of the glands which lasts for about two weeks. (See also main entry for MUMPS.)

Tumours may occur in all parts of the mouth, and may be BENIGN or MALIGNANT. Benign tumours are common and may follow mild trauma or be an exaggerated response to irritation. Polyps are found in the cheeks and on the tongue and become a nuisance as they may be bitten frequently. They are easily excised.

A MUCOCOELE is found mainly in the lower lip.

An exostosis or bone outgrowth is often found in the mid line of the palate and on the inside of the mandible (bone of the lower jaw). This only requires removal if it becomes unduly large or pointed and easily ulcerated.

Malignant tumours within the mouth are often large before they are noticed, whereas those on the lips are usually seen early and are more easily treated. The cancer may arise from any of the tissues found in the mouth including epithelium, bone, salivary tissue and tooth-forming tissue remnants. Oral cancers represent about 5 per cent of all reported malignancies, and in England and Wales around 3,300 people are diagnosed annually as having cancer of the mouth and PHARYNX.

Cancer of the mouth is less common below the age of 40 years and is more common in men. It is often associated with chronic irritation from a broken tooth or ill-?tting denture. It is also more common in those who smoke and those who chew betel leaves. Leukoplakia (see above) may be a precursor of cancer. Spread of the cancer is by way of the lymph nodes in the neck. Early treatment by surgery, radiotherapy or chemotherapy will often be e?ective, except for the posterior of the tongue where the prognosis is very poor. Although surgery may be extensive and potentially mutilating, recent advances in repairing defects and grafting tissues from elsewhere have made treatment more acceptable to the patient.... mouth, diseases of

Reiter’s Syndrome

A condition probably caused by an immunological response to a virus (see IMMUNITY), in which the patient has URETHRITIS, ARTHRITIS and conjunctivitis (see under EYE, DISORDERS OF). The skin may also be affected by horny areas which develop in it. The disorder was ?rst described by a German physician, H. Reiter (1881–1969); it is more common in men than in women, and is the most common cause of arthritis in young men. It usually develops in people who have a genetic predisposition for it: around 80 per cent of sufferers have the HLA B27 tissue type. Treatment is symptomatic with ANALGESICS and NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS). (See also REACTIVE ARTHRITIS.)... reiter’s syndrome

Renal Diseases

See KIDNEYS, DISEASES OF.... renal diseases

Scalded-skin Syndrome

In infants, certain staphylococcal bacteria (see STAPHYLOCOCCUS) can cause an acute toxic illness in which the subject develops sheets of bright ERYTHEMA, accompanied by shedding of layers of outer epidermis. The result is similar to a hot-water scald. The condition responds promptly to appropriate antibiotic therapy. Drug reactions, especially from sulphonamides, may cause a similar syndrome in adults. In drug-induced forms, mucosae are also affected and the disease is often fatal.... scalded-skin syndrome

Munchausen’s Syndrome

Munchausen’s syndrome, also known as ‘hospital addiction’ syndrome, is a disorder in which the patient presents repeatedly to hospitals with symptoms and signs (often simulated) suggestive of serious physical illness. More common among men than women, it differs from MALINGERING in that no obvious reward results from the imagined or simulated symptoms. Patients may simulate signs and symptoms in a bizarre way – for instance, by swallowing blood or inserting needles into the chest. Abdominal symptoms are particularly common. They often have a history of multiple hospital admissions and operations, and show extensive pathological lying and lack of personal rapport. Although the cause is unclear, it is thought to be a form of hysterical behaviour in a severely disordered personality. Patients are often masochistic, attention-seeking, and constantly trying to obtain ANALGESICS. Occasionally there may be a degree of treatable DEPRESSION, but on the whole management is very di?cult as patients often abscond from psychiatric treatment.

A variation of the syndrome – Munchausen’s syndrome by proxy, better termed ‘fabricated and induced illness’ – has been identi?ed, in which the persons affected in?ict damage upon others, usually children (or even animals) in their care. Factitious illness refers to simulating symptoms, such as stating that the child has blood in its urine when it is actually the parent’s blood. Induced illness includes such events as injecting dirty water into a baby’s muscles, dropping mild caustic into their eyes, adding salt to a baby’s milk or diluting it 50–50 with water, and so on. Much debate has ensued about the suggestion that some sudden infant deaths are due to smothering rather than natural causes, as a type of induced illness. As a consequence of two successful appeals against conviction for murder in 2004, the UK attorney general ordered a review of all criminal and family court cases in which disputed medical evidence had formed the basis of the decision. Paediatricians are concerned that one result is likely to be an increase in undetected child abuse.... munchausen’s syndrome

Nails, Diseases Of

Disease may affect the nail fold, nail plate or nail bed (see SKIN – Nail). In?ammation of the nail fold is called paronychia: acute paronychia is usually caused by a minor injury allowing in bacteria, which set up infection; chronic paronychia is often an occupational hazard, due to constant exposure of the hands to water – for example, in the catering industry, agriculture and housework – but may also be caused by impaired circulation in the ?ngers. Often, ANTIBIOTICS are su?cient for treatment, but sometimes surgical incision is needed.

PSORIASIS is a common cause of disease of the nail plate, as are eczema (see DERMATITIS) and fungal infection (see FUNGAL AND YEAST INFECTIONS). Deformity of the nail may point to systemic disease, as in CLUBBING, or the spoon-shaped concave nails (koilonychia) of severe iron de?ciency. Acute toxic illnesses may temporarily disturb nail growth causing horizontal ridges (Beau’s lines) which grow out slowly.

Onycholysis is separation of the nail plate from its bed. It may be due to psoriasis of the nail bed and trauma, or may occur spontaneously. Gross thickening of nails is common in the toes, caused by psoriasis or fungal infection.... nails, diseases of

Notifiable Diseases

Diseases, usually of an infectious nature, which are required by law to be made known to a health o?cer or local authority. (See INFECTION.) Certain occupational diseases are also noti?able.

Noti?able diseases in the UK (For more information on a speci?c disease, refer to the separate dictionary entry.) Acute encephalitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Ebola virus disease Food poisoning Lassa fever Leprosy (reported to Chief Medical O?cer at the Department of Health) Leptospirosis Malaria Marburg disease Measles Meningitis Meningococcal septicaemia (without meningitis) Mumps Ophthalmia neonatorum Paratyphoid fever Plague Rabies Relapsing fever Rubella Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Viral haemorrhagic fever (including Lassa fever) Viral hepatitis Whooping cough Yellow fever

Reporting AIDS is voluntary (and in con?dence) to the Director, Communicable Diseases Surveillance Centre (PHLS).... notifiable diseases

Severe Acute Respiratory Syndrome (sars)

See SARS.... severe acute respiratory syndrome (sars)

Somatoform Diseases

A group of disorders in which the affected individuals suffer from repeated physical symptoms for which no physical cause can be discovered. Somatisation is the process by which a person’s psychological needs are expressed in the form of physical symptoms. (See also PSYCHOSOMATIC DISEASES.)... somatoform diseases

Stevens-johnson Syndrome

See ERYTHEMA – Erythema multiforme.... stevens-johnson syndrome

Still’s Disease

Or juvenile rheumatoid arthritis – see JUVENILE IDIOPATHIC ARTHRITIS (JIA).... still’s disease

Nature Of The Disease Tuberculosis Has

been recognised from earliest times. Evidence of the condition has been found in Egyptian mummies; in the fourth century BC Hippocrates, the Greek physician, called it phthisis because of the lung involvement; and in 1882 Koch announced the discovery of the causative organism, the tubercle bacillus or Mycobacterium tuberculosis.

The symptoms depend upon the site of the infection. General symptoms such as fever, weight loss and night sweats are common. In the most common form of pulmonary tuberculosis, cough and blood-stained sputum (haemoptysis) are common symptoms.

The route of infection is most often by inhalation, although it can be by ingestion of products such as infected milk. The results of contact depend upon the extent of the exposure and the susceptibility of the individual. Around 30 per cent of those closely exposed to the organism will be infected, but most will contain the infection with no signi?cant clinical illness and only a minority will go on to develop clinical disease. Around 5 per cent of those infected will develop post-primary disease over the next two or three years. The rest are at risk of reactivation of the disease later, particularly if their resistance is reduced by associated disease, poor nutrition or immunosuppression. In developed countries around 5 per cent of those infected will reactivate their healed tuberculosis into a clinical problem.

Immunosuppressed patients such as those infected with HIV are at much greater risk of developing clinical tuberculosis on primary contact or from reactivation. This is a particular problem in many developing countries, where there is a high incidence of both HIV and tuberculosis.

Diagnosis This depends upon identi?cation of mycobacteria on direct staining of sputum or other secretions or tissue, and upon culture of the organism. Culture takes 4–6 weeks but is necessary for di?erentiation from other non-tuberculous mycobacteria and for drug-sensitivity testing. Newer techniques involving DNA ampli?cation by polymerase chain reaction (PCR) can detect small numbers of organisms and help with earlier diagnosis.

Treatment This can be preventative or curative. Important elements of prevention are adequate nutrition and social conditions, BCG vaccination (see IMMUNISATION), an adequate public-health programme for contact tracing, and chemoprophylaxis. Radiological screening with mass miniature radiography is no longer used.

Vaccination with an attenuated organism (BCG – Bacillus Calmette Guerin) is used in the United Kingdom and some other countries at 12–13 years, or earlier in high-risk groups. Some studies show 80 per cent protection against tuberculosis for ten years after vaccination.

Cases of open tuberculosis need to be identi?ed; their close contacts should be reviewed for evidence of disease. Adequate antibiotic chemotherapy removes the infective risk after around two weeks of treatment. Chemoprophylaxis – the use of antituberculous therapy in those without clinical disease – may be used in contacts who develop a strong reaction on tuberculin skin testing or those at high risk because of associated disease.

The major principles of antibiotic chemotherapy for tuberculosis are that a combination of drugs needs to be used, and that treatment needs to be continued for a prolonged period – usually six months. Use of single agents or interrupted courses leads to the development of drug resistance. Serious outbreaks of multiply resistant Mycobacterium tuberculosis have been seen mainly in AIDS units, where patients have greater susceptibility to the disease, but also in developing countries where maintenance of appropriate antibacterial therapy for six months or more can be di?cult.

Streptomycin was the ?rst useful agent identi?ed in 1944. The four drugs used most often now are RIFAMPICIN, ISONIAZID, PYRAZINAMIDE and ETHAMBUTOL. Three to four agents are used for the ?rst two months; then, when sensitivities are known and clinical response observed, two drugs, most often rifampicin and isoniazid, are continued for the rest of the course. Treatment is taken daily, although thrice-weekly, directly observed therapy is used when there is doubt about the patient’s compliance. All the antituberculous agents have a range of adverse effects that need to be monitored during treatment. Provided that the treatment is prescribed and taken appropriately, response to treatment is very good with cure of disease and very low relapse rates.... nature of the disease tuberculosis has

Oesophagus, Diseases Of

Oesophagitis is in?ammation of the OESOPHAGUS and may be due to swallowing a corrosive chemical (corrosive oesophagitis) or because the muscles of the lower part of the oesophagus do not work properly (ACHALASIA), allowing the stomach’s acidic contents to regurgitate (re?ux oesophagitis). HIATUS HERNIA is sometimes associated with the latter condition. Diagnosis can be made by ENDOSCOPY of the oesophagus and/or an X-ray examination using a barium swallow. Treatment of re?ux oesophagitis is by an appropriate diet and weight loss. Stricture of the oesophagus can result from swallowing a corrosive ?uid and may produce severe narrowing. Such strictures may sometimes be dilated by the use of suitable instruments; otherwise, surgery may be necessary.

A still more serious and frequent cause of oesophageal stricture is that due to cancer, which may occur at any part, but is most common at the lower end, near the entrance into the stomach. The chief symptoms of this condition are increasing di?culty in swallowing, increasing debility, together with enlargement of the glands in the neck. The condition usually occurs in middle age or beyond and around 5,000 people are diagnosed with such cancer every year in the United Kingdom. In many cases treatment can only be palliative, but recent advances in surgery are producing promising results. In some cases treatment with irradiation or anti-cancer drugs produces relief, if not cure. In those in whom neither operation nor radiation can be performed, life may be prolonged and freedom from pain obtained by ?uid food which is either swallowed or passed down a tube. In cases of achalasia (see above), the passage of a special bougie down the oesophagus to dilate the sphincter may be e?ective.

Strictures of the oesophagus may also be produced by the pressure of tumours or aneurysms within the cavity of the chest but external to the gullet.

Finally, di?culty in swallowing sometimes occurs in certain serious nervous diseases from paralysis affecting the nerves supplying the muscular coats of the PHARYNX, which thus loses its propulsive power (bulbar paralysis).

Foreign bodies which lodge in the respiratory part of the throat – i.e. at the entrance to, or in the cavity of, the larynx – set up immediate symptoms of CHOKING. Those which lodge in the gullet, on the contrary, do not usually set up any immediately serious symptoms, although their presence causes considerable discomfort. Medical attention is usually required.... oesophagus, diseases of

Stomach, Diseases Of

Gastritis is the description for several unrelated diseases of the gastric mucosa.

Acute gastritis is an in?ammatory reaction of the gastric mucosa to various precipitating factors, ranging from physical and chemical injury to infections. Acute gastritis (especially of the antral mucosas) may well represent a reaction to infection by a bacterium called Helicobacter pylori. The in?ammatory changes usually go after appropriate antibiotic treatment for the H. pylori infection. Acute and chronic in?ammation occurs in response to chemical damage of the gastric mucosa. For example, REFLUX of duodenal contents may predispose to in?ammatory acute and chronic gastritis. Similarly, multiple small erosions or single or multiple ulcers have resulted from consumption of chemicals, especialy aspirin and antirheumatic NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS).

Acute gastritis may cause anorexia, nausea, upper abdominal pain and, if erosive, haemorrhage. Treatment involves removal of the o?ending cause.

Chronic gastritis Accumulation of cells called round cells in the gastric mucosal characterises chronic gastritis. Most patients with chronic gastritis have no symptoms, and treatment of H. pylori infection usually cures the condition.

Atrophic gastritis A few patients with chronic gastritis may develop atrophic gastritis. With or without in?ammatory change, this disorder is common in western countries. The incidence increases with age, and more than 50 per cent of people over 50 may have it. A more complete and uniform type of ATROPHY, called ‘gastric atrophy’, characterises a familial disease called PERNICIOUS ANAEMIA. The cause of the latter disease is not known but it may be an autoimmune disorder.

Since atrophy of the corpus mucosa results in loss of acid- and pepsin-secreting cells, gastric secretion is reduced or absent. Patients with pernicious anaemia or severe atrophic gastritis of the corpus mucosa may secrete too little intrinsic factor for absorption of vitamin B12 and so can develop severe neurological disease (subacute combined degeneration of the spinal cord).

Patients with atrophic gastritis often have bacterial colonisation of the upper alimentary tract, with increased concentration of nitrite and carcinogenic N-nitroso compounds. These, coupled with excess growth of mucosal cells, may be linked to cancer. In chronic corpus gastritis, the risk of gastric cancer is about 3–4 times that of the general population.

Postgastrectomy mucosa The mucosa of the gastric remnant after surgical removal of the distal part of the stomach is usually in?amed and atrophic, and is also premalignant, with the risk of gastric cancer being very much greater than for patients with duodenal ulcer who have not had surgery.

Stress gastritis Acute stress gastritis develops, sometimes within hours, in individuals who have undergone severe physical trauma, BURNS (Curling ulcers), severe SEPSIS or major diseases such as heart attacks, strokes, intracranial trauma or operations (Cushing’s ulcers). The disorder presents with multiple super?cial erosions or ulcers of the gastric mucosa, with HAEMATEMESIS and MELAENA and sometimes with perforation when the acute ulcers erode through the stomach wall. Treatment involves inhibition of gastric secretion with intravenous infusion of an H2-receptorantagonist drug such as RANITIDINE or FAMOTIDINE, so that the gastric contents remain at a near neutral pH. Despite treatment, a few patients continue to bleed and may then require radical gastric surgery.

Gastric ulcer Gastric ulcers were common in young women during the 19th century, markedly fell in frequency in many western countries during the ?rst half of the 20th century, but remained common in coastal northern Norway, Japan, in young Australian women, and in some Andean populations. During the latter half of this century, gastric ulcers have again become more frequent in the West, with a peak incidence between 55 and 65 years.

The cause is not known. The two factors most strongly associated with the development of duodenal ulcers – gastric-acid production and gastric infection with H. pylori bacteria – are not nearly as strongly associated with gastric ulcers. The latter occur with increased frequency in individuals who take aspirin or NSAIDs. In healthy individuals who take NSAIDs, as many as 6 per cent develop a gastric ulcer during the ?rst week of treatment, while in patients with rheumatoid arthritis who are being treated long term with drugs, gastric ulcers occur in 20–40 per cent. The cause is inhibition of the enzyme cyclo-oxygenase, which in turn inhibits the production of repair-promoting PROSTAGLANDINS.

Gastric ulcers occur especially on the lesser curve of the stomach. The ulcers may erode through the whole thickness of the gastric wall, perforating into the peritoneal cavity or penetrating into liver, pancreas or colon.

Gastric ulcers usually present with a history of epigastric pain of less than one year. The pain tends to be associated with anorexia and may be aggravated by food, although patients with ‘prepyloric’ ulcers may obtain relief from eating or taking antacid preparations. Patients with gastric ulcers also complain of nausea and vomiting, and lose weight.

The principal complications of gastric ulcer are haemorrhage from arterial erosion, or perforation into the peritoneal cavity resulting in PERITONITIS, abscess or ?stula.

Aproximately one in two gastric ulcers heal ‘spontaneously’ in 2–3 months; however, up to 80 per cent of the patients relapse within 12 months. Repeated recurrence and rehealing results in scar tissue around the ulcer; this may cause a circumferential narrowing – a condition called ‘hour-glass stomach’.

The diagnosis of gastric ulcer is con?rmed by ENDOSCOPY. All patients with gastric ulcers should have multiple biopsies (see BIOPSY) to exclude the presence of malignant cells. Even after healing, gastric ulcers should be endoscopically monitored for a year.

Treatment of gastric ulcers is relatively simple: a course of one of the H2 RECEPTOR ANTAGONISTS heals gastric ulcers in 3 months. In patients who relapse, long-term inde?nite treatment with an H2 receptor antagonist such as ranitidine may be necessary since the ulcers tend to recur. Recently it has been claimed that gastric ulcers can be healed with a combination of a bismuth salt or a gastric secretory inhibitor

for example, one of the PROTON PUMP INHIBITORS such as omeprazole or lansoprazole

together with two antibiotics such as AMOXYCILLIN and METRONIDAZOLE. The long-term outcome of such treatment is not known. Partial gastrectomy, which used to be a regular treatment for gastric ulcers, is now much more rarely done unless the ulcer(s) contain precancerous cells.

Cancer of the stomach Cancer of the stomach is common and dangerous and, worldwide, accounts for approximately one in six of all deaths from cancer. There are marked geographical di?erences in frequency, with a very high incidence in Japan and low incidence in the USA. In the United Kingdom around 33 cases per 100,000 population are diagnosed annually. Studies have shown that environmental factors, rather than hereditary ones, are mainly responsible for the development of gastric cancer. Diet, including highly salted, pickled and smoked foods, and high concentrations of nitrate in food and drinking water, may well be responsible for the environmental effects.

Most gastric ulcers arise in abnormal gastric mucosa. The three mucosal disorders which especially predispose to gastric cancer include pernicious anaemia, postgastrectomy mucosa, and atrophic gastritis (see above). Around 90 per cent of gastric cancers have the microscopic appearance of abnormal mucosal cells (and are called ‘adenocarcinomas’). Most of the remainder look like endocrine cells of lymphoid tissue, although tumours with mixed microscopic appearance are common.

Early gastric cancer may be symptomless and, in countries like Japan with a high frequency of the disease, is often diagnosed during routine screening of the population. In more advanced cancers, upper abdominal pain, loss of appetite and loss of weight occur. Many present with obstructive symptoms, such as vomiting (when the pylorus is obstructed) or di?culty with swallowing. METASTASIS is obvious in up to two-thirds of patients and its presence contraindicates surgical cure. The diagnosis is made by endoscopic examination of the stomach and biopsy of abnormal-looking areas of mucosa. Treatment is surgical, often with additional chemotherapy and radiotherapy.... stomach, diseases of

Ovaries, Diseases Of

Oöphoritis (infection of the ovaries) rarely occurs alone, except in viral infections such as mumps. Usually it is associated with infection of the FALLOPIAN TUBES (SALPINGITIS). It may occur as a complication of a miscarriage, a therapeutic abortion, or the birth of a baby. Cases not associated with pregnancy typically result from sexual activity: the most common organisms involved are Chlamydia, E. coli, and Neisseria gonorrhoea. Cervical swabs should be sent for culture and analgesics given, together with the appropriate antibiotics.

Failure of OVULATION is the cause of INFERTILITY in around a third of couples seeking help with conception. It may also lead to menstrual problems (see MENSTRUATION), such as an irregular menstrual cycle or MENORRHAGIA. An uncommon cause of failure of ovulation is POLYCYSTIC OVARY SYNDROME, often associated with acne, hirsutism, and obesity. Treatment depends on the symptoms. Early ovarian failure is the cause of premature MENOPAUSE. Treatment consists of hormone replacement therapy using a combination of oestrogen and progestogen.

Ovarian cysts (for example, follicular cysts) result from ovulation. They may be symptomless but sometimes cause abdominal pain, pain during intercourse or disturbances in menstruation. Twisting or rupture can cause severe pain, pyrexia (fever) and nausea, and explorative surgery – endoscopic laparotomy – may be needed to establish a diagnosis (symptoms of ECTOPIC PREGNANCY are similar). The ovary may have to be removed. Simple cysts often disappear of their own accord but a large cyst can cause pressure on surrounding structures and therefore should be surgically removed.

In young women the most common benign tumour is a dermoid cyst, while in older women, ?broma (see under UTERUS, DISEASES OF) is more common. All benign tumours should be removed surgically in order to be sure they are not malignant.

Malignant tumours may be primary (arising in the ovary) or secondary (metastases from a cancer developing in another organ). Treatment depends upon the site and type of the primary tumour.

Around 5,000 women a year are diagnosed as having ovarian cancer in England and Wales. Unfortunately it is not readily detected in its early stages; around 85 per cent of women do not see a doctor until after the tumour has spread. Early tumours present with symptoms similar to benign tumours, while late ones present with abdominal distension, pain and vague gastrointestinal symptoms. The disease is most common in menopausal women. Earlier diagnosis and treatment can be achieved by ULTRASOUND screening. Treatment is surgical, aimed at totally removing the tumour mass. Nowadays RADIOTHERAPY is only used for palliation. CHEMOTHERAPY is often given to patients with ovarian metastases, or who have residual disease after surgery. The most active cytotoxic agent is the taxane, PACLITAXEL – especially when it is combined with cisplatin.... ovaries, diseases of

Paget’s Disease Of Bone

Also called osteitis deformans, this is a chronic disease in which the bones (see BONE) – especially those of the skull, limbs, and spine – gradually become thick and also soft, causing them to bend. It is said to be the most common form of bone disease in the world, and it is estimated that some 600,000 people in England may suffer from it. It seldom occurs under the age of 40. Pain is its most unpleasant manifestation. The cause is not known, and there is no known cure, but satisfactory results are being obtained from the use of CALCITONIN and a group of drugs known as BISPHOSPHONATES

(e.g. etidronate). Those with the disease can obtain help and advice from the National Association for the Relief of Paget’s Disease.... paget’s disease of bone

Pelvic Inflammatory Disease(pid)

An infection of the endometrium (membraneous lining) of the UTERUS, FALLOPIAN TUBES and adjacent structures caused by the ascent of micro-organisms from the vulva and vagina. Around 100,000 women develop PID each year in the UK; most of those affected are under 25 years of age. Infection is commonly associated with sexual intercourse; Chlamydia trachomatis (see CHLAMYDIA) and Neisseria gonorrhoeae (see NEISSERIACEAE) are the most common pathogens. Although these bacteria initiate PID, opportunistic bacteria such as STREPTOCOCCUS and bacteroides often replace them.

The infection may be silent – with no obvious symptoms – or symptoms may be troublesome, for example, vaginal discharge and sometimes a palpable mass in the lower abdomen. If a LAPAROSCOPY is done – usually by endoscopic examination – overt evidence of PID is found in around 65 per cent of suspected cases.

PID may be confused with APPENDICITIS, ECTOPIC PREGNANCY – and PID is a common cause of such pregnancies – ovarian cyst (see OVARIES, DISEASES OF) and in?ammatory disorders of the intestines. Treatment is with a combination of ANTIBIOTICS that are active against the likely pathogens, accompanied by ANALGESICS. Patients may become seriously ill and require hospital care, where surgery is sometimes required if conservative management is unsuccessful. All women who have PID should be screened for sexually transmitted disease and, if this is present, should be referred with their partner(s) to a genito-urinary medicine clinic. Up to 20 per cent of women who have PID become infertile, and there is a seven-to ten-fold greater risk of an ectopic pregnancy occurring.... pelvic inflammatory disease(pid)

Swollen Belly Syndrome

A condition seen in very young children in Papua New Guinea infected with a Strongyloides fu?lleborni-like species of intestinal nematode.... swollen belly syndrome

Prostate Gland, Diseases Of

Disease of the PROSTATE GLAND can affect the ?ow of URINE so that patients present with urological symptoms.

Prostatitis This can be either acute or chronic. Acute prostatitis is caused by a bacterial infection, while chronic prostatitis may follow on from an acute attack, arise insidiously, or be non-bacterial in origin.

Symptoms Typically the patient has pain in the PERINEUM, groins, or supra pubic region, and pain on EJACULATION. He may also have urinary frequency, and urgency.

Treatment Acute and chronic prostatitis are treated with a prolonged course of antibiotics. Patients with chronic prostatitis may also require anti-in?ammatory drugs, and antidepressants.

Prostatic enlargement This is the result of benign prostatic hyperplasia (BPH), causing enlargement of the prostate. The exact cause of this enlargement is unknown, but it affects 50 per cent of men between 40 and 59 years and 95 per cent of men over 70 years.

Symptoms These are urinary hesitancy, poor urinary stream, terminal dribbling, frequency and urgency of urination and the need to pass urine at night (nocturia). The diagnosis is made from the patient’s history; a digital examination of the prostate gland via the rectum to assess enlargement; and analysis of the urinary ?ow rate.

Treatment This can be with tablets, which either shrink the prostate – an anti-androgen drug such as ?nasteride – or relax the urinary sphincter muscle during urination. For more severe symptoms the prostate can be removed surgically, by transurethral resection of prostate (TURP), using either electrocautery or laser energy. A new treatment is the use of microwaves to heat up and shrink the enlarged gland.

Cancer Cancer of the prostate is the fourth most common cause of death from cancer in northern European males: more than 10,000 cases are diagnosed every year in the UK and the incidence is rising by 3 per cent annually.

Little is known about the cause, but the majority of prostate cancers require the male hormones, androgens, to grow.

Symptoms These are similar to those resulting from benign prostatic hypertrophy (see above). Spread of the cancer to bones can cause pain. The use of a blood test measuring the amount of an ANTIGEN, PROSTATE SPECIFIC ANTIGEN (PSA), can be helpful in making the diagnosis – as can an ULTRASOUND scan of the prostate.

Treatment This could be surgical, with removal of the prostate (either via an abdominal incision, total prostatectomy, or transurethrally), or could be by radiotherapy. In more advanced cancers, treatment with anti-androgen drugs, such as cyprotexone acetate or certain oestrogens, is used to inhibit the growth of the cancer.... prostate gland, diseases of

Thyroid Gland, Diseases Of

... thyroid gland, diseases of

Tourette’s Syndrome

See GILLES DE LA TOURETTE’S SYNDROME.... tourette’s syndrome

Urethral Syndrome

A group of symptoms of unknown cause. It mainly affects women, and occasionally men, with pain and discomfort in the lower abdomen, a frequent urge to urinate and, in women, pain in the area of the VULVA. Investigation rarely results in any abnormal ?ndings. Postmenopausal women (see MENOPAUSE), who are the most common sufferers, may have in?ammation of the vulva due to thinning of the tissues in that area. Treatment is supportive, with the patient being advised to drink a lot of ?uid and maintain a high standard of personal hygiene.... urethral syndrome

Psychosomatic Diseases

Taken at face value, the term ‘psychosomatic’ simply means the interaction of psyche (mind) and soma (body). As such it is a noncontroversial concept that points out the many ways in which psychological factors affect the expression of physical disorder and vice-versa. Few doubt that stress makes many physical illnesses worse, at least as far as symptoms are concerned. There are also few physical illnesses in which the outcome is not made worse by psychological factors: depression after a heart attack, for example, has a worse e?ect on prognosis than even smoking. A little more problematic is the very popular belief that stress causes relapses of physical disorders, such as cancer; some studies have found this to be the case, others not.

However, calling a condition psychosomatic implies something more – the primacy of the psyche over the soma. Going back to the in?uential theories and practice of PSYCHOANALYSIS as expounded from the 1930s, many diseases have been proposed as the result of psychological factors.These have included PEPTIC ULCER, ULCERATIVE COLITIS, ASTHMA, PSORIASIS and others. In this view, much physical disorder is due to repressed or excessive emotions. Likewise it is also argued that whereas some people express psychological distress via psychological symptoms (such as anxiety, depression and so on), others develop physical symptoms instead – and that they are also at greater risk of physical disease.

The trouble with this view is that medical advances repeatedly show that it goes too far. Stress certainly causes physical symptoms – for example, DYSPEPSIA – but the belief that it caused peptic ulcers vanished with the discovery of the true cause: colonisation of the stomach by the bacterium, Helicobacter pylori. Of course, stress and social adversity affect the risk of many diseases. For example, the incidence of heart disease among UK government employees (civil servants) has been shown to be in?uenced by their social class and their degree of job satisfaction. But we do not know how this works. Some argue that social adversity and stress in?uence how the heart functions (‘He died of a broken heart’). Stress can also affect IMMUNITY but it cannot cause AIDS/HIV and we do not know if there is a link running from stress to abnormal immune function to actual illness.

We can say that psychological factors provoke physical symptoms, and often even explain how this can happen. For example, when you are anxious you produce more epinephrine (adrenaline), which gives rise to chest pain, ‘butter?ies in the stomach’ and PALPITATION. These symptoms are not ‘all in the mind’, even if the trigger is a psychological one. People who are depressed are more likely to experience nearly every physical symptom there is, but especially pain and fatigue. Taken as a whole, psychologically induced symptoms are an enormous burden on the NHS and probably responsible for more doctor visits and sickness absence than any other single cause. Also we can be con?dent that social adversity and stress powerfully in?uence the outcome of many illnesses; likewise, a vast range of unhealthy activities and behaviours such as smoking, excessive alcohol intake, excessive eating, and so on. But we must be careful not to assume that our emotions directly cause our illnesses.... psychosomatic diseases

Raynaud’s Disease

So called after Maurice Raynaud (1834–81), the Paris physician who published a thesis on the subject in 1862. This is a condition in which the circulation (see CIRCULATORY SYSTEM OF THE BLOOD) becomes suddenly obstructed in outlying parts of the body. It is supposed to be due to spasm of the smaller arteries in the affected part, as the result of them responding abnormally to impuilses from the SYMPATHETIC NERVOUS SYSTEM. Its effects are increased both by cold and by various diseases involving the blood vessels.

Symptoms The condition is most commonly con?ned to the occurrence of ‘dead ?ngers’ – the ?ngers (or the toes, ears, or nose) becoming white, numb, and waxy-looking. This condition may last for some minutes, or may not pass o? for several hours, or even for a day or two.

Treatment People who are subject to these attacks should be careful in winter to protect the feet and hands from cold, and should always use warm water when washing the hands. In addition, the whole body should be kept warm, as spasm of the arterioles in the feet and hands may be induced by chilling of the body. Su?erers should not smoke. VASODILATORS are helpful, especially the calcium antagonists. In all patients who do not respond to such medical treatment, surgery should be considered in the form of sympathectomy: i.e. cutting of the sympathetic nerves to the affected part. This results in dilatation of the arterioles and hence an improved blood supply. This operation is more successful in the case of the feet than in the case of the hands.... raynaud’s disease

Uterus, Diseases Of

Absence or defects of the uterus

Rarely, the UTERUS may be completely absent as a result of abnormal development. In such patients secondary sexual development is normal but MENSTRUATION is absent (primary amennorhoea). The chromosomal make-up of the patient must be checked (see CHROMOSOMES; GENES): in a few cases the genotype is male (testicular feminisation syndrome). No treatment is available, although the woman should be counselled.

The uterus develops as two halves which fuse together. If the fusion is incomplete, a uterine SEPTUM results. Such patients with a double uterus (uterus didelphys) may have fertility problems which can be corrected by surgical removal of the uterine septum. Very rarely there may be two uteri with a double vagina.

The uterus of most women points forwards (anteversion) and bends forwards (ante?exion). However, about 25 per cent of women have a uterus which is pointed backwards (retroversion) and bent backwards (retro?exion). This is a normal variant and very rarely gives rise to any problems. If it does, the attitude of the uterus can be corrected by an operation called a ventrosuspension.

Endometritis The lining of the uterine cavity is called the ENDOMETRIUM. It is this layer that is partially shed cyclically in women of reproductive age giving rise to menstruation. Infection of the endometrium is called endometritis and usually occurs after a pregnancy or in association with the use of an intrauterine contraceptive device (IUCD – see CONTRACEPTION). The symptoms are usually of pain, bleeding and a fever. Treatment is with antibiotics. Unless the FALLOPIAN TUBES are involved and damaged, subsequent fertility is unaffected. Very rarely, the infection is caused by TUBERCULOSIS. Tuberculous endometritis may destroy the endometrium causing permanent amenorrhoea and sterility.

Menstrual disorders are common. Heavy periods (menorrhagia) are often caused by ?broids (see below) or adenomyosis (see below) or by anovulatory cycles. Anovulatory cycles result in the endometrium being subjected to unopposed oestrogen stimulation and occasionally undergoing hyperplasia. Treatment is with cyclical progestogens (see PROGESTOGEN) initially. If this form of treatment fails, endoscopic surgery to remove the endometrium may be successful. The endometrium may be removed using LASER (endometrial laser ablation) or electrocautery (transcervical resection of endometrium). Hysterectomy (see below) will cure the problem if endoscopic surgery fails. Adenomyosis is a condition in which endometrial tissue is found in the muscle layer (myometrium) of the uterus. It usually presents as heavy and painful periods, and occasionally pain during intercourse. Hysterectomy is usually required.

Oligomenorhoea (scanty or infrequent periods) may be caused by a variety of conditions including thyroid disease (see THYROID GLAND, DISEASES OF). It is most commonly associated with usage of the combined oral contraceptive pill. Once serious causes have been eliminated, the patient should be reassured. No treatment is necessary unless conception is desired, in which case the patient may require induction of ovulation.

Primary amenorrhoea means that the patient has never had a period. She should be investigated, although usually it is only due to an inexplicable delay in the onset of periods (delayed menarche) and not to any serious condition. Secondary amenorrhoea is the cessation of periods after menstruation has started. The most common cause is pregnancy. It may be also caused by endocrinological or hormonal problems, tuberculous endometritis, emotional problems and severe weight loss. The treatment of amenorrhoea depends on the cause.

Dysmenorrhoea, or painful periods, is the most common disorder; in most cases the cause is unknown, although the disorder may be due to excessive production of PROSTAGLANDINS.

Irregular menstruation (variations from the woman’s normal menstrual pattern or changes in the duration of bleeding or the amount) can be the result of a disturbance in the balance of OESTROGENS and PROGESTERONE hormone which between them regulate the cycle. For some time after the MENARCHE or before the MENOPAUSE, menstruation may be irregular. If irregularity occurs in a woman whose periods are normally regular, it may be due to unsuspected pregnancy, early miscarriage or to disorders in the uterus, OVARIES or pelvic cavity. The woman should seek medical advice.

Fibroids (leiomyomata) are benign tumours arising from the smooth muscle layer (myometrium) of the uterus. They are found in 80 per cent of women but only a small percentage give rise to any problems and may then require treatment. They may cause heavy periods and occasionally pain. Sometimes they present as a mass arising from the pelvis with pressure symptoms from the bladder or rectum. Although they can be shrunk medically using gonadorelin analogues, which raise the plasma concentrations of LUTEINISING HORMONE and FOLLICLE-STIMULATING HORMONE, this is not a long-term solution. In any case, ?broids only require treatment if they are large or enlarging, or if they cause symptoms. Treatment is either myomectomy (surgical removal) if fertility is to be retained, or a hysterectomy.

Uterine cancers tend to present after the age of 40 with abnormal bleeding (intermenstrual or postmenopausal bleeding). They are usually endometrial carcinomas. Eighty per cent present with early (Stage I) disease. Patients with operable cancers should be treated with total abdominal hysterectomy and bilateral excision of the ovaries and Fallopian tubes. Post-operative RADIOTHERAPY is usually given to those patients with adverse prognostic factors. Pre-operative radiotherapy is still given by some centres, although this practice is now regarded as outdated. PROGESTOGEN treatment may be extremely e?ective in cases of recurrence, but its value remains unproven when used as adjuvant treatment. In 2003 in England and Wales, more than 2,353 women died of uterine cancer.

Disorders of the cervix The cervix (neck of the womb) may produce an excessive discharge due to the presence of a cervical ectopy or ectropion. In both instances columnar epithelium – the layer of secreting cells – which usually lines the cervical canal is exposed on its surface. Asymptomatic patients do not require treatment. If treatment is required, cryocautery – local freezing of tissue – is usually e?ective.

Cervical smears are taken and examined in the laboratory to detect abnormal cells shed from the cervix. Its main purpose is to detect cervical intraepithelial neoplasia (CIN) – the presence of malignant cells in the surface tissue lining the cervix – since up to 40 per cent of women with this condition will develop cervical cancer if the CIN is left untreated. Women with abnormal smears should undergo colposcopy, a painless investigation using a low-powered microscope to inspect the cervix. If CIN is found, treatment consists of simply removing the area of abnormal skin, either using a diathermy loop or laser instrument.

Unfortunately, cervical cancer remains the most common of gynaecological cancers. The most common type is squamous cell carcinoma and around 4,000 new cases (all types) are diagnosed in England and Wales every year. As many as 50 per cent of the women affected may die from the disease within ?ve years. Cervical cancer is staged clinically in four bands according to how far it has extended, and treatment is determined by this staging. Stage I involves only the mucosal lining of the cervix and cone BIOPSY may be the best treatment in young women wanting children. In Stage IV the disease has spread beyond the cervix, uterus and pelvis to the URINARY BLADDER or RECTUM. For most women, radiotherapy or radical Wertheim’s hysterectomy – the latter being preferable for younger women – is the treatment of choice if the cancer is diagnosed early, both resulting in survival rates of ?ve years in 80 per cent of patients. Wertheim’s hysterectomy is a major operation in which the uterus, cervix, upper third of vagina and the tissue surrounding the cervix are removed together with the LYMPH NODES draining the area. The ovaries may be retained if desired. Patients with cervical cancer are treated by radiotherapy, either because they present too late for surgery or because the surgical skill to perform a radical hysterectomy is not available. These operations are best performed by gynaecological oncologists who are gynaecological surgeons specialising in the treatment of gynaecological tumours. The role of CHEMOTHERAPY in cervical and uterine cancer is still being evaluated.

Prolapse of the uterus is a disorder in which the organ drops from its normal situation down into the vagina. First-degree prolapse is a slight displacement of the uterus, second-degree a partial displacement and third-degree when the uterus can be seen outside the VULVA. It may be accompanied by a CYSTOCOELE (the bladder bulges into the front wall of the vagina), urethrocoele (the urethra bulges into the vagina) and rectocoele (the rectal wall bulges into the rear wall of the vagina). Prolapse most commonly occurs in middle-aged women who have had children, but the condition is much less common now than in the past when prenatal and obstetric care was poor, women had more pregnancies and their general health was poor. Treatment is with pelvic exercises, surgical repair of the vagina or hysterectomy. If the woman does not want or is not ?t for surgery, an internal support called a pessary can be ?tted – and changed periodically.

Vertical section of female reproductive tract (viewed from front) showing sites of common gynaecological disorders.

Hysterectomy Many serious conditions of the uterus have traditionally been treated by hysterectomy, or removal of the uterus. It remains a common surgical operation in the UK, but is being superseded in the treatment of some conditions, such as persistent MENORRHAGIA, with endometrial ablation – removal of the lining of the uterus using minimally invasive techniques, usually using an ENDOSCOPE and laser. Hysterectomy is done to treat ?broids, cancer of the uterus and cervix, menorrhagia, ENDOMETRIOSIS and sometimes for severely prolapsed uterus. Total hysterectomy is the usual type of operation: it involves the removal of the uterus and cervix and sometimes the ovaries. After hysterectomy a woman no longer menstruates and cannot become pregnant. If the ovaries have been removed as well and the woman had not reached the menopause, hormone replacement therapy (HRT – see MENOPAUSE) should be considered. Counselling helps the woman to recover from the operation which can be an emotionally challenging event for many.... uterus, diseases of

Valvular Disease

See under HEART, DISEASES OF.... valvular disease

Von Recklinghausen’s Disease

An inherited disease, now called neuro?bromatosis. About one case occurs every 3,000 live births. The disease is characterised by tumours along the course of nerves which can be felt beneath the skin. Soft tumours may also develop beneath the skin. The condition may have other associated abnormalities such as SCOLIOSIS, decalci?cation of the bones due to overactivity of the PARATHYROID glands, and ?brosis in the lungs. Surgery may be needed for cosmetic reasons or to relieve pressure on the nervous system.... von recklinghausen’s disease

Von Willebrand’s Disease

A genetically determined blood disorder in which the affected person suffers episodes of spontaneous bleeding similar to that occurring in people with HAEMOPHILIA. It may be associated with a lack of FACTOR VIII (see COAGULATION) in the blood. The disorder is inherited as an autosomal dominant gene (see GENETIC DISORDERS).... von willebrand’s disease

Werner’s Syndrome

A rare inherited condition in which the affected person suffers from premature ageing from adolescence onwards. His or her growth may be retarded, the skin become thin, and arterial disease, DIABETES MELLITUS and leg ulcers (see ULCER) develop. Treatment is symptomatic.... werner’s syndrome

Rectum, Diseases Of

The following are described under their separate dictionary entries: FAECES; HAEMORRHOIDS; FISTULA; DIARRHOEA; CONSTIPATION.

Imperforate anus, or absence of the anus, may occur in newly born children, and the condition is relieved by operation.

Itching at the anal opening is common and can be troublesome. It may be due to slight abrasions, to piles, to the presence of threadworms (see ENTEROBIASIS), and/or to anal sex. The anal area should be bathed once or twice a day; clothing should be loose and smooth. Local application of soothing preparations containing mild astringents (bismuth subgallate, zinc oxide and hamamelis) and CORTICOSTEROIDS may provide symptomatic relief. Proprietary preparations contain lubricants, VASOCONSTRICTORS and mild ANTISEPTICS.

Pain on defaecation is commonly caused by a small ulcer or ?ssure, or by an engorged haemorrhoid (pile). Haemorrhoids may also cause an aching pain in the rectum. (See also PROCTALGIA.)

Abscess in the cellular tissue at the side of the rectum – known from its position as an ischio-rectal abscess – is fairly common and may produce a ?stula. Treatment is by ANTIBIOTICS and, if necessary, surgery to drain the abscess.

Prolapse or protrusion of the rectum is sometimes found in children, usually between the ages of six months and two years. This is generally a temporary disorder. Straining at defaecation by adults can cause the lining of the rectum to protrude outside the anus, resulting in discomfort, discharge and bleeding. Treatment of the underlying constipation is essential as well as local symptomatic measures (see above). Haemorrhoids sometimes prolapse. If a return to normal bowel habits with the production of soft faeces fails to restore the rectum to normal, surgery to remove the haemorrhoids may be necessary. If prolapse of the rectum recurs, despite a return to normal bowel habits, surgery may be required to rectify it.

Tumours of small size situated on the skin near the opening of the bowel, and consisting of nodules, tags of skin, or cauli?ower-like excrescences, are common, and may give rise to pain, itching and watery discharges. These are easily removed if necessary. Polypi (see POLYPUS) occasionally develop within the rectum, and may give rise to no pain, although they may cause frequent discharges of blood. Like polypi elsewhere, they may often be removed by a minor operation. (See also POLYPOSIS.)

Cancer of the rectum and colon is the commonest malignancy in the gastrointestinal tract: around 17,000 people a year die from these conditions in the United Kingdom. Rectal cancer is more common in men than in women; colonic cancer is more common in women. Rectal cancer is a disease of later life, seldom affecting young people, and its appearance is generally insidious. The tumour begins commonly in the mucous membrane, its structure resembling that of the glands with which the membrane is furnished, and it quickly in?ltrates the other coats of the intestine and then invades neighbouring organs. Secondary growths in most cases occur soon in the lymphatic glands within the abdomen and in the liver. The symptoms appear gradually and consist of diarrhoea, alternating with attacks of constipation, and, later on, discharges of blood or blood-stained ?uid from the bowels, together with weight loss and weakness. A growth can be well advanced before it causes much disturbance. Treatment is surgical and usually this consists of removal of the whole of the rectum and the distal two-thirds of the sigmoid colon, and the establishment of a COLOSTOMY. Depending upon the extent of the tumour, approximately 50 per cent of the patients who have this operation are alive and well after ?ve years. In some cases in which the growth occurs in the upper part of the rectum, it is now possible to remove the growth and preserve the anus so that the patient is saved the discomfort of having a colostomy. RADIOTHERAPY and CHEMOTHERAPY may also be necessary.... rectum, diseases of

Wilson’s Disease

Wilson’s disease, or hepatolenticular degeneration, is a familial disease in which there is an increased accumulation of COPPER in the liver, brain, and other tissues including the kidneys. Its main manifestation is the development of tremor and rigidity, with di?culty in speech. In many cases there is improvement following the administration of dimercaprol, penicillamine, or trientine dihydrochloride; these substances cause an increased excretion of copper.... wilson’s disease

Wool-sorters’ Disease

Another name for ANTHRAX.... wool-sorters’ disease

Building Sickness Syndrome

Work-related lethargy coming on in the afternoon may be the result of this syndrome. Air-conditioned buildings promote symptoms not encountered in naturally ventilated offices, shops, etc.

Symptoms: dry throat, eye irritation, headache, fatigue, wheezy chest and flu-like colds may be a product of modern ventilating systems. The headache may come on in the afternoon and improve on leaving work. Humidifier fever. Passive inhalation of cigarette smoke a factor.

Alternatives. Treatment. Ginseng, Iceland Moss, Irish Moss, German Chamomile tea. ... building sickness syndrome

Reye’s Syndrome

A condition, now rare, which occurs predominantly in young children following a viral infection of the upper respiratory tract or a viral infection such as CHICKENPOX or INFLUENZA.

The cause is not known, but there is evidence that ASPIRIN may also play a part in its causation. Doctors recommend that children should be given PARACETAMOL in place of aspirin. The initial feature is severe, persistent vomiting and fever. This is followed by outbursts of wild behaviour, DELIRIUM and CONVULSIONS terminating in COMA and death, often from liver failure. The MORTALITY rate is around 23 per cent, and 50 per cent of the survivors may have persistent mental or neurological disturbances. The younger the patient, the higher the death rate and the more common the permanent residual effects. Since aspirin has no longer been licensed for use in children and young people the incidence of the condition has fallen dramatcally. Some cases, previously thought to be Reye’s syndrome, have subsequently turned out to have been due to certain inherited metabolic diseases and to be unconnected with aspirin.... reye’s syndrome

Sexually Transmitted Diseases (stds)

Sexually transmitted diseases – traditionally called venereal diseases – are infections transmitted by sexual intercourse (heterosexual and homosexual). In the United Kingdom they are treated in genito-urinary medicine (GUM) clinics. The incidences of these diseases are more common among people who have several sexual partners, as STDs are very infectious; some of the major STDs, particularly AIDS/HIV, are also transmitted by blood and so can result from needle-sharing by drug addicts, or by TRANSFUSION. The ‘traditional’ STDs – SYPHILIS, GONORRHOEA and CHANCROID – now comprise only 10 per cent of all such diseases treated in STD clinics: these clinics also treat patients with CHLAMYDIA, TRICHOMONIASIS, HERPES GENITALIS, MOLLUSCUM CONTAGIOSUM and genital WARTS. SCABIES and pubic lice (see PEDICULOSIS – Pediculus pubis) can also be transmitted by sexual intercourse, and HEPATITIS B is also recognised as an STD.

The incidence of STDs rose sharply during World War II but the advent of PENICILLIN and subsequent antibiotics meant that syphilis and gonorrhoea could be treated e?ectively. The arrival of oral contraception and more tolerant public attitudes to sexual activities resulted in an increase in the incidence of sexually transmitted infections. The diagnosis of NONSPECIFIC URETHRITIS (NSU), once given to many patients whose symptoms were not due to the traditional recognised infections, was in the 1970s realised to be wrong, as the condition was proved to be the result of infection by chlamydia.

Most STDs are treatable, but herpes is an infection that could become chronic, while hepatitis B and, of course, AIDS/HIV are potentially fatal – although treatment of HIV is now proving more e?ective. As well as the treatment and subsequent monitoring of patients with STDs, one of the important functions of clinics has been the tracing, treatment and follow-up of sexual contacts of infected individuals, a procedure that is conducted con?dentially.

Apart from AIDS/HIV, the incidence of STDs fell during the 1980s; however in some countries the agents causing syphilis and gonorrhoea began to develop resistance to antibiotics, which showed the continued importance of practising safe sex – in particular by restricting the number of sexual partners and ensuring the regular use of condoms. In the United Kingdom the rates per million of the male population infected by syphilis rose from 8.8 in 1991 to 9.7 in 1999; in females the ?gures were 4.0 to 4.5, respectively. For gonorrhoea, the ?gures for men were 399.4 in 1991 and 385 in 1999, with women also showing a reduction, from

216.5 to 171.3. In 1991, 552.6 per million of men had chlamydia, a ?gure which rose to

829.5 in 1999; for women in the same period the incidence also rose, from 622.5 to 1,077.1 per million. For genital herpes simplex virus, the infection rate for men fell from 236.6 per million to 227.7, whereas the ?gures for women showed a rise, 258.5 to 357. The incidence of AIDS/HIV is given under the relevant entry. (These ?gures are based on information in United Kingdom Health Statistics, 2001 edition, UKHSI, published by the O?ce of National Statistics.)... sexually transmitted diseases (stds)

Shaken Impact Syndrome

A type of non-accidental head-injury to infants. A study published in 2000 (Lancet, 4 November) suggests that almost 25 out of 100,000 children under a year old sustain brain damage from shaken impact syndrome, even if they do not strike any hard surface. So, of around 685,000 babies in this age-group in Britain, as many as 170 a year may suffer injury from violent shaking. The median age for admission to hospital for the condition in Scotland was 2.2 months in the 18 months from July 1998. A Swedish report has concluded that children at risk from CHILD ABUSE can be identi?ed and the incidence reduced by legislation banning corporal punishment. (See also NON-ACCIDENTAL INJURY (NAI).)... shaken impact syndrome

Commuter’s Syndrome

A range of complaints blamed on the effects of commuting to and from work.

Symptoms: headaches, palpitations, skin complaints, sleeplessness, digestive disorders, chest pains and excessive perspiration. These may be due to exposure to unsatisfactory levels of bacterial and chemical pollution. Where symptoms are not due to any underlying condition, Ginseng, Gota Kola and Chaparral may usually be relied on.

Preparations: teas, tablets, liquid extracts. Professional woman’s fatigue may be dispelled by German Chamomile tea. ... commuter’s syndrome

Damp Hay Disease

Farmer’s lung. A disease contracted from working in mouldy hay. A wet summer means much moist hay, ideal breeding ground for micro-organisms.

Symptoms: inflammation of the lung and high temperature with dry cough.

Tea: Equal parts; Elderflowers (to reduce temperature). Comfrey leaves (cough), Thyme (antibiotic), Peppermint (to assist breathing). 2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup freely. Alternative: Combine Tinctures: Pleurisy root 2; Lobelia 1; Ginger half. One or two 5ml teaspoons in water 3-4 times daily. ... damp hay disease

Eosinophilic Myalgia Syndrome (ems)

An increase in the number of eosinophils in the blood. May occur in a number of allergies, infections, and is sometimes responsible for leukaemia. Among other causes, food supplement tryptophan has been linked. See entry.

Symptoms. Stiffness and severe muscle pain.

Treatment. Formula. Echinacea 2; Burdock 1; Yarrow 1; Poke root quarter. Dose: Liquid Extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Thrice daily. ... eosinophilic myalgia syndrome (ems)

Sjogren’s Syndrome

A disorder of CONNECTIVE TISSUE, with dryness of the mouth (xerostomia) and dryness of the eye (kerato conjunctivitis sicca) occurring in association with RHEUMATOID ARTHRITIS. It occurs in approximately 10 per cent of patients with the latter condition, but it can occur – and frequently does so – independently of rheumatoid disease. The lack of tears gives rise to symptoms of dryness and grittiness of the eyes; the dry mouth can occasionally be so severe as to cause a DYSPHAGIA. The disease is due to the autoimmune destruction of the SALIVARY GLANDS and the lacrimal glands (see EYE – Lacrimal apparatus). The disorder is usually associated with speci?c HLA antigen (see HLA SYSTEM). Treatment is unsatisfactory and is limited to oral and ocular hygiene as well as the provision of arti?cial tears in the form of cellulose eye drops.... sjogren’s syndrome

Skin, Diseases Of

They may be local to the SKIN, or a manifestation of systemic disorders – inherited or acquired. Some major types are described below.

Others appear under their appropriate alphabetical headings: ACNE; ALBINISM; ALOPECIA; ALOPECIA AREATA; APHTHOUS ULCER; BASAL CELL CARCINOMA; BOILS (FURUNCULOSIS); BOWEN’S DISEASE; CALLOSITIES; CANDIDA; CHEILOSIS; CHEIRAPOMPHOLYX; DANDRUFF; DERMATOFIBROMA; DERMATOMYOSITIS; DERMATOPHYTES; DERMOGRAPHISM; ECTHYMA; ERYSIPELAS; ERYTHEMA; ERYTHRASMA; ERYTHRODERMA; ESCHAR; EXANTHEM; FUNGAL AND YEAST INFECTIONS; HAND, FOOT AND MOUTH DISEASE; HERPES GENITALIS; HERPES SIMPLEX; HERPES ZOSTER; IMPETIGO; INTERTRIGO; KELOID; KERATOSIS; LARVA MIGRANS; LICHEN; LUPUS; MADURA FOOT; MELANOMA; MILIARIA; MOLLUSCUM CONTAGIOSUM; MOLE; MYCOSIS FUNGOIDES; NAEVUS; ORF; PEDICULOSIS; PEMPHIGUS; PHOTOCHEMOTHERAPY; PHOTODERMATOSES; PITYRIASIS; PORPHYRIAS; PRURITUS; PSORIASIS; RINGWORM; ROSACEA; SARCOIDOSIS; SCABIES; SCLERODERMA; URTICARIA; VITILIGO; WARTS; XANTHOMATA.

Skin cancer Primary cancer is common and chronic exposure to ultraviolet light is the most important cause. BASAL CELL CARCINOMA is the most common form; squamous cell carcinoma is less common and presents as a growing, usually painless nodule which may ulcerate. Squamous cancer may spread to regional lymph glands and metastasise, unlike basal cell cancer. Occupational exposure to chemical carcinogens may cause squamous carcinoma – for example, cancer from pitch warts or the scrotal carcinoma of chimney sweeps exposed to coal dust in earlier centuries. Squamous carcinoma of the lip is associated with clay-pipe smoking.

Cancer may arise from the population of melanocytes of the skin (see MELANOCYTE; MELANOMA).

Apart from these three most frequent forms of skin cancer, various forms of cancer can arise from cells of the dermis, of which LYMPHOMA is the most important (see also MYCOSIS FUNGOIDES).

Lastly, secondary deposits from internal cancer, particularly from the breast, may metastasise to the skin.

Dermatitis and eczema These are broadly synonymous, and the terms are frequently interchangeable. Eczema is a pattern of in?ammation with many potential causes. Dermatitis is commonly used to suggest an eczema caused by external factors; it is a common pattern of in?ammation of the skin characterised by redness and swelling, vesiculation (see VESICLE), and scaling with intense itching and often exudation (weeping). Fissuring, thickening (licheni?cation – see LICHEN) and secondary bacterial infection may follow. Dermatitis can affect any part of the body. It may be genetically detemined or due to other ‘internal’ factors, such as venous HYPERTENSION in a leg, or stress. Often it is ‘external’ in origin – due to strong irritants or chemical allergens. (See also ALLERGY; ALLERGEN.) ATOPIC DERMATITIS is genetic in origin and usually begins in infancy. It may persist for years, and ASTHMA, allergic RHINITIS and conjunctivitis (see under EYE, DISORDERS OF) – ‘hay fever’ – may be associated. Atopic children tend to have multiple allergies, especially to inhaled allergens such as house-dust mite, cat and dog dander and pollens. Allergy to foods is less common but potentially more dangerous, especially if to nuts, when it can cause acute URTICARIA or even ANAPHYLAXIS. Atopic subjects are particularly prone to persistent and multiple verrucae (see WARTS) and mollusca (see MOLLUSCUM CONTAGIOSUM) and to severe HERPES SIMPLEX infections. (See also ATOPY.)

EXFOLIATE DERMATITIS (PITYRIASIS RUBRA)

Generalised exfoliation and scaling of the skin, commonly with ERYTHEMA. Drugs may cause it, or the disorder may be linked with other skin diseases such as benign dermatoses and lupus erythematosus (see under LUPUS). SUMMER POMPHOLYX is an acute vesicular eczema of the palms and soles recurring every summer. Inhaled allergens are a frequent cause. VENOUS (STASIS) DERMATITIS begins on a lower calf, often in association with PURPURA, swelling and sometimes ulceration. Chronic venous hypertension in the leg, consequent on valvular incompetence in the deep leg veins owing to previous deep vein thrombosis (see VEINS, DISEASES OF), is the usual cause. NEURODERMATITIS A pattern of well-de?ned plaques of licheni?ed eczema particularly seen on the neck, ulnar forearms or sides of the calves in subjects under emotional stress. IRRITANT CONTACT DERMATITIS Most often seen in an industrial setting (occupational dermatitis), it is due to damage by strong chemicals such as cutting oils, cement, detergents and solvents. In almost all cases the hands are most severely affected. ALLERGIC CONTACT DERMATITIS, in contrast, can affect any part of the body depending on the cause – for example, the face (cosmetics), hands (plants, occupational allergens) or soles (rubber boots). Particularly common allergens include metals (nickel and chromate), rubber addititives, and adhesives (epoxy resins).

Treatment Avoidance of irritants and contact allergens, liberal use of EMOLLIENTS, and topical application of corticosteroid creams and ointments (see CORTICOSTEROIDS) are central.... skin, diseases of

Exfoliative Disease

See: DERMATITIS. ... exfoliative disease

Fabry’s Disease

Rare. Chiefly due to passage of a gene from a parent to an offspring, preventing production of an enzyme giving rise to symptoms including a pin-prick blood vessel rash, loss of weight, allergies, but the person is reasonably fit.

Symptomatic relief. Rutin, Hawthorn, Echinacea. Vitamin E: 200iu daily. ... fabry’s disease

Goat Disease

The disease (caseous lymphadenitis) attacks the lymphatic system and may spread to sheep and humans. Breaks out sporadically in goats imported from abroad. Those in close contact with infected animals are at risk.

Symptoms: loss of weight, wasting illness, skin abscesses.

Treatment. Tea: Aniseed 1; Senna leaf 1; Nettles 2. 2 teaspoons to each cup boiling water; infuse 10-15 minutes in covered vessel. 1 cup thrice daily. Add to each dose: 30 drops Tincture Echinacea. ... goat disease

Spine And Spinal Cord, Diseases And Injuries Of

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

Spleen, Diseases Of

In certain diseases associated with marked changes in the blood, such as LEUKAEMIA and MALARIA, the SPLEEN becomes chronically enlarged. In some of the acute infectious diseases, it becomes congested and acutely enlarged: for example, in typhoid fever (see ENTERIC FEVER), ANTHRAX and infectious MONONUCLEOSIS. Rupture of the spleen may occur, like rupture of other internal organs, in consequence of extreme violence – but in malarious countries, where many people have the spleen greatly enlarged and softened as the result of malaria, rupture of this organ occasionally occurs following even a light blow to the left side of the abdomen. The spleen, in consequence of its structure, bleeds excessively when torn, so that this accident is generally followed by collapse, signs of internal haemorrhage – and death if not dealt with promptly by operation.... spleen, diseases of

Grave’s Disease

Hyperactive thyroid gland. See: THYROID. ... grave’s disease

Mad-cow Disease, Human

Creutzfeldt-Jakob disease. See: BOVINE SPONGIFORM ENCEPHALOPATHY. ... mad-cow disease, human

Mitral Disease

A serious defect of the mitral valve of the heart. Two kinds: (1) a permanently deformed narrowed valve (mitral stenosis), or (2) a dilated, over-stretched or distorted valve through enlargement of the left ventricle. In this case imperfect closure causes back pressure which produces chest symptoms. Incompetence leads to enlargement of the heart. Often a legacy from rheumatic fever in children. Sooner or later the liver congests with possible jaundice. Presence of albumin in the urine follows kidney involvement.

Treatment. See: HEART – LEFT VENTRICULAR FAILURE. ... mitral disease

Sudden Infant Death Syndrome (sids)

Sudden infant death syndrome, or cot death, refers to the unexpected death – usually during sleep – of an apparently healthy baby. Well over 1,500 such cases are thought to have occurred in the United Kingdom each year until 1992, when government advice was issued about laying babies on their backs. The ?gure was 192 in 2002 and continues to fall. Boys are affected more than girls, and over half of these deaths occur at the age of 2–6 months. More common in lower social classes, the incidence is highest in the winter; most of the infants have been bottle-fed (see also INFANT FEEDING).

Causes These are unknown, with possible multiple aetiology. Prematurity and low birth-weight may play a role. The sleeping position of a baby and an over-warm environment may be major factors, since deaths have fallen sharply since mothers were o?cially advised to place babies on their backs and not to overheat them. Some deaths are probably the result of respiratory infections, usually viral, which may stop breathing in at-risk infants, while others may result from the infant becoming smothered in a soft pillow. Faults in the baby’s central breathing control system (central APNOEA) may be a factor. Other possible factors include poor socioeconomic environment; vitamin E de?ciency; or smoking, drug addiction or anaemia in the mother. Help and advice may be obtained from the Foundation for the Study of Infant Deaths and the Cot Death Society.... sudden infant death syndrome (sids)

Surveillance Of Disease

As distinct from surveillance of persons, surveillance of disease is the continuing scrutiny of all aspects of occurrences and spread of a disease that are pertinent to effective control. Included are the systematic collection and evaluation of: 1. morbidity and mortality reports; 2. special reports of field investigations, of epidemics and of individual cases; 3. isolation and identification of infectious agents by laboratories; 4. data concerning the availability and use of vaccines and toxoids, immunoglobulin, insecticides, and other substances used in control; 5. information regarding immunity levels in segments of the population; and 6. other relevant epidemiological data.... surveillance of disease

Testicle, Diseases Of

The SCROTUM may be affected by various skin diseases, particularly eczema (see DERMATITIS) or fungal infection. A HERNIA may pass into the scrotum. Defective development of the testicles may lead to their retention within the abdomen, a condition called undescended testicle.

Hydrocoele is a collection of ?uid distending one or both sides of the scrotum with ?uid. Treatment is by withdrawal of the ?uid using a sterile syringe and aspiration needle.

Hypogonadism Reduced activity of the testes or ovaries (male and female gonads). The result is impaired development of the secondary sexual characteristics (growth of the genitals, breast and adult hair distribution). The cause may be hereditary or the result of a disorder of the PITUITARY GLAND which produces GONADOTROPHINS that stimulate development of the testes and ovaries.

Varicocoele is distension of the veins of the spermatic cord, especially on the left side, the causes being similar to varicose veins elsewhere (see VEINS, DISEASES OF). The chief symptom is a painful dragging sensation in the testicle, especially after exertion. Wearing a support provides relief; rarely, an operation may be advisable. Low sperm-count may accompany a varicocele, in which case surgical removal may be advisable.

Orchitis or acute in?ammation may arise from CYSTITIS, stone in the bladder, and in?ammation in the urinary organs, especially GONORRHOEA. It may also follow MUMPS. Intense pain, swelling and redness occur; treatment consists of rest, support of the scrotum, analgesics as appropriate, and the administration of antibiotics if a de?nitive microorganism can be identi?ed. In some patients the condition may develop and form an ABSCESS.

Torsion or twisting of the spermatic cord is relatively common in adolescents. About half the cases occur in the early hours of the morning during sleep. Typically felt as pain of varying severity in the lower abdomen or scrotum, the testis becomes hard and swollen. Treatment consists of immediate undoing of the torsion by manipulation. If done within a few hours, no harm should ensue; however, this should be followed within six hours by surgical operation to ensure that the torsion has been relieved and to ?x the testes. Late surgical attention may result in ATROPHY of the testis.

Tuberculosis may occur in the testicle, especially when the bladder is already affected. Causing little pain, the infection is often far advanced before attracting attention. The condition generally responds well to treatment with a combination of antituberculous drugs (see also main entry for TUBERCULOSIS).

Tumours of the testes occur in around 600 males annually in the United Kingdom, and are the second most common form of malignant growth in young males. There are two types: SEMINOMA and TERATOMA. When adequately treated the survival rate for the former is 95 per cent, while that for the latter is 50 per cent.

Injuries A severe blow may lead to SHOCK and symptoms of collapse, usually relieved by rest in bed; however, a HAEMATOMA may develop.... testicle, diseases of

Paget’s Disease Of The Nipple

Cancer of the mammary ducts (rare). Nipple: encrusted, red, inflamed. See: CANCER OF THE BREAST. ... paget’s disease of the nipple

Binge–purge Syndrome

An alternative term for bulimia.... binge–purge syndrome

Turner’s Syndrome

This occurs in one in 2,500 live female births. It is caused by either the absence of or an abnormality in one of the two X CHROMOSOMES. Classical Turner’s syndrome is a complete deletion of one X so that the karyotype is 45XO. Half of the people with Turner’s syndrome have MOSAICISM with a mixture of Turner cells and normal cells, or other abnormalities of the X chromosome such as partial deletions or a ring X. They are females, both in appearance and sexually; clinical features are variable and include short stature, with ?nal height between 1·295 m and 1·575 m, and ovarian failure. Other clinical features may include a short neck, webbing of the neck, increased carrying angle at the elbow (cubitus valgus), widely spaced nipples, cardiovascular abnormalities (of which the commonest is coarctation of the aorta [about 10 per cent]), morphological abnormalities of the kidneys (including horseshoe kidney and abnormalities of the pelviureteric tracts), recurrent otitis media (see under EAR, DISEASES OF), squints, increased incidence of pigmented naevi (see NAEVUS), hypothyroidism (see under THYROID, DISEASES OF) and DIABETES MELLITUS. Intelligence is across the normal range, although there are speci?c learning defects which are related to hand-eye coordination and spatial awareness.

Patients with Turner’s syndrome may require therapeutic help throughout their life. In early childhood this may revolve around surgical correction of cardiovascular disease and treatment to improve growth. Usually, PUBERTY will need to be induced with oestrogen therapy (see OESTROGENS). In adult life, problems of oestrogen therapy, prevention of osteoporosis (see under BONE, DISORDERS OF), assessment and treatment of HYPERTENSION and assisted fertility predominate. For the address of the UK Turner Syndrome Society, see Appendix 2.... turner’s syndrome

Urethra, Diseases Of And Injury To

Trauma Injury to the urethra is often the result of severe trauma to the pelvis – for example, in a car accident or as the result of a fall. Trauma can also result from catheter insertion (see CATHETERS) or the insertion of foreign bodies into the urethra. The signs are the inability to pass urine, and blood at the exit of the urethra. The major complication of trauma is the development of a urethral stricture (see below).

Urethritis is in?ammation of the urethra from infection.

Causes The sexually transmitted disease GONORRHOEA affects the urethra, mainly in men, and causes severe in?ammation and urethritis. Non-speci?c urethritis (NSU) is an in?ammation of the urethra caused by one of many di?erent micro-organisms including BACTERIA, YEAST and CHLAMYDIA.

Symptoms The classic signs and symptoms are a urethral discharge associated with urethral pain, particularly on micturition (passing urine), and DYSURIA.

Treatment This involves taking urethral swabs, culturing the causative organism and treating it with the appropriate antibiotic. The complications of urethritis include stricture formation.

Stricture This is an abrupt narrowing of the urethra at one or more places. Strictures can be a result of trauma or infection or a congenital abnormality from birth. Rarely, tumours can cause strictures.

Symptoms The usual presenting complaint is one of a slow urinary stream. Other symptoms include hesitancy of micturition, variable stream and terminal dribbling. Measurement of the urine ?ow rate may help in the diagnosis, but often strictures are detected during cystoscopy (see CYSTOSCOPE).

Treatment The traditional treatment was the periodic dilation of the strictures with ‘sounds’

– solid metal rods passed into the urethra. However, a more permanent solution is achieved by cutting the stricture with an endoscopic knife (optical urethrotomy). For more complicated long or multiple strictures, an open operation (urethroplasty) is required.... urethra, diseases of and injury to

Budd–chiari Syndrome

A rare disorder in which the veins draining blood from the liver become blocked or narrowed.

Blood accumulates in the liver, which swells.

Liver failure and portal hypertension result.

Treatment is aimed at removing the cause of the obstruction: this may be a blood clot, pressure on the veins from a liver tumour, or a congenital abnormality of the veins.

In most cases, treatment has only a limited effect and, unless a liver transplant can be done, the disease is fatal within 2 years.... budd–chiari syndrome

Capgras’ Syndrome

The delusion that a relative or friend has been replaced by an identical impostor. Also known as the

“illusion of doubles’’, the syndrome is seen most frequently in paranoid schizophrenia, but also occurs in organic brain disorders (see brain syndrome, organic) and affective disorders.... capgras’ syndrome

Urinary Bladder, Diseases Of

Diseases of the URINARY BLADDER are diagnosed by the patient’s symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a ?breoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.

Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).

Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.

Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.

Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.

Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.

Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).

Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.

Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.

Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of

Winter Vomiting Disease

Winter vomiting disease, or epidemic nausea and vomiting, is a condition caused by subtypes of the genus Norwalk-like virus and is characterised by nausea, vomiting, diarrhoea and giddiness, which occurs during the winter. Outbreaks of it usually involve whole families or may affect communities like schools. The incubation period is 24–48 hours, and attacks seldom persist for more than 72 hours. In England and Wales in 2000, more than 1,600 infections were reported compared to more than 16,400 cases of salmonella infections and 56,420 of CAMPYLOBACTER. However, in England it is estimated that around 1,500 times more people are infected in the community than are reported. Humans are the only known hosts of the virus and infection can be acquired via contaminated food or water or, more commonly, from an infected individual via the faeco-oral route, aerosol-spread and FOMITES.... winter vomiting disease

Chagas’ Disease

An infectious parasitic disease found only in parts of South and Central America that is spread by insects commonly called cone-nosed or assassin bugs.

The parasites live in the bloodstream and can affect the heart, intestines, and nervous system.

Symptoms include swelling of the lymph nodes and fever.

Long-term complications include damage to the heart.

The drug nifurtimox kills the parasites in the blood but has unpleasant side effects.... chagas’ disease

Veins, Diseases Of

Veins are the blood vessels that convey blood back from the tissues towards the heart. Two common conditions that affect them are THROMBOSIS and varicosities (see below).

Varicose veins are dilated tortuous veins occurring in about 15 per cent of adults – women more than men. They most commonly occur in the legs but may also occur in the anal canal (HAEMORRHOIDS) and in the oesophagus (due to liver disease).

Normally blood ?ows from the subcutaneous tissues to the super?cial veins which drain via perforating veins into the deep veins of the leg. This ?ow, back towards the heart, is aided by valves within the veins. When these valves fail, increased pressure is exerted on the blood vessels leading to dilatations known as varicose veins.

Treatment is needed to prevent complications such as ulceration and bleeding, or for

cosmetic purposes. Treatment alternatives include injection with sclerosing agents to obliterate the lumen of the veins (sclerotherapy), or surgery; in the elderly or un?t, an elastic stocking may su?ce. One operation is the Trendelenburg operation in which the saphenous vein is disconnected from the femoral vein and individual varicose veins are avulsed. (See also VASCULITIS.)

Thrombosis Thrombosis occurs when blood, which is normally a liquid, clots within the vein to form a semisolid thrombus (clot). This occurs through a combination of reduced blood ?ow and hypercoagulability (a reduced threshold for clotting). The most common site for this to occur is in the deep veins of the leg, where it is known as a deep-vein thrombosis (DVT).

Predisposing factors include immobility (leading to reduced blood ?ow), such as during long journeys (e.g. plane ?ights) where there is little opportunity to stretch one’s legs; surgery (leading to temporary post-operative immobility and hypercoagulability of blood); oestrogen administration (low-dose oestrogen oral contraceptives carry a very low relative risk); and several medical illnesses such as heart failure, stroke and malignancy.

Deep-vein thrombosis presents as a tender, warm, red swelling of the calf. Diagnosis may be con?rmed by venogram (an X-ray taken following injection of contrast medium into the foot veins) or by ultrasound scanning looking for ?ow within the veins.

Prevention is important. This is why patients are mobilised and/or given leg exercises very soon after an operation, even major surgery. People should avoid sitting for long periods, particularly if the edge of the seat is hard, thus impeding venous return from the legs. Car drivers should stop regularly on a long journey and walk around; airline travellers should, where possible, walk round the aisle(s) and also exercise and massage their leg muscles, as well as drinking ample non-alcoholic ?uids.

Diagnosis and treatment are important because there is a risk that the clotted blood within the vein becomes dislodged and travels up the venous system to become lodged in the pulmonary arteries. This is known as PULMONARY EMBOLISM.

Treatment is directed at thinning the blood with ANTICOAGULANTS, initially with heparin and subsequently with WARFARIN for a period of time while the clot resolves.

Blocked super?cial veins are described as super?cial thrombophlebitis, which produces in?ammation over the vein. It responds to antiin?ammatory analgesics. Occasionally heparin and ANTIBIOTICS are required to treat associated thrombosis and infection.... veins, diseases of

Bechet’s Disease

Ulceration of the mouth and genitals, with iritis. Hippocrates wrote of it as one of the epidemics of Ancient Greece. Prof Behcot, himself, believed it to be due to a virus. Afflicted age group: 30s-40s.

Symptoms. Vulva or penis swollen and itching. Neuritis of the eye with possible ensuing blindness. A specific disease unrelated to herpes simplex which it resembles. There is no evidence that it is venereal. Basic pathology is inflammation of the veins, arteries and capillaries (Nettles). Thrombosis is possible (Hawthorn).

Treatment. Tea. (1) Nettles. Or (2): place half an ounce Burdock root in 1 pint water; simmer gently 20 minutes: Add 1oz Nettles. Allow to steep for further 15 minutes. Dose: 1 cup thrice daily.

Tablets/capsules. Kelp, Echinacea, Blue Flag.

Tinctures. Combine Echinacea 2; Goldenseal three-quarters; Myrrh quarter. Dose: 1-2 teaspoons in water thrice daily.

Practitioner. Tincture Colchicum BP 1973.

Topical. Bathe with dilute cider vinegar. Cold tea. Garlic ointment. Tea Tree oil diluted many times. Houseleek.

Eyedrops. Goldenseal eyedrops.

Diet. Avoid hot peppery foods, fried foods.

Low-salt. Regular raw food days.

Supplementation. Vitamin E: 500-1000iu daily. Vitamin B-complex. Calcium and Magnesium. Avoid: scented soap, talcum powder, wool (alternatives: cotton briefs, open gusset tights). Information: Bechet’s Syndrome Society, 3 Belgrave Street, Haxby Road, York Y03 7YY. ... bechet’s disease

Charcot–marie–tooth Disease

An inherited muscle-wasting disease of the legs (see peroneal muscular atrophy).... charcot–marie–tooth disease

Connective Tissue Diseases

Types of autoimmune disorders that often affect blood vessels and produce secondary connective tissue damage. They include rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa, scleroderma, and dermatomyositis.... connective tissue diseases

Bright’s Disease (acute)

Glomerulonephritis. Recognised by slight puffiness of the eyes and a dropsical accumulation of fluid in body cavities. Blood pressure rises. Appetite disappears. Digestion is deranged, urine may be blood-stained and a variety of symptoms present as dizziness, headache, nausea. Commonly caused by post streptococcal throat infection circulating in the blood, yet it is now known that the condition may arise from exposure to common garden insecticides and toxic substances of commercial importance that alter the body’s immune system and affect kidney function.

Acute toxic nephritis is possible in the convalescent stage of scarlet and other infectious fevers, even influenza. Causes are legion, including septic conditions in the ear, nose, throat, tonsils, teeth or elsewhere. Resistance to other infections will be low because of accumulation of toxins awaiting elimination. When protein escapes from the body through faulty kidneys general health suffers.

This condition should be treated by or in liaison with a qualified medical practitioner.

Treatment. Bedrest essential, with electric blanket or hot water bottle. Attention to bowels; a timely laxative also assists elimination of excessive fluid. Diuretics. Diaphoretics. Abundant drinks of bottled water or herb teas (3-5 pints daily). Alkaline drinks have a healing effect upon the kidneys. Juniper is never given for active inflammation.

Useful teas. Buchu, Cornsilk, Couchgrass, Clivers, Bearberry, Elderflowers, Marshmallow, Mullein, Marigold flowers, Wild Carrot, Yarrow.

Greece: traditional tea: equal parts, Agrimony, Bearberry, Couchgrass, Pellitory.

Powders. Equal parts: Dandelion, Cornsilk, Mullein. Dose: 750mg (three 00 capsules or half teaspoon) every 2 hours. In water or cup of Cornsilk tea.

Tinctures. Equal parts: Buchu, Elderflowers, Yarrow. Mix. Dose: 1-2 teaspoons in water or cup of Cornsilk tea, every two hours.

Topical. Hot poultices to small of the back; flannel or other suitable material saturated with an infusion of Elderflowers, Goldenrod, Horsetail or Yarrow. Herbal treatment offers a supportive role. ... bright’s disease (acute)

Dressler’s Syndrome

An uncommon disorder, also known as postinfarction syndrome, that may occur after a myocardial infarction (heart attack) or heart surgery.

It is characterized by fever, chest pain, pericarditis, and pleurisy.

Treatment is with aspirin or, in severe cases, with corticosteroid drugs.... dressler’s syndrome

Dust Diseases

Lung disorders caused by dust particles inhaled and absorbed into the lung tissues. There they may cause fibrosis (formation of scar tissue) and progressive lung damage. The main symptoms are a cough and breathing difficulty. It may take at least 10 years of exposure to dusts containing coal, silica, talc, or asbestos before serious lung damage develops (see pneumoconiosis). Hypersensitivity to moulds on hay or grain may lead to allergic alveolitis. Preventive measures, such as the installation of dust extraction machinery, have reduced the incidence of dust diseases.... dust diseases

Auto Immune Disease

An abnormal reaction of the body to groups of its own cells which the immune system attacks. In a case of anaemia, it may destroy the red blood cells. Failure of the body’s tolerance mechanism.

The immune system is the body’s internal defence armoury which protects from sickness and disease. White blood cells are influenced by the thymus gland and bone marrow to become “T” lymphocytes or “B” lymphocytes which absorb and destroy bacteria. There are times when these powerful defence components inflame and attack healthy tissue, giving rise to auto immune disease which may manifest as one of the numerous anaemic, rheumatic or nervous disorders, even cancer.

A watchful eye should be kept on any sub-acute, non-specific inflammation going on quietly over a long period – a certain indication of immune-inadequacy. It would appear that some unknown body intelligence operates behind the performance of the immune system; emotional and physic stresses such as divorce or job dissatisfaction can lead to a run-down of body defences. Some psychiatrists believe it to be a self-produced phenomenon due to an unresolved sense of guilt or a dislike of self. When this happens, bacterial, virus or fungus infections may invade and spread with little effective opposition. People who are happy at their home and work usually enjoy a robust immune system.

An overactive immune system may develop arthritis with painful joint inflammation, especially with a background of a fat-rich diet. A link between silicone implants and auto-immune disease is suspected.

“There is increasing evidence,” writes Dr D. Addy, Consulting Pediatrician, “that fevers may enhance the defence mechanism against infection.” (See: FEVER) “There is also increasing evidence of a weakening of the immune system through suppression of fevers by modern drugs. In this way, aspirin and other powerful anti-inflammatories may be responsible for feeble immune response.”

White cell stimulators: Liquorice, Ginseng (Siberian), Goldenseal, Echinacea. These increase ability of white blood cells to attack bacteria and invading cells. Chinese medicine: Ginseng (men), Chinese Angelica (women).

Treatment. To strengthen body defences. Garlic, Borage, Comfrey, Agrimony, Balm, Chamomile (German), Echinacea, Horsetail, Liquorice, Lapacho, Sage, Wild Yam, Wild Indigo, Poke root, Thuja. Shiitake Mushroom. Reishi Mushroom, Chlorella..

Tea. Combine, equal parts, St John’s Wort, Borage, Chamomile (German). 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Powders. Combine, Echinacea 4; Comfrey root 2; Wild Yam 1. 500mg (two 00 capsules, or one-third teaspoon) thrice daily.

Tinctures. Combine, Echinacea 4; Poke root 1; Thuja 1. 1-2 teaspoons in water thrice daily.

Tincture: Tincture Myrrh BPC 1973: 5-10 drops in water, morning and evening.

Decoctions. Horse-radish. Fenugreek seeds.

Bio-strath. Yeast-based herbal tonic. Exerts a positive influence on the immune system by rapid and marked increase in white blood cells.

Diet. Foods rich in essential fatty acids: nuts, seeds, beans, pulses, Evening Primrose oil, Cod Liver oil flavoured with mint or lemon. High protein: eggs, fish. (Low protein – acute stage). Foods rich in selenium. Yoghurt, cider vinegar, pineapple juice. Sugar has an immune suppressing effect.

Supplements. To rebuild immune system. Vitamins A, B5, B6, C, D, E. Zinc is required to produce histamine which is a vasodilator. Combination: zinc, selenium and GLA. Iron. Calcium.

Aromatherapy. Lavender oil: massage or baths.

Note: An alleged link exists between silicone implants and auto-immune disease. A new study reveals evidence that women with silicone breast implants who breast-feed their children put them at risk of developing systemic sclerosis. (JAMA Jan 19 1994) ... auto immune disease

Ehlers–danlos Syndrome

An inherited disorder of collagen, the most important structural protein in the body. Affected individuals have abnormally stretchy, thin skin that bruises easily. Wounds are slow to heal and leave paper-thin scars, and the joints are loose and prone to recurrent dislocation. Sufferers bleed easily from the gums and digestive tract. Ehlers–Danlos syndrome is most often inherited in an autosomal dominant pattern (see genetic disorders). There is no known specific treatment.... ehlers–danlos syndrome

Fibrocystic Disease

A term used to refer either to the inherited disorder cystic fibrosis or the presence of general lumpiness of the breasts that is a variation of normal.

(See also fibroadenosis).... fibrocystic disease

Bright’s Disease (chronic)

Chronic glomerulonephritis. The final stage. May follow the sub- acute stage or repeated attacks of the acute stage. Kidneys small and white due to scar tissue. Amount of urine passed is considerably increased, pale and low specific gravity. Kidneys ‘leak’ protein in large quantities of water passed, their efficiency as filters greatly impaired. Tissues of eyelids and ankles waterlogged. Symptoms include loin pain, anaemia, loss of weight, progressive kidney damage.

A constant fear is the onset of uraemia caused by accumulation in the blood of waste by-products of protein digestion, therefore the patient should reject meat in favour of fish. Eggs and dairy products taken in strict moderation.

Where urea accumulates in the circulation ‘sustaining’ diuretics are indicated; these favour excretion of solids without forcing the discharge of more urine: including Shepherd’s Purse, Gravel root, or Uva Ursi when an astringent diuretic is needed for a show of blood in the urine. According to the case, other agents in common practice: Dandelion root, Yarrow, Hawthorn, Marigold, Stone root, Hydrangea. Parsley Piert, Buchu, Hawthorn, Golden Rod.

The patient will feel the cold intensely and always be tired. Warm clothing and ample rest are essential. Heart symptoms require treatment with Lily of the Valley or Broom.

This condition should be treated by or in liaison with a qualified medical practitioner.

Treatment. As kidney damage would be established, treatment would be palliative; efforts being to relieve strain and obtain maximum efficiency. There may be days of total bed-rest, raw foods and quiet. Consumption of fluids may not be as abundant as formerly. Soothing herb teas promote well-being and facilitate elimination. Oil of Juniper is avoided.

Efforts should be made to promote a rapid absorption – to restore the balance between the circulation and the lymphatics. For this purpose Mullein is effective. A few grains of Cayenne or drops of Tincture Capsicum enhances action.

Indicated. Antimicrobials, urinary antiseptics, diuretics, anti-hypertensives. For septic conditions add Echinacea.

Of Therapeutic Value. Alfalfa, Broom, Buchu, Couchgrass, Cornsilk, Dandelion, Lime flowers, Marigold, Mullein, Marshmallow, Parsley Piert, Periwinkle (major), Wild Carrot, Water Melon seed tea. Tea. Combine equal parts: Couchgrass, Dandelion, Mullein. 2 teaspoons to each cup boiling water. Infuse 5-15 minutes. 1 cup freely.

Powders. Combine equal parts: Stone root, Hydrangea, Hawthorn. Dose: 500mg (two 00 capsules or one-third teaspoon) 3 or more times daily in water or cup Cornsilk tea. A few grains Cayenne enhances action. Formula. Buchu 2; Mullein 2; Echinacea 1; Senna leaves half. Mix. Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or cup Cornsilk tea 3 or more times daily. 2-3 drops Tincture Capsicum to each dose enhances action.

Diffusive stimulant for the lymphatic vessels. Onion milk is an effective potassium-conserving diuretic and diaphoretic. Onions are simmered gently in milk for 2 hours and drunk when thirsty or as desired – a welcome alternative to water. May be eaten uncooked.

Diet. Salt-free, low fat, high protein. Spring water. Raw goat’s milk, potassium broth. Fish oils. Avoid eggs and dairy products. No alcohol.

Supplements. Vitamins A, B-complex, C plus bioflavonoids, B6, D, E, Magnesium, Lecithin. Herbal treatment offers a supportive role. ... bright’s disease (chronic)

Carpal Tunnel Syndrome (cts)

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)

Floppy Valve Syndrome

See mitral valve prolapse.... floppy valve syndrome

Charcot’s Disease

Neurogenic arthritis. A degenerative and destructive joint lesion due to loss of the normal protection and pain sense. It is associated with tabes dorsalis and syringomyelia. In tabes, knee is chiefly affected; in syringomyelia, the elbow. Joint swelling in late locomotor ataxia. Usually painless.

Alternatives. Cramp bark, Cayenne, Chamomile, Guaiacum, Hops, Meadowsweet, Celery, Prickly Ash, Valerian, Wild Lettuce, Wild Yam. Mistletoe (F. Hyde). White Willow.

Tea. Equal parts: German Chamomile, Hops, Meadowsweet. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes; 1 cup 3 or more times daily.

Tablets/capsules. Chamomile, Mistletoe, Prickly Ash, Ligvites, Wild Yam, Valerian, Kelp.

Alternative formulae:– Powders. Prickly Ash 1; Valerian 1; Cramp bark half; Guaiacum quarter. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Liquid Extracts. White Willow 2; Prickly Ash 1; Celery seeds half; Liquorice quarter; Tincture Capsicum quarter. Mix. 30-60 drops thrice daily.

Tinctures. White Willow 2; Prickly Ash 1; Valerian 1; Meadowsweet 1; Tincture Capsicum quarter. Mix. 2 teaspoons thrice daily.

Topical. Comfrey poultices (Maria Treben). “Three oils.”

Diet. Lacto-vegetarian. Dandelion coffee. Oily fish.

General. Straight knee brace for rigid support. ... charcot’s disease

Gilbert’s Disease

A common inherited condition that affects the way in which bilirubin is processed by the liver. Usually there are no symptoms, but jaundice may be brought on by an unrelated illness. Sufferers are otherwise healthy. No treatment is necessary.... gilbert’s disease

Graves’ Disease

An autoimmune disorder that is characterized by toxic goitre (an overactive and enlarged thyroid gland), excessive production of thyroid hormones leading to thyrotoxicosis, and exophthalmos.... graves’ disease

Haemolytic–uraemic Syndrome

A rare disease in which red blood cells are destroyed prematurely and the kidneys are damaged, causing acute kidney failure. Thrombocytopenia can also occur. Haemolytic–uraemic syndrome most commonly affects young children and may be triggered by a serious bacterial or viral infection. Symptoms include weakness, lethargy, and a reduction in the volume of urine. Seizures may occur. Blood and urine tests can determine the degree of kidney damage. Dialysis may be needed until the kidneys have recovered. Most patients recover normal renal function.... haemolytic–uraemic syndrome

Demyelinating Diseases

Disorders that destroy myelin, a fatty substance which forms a sheath round nerve fibres and appears in the central nervous system. A typical example is multiple sclerosis.

Essential fatty acids have an important role in the function of the nervous system, being closely related to the fatty (myelin) sheath and cell membranes. Disturbance in their metabolism may result in nerve disorder. Thus, vegetable oils of Soya, corn, safflower and sunflower should replace animal fats and dairy products.

Symptoms. Numb, prickling, tickling sensation on the skin, paralysis, incoordination, physical weakness and visual complaints.

Treatment. Indeterminate diagnosis.

Tablets/capsules. Prickly Ash, Black Cohosh, Ginseng, Ginkgo.

Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Black Cohosh, Prickly Ash, Ginseng. Doses. Powders: two 00 capsules or one-third teaspoon, (500mg). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water, honey or fruit juice.

Evening Primrose oil capsules or tablets: two 500mg thrice daily.

Aromatherapy. Rosemary spinal rub: 6 drops Oil Rosemary in 2 teaspoons Almond oil.

Diet. High protein, low fat, oily fish or 2 teaspoons Cod Liver oil daily. Gluten-free diet. Cholesterol- free – avoid milk, meat fat and dairy products. Avoid coffee and other caffeine stimulants. Dandelion coffee.

Supplements. B-complex, B3, B6, B12, C, E. Dolomite, Manganese, Zinc. ... demyelinating diseases

Fibrocystic Breast Disease (fbd)

Most lumps are harmless, including cysts (adenosis) and benign tumours. Not forerunners of cancer. Largely due to hormone imbalance. Fluid may be aspirated from a cyst. Thickened patches of fibrous tissue are freely movable and occur chiefly during years of menstruation depending upon the presence of oestrogen. An accurate diagnosis is necessary by a competent authority. Excessive sugar consumption suspected.

Prominent cyst formations have been reduced, even eliminated by Poke root, internally and externally, though surgery is sometimes indicated. Diuretics influence the kidneys to expel more body fluids and are sometimes helpful to reduce size. Cold water packs may be applied to the affected area two or more times daily, as practical.

Alternatives. Tea. Formula. Equal parts: Ground Ivy, Clivers, Horsetail. One heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup morning and evening.

Poke root. Tablets, powders. Tincture. 5-10 drops in water 3 times daily.

Evening Primrose oil. Two 500mg capsules, 3 times daily. Trials carried out by departments of Surgery at the University of Wales and the University of Dundee found Evening Primrose oil effective and safe. Poultice. Poke root. Horsetail.

Diet. As salt favours retention of fluid in cystic tissue it should be restricted.

Supplements. Daily. Beta carotene; B-complex; B6, Vitamin C 1g; Zinc. Vitamin E contra-indicated.

Treatment by or in liaison with a general medical practitioner. ... fibrocystic breast disease (fbd)

Hand–arm Vibration Syndrome

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

Heart Disease, Ischaemic

The most common form of heart disease, in which narrowing or obstruction of the coronary arteries, usually by atherosclerosis, results in a reduced blood supply (see coronary artery disease).... heart disease, ischaemic

Flesh-eating Disease

Necrotising fasciitis, in which flesh and muscle are destroyed at a rate of inches an hour. Can spring from a range of streptococcal bacteria of which there are over 80 sub-types.

It seems that this common bacteria, in some unknown way, receives a booster by taking on viral DNA. Lungs, liver and stomach may be attacked, while red blood cells are disrupted and their haemoglobin released. Among other conditions caused by streptococcus is the bright red rash of scarlet fever, sinusitis, meningitis and rheumatic fever. Flesh-eater disease may take just twenty hours to kill a man (“galloping gangrene”).

Symptoms. High temperature – body hot, hands and feet freezing cold. ‘Strep’ sore throat (pharyngitis). Bright red skin rash. Pains in arms and legs as if straining a muscle.

Treatment. The disease is resistant to penicillin. Frequent hot lemon drinks well-laced with honey. Tinctures. Echinacea 2; Goldenseal 1; Myrrh half. Dose: 10-20 drops in dessertspoon water or honey, hourly, acute cases.

Treatment by or in liaison with medical practitioner or infectious diseases specialist. ... flesh-eating disease

Fluid Retention Syndrome (frs)

Accumulation of fluid beneath the skin; frequent sites – fingers, abdomen, breast, ankles.

Symptoms. Headache, frequency of urine, palpitation, possible irritable bowel syndrome. “My feet are killing me”, “I can’t get my wedding ring off” are typical complaints by women with FRS. Sometimes a complication of diabetes, or follows abuse of laxatives or diuretic drugs. A part of the premenstrual syndrome.

Alternatives. Teas. Any of the following: Buchu, Dandelion, Hawthorn, Motherwort, Yarrow. One or more cups daily, cold.

Tablets. Popular combination. Powdered Dandelion root BHP (1983) 90mg; powdered Horsetail extract 3:1 10mg; powdered Uva Ursi extract 3:1 75mg. (Gerard House)

Formula. Equal parts: Hawthorn, Dandelion, Broom. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Thrice daily.

Practitioner. Tincture Lily of the Valley (Convallaria) BHP (1983) (1:5 in 40 per cent alcohol). Dose 8- 15 drops (0.5-1ml). Thrice daily.

Aromatherapy. 6 drops Lavender oil on wet handkerchief: use as a compress for relief of ankles during a journey.

Traditional Gypsy Medicine. The sufferer is exposed to the rising smoke of smouldering Juniper berries which exudes volatile oils and has a gentle diuretic effect.

Diet. Salt-free. High protein. Dandelion coffee. Supplements. Vitamin B-complex, Potassium, Copper. ... fluid retention syndrome (frs)

Gluten-sensitive Disease

Adult coeliac disease, coeliac sprue, non-tropical sprue, idiopathic steatorrhoea. Allergy to gluten which disturbs the small intestine by preventing the body from absorbing food nutrients. A child’s condition may worsen when put on solid cereals containing wheat, barley, rye or oats. “Allergic to pasta” disease. A change in the mucous membrane of the intestines with enzyme deficiency.

Symptoms: diarrhoea, abdominal swelling and pain, irritability, inability to gain weight, neuritis, ulcers on tongue and mouth, low blood pressure, debility, lactase-deficiency. Breast-feeding stops coeliac disease.

Alternatives. Tea. Mix, equal parts: Raspberry leaves, Agrimony, Lemon Balm. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup freely.

Tablets/capsules. Goldenseal, Slippery Elm. Calamus. Fenugreek seeds, Papaya. Wild Yam.

Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Sarsaparilla, Wild Yam, Stone root. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons. In water, banana mash or honey, thrice daily.

Papaya (papain) digests wheat gluten and assists recovery. Half-1g with meals.

Aloe Vera juice. Promotes improved bowel motility, increases stool specific gravity, and reduces indication of protein putrefaction, flatulence and bloating after meals. (J. Bland PhD. JAM June 1985, p.11)

Topical. Warm hip baths of Lemon Balm, Chamomile, etc. (Alfred Vogel)

Diet. Gluten-free. Rice. Unpasteurised yoghurt. Buttermilk. Sweet acidophilus milk. Raw carrot juice. Bananas mashed with a little Slippery Elm or dried milk powder, carob bean powder and Soya milk. Supplementation. Vitamins A, B-complex, B6, B12, Folic acid, C, D, E, K (Alfalfa tea). Calcium, Iron and Magnesium orotates. ... gluten-sensitive disease

Laurence–biedl–moon Syndrome

A rare inherited disorder characterized by increasing obesity, retinitis pigmentosa that may lead to blindness, learning difficulties, polydactyly, and hypogonadism.

(See also genetic disorders.)... laurence–biedl–moon syndrome

Legionnaires’ Disease

A form of pneumonia that is caused by LEGIONELLA PNEUMOPHILA, a bacterium that breeds in warm, moist conditions. The source of infection is often an air-conditioning system in a large, public building.

The first symptoms include headache, muscular and abdominal pain, diarrhoea, and a dry cough.

Over the next few days, pneumonia develops, resulting in a high fever, shaking chills, coughing up of thick sputum (phlegm), drowsiness, and sometimes delirium.

Treatment is with the antibiotic drug erythromycin.... legionnaires’ disease

Haemolytic Disease Of Infants

Severe disease of the newly born and infants with jaundice and anaemia. Occurs when a Rhesus negative mother gives birth to a Rhesus positive child. There may be degeneration of nerve cells of the brain through circulating bile. Followed by water-logging of tissues lining lungs, abdomen or heart (hydrops).

Treatment. Purpose of medication is to stimulate flow of bile and support the liver.

Arthur Hyde, MNIMH recommends a selection from the following according to individual case: Balmony, Barberry, Dandelion, Goldenseal, Hops, Ladyslipper, Mistletoe, Passion flower, Stone root. Tinctures. Formula. Marigold 2; Barberry 2; Ginkgo 1. Dose: 2 drops in feed, or in water, thrice daily. Infants 3-5 years: 10 drops.

To be treated by or in liaison with a qualified medical practitioner. ... haemolytic disease of infants

Haemolytic-uraemia Syndrome (hus)

An uncommon cause of kidney failure in children. The association of three processes: reduced platelets, haemolytic anaemia and kidney failure. Foodborne infection is spread by micro-organisms (E. coli, etc) with an affinity for the alimentary canal. The central nervous system is involved.

Onset: diarrhoea with streaks of blood, vomiting, breathlessness, feverishness, dizziness, jaundice and enlargement of the spleen.

Other causes may be mismatched food transfusion, environmental chemicals, nitrite food preservatives and analgesic drugs.

Alternatives. Tea. Combine herbs: Red Clover (to increase platelets) 3; Yarrow (kidneys) 2; Hops (cerebrospinal supportive) 1. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup freely.

Formula: Combine, Tinctures. Red Clover 2; Fringe Tree 1; Hops half. Dose: one 5ml teaspoon. Babies: 2 drops in feed; infants 3-5 years 10 drops in water and honey thrice daily.

Supplementation. Vitamin B-complex. C.

To be treated by or in liaison with a qualified medical practitioner. ... haemolytic-uraemia syndrome (hus)

Lung Disease, Chronic Obstructive

See pulmonary disease, chronic obstructive.... lung disease, chronic obstructive

Mad Cow Disease

The commonly used name for bovine spongiform encephalopathy (BSE).... mad cow disease

Mallory–weiss Syndrome

A tear at the lower end of the oesophagus, causing vomiting of blood. The syndrome is commonly caused by retching and vomiting after drinking excessive amounts of alcohol. Less often, violent coughing, a severe asthma attack, or epileptic convulsions may be the cause.

An endoscope is passed down the oesophagus to confirm the diagnosis. The tear generally heals within 10 days and no special treatment is usually required. However, a blood transfusion may sometimes be necessary.... mallory–weiss syndrome

Meig’s Syndrome

A rare condition in which a tumour of an ovary is accompanied by ascites and a pleural effusion. The fluid usually disappears when the tumour is removed.... meig’s syndrome

Milk–alkali Syndrome

A rare type of hypercalcaemia accompanied by alkalosis and kidney failure. The syndrome is due to excessive, long-term intake of calciumcontaining antacid drugs and milk. It is most common in people with a peptic ulcer and associated kidney disorders. Symptoms include weakness, muscle pains, irritability, and apathy. Treatment is to reduce milk and antacid intake.... milk–alkali syndrome

Mites And Disease

Mites are small animals, usually less than 1.2 mm, with 8 legs. Many species have piercing and blood-sucking mouthparts.

Species causing disorders include the scabies mite, which burrows in human skin causing intense itching; the housedust mite, which can cause asthma when inhaled in dust; and chiggers (American harvest mites), which are found in thick grass and cause an itchy rash when they bite. Mites in grain or fruit may cause skin irritation, sometimes known as grocers’ or bakers’ itch.Certain mites transmit diseases, particularly scrub typhus and rickettsial pox.... mites and disease

Legionnaire’s Disease

Non-contagious acute infection affecting the mucous membrane of the lungs. A form of pneumonia, caused by the organism Legionella pneumophilla.

Onset: 2-10 days.

Sources of infection: water-cooling and air-conditioning plants, Aerosols.

Usually attacks those with existing lung weakness. Those with low natural resistance and smokers are most at risk. Epidemic or single cases. Diagnosis confirmed by Haematological laboratory.

Symptoms. High body temperature (above 39°C). Rigor. Shivering. Diarrhoea. Dry cough. Bleeding from stomach and intestines. Mental confusion. Chest pains, shortness of breath, occasional diarrhoea. Differential diagnosis. Glandular fever. Other forms of pneumonia.

Indicated: anti-microbials and expectorants.

Treatment. Formula. Pleurisy root 2; Echinacea root 2; Grindelia quarter. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Every 3 hours. Take together with:–

Fenugreek tea. 2 heaped teaspoons seeds to each cup water simmered gently 10 minutes. Drink freely 1 cup. Seeds should be swallowed.

Enema. Strong Yarrow tea enema to control bowel bleeding. ... legionnaire’s disease

Monosodium Glutamate Syndrome

Pains in arms, neck, shoulders and spine from excessive consumption of monosodium glutamate which increases the body’s salt levels.

Tea. Mix, equal parts: Agrimony, Centuary, Meadowsweet.

Decoction. Mix, equal parts: Dandelion root, Echinacea root.

Tablets/capsules. Blue Flag. Devil’s Claw. Wild Yam.

Formula (1). Turkey Rhubarb, with pinch of Cayenne or drops of Tincture Capsicum. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Formula (2). Dandelion 2; Meadowsweet 1; Goldenseal quarter. Dose: as above. ... monosodium glutamate syndrome

Myofascial Pain Syndrome

See temporomandibular joint syndrome.... myofascial pain syndrome

Organic Brain Syndrome

See brain syndrome, organic.... organic brain syndrome

Osgood–schlatter Disease

Painful enlargement and tenderness of the tibial tuberosity (the bony prominence of the tibia), which occurs most commonly in boys aged between 10 and 14. It results from excessive, repetitive pulling of the quadriceps muscle, due to repeated exercise. The disorder often clears up without treatment; severe pain may require physiotherapy or immobilization of the knee in a plaster cast.... osgood–schlatter disease

Nervous Bowel Syndrome

Frequent urging to stool due to nervous irritability or emotional distress.

Indicated: astringents, nerve relaxants.

Teas. Hops, Vervain, Chamomile, Cranesbill.

Tablets/capsules. Chamomile, Calamus, Wild Yam, Fenugreek.

Formula. Bayberry 2; Wild Yam 1; Valerian half. Dose: Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Thrice daily.

Tincture. Black Catechu BHP (1983). 1:5 in 45 per cent alcohol. Dose 2.5 to 5ml in water, thrice daily. Fenulin. (Gerard House)

Diet. Slippery Elm gruel.

Supplements. Vitamins A, B6, C, Calcium, Dolomite. ... nervous bowel syndrome

Asbestos-related Diseases

A variety of diseases caused by inhalation of asbestos fibres. Asbestos is a fibrous mineral formerly used as a heat- and fire-resistant insulating material. There are 3 main types of asbestos fibre: white, which is widely used; blue; and brown, the most dangerous. The use of all types is now carefully controlled.

In asbestosis, widespread fine scarring occurs in the lungs. The disease causes breathlessness and a dry cough, eventually leading to severe disability and death. It develops mostly in industrial workers who have been heavily exposed to asbestos. The period from initial exposure to development of the disease is usually at least 20 years. Diagnosis is by chest X-ray. Asbestosis increases the risk of lung cancer.

Mesothelioma is a cancerous tumour of the pleura (the membrane surrounding the lungs) or the peritoneum (the membrane lining the abdominal cavity). In the pleura, mesotheliomas cause pain and breathlessness; in the peritoneum they cause enlargement of the abdomen and intestinal obstruction. The condition cannot be treated and usually leads to death within 1 or 2 years. The average interval between initial exposure to asbestos and death is 20–30 years. Mesothelioma affects people who have worked with blue or brown asbestos.

In diffuse pleural thickening, the outer and inner layers of the pleura become thickened, and excess fluid may accumulate in the cavity between them.

This combination restricts the ability of the lungs to expand, resulting in shortness of breath.

The condition may develop even after short exposure to asbestos.... asbestos-related diseases

Paget’s Disease Of The Nipple

A rare type of breast cancer in which a tumour develops in the nipple.

The disease resembles eczema and can cause itching and a burning feeling.

A non-healing sore may develop.

Without treatment, the tumour may spread into the breast.

Diagnosis is made with a biopsy.... paget’s disease of the nipple

Painful Arc Syndrome

A condition in which pain occurs when the arm is raised between 45 and 160 degrees from the side. The usual cause is an inflamed

tendon or bursa around the shoulder joint being squeezed between the scapula and humerus.

Treatment includes physiotherapy and injection of corticosteroid drugs.... painful arc syndrome

Parkinson’s Disease

(PD). Paralysis agitans. First described by James Parkinson, 1817. His description is as apt today as when it appeared in his book “Essay on the Shaking Palsy”. He wrote: “It is characterised by involuntary tremulous motion, with lessened muscular power in parts not in action and even when supported. There is a tendency to bend the trunk forward and to pass from a walking to a running pace. The senses and intellect are uninjured.”

Added to the above are:– muscular rigidity, loss of reflexes, drooling – escape of saliva from the mouth. Muscles of the face are stiff giving a fixed expression, the back presents a bowed posture. The skin is excessively greasy and the patient is unable to express emotional feelings. Loss of blinking. Pin- rolling movement of thumb and forefinger.

Causes: degeneration of groups of nerve cells deep within the brain which causes a lack of neurotransmitting chemical, dopamine. Chemicals such as sulphur used by agriculture, drugs and the food industry are suspected. Researchers have found an increase in the disease in patients born during influenza pandemics.

Treatment. While cure is not possible, a patient may be better able to combat the condition with the help of agents that strengthen the brain and nervous system.

Tea. Equal parts: Valerian, Passion flower, Mistletoe. 1 heaped teaspoon to each cup water; bring to boil; simmer 1 minute; dose: half-1 cup 2-3 times daily.

Gotu Kola tea. (CNS stimulant).

Tablets/capsules. Black Cohosh, Cramp bark, Ginseng, Prickly Ash, Valerian.

Formula. Ginkgo 2; Black Cohosh 1; Motherwort 2; Ginger 1. Mix. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-3 teaspoons in water or honey. Fava Bean Tea.

Case report. Two patients unresponsive to Levodopa treatment reported improvement following meals of fresh broad beans. (Vicia faba) The beans contain levodopa in large amounts. (Parkinson Disease Update Vol 8, No 66, p186, Medical Publications, PO Box 24622-H, Philadelphia, USA) See also: BROAD BEANS. L-DOPA.

Nacuna Pruriens. Appropriate. Essential active constituent: L-dopa. (Medicinal plants and Traditional Medicine in Africa, by Abayomi Sofowora, Pub: John Wiley)

Practitioner. To reduce tremor: Tincture Hyoscyamus BP. To reduce spasm: Tincture Belladonna BP. To arrest drooling: Tincture Stramonium BP.

Diet. It is known that people who work in manganese factories in Chile may develop Parkinson’s disease after the age of 30. Progress of the disease is arrested on leaving the factory. Two items of diet highest in manganese are wheat and liver which should be avoided, carbohydrates in place of wheat taking the form of rice and potatoes.

Supplements. Daily: B-complex, B2, B6, niacin. C 200mg to reduce side-effects of Levodopa. Vitamin E 400iu to possibly reduce rigidity, tremors and loss of balance.

Treatment of severe nerve conditions should be supervised by neurologists and practitioners whose training prepares them to recognise serious illness and to integrate herbal and supplementary intervention safely into the treatment plan.

Antioxidants. Evidence has been advanced showing how nutritional antioxidants, high doses of Vitamin C and E, can retard onset of the disease, delaying the use of Levodopa for an average of 2 and a half years. (Fahn S., High Dose Alpha-tocopherol and ascorbate in Early Parkinson’s Disease – Annals of Neurology, 32-S pp128-132 1992)

For support and advice: The Parkinson’s Disease Society, 22 Upper Woburn Place, London WC1H 0RA, UK. Send SAE. ... parkinson’s disease

Brain Syndrome, Organic

Disorder of consciousness, intellect, or mental functioning that is of organic (physical), as opposed to psychiatric, origin. Causes include degenerative diseases, such as Alzheimer’s disease; infections; certain drugs; or the effects of injury, stroke, or tumour. Symptoms range from mild confusion to stupor or coma. They may also include disorientation, memory loss, hallucinations, and delusions (see delirium). In the chronic form, there is a progressive decline in intellect, memory, and behaviour (see dementia). Treatment is more likely to be successful with the acute form. In chronic cases, irreversible brain damage may already have occurred. (See also psychosis.)... brain syndrome, organic

Cats, Diseases From

Various parasites and infectious organisms can spread from cats to humans. The most serious disease is rabies. Cat-scratch fever is an uncommon illness caused by infection with the bacterium ROCHALIMAEA HENDELAE following a cat scratch or bite. Cats commonly carry the protozoan TOXOPLASMA GONDII, which causes toxoplasmosis.

Infection, usually from contact with cat’s faeces, is not generally serious but has serious consequences if a woman is infected during pregnancy.

Cat faeces may also carry eggs of the cat roundworm, a possible cause of toxocariasis.

Rarely, a larva from an ingested roundworm egg migrates to and lodges in an eye, causing deterioration of vision or even blindness.

Children who have been playing in sand or soil contaminated by cat faeces are most commonly affected.

Other cat-related disorders in humans include tinea (ringworm), fungal infections of the skin, bites from cat fleas, and allergic reactions to dander that may cause asthma or urticaria.

Diseases from cats can be avoided by good hygiene, veterinary care for animals that are ill, and regular worming and flea treatment of cats.... cats, diseases from

Perthes’ Disease

Inflammation of an epiphysis of the head of the femur.

The disease is a type of osteochondritis juvenilis, thought to be due to disrupted blood supply to the bone.

The condition is most common in boys aged 5–10, and usually affects 1 hip.

Symptoms include pain in the thigh and groin, and a limp on the affected side.

Diagnosis is made with X-rays.

Treatment may be rest for a few weeks, followed by splinting of the hip, or surgery.

The disease usually clears up by itself within 3 years, but the hip may be permanently deformed.... perthes’ disease

Peutz–jeghers Syndrome

A very rare, inherited condition in which polyps occur in the gastrointestinal tract and small, flat, brown spots appear on the lips and in the mouth. Occasionally the polyps bleed, or cause abdominal pain or intussusception. Tests include barium X-ray examination and endoscopy. Bleeding polyps may be removed.... peutz–jeghers syndrome

Creutzfeldt–jakob Disease

A rare, rapidly progressive degenerative condition of the brain. Creutzfeldt–Jakob disease (CJD) is thought to be due to an infection with a prion (slow virus). This is similar to the agent that causes scrapie in sheep and bovine spongiform encephalopathy (BSE) in cattle. One main variant of CJD largely affects middleaged or elderly people and has no obvious cause. A second main variant, occurring in younger people, is associated with contamination during brain surgery or transplants from infected people, or treatment with human growth hormone or gonadotrophin hormones. Recently, a 3rd variant, called new variant (nv) CJD, that attacks people in their teens and 20s has been identified. NvCJD causes pathological changes in the brain similar to those seen in BSEinfected cattle. It is thought to be acquired by eating infected beef.

Symptoms are similar for all variants. Progressive dementia and myoclonus (sudden muscular contractions) occur; muscular coordination diminishes; the intellect and personality deteriorate; and blindness may develop. As the disease progresses, speech is lost and the body becomes rigid. There is no treatment and death usually occurs within 2–3 years.... creutzfeldt–jakob disease

Diet And Disease

Several diseases are linked with diet. Diseases due to a deficiency are rare in developed countries, but many disorders are due partly to overconsumption of certain foods. A diet high in fats may contribute to atherosclerosis and heart disease. A high-fat diet has also been linked with cancer of the bowel (see colon, cancer of) and breast cancer. Obesity increases the risk of many other disorders, including diabetes mellitus and stroke.

Overconsumption of alcohol can lead to various alcohol-related disorders. A high salt intake predisposes a person towards hypertension. Some components of the diet protect against disease. For example, fibre protects against diverticular disease, chronic constipation, and haemorrhoids.

Many people’s diets contain too few natural vitamins. Pregnant women need high intakes of folic acid to reduce the risk of neural tube defects.

Although many illnesses are commonly ascribed to food allergy, it is only rarely that a definite link is proved. (See also nutritional disorders).... diet and disease

Dogs, Diseases From

Infectious or parasitic diseases that are acquired from contact with dogs. They may be caused by viruses, bacteria, fungi, protozoa, worms, insects, or mites living in or on a dog. Many parasites that live on dogs can be transferred to humans. The most serious disease from dogs is rabies. The is free of rabies, but travellers to countries in which rabies exists should treat any bite with suspicion. Dog bites can cause serious bleeding and shock and may become infected. Toxocariasis and hydatid disease are potentially serious diseases caused by the ingestion of worm eggs from dogs. In the tropics, walking barefoot on soil that is contaminated with dog faeces can lead to dog hookworm infestation.

Bites from dog fleas are an occasional nuisance. Ticks and mites from dogs, including a canine version of the scabies mite, are other common problems. The fungi that cause tinea infections in dogs can be caught by humans.

Some people become allergic to animal dander (tiny scales from fur or skin). They may, for example, have asthma or urticaria when a dog is in the house. (See also zoonoses.)... dogs, diseases from

Pickwickian Syndrome

An unusual disorder characterized by extreme obesity, shallow breathing, and sleep apnoea.

The cause is unclear.

Symptoms usually improve with weight loss.... pickwickian syndrome

Plummer–vinson Syndrome

Difficulty in swallowing due to webs of tissue forming across the upper oesophagus. The syndrome often occurs with severe iron-deficiency anaemia and affects middle-aged women.... plummer–vinson syndrome

Postmyocardial Infarction Syndrome

Another name for Dressler’s syndrome.... postmyocardial infarction syndrome

Shoulder–hand Syndrome

Pain and stiffness affecting one shoulder and the hand on the same side; the hand may also become hot, sweaty, and swollen. Arm muscles may waste through lack of use (see Sudeck’s atrophy). The cause of shoulder–hand syndrome is unknown, but it may occur as a complication of myocardial infarction, stroke, herpes zoster, or shoulder injury. Recovery usually occurs in about 2 years. This period may be shortened by physiotherapy and corticosteroid drugs. In rare cases, a cervical sympathectomy is performed.... shoulder–hand syndrome

Guillain–barré Syndrome

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

Guinea Worm Disease

A tropical disease caused by a female parasitic worm more than 1 m long. Infection is the result of drinking water containing the water flea cyclops, which harbours larvae of the worm. The larvae pass through the intestine and mature in body tissues. After about a year, the adult female worm, now pregnant, approaches the skin surface and creates an inflamed blister that bursts, exposing the end of the worm. Urticaria, nausea, and diarrhoea often develop while the blister is forming. The disease occurs in Africa, South America, the Caribbean, Middle East, and India.

The traditional remedy is to wind the worm from the skin on to a small stick. Once the worm is out, the condition usually clears up. The drugs tiabendazole and niridazole are given to reduce inflammation, antibiotics are given to control secondary infection, and the patient is immunized against tetanus.... guinea worm disease

Hypoplastic Left-heart Syndrome

A very serious form of congenital heart disease (see heart disease, congenital). The baby is born with a poorly formed left ventricle, often associated with other heart defects. The aorta is malformed and blood can reach it only via a duct (the ductus arteriosus) that links the aorta to the pulmonary artery.

At birth, the baby may seem healthy. However, within a day or 2 the ductus arteriosus naturally closes off and the baby collapses, becoming pale and breathless. In most cases, hypoplastic left-heart syndrome cannot be treated surgically, and most affected babies die within a week. A few infants have been treated with heart transplants.... hypoplastic left-heart syndrome

Shy–drager Syndrome

A rare degenerative disorder of unknown cause that progressively damages the autonomic nervous system. It begins gradually at age 60–70 and is more common in men. Symptoms include dizziness and fainting due to postural hypotension, urinary incontinence, impotence, reduced ability to sweat, and parkinsonism. The condition eventually leads to disability, and sometimes premature death. There is no cure or means of slowing degeneration, but many symptoms are relieved by drugs.... shy–drager syndrome

Sick Building Syndrome

A collection of symptoms reported by some workers in office buildings.

Symptoms include loss of energy, headaches, and dry, itching eyes, nose, and throat.

The cause is unknown, but various factors are involved, including air conditioning, passive smoking, lack of natural ventilation and light, and psychological factors.... sick building syndrome

Sick Sinus Syndrome

Abnormal function of the heart’s sinoatrial node that leads to episodes of bradycardia (slow heart-rate), alternating bradycardia and tachycardia (fast heart-rate), or very short episodes of cardiac arrest.

The cause is usually coronary artery disease, but may be a cardiomyopathy.

Symptoms may include lightheadedness, fainting, and palpitations.

The diagnosis is confirmed by a 24-hour ECG recording.

Treatment is usually by antiarrhythmic drugs and the fitting of an artificial pacemaker.... sick sinus syndrome

Slow Virus Diseases

A group of diseases of the central nervous system that occur many months or even years after infection with a virus. They cause gradual widespread destruction of nerve tissue, with progressive loss of brain function and a fatal outcome. Examples include Creutzfeldt–Jakob disease and kuru.... slow virus diseases

Insects And Disease

Relatively few insect species cause disease directly in humans. Some parasitize humans, living under the skin or on the body surface (see lice; chigoe; myiasis). The most troublesome insects are flies and biting insects. Flies can carry disease organisms from human or animal excrement via their feet or legs and contaminate food or wounds.

A number of serious diseases are spread by biting insects.

These include malaria and filariasis (transmitted by mosquitoes), sleeping sickness (tsetse flies), leishmaniasis (sandflies), epidemic typhus (lice), and plague (rat fleas).

Mosquitoes, sandflies, and ticks can also spread illnesses such as yellow fever, dengue, Lyme disease, and some types of viral encephalitis.

Organisms picked up when an insect ingests blood from an infected animal or person are able to survive or multiply in the insect.

Later, the organisms are either injected into a new human host via the insect’s saliva or deposited in the faeces at or near the site of the bite.

Most insect-borne diseases are confined to the tropics and subtropics, although tick-borne Lyme disease occurs in some parts of the.

The avoidance of insect-borne disease is largely a matter of keeping flies off food, discouraging insect bites by the use of suitable clothing and insect repellents, and, in parts of the world where malaria is present, the use of mosquito nets and screens, pesticides, and antimalarial tablets.... insects and disease

Liver Disease, Alcoholic

Damage to the liver caused by excessive alcohol consumption.

The longer consumption goes on, the more severe the damage.

The initial effect is the formation of fat globules between liver cells, a condition called fatty liver.

This is followed by alcoholic hepatitis, and damage then progresses to cirrhosis.

Alcohol-related liver disease increases the risk of developing liver cancer.

Liver function tests show a characteristic pattern of abnormalities, and liver biopsy may be needed to assess the severity of damage.

There is no particular treatment, but abstinence from alcohol prevents further damage.

Treatment for alcohol dependence may be required.... liver disease, alcoholic

Snails And Disease

Snails act as host to various types of fluke that infest humans, such as liver flukes.... snails and disease

Stevens–johnson Syndrome

A rare, life-threatening form of erythema multiforme characterized by severe blisters and bleeding in the mucous membranes of the eyes, mouth, nose, and genitals.... stevens–johnson syndrome

Stokes–adams Syndrome

Recurrent episodes of temporary loss of consciousness caused by insufficient blood flow from the heart to the brain. This is due to irregularity of the heartbeat (see arrhythmia, cardiac) or to complete heart block.

Most people with the syndrome are fitted with a pacemaker to prevent attacks.... stokes–adams syndrome

Sturge–weber Syndrome

A rare, congenital condition that affects the skin and the brain. Characteristically, a large purple birthmark (port wine stain) extends over one side of the face, including the eye. Malformation of cerebral blood vessels may cause weakness on one side of the body, progressive mental handicap, and epilepsy. Glaucoma may develop in the affected eye, leading to loss of vision.

Seizures can usually be controlled with anticonvulsant drugs.

In severe cases, brain surgery may be necessary.... sturge–weber syndrome

Occupational Disease And Injury

Illnesses, disorders, or injuries that result from exposure to chemicals or dust, or are due to physical, psychological, or biological factors in the workplace.

Pneumoconiosis is fibrosis of the lung due to inhalation of industrial dusts, such as coal. Asbestosis is associated with asbestos in industry. Allergic alveolitis is caused by organic dusts (see farmer’s lung).

Industrial chemicals can damage the lungs if inhaled, or other major organs if they enter the bloodstream via the lungs or skin. Examples include fumes of cadmium, beryllium, lead, and benzene. Carbon tetrachloride and vinyl chloride are causes of liver disease. Many of these compounds can cause kidney damage. Work-related skin disorders include contact dermatitis and squamous cell carcinoma. Rare infectious diseases that are more common in certain jobs include brucellosis and Q fever (from livestock), psittacosis (from birds), and leptospirosis (from sewage). People who work with blood or blood products are at increased risk of viral hepatitis (see hepatitis, viral) and AIDS, as are healthcare professionals. The nuclear industry and some healthcare professions use measures to reduce the danger from radiation hazards. Other occupational disorders include writer’s cramp, carpal tunnel syndrome, singer’s nodes, Raynaud’s phenomenon, deafness, and cataracts.... occupational disease and injury

Pulmonary Disease, Chronic Obstructive

A combination of chronic bronchitis and emphysema, in which there is persistent disruption of air flow into or out of the lungs. Patients are sometimes described as either pink puffers or blue bloaters, depending on their condition. Pink puffers maintain adequate oxygen in their bloodstream through an increase in their breathing rate, and remain “pink” despite damage to the lungs. However, they suffer from almost constant shortness of breath. Blue bloaters are cyanotic (have a bluish discoloration of the skin and mucous membranes) because of obesity, and sometimes oedema, mainly due to heart failure resulting from the lung damage.... pulmonary disease, chronic obstructive

Rats, Diseases From

Rats are rodents that live close to human habitation. They damage and contaminate crops and food stores and can spread disease. The organisms responsible for plague and a type of typhus are transmitted to humans by the bites of rat fleas. Leptospirosis is caused by contact with anything contaminated by rat’s urine.

Rat-bite fever is a rare infection transmitted directly by a rat bite. There are 2 types of this infection, caused by different bacteria. The symptoms include inflammation at the site of the bite and in nearby lymph nodes and vessels, bouts of fever, a rash, and, in one type, painful joint inflammation. Treatment for both types is with antibiotic drugs.

Rabies virus can be transmitted by the bites of infected rats. Lassa fever, also a viral disease, may be contracted from the urine of rats in West Africa. Rats also carry the viral infection lymphocytic chorio-meningitis, as well as the bacterial infection tularaemia.... rats, diseases from

Supraspinatus Syndrome

See painful arc syndrome.... supraspinatus syndrome

Tay–sachs Disease

A serious inherited metabolic disorder (see metabolism, inborn errors of) that causes premature death. The cause is deficiency of the enzyme hexosaminidase A, which results in a buildup in the brain of a harmful substance. Symptoms usually appear after age 6 months and include blindness, paralysis, and seizures leading to death. Diagnosis is made by enzyme analysis of white blood cells. It is now largely prevented by genetic.... tay–sachs disease

Thoracic Outlet Syndrome

A condition in which pressure on the brachial plexus causes pain in the arms and shoulders, pins-and-needles sensation in the fingers, and weakness of grip and other hand movements. Severe symptoms are usually caused by a cervical rib. Thoracic outlet syndrome may also be caused by drooping of the shoulders, an enlarged scalenus muscle in the neck, or a tumour.The condition is made worse by lifting and carrying heavy loads or by increases in body weight.

Treatment of thoracic outlet syndrome usually consists of exercises to improve posture, sometimes together with nonsteroidal anti-inflammatory drugs and muscle-relaxant drugs. Severe cases may be treated by surgical removal of the 1st rib.... thoracic outlet syndrome

Ticks And Disease

Small, 8-legged animals that feed on blood and sometimes transmit diseases to humans via their bites. Ticks are about 3 mm long before feeding and become larger when bloated with blood. Ticks may be picked up in long grass, scrub, woodland, or caves.

In the , the only disease known to be transmitted to humans by ticks is Lyme disease. Others transmitted in various parts of the world include relapsing fever, Rocky Mountain spotted fever, Q fever, tularaemia, and certain types of viral encephalitis. The prolonged bite of certain female ticks can cause tick paralysis, in which a toxin in the tick saliva affects the nerves that control movement. In extreme cases, this can be fatal.... ticks and disease

Tmj Syndrome

See temporomandibular joint syndrome.... tmj syndrome

Trisomy 21 Syndrome

Another name for Down’s syndrome.... trisomy 21 syndrome

Urethral Syndrome, Acute

A set of symptoms, usually affecting women, that are very similar to cystitis but which occur in the absence of infection.... urethral syndrome, acute

Valvular Heart Disease

A defect of 1 or more of the heart valves.... valvular heart disease

Vincent’s Disease

A severe form of gingivitis in which bacterial infection causes painful ulceration of the gums.

(See also gingivitis, acute ulcerative.)... vincent’s disease

Werdnig–hoffmann Disease

A very rare inherited disorder of the nervous system that affects infants. Also known as infantile spinal muscular atrophy, Werdnig–Hoffmann disease is a type of motor neuron disease, affecting the nerve cells in the spinal cord that control muscle movement.

Marked floppiness and paralysis occur during the first few months, and affected children rarely survive beyond age 3.

There is no cure for the disease. Treatment aims to keep the affected infant as comfortable as possible.... werdnig–hoffmann disease

Wernicke–korsakoff Syndrome

An uncommon brain disorder almost always related to malnutrition occurring in chronic alcohol dependence, but occasionally due to that which occurs in other conditions, such as cancer. Wernicke–Korsakoff syndrome is caused by deficiency of thiamine (see vitamin B complex), which affects the brain and nervous system.The disease consists of 2 stages: Wernicke’s encephalopathy and Korsakoff’s psychosis. Wernicke’s encephalopathy usually develops suddenly and produces nystagmus (abnormal, jerky eye movements), ataxia (difficulty in coordinating body movements), slowness, and confusion. Sufferers usually have signs of neuropathy, such as loss of sensation, pins-and-needles, or impaired reflexes. The level of consciousness falls progressively and may lead to coma and death unless treated. The condition is a medical emergency. Treatment with high doses of intravenous thiamine often reverses most of the symptoms, sometimes within a few hours.

Korsakoff’s psychosis may follow Wernicke’s encephalopathy if treatment is not begun promptly enough. Symptoms consist of severe amnesia, apathy, and disorientation. Korsakoff’s psychosis is usually irreversible.... wernicke–korsakoff syndrome

Withdrawal Syndrome

Unpleasant mental and physical symptoms experienced when a person stops using a drug on which he or she is dependent (see drug dependence). Withdrawal syndrome most commonly occurs in those with alcohol dependence or dependence on opioids, in smokers, and in people addicted to tranquillizers, amfetamines, cocaine, marijuana, and caffeine.

Alcohol withdrawal symptoms start 6–8 hours after cessation of intake and may last up to 7 days. They include trembling of the hands, nausea, vomiting, sweating, cramps, anxiety, and, sometimes, seizures. (See also confusion, delirium tremens, and hallucinations.)

Opioid withdrawal symptoms start after 8–12 hours and may last for 7–10 days. Symptoms include restlessness, sweating, runny eyes and nose, yawning, diarrhoea, vomiting, abdominal cramps, dilated pupils, loss of appetite, irritability, weakness, tremor, and depression.

Withdrawal symptoms from barbiturate drugs and meprobamate start after 12–24 hours, beginning with tremor, anxiety, restlessness, and weakness, sometimes followed by delirium, hallucinations, and, occasionally, seizures. A period of prolonged sleep occurs 3–8 days after onset. Withdrawal from benzodiazepine drugs may begin much more slowly and can be life-threatening.

Withdrawal symptoms from nicotine develop gradually over 24–48 hours and include irritability, concentration problems, frustration, headaches, and anxiety. Discontinuation of cocaine or amfetamines results in extreme tiredness, lethargy, and dizziness. Cocaine withdrawal may also lead to tremor, severe depression, and sweating.

Withdrawal symptoms from marijuana include tremor, nausea, vomiting, diarrhoea, sweating, irritability, and sleep problems. Caffeine withdrawal may lead to tiredness, headaches, and irritability.

Severe withdrawal syndromes require medical treatment.

Symptoms may be suppressed by giving the patient small quantities of the drug he or she had been taking.

More commonly, a substitute drug is given, such as methadone for opioid drugs or diazepam for alcohol.

The dose of the drug is then gradually reduced.... withdrawal syndrome

Zollinger–ellison Syndrome

A rare condition characterized by severe and recurrent peptic ulcers in the stomach, duodenum, and jejunum (the 2nd part of the small intestine). Zollinger–Ellison syndrome is caused by 1 or more tumours in the pancreas that secrete the hormone gastrin. Gastrin stimulates production of large quantities of acid by the stomach, which leads to ulceration. The high levels of acid in the digestive tract often also cause diarrhoea.

The tumours are cancerous, but of a slow-growing type.

If possible, they are removed surgically.

Proton pump inhibitor drugs are given to treat the ulcers.... zollinger–ellison syndrome

Acquired Immune Deficiency Syndrome

see AIDS.... acquired immune deficiency syndrome

Acute Coronary Syndrome

a combination of angina (unstable or stable), non-S–T elevation *myocardial infarction (NSTEMI), and S–T elevation myocardial infarction (STEMI). It implies the presence of coronary artery disease.... acute coronary syndrome

Acute Respiratory Distress Syndrome

see adult respiratory distress syndrome.... acute respiratory distress syndrome

Adams–stokes Syndrome

see Stokes–Adams syndrome.... adams–stokes syndrome

Adie’s Syndrome

(Holmes-Adie syndrome) an abnormality of the pupils of the eyes, often affecting only one eye. The affected pupil is dilated and reacts slowly to light; the response on convergence *accommodation of the eyes is also slow (see tonic pupil). Tendon reflexes may be absent. The condition is almost entirely restricted to women. [W. J. Adie; Sir G. M. Holmes (1876–1965), British neurologist]... adie’s syndrome

Adult Respiratory Distress Syndrome

(acute respiratory distress syndrome, ARDS) a form of *acute respiratory failure that occurs after a precipitating event, such as trauma, aspiration, or inhalation of a toxic substance; it is particularly associated with septic shock. Lung injury is characterized by reduced oxygen in the arteries, reduced lung volume, and decreased lung compliance, and diffuse infiltrates are seen on a chest X-ray. Treatment is correction of the original cause, volume replacement, diuretics, oxygen, and mechanical ventilation.... adult respiratory distress syndrome

Aicardi Syndrome

a syndrome caused by abnormal development of the brain in which the two halves of the brain do not connect. The *corpus callosum is absent. Affected individuals suffer from learning disability and seizures. They may also have associated abnormalities of the eyes and spine. [J. D. Aicardi (20th century), French neurologist]... aicardi syndrome

Alagille Syndrome

(arteriohepatic dysplasia) an inherited condition in which the bile ducts, which drain the liver, become progressively smaller, causing increased *jaundice. It is associated with abnormalities of other organs, such as the heart, kidneys, eyes, and spine. [D. Alagille (1925–2005), French physician]... alagille syndrome

Albers-schönberg Disease

see osteopetrosis. [H. E. Albers-Schönberg (1865–1921), German radiologist]... albers-schönberg disease

Alien Limb Syndrome

a rare neurological condition in which upper limb movements occur without an individual’s awareness of or control over the actions. In extreme cases, a person will deliberately use their other arm to restrain the ‘alien limb’. It is caused by damage to connections between the cerebral hemispheres or the frontal or occipital brain areas and can occur following stroke or in dementia.... alien limb syndrome

Alport’s Syndrome

a hereditary disease that causes *nephritis accompanied by deafness and, less commonly, ocular defects, such as cataracts. Affected males usually develop end-stage renal failure and, unless treated with a kidney transplant, die before the age of 40. Females have a better prognosis. [A. C. Alport (1880–1959), South African physician]... alport’s syndrome

Anderson–fabry Disease

see Fabry disease.... anderson–fabry disease

Androgen Insensitivity Syndrome

(AIS) an X-linked (see sex-linked) disorder in which the body does not react to androgens because of structural abnormalities in androgen receptors. In its most extreme form, complete AIS (formerly known as testicular feminization syndrome), there is a fully female body appearance with breast development and a short vagina (but no uterus; testes are present internally). Psychosexuality is female orientated. Partial AIS is also known as *Reifenstein’s syndrome.... androgen insensitivity syndrome

Angelman Syndrome

a neurogenetic disorder characterized by severe developmental delay, absence of speech, seizures, a jerky puppet-like gait (see ataxia), and paroxysmal laughter (giving it the alternative name happy puppet syndrome). Affected children commonly have cranial and facial abnormalities, such as a small or flattened head. Angelman syndrome is a prototype of genomic *imprinting: a deletion on maternal chromosome 15 is the cause in a majority of cases. [H. Angelman (1915–96), British paediatrician]... angelman syndrome

Antiphospholipid Antibody Syndrome

(APS, Hughes syndrome) an autoimmune disease in which the presence of antibodies against phospholipid (see anticardiolipin antibodies; lupus anticoagulant) is associated with a tendency to arterial or venous thrombosis and, in women of childbearing age, to recurrent miscarriage. APS may be primary or occur in association with systemic lupus erythematosus (SLE) or other connective-tissue diseases. Treatment is by low-dose aspirin or heparin.... antiphospholipid antibody syndrome

Anton’s Syndrome

see anosognosia. [G. Anton (1858–1933), Austrian neurologist]... anton’s syndrome

Apert Syndrome

a hereditary disorder characterized by *craniosynostosis, underdevelopment of the midfacial tissues resulting in a sunken facial appearance, and *syndactyly (fusion) of 2–5 digits (‘mitten glove’). Variable mental deficits and cleft palate may result. The condition may be associated with *Crouzon syndrome, in which case the fusion of the digits is less marked. See also acrocephalosyndactyly. [E. Apert (1868–1940), French physician]... apert syndrome

Asbestos-related Pleural Disease

any one of a variety of conditions involving the *pleura, but not the lungs (see asbestosis), in subjects exposed to asbestos. These include the formation of pleural plaques, diffuse pleural thickening, and pleural effusions (see oedema).... asbestos-related pleural disease

Asherman Syndrome

a condition in which *amenorrhoea and infertility follow a major haemorrhage in pregnancy. It may result from overvigorous curettage of the uterus in an attempt to control the bleeding. This removes the lining, the walls adhere, and the cavity is obliterated to a greater or lesser degree. Some 50% of such patients are subsequently infertile, and of those who become pregnant, only a minority achieve an uncomplicated delivery. Compare Sheehan’s syndrome. [J. G. Asherman (20th century), Czechoslovakian gynaecologist]... asherman syndrome

Atheroembolic Renal Disease

a disease associated with diffuse atherosclerosis and sloughing of atheromatous plaques in the aorta and main renal arteries. This results in occlusion of smaller arteries and arterioles downstream within the kidney, with ischaemic and inflammatory reactions. This leads to the onset of renal impairment. Precipitating factors include invasive procedures with aortic cannulae, vascular surgery, and therapy with thrombolytics or anticoagulants. Less commonly the condition can occur spontaneously.... atheroembolic renal disease

Atypical Mole Syndrome

(dysplastic naevus syndrome) a condition in which patients have numerous moles, some of which are relatively large and irregular in shape or pigmentation. There may be a family history of this syndrome or of malignant *melanoma.... atypical mole syndrome

Autoimmune Disease

one of a number of otherwise unrelated disorders caused by inflammation and destruction of tissues by the body’s own *immune response. These disorders include acquired haemolytic anaemia, pernicious anaemia, rheumatic fever, rheumatoid arthritis, glomerulonephritis, systemic lupus erythematosus, myasthenia gravis, Sjögren’s syndrome, and several forms of thyroid dysfunction, including Hashimoto’s disease. It is not known why the body should lose the ability to distinguish between substances that are ‘self’ and those that are ‘non-self’.... autoimmune disease

Balint’s Syndrome

a disorder, arising from bilateral occipito-parietal *strokes, characterized by inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes (oculomotor apraxia), and inability to move the hand to a specific object using vision (optic ataxia). [R. Balint (1874–1929), Hungarian neurologist]... balint’s syndrome

Ballantyne Syndrome

(maternal mirror syndrome) a condition that occurs in cases of *hydrops fetalis when the maternal condition begins to mirror the state of the fetus. The maternal signs and symptoms are similar to those of *pre-eclampsia, including vomiting, hypertension, oedema, and proteinuria.... ballantyne syndrome

Banti’s Syndrome

a disorder in which enlargement and overactivity of the spleen occurs as a result of increased pressure within the splenic vein (see hypersplenism; splenomegaly). It arises primarily in children and occurs with *cirrhosis of the liver. [G. Banti (1852–1925), Italian pathologist]... banti’s syndrome

Bartter Syndrome

an inherited condition of the kidney, which causes abnormalities in the excretion and reabsorption of salts from the blood. This results in lowered levels of potassium and chloride and an increased level of calcium. The baby fails to grow properly and becomes progressively weaker and dehydrated. Treatment consists of correcting the salt imbalance with appropriate supplements. [F. C. Bartter (1914–83), US physician]... bartter syndrome

Batten’s Disease

one of a group of rare hereditary disorders (known as the neuronal ceroid lipofuscinoses) that also includes *Tay-Sachs disease. Fatty substances accumulate in the cells of the nervous system, causing progressive dementia, epilepsy, spasticity, and visual failure. The condition starts in late infancy or childhood. There is no treatment. [F. E. Batten (1865–1918), British neurologist]... batten’s disease

Battered Baby Syndrome

see nonaccidental injury.... battered baby syndrome

Bazin’s Disease

a rare disease of young women in which tender nodules develop under the skin in the calves. The condition is a *tuberculide; the nodules may break down and ulcerate though they may clear up spontaneously. Medical name: erythema induratum. [A. P. E. Bazin (1807–78), French dermatologist]... bazin’s disease

Best’s Disease

see vitelliform degeneration. [F. Best (20th century), German physician]... best’s disease

Binge–purge Syndrome

see bulimia.... binge–purge syndrome

Blocq’s Disease

see abasia.... blocq’s disease

Bloom’s Syndrome

a specific abnormality of chromosome 15 in which the individual suffers from recurrent infections, blisters on the hands and lips, and poor growth. Such children have a much higher than normal risk of developing cancer. [D. Bloom (20th century), US dermatologist]... bloom’s syndrome

Blount Disease

a condition causing *bow-legs as a result of abnormal growth at the *epiphysis at the top of the tibia (shin bone). It is more common in Africans and is most noticeable in childhood. The condition may affect one or both legs, and affected children are often obese. Treatment depends upon the severity and the age of the child but usually involves surgery. [W. P. Blount (1900–92), US orthopaedic surgeon]... blount disease

Boeck’s Disease

see sarcoidosis. [C. P. M. Boeck (1845–1913), Norwegian dermatologist]... boeck’s disease

Boerhaave’s Syndrome

spontaneous rupture (see perforation) of the gullet (oesophagus) following forceful retching and vomiting. Usual symptoms are severe chest and upper abdominal pain (that is aggravated by swallowing), fever, and shortness of breath. Surgical *emphysema is often present. Diagnosis is usually made with CT scanning. Surgery is required in most of the cases, combined with broad-spectrum antibiotics and parenteral *nutrition. [H. Boerhaave (1668–1738), Dutch physician]... boerhaave’s syndrome

Bourneville’s Disease

see tuberous sclerosis. [D.-M. Bourneville (1840–1909), French neurologist]... bourneville’s disease

Brown-séquard Syndrome

the neurological condition resulting when the spinal cord has been damaged. In those parts of the body supplied by the damaged segment there is a flaccid weakness and loss of feeling in the skin. Below the lesion there is a spastic paralysis on the same side and a loss of pain and temperature sensation on the opposite side. The causes include trauma and multiple sclerosis. [C. E. Brown-Séquard (1818–94), French physiologist]... brown-séquard syndrome

Brown’s Syndrome

a condition, usually congenital, in which the tendon sheath of the superior oblique muscle of the *eye does not relax, thus limiting the elevation of the eye, especially in adduction. [H. W. Brown (20th century), US ophthalmologist]... brown’s syndrome

Budd–chiari Syndrome

a rare condition that follows occlusion of the hepatic veins by thrombosis or nonthrombotic processes. In the majority of cases the cause is unknown but hypercoagulable states, local or disseminated malignancy, and infection are possible causes. It is characterized by abdominal pain, abdominal distension due to ascites, and jaundice. Clinical examination may reveal hepatomegaly, and *hepatic encephalopathy. [G. Budd (1808–82), British physician; H. Chiari (1851–1916), German pathologist]... budd–chiari syndrome

Buried Bumper Syndrome

a condition in which feeding via a PEG tube (see gastrostomy) is blocked. It occurs when the internal retention disc (bumper) of the tube, which holds it in place inside the stomach, is overgrown by hypertrophic gastric mucosa and becomes embedded in the stomach wall. This serious complication requires surgical removal of the tube. It can be prevented by correct tube care: advancing, retracting, and rotating of the tube.... buried bumper syndrome

Caffey’s Disease

see hyperostosis. [J. Caffey (1895–1966), US paediatrician]... caffey’s disease

Calcium Pyrophosphate Deposition Disease

a condition in which calcium pyrophosphate is deposited in joints. The most common manifestation is *pseudogout, marked by acute pain, redness, and swelling resembling gout. Alternatively it may be asymptomatic in association with *chondrocalcinosis seen on X-ray, it may occur with osteoarthritis in the affected joint, or there may be chronic inflammation of the joint.... calcium pyrophosphate deposition disease

Capgras’ Syndrome

(illusion of doubles) the delusion that a person closely involved with the patient has been replaced by an identical-looking impostor. It is often, but not necessarily, a symptom of paranoid *schizophrenia. [J. M. J. Capgras (1873–1950), French psychiatrist]... capgras’ syndrome

Cardiotomy Syndrome

(postcardiotomy syndrome) a condition that may develop weeks or months after heart surgery and is characterized by fever and *pericarditis. Pneumonia and pleurisy may form part of the syndrome. It is thought to be an *autoimmune disease and may be recurrent. A similar syndrome (Dressler’s syndrome) may follow myocardial infarction. It may respond to anti-inflammatory drugs.... cardiotomy syndrome

Caroli’s Disease

an inherited condition in which the bile ducts, which drain the liver, are widened, causing an increased risk of infection or cancer in the gall bladder. Compare Caroli’s syndrome. [J. Caroli (20th century), French physician]... caroli’s disease

Caroli’s Syndrome

an inherited condition in which the bile ducts, which drain the liver, are widened and there are fibrous changes in the liver and cysts within the kidneys. Compare Caroli’s disease. [J. Caroli]... caroli’s syndrome

Cat-scratch Disease

an infectious disease caused by the bacterium *Bartonella henselae, which infects cats and is transmitted to humans by a cat scratch or bite. A papule or pustule develops at the site of the injury followed, a week to two months after infection, by swelling of the lymph nodes (usually those closest to the wound). Fever and malaise are common. The condition usually resolves without treatment but antibiotics may be given to prevent complications.... cat-scratch disease

Cauda Equina Syndrome

damage to the *cauda equina, the nerve roots arising from the terminal end of the spinal cord, due to trauma or compression. Without urgent surgical intervention, it can result in paralysis, loss of sensation in the legs, and bladder and bowel incontinence.... cauda equina syndrome

Charcot–marie–tooth Disease

(peroneal muscular atrophy) a group of inherited diseases of the peripheral nerves, also known as hereditary sensorimotor neuropathy, causing a gradually progressive weakness and wasting of the muscles of the legs and the lower part of the thighs. The hands and arms are eventually affected. The genetic defect responsible for the most common form, type Ia, is a duplication on chromosome 17. The diagnosis is made by nerve conduction tests followed by genetic blood tests. [J. M. Charcot; P. Marie (1853–1940), French physician; H. H. Tooth (1856–1925), British physician]... charcot–marie–tooth disease

Chediak–higashi Syndrome

a rare fatal hereditary (autosomal *recessive) condition causing enlargement of the liver and spleen, albinism, and abnormalities of the eye. It is thought to be due to a disorder of glycolipid metabolism. [A. Chediak (20th century), Cuban physician; O. Higashi (20th century) Japanese paediatrician]... chediak–higashi syndrome

Churg–strauss Syndrome

(eosinophilic granulomatosis with polyangiitis) a systemic autoimmune *vasculitis comprising severe asthma, allergic rhinitis, and sinusitis associated with an increased *eosinophil count in the peripheral blood and eosinophilic deposits in the small vessels of the lungs. It usually responds to oral corticosteroids. [J. Churg (1910–2005) and L. Strauss (1913–85), US pathologists]... churg–strauss syndrome

Coats’ Disease

a congenital anomaly of the blood vessels of the retina, which are abnormally dilated and leaking. This results in subretinal haemorrhage and exudative *retinal detachment. [G. Coats (1876–1915), British ophthalmologist]... coats’ disease

Cockayne’s Syndrome

a hereditary disorder (inherited as an autosomal *recessive condition) associated with *trisomy of chromosome no. 20. Clinical features include *epidermolysis bullosa, dwarfism, learning disabilities, and pigmentary degeneration of the retina. [E. A. Cockayne (1880–1956), British physician]... cockayne’s syndrome

Coffin–lowry Syndrome

(CLS) an inherited disease, more severe in males, that results in developmental delay and profound learning disability. It is characterized by distinctive facial anomalies, short stature, microcephaly, and *kyphoscoliosis; some patients have episodes of collapse when startled or excited (stimulus-induced drop episodes; SIDE). [G. S. Coffin (1923– ), US paediatrician; R. B. Lowry (1932– ), British geneticist]... coffin–lowry syndrome

Cogan’s Syndrome

a disorder in which *keratitis and iridocyclitis (see uveitis) are associated with tinnitus, vertigo, and bilateral sensorineural deafness. [D. G. Cogan (1908–93), US ophthalmologist]... cogan’s syndrome

Collagen Disease

an obsolete term for *connective-tissue disease.... collagen disease

Communicable Disease Control

the control of disease due to infectious agents or their toxic products. See Consultant in Health Protection.... communicable disease control

Complex Regional Pain Syndrome

(CRPS, reflex sympathetic dystrophy, RSD, Sudek’s atrophy) neurological dysfunction in a limb following trauma, surgery, or disease, characterized by intense burning pain, swelling, stiffness, and sweaty shiny mottled skin. It is caused by overactivity of the sympathetic nervous system. The *ESR is often elevated, X-rays may reveal some patchy osteoporosis, and a bone scan usually demonstrates increased blood flow. Early treatment with splinting and physiotherapy are essential, in combination with *sympatholytic drugs, corticosteroids, and regional sympathetic blocks; *sympathectomy may be required in chronic cases.... complex regional pain syndrome

Connective-tissue Disease

any one of a group of diseases that are characterized by inflammatory changes in connective tissue and can affect virtually any body system. Formerly known as collagen diseases (connective-tissue disease has been the preferred term since 1978), they include *dermatomyositis, systemic and discoid *lupus erythematosus, *morphoea, *polyarteritis nodosa, and *rheumatoid arthritis.... connective-tissue disease

Cortical Lewy Body Disease

a disorder characterized by a combination of *parkinsonism and *dementia, which typically fluctuates. Visual hallucinations are common, and there is exquisite sensitivity to phenothiazine drugs. Abnormal proteins called Lewy bodies are found within the nerve cells of the cortex and the basal ganglia. It is the third most common cause of dementia (dementia with Lewy bodies) after *Alzheimer’s disease and vascular dementia.... cortical lewy body disease

Crest Syndrome

a disease characterized by the association of *calcinosis, Raynaud’s phenomenon (see Raynaud’s disease), (o)esophageal malfunction, sclerodactyly (tapering fingers), and *telangiectasia (see telangiectasis). It represents a variant of *systemic sclerosis and is also called limited cutaneous systemic sclerosis. It may be associated with severe pulmonary hypertension.... crest syndrome

Creutzfeldt–jakob Disease

(CJD) a rapidly progressive rare neurological disease, a form of human *spongiform encephalopathy in which dementia progresses to death after a period of 3–12 months. There is no effective treatment. The causative agent is an abnormal *prion protein that accumulates in the brain and causes widespread destruction of tissue. CJD typically affects middle-aged to elderly people. Some 15% of cases are due to a form of the disease that is inherited as an autosomal *dominant trait but most cases are sporadic, susceptibility being genetically determined. A few cases of CJD are acquired: the agent is known to have been transmitted by tissue and organ transplantation and by human growth hormone injections, but the disease may take years to manifest itself. Variant Creutzfeldt–Jakob disease (vCJD) is the human form of bovine spongiform encephalopathy (BSE), which is most likely acquired by the ingestion of infected beef products. Patients are younger than those affected with sporadic CJD and present with psychiatric symptoms (e.g. depression, anxiety) and hypersensitivity to touch, which are followed after months by myoclonic jerks (see myoclonus) and dementia. [H. G. Creutzfeldt (1885–1964) and A. M. Jakob (1884–1931), German psychiatrists]... creutzfeldt–jakob disease

Crigler–najjar Syndrome

a rare genetic disease in which the liver enzyme glucuronyl transferase, responsible for dealing with bilirubin, is absent. A large amount of unconjugated bilirubin accumulates in the blood leading to refractory jaundice in early childhood. The definitive treatment is a liver transplant; if left untreated, life expectancy is usually less than two years. [J. F. Crigler and V. A. Najjar (20th century), US paediatricians]... crigler–najjar syndrome

Crouzon Syndrome

(craniofacial dysostosis) a genetic disorder characterized by premature fusion of the skull sutures, leading to distortion in the shape of the head. It is a generalized form of *craniosynostosis, with a wide skull, high forehead, widely spaced eyes (ocular *hypertelorism), and *exophthalmos.See also Apert syndrome. [O. Crouzon (1874–1938), French neurologist]... crouzon syndrome

Dandy–walker Syndrome

a form of *cerebral palsy in which the *cerebellum is usually the part of the brain affected. It leads to unsteadiness of balance and an abnormal gait and may be associated with *hydrocephalus. [W. E. Dandy (1886–1946) and A. E. Walker (1907–95), US surgeons]... dandy–walker syndrome

De Clérambault Syndrome

see erotomania. [G. G. de Clérambault (1872–1934), French physician]... de clérambault syndrome

Deficiency Disease

any disease caused by the lack of an essential nutrient in the diet. Such nutrients include *vitamins, minerals, *essential amino acids, and *essential fatty acids.... deficiency disease

Dense Deposit Disease

see mesangiocapillary glomerulonephritis.... dense deposit disease

Dent’s Disease

a rare X-linked (see sex-linked) recessive inherited condition usually presenting in childhood or early adult life with polyuria, microscopic haematuria, renal stone disease, or rickets. The majority of patients have a mutation of the gene encoding chloride channel 5 (CLCN5); others have a defect of the OCRL1 gene, normally associated with Lowe’s syndrome, but do not present with the cataracts, learning disability, and tubular acidosis associated with this condition. In still others the genetic defect has yet to be defined but is not associated with either CLCN5 or OCRL1. Patients with Dent’s disease have evidence of proximal tubular dysfunction. [C. E. Dent (1911–76), British physician]... dent’s disease

Denys–drash Syndrome

a rare disorder consisting of the triad of *nephroblastoma (Wilms’ tumour), congenital nephropathy, and intersex disorders, resulting from mutations in the Wilm’s tumour suppressor gene (WT1). Incomplete forms exist; congenital nephropathy, with diffuse mesangial sclerosis, is the constant feature with either Wilms’ tumour or intersex disorders, usually in the form of male *pseudohermaphroditism. [P. Denys (20th century), French physician; A. Drash (20th century), British physician]... denys–drash syndrome

Devic’s Disease

see neuromyelitis optica. [E. Devic (1869–1930), French physician]... devic’s disease

Diabetic Hand Syndrome

the combination of features, often found in the hands of long-standing diabetic subjects, consisting of *Dupuytren’s contractures, knuckle pads, *carpal tunnel syndrome, *cheiroarthropathy, and sclerosing *tenosynovitis.... diabetic hand syndrome

Diabetic Holiday Foot Syndrome

a condition in which patients with diabetic sensory polyneuropathy (see diabetic neuropathy) suffer significant trauma to their insensate feet through holiday activities. These may include walking on hot flagstones or sand and wearing ill-fitting shoes. The condition may be prevented with prior education and advice and by maintaining safe footcare practices.... diabetic holiday foot syndrome

Didmoad Syndrome

see Wolfram syndrome.... didmoad syndrome

Di George Syndrome

a hereditary condition resulting in an inability to fight infections (immunodeficiency) associated with absence of the parathyroid gland and the thymus, abnormalities of the heart, and low calcium levels. Affected children are prone to *Candida infections and often present with *failure to thrive. The condition has also been named CATCH-22: Cardiac abnormalities, Abnormal facies, T-cell deficiency (from absent thymus), Cleft palate, Hypocalcaemia, chromosome 22 (in which the defect lies). [A. M. di George (1921–2009), US paediatrician]... di george syndrome

Discontinuation Syndrome

symptoms that arise from the sudden cessation of certain centrally acting drugs, such as antidepressants, beta blockers, and antihypertensives. Experiences include a rebound effect in which the original symptoms return but are temporarily worse than before, flulike symptoms and headaches, nausea, and giddiness that is usually short-lived and stops within 36 hours. This syndrome is not a sign of addiction and it does not indicate dependency.... discontinuation syndrome

Disease-modifying Antirheumatic Drug

(DMARD) any of various drugs used in the treatment of rheumatic disease: they affect the progression of the disease by suppressing the disease process. DMARDs include drugs affecting the immune response (immunomodulators), such as *immunosuppressants (e.g. methotrexate) and *cytokine inhibitors; *gold salts; *penicillamine; *sulfasalazine; and *hydroxychloroquine.... disease-modifying antirheumatic drug

Disembarkment Syndrome

see mal de debarquement.... disembarkment syndrome

Duane’s Syndrome

an abnormality of the eye muscles leading most commonly to restricted abduction (outward movement of the eye away from the midline) of one eye. On attempted adduction (inward movement of the eye towards the midline) of that same eye there is retraction of the eye into the orbit and narrowing of the opening between the eyelids. [A. Duane (1858–1926), US ophthalmologist]... duane’s syndrome

Duncan Disease

see X-linked lymphoproliferative syndrome. [Duncan family, in whom the disease was first studied]... duncan disease

Dysmnesic Syndrome

a disorder of memory in which new information is not learned but old material is well remembered. See Korsakoff’s syndrome.... dysmnesic syndrome

Eagle–barrett Syndrome

see prune belly syndrome.... eagle–barrett syndrome

Eales’ Disease

inflammation of the blood vessels of the retina occurring in young adults. It is characterized by leakage from abnormal growths of new vessels as well as recurrent haemorrhages into the vitreous humour. [H. Eales (1852–1913), British physician]... eales’ disease

Edwards’ Syndrome

a condition resulting from a genetic abnormality in which an extra chromosome is present – there are three no. 18 chromosomes instead of the usual two. Affected babies, who rarely survive, have a characteristic abnormally shaped head, low birth weight, prominent heels (‘rocker-bottom feet’), heart abnormalities, and severe learning disabilities. Prenatal screening (by *nuchal translucency scanning) and diagnosis (by *amniocentesis or *chorionic villus sampling) are possible. [J. H. Edwards (1928–2007), British geneticist]... edwards’ syndrome

Ehlers–danlos Syndrome

any one of a rare group of inherited (autosomal *dominant or autosomal *recessive) disorders of the connective tissue involving abnormal or deficient *collagen, the protein that gives the body tissues strength. There are several types of differing severity. The skin of affected individuals is very elastic but also very fragile: it bruises easily and scars poorly, the scars often being paper-thin. The joints of those affected tend to be very mobile (double-jointed) and dislocate easily. In some types the uterus or bowel can rupture or the valves in the heart can be weaker than normal. [E. L. Ehlers (1863–1937), Danish dermatologist; H. A. Danlos (1844–1912), French dermatologist]... ehlers–danlos syndrome

Ekbom’s Syndrome

1. see restless legs syndrome. 2. see delusional infestation. [K. A. Ekbom (1907–77), Swedish neurologist]... ekbom’s syndrome

Empty Nose Syndrome

an *iatrogenic condition that can follow surgery to widen the internal nasal cavity, particularly *turbinectomy. It is characterized by a sensation of dryness, and although the nasal cavity has been enlarged there is often a paradoxical feeling of nasal obstruction.... empty nose syndrome

Empty Sella Syndrome

a congenital malformation of the bony structure (the *sella turcica) that houses the pituitary gland such that the space is largely filled with cerebrospinal fluid, which squashes the usually spherical gland into a flattened shape against the floor of the sella. It is usually associated with enlargement of the sella, which can be seen on lateral X-ray. Only 10% of cases of this condition have defective pituitary function.... empty sella syndrome

Euthyroid Sick Syndrome

(sick euthyroid syndrome) a syndrome characterized by alteration in the thyroid function tests in which the level of triiodothyronine is markedly reduced, thyroxine is slightly reduced, and thyroid-stimulating hormone is reduced or normal. This syndrome is commonly seen in nonthyroidal illness, due to altered metabolism and transport of the thyroid hormones, but can be mistaken for secondary *hypothyroidism.... euthyroid sick syndrome

Exploding Head Syndrome

(EHS, episodic cranial sensory shock) an auditory *hallucination, characterized by the perception of a sudden loud noise in the head or ears, that is experienced during a transition between sleep stages. The cause is not currently known.... exploding head syndrome

fabry Disease

(Anderson–Fabry disease) an inherited disorder – an X-linked recessive condition (see sex-linked) – characterized by deficiency of the enzyme ?-galactosidase. It causes accumulation of glycosphingolipid (see cerebroside) in the body, leading to prominent and progressive involvement of the skin (with the formation of *angiokeratomas), heart, kidneys, and nervous system. The disease is treated with genetically engineered enzyme replacement therapy. [J. Fabry (1860–1930), German dermatologist]... fabry disease

Felty’s Syndrome

a disorder characterized by enlargement of the spleen (*splenomegaly), rheumatoid arthritis, and a decrease in the number of neutrophils in the blood (see neutropenia). [A. R. Felty (1895–1964), US physician]... felty’s syndrome

Fitz-hugh–curtis Syndrome

a condition in which infection due to *pelvic inflammatory disease spreads to the right upper quadrant of the *abdomen. Adhesions form between the liver and the anterior abdominal wall causing *perihepatitis, with pain and liver function abnormalities. [T. Fitz-Hugh and A. H. Curtis (20th century), US physicians]... fitz-hugh–curtis syndrome

Floppy Baby Syndrome

see amyotonia congenita.... floppy baby syndrome

Fröhlich’s Syndrome

a disorder of the *hypothalamus (part of the brain) affecting males: the boy is overweight with sexual development absent and disturbances of sleep and appetite. Medical name: dystrophia adiposogenitalis. [A. Fröhlich (1871–1953), Austrian neurologist]... fröhlich’s syndrome

Froin’s Syndrome

a condition in which the cerebrospinal fluid (CSF) displays a combination of yellow colour and high protein content. It is characteristic of a block to the spinal circulation of CSF often caused by a tumour. [G. Froin (1874–1932), French physician]... froin’s syndrome

Gardner–diamond Syndrome

(painful bruising syndrome, psychogenic purpura) a rare disorder, characterized by unexplained, recurrent, and painful bruising, typically arising after physical and/or psycho-emotional stress. Classically, ecchymoses spontaneously appear and are associated with a prodrome of warmth and pain at the sites. The condition, which is seen primarily in young to middle-aged women, is induced by trauma and associated with *personality disorders. Research into the syndrome is sparse but recent publications suggest that only a minority of patients experience a serious reduction in their quality of life, that the condition seems to be dermal rather than systematic in most patients, and that it seems to be associated with ongoing stress. [L. K. Diamond (1902–1999), US paediatrician; F. H. Gardner (1919–2013), US haematologist]... gardner–diamond syndrome

Gardner’s Syndrome

a variant form of familial adenomatous *polyposis in which polyps in the colon are associated with fibromas, *sebaceous cysts, and *osteomas (benign tumours), especially of the skull and jaw. [E. J. Gardner (1909–89), US physician]... gardner’s syndrome

Gerstmann’s Syndrome

a group of symptoms that represent a partial disintegration of the patient’s recognition of his or her *body image. It consists of an inability to name the individual fingers, misidentification of the right and left sides of the body, and inability to write or make mathematical calculations (see acalculia; agraphia). It is caused by disease in the association area of the dominant (usually left) parietal lobe of the brain. [J. G. Gerstmann (1887–1969), Austrian neurologist]... gerstmann’s syndrome

Gerstmann–straussler–scheinker Syndrome

an autosomal *dominant condition that is caused by a mutation in the *prion protein gene and resembles *Creutzfeldt-Jakob disease (CJD). Patients present with cerebellar dysfunction (*ataxia and *dysarthria) and later develop dementia. They continue to deteriorate over several years, in contrast with patients with CJD, who deteriorate rapidly over periods of less than 12 months. [J. G. Gerstmann]... gerstmann–straussler–scheinker syndrome

Gestational Trophoblastic Disease

(GTD) a group of disorders spanning the conditions of complete and partial molar pregnancies (see hydatidiform mole) through to the malignant conditions of invasive mole, *choriocarcinoma, and the very rare placental site trophoblastic tumour (PSTT). If there is any evidence of persistence of GTD, most commonly defined as a persistent elevation of *human chorionic gonadotrophin, the condition is described as *gestational trophoblastic neoplasia.... gestational trophoblastic disease

Gilbert’s Syndrome

familial unconjugated hyperbilirubinaemia: a condition due to a congenital deficiency of the enzyme UDP glucuronyl transferase in liver cells that is inherited as an autosomal *dominant or autosomal *recessive characteristic. Patients become mildly jaundiced, especially if they fast, overexert themselves, or have concomitant infection. Most patients are diagnosed following investigation of mildly abnormal liver function tests. The condition is lifelong but of little clinical consequence. [N. A. Gilbert (1858–1927), French physician]... gilbert’s syndrome

Goodpasture’s Disease

a rare autoimmune illness with production of antibodies directed against the glomerular basement membrane (anti-GBM antibodies). Classically patients present with lung haemorrhage and a rapidly progressive glomerulonephritis. Most cases will respond to aggressive treatment with plasma exchange and immunosuppression. [E. W. Goodpasture (1886–1960), US pathologist]... goodpasture’s disease

Gordon’s Syndrome

(pseudohypoaldosteronism type II, chloride shunt syndrome) an autosomal *dominant condition associated with increased chloride absorption in the distal tubule leading to a syndrome of mild volume expansion, hypertension, and metabolic acidosis with otherwise normal renal function. Plasma *renin and *aldosterone are suppressed as a result of the volume expansion. Other features can include short stature, intellectual impairment, muscle weakness, and renal stones.... gordon’s syndrome

Gorlin’s Syndrome

a genetic condition characterized by disorders of the skin, bones, and nervous system, with a markedly increased risk of developing multiple *basal cell carcinomas. [R. J. Gorlin (1923– ), US pathologist]... gorlin’s syndrome

Green Monkey Disease

see Marburg disease.... green monkey disease

Haemorrhagic Disease Of The Newborn

a temporary disturbance in blood clotting caused by *vitamin K deficiency and affecting infants on the second to fourth day of life. It varies in severity from mild gastrointestinal bleeding to profuse bleeding into many organs, including the brain. It is more common in breast-fed and preterm infants. The condition can be prevented by giving all babies vitamin K, either by injection or orally, shortly after birth. Medical name: melaena neonatorum.... haemorrhagic disease of the newborn

Hand–foot Syndrome

see palmoplantar erythrodysaesthesia.... hand–foot syndrome

Hand–schüller–christian Disease

see Langerhans cell histiocytosis. [A. Hand (1868–1949), US paediatrician; A. Schüller (1874–1958), Austrian neurologist; H. A. Christian (1876–1951), US physician]... hand–schüller–christian disease

Happy Puppet Syndrome

see Angelman syndrome.... happy puppet syndrome

Hartnup Disease

a rare hereditary defect in the absorption of the amino acid tryptophan, leading to learning disability, thickening and roughening of the skin on exposure to light, and lack of muscular coordination. The condition is similar to *pellagra. Treatment with nicotinamide is usually effective. [Hartnup, the family in whom it was first reported]... hartnup disease

Heavy-chain Disease

a disorder associated with proliferation of B lymphocytes producing heavy chains – one of the two types of polypeptide chains (the other being light chains) that make up the structure of immunoglobulins. It results in the production of abnormal immunoglobulins with distorted heavy chains and no light chains.... heavy-chain disease

Heerfordt’s Syndrome

a rare syndrome in which *sarcoidosis is associated with swelling of the parotid and other salivary glands, uveitis, fever, and paralysis of the facial nerve. It can be treated with steroids but generally resolves spontaneously.... heerfordt’s syndrome

Hepatorenal Syndrome

impairment of renal function, which can occur in acute or chronic liver disease. The condition is associated with intrarenal vasoconstriction and extrarenal vasodilation and hypotension, and the kidney disease is functional rather than structural in nature. There are two common clinical presentations. An acute form (type 1) is characterized by rapid spontaneous deterioration in renal function against a background of acute liver failure, acute alcoholic hepatitis, or acute decompensation of chronic cirrhotic liver disease. A chronic form (type 2) is characterized by insidious onset and slowly progressive deterioration in renal function. This is most often observed in patients with decompensated cirrhosis and portal hypertension. The prognosis of hepatorenal syndrome is extremely poor, and the best hope of survival is usually with liver transplantation.... hepatorenal syndrome

Holmes-adie Syndrome

see Adie’s syndrome.... holmes-adie syndrome

Hookworm Disease

a condition resulting from an infestation of the small intestine by hookworms. Hookworm larvae live in the soil and infect humans by penetrating the skin. The worms travel to the lungs in the bloodstream and from there pass via the windpipe and gullet to the small intestine. Heavy hookworm infections may cause considerable damage to the wall of the intestine, leading to a serious loss of blood; this, in conjunction with malnutrition, can provoke severe anaemia. Symptoms include itching and rash at the site of infection, followed by abdominal pain, diarrhoea, debility, and mental inertia. More serious effects can include difficulty in breathing, heart enlargement, and irregular heartbeat. The disease occurs mostly in the tropics and subtropics; mebendazole is used in treatment.... hookworm disease

Hughes Syndrome

see antiphospholipid antibody syndrome. [G. Hughes (21st century), British physician]... hughes syndrome

Hunter’s Syndrome

a hereditary disorder caused by deficiency of an enzyme that results in the accumulation of protein–carbohydrate complexes and fats in the cells of the body (see mucopolysaccharidosis). This leads to learning disability, enlargement of the liver and spleen, and prominent coarse facial features (gargoylism). The disease is *sex-linked, being restricted to males, although females can be *carriers. Medical name: mucopolysaccharidosis type II. [C. H. Hunter (1872–1955), US physician]... hunter’s syndrome

Hyper-igm Syndrome

an inherited immunodeficiency syndrome characterized by normal or high IgM levels with absence of IgA, IgG, and IgE (see immunoglobulin). Patients are susceptible to bacterial and opportunistic infections. Some cases are due to a mutation in the gene encoding the CD40 ligand, which is synthesized by *helper T cells and is involved in activation of B cells to produce circulating antibodies.... hyper-igm syndrome

Hyperviscosity Syndrome

a collection of symptoms resulting from an increase in the viscosity of blood. These symptoms include epistaxis (nosebleed), blurred vision, dizziness, headaches, drowsiness, confusion, and breathlessness. Hyperviscosity of the blood occurs in conditions such as polycythaemia, plasma-cell myeloma, leukaemia, and Waldenström’s macroglobulinaemia.... hyperviscosity syndrome

Industrial Disease

see occupational disease.... industrial disease

International Classification Of Diseases

(ICD) a list of all known diseases and syndromes, including mental and behavioural disorders, published by the *World Health Organization every ten years (approximately). Over the years the classification has moved from being disease-orientated to include a wider framework of illness and other health problems. The version in current use, ICD-10, was published in 1992 and employs alphanumeric coding. It is used in many countries as the principal means of classifying both mortality and morbidity experience and allows comparison of morbidity and mortality rates nationally and internationally. The clinical utility of the ICD is a matter of some controversy, especially in the field of psychiatry. ICD-11 was published in June 2018 and is intended to come into use from 2022. It includes about 55,000 codes for injuries, diseases, and causes of death, which is three times more than its predecessor. It also differs substantially from ICD-10 as each disease entry includes descriptions and guidance as to what is covered by the term, rather than the term alone. For the first time it includes specific sections on sexual health and traditional medicine. A parallel list, the International Classification of Functioning, Disabilities and Health (ICF), has also been compiled and is being used alongside the ICD. See also handicap.

The standard international classification for statistical, administrative, and epidemiological purposes, as supplied by the World Health Organization

The WHO framework for measuring health and disability in individuals and populations... international classification of diseases

Iron-storage Disease

see haemochromatosis.... iron-storage disease

Kallmann’s Syndrome

a familial condition that is the most common form of isolated *gonadotrophin deficiency; it is combined with underdevelopment of the olfactory lobes, causing *anosmia. The syndrome is caused by a gene *deletion on the short arm of the X chromosome. Patients often present with delayed puberty. There is an association with *ichthyosis, learning disabilities, obesity, renal and skeletal abnormalities, and undescended testes, but these features are very variable. [F. J. Kallmann (1897–1965), US geneticist]... kallmann’s syndrome

Kartagener’s Syndrome

a hereditary condition in which the heart and other internal organs lie on the opposite side of the body to the norm (i.e. the heart lies on the right; see dextrocardia); it is associated with chronic sinusitis and bronchiectasis. [M. Kartagener (1897–1975), German physician]... kartagener’s syndrome

Kienböck’s Disease

necrosis of the *lunate bone of the wrist caused by interruption of its blood supply (see osteochondritis; osteonecrosis). It usually follows chronic stress or injury to the wrist and presents with pain and stiffness, with reduced grip strength. Initially, X-rays may show no abnormality; if the disease is suspected, a bone scan or MRI is indicated. Treatment is with rest, splintage, and *NSAIDs, but some cases require surgical shortening of the radius or *arthrodesis of the wrist. [R. Kienböck (1871–1953), Austrian radiologist]... kienböck’s disease

King–kopetzky Syndrome

see obscure auditory dysfunction.... king–kopetzky syndrome

Kleine–levin Syndrome

a rare episodic disorder characterized by periods (usually of a few days or weeks), in which sufferers eat enormously, sleep for most of the day and night, and may become more dependent or aggressive than normal. Between episodes they are usually quite unaffected. The disorder almost always resolves spontaneously. [W. Kleine (20th century), German neuropsychiatrist; M. Levin (20th century), US neurologist]... kleine–levin syndrome

Kobberling–dunnigan Syndrome

see lipodystrophy.... kobberling–dunnigan syndrome

Köhler’s Disease

osteonecrosis of the *navicular bone of the foot (see osteochondritis). It occurs in children aged 3–7 years, causing pain and limping, and is treated by strapping the foot, rest, and anti-inflammatory drugs. [A. Köhler (1874–1947), German physician]... köhler’s disease

Korsakoff’s Syndrome

an organic disorder affecting the brain that results in a memory defect in which new information fails to be learnt although events from the past are still recalled; *disorientation in time and place; and a tendency to unintentionally invent material to fill memory blanks (see confabulation). The commonest cause of the condition is untreated *Wernicke’s encephalopathy in the context of alcoholism. Large doses of thiamine are given as treatment. The condition often becomes chronic. [S. S. Korsakoff (1854–1900), Russian neurologist]... korsakoff’s syndrome

Kostmann’s Syndrome

(severe congenital neutropenia) a hereditary (autosomal *recessive) disorder characterized by severe *neutropenia. This results in frequent bacterial infections, and death often occurs before the age of six months.... kostmann’s syndrome

Kugelberg–wellander Disease

(juvenile spinal muscular atrophy) see spinal muscular atrophy. [E. Kugelberg and L. Wellander (20th century), Swedish neurologists]... kugelberg–wellander disease

Kyasanur Forest Disease

a tropical disease, common in southern India, caused by a virus transmitted to humans through the bite of the forest-dwelling tick Haemaphysalis spinigera. Symptoms include fever, headache, muscular pains, vomiting, conjunctivitis, exhaustion, bleeding of nose and gums and, subsequently, internal bleeding and the *necrosis of various tissues. General therapy, in the absence of specific treatment, involves relief of dehydration and loss of blood; analgesics are given to alleviate pain.... kyasanur forest disease

Laurence–moon–biedl Syndrome

an autosomal *recessive condition characterized by obesity, short stature, learning disabilities, *retinitis pigmentosa, *hypogonadism, and delayed puberty. [J. Z. Laurence (1830–74), British ophthalmologist; R. C. Moon (1844–1914), US ophthalmologist; A. Biedl (1869–1933), Austrian physician]... laurence–moon–biedl syndrome

Legg–calvé–perthes Disease

(Perthes disease, pseudocoxalgia) necrosis of the head of the femur (thigh bone) due to interruption of its blood supply (see osteochondritis). Of unknown cause, it occurs most commonly in boys between the ages of 5 and 10 and causes aching and a limp. The head of the femur can collapse and become deformed, resulting in a short leg and restricted hip movement. Affected boys are kept under observation and their activities are restricted; surgery may be required in more severe cases. [A. T. Legg (1874–1939), US surgeon; J. Calvé (1875–1954), French orthopaedist; G. C. Perthes (1869–1927), German surgeon]... legg–calvé–perthes disease

Leigh Syndrome

a rare metabolic disorder that affects movement and development. Affected children are initially normal but lose coordination and balance as the disease progresses. There is no known cure at present. See also mitochondrial disorders. [D. Leigh (1915–98), British psychiatrist]... leigh syndrome

Leriche’s Syndrome

a condition in males characterized by absence of penile erection combined with absence of pulses in the femoral arteries and wasting of the buttock muscles. It is caused by occlusion of the abdominal aorta and iliac arteries. [R. Leriche (1879–1956), French surgeon]... leriche’s syndrome

Lesch–nyhan Disease

a *sex-linked hereditary disease caused by an enzyme deficiency resulting in overproduction of uric acid. Affected boys have learning disabilities and suffer from *spasticity and gouty arthritis. They also have a compulsion for self-mutilation. [M. Lesch (1939–2008) and W. L. Nyhan Jr. (1926– ), US physicians]... lesch–nyhan disease

Letterer–siwe Disease

see Langerhans cell histiocytosis. [E. Letterer (20th century) and S. A. Siwe (1897–1966), German physicians]... letterer–siwe disease

Liddle’s Syndrome

a rare autosomal *dominant condition characterized by hypertension associated with hypokalaemia, metabolic alkalosis, and low levels of plasma *renin and *aldosterone. The hypertension often starts in infancy and is due to excess resorption of sodium and excretion of potassium by the renal tubules. The syndrome is caused by a single genetic mutation on chromosome 16, which results in dysregulation of a sodium channel in the distal convoluted tubule. Treatment is with a low salt diet and a potassium-sparing diuretic that directly blocks the sodium channel, such as amiloride or triamterene. [G. G. Liddle (1921–89), US endocrinologist]... liddle’s syndrome

Little’s Disease

a form of *cerebral palsy involving both sides of the body and affecting the legs more severely than the arms. [W. J. Little (1810–94), British surgeon]... little’s disease

Löfgren’s Syndrome

an acute form of *sarcoidosis characterized by fever, *erythema nodosum, enlarged lymph nodes near the inner border of the lungs, joint pain or inflammation, often involving the ankles, and *uveitis. Symptoms may resolve spontaneously after a few weeks or may need therapy with NSAIDs or low-dose corticosteroids. Recurrence may occur in a minority of patients. [S. Löfgren (1910–78), Swedish clinician]... löfgren’s syndrome

Long Qt Syndrome

prolongation of the *Q–T interval on the electrocardiogram. It indicates susceptibility to ventricular tachycardia (especially *torsades de pointes), ventricular fibrillation, and sudden death. It may be familial or caused by certain drugs (e.g. sotalol, amiodarone, certain antipsychotic drugs).... long qt syndrome

Lowe’s Syndrome

see Dent’s disease.... lowe’s syndrome

Lyell’s Syndrome

see toxic epidermal necrolysis. [A. Lyell (20th century), British dermatologist]... lyell’s syndrome

Lynch Syndrome

see hereditary nonpolyposis colorectal cancer.... lynch syndrome

Macleod’s Syndrome

(Swyer-James syndrome) pulmonary *emphysema affecting only one lung and beginning in childhood or in adolescence; it occurs secondarily to necrotizing bronchitis, probably caused by a virus. [W. M. Macleod (1911–77), British physician]... macleod’s syndrome

Mal De Debarquement Syndrome

(MdDS, disembarkment syndrome) a form of *vertigo in which sufferers experience a sensation of bobbing, rocking, or swaying after getting off a boat or other form of transport. The condition remains little understood.... mal de debarquement syndrome

Malignant Vasovagal Syndrome

see neurocardiogenic syncope.... malignant vasovagal syndrome

Mallory–weiss Syndrome

trauma of the mucosal lining at the junction of the oesophagus (gullet) and stomach following protracted vomiting and retching. It is associated with *haematemesis and rarely perforation of the oesophagus. [G. K. Mallory (1926– ), US pathologist; S. Weiss (1899–1942), US physician]... mallory–weiss syndrome

Maple Syrup Urine Disease

(aminoacidopathy) an inborn defect of amino acid metabolism causing an excess of valine, leucine, isoleucine, and alloisoleucine in the urine, which has an odour like maple syrup. Treatment is dietary; if untreated, the condition leads to learning disabilities and death in infancy.... maple syrup urine disease

Marcus Gunn Jaw-winking Syndrome

a congenital condition characterized by drooping (*ptosis) of one eyelid. On opening or moving the mouth, the droopy lid elevates momentarily, resembling a wink. It is believed to be due to an abnormal innervation of the levator muscle by the trigeminal nerve. [R. Marcus Gunn (1850–1909), British ophthalmologist]... marcus gunn jaw-winking syndrome

Marion’s Disease

obstruction of the outlet of the bladder caused by enlargement of the muscle cells in the neck of the bladder. [J. B. C. G. Marion (1869–1960), French surgeon]... marion’s disease

Mayer–rokitansky–küster–hauser Syndrome

(Rokitansky–Küster–Hauser syndrome, Müllerian agenesis) congenital absence of the uterus and upper part of the vagina due to failure of development of the *Müllerian duct. It may be associated with skeletal, renal, and auditory abnormalities, but usually presents with amenorrhoea in a patient with otherwise normal secondary sexual characteristics. There is a multidisciplinary approach to treatment, with psychological support, counselling, discussion of creation of a ‘neovagina’ with gradual use of vaginal dilators, and/or surgical vaginal reconstruction. Surrogacy is the only option for childbearing, although oocyte donation from the mother to a surrogate can be discussed. [K. W. Mayer (1795–1868), German gynaecologist; K. von Rokitansky (1804–78), Austrian pathologist; H. Küster and G. A. Hauser (20th century), German gynaecologists]... mayer–rokitansky–küster–hauser syndrome

Mccune–albright Syndrome

polyostotic *fibrous dysplasia of long bones coupled with *café au lait spots and precocious puberty, occurring in both males and females. [D. J. McCune (1902–76), US paediatrician; F. Albright (1900–69), US physician]... mccune–albright syndrome

Meigs Syndrome

the rare combination of a benign ovarian *fibroma with *ascites and a right-sided pleural effusion. [J. V. Meigs (1892–1963), US gynaecologist]... meigs syndrome

Melkersson–rosenthal Syndrome

a rare disorder characterized by the occurrence together of facial paralysis, enlargement of the glottis, and swollen lips, which is due to lymphatic *stasis and the consequent build-up of protein in the facial tissues. [E. Melkersson (1898–1932), Swedish physician; C. Rosenthal (20th century), German neurologist]... melkersson–rosenthal syndrome

Ménétrier’s Disease

a rare disorder caused by *hypertrophy of the mucosa. It is characterized by diffusely enlarged gastric folds and excess mucus production, leading to anaemia, protein loss, and peripheral oedema. [P. Ménétrier (1859–1935), French physician]... ménétrier’s disease

Menkes Kinky-hair Disease

a genetic disorder characterized by severe learning disabilities, seizures, poor vision, colourless fragile hair, and chubby red cheeks. It is inherited as an X-linked (see sex-linked) recessive characteristic. There is no treatment and affected infants usually die before the age of three. [J. H. Menkes (1928–2008), US neurologist]... menkes kinky-hair disease

Metabolic Syndrome

(insulin resistance syndrome, syndrome X) a very common condition in which impaired glucose tolerance, impaired fasting glucose, or type 2 diabetes (see glucose tolerance test) is combined with central obesity (increased fat within the abdomen), raised blood pressure (*hypertension), and *hyperlipidaemia. It is associated with a risk of premature vascular disease (heart attack and stroke). The principal underlying cause is *insulin resistance, which is genetically determined.... metabolic syndrome

Middle East Respiratory Syndrome

(MERS) a viral respiratory infection that was first identified in 2012. Humans seem to be infected most easily by contact with dromedary camels (hence the informal name camel flu), although human-to-human infection also occurs. Symptoms include fever, cough, and shortness of breath. Although the syndrome is often mild, death occurs in about a third of diagnosed cases. Most reported cases have been in the Arabian Peninsula, although there was a major outbreak in South Korea in 2015. At present there is no vaccine or treatment.... middle east respiratory syndrome

Mikulicz’s Disease

swelling of the lacrimal and salivary glands as a result of infiltration with *lymphoid tissue. [J. von Mikulicz Radecki (1850–1905), Polish surgeon]... mikulicz’s disease

Miller–deiker Syndrome

a chromosomal abnormality resulting in a characteristic facial appearance and the absence of the grooves on the surface of the brain (see lissencephaly). Affected individuals have severe learning disabilities.... miller–deiker syndrome

Milroy’s Disease

see lymphoedema. [W. F. Milroy (1855–1942), US physician]... milroy’s disease

Mixed Connective Tissue Disease

a disease with features in common with systemic *lupus erythematosus, *polymyositis, and *scleroderma. It is characterized by high levels of antibodies to ribonucleoprotein and most commonly affects women between 20 and 40 years of age.... mixed connective tissue disease

Morquio–brailsford Disease

a defect of *mucopolysaccharide metabolism (see inborn error of metabolism) that causes dwarfism with a *kyphosis, a short neck, *knock-knee, and an angulated sternum in affected children. Intelligence is normal. [L. Morquio (1865–1935), Uruguayan physician; J. F. Brailsford (1888–1961), British radiologist]... morquio–brailsford disease

Multiple Organ Dysfunction Syndrome

(MODS, multi-organ failure, multiple organ failure, MOF) a common cause of death following severe injury, overwhelming infection, or immune deficiency states.... multiple organ dysfunction syndrome

Neglected Tropical Diseases

(NTDs) as defined by the *World Health Organization (WHO), a diverse group of *communicable diseases found almost entirely among poor populations in tropical and subtropical parts of Africa, Asia, and the Americas. Although they affect more than 1.4 billion people, and countermeasures would in many cases be inexpensive, NTDs have traditionally received far less attention than the major infectious diseases HIV/AIDS, tuberculosis, and malaria. In 2013 the WHO resolved to intensify its efforts to eradicate or control NTDs. The current WHO list identifies 24 such diseases, including *Buruli ulcer, *chikungunya fever, *dengue, *leishmaniasis, and *Madura foot (mycetoma).... neglected tropical diseases

Neglect Syndrome

see hemispatial neglect.... neglect syndrome

Neonatal Abstinence Syndrome

(NAS) symptoms and signs exhibited by a newborn baby (neonate) due to drug withdrawal (see dependence). This results when the fetus has been exposed to addictive drugs through maternal substance abuse or misuse. Symptoms tend to occur in the first few days of life (in the case of methadone, which is a long-acting opioid, symptom onset may be delayed). They include tremors and jerking, high-pitched crying, sneezing, sucking of fists, feeding difficulties, shortened periods of sleep between feeds, rapid breathing, sweating, loose stools, nasal stuffiness, and frequent yawning. Treatment includes swaddling or snugly wrapping in a blanket, as babies with NAS are often difficult to comfort. Other nonpharmacological measures include frequent small feeds using high-calorie formula and intravenous fluids if babies become dehydrated. Drug therapy may be used for seizures and withdrawal symptoms.... neonatal abstinence syndrome

Nephritic Syndrome

generalized inflammation of the glomeruli of the kidneys resulting in a reduction in *glomerular filtration rate, with mild oedema and hypertension resulting from renal salt and water retention. Urine analysis shows the presence of proteinuria and microscopic haematuria with red cell casts. Common and usually self-limiting causes are *Berger’s nephropathy and poststreptococcal glomerulonephritis. Less common but more serious causes of the nephritic syndrome are the vasculitides (see vasculitis) and *Goodpasture’s disease, which, untreated, usually prove fatal.... nephritic syndrome

Nerve Entrapment Syndrome

any syndrome resulting from pressure on a nerve from surrounding structures. Examples include the *carpal tunnel syndrome and *meralgia paraesthetica.... nerve entrapment syndrome

Neuroleptic Malignant Syndrome

a life-threatening syndrome seen after starting *antipsychotic medication. It is characterized by confusion, muscle rigidity, fever, pallor and sweating, urinary incontinence, and a high level of *creatine kinase. Its symptoms can appear similar to *catatonia. Treatment in a high-dependency unit with high-dose benzodiazepines and immediate cessation of antipsychotic drugs is usually indicated.... neuroleptic malignant syndrome

Niemann–pick Disease

an inherited (autosomal *recessive) disorder of lipid metabolism due to a defect in the enzyme sphingomyelinase and resulting in accumulation of sphingomyelin (a sphingolipid) and other phospholipids in the bone marrow, brain, liver, and spleen. Patients present with neurological problems, learning disabilities, and enlargement of the liver and spleen at a young age. There are four known types of the disease. [A. Niemann (1880–1921), German paediatrician; L. Pick (1868–1944), German pathologist]... niemann–pick disease

Noonan’s Syndrome

an autosomal *dominant condition of males who have all or some of the physical features of *Turner’s syndrome in females but normal sex chromosomes. It is often associated with a low testosterone level and sometimes with reduced sperm production. Other features include cardiovascular defects and most affected individuals have short stature and mild learning disabilities. [J. Noonan (1928– ), US paediatrician]... noonan’s syndrome

Nystagmus Block Syndrome

a type of squint (convergent *strabismus) that results from the use of the convergence mechanism to block or dampen down *nystagmus in an attempt to improve visual acuity.... nystagmus block syndrome

Obstructive Sleep Apnoea Syndrome

(OSAS) see obstructive sleep apnoea.... obstructive sleep apnoea syndrome

Nonalcoholic Fatty Liver Disease

(NAFLD) a spectrum of conditions affecting the liver in the absence of excessive alcohol consumption. NAFLD is a common cause of referral for patients with abnormal liver function tests. Fatty liver is excessive fat accumulation in the liver seen as an area of brightness within the liver on ultrasound examination. Fatty liver does not lead to irreversible liver damage in the majority of cases. Nonalcoholic steatohepatitis (NASH) is inflammation of the liver associated with accumulation of fat. It is often linked to insulin resistance, diabetes, hypertension, obesity, and *metabolic syndrome. Treatment involves dietary modification, regular physical exercise, weight reduction, and management of underlying conditions (e.g. diabetes, hypertension, and hiperlipidaemia). NASH may predispose to *cirrhosis and may ultimately require liver transplantation.... nonalcoholic fatty liver disease

Occupational Disease

a disease to which workers in certain occupations are particularly prone. Industrial diseases, associated with a particular industry or group of industries, fall within this category. Examples of such diseases include the various forms of *pneumoconiosis, which affect the lungs of workers continually exposed to dusty atmospheres; cataracts in glassblowers; decompression sickness in divers; poisoning from toxic metals in factory and other workers; and infectious diseases contracted from animals by farm workers, such as woolsorter’s disease (see anthrax). See also coshh, prescribed disease; industrial injuries disablement benefit.... occupational disease

Ogilvie’s Syndrome

see pseudo-obstruction.... ogilvie’s syndrome

Ollier’s Disease

see dyschondroplasia. [L. L. X. E. Ollier (1830–1900), French surgeon]

ology combining form. see -logy.... ollier’s disease

Osler–rendu–weber Disease

(hereditary haemorrhagic telangiectasia) a hereditary (autosomal *dominant) disorder characterized by thinning of the blood vessel walls, resulting in abnormally wide and fragile blood vessels. Patients may develop telangiectasia (see telangiectasis), nosebleeds, and arteriovenous malformations (see angioma). It is caused by mutations in the endoglin (ENG) gene or the activin receptor-like kinase (ALK-1) gene. [Sir W. Osler (1849–1919), Canadian physician; H. J. M. Rendu (1844–1902), French physician; F. P. Weber (1863–1962), British physician]... osler–rendu–weber disease

Ovarian Hyperstimulation Syndrome

a potentially life-threatening condition classically associated with ovarian stimulation using gonadotrophins in assisted conception procedures, such as in vitro fertilization (see superovulation). It is characterized by gross enlargement of the ovaries resulting in pain, bloating, nausea, vomiting, *haemoconcentration, and *ascites. The most severe cases require intensive care due to the high risk of thromboembolism and acute respiratory distress.... ovarian hyperstimulation syndrome

Overactive Bladder Syndrome

see detrusor.... overactive bladder syndrome

Painful Bruising Syndrome

see Gardner–Diamond syndrome.... painful bruising syndrome

Pancoast Syndrome

pain and paralysis involving the lower branches of the brachial plexus due to infiltration by a malignant tumour of the apical region of the lung. *Horner’s syndrome may also be present. [H. K. Pancoast (1875–1939), US radiologist]... pancoast syndrome

Paraneoplastic Syndrome

signs or symptoms occurring in a patient with cancer that result from antibodies or *ectopic hormones produced by the cancer and are not due directly to local effects of the cancer cells. Examples are *myasthenia gravis secondary to a tumour of the thymus, a cerebellar syndrome in patients with lung cancer (due to anti-*Purkinje cell antibody), and a peripheral neuropathy in patients with breast cancer. Removal of the cancer usually leads to resolution of the problem.... paraneoplastic syndrome

Patau Syndrome

a chromosome disorder in which there are three no. 13 chromosomes (instead of the usual two), causing abnormal brain development, severe learning disabilities, and defects in the heart, kidney, and scalp. Affected individuals rarely survive. [K. Patau (20th century), US geneticist]... patau syndrome

Pendred’s Syndrome

goitre associated with congenital deafness due to deficiency of *peroxidase, an enzyme that is essential for the utilization of iodine. [V. Pendred (1869–1946), British physician]... pendred’s syndrome

Peutz–jeghers Syndrome

a hereditary disorder in which the presence of multiple *polyps in the lining of the small intestine (intestinal *polyposis) is associated with pigmented areas (similar to freckles) around the lips, on the inside of the mouth, and on the palms and soles. The polyps can also occur in the colon and stomach. They may bleed, resulting in anaemia, or may cause obstruction of the bowel. Half of the patients develop malignant tumours (not necessarily of the bowel). [J. L. A. Peutz (1886–1957), Dutch physician; H. J. Jeghers (1904–90), US physician]... peutz–jeghers syndrome

Pick’s Disease

see frontotemporal dementia. [A. Pick (1851–1924), Czech psychiatrist]... pick’s disease

Pierre Robin Syndrome

a congenital disease in which affected infants have a very small lower jawbone (mandible) and a cleft palate. They are susceptible to feeding and respiratory problems. [Pierre Robin (1867–1950), French dentist]... pierre robin syndrome

Pink Disease

a severe illness of children of the teething age, marked by pink cold clammy hands and feet, heavy sweating, raised blood pressure, rapid pulse, photophobia, loss of appetite, and insomnia. Affected infants are very prone to secondary infection, which may be fatal. It has been suggested that the condition is an allergic reaction to mercury, since it used to occur when teething powders, lotions, and ointments containing mercury were used. Although there is no definite proof of this, the disease has virtually disappeared since all mercury-containing paediatric preparations have been banned. Medical names: acrodynia, erythroedema, erythromelalgia.... pink disease

Plummer’s Disease

a hyperfunctioning, usually benign, *adenoma of the thyroid gland, which can be palpated and appears as a ‘hot nodule’ on radioactive thyroid scanning. Treatment is to control the nodule with antithyroid drugs and then remove it surgically or destroy it permanently with radioactive iodine. [H. S. Plummer (1874–1937), US physician]... plummer’s disease

Poems Syndrome

a syndrome, mostly reported in Japanese males, consisting of polyneuropathy (see peripheral neuropathy), organomegaly, endocrine failure, M protein (immunoglobulins) in the plasma, and skin changes, such as thickening, hirsutism, or excess sweating. Each of the components occurs with varying consistency. The cause is not known but it is not thought to be autoimmune in nature.... poems syndrome

Polycystic Disease Of The Kidneys

either of two inherited disorders in which renal cysts are a common feature. Autosomal recessive polycystic kidney disease (ARPKD) occurs in about 1 in 20,000 live births. It is due to a single mutation on chromosome 6 for the gene encoding the protein fibrocystin. The majority of cases are diagnosed before or at birth. The most severely affected fetuses have enlarged kidneys and *oligohydramnios due to poor fetal renal output. These fetuses develop the ‘Potter’ phenotype with characteristic facies, pulmonary hypoplasia, and deformities of the spine and limbs. Those surviving the neonatal period (50–70%) develop varying degrees of renal impairment but this may not proceed to end-stage until early adulthood.

Autosomal dominant polycystic kidney disease (ADPKD) affects between 1 in 400 and 1 in 1000 individuals and is one of the most common hereditary diseases. Two types have been defined. ADPKD 1 is the commonest and responsible for about 85% of cases. It is due to a mutation in the PKD1 gene on chromosome 16, which encodes polycystin 1, an *ion-channel-regulating protein. ADPKD2 is due to a mutation in the PKD2 gene on chromosome 4, which encodes the protein polycystin 2, a calcium-release channel. ADPKD2 tends to be a milder disease with later presentation.

ADPKD is a multisystem disorder that is also associated with cyst formation in other organs (particularly the liver), cardiovascular disorders, and colonic diverticular disease. Renal disease presents in early adult life with haematuria, loin pain, urinary tract infection, hypertension, renal stone disease, or the finding of a mass in the abdomen. Other cases are identified by family contact tracing; the findings of a few cysts on renal ultrasonography in a young adult with a family history of ADPKD is highly suggestive of the disease. Renal disease is progressive and about 50% of patients will have reached end-stage by the time they enter their seventh decade. The progress of the renal failure can be slowed by good blood pressure control. In the UK, patients with ADPKD are responsible for 5–10% of the total on renal replacement therapy.

There are a number of separate rare autosomal dominant conditions other than ADPKD1 and ADPKD 2 that can present with polycystic kidneys. These include *von Hippel-Lindau disease and *tuberous sclerosis.... polycystic disease of the kidneys

Postgastrectomy Syndrome

see dumping syndrome.... postgastrectomy syndrome

Post-polio Syndrome

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

Postviral Fatigue Syndrome

see CFS/ME/PVF.... postviral fatigue syndrome

Potter Syndrome

a congenital condition characterized by absence of kidneys, resulting in decreased amniotic fluid (see oligohydramnios) and compression of the fetus. Babies have poorly developed lungs, a characteristic wrinkled and flattened facial appearance, and leg deformities and do not usually survive. [E. L. Potter (20th century), US pathologist]... potter syndrome

Pott’s Disease

*tuberculosis of the backbone. Untreated, it can lead to a hunchback deformity. Treatment is antituberculous chemotherapy and occasionally surgery. [P. Pott (1714–88), British surgeon]... pott’s disease

Prader–willi Syndrome

(Prader–Willi–Labhart syndrome) a congenital condition that is inherited as an autosomal *dominant trait and is due to an abnormality of chromosome 15 (see imprinting). It is marked by pathological overeating and resulting obesity (affected children often subsequently develop type 2 diabetes), lethargy, short stature, a characteristic facial expression, learning disabilities, and underactivity of the testes or ovaries (*hypogonadism) due to lack of pituitary gonadotrophins. It is a cause of delayed puberty. [A. Prader, H. Willi, and A. Labhart (20th century), Swiss paediatricians]... prader–willi syndrome

Prune Belly Syndrome

(Eagle–Barrett syndrome) a hereditary condition, occurring exclusively in males, characterized by a deficiency of abdominal muscles, complex malformation of the urinary tract, and bilateral undescended testes. The lungs may be underdeveloped. The name derives from the typically wrinkled appearance of the skin over the abdomen.... prune belly syndrome

Prescribed Disease

one of a number of *occupational diseases for which benefits are payable. These diseases arise as a result of employment requiring close contact with a hazardous substance or circumstance. Prescribed diseases are categorized by cause: physical, biological, chemical, or other. Examples include poisoning by such chemicals as mercury or benzene, decompression sickness in divers, and infections such as *anthrax in those handling wool. Some diseases that occur widely in the population may be prescribed in relation to a specific occupation (e.g. deafness in those working with pneumatic drills or tuberculosis in mortuary attendants). See also COSHH.... prescribed disease

Pseudoexfoliation Syndrome

the appearance of white dandruff-like deposits on structures in the anterior chamber of the eye, which are especially prominent around the pupil margin and on the anterior lens capsule. It is a sign of zonular weakness and indicates an increased risk of secondary glaucoma.... pseudoexfoliation syndrome

Pulseless Disease

see Takayasu’s disease.... pulseless disease

Punch-drunk Syndrome

a group of symptoms consisting of progressive *dementia, tremor of the hands, epilepsy, and parkinsonism. It is a consequence of repeated blows to the head that have been severe enough to cause *concussion.... punch-drunk syndrome

Ramsay Hunt Syndrome

a form of *herpes zoster affecting the facial nerve, associated with facial paralysis and loss of taste. It also produces pain in the ear and other parts supplied by the nerve. [J. R. Hunt (1872–1937), US neurologist]... ramsay hunt syndrome

Refeeding Syndrome

a potentially fatal condition that may affect severely malnourished patients in response to the reintroduction of a protein- and calorie-rich diet. It is thought to be due to severe fluid and *electrolyte shifts (especially low phosphate, magnesium, and potassium levels in the blood) and related metabolic complications (e.g. raised levels of insulin in the blood). Clinical complications include heart failure, *paraesthesia, muscle weakness, cardiac *arrhythmias, fitting, and death. An assessment to identify at-risk patients before the reinstatement of feeding, regular monitoring, and prompt correction of electrolyte abnormalities helps to prevent this condition.... refeeding syndrome

Refsum’s Disease

an inherited disorder of lipid metabolism resulting in abnormal accumulation of phytanic acid (a fatty acid) in body tissues. This results in a *peripheral neuropathy affecting the sensory and motor nerves, diminishing vision due to *retinitis pigmentosa, and unsteadiness (*ataxia) caused by damage to the cerebellum. [S. Refsum (20th century), Norwegian physician]... refsum’s disease

Reifenstein’s Syndrome

(partial androgen insensitivity syndrome) a congenital resistance to androgen hormones (see androgen insensitivity syndrome) resulting in poor development of the male sexual characteristics, which often becomes more obvious at puberty. Some features of feminization may occur (e.g. breast development). [E. C. Reifenstein (1908–75), US endocrinologist]... reifenstein’s syndrome

Ritter’s Disease

see staphylococcal scalded skin syndrome. [G. Ritter von Rittershain (1820–83), German physician]... ritter’s disease

Rokitansky–küster–hauser Syndrome

see Mayer–Rokitansky–Küster–Hauser syndrome.... rokitansky–küster–hauser syndrome

Russell–silver Syndrome

(Silver–Russell syndrome) a congenital condition characterized by short stature, a triangular face with a small mandible (lower jaw), and asymmetry of the body. [A. Russell (1918–2003), British paediatrician; H. K. Silver (1918–91), US paediatrician]... russell–silver syndrome

Scalenus Syndrome

(thoracic outlet syndrome) the group of symptoms caused by compression of the subclavian artery and the lower roots of the brachial plexus against the fibrous and bony structures of the outlet of the upper thoracic vertebrae. Loss of sensation, wasting, and vascular symptoms may be found in the affected arm, which may also be painful.... scalenus syndrome

Scheuermann’s Disease

(adolescent kyphosis) a disorder of spinal growth in which a sequence of three or more vertebrae become slightly wedge-shaped. It arises in adolescence and usually occurs in the thoracic spine, causing poor posture, backache, fatigue, and exaggerated *kyphosis. X-ray findings include *Schmorl’s nodes. [H. W. Scheuermann (1877–1960), Danish surgeon]... scheuermann’s disease

Schmidt’s Syndrome

the autoimmune destruction of a combination of the thyroid, the adrenals, and the beta cells of the islets of Langerhans, causing type 1 *diabetes mellitus. It is often associated with failure of the ovaries (causing an early menopause), the parathyroids, and the parietal cells of the *gastric glands (causing pernicious anaemia). [M. B. Schmidt (1863–1949), German physician]... schmidt’s syndrome

Schnitzler’s Syndrome

a rare disorder characterized by chronic *urticaria, fever, bone or joint pain, and enlarged lymph nodes in the neck. There are increased levels of an antibody, IgM (see immunoglobulin), produced by plasma cells. Treatment with *anakinra is very effective. [L. Schnitzler (20th century), French dermatologist]... schnitzler’s syndrome

Seat-belt Syndrome

thoracic injuries that arise from violent contact with a restraining seat belt in motor vehicle accidents occurring at high speeds.... seat-belt syndrome

Seip–beradinelli Syndrome

see lipodystrophy. [M. Seip (20th century), Scandinavian physician; W. Beradinelli (1903–56), Argentinian physician]... seip–beradinelli syndrome

Severe Chronic Upper Airway Disease

(SCUAD) severe *rhinitis and *rhinosinusitis that has not been fully controlled by optimal pharmacological treatment.... severe chronic upper airway disease

Sever’s Disease

*apophysitis caused by pulling at the point of insertion of the Achilles tendon into the calcaneus (heel bone), causing heel pain. [J. W. Sever (20th century), US orthopaedic surgeon]... sever’s disease

Sexually Transmitted Disease

(STD) any disease transmitted by sexual intercourse, formerly known as venereal disease. STDs include *AIDS, *syphilis, *gonorrhoea, some *Chlamydia infections, genital *herpes, and *soft sore. The medical specialty concerned with STDs is genitourinary medicine.... sexually transmitted disease

Sheehan’s Syndrome

a condition in which *amenorrhoea and infertility follow a major haemorrhage in pregnancy. It is caused by necrosis (death) of the anterior lobe of the pituitary gland as a direct result of the haemorrhage reducing the blood supply to the gland. Compare Asherman syndrome. [H. L. Sheehan (20th century), British pathologist]... sheehan’s syndrome

Short Bowel Syndrome

intestinal failure that occurs when the small bowel is shortened by surgery or trauma, resulting in reduced absorption of nutrients. Some bowel adaptation does occur, but if under 200 cm of small bowel remain it is likely patients will need long-term *total parenteral nutrition.... short bowel syndrome

Sickle-cell Disease

(drepanocytosis) a hereditary blood disease that mainly affects people of African ancestry but also occurs in the Mediterranean region and reaches high frequencies in parts of Saudi Arabia and India. It occurs when the sickle-cell gene has been inherited from both parents and is characterized by the production of an abnormal type of *haemoglobin – sickle-cell haemoglobin (Hbs) – which precipitates in the red cells when the blood is deprived of oxygen, forming crystals that distort the cells into the characteristic sickle shape: this process is known as sickling. An excess of sickle cells in the circulation results in blockage of small blood vessels, producing episodes of severe pain (a sickle-cell crisis). Sickle cells are rapidly removed from the circulation, leading to anaemia and jaundice. There is no satisfactory treatment; the highest mortality is in childhood but some patients may live to an age of 60–70 years.

The carrier condition (sickle-cell trait) occurs when the defective gene is inherited from only one parent. It generally causes no symptoms but confers some protection from malaria, which accounts for the high frequency of the gene in malarious areas. If a general anaesthetic is to be given to a patient with this condition, the anaesthetist should be alerted.... sickle-cell disease

Silver–russell Syndrome

see Russell–Silver syndrome.... silver–russell syndrome

Sipple’s Syndrome

see MENS. [J. H. Sipple (1930– ), US physician]... sipple’s syndrome

Sleep Apnoea Syndrome

(SAS) see obstructive sleep apnoea.... sleep apnoea syndrome

Solitary Rectal Ulcer Syndrome

an uncommon anorectal condition that produces symptoms of anal pain, rectal bleeding, straining during defecation, and obstructed defecation (dyssynergic defecation). *Proctoscopy reveals one or more benign rectal lesions, which are thought to be due to abnormal straining during defecation leading to prolapse of the distal anterior rectal wall and internal anal *intussusception.... solitary rectal ulcer syndrome

Sotos Syndrome

(cerebral gigantism) a rare inherited disorder resulting in excessive physical growth during the first 2–3 years of life. It presents in childhood with a characteristic facial appearance, a disproportionately large head, large hands and feet, abnormally widely spaced eyes (ocular *hypertelorism), developmental delay, and tall stature for age. Children with Sotos syndrome tend to be large at birth and taller and heavier, stabilizing after about five years to achieve normal adult height. Most cases occur sporadically, although familial cases have been reported. [J. F. Sotos (1927– ), U.S. paediatrician]... sotos syndrome

Stagnant Loop Syndrome

see blind loop syndrome.... stagnant loop syndrome

Steele–richardson–olszewski Syndrome

see progressive supranuclear palsy. [J. C. Steele and J. C. Richardson (20th century), Canadian neurologists; J. Olszewski (1913–64), Polish-born Canadian neuropathologist]... steele–richardson–olszewski syndrome

Streptococcal Toxic Shock Syndrome

a bacterial disease characterized by fever, shock, and multiple organ failure. It is similar to the *toxic shock syndrome caused by staphylococci, but in these cases the infecting organisms are *Streptococcus Type A bacteria. See also necrotizing fasciitis.... streptococcal toxic shock syndrome

Staphylococcal Scalded Skin Syndrome

(Ritter’s disease) a potentially serious condition of young infants (and occasionally seen in adults) in which the skin becomes reddened and tender and then peels off, giving the appearance of a scald. The area of skin loss may be quite extensive and is usually centred on the armpits and groin. The underlying cause is an infection by certain bacteria of the genus *Staphylococcus. It is contagious and may occur in clusters. Treatment is by antibiotics (usually intravenous), but careful nursing is essential to prevent skin damage. Admission to hospital is mandatory for small children.... staphylococcal scalded skin syndrome

Sturge–weber Syndrome

see angioma. [W. A. Sturge (1850–1919) and F. P. Weber (1863–1962), British physicians]... sturge–weber syndrome

Superior Canal Dehiscence Syndrome

(SCDS) a rare condition characterized by sound- or pressure-induced vertigo (see Tullio phenomenon), hearing loss, *autophony, and a sense of fullness in the affected ear. It is associated with absence of the bone that normally lies over the superior *semicircular canal. Diagnosis involves computerized tomography and *vestibular evoked myogenic potential testing. Treatment involves surgery to repair the bony defect.... superior canal dehiscence syndrome

Syndrome Of Inappropriate Secretion Of Antidiuretic Hormone

(SIADH) a condition of inappropriately high plasma levels of ADH (see vasopressin) with associated water retention, dilutional *hyponatraemia, and the production of highly concentrated urine. Renal, adrenal, thyroid, and hepatic function are normal, as is the volume of circulating blood (euvolaemia). It is caused by a variety of pathological conditions, usually intrathoracic and intracerebral, and also by a number of drugs, including antidepressants, chemotherapy agents, and some of the older antidiabetic agents. The treatment involves fluid restriction, treatment (or removal) of the underlying cause (or drug), and, in severe cases, administration of *demeclocycline to reduce the effects of ADH on the kidney. Very rarely, hypertonic saline is given.... syndrome of inappropriate secretion of antidiuretic hormone

Syndrome X

see metabolic syndrome.... syndrome x

Takayasu’s Disease

(pulseless disease) progressive occlusion of the arteries arising from the arch of the aorta (including those to the arms and neck), resulting in the absence of pulses in the arms and neck. Symptoms include attacks of unconsciousness (syncope), paralysis of facial muscles, and transient blindness, due to an inadequate supply of blood to the head. [M. Takayasu (1860–1938), Japanese ophthalmologist]... takayasu’s disease

Takotsubo Syndrome

sudden extensive damage to the left *ventricle that classically occurs following acute emotional shock. The clinical syndrome mimics acute *myocardial infarction, but no coronary artery is occluded and the extent of ventricular damage exceeds that supplied by any single coronary artery. The appearance of the left ventriculogram resembles a Japanese lobster pot, from which the name derives. The cause is unknown, and in most cases spontaneous recovery occurs.... takotsubo syndrome

Thalamic Syndrome

a condition resulting from damage to the thalamus, often by a stroke, that is characterized by severe intractable pain and hypersensitivity in the area of the body served by the damaged brain region. It is extremely resistant to treatment.... thalamic syndrome

Thin Membrane Disease

an inherited disease of the kidneys in which the glomerular basement membrane, which filters waste material from the blood, is too thin, allowing small amounts of blood to pass across it. This can be a cause of benign familial haematuria and thin membrane disease is a common finding in renal biopsy series where the procedure has been carried out as part of the investigation of *haematuria. Thin membranes are also found in other conditions, e.g. in some cases of *Alport’s syndrome and *Berger’s nephropathy.... thin membrane disease

Tonic Tensor Tympani Syndrome

involuntary persistent contraction of the tensor tympani muscle in the middle ear, attached to the malleus bone, giving rise to tinnitus, distorted hearing, a sensation of blockage of the ear, or pain.... tonic tensor tympani syndrome

Treacher Collins Syndrome

(Treacher Collins deformity) a hereditary disorder of facial development. It is characterized by underdevelopment of the jaw and zygomatic (cheek) bones and the precursors of the ear fail to develop, which results in a variety of ear and facial malformations. The ear abnormality may cause deafness. [E. Treacher Collins (1862–1919), British ophthalmologist]... treacher collins syndrome

Tsutsugamushi Disease

see scrub typhus.... tsutsugamushi disease

Ugh Syndrome

*uveitis associated with *glaucoma and *hyphaema. This is an uncommon inflammatory condition occurring as a complication of intraocular lens *implants.... ugh syndrome

Vaquez–osler Disease

see polycythaemia vera. [L. H. Vaquez (1860–1936), French physician; Sir W. Osler (1849–1919), Canadian physician]... vaquez–osler disease

Variant Creutzfeldt–jakob Disease

(vCJD) see Creutzfeldt–Jakob disease.... variant creutzfeldt–jakob disease

Twin-to-twin Transfusion Syndrome

(TTTS) a condition in which communicating vessels in the shared placenta of monochorionic twins (see chorionicity) divert blood to one fetus (the recipient) from the other (the donor), resulting in one fetus with increased blood volume and one anaemic fetus. It complicates 15% of monochorionic twin pregnancies, and a system of ultrasound staging has been developed to assess the severity of the syndrome. TTTS is associated with a high perinatal mortality rate. There is significant morbidity and poor neurodevelopmental outcome in surviving infants due to complications of the disease itself and the high preterm birth rate that invariably accompanies this condition. A range of treatments, including *amnioreduction, *septostomy, and laser ablation of the communicating vessels, have led to an improvement in overall perinatal survival rates.... twin-to-twin transfusion syndrome

Venereal Disease

(VD) see sexually transmitted disease.... venereal disease

Verner–morrison Syndrome

see VIPoma. [J. V. Verner (1927– ), US physician; A. B. Morrison (1922– ), Irish pathologist]... verner–morrison syndrome

Von Hippel–lindau Disease

an inherited syndrome in which *haemangioblastomas, particularly in the cerebellum, are associated with renal and pancreatic cysts, *angiomas in the retina (causing blindness), cancer of the kidney cells, and red birthmarks. [E. von Hippel (1867–1939), German ophthalmologist; A. Lindau (1892–1958), Swedish pathologist]... von hippel–lindau disease

waardenburg’s Syndrome

an inherited form of deafness accompanied by a characteristic white forelock of hair and multiple colours within the irises of the eyes. It is inherited as an autosomal *dominant disease, i.e. the children of an affected parent have a 50% chance of inheriting the disorder, although severity is variable. The gene responsible has been identified. [P. J. Waardenburg (1886–1979), Dutch ophthalmologist]... waardenburg’s syndrome

Wagr Syndrome

Wilms’ tumour (see nephroblastoma), aniridia, genitourinary abnormalities, and mental retardation: a condition due to a deletion of part of the short arm of chromosome 11.... wagr syndrome

Waterhouse–friderichsen Syndrome

acute haemorrhage in the adrenal glands with haemorrhage into the skin associated with the sudden onset of acute bacteraemic *shock. It is usually caused by meningococcal septicaemia (see meningitis). [R. Waterhouse (1873–1958), British physician; C. Friderichsen (20th century), Danish physician]... waterhouse–friderichsen syndrome

Werdnig–hoffmann Disease

a hereditary disorder – a severe form of *spinal muscular atrophy – in which the cells of the spinal cord begin to die between birth and the age of six months, causing a symmetrical muscle weakness. Affected infants become floppy and progressively weaker; respiratory and facial muscles become affected. Children usually die by the age of 20 months from respiratory failure and there is no treatment. *Genetic counselling is required for parents of an affected child as each of their subsequent children has a one in four chance of being affected. [G. Werdnig (1844–1919), Austrian neurologist; J. Hoffmann (1857–1919), German neurologist]... werdnig–hoffmann disease

Wermer’s Syndrome

see MENS. [P. Wermer, US physician]... wermer’s syndrome

Werner’s Syndrome

a rare genetic disorder resulting in premature ageing that starts at adolescence. Growth may be retarded and affected individuals may suffer from a thin skin, arterial disease, leg ulcers, and diabetes. Treatment is limited to the management of complications, such as diabetes. The gene responsible codes for an enzyme involved in the mechanisms of DNA replication and repair, which in affected individuals is defective. [C. W. O. Werner (1879–1936), German physician]... werner’s syndrome

Williams Syndrome

a hereditary condition, caused by a defect (a *deletion) in chromosome 7, marked by a characteristic ‘elfin’ facial appearance (including large eyes, a wide mouth, and small chin), *hypercalcaemia, short stature, learning disabilities, and *aortic stenosis. Most affected children are highly sociable and have unusual conversational ability, using a rich and complex vocabulary. The condition can be diagnosed prenatally. [J. C. P. Williams (20th century), British physician]... williams syndrome

Wiskott–aldrich Syndrome

a rare *sex-linked recessive disorder characterized by eczema, *thrombocytopenia, and deficiency in the immune response (*immunodeficiency). It is caused by a decrease in the amount of Wiskott–Aldrich syndrome protein (WASP: a protein occurring in lymphocytes, platelets, and other cells) due to a mutation in the WASP gene.... wiskott–aldrich syndrome

Wolfram Syndrome

(DIDMOAD syndrome) a rare syndrome consisting of a combination of *diabetes insipidus, *diabetes mellitus, *optic atrophy, and *deafness.... wolfram syndrome

Woolsorter’s Disease

see anthrax.... woolsorter’s disease

X-linked Disease

see sex-linked.... x-linked disease

X-linked Lymphoproliferative Syndrome

(XLP syndrome, Duncan’s disease) a hereditary disorder of the immune system caused by a defective *sex-linked gene carried on an *X chromosome. There is uncontrolled proliferation of B-*lymphocytes in response to infection by the Epstein-Barr virus, which can lead to fulminating hepatitis or lymphoma. This condition is due to a defect in a gene, SAP, which encodes a signalling molecule found in the cytoplasm of cells.... x-linked lymphoproliferative syndrome

Wolff–parkinson–white Syndrome

a congenital abnormality of heart conduction caused by the presence of an *accessory pathway of conduction between the atria and ventricles. It results in premature excitation of one ventricle and is characterized by an abnormal wave (delta wave) at the start of the QRS complex on the electrocardiogram. The accessory pathway predisposes the patient to episodes of fast heart rate due to the rapid self-sustaining circulation of an electrical impulse from the atria to the ventricles and back again (*atrioventricular reciprocating tachycardia). Emergency treatment is in the form of drugs that temporarily block the re-entry circuit. Permanent destruction of the accessory pathway by *radiofrequency ablation is usually curative. [L. Wolff; Sir J. Parkinson (1885–1976), British physician; P. D. White (1886–1973), US cardiologist]... wolff–parkinson–white syndrome

Xlp Syndrome

see X-linked lymphoproliferative syndrome.... xlp syndrome

Zieve’s Syndrome

a combination of severe *hyperlipidaemia, haemolytic *anaemia, and *jaundice seen in susceptible individuals drinking alcohol to excess. [L. Zieve (1915–2000), US physician]... zieve’s syndrome

Zymotic Disease

an old name for a contagious disease, which was formerly thought to develop within the body following infection in a process similar to the fermentation and growth of yeast.... zymotic disease

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