a flexible *nasogastric tube that enables aspiration of gastric secretions and evacuation of intestinal gas. [J. A. Ryle (1889–1950), British physician]
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The weight loss and wasting associated with tuberculosis before treatment was available led to the disease’s popular name of consumption. Enlargement of the glands in the neck, formerly called scrofula, was known also as the ‘king’s evil’ from the supersition that a touch of the royal hand could cure the condition. Lupus vulgaris (see under LUPUS) is another of the skin manifestations of the disease.
The typical pathological change in tuberculosis involves the formation of clusters of cells called granulomas (see GRANULOMA) with death of the cells in the centre producing CASEATION.
It is estimated that there are 7–8 million new cases of tuberculosis worldwide each year, with 2–3 million deaths. The incidence of tuberculosis in developed countries has shown a steady decline throughout the 20th century, mainly as a result of improved nutrition and social conditions and accelerated by the development of antituberculous chemotherapy in the 1940s. Since the mid-1980s the decline has stopped, and incidence has even started to rise again in inner-city areas. In 2002, 7,239 cases of tuberculosis were noti?ed in the UK compared with 6,442 a decade earlier; more than 390 deaths in 2003 were attributed to the disease. Factors involved in this rise are immigration from higher-prevalence areas, poorer social conditions and homelessness in some urban centres and the association with HIV infection and drug abuse. The incidence of tuberculosis is also rising in many developing countries because of the emergence of resistant strains of the tubercle bacillus (see below). In the UK recently there have been serious outbreaks in a handful of urban-based schools.... tuberculosis
Characteristic white streaks appear on the optic fundi (see EYE). Molecular genetic testing can identify up to 90 per cent of individuals with a tuberin gene. Genetic counselling of families is helpful. Relatives of those with this condition can obtain help and guidance from the Tuberous Sclerosis Association of Great Britain.... tuberous sclerosis
When a viral infection such as a cold causes blockage of the eustachian tube, equalization cannot occur, resulting in severe pain and temporary impairment of hearing. A person with a blocked eustachian tube who is subjected to rapid pressure changes may suffer from barotrauma. Glue ear or chronic otitis media may occur if the tube is blocked, preventing adequate drainage from the middle ear. These conditions, which often result in partial hearing loss are more common in children. This is partly because their adenoids are larger and more likely to cause a blockage if they become infected and partly because children’s eustachhian tubes are shorter than those of adults.... eustachian tube
The tube opens into the uterus at one end, and the other end, which is divided into fimbriae (finger-like projections), lies close to the ovary. The tube has muscular walls lined by cells with cilia (hair-like projections). The fimbriae take up the egg after it is expelled from the ovary. The beating cilia and muscular contractions propel the egg towards the uterus. After intercourse, sperm swim up the fallopian tube from the uterus. The lining of the tube and its secretions sustain the egg and sperm, encouraging fertilization, and nourish the egg until it reaches the uterus.
Salpingitis is inflammation of the fallopian tube, usually the result of a sexually transmitted bacterial infection, that can lead to infertility.
An ectopic pregnancy (development of an embryo outside the uterus) most commonly occurs in the fallopian tube.... fallopian tube
Habitat: Central and Peninsular India up to 1,350 m.
Ayurvedic: Musali, Mushali.Unani: Musali.Siddha: Vallaimusali.Action: Dried tubers are used as tonic.
The commercial drug, Safed Musali, contains the tubers of C. arundinaceum Baker, C. tuberosum Baker and C. in- dicum (Willd.) Dress, synonym C. at- tenuatum Baker.C. indicum is found on the hills in Kerala, Karnataka, Tamil Nadu and on the hills near Udaipur in Rajasthan.Dosage: Dried tuber—3-5 g powder. (CCRAS.)... chlorophytum tuberosumHabitat: Throughout India, also planted as an ornamental.
Ayurvedic: Krishnamokshaka.Siddha/Tamil: Selluppaimaram.Folk: Kaalaa-mokhaa, Ratangaruur. Jamrasi (gum).Action: Astringent, anti- inflammatory, emetic.
The bark and the leaves contain 813.5 and 8-15% tannin respectively.Powdered leaves have a sternutatory action and are used as snuff to relieve headache and as a fumigatory in hysteria (in folk medicine it is believed that the smoke wards off ghosts.)Fresh root bark is rubbed into a paste with water and applied to swellings. A cold water extract of the crushed roots is used as an emetic (fatal in overdoses).Family: Elaeocarpaceae.Habitat: Western Ghats from Kanara southwards. Ayurvedic: Rudraaksha (var.).... elaeocarpus tuberculatus
Habitat: Maharashtra and Tamil Nadu, in bushes along the banks of water courses. (It is not cultivated.)
Ayurvedic: Kaarali-Kanda, Kudu- hunchi.Siddha/Tamil: AthalaikaiFolk: Kakrol (Maharashtra).Action: Tuberous root—emmena- gogue, abortifacient; acrid; contains a bitter glycoside.... momordica tuberosa
Habitat: Native to central America; grown in Indian gardens.
English: Meadow-weed.Siddha/Tamil: Tapas-kaaya.Action: Herb—emetic; used as a substitute for ipecacuanha. A decoction is given in chronic bronchitis; also used as a diuretic for the treatment of stones in the bladder.... ruellia tuberosa
Habitat: Marshy areas and on the banks of streams up to an altitude of 3,000 m.
English: Sea Clubrush.Ayurvedic: Raaj Kasheruka.Action: Tuberous root—astringent, diuretic, laxative.
Oil from rhizomes on hydrolysis gave phellonic acid.... scirpus tuberosusThe 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
Habitat: Native to Mexico; cultivated for ornamental use.
English: Tuberose.Ayurvedic: Rajanigandhaa.Siddha/Tamil: Nilasampangi.Folk: Gulcheri, Gulshabbu.Action: Flowers and bulbs— diuretic. Externally used for skin eruptions. The bulbs are rubbed with turmeric and butter and applied over red pimples of infants. The bulbs are reported to contain an alkaloid, lycorin, which causes vomiting.
Dried and powdered bulbs are used for gonorrhoea.... polianthes tuberosaHabitat: Peninsular India, near sea-coasts.
Ayurvedic: Bichhuu-buuti.Folk: Jangali Gaajar (Gujarat), Sanjivani (Bihar).Action: Leaves—an infusion is given internally in dysuria; externally applied to erysipelas. The herb shows diuretic, calculolythic, analgesic and antipyretic properties.
The aerial parts contain diterpe- noids, pilosanone A and B. leucorrhoea, dysmenorrhoea, arthritis, cramps, kidney stones, bleeding piles; as a mouth wash in pyrrhoea, gingivitis and sore throat.Key application: In mild dismenor- rhoeal disorders; as a support for treatment of milder, nonspecific, acute diarrhoea and in light inflammation of the oral and pharyngeal mucosa. (German Commission E.)The plant gave anthocyanins—cy- anidin and delphinidin. Aerial parts gave tannins (2-10%). The plant also gave choline, betaine, histidine, an essential oil and vitamin E.The maximum amounts of tannins occur in the root stock (up to 17.5% on dry basis). The ethanolic and aqueous extract of the herb (1 : 5) contain 0.3 to 0.8% of tannin. The tannin fraction exhibited anti-mutagenic effect.Potentilla fruticosa HK. (temperate Himalaya) is also used like Silverweed.The flowers and young shoots contain flavonoids, quercetin, terniflorin, tribuloside and (-)-catechin. The plant also contains stigmasterol, beta-sitos- terol and campesterol; (-)-epicatechol gallate, (±)-catechol, (-)-epicatechol, (-)-epigallocatechol and (-)-epigallo- catechol gallate have been isolated from aerial parts.... portulaca tuberosaHabitat: Punjab, Western Uttar Pradesh, Central India.
English: Indian Kudze.Ayurvedic: Vidaari, Swaadukandaa, Ikshugandhaa, Gajavaajipriyaa, Kandapalaasha, Bhuumikushmaan- da. (Substitute for Jivaka and Rshabhaka.)Folk: Bhui-kumhadaa, Suraal.Action: Tuber—diuretic, cardiac tonic, galactagogue. Also used for fertility control. Root—used as a demulcent, and refrigerant in fevers, as cataplasm for swelling of joints, as galactagogue.
The butanolic extract of Pueraria tuberosa showed significant protection against hepatic damage in rats. The ethanolic extract of the tubers and its butanol and pre-puerarin fractions exhibited anti-implantation effect. The pure compounds, puerarin, daidzein and tuberosin, exhibited significant anti-implantation activity in hamsters.In Indian medicine, Vidaari and Kshira-vidaari are used for promoting breast milk and semen, and as a restorative tonic. Most authors have equated Vidaari with Pueraria tuberosa and Kshira-vidaari with Ipomoea digi- tata.In Western herbal, Pueraria lobata and P. tuberosa roots are used alone or in combination with other products for symptoms due to alcoholism. But preliminary research shows that Kudze does not improve sobriety in chronic alcoholics. (Natural Medicines Comprehensive Database, 2007.)Dosage: Tuber—3-5 g powder. (CCRAS.)... pueraria tuberosaHabitat: Native to South America; grown almost throughout India.
English: Patoto.Ayurvedic: Aaluka, Aaruka, Golaalu. (Aaluka, yam of Indian medicine, is equated with species of Dioscorea.)Folk: Aaluu.Action: Potatoes are consumed as food. Extract of leaves is used as antispasmodic in cough. Potato juice is given as an adjuvant in the treatment of peptic ulcer for bringing relief from pain and acidity. Starch and very small quantities of atropine alkaloids reduce digestive secretions and stomach acids. Potatoes are good for patients suffering from hyperacidity; boiled potatoes make an excellent diet for those having hypertension.... solanum tuberosum
A T-shaped rubber tube is inserted into the bile duct during the surgery.
A week or so later, contrast medium is inserted into the tube and X-rays are taken.... t-tube cholangiography
Elecampane (Inula) has a direct effect on TB bacilli, controlling night sweats and localising the disease. Agents yielding salicylates (mild analgesics) Meadowsweet, White Willow, etc are of value. Echinacea increases phagocytic power of the leucocytes and may normalise percentage count of neutraphiles. To meet individual needs, it will be necessary to vary treatment many times during the course of the disease.
Alternatives. Echinacea, Elecampane, Balm of Gilead buds (Hyde), Gotu Kola, Comfrey root, Iceland Moss. Rupturewort promotes elasticity of lung tissue.
Decoction. Equal parts: Iceland Moss, Comfrey root, Elecampane root, Liquorice. Mix. 1oz to 1 pint water gently simmered 20 minutes in a covered vessel. Dose: Half a cup thrice daily.
Alternative formulae:– Powders. White Willow 2; Comfrey 1; Echinacea 1; Ginger quarter. Mix. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.
Tinctures. White Willow 2; Echinacea 1; Blue Cohosh half; White Poplar half; Tincture Capsicum quarter. Mix. 1 teaspoon thrice daily before meals.
Tincture Krameria (Rhatany root), Dose: 30-60 drops in water thrice daily.
Fenugreek seed tea.
Comfrey. Potential benefit of Comfrey root outweighs risk.
Topical. Compresses: Mullein leaves, Lobelia, Comfrey root or Fenugreek. Evening Primrose oil. No massage to affected joints.
Diet. Low carbohydrate. Oily fish.
Supplements. Vitamins A, B6, B12, D, Niacin, Calcium, Iron, Phosphorus.
General. Tuberculosis is a notifiable disease for which specific medical treatment is available. Failure to comply may expose a practitioner to a charge of negligence. ... arthritis – tuberculous
There are different forms of spina bifida. In spina bifida occulta, the only defect is a failure of the fusion of the bony arches behind the spinal cord, which may not cause any problems. When the bone defect is more extensive, there may be a meningocele, a protrusion of the meninges, or a myelomeningocele, a malformation of the spinal cord. Myelomeningocele is likely to cause severe handicap, with paralysis of the legs, loss of sensation in the lower body, hydrocephalus, and paralysis of the anus and bladder, causing incontinence. Associated problems include cerebral palsy, epilepsy, and mental handicap.
Surgery is usually performed a few days after birth. In mild cases, the defect can usually be corrected, but in myelomeningocele, some handicap will remain.
Genetic factors play a part in neural tube defects, which show multifactorial inheritance. Couples who have had an affected child or who have a family history of neural tube defects should seek genetic counselling. The risk of a neural tube defect occurring can be substantially reduced if the mother takes folic acid supplements for a month before conception and during the early part of the pregnancy.
Ultrasound scanning and amniocentesis allow accurate antenatal testing for neural tube defects.... neural tube defect
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