(siderophilin) n. a *glycoprotein, found in the blood plasma, that is capable of binding iron and thus acts as a carrier for iron in the bloodstream.
Sarcoma (see CANCER) of bone, muscle or connective tissues in a limb is another reason for amputation.
The aim is to restore the patient to full mobility with a prosthetic (arti?cial) limb, which requires both a well-?tting PROSTHESIS and a well-healed surgical wound. If this is not possible, the aim is to leave the patient with a limb stump that is still useful for balancing, sitting and transferring. Common types of lower-limb amputation are shown in the illustration. The Symes amputation can be walked upon without requiring a prosthesis. The below-knee amputation preserves normal ?exion of the knee, and virtually normal walking can be achieved with a well-?tting arti?cial limb. Learning to walk is more di?cult following an above-knee amputation, but some highly motivated patients can manage well. After any amputation it is not unusual for the patient to experience the sensation that the limb is still present: this is called a ‘PHANTOM LIMB’ and the sensation may persist for a long time.... amputation
Breast feeding Unless there is a genuine contraindication, every baby should be breast fed. The nutritional components of human milk are in the ideal proportions to promote the healthy growth of the human newborn. The mother’s milk, especially colostrum (the ?uid secreted before full lactation is established) contains immune cells and antibodies that increase the baby’s resistance to infection. From the mother’s point of view, breast feeding helps the womb to return to its normal size and helps her to lose excess body fat gained during pregnancy. Most importantly, breast feeding promotes intimate contact between mother and baby. A ?nal point to be borne in mind, however, is that drugs taken by a mother can be excreted in her milk. These include antibiotics, sedatives, tranquillisers, alcohol, nicotine and high-dose steroids or vitamins. Fortunately this is rarely a cause of trouble. (See also main entry on BREAST FEEDING.)
Arti?cial feeding Unmodi?ed cows’ milk is not a satisfactory food for the human newborn and may cause dangerous metabolic imbalance. If breast feeding is not feasible, one of the many commerciallly available formula milks should be used. Most of these are made from cows’ milk which has been modi?ed to re?ect the composition of human milk as closely as possible. For the rare infant who develops cows’-milk-protein intolerance, a milk based on soya-bean protein is indicated.
Feeding and weight gain The main guide as to whether an infant is being adequately fed is the weight. During the ?rst days of life a healthy infant loses weight, but should by the end of the second week return to birth weight. From then on, weight gain should be approximately 6oz. (170g) each week.
The timing of feeds reffects social convention rather than natural feeding patterns. Among the most primitive hunter-gatherer tribes of South America, babies are carried next to the breast and allowed to suckle at will. Fortunately for developed society, however, babies can be conditioned to intermittent feedings.
As the timing of breast feeding is ?exible – little or no preparation time being required – mothers can choose to feed their babies on demand. Far from spoiling the baby, demand feeding is likely to lead to a contented infant, the only necessary caution being that a crying baby is not always a hungry baby.
In general, a newborn will require feeding every two to four hours and, if well, is unlikely to sleep for more than six hours. After the ?rst months, a few lucky parents will ?nd their infant sleeping through the night.
Weaning Weaning on to solid foods is again a matter of individuality. Most babies will become dissatis?ed with a milk-only diet at around six months and develop enthusiasm for cereal-based weaning foods. Also at about this time they enjoy holding objects and transferring them to their mouths – the mouth being an important sense organ in infants. It is logical to include food items that they can hold, as this clearly brings the baby pleasure at this time. Introduction of solids before the age of four months is unusual and best avoided. The usual reason given for early weaning is that the baby appears hungry, but this is unlikely to be the case; crying due to COLIC, for example, is more probable. Some mothers take the baby’s desire to suck – say, on their ?nger – as a sign of hunger when this is, in fact, re?ex activity.
Delaying the start of weaning beyond nine months is nutritionally undesirable. As weaning progresses, the infant’s diet requires less milk. Once established on a varied solid diet, breast and formula milks can be safely replaced with cows’ milk. There is, however, no nutritional contraindication to continued breast feeding until the mother wishes to stop.
It is during weaning that infants realise they can arouse extreme maternal anxiety by refusing to eat. This can lead to force-feeding and battles of will which may culminate in a breakdown of the mother-child relationship. To avoid this, parents must resist the temptation to coax the child to eat. If the child refuses solid food, the meal should be taken away with a minimum of fuss. Children’s appetites re?ect their individual genetic structure and a well child will eat enough to grow and maintain satisfactory weight gain. If a child is not eating properly, weight gain will be inadequate over a prolonged period and an underlying illness is the most likely cause. Indeed, failure to thrive is the paediatrician’s best clue to chronic illness.
Advice on feeding Many sources of con?icting advice are available to new parents. It is impossible to satisfy everyone, and ultimately it is the well-being of the mother and infant and the closeness of their relationship that matter. In general, mothers should be wary of rigid advice. An experienced midwife, health visitor or well-baby-clinic nursing sister are among the most reliable sources of information.
Protein Fat per Sugar Calories per cent cent per cent per cent
Human milk 1·1 4·2 7·0 70 Cows’ milk 3·5 3·9 4·6 66
Composition of human and cows’ milk... infant feeding
Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.
Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.
WILSON’S DISEASE.
Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).
Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.
Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.
Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.
Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.
•Hepatitis A virus (HAV) is an ENTEROVIRUS
which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.
Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.
Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.
Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.
Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic
viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.
As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.
Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around
0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).
Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:
Parenteral drug abusers.
Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.
Men who have sex with men.
Patients undergoing regular haemodialysis.
Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis
The Hoxsey Cancer Clinic was founded in Dallas, which became a mecca for the herbal treatment of that disease. However, he received such persecution from the American Medical Association that he was persuaded to sign a contract transferring to them his herbal formulae, medicines and ointments, and to abandon his practice. This he did in good faith but the opposition continued. Worn out by long prison sentences for practising medicine without a licence, he died a broken man.
Though it is still illegal to offer the Hoxsey treatment in the United States, his main formula is still used by individuals left to their own resources.
Formula. Liquid Medicine: Red Clover, Burdock root, Queen’s Delight root, Barberry root, Liquorice, Poke root, Cascara sagrada, Potassium iodide, Prickly Ash bark, Buckthorn powder.
Pills: Red Clover, Queen’s Delight root, Poke root, Buckthorn, Pepsin.
A popular version revised by Paul Bergner, American Medical Herbalist reads: Liquorice 4 parts; Red
Clover 4 parts; Burdock 2 parts; Queen’s Delight 2 parts; Mountain Grape 2 parts; Poke root 2 parts; Prickly Ash bark 1 part; Frangula bark 1 part. (P. Bergner, ‘Botanic Medicine: Alterative Medicine’. Townsend Letter for Doctors, Nov. 1988, No 64, p487-8) ... hoxsey
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