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Malfunctions

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As there are so many organs involved, it is likely that malfunctions will take place from time to time. In the main, these happen surprisingly seldom. But as with any bodily organ, with the passage of time, and with wear and tear, with the incessant bombardment of hostile outside influences such as viruses and bacteria, a series of pathological disorders may take place.

Infections can occur. Overgrowth of tissue may occur. Cancers can grow, as certain cells take on abnormal qualities and develop along these bizarre lines causing neoplasms or new growths or carcinomas—all words meaning cancer. This section sets out the chief abnormalities that can occur in the urinary system. Some are very common and affect many people. Others are rare and are seldom seen in everyday life.

More attention has been focused on the common disorders and those that the reader might contract or develop or hear about. It is not meant to be a total encyclopedia of urinary-tract knowledge, but a discussion of practical value that may be of some everyday use.

The key parts, we believe, are the sections dealing with symptoms, for these are the factors of vital importance. These are the telltale features that may occur. If one has some knowledge of them, knows what to look for, knows what the hidden meaning may be, then there will be much more incentive to act. Action in medicine is often imperative to prevent the development of what starts out to be something simple, into something that may be disastrous.

On a regular, ongoing basis, more information and knowledge are being amassed each year.

The kidney structure in itself has an incredible number of classifications and sub-classifications and lists of names that are too much for even some doctors, to say nothing of the confusion that exists with the lay reader.

An effort to be as up to date as possible has been made with all parts of this book. Some of the more recent work is of academic interest mainly, and often makes little difference to the actual handling and treatment of a sick patient. Some areas in this section may be in the melting pot of current research, and may change in certain respects as time passes. But for all practical purposes it should remain “in date” for some time to come.

Retroversion

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Because of the mobility of the pelvic organs, and the fact that they are subjected to pressure from above during such actions as sneezing, coughing, straining, or even breathing, certain mechanical results can take place that are peculiar to this particular area. This is accentuated by the presence of the vaginal canal, which really represents an opening in the pelvic floor.

Some doctors liken this situation to other parts of the body where apertures exist and internal contents can be forced through the lightly covered orifices. This is the basic pathology of hernias, whether they be about the navel region (as in babies), or lower down in the inguinal (groin) region in adults.

The more common uterine displacements will be discussed. After this, a short word will be given over to the urinary tract that forms part of the pelvic cavity, for this is very significant, and is a well-known cause of trouble to many women.

The uterus is normally positioned pointing upwards and forwards. The cervical (neck) portion forms the upper part of the vaginal canal. From here, the body of the womb wells up into the pelvic cavity, tilting toward the front of the body. This is referred to as the normal anteverted position.

It is held in this position by a variety of anatomical bands and ligaments. It tends to remain in this position throughout life.

It is often believed that this position is significant. Under conditions of normal copulation, with the female partner lying on her back, and with the male uppermost. the seminal pool following ejaculation will be placed automatically in such a way that the cervix is bathed in it while the female remains in this position. It is essential that the sperms have ready and prompt access to the cervical canal. The entire mechanics of a uterus located in the way described will ensure maximum possibility for a pregnancy to result, provided the timing of the menstrual cycle is correct.

In some cases of infertility, the uterus is in the opposite position. It tilts backwards, and is described as being retroverted. At this time, if a similar position is used during intercourse, the cervical canal could be some distance away from the vital seminal pool. Fertilisation may thus become difficult or even impossible.

This of course assumes that the male uppermost position is being used. If other positions are utilised at a time when pregnancy is desired, then other mechanical problems may arise.

In recent times, many gynaecologists have studied the problem of retroversion. Once it was claimed to play a significant part not only in infertility, but was blamed for many other gynaecological symptoms. These ranged from backache, and pelvic pain, to abortion.

Many now believe that the uterus is a very mobile organ, and rarely plays much part in producing symptoms. However, fairly simple tests can be carried out to see if the apparent misplacement is really producing the symptoms claimed. It may be necessary to make further investigations.

In years past, innumerable surgical operations were carried out to correct retroversion. Many complex arrangements were entered into. The uterus was dragged from its backward tilt and forced to point forwards. In retrospect, it is not known just how much good these operations accomplished. Undoubtedly they had their part and assisted many women. But, some modern-thinking gynaecologists now claim that the effect was probably more in their minds (both the patients’ as well as the doctors’) than in the pelvis.

Be that as it may, it still holds a place in gynaecological practice. Often when there is not much else to do, it seems to be a potent factor in assisting couples with infertility problems.

Cogenital Abnormality

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Blanket advice is now given to women: No drugs of any description should be taken during the first three months of pregnancy unless on the specific instructions of the doctor. This includes everything, even simple aspirin. Drugs can have a very adverse effect on the developing infant at the time when the vital organs are being formed, which is during the first 12 weeks. Intending mothers must adhere to this advice to avoid problems later on.

However, there are many other things that can produce anomalies during pregnancy. It is well-known that rubella (German measles) can produce outstanding fetal disorders of development. Therefore, any pregnant woman contacting or contracting rubella must seek immediate professional advice.

Tests will show if she is safe or vulnerable. Today, legal termination of pregnancy is often recommended if the baby is obviously at risk.

Other viral infections in early pregnancy are possible producers of fetal problems. The mother-to-be should make every attempt to keep free from infections during the vital early weeks. Smoking in pregnancy is well-known to produce problems in the newborn.

Smoking should be given up entirely during pregnancy and preferably in the months following confinement. Best of all, give it up altogether.

Alcohol is also a severe cause of congenital abnormalities and should not be taken during pregnancy. The fetal alcohol syndrome (FAS) is a potent cause of mental retardation, physical defects and premature death.

If abnormalities still occur and a child is born with some disability, much can now be offered in the expert centers in the major capital cities. The family doctor is a valuable guide in these cases.

Foreign Bodies in the Nose

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Any chronically discharging or unpleasant-smelling nose should be carefully inspected (ideally by the doctor) for a deeply placed foreign body. It’s a fairly common childhood problem. The symptoms may mimic a common cold, but it usually persists.

One investigation not long ago indicated children had stuffed bits of tightly rolled-up cotton into their noses, causing a persisting, vile, pus-filled discharge. Removal of the debris rapidly resulted in a magical cure.

Foreign Bodies in the Nose Treatment

Any persisting nasal discharge requires a proper examination, both from the front, as well as from the far end of the nasal passages. Often this is in the realm of the specialist who has the equipment for such examinations. It also needs special devices to remove. Sometimes hospital and a general anesthetic may be necessary, particularly with deeply placed debris.

Children are the worst offenders, and it is amazing the nature and variety of objects they will poke into the nasal canals. Pieces of gravel, bits of plastic toys, peanuts, peas and beans, bits of Indian-rubber, they have all found their way there.

When practicing in a country town some years ago, a patient complained of a “big white worm” in his nose. This moved with breathing or any facial movement. It proved to be several grains of wheat poked into the nostril several days beforehand. These had subsequently absorbed moisture and germinated. The “worm” was the growing wheat grain, which naturally started to protrude from the nostril and moved along with normal facial movements.

The prompt removal of the foreign body brought great relief to the patient and his parents who believed lie was being internally devoured by some foul monster.

Foreign Bodies in the Nose Symptoms

These usually include nasal obstruction on one side, together with a foul-smelling discharge that often contains pus. There may be a known history of having inserted a foreign body, but children may be afraid to admit this.

In adults, the symptoms are the same but there may also be a history of previous nasal difficulties, such as nosebleed and nasal gauze packing. It is possible for bits of gauze to have remained, and slowly become calcified forming larger bodies (rhinoliths) that suddenly produce obstruction.


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