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Ovaries

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The pelvis contains two ovaries in the female, each measuring about 3 cm in length by 1 – 1.5 cm in width. Until the onset of puberty, they remain inactive, but then come to life, being stimulated by hormones called gonadotrophins produced by the pituitary gland. These start to act on the ovaries about two years before the menarche, the time when puberty occurs.
The gonadotrophins consist of two separate hormones. one called the follicle- stimulating hormone (FSH), and the other the luteinising hormone (LH). Both are necessary for the natural progression of ovulation that occurs each month. and pregnancy.
The ovaries contain a large number of Graafian follicles. Each menstrual month, under stimulation from FSH, one of these matures, comes to the surface of the ovary and ruptures in the process known as ovulation. The cavity left fills with fluid, and under the influence of both FSH and LH develops into a white organ called the corpus luteum, which itself starts to excrete a hormone called progesterone. The aim of this hormone is to prepare the uterus for a possible pregnancy. If pregnancy does not occur, the corpus luteum tends to atrophy after 10 days, but it persists for about seven months if pregnancy ensues.
FSH and LH are both produced by the anterior lobe of the pituitary, an endocrine gland located at the base of the brain. Both of these hormones may be measured by the modern methods of radioimmunoassay. They are in peak concentrations at the time of ovulation.
In the past gonadotrophins have been used in women with infertility problems. Their use has sometimes resulted in multiple foetuses in the resulting pregnancies. The use of these hormones for infertility has been largely replaced by bromocriptine that lowers plasma prolactin. a hormone known to prevent ovulation. With prolactin levels reduced, ovulation can return to normal and pregnancy ensue, if this was the basic cause of the infertility problem. LH is very similar to chorionic gonadotrophin, a hormone produced during pregnancy by the placenta (later the afterbirth).
This product can readily be measured in the urine of the pregnant woman. Indeed, most of the simple home  “do-it-yourself” immunochemical pregnancy tests depend on detecting this substance in the woman’s urine. It may be detected about six weeks after the last menstrual period in the event of pregnancy having become established. The ovary secretes important hormones itself.
Oestrogens arc produced by the ovary and corpus luteum in direct response to FSH and LH. Oestrone and oestradiol are the primary hormones, and they readily convert into oestrogen. Oestriol is a breakdown product of oestrogen, and has its main effect on the vagina and cervix, whereas oestrogen mainly acts on the uterus.
During pregnancy, oestriol is secreted, and its detection in the urine is a handy guide as to the efficiency of the placenta in carrying out its work. These hormones have confusing names,but although they are only of academic interest to the reader, they are very important in gynaecology and obstetrics, for they give excellent guidance to the obstetrician as to the progress of the pregnancy. Progesterone is secreted by the corpus luteum under stimulation from LH.
Progesterone has a depressive effect on the higher centres, and has often been incriminated for the common sensations of irritability and depression that trouble many women in the week or so prior to normal menstruation. It may also increase the risk of attacks in epileptics, and even bouts of kleptomania or suicide in susceptible women.
Fortunately, medication is now able to overcome most of these problems. It is also responsible for the outcropping of acne and facial pimples that is notorious at this time, and complained about most volubly by teenage girls. Although the contraceptive pill will often reduce the mental changes, it will tend at the same time to make the skin problems worse, particularly if the pill has a fairly high level of progesterone.
Tests for ovarian function are possible. The vaginal smear takes cells from the upper walls of the vagina, and shows a typical pattern if hormonal secretions are normal or otherwise. The urine may be checked for the metabolites (breakdown products) of oestrogen. The cervical mucus can be examined, and cells will show a typical pattern if hormonal secretions are normal. Similar tests are available for a check on progesterone secretion, the pregnanediol test, and others.
Often taking scrapings from the walls of the uterus (as during a D and C examination) can also yield valuable information on the hormonal levels of the ovaries.

Asthma Treatment

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A child of any age with asthma needs a team of attentive parents and health-care providers on his side. Good rapport among all concerned is essential. The specific approaches used for your child will depend upon the frequency and severity of the asthma episodes and the triggers that set it off. Treatment may be needed sporadically or year-round. The most important intervention for asthma may be daily medication that prevents wheezing, not the sporadic treatment of flare-ups.

Several types of medications are prescribed to treat asthma, but patients (or the parents of young children) most clearly understand their specific functions and when and how they should be used.

A fuzzily of medications called bronchodilators-for example, albuterol (Proventil or Ventolin) or team-taline (Brethaire) – immediately relieve wheezing and usually maintain improved airflow for four to six hours. These are usually taken through metered dose inhalers (MDIs), which dispense measured bursts of medication. For very young children as well as older children with more severe asthma, a home nebulizer device may be more appropriate. This converts liquid medication into an aerosol form that is easily inhaled using a facemask or mouthpiece. Because bronchodilators are distantly related to adrenaline, they may cause tremors or rapid heart rate, especially if taken more often than prescribed. (These symptoms are more likely if the pill or syrup forms are used rather than an inhaler.) In children twelve years or older, the inhaled bronchodilator salmeterol (Serevent) may be used for maintenance to prevent attacks, since it is active for up to twelve hours.

However, salmeterol cannot be used to treat an asthma attack.

Because they help asthmatic children feel much better right away, they are frequently use. Repeated doses of this type of medication may cause enough temporary relief. While it is okay, it actually is deteriorating your child if using it for four or five times a day regularly. Asthma is very likely to get out of hand and you should see his doctor about additional treatment. Do not buy and use over-the-counter as a substitute for proper medical care supervision.

Steroids in various forms more directly quiet in the inflammation that underlies the reactive arms response. Your child’s doctor might prescribe a course of oral steroids to bring an intense episode when under rapid control. Long-term oral 5 treatment can pose a major dilemma because of its fixation of lifesaving benefits and major side effects – the same treatment given by inhaler does not risk the side effects. Using a steroid inhaler daily for weeks to months to prevent wheezing will generally be safe, intermittent doses of bronchodilators to stop acute air attacks.

Cromolyn (Intal and other brands) is another for long-term prevention, especially for a child exercise-induced wheezing or a strong allergic comet to his asthma. This medication is given by inhaler. While it is not as potent as a steroid, cromolyn can help minimize wheezing in a child.

Inhalers are usually more effective in children when spacers such as AeroChamber or InspireEase are used with them. A spacer is purchased separately or provided by the physician, and the inhaler canister inserted prior to each use. (One steroid product, Annacomes, comes with a built-in spacer.) These devices eliminate the need for precise coordination of the child’s inhalation and the actuation (firing the puff) of the inhaler. Spacers also prevent larger droplets of medication from being deposited in the mouth and throat. If your child is going to use a chodilator and a steroid and/or cromolyn inhaler at any same time, the bronchodilator should be given firs t because it will open up the airways and allow better distribution of the other medication. Holding the breath for a few seconds after inhaling a puff will help more of it arrive at its destination. Theophylline has been used to treat asthma for and may still be helpful for some children.

Glandular Fever

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What is Glandular Fever?

This is a disorder that commonly attacks adolescents, particularly girls in the 15-25 year age group. It is caused by a virus called the Epstein-Barr virus (EB virus for short), and can produce debilitating symptoms that may persist for weeks or even months. A sore throat and swollen glands under the jaw, and later in almost any part of the body (armpits, groin etc) may occur. These become tender.

There is often a fever, poor appetite, aches and pains all over, frequently depression and disinclination for one’s normal activities and interests. Diagnosis is confirmed when the Paul Bunnell blood test or a serum antibody test yields a positive result, although this does not always occur. The disorder is not highly contagious. It is chiefly of nuisance value, for when the acute symptoms subside, so many feel generally off-color, depressed and unable to get back to normal duties with their usual bright, happy disposition and enthusiasm.

However, the outcome is invariably satisfactory. Unfortunately, treatment is mainly symptomatic, for there is no effective antibiotic against this virus. As glandular fever is essentially a disorder of the body’s lymph gland system, it is considered in detail in that part.

We seem to be hearing more about this strange disease. What is it all about? Glandular fever, or, to use its technical name, infectious mononucleosis, has skyrocketed to prominence over the past few years for various reasons. First, it is more common in adolescents, and is laughingly referred to by many as the kissing disease, or the disease of lovers, and so on.

After many years, it has been found the disease is caused by a special germ called the Epstein-Barr virus. This is often contacted during early childhood, way back in the first two to three years of life. At the time, no symptoms occur, but years later, they can suddenly erupt. During infancy the complaint is rare. The late teens are when it is more likely to cause trouble.

Glandular Fever Symptoms

A gradual onset of fever up to 38.9°C (102°F) is accompanied by a sore throat, swollen glands under the jaw, and elsewhere in the body, feeling distinctly unwell and possibly an enlargement of the liver and spleen, the two large organs located under the lower rib cage.

With obvious symptoms that steadily worsen and fail to respond to simple, do-it-yourself measures already outlined, she should call the doctor.

Glandular Fever Treatment

If there are plenty of similar cases around, diagnosis are often easy for the professional. But certain tests may be carried out that will quickly give the right diagnosis. These are based on testing samples of blood. Certain cells are present in the blood, and also a specific test will tell if the disease is glandular fever.

What kind of treatment is prescribed? As with so many of the viral infections, there is no special antibiotic that will destroy the germ. We hope to have one some day. Usually the patient is put to bed until the fever has subsided and he feels better. Fluids, vitamins, antipyretics (drugs such as paracetamol that will reduce fever and pain) all give some assistance.

The doctor will tailor-make a special routine for each patient. Sometimes severely infected patients may need hospital care, but this is unusual.

Recovery may take anywhere from two four weeks, and in severe cases, several months. Depression and psychological problems occur, often worse in teenagers studying for exams and miss school for prolonged periods of time. But fortunately, recurrences are rare; the on-term outlook is good, and seldom does a patient die from the complaint.

Subdural Hematoma

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This is caused usually by injury to the front or back of the head. It produces a tear of the lining of the brain or of the vessels as they enter the brain substance. Blood accumulates between the brain and the bony cranium. It occurs mainly in older people in the fifty and over age group, but may also occur in younger persons. The blood clots, and later the internal parts liquefy and may absorb additional fluid from the brain fluids. The mechanical pressure of this mass on the brain will ultimately produce symptoms.

Subdural Hematoma Symptoms

There is nearly always a history of injury, but it is emphasized that this is often trivial. Considerable time may elapse, with varying symptoms often difficult to interpret, before the suspicion of a hematoma occurs. It may take days to weeks or months before symptoms occur. The time lapse is shorter in younger people and the symptoms are often more dramatic. Usually there is a definite history of accident often in sports or falls.

Headaches are the most common initial symptom, often severe, on wakening in the morning or after exertion. Other symptoms develop, such as lapsing into stupor or coma, to awaken with almost normal feelings. Mental confusion may occur. Gradually the symptoms increase in intensity.

New diagnostic techniques may quickly identify the trouble. Brain scans, ultra sonograms and the CT scan or MRI can quickly and accurately give a diagnosis and localize the lesion. Unless diagnosis is made and treatment undertaken, the outcome is often fatal. Newer techniques, if available, may assist in the diagnosis. Treatment (and perhaps diagnosis) involves repeated tapping of the cranium with trephine holes through which the blood clot may be sucked out. Sometimes a flap of bone is lifted from the cranium and the clot removed in this manner. Recognition and treatment of a subdural hematoma is usually dramatic and curative.

A variety of other conditions may occur in this category, but in principle they are covered, and for practical purposes the chief ones have been described. Hypertensive cephalopathy may take place. This happens when the blood pressure in a patient already suffering from high blood pressure rises still further. A stroke does not result, but headache, sickness, drowsiness and maybe coma could follow. A crisis lasting from hours to days may occur, and then the patient may recover again. This is an emergency measure that must be treated in hospital.


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