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Heart Transplant

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More than 25 years have elapsed since the first heart transplantation took place. It was a brave effort, and the first step into what was then brand-new technology. Since then, an enormous amount of work, and more than 250 million in research in America alone, has now brought heart transplants to a sophisticated, successful state-of-the-art operation. The major improvement came with the development of cyclosporine A, a special drug that virtually prevented tissue rejection, until then the chief cause of failure.

Cardiac transplantation has become a regularly performed surgical procedure for patients with end-stage heart disease. These are patients who had exhausted all medical and surgical options. Once viewed as a clinical experiment, transplantation has now emerged as a cost-effective therapy that improves both quality and length of life of the recipient. Studies have confirmed that there is a benefit in costs to the patient’s family network and to the community as a whole, the Medical Journal of Australia reported recently. However, it still remains an evolving high technology procedure.

Cyclosporine A, azathioprine and prednisolone have been used as the major antirejection drugs. But the new OKT3, a monoclonal antibody, is the newest step forward in treatment. By using a combination of drugs it means that smaller doses are needed, reducing the adverse side effects that accompany large doses of any single drug.

The limited supply of donor organs remains the most restricting factor at present. This is the case in Australia, New Zealand and in cardiac units around the world. In the United States, around 30,000 people die annually from end stage heart disease. At the same time 2000 or so hearts become available for transplant, so the deficit is enormous.

As an interim measure, a new technique called the “bridges-to-transplantation” is being used more frequently. Patients are given an artificial heart. (This is based on the Jarvik-7 device used in the mid 1980s, but unsuccessful as a long-term device.) It is aimed at keeping patients alive until a suitable donor organ becomes available, and it appears to be successful in up to 80 per cent of patients.

The procedure is not without its cost. “The cost of cardiac transplantation varies with individual patients. In Australia, the average cost is approximately $75,000. This includes the pretransplantation assessment, the operative procedure and in-hospital care,” the Medical Journal of Australia says. “The contribution of cyclosporine A to these costs is approximately S7500 a year.” Once again, the limited supply of donor hearts acts as cost containment.

In America with its astronomical medical costs, treating a terminally ill cardiac patient costs about SUS2000 a month. -The costs of convalescence for a cardiac transplant recipient are somewhat lower and the ‘investment’ results in survival of 70 – 75 per cent of recipients at five years after the operation.” the Journal says. Medium and long-term results of transplant are gratifying, surgeons say.

Most patients return to normal exercise capabilities, and are fully rehabilitated to active and productive lifestyles. In the Australian programs, about 70 per cent of recipients return to work, study or home duties.

The next stage forward is replacement of lungs and heart. Most have been carried out in Britain and America, some in Australia, and it is now considered to be the latest hurdle to clear to help patients with both heart and lung problems. It is an exciting time. The results are improving. The outlook seems promising.


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What is Chickenpox?

Chickenpox is a highly contagious childhood viral disease, transmitted either by minute infected droplets from somebody’s throat or nose, or by directly touching infected articles or toys. A person can infect others anywhere from one day before the rash appears to six days after it vanishes. It takes between 14 and 21 days (15 on average) for the viruses to incubate and cause symptoms.

Chickenpox is a common childhood viral illness characterized by the eruption of multiple red bumps, each with a small fluid-filled central blister.

New “crops” of pox erupt for three to five days. Gradually the blisters become crusted, form tiny scabs, and disappear, usually without leaving a scar. The rash is most prominent on the chest, abdomen, and face, but might cover the entire body, including the scalp, genital area, and inside the mouth. In some children, only a few scattered bumps will be visible, while other children are covered from head to toe. Adolescents or adults who develop chicken pox sometimes have a more severe case than do their younger counterparts. Fever may or may not be present. Itching is common and at times can be intense.

The incubation period for chicken pox can range from 11 to 21 days, but most often the time from exposure to onset of symptoms is 14 to 16 days. A child with chicken pox it contagious one or two days before the rash erupts and continues to be so until all the blisters have crusted. This will occur five to seven days after the rash first appears. Children should be kept out of school for about a week. An expectant mother who has never had chicken pox or is uncertain about her immunity to it should avoid exposure to this infection, especially during the first half of her pregnancy. (Chicken pox can cause congenital abnormalities in about 2 percent of newborns whose mothers become infected during the first 20 weeks of gestation. Most infants and children who develop chickenpox recover without any major problem. A few scars may remain, especially in areas where scabs have been repeatedly picked or scratched off. In some cases, bacteria such as streptococci or staphylococci infect a number of pox lesions. A child, who suddenly worsens four or five days into the chicken pox outbreak, especially if fever recurs, should be seen by a physician to check for this complication.

Pneumonia is a rare but potentially serious complication of chicken pox. If a child develops a cough, shortness of breath, and rapid respirations during or shortly after chicken pox, contact a doctor as soon as possible. Reye’s syndrome, a rare but potentially fatal illness affecting brain and liver, has been linked to the use of aspirin during chicken pox and other acute viral infections. Aspirin should not be used to treat fever or aches for anyone, child or adult, who has chickenpox. Persistent vomiting or a significant change in alertness or orientation could indicate this rare complication.

Chickenpox Symptoms

Frequently the youthful patient feels a bit off-colour for a day or so, and runs a mild fever. But the first definite sign is a rash. This comes in waves, and two to four crops can occur in a period of two to six days. All stages can occur simultaneously and in the same region. It usually starts in the scalp, visits the lining of the mouth, then spreads to the body. The rash is usually less obvious on the limbs, and is rarely seen on the palms and soles.

Once seen, the characteristic rash is hard to forget and usually easy to diagnose. All stages can occur, and often a child with a mild attack may have only a few of the typical marks.

It starts with a small reddish mark on the skin. Then a blister forms, rather like a drop of water on a pink base. The top is easily scratched off, through clothing or simple rubbing. Soon after a hard top forms, called the crust. After a while (usually around 13 days) the scab falls off. Sometimes a depression remains in the skin, especially if the blister has become infected with other germs. On the face, this may persist into adult life, much to the dismay of young women who dislike the sight of any facial blemish.

Can serious complications take place? The blisters can become infected, but serious complications are rare. An occasional case of brain infection has been reported (encephalitis with headaches, fever, convulsions), but this is unlikely with most cases.

Chickenpox Treatment

For most children and adolescents with chickenpox, treatment is supportive: rest, fluids, acetaminophen for fever and aches, and antihistamines such as diphen-hydramine (Benadryl and other brands) as needed to relieve itching. Cool baths and calamine lotion also may relieve itching. These measures (along with gentle parental reminders and trimming the fingernails) can help a child resist the urge to scratch and pick at the blisters and scabs, minimizing the risk of scarring. If sores are present in the mouth, cool liquids (other than citrus or tomato juices, which may sting) and soft foods will be easier for your child to swallow than other foods. There are specific measures for treatment and prevention of chicken pox:

  • The prescription medication acyclovir (Zovirax) is sometimes given to reduce the severity of the illness. To be effective it must be started within 24hours of the onset of the eruption.
  • Varicella-Zoster Immune Globulin (VZIG) contains antibodies to the chicken pox virus. It is used in specific and very uncommon situations where immediate (although temporary) protection is needed. These situations might include a person with a severely impaired immune system who is exposed to chicken pox or a newborn whose mother develops this illness between five days before and two days after delivery. In the latter case, the newborn will be at risk for a more intense infection because of the immaturity of the immune system at this age combined with a lack of antibody protection from the mother.
  • Chicken pox vaccine (Varivax) induces the body’s immune system to create antibodies against the virus and can provide long-term protection. It is now commonly given to infants at the first birth-day but may be used in older children and adults who have never had chicken pox.

There is no specific antibiotic that will cure chickenpox, so therapy is mainly symptomatic. Simple anti-itch lotions may be applied if the skin itch produces a desire to scratch (and increase the risk of further skin infections).

Bathe the patient in a warm bath, and dab dry with a soft towel. Do not rub, for this will break the blisters. Some think infection may be reduced by making the bath water pink by adding a crystal of Condy’s. (Caution: This may stain a white bath, so cleanse the bath quickly and completely afterwards.) Various other antiseptics are also used, but it is not really essential.

If skin scratching is annoying, keeping junior’s nails trimmed short, or giving him gloves to wear will reduce skin trauma. Mouth blisters may be treated with simple saline rinses, cotton wool buds and gargles. However, most children don’t like gargling and many find the method difficult to comprehend. Is it necessary to call the doctor? Most simple cases can be treated by a sensible mother. But if there are obvious complications, marked skin infections, persisting fever, headaches or convulsions, of course it is essential to call the doctor. Never take any risks.

Chickenpox is related to shingles. It seems that the virus, called the varicella virus, which causes a skin eruption in childhood, may in later adult life also cause an extremely painful nerve rash that is also present on the skin. The virus remains in the body for years, slowly smouldering on. In fact, it may persist forever in the body.

Shingles (also known as herpes zoster) commonly occurs on the face or the trunk, usually on one side only. Researchers are working on vaccines and new drugs they hope will ultimately prevent both chickenpox and shingles. According to the medical journals of the world, great progress has been made recently in this field. The drug acyclovir is now successfully used to treat early cases of adult herpes zoster (shingles).

Larynx Cancer

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What is Larynx Cancer?

This is a very serious disease, and it is essential that any of the telltale symptoms lead to prompt investigation.

Treated early, results are excellent. But if left, the condition may be fatal.

Larynx Cancer Symptoms

The earliest symptom is hoarseness. “It should be a rule that every patient who has suffered from hoarseness for a period of three weeks without improvement should have the larynx examined by a competent laryngologist,” a government authority, Simpson Hall, states. Of course, if it is neglected, tragedy can soon result. “The difficulty constantly encountered in treatment of these patients is that treatment has been delayed, and the growth has spread too far before the advice of a specialist is sought.

This is especially unfortunate, as in the early stages the prognosis [future outlook’ is excellent if treatment is properly carried out; whereas in the later stages it is frequently hopeless.” Apart from hoarseness, there may be vague generalized symptoms from other sites. There may be some local discomfort, a feeling as though one wishes to clear the throat often, a slight irritating cough, feeling a lump on swallowing.

There may be discomfort referred to the ear, or a swelling in the neck. If the growth is very extensive, there may be swallowing or breathing difficulties.

Larynx Cancer Treatment

Diagnosis and treatment are essentially in the hands of the specialist, the ENT surgeon. If the cancer is confined to one cord, the results are highly favorable. “The five-year cure rate is about 95 per cent after surgery or after irradiation in expert hands with modern methods.” As irradiation leaves a normal voice, it is considered to be the treatment of choice. It may be carried out in the form of external irradiation. If this is not available, surgical intervention is the next best form of therapy. The diseased cord is removed. After surgery, the voice is often better than may be expected. A fibrous band often grows in to replace the cord, permitting relatively good speech.

If the cancer has extended beyond the cords, more extensive surgery may be necessary, and total removal of the voice box carried out. This is called a total laryngectomy. After this the patient has a permanent tracheotomy, and has to learn to speak all over again. A tube is placed into the windpipe and the hole is a permanent one. Often speech therapy may assist. In many countries, “Lost Cord” clubs exist to give practical and psychological assistance to persons involved in this form of surgery. Much is now available in the way of assistance after the operation is over, and the person is trying to rehabilitate himself.

Menstrual Cycle Irregularities

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As the child develops, puberty will occur and menstruation and secondary sexual development commence. This is usually anywhere from the age of nine to fourteen years. The first outward sign is often breast development, pubic and underarm hair and the appearance of the periods.

It takes the hormones several years, often, to develop to a point where regular ovulation and menstruation occur. In some girls it may be delayed. This often worries them, especially if they compare notes with school friends and they seem “abnormal.” There is nothing worse than being different from all your peers. It is often mentally traumatizing, too.

A medical check may give the mother and daughter some mental relief. In due course, regularity of menstruation nearly always takes place, but occasionally I’ve seen girls not in this regular pattern until they have reached the ripe old age of 20 years. Variations are enormous. In recent years, a few interesting features have become apparent. Very active girls, especially those on limited diets (many girls simply hate eating), or those engaging in sport, ballet and similar active pastimes, tend to have delayed periods. This activity seems capable of affecting their hormonal system somehow and causing a postponement. So bear this in mind, mother, if you happen to be a worrier.

Another interesting thing is the reverse. In Western countries, in the past few decades, girls appear to be “maturing” (periods starting) at a progressively earlier age. It is believed that this is tied up with our way of life, our busy, hectic schedules, the stresses and tensions of the 20th century. But, it is now an established fact of life.

From the age of the menarche, when secondary sexual development takes place in the female, the normal menstrual period commences. The age at which this starts is variable, but it usually occurs anywhere between the ages of 10 and 16 years. In some women it is even later, but this is rare, being about one in every 100 women. Menstruation normally proceeds fairly regularly until the age of 45 – 50 years, when the change of life sets in, and normal menstruation finally ceases.

Some women may continue with regular periods well into their 50s, but this is not usual. There are many factors that play a part in ensuring this regular cycle. Some are physical, but emotional overtones and bleeding external stresses, tensions and related psychological events can all play their part via the higher cerebral centers. For this reason, although periods arc traditionally normal and regular, and the level of loss is about the same, great variations can take place. In fact, some females do not start their periods as anticipated.

Others commence very late. Some bleed very heavily for no outward obvious reason. Others have a scanty flow. Some women have a cycle of 21 days; in others it is prolonged, and successive periods may be separated by as many as 35 – 40 days. Many women tend to develop a menstrual pattern, and this may persist for many years. What seems normal to one person may seem totally abnormal and unacceptable to another. The natural variations are wide. For many years some women will accept their particular pattern as being satisfactory to them.

The chief reason may be that this is how it has always been, and they know no different way of life. But then they may read a magazine article (probably about the possibility of cancer being related to a particular bleeding pattern). This gets hold of their imagination, and they quickly seek medical opinion, probably for the first time in many years, with the fear that they may be so afflicted, or that they may face some real dangers. This is not a bad effect.

Anything that will drive women to the doctor for a cancer check is to be applauded, for the rate of cancer deaths, worldwide, ranks it as number two cause of death. Apathy and lethargy, and perhaps absolute ignorance, are some reasons for this. Fortunately, a great many cancers of the genital tract (and the breast) are accessible, and can be diagnosed fairly early. Abnormal bleeding habits may be an early sign that all is not well. Many different classifications of bleeding abnormalities in women exist.

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