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Pyloric Stenosis

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What is Pyloric Stenosis?

When this condition occurs in adults, it is nearly always due to a peptic ulcer that is usually in the duodenum close to the pyloric valve separating it from the stomach. However, if dyspeptic symptoms have been present for less than a year, a cancer must be suspected.

This condition is now seen much less frequently, for most patients seek treatment at an earlier stage of their abdominal disabilities than in former years. If an ulcer is present, narrowing of the canal (so producing an obstruction to the normal flow of material through it) takes place. Swelling of tissues, together with scarring from attempts at natural healing, collectively produce the symptoms.

Pyloric Stenosis Symptoms

The cardinal symptom is vomiting large amounts of fluid, which is always free from the greenish bile colouration (as compared to vomiting from areas below the pyloric valve in which bile is always present). Often there is fetid, gaseous material contained in the vomit. It may be offensive, due to the partial bacterial contamination during its stay in the stomach. Typically, the vomiting occurs toward the end of the day, and it may contain residue of food eaten the previous day.

Pain may be present, which is usually cased after vomiting. Similarly the sensation of dyspepsia, fullness and distension will disappear. With the reduced nutritional intake, weight loss is inevitable. Lack of appetite is common. About 2 to 5 per cent of patients suffer from diarrhoea; some have constipation. There is often weakness and lethargy due to dehydration. The history, endoscopic and X-ray examinations usually clinch the diagnosis.

Pyloric Stenosis Treatment

This of course must he under adequate medical supervision. Any symptom of this nature essentially requires expert supervision, not only to form the correct diagnosis, but to manage subsequent treatment. Apart from the immediate measures of rectifying fluid and chemical imbalances, the treatment is usually a surgical cure of the narrowed canal.

Hermaphroditism

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Hermaphroditism is a very rare condition in which the person has both ovarian and testicular tissue occurring together. The appearance of the external genitals varies greatly, and the persons have a problem for life. With more recent methods of studying chromosomal anomalies today, many have been found to have aberrations. In some it seems there has been a double fertilization of the ovum by two sperms, one giving female attributes and the other male ones, so producing a final ambiguous picture.

Hermaphroditism Treatment

This depends on how the child was originally brought up, and there is considerable feeling that whatever this has been should be continued. In recent years this has been an emotive topic.

Many teenage girls may fail to menstruate, or normal periods may suddenly cease. This may be due to excessive hormonal production preventing normal monthly ovulation, as well as obsessively over exercising. It may affect one in 20 among young ballet dancers and athletes.

Fortunately, when the vigorous sports are reduced, in most cases ovulation (and normal menstrual periods and the chances of pregnancy) returns to normal levels. This may be a worrying time for many young people. If continuing indefinitely (as with estrogen lack in the blood), calcium may be drawn from the bones, causing osteoporosis, with the high risk of fractures common in older postmenopausal women. It needs careful evaluation.

Two related conditions called female and male pseudohermaphroditism show that genetically a person with a female type chromosomal structure has varying degrees of masculinisation, and vice versa. In women, corticosteroids are used. In males, as there is a high risk of cancer developing in the testes, they may be removed, and plastic surgery carried out (with appropriate prosthetics). Testosterone is given to increase maleness.

Chronic Leukemia

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What is Chronic Leukemia?

This is also known as chronic granulocytic anaemia, chronic myeloid leukaemia or chronic myelocytic leukemia. These names are mentioned, for a patient with the disorder may have heard of these various terms.

It means that there is a malignant change in the bone marrow involving the granulocyte type of white blood cells.

The disease is rare in children and the very old. Most cases occur in those in the 30-60-years age group, and the sexes are affected equally. There are certain known causes. As with acute leukaemia, these include exposure to nuclear explosions, and in patients receiving radiotherapy for other disorders (most commonly for ankylosing spondylitis, a chronic painful and crippling back disorder). It is also seen in patients who were X-rayed repeatedly as a check for artificial pneumothorax, which was widely used for treatment of certain chest diseases in the past.

Chronic Leukemia Symptoms

The most common symptoms include fatigue and lassitude, feeling listless and weak, “off-color,” and abdominal swelling or frank pain due to enlargement of the spleen. There may be loss of weight, the symptoms of anaemia (see anaemia) or purpura (bruising).

Sometimes the disease is found by chance when a blood test is being carried out for some other purpose. Almost always there is enlargement of the spleen and this may be massive. Sometimes the lymph glands may be involved; this is not a good sign. Sometimes the skin and bones may be involved as well. The blood picture usually confirms the diagnosis and white-cell counts of 100 or more are common. (The normal figure is between 4.0 and 11.0 x 10 9/L.) All forms of developing white cells are seen, from the very immature to the well-developed. Often the platelet count is also raised.

Chronic Leukemia Treatment

At present the medication of choice is one called busulphan, given orally. Gradually the white-cell count drops. When this reaches the relatively normal figure of 10.0, maintenance doses are given.

Gradually this may be replaced with other forms of drug therapy, similar to those used for acute leukaemia. Busulphan has virtually replaced other forms of treatment that were popular in the past, including radiotherapy and other forms of chemotherapy.

A wide range of drugs has been used with varying degrees of success in leukaemia. Long-term, most fail, for the disease is often a fatal one. Many drugs, which appear to be promising at first, later prove to be less effective. Marrow transplants have been tried, and these also have proved successful in some patients, but often relapses have taken place as time advances. Patients with this disease will be under the care of experts in the field, and ideally attached to major public hospitals where the full range of facilities, at that time, will be made available. In short, despite our advances with modern drugs, technology, transplants and success in the field of acute cases, the outlook for older persons with leukaemia is still not good. Other aspects of the disease must be treated as supportive measures.

Antibiotics will be given to check any infection. Anaemia will be treated, and may require repeated blood transfusions. Platelets may be needed for the clotting abnormalities. With the early stages of treatment there is often a rise in the level of uric acid in the blood, and the drug al-allopurinol is often ordered. Otherwise, bouts of acute gout may complicate the picture as well as making life one of abject misery for the unfortunate patient.

Therapy has vastly improved the quality of life for these patients, but, sad to relate, it has not materially augmented the total life span. The disease is inevitably fatal. However, it is now possible for many to live relatively symptom-free lives for the two to three years that usually occur from the time of diagnosis to the time of death.

Hemolytic Anemia

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What is Hemolytic Anemia?

This type of anemia is due to a premature destruction of the red cells. Generally speaking it is fairly uncommon, and as care in the use of drugs looking out for situations in which it is likely to occur (such as Rh incompatibilities), and taking the necessary precautions increases, the risks are now far less than they were a few years ago. Apart from some of the usual symptoms of anemia (sometimes a feature. sometimes not, depending on the degree of anemia present), other typical symptoms are associated with it.

Hemolytic Anemia Symptoms

Jaundice (yellowing of the skin and whites of the eyes) can occur. This is due to the excessive breakdown of the red cells, and the production in large amounts of a chemical called bilirubin. The urine and feces may become severely pigmented also, as large amounts of bilirubin are excreted through these systems.

The blood picture (when examined under the microscope) shows typical changes. The bone marrow makes increasing efforts at stepping up red cell production to cope with the rapid rate of cell destruction. For this reason, red cells that have not matured properly are pumped into the general circulation.

These immature cells appear in profusion. The level of actual anemia depends on the body’s ability at balancing the rate of cell destruction with the rate of new cells being made available. In this way, the symptoms of typical red cell anemia will vary from case to case.

Also, abnormal by-products of red cell destruction are usually found in the urine. There is an extensive battery of tests available to help doctors decide which type of anemia is present, and to help pinpoint the probable cause. Most of the others are rarely seen by doctors in the ordinary routine of practice, and the majority is only diagnosed upon investigation in a large hospital equipped to deal with the full range of investigations.

From the practical point of view, it is essential that any of the telltale symptoms mentioned receive prompt medical attention. Your doctor will very quickly have you referred to the appropriate centers for total assessment and treatment. Treatment of these disorders has no place in home medicine, and trying simple home remedies and following the advice of well-meaning relatives and friends is a total waste of time and could be harmful in precluding vital medical attention.

Jaundice, an important symptom in this type of anemia, warrants immediate medical advice from a doctor.

Some of the more probable types of hemolytic anemia include:

Hemolytic Disease of the Newborn

The most likely situation in which this may occur is when an Rh-negative mother produces an Rh-positive infant, and the cells from the baby stimulate the mother to form anti-Rh (usually anti-D) antibodies.

These antibodies can then cross via the placenta and become attached to the baby’s red cells, causing their destruction (hemolysis).

Generally there is a history of a previous pregnancy or miscarriage in the mother, and during the birth of the first baby (who usually comes through unscathed) the release of fetal cells into the mother’s circulation takes place, and sets up the antibody production that will affect later babies.

Each subsequent baby will tend to be affected more severely It may be lethal to the baby, and a condition called hydrops foctolis can develop unless immediate steps are taken soon after birth. Formerly the only method of treatment was to give a prompt exchange transfusion to the baby. In this way, the diseased blood was removed, new blood replacing it completely.

It was a time-consuming and arduous undertaking and a marathon event for a newborn infant. However many lives were saved in this manner. In the late 1960s it was found that if the mother were given a special single injection of anti-D antibody within 7 2 hours of the birth of her Rh-positive infant, this effectively stopped production of the antibodies, and the risk to subsequent babies was greatly reduced.

As a new generation of mothers is growing up, and with routine blood tests being carried out before and at the time of birth (on the mother and infant), treatment is now effectively cutting back on this form of anemia. In time it will most likely disappear altogether.

However, a miscarriage, abortion or blood transfusion (with Rh-positive blood in an Rh-negative woman) may lead to similar complications later on in pregnancy.

Incompatible Blood Transfusion

The most obvious example of hemolytic anemia occurs when a patient is given the wrong blood during a transfusion. This is termed “incompatible” blood. In 1900 Karl Landsteiner showed that there were four main blood groups that could destroy incompatible red cells. For example, if a patient of group B is given group A blood, the group A cells will be destroyed by the anti-A in the recipient’s plasma. That is why great care is taken to type and cross-match blood before every blood transfusion. Only group 0 blood may be given in a dire emergency without cross-matching with relative safety, for it contains no antigens.

Symptoms that may occur when the wrong blood is given include acute hemolysis, the appearance of hemoglobin in the urine, fever and severe back pain, and frequently renal disorders. Most of the mistakes that occur causing this reaction have been found due to administrative errors at the hospital (wrong labels on bottles, failure to check labels correctly etc).

Hemolytic Anemia Due to Drugs and Chemicals

Certain drugs are well-known for their ability at reacting on the red cells and causing their premature destruction. This may occur almost at once, or in others it may occur about 10 days after administration of the drug, the first dose apparently sensitizing the system and later doses having an immune type reaction. But the result is the same, irrespective of the cause—red cells disintegrating and possibly causing a medical emergency.

Other Causes

A variety of other causes have been incriminated. Certain bacterial infections appear capable of producing bone-marrow depression and red-cell destruction.

Mechanical trauma of the red cells can cause their premature breakdown in others. Apparently healthy young men doing a lot of marching or running particularly on hard surfaces for prolonged periods of time, may damage the red cells in the blood circulating in their feet.

Hemoglobin is later passed in the urine a frightening experience. It is harmless and wearing rubber insoles in the boots should correct the problem.

Burns may have a similar effect, the red cells becoming directly damaged or else suffering damage as they flow through injured vessels. They subsequently tend to fragment and hemolyse. In these modern times, when Teflon is being used in cardiac surgery unless the prosthesis is completely covered with normal cells, red cell damage can occur similarly leading to cell destruction.

Other prosthetics can cause similar cell damage, a problem of modern surgery limited to the second half of the 20th century. It will probably increase as does the rate of surgery of this nature.

Enlarged Spleen

The spleen is an integral part of the reticulo-endothelial system of the body apparatus that deals with red cells once their useful life has come to an end. They are disposed of quietly, and their place taken over by the ever-proliferating number of new red cells produced in bone marrow.

However, if there is splenic enlargement from any reason, the organ may overreact and increase in its rate of destroying the red cells.

Many disorders can lead to splenic enlargement, even simple viral infections such as a glandular fever or viral hepatitis or any other mild viral infection. But some of the infections and conditions producing an enlarged spleen are rarer and more bizarre.

If it can be shown that normal red-cell production is taking place in the marrow and that destruction in the spleen is excessive, its removal could be the choice of treatment.


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