Half of all people age 65 and older have arthritis. There are over 100 different forms of arthritis and many different symptoms and treatments. We do not know what causes most forms of arthritis. Some forms are better understood than others.
Arthritis causes pain and loss of movement. It can affect joints in any part of the body. Arthritis is usually chronic, meaning it can occur over a long period of time. The more serious forms can cause swelling, warmth, redness, and pain. The three most common kinds of arthritis in older people are osteoarthritis, rheumatoid arthritis, and gout.
Common Forms of Arthritis
Osteoarthritis (OA), at one time called degenerative joint disease, is the most common type of arthritis in older people. Symptoms can range from stiffness and mild pain that comes and goes to severe joint pain and even disability.
OA usually affects the hands and the large weight-bearing joints of the body: the knees and hips. Early in the disease, pain occurs after activity and rest brings relief; later on, pain occurs with very little movement, even during rest.
Scientists think that several factors may cause OA in different joints. OA in the hands or hips may run in families. OA in the knees is linked with being overweight. Injuries or overuse may cause OA in joints such as knees, hips, or hands.
Rheumatoid arthritis (RA) can be one of the more disabling forms of arthritis. Signs of RA often include morning stiffness, swelling in three or more joints, swelling of the same joints on both sides of the body (both hands, for example), and bumps (or nodules) under the skin most commonly found near the elbow. RA can occur at any age and affects women about three times more often than men.
Scientists don't know what causes RA but think it has something to do with a breakdown in the immune system, the body's defense against disease. It is also likely that people who get RA have certain inherited traits (genes) that cause a disturbance in the immune system.
Gout occurs most often in older men. It affects the toes, ankles, elbows, wrists, and hands. An acute attack of gout is very painful. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender. Medicines can stop gout attacks, as well as prevent further attacks and damage to the joints.
Treatments
Treatments for arthritis work to reduce pain and swelling, keep joints moving safely, and avoid further damage to joints. Treatments include medicines, special exercise, use of heat or cold, weight control, and surgery.
Medicines help relieve pain and reduce swelling. Acetaminophen or ACT should be the first drug used to control pain in patients with osteoarthritis (OA). Patients with OA who don't respond to ACT and patients with RA and gout are most commonly treated with nonsteroidal anti-inflammatory drugs such as ibuprofen. People taking medicine for any form of arthritis should limit the amount of alcohol they drink. (For more information, see the Age Page "Arthritis Medicines.")
Exercise, such as a daily walk or swim, helps keep joints moving, reduces pain, and strengthens muscles around the joints. Rest is also important for the joints affected by arthritis. Physical therapists can develop personal programs that balance exercise and rest.
Many people find that soaking in a warm bath, swimming in a heated pool, or applying heat or cold to the area around the joint helps reduce pain. Controlling or losing weight can reduce the stress on joints and can help avoid further damage.
When damage to the joints becomes disabling or when other treatments fail to reduce pain, your doctor may suggest surgery. Surgeons can repair or replace damaged joints with artificial ones. The most common operations are hip and knee replacements.
Unproven Remedies
Arthritis symptoms may go away by themselves but then come back weeks, months, or years later. This may be why many people with arthritis try quack cures or remedies that have not been proven instead of getting medical help. Some of these remedies, such as snake venom, are harmful. Others, such as copper bracelets, are harmless but also useless. The safety of many quack cures is unknown.
Here are some tipoffs that a remedy may be unproven: claims that a treatment like a lotion or cream works for all types of arthritis and other diseases too; scientific support comes from only one research study; or the label has no directions for use or warnings about side effects.
Common Warning Signs of Arthritis
Swelling in one or more joint(s)
Morning stiffness lasting 30 minutes or longer
Joint pain or tenderness that is constant or that comes and goes
Not being able to move a joint in the normal way
Redness or warmth in a joint
Weight loss, fever, or weakness and joint pain that can't be explained
If any one of these symptoms lasts longer than 2 weeks, see your regular doctor or a doctor who specializes in arthritis (a rheumatologist). The doctor will ask questions about the history of your symptoms and do a physical exam. The doctor may take x-rays or do lab tests before developing a treatment plan.
Resources
For more information on arthritis contact:
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Building 31, Room 4C05
Bethesda, MD 20892
(301) 496-8188
The Arthritis Foundation
P.O. Box 19000
Atlanta, GA 30325
(800) 283-7800
For a list of free publications from the National Institute on Aging (NIA), contact the NIA Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057; 1-800-222-2225;
Advertiestment
Senin, 02 Januari 2012
Rabu, 28 Desember 2011
Arthritis Drugs for Rheumatoid Arthritis and Osteoarthritis
Arthritis treatments aim to relieve pain, reduce inflammation, and slow or stop joint damage to maintain or restore the patient's functional ability and quality of life. Arthritis therapies generally used today address the medical needs of many patients. However, these therapies are occasionally associated with harmful side effects ranging from mild to severe. Medical research continues to search for effective, fast-acting treatments with fewer side effects.
New arthritis drugs designed to meet these treatment needs are presently available or awaiting approval by the U.S. Food and Drug Administration (FDA). The foundation for these new drugs was laid in basic biomedical research supported by the National Institutes of Health.
Drug Category: Biological Response Modifiers for Rheumatoid Arthritis
Description: One class of drugs in this category reduces inflammation in the joints by blocking the action of a substance called tumor necrosis factor (TNF). TNF is a protein of the body's immune system that triggers inflammation during normal immune responses; however, when overproduced, TNF can lead to excessive inflammation such as that experienced by patients with rheumatoid arthritis.
Medication (drug name): Kineret® (anakinra)
Description: Kineret® is the first direct and selective blocker of interleukin-1 (IL-1), a protein seen in excess in patients with rheumatoid arthritis. By blocking IL-1, Kineret® inhibits the inflammatory response in rheumatoid arthritis.
How taken: Daily subcutaneous (under the skin) injections by the patient or health care provider
Most common side effects: mild injection-site reactions (redness, pain, swelling)
Drug status: approved by the FDA; can be used alone or in combination with disease-modifying antirheumatic drugs that are not tumor necrosis factor (TNF) blocking agents
For more information:
Amgen Inc.
One Amgen Center Drive
Thousand Oaks, CA 91320-1799
1-866-Kineret
World Wide Web Address: http://www.kineretrx.com
Medication (drug name): Enbrel® (etanercept)
How taken: twice-weekly subcutaneous (under the skin) injections by the patient or health care provider
Most common side effects: mild to moderate injection-site reactions (itching, pain, swelling)
Drug status: approved by the FDA; not recommended for patients with active infections; caution should be used in patients with a history of infections or those who develop new infections while taking Enbrel®; not recommended for pregnant women.
For more information:
Immunex Corporation
51 University Street
Seattle, WA 98101
(800) 436-2735
World Wide Web Address: http://www.enbrelinfo.com/
Medication (drug name): Remicade® (infliximab)
How taken: intravenous (in the vein) injections by the health care provider once every 8 weeks
Most common side effects: mild infusion reactions
Drug status: approved by the FDA for use in combination with methotrexate; not recommended for pregnant women
For more information:
Centocor
200 Great Valley Parkway
Malvern, PA 19355
(800) 457-6399
World Wide Web Address: http://www.centocor.com/
Drug Category: Disease-Modifying Antirheumatic Drugs (DMARDs) for Rheumatoid Arthritis
Description: These are the mainstay arthritis drugs that are known to relieve painful, swollen joints and to slow joint damage.
Medication (drug name): Arava® (leflunomide)
How taken: orally, once daily
Most common side effects: diarrhea, hair loss, rash
Drug status: approved by the FDA; not recommended for pregnant women
For more information:
Aventis
P.O. Box 9627
Kansas City, MO 64134-0627
(816) 966-4000
World Wide Web Address: http://www.aventis.com/
Drug Category: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Specifically Cyclo-Oxygenase-2 (COX-2) Inhibitors, for Rheumatoid Arthritis and Osteoarthritis
Description: COX-2 inhibitors, like traditional NSAIDs, block COX-2, an enzyme in the body known to stimulate an inflammatory response. Unlike traditional NSAIDs, however, they do not block the action of COX-1, an enzyme known to protect the stomach lining. Therefore, drugs in this category reduce joint pain and inflammation with reduced risk of gastrointestinal ulceration and bleeding.
Medication (drug name): Celebrex® (celecoxib) for rheumatoid arthritis and osteoarthritis
How taken: orally once or twice daily, dosage determined by the physician
Most common side effects: abdominal pain, nausea, indigestion, diarrhea
Drug status: approved by the FDA
For more information:
G.D. Searle & Company
5200 Old Orchard Road
Skokie, IL 60077
World Wide Web Address: http://www.searle.com/
Medication (drug name): Vioxx® (rofecoxib) for rheumatoid arthritis and osteoarthritis, as well as acute pain associated with primary dysmenorrhea (painful menstruation) and postsurgical pain
How taken: orally, once daily
Most common side effects: abdominal pain, diarrhea, indigestion, insomnia, edema
Drug status: approved by the FDA
For more information:
Merck & Co., Inc.
One Merck Drive
Whitehouse Station, NJ 08889-0100
World Wide Web Address: http://www.merck.com/product/usa/
Drug Category: Other Products
Description: Hyaluronic acid viscosupplementation products for osteoarthritis. These products mimic a naturally occurring substance in the body called hyaluronic acid by providing lubrication to the knee joint, thus permitting flexible joint movement without pain.
Medication (drug name): Hyalgan® (hyaluronan)
How taken: a series of five injections per knee by a health care provider over 4 weeks
Most common side effects: some pain and swelling at the injection site
Drug status: approved by the FDA
For more information:
Sanofi~Synthelabo, Inc.
90 Park Avenue
New York, NY 10016
(800) 446-6267
World Wide Web Address: http://www.hyalgan.com/
Medication (drug name): Synvisc® (hylan G-F20)
How taken: a series of three injections per knee by a health care provider over a 15-day period
Most common side effects: some pain and swelling at the injection site
Drug status: approved by the FDA
For more information:
Genzyme Biosurgery
One Kendall Square
Cambridge, MA 02139
(800) 666-7248
World Wide Web Address: http://www.synvisc.com or http://www.genzymebiosurgery.com
Description: Blood filtering device for severe rheumatoid arthritis. This device is designed to remove harmful antibodies from the patient's immune system, thus lowering disease activity associated with severe rheumatoid arthritis.
Device (device name): Prosorba Column® (apheresis)
How used: The device consists of a catheter, tubing, and a column. The catheter and tubing are used to filter the patient's blood through the column (which is coated with protein A, a substance that attracts harmful antibodies), then reinfuse it into the patient's body. The procedure takes 2 hours and is performed weekly at a health care facility for 12 weeks.
Most common side effects: flu-like symptoms (chills, fever, nausea, and joint/muscle pain)
Drug status: approved by the FDA
For more information:
Frenesius HemoCare, Inc.
6675 185th Avenue NE, Suite 100
Redmond, WA 98052
(800) 909-3872 or 425-497-1197
World Wide Web Address: http://www.freseniushc.com/
Additional Resources
To find out more about these drugs and devices, including dosage, full range of side effects, and study results, check the following resources:
National Library of Medicine's (NLM's) Internet Grateful Med is a computer system that allows users to search through 15 of the NLM's databases for bibliographic references and abstracts on medical and scientific information pertaining to rheumatic diseases, including treatments.
World Wide Web Address: http://www.nlm.nih.gov/
U.S. Food and Drug Administration (FDA), Center for Evaluation and Research, provides information on drugs that have been approved, as well as those undergoing the approval process.
World Wide Web Address: http://www.fda.gov/cder/
The Arthritis Foundation offers The Drug Guide, a reprint from Arthritis Today. World Wide Web Address: http://www.arthritis.org/
Local public university libraries have journals on rheumatic diseases and pharmaceutical (drug) therapies, as well as reference books such as the Physician's Desk Reference, an annually updated guide that describes the use, effects, dosages, and administration of FDA-approved drugs, as well as warnings, side effects, and precautions. Many libraries also provide computers with public access to the Internet.
New arthritis drugs designed to meet these treatment needs are presently available or awaiting approval by the U.S. Food and Drug Administration (FDA). The foundation for these new drugs was laid in basic biomedical research supported by the National Institutes of Health.
Drug Category: Biological Response Modifiers for Rheumatoid Arthritis
Description: One class of drugs in this category reduces inflammation in the joints by blocking the action of a substance called tumor necrosis factor (TNF). TNF is a protein of the body's immune system that triggers inflammation during normal immune responses; however, when overproduced, TNF can lead to excessive inflammation such as that experienced by patients with rheumatoid arthritis.
Medication (drug name): Kineret® (anakinra)
Description: Kineret® is the first direct and selective blocker of interleukin-1 (IL-1), a protein seen in excess in patients with rheumatoid arthritis. By blocking IL-1, Kineret® inhibits the inflammatory response in rheumatoid arthritis.
How taken: Daily subcutaneous (under the skin) injections by the patient or health care provider
Most common side effects: mild injection-site reactions (redness, pain, swelling)
Drug status: approved by the FDA; can be used alone or in combination with disease-modifying antirheumatic drugs that are not tumor necrosis factor (TNF) blocking agents
For more information:
Amgen Inc.
One Amgen Center Drive
Thousand Oaks, CA 91320-1799
1-866-Kineret
World Wide Web Address: http://www.kineretrx.com
Medication (drug name): Enbrel® (etanercept)
How taken: twice-weekly subcutaneous (under the skin) injections by the patient or health care provider
Most common side effects: mild to moderate injection-site reactions (itching, pain, swelling)
Drug status: approved by the FDA; not recommended for patients with active infections; caution should be used in patients with a history of infections or those who develop new infections while taking Enbrel®; not recommended for pregnant women.
For more information:
Immunex Corporation
51 University Street
Seattle, WA 98101
(800) 436-2735
World Wide Web Address: http://www.enbrelinfo.com/
Medication (drug name): Remicade® (infliximab)
How taken: intravenous (in the vein) injections by the health care provider once every 8 weeks
Most common side effects: mild infusion reactions
Drug status: approved by the FDA for use in combination with methotrexate; not recommended for pregnant women
For more information:
Centocor
200 Great Valley Parkway
Malvern, PA 19355
(800) 457-6399
World Wide Web Address: http://www.centocor.com/
Drug Category: Disease-Modifying Antirheumatic Drugs (DMARDs) for Rheumatoid Arthritis
Description: These are the mainstay arthritis drugs that are known to relieve painful, swollen joints and to slow joint damage.
Medication (drug name): Arava® (leflunomide)
How taken: orally, once daily
Most common side effects: diarrhea, hair loss, rash
Drug status: approved by the FDA; not recommended for pregnant women
For more information:
Aventis
P.O. Box 9627
Kansas City, MO 64134-0627
(816) 966-4000
World Wide Web Address: http://www.aventis.com/
Drug Category: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Specifically Cyclo-Oxygenase-2 (COX-2) Inhibitors, for Rheumatoid Arthritis and Osteoarthritis
Description: COX-2 inhibitors, like traditional NSAIDs, block COX-2, an enzyme in the body known to stimulate an inflammatory response. Unlike traditional NSAIDs, however, they do not block the action of COX-1, an enzyme known to protect the stomach lining. Therefore, drugs in this category reduce joint pain and inflammation with reduced risk of gastrointestinal ulceration and bleeding.
Medication (drug name): Celebrex® (celecoxib) for rheumatoid arthritis and osteoarthritis
How taken: orally once or twice daily, dosage determined by the physician
Most common side effects: abdominal pain, nausea, indigestion, diarrhea
Drug status: approved by the FDA
For more information:
G.D. Searle & Company
5200 Old Orchard Road
Skokie, IL 60077
World Wide Web Address: http://www.searle.com/
Medication (drug name): Vioxx® (rofecoxib) for rheumatoid arthritis and osteoarthritis, as well as acute pain associated with primary dysmenorrhea (painful menstruation) and postsurgical pain
How taken: orally, once daily
Most common side effects: abdominal pain, diarrhea, indigestion, insomnia, edema
Drug status: approved by the FDA
For more information:
Merck & Co., Inc.
One Merck Drive
Whitehouse Station, NJ 08889-0100
World Wide Web Address: http://www.merck.com/product/usa/
Drug Category: Other Products
Description: Hyaluronic acid viscosupplementation products for osteoarthritis. These products mimic a naturally occurring substance in the body called hyaluronic acid by providing lubrication to the knee joint, thus permitting flexible joint movement without pain.
Medication (drug name): Hyalgan® (hyaluronan)
How taken: a series of five injections per knee by a health care provider over 4 weeks
Most common side effects: some pain and swelling at the injection site
Drug status: approved by the FDA
For more information:
Sanofi~Synthelabo, Inc.
90 Park Avenue
New York, NY 10016
(800) 446-6267
World Wide Web Address: http://www.hyalgan.com/
Medication (drug name): Synvisc® (hylan G-F20)
How taken: a series of three injections per knee by a health care provider over a 15-day period
Most common side effects: some pain and swelling at the injection site
Drug status: approved by the FDA
For more information:
Genzyme Biosurgery
One Kendall Square
Cambridge, MA 02139
(800) 666-7248
World Wide Web Address: http://www.synvisc.com or http://www.genzymebiosurgery.com
Description: Blood filtering device for severe rheumatoid arthritis. This device is designed to remove harmful antibodies from the patient's immune system, thus lowering disease activity associated with severe rheumatoid arthritis.
Device (device name): Prosorba Column® (apheresis)
How used: The device consists of a catheter, tubing, and a column. The catheter and tubing are used to filter the patient's blood through the column (which is coated with protein A, a substance that attracts harmful antibodies), then reinfuse it into the patient's body. The procedure takes 2 hours and is performed weekly at a health care facility for 12 weeks.
Most common side effects: flu-like symptoms (chills, fever, nausea, and joint/muscle pain)
Drug status: approved by the FDA
For more information:
Frenesius HemoCare, Inc.
6675 185th Avenue NE, Suite 100
Redmond, WA 98052
(800) 909-3872 or 425-497-1197
World Wide Web Address: http://www.freseniushc.com/
Additional Resources
To find out more about these drugs and devices, including dosage, full range of side effects, and study results, check the following resources:
National Library of Medicine's (NLM's) Internet Grateful Med is a computer system that allows users to search through 15 of the NLM's databases for bibliographic references and abstracts on medical and scientific information pertaining to rheumatic diseases, including treatments.
World Wide Web Address: http://www.nlm.nih.gov/
U.S. Food and Drug Administration (FDA), Center for Evaluation and Research, provides information on drugs that have been approved, as well as those undergoing the approval process.
World Wide Web Address: http://www.fda.gov/cder/
The Arthritis Foundation offers The Drug Guide, a reprint from Arthritis Today. World Wide Web Address: http://www.arthritis.org/
Local public university libraries have journals on rheumatic diseases and pharmaceutical (drug) therapies, as well as reference books such as the Physician's Desk Reference, an annually updated guide that describes the use, effects, dosages, and administration of FDA-approved drugs, as well as warnings, side effects, and precautions. Many libraries also provide computers with public access to the Internet.
Rabu, 14 Desember 2011
Breast Cancer and Pregnancy
General Information about Breast Cancer and Pregnancy
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. The lobes and lobules are connected by thin tubes called ducts.
Each breast also contains blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. The lymph vessels lead to small, bean-shaped organs called lymph nodes that help the body fight infection and disease. Lymph nodes are found throughout the body. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
Breast cancer is sometimes detected (found) in women who are pregnant or have just given birth.
In women who are pregnant or who have just given birth, breast cancer occurs most often between the ages of 32 and 38. Breast cancer occurs about once in every 3,000 pregnancies.
It may be difficult to detect (find) breast cancer early in pregnant or nursing women, whose breasts are often tender and swollen.
Women who are pregnant, nursing, or have just given birth usually have tender, swollen breasts. This can make small lumps difficult to detect and may lead to delays in diagnosing breast cancer. Because of these delays, cancers are often found at a later stage in these women.
Breast examination should be part of prenatal and postnatal care.
To detect breast cancer, pregnant and nursing women should examine their breasts themselves. Women should also receive clinical breast examinations during their routine prenatal and postnatal examinations.
Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
If an abnormality is found, one or all of the following tests may be used:
Ultrasound: A test that uses sound waves to create images of areas inside the body. High-energy sound waves are bounced off internal tissues and organs. The echoes are changed into pictures called sonograms. The doctor can identify tumors by looking at the sonogram. Mammogram: A special x-ray of the breast that may find tumors that are too small to feel. A mammogram can be performed with little risk to the fetus. Mammograms in pregnant women may appear negative even though cancer is present. Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease.
Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the breast only or has spread to other places in the body), the tumor size, the type of breast cancer, the age of the fetus, whether there are symptoms, and the patient's general health.
Survival rates of pregnant women with breast cancer may be lower than for women who are not pregnant.
Pregnant women with breast cancer may be less likely to survive because the diagnosis of their cancer is often delayed and the cancers are more advanced when they are found. Cancers found at later stages are more difficult to treat successfully.
Stages of Breast Cancer
After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
The process used to find out if the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. (Refer to the PDQ summary on Breast Cancer Treatment for more information on the stages used for breast cancer.)
Methods used to stage breast cancer can be changed to make them safer for the fetus.
Standard methods for giving imaging scans can be adjusted so that the fetus is exposed to less radiation. Tests to measure the level of hormones in the blood may also be used in the staging process.
Treatment Option Overview
There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Treatment options for pregnant women depend on the stage of the disease and the age of the fetus.
Three types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:
Lumpectomy: Removal of the tumor and a small amount of normal tissue around it. Lumpectomy is usually followed by radiation therapy to the breast. Most doctors also take out some of the lymph nodes under the arm. Partial or segmental mastectomy: Removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Some of the lymph nodes under the arm are usually taken out. In most cases, partial mastectomy is followed by radiation therapy.
Other types of surgery include the following:
Total or simple mastectomy: Removal of the whole breast. Sometimes lymph nodes under the arm are also taken out.
Modified radical mastectomy: Removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.
Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Radiation may be used after surgery in addition to chemotherapy, and hormone therapy. Breast cancer is treated with external radiation.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.
Chemotherapy should not be given during the first 3 months of pregnancy. Chemotherapy given after this time does not usually harm the fetus but may cause early labor and low birth weight.
Other types of treatment are being tested in clinical trials. These include the following:
Hormone therapy
Hormones are chemicals produced by glands in the body and are circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way some cancers grow. If tests show that the cancer cells have estrogen and progesterone receptors (molecules found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the way these hormones help the cancer grow. This may be done by using drugs that block the way hormones work or by surgically removing organs that make hormones, such as the ovaries.
The effectiveness of hormone therapy, alone or combined with chemotherapy, in treating breast cancer in pregnant women is not yet known.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Ending the pregnancy does not seem to improve the mother's chance of survival and is not usually a treatment option.
If the cancer must be treated with chemotherapy and radiation therapy, which may harm the fetus, ending the pregnancy is sometimes considered. This decision may depend on the stage of cancer, the age of the fetus, and the mother's chance of survival.
Treatment Options by Stage
Early Stage Breast Cancer (Stage I and Stage II)
Treatment of early stage breast cancer (stage I and stage II) may be surgery followed by adjuvant therapy as follows:
Modified radical mastectomy. Breast-conserving surgery: Lumpectomy, partial mastectomy or segmental mastectomy. Surgery during pregnancy followed by radiation therapy after the baby is born. Surgery during pregnancy followed by chemotherapy after the first 3 months of pregnancy. Clinical trials of surgery followed by hormone therapy with or without chemotherapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late stage breast cancer (stage III and stage IV) may include the following:
Radiation therapy.
Chemotherapy.
Other Considerations for Pregnancy and Breast Cancer
Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned.
If surgery is planned, breast-feeding should be stopped to reduce blood flow in the breasts and make them smaller. Breast-feeding should also be stopped if chemotherapy is planned. Many anticancer drugs, especially cyclophosphamide and methotrexate, may occur in high levels in breast milk and may harm the nursing baby. Women receiving chemotherapy should not breast-feed. Stopping lactation does not improve survival of the mother.
Breast cancer does not appear to harm the fetus.
Breast cancer cells do not seem to pass from the mother to the fetus.
Pregnancy does not seem to affect the survival of women who have had breast cancer in the past.
Some doctors recommend that a woman wait 2 years after treatment for breast cancer before trying to have a baby, so that any early return of the cancer would be detected. This may affect a woman's decision to become pregnant. The fetus does not seem to be affected if the mother has previously had breast cancer.
Effects of certain cancer treatments on later pregnancies are not known.
The effects of treatment with high-dose chemotherapy and a bone marrow transplant, with or without radiation therapy, on later pregnancies are not known.
To Learn More
Call
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. The lobes and lobules are connected by thin tubes called ducts.
Each breast also contains blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. The lymph vessels lead to small, bean-shaped organs called lymph nodes that help the body fight infection and disease. Lymph nodes are found throughout the body. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
Breast cancer is sometimes detected (found) in women who are pregnant or have just given birth.
In women who are pregnant or who have just given birth, breast cancer occurs most often between the ages of 32 and 38. Breast cancer occurs about once in every 3,000 pregnancies.
It may be difficult to detect (find) breast cancer early in pregnant or nursing women, whose breasts are often tender and swollen.
Women who are pregnant, nursing, or have just given birth usually have tender, swollen breasts. This can make small lumps difficult to detect and may lead to delays in diagnosing breast cancer. Because of these delays, cancers are often found at a later stage in these women.
Breast examination should be part of prenatal and postnatal care.
To detect breast cancer, pregnant and nursing women should examine their breasts themselves. Women should also receive clinical breast examinations during their routine prenatal and postnatal examinations.
Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
If an abnormality is found, one or all of the following tests may be used:
Ultrasound: A test that uses sound waves to create images of areas inside the body. High-energy sound waves are bounced off internal tissues and organs. The echoes are changed into pictures called sonograms. The doctor can identify tumors by looking at the sonogram. Mammogram: A special x-ray of the breast that may find tumors that are too small to feel. A mammogram can be performed with little risk to the fetus. Mammograms in pregnant women may appear negative even though cancer is present. Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease.
Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the breast only or has spread to other places in the body), the tumor size, the type of breast cancer, the age of the fetus, whether there are symptoms, and the patient's general health.
Survival rates of pregnant women with breast cancer may be lower than for women who are not pregnant.
Pregnant women with breast cancer may be less likely to survive because the diagnosis of their cancer is often delayed and the cancers are more advanced when they are found. Cancers found at later stages are more difficult to treat successfully.
Stages of Breast Cancer
After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
The process used to find out if the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. (Refer to the PDQ summary on Breast Cancer Treatment for more information on the stages used for breast cancer.)
Methods used to stage breast cancer can be changed to make them safer for the fetus.
Standard methods for giving imaging scans can be adjusted so that the fetus is exposed to less radiation. Tests to measure the level of hormones in the blood may also be used in the staging process.
Treatment Option Overview
There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Treatment options for pregnant women depend on the stage of the disease and the age of the fetus.
Three types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:
Lumpectomy: Removal of the tumor and a small amount of normal tissue around it. Lumpectomy is usually followed by radiation therapy to the breast. Most doctors also take out some of the lymph nodes under the arm. Partial or segmental mastectomy: Removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Some of the lymph nodes under the arm are usually taken out. In most cases, partial mastectomy is followed by radiation therapy.
Other types of surgery include the following:
Total or simple mastectomy: Removal of the whole breast. Sometimes lymph nodes under the arm are also taken out.
Modified radical mastectomy: Removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.
Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Radiation may be used after surgery in addition to chemotherapy, and hormone therapy. Breast cancer is treated with external radiation.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.
Chemotherapy should not be given during the first 3 months of pregnancy. Chemotherapy given after this time does not usually harm the fetus but may cause early labor and low birth weight.
Other types of treatment are being tested in clinical trials. These include the following:
Hormone therapy
Hormones are chemicals produced by glands in the body and are circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way some cancers grow. If tests show that the cancer cells have estrogen and progesterone receptors (molecules found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the way these hormones help the cancer grow. This may be done by using drugs that block the way hormones work or by surgically removing organs that make hormones, such as the ovaries.
The effectiveness of hormone therapy, alone or combined with chemotherapy, in treating breast cancer in pregnant women is not yet known.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Ending the pregnancy does not seem to improve the mother's chance of survival and is not usually a treatment option.
If the cancer must be treated with chemotherapy and radiation therapy, which may harm the fetus, ending the pregnancy is sometimes considered. This decision may depend on the stage of cancer, the age of the fetus, and the mother's chance of survival.
Treatment Options by Stage
Early Stage Breast Cancer (Stage I and Stage II)
Treatment of early stage breast cancer (stage I and stage II) may be surgery followed by adjuvant therapy as follows:
Modified radical mastectomy. Breast-conserving surgery: Lumpectomy, partial mastectomy or segmental mastectomy. Surgery during pregnancy followed by radiation therapy after the baby is born. Surgery during pregnancy followed by chemotherapy after the first 3 months of pregnancy. Clinical trials of surgery followed by hormone therapy with or without chemotherapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late stage breast cancer (stage III and stage IV) may include the following:
Radiation therapy.
Chemotherapy.
Other Considerations for Pregnancy and Breast Cancer
Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned.
If surgery is planned, breast-feeding should be stopped to reduce blood flow in the breasts and make them smaller. Breast-feeding should also be stopped if chemotherapy is planned. Many anticancer drugs, especially cyclophosphamide and methotrexate, may occur in high levels in breast milk and may harm the nursing baby. Women receiving chemotherapy should not breast-feed. Stopping lactation does not improve survival of the mother.
Breast cancer does not appear to harm the fetus.
Breast cancer cells do not seem to pass from the mother to the fetus.
Pregnancy does not seem to affect the survival of women who have had breast cancer in the past.
Some doctors recommend that a woman wait 2 years after treatment for breast cancer before trying to have a baby, so that any early return of the cancer would be detected. This may affect a woman's decision to become pregnant. The fetus does not seem to be affected if the mother has previously had breast cancer.
Effects of certain cancer treatments on later pregnancies are not known.
The effects of treatment with high-dose chemotherapy and a bone marrow transplant, with or without radiation therapy, on later pregnancies are not known.
To Learn More
Call
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Selasa, 06 Desember 2011
Splenomegaly – Symptoms And Causes
Splenomegaly is defined as enlargement of the spleen, exceeding the limits of physiological variations. The spleen has an average weight of 180-250 g lower in women and older men than men with the physiological property to relax for blood storage and to contract, throwing blood rich in red blood cells into circulation in case of effort or major bleeding. Splenomegaly must be distinguished from organ changes that occur in the same external region of the body in which the spleen is situated (enlarged left lobe of the liver, kidney tumors , splenic left angle tumors of the colon, pancreas tail tumors, spine tumors, uterine fibroids or cysts ovary.
Splenomegaly sometimes causes a feeling of heaviness in the left upper quadrant (upper left abdomen) and pain. Also, these changes should be considered when the cause of an illenes is not detected, the cause of splenomegaly must be found eliminating infectious diseases, parasitic diseases, taking into account the physiology and functional links with other organs of the spleen, hematopoietic system diseases, liver diseases.
Splenomegaly symptoms
Splenomegaly symptoms include mild pain, sensation of weight in the spleen area, the spleen may be palpable, under ribs (normal spleen is not palpable, and increases its volume only in pathological conditions). Palpation along with imaging test are indispensable to diagnose splenomegaly.
Splenomegaly causes
Different diseases or infections can cause splenomegaly: liver disease as cirrhosis, bacterial infections: septicemia, typhoid and paratyphoid, brucellosis, tuberculosis, systemic diseases: lupus erythematosus, sarcoidosis or amyloidosis, haematological diseases: leukemia or myeloid splenomegaly, parasitic diseases like malaria, viral diseases: infectious mononucleosis. Splenomegaly may be caused by certain diseases such as blood diseases, viral diseases, liver diseases, parasites, bacteria, cysts and tumors.
Splenomegaly may be confused sometimes with a large left kidney, a tumor of the colon or left liver lobe hypertrophy. It can also be caused by infectious diseases such as typhoid fever, endocarditis, infectious mononucleosis, streptococcal septicemia and parasitic splenomegaly (malaria, spleen hydatid cyst), splenic tumors, hypersplenism (exaggerated destruction of red blood cells and platelets), cirrhosis, haemolytic anemia , septicemia, brucellosis, tuberculosis, lupus erythematosus, leukemia or myeloid splenomegaly, infectious mononucleosis. The diagnosis of splenomegaly is achieved by X-rays, echography, chest puncture, blood examination, splenic puncture, liver tests, etc..
Treatment depends on the disease that lead to splenomegaly. Chemotherapy in splenomegaly is used in the case of hematological malignancies, antibiotics in infections, and surgery in the case of splenic abscess. Voluminous spleen predisposes to a ruptured spleen by abdominal wounds or chest trauma. Morbidity and mortality in case of splenomegaly results from associated diseases and surgical procedures.
Splenomegaly sometimes causes a feeling of heaviness in the left upper quadrant (upper left abdomen) and pain. Also, these changes should be considered when the cause of an illenes is not detected, the cause of splenomegaly must be found eliminating infectious diseases, parasitic diseases, taking into account the physiology and functional links with other organs of the spleen, hematopoietic system diseases, liver diseases.
Splenomegaly symptoms
Splenomegaly symptoms include mild pain, sensation of weight in the spleen area, the spleen may be palpable, under ribs (normal spleen is not palpable, and increases its volume only in pathological conditions). Palpation along with imaging test are indispensable to diagnose splenomegaly.
Splenomegaly causes
Different diseases or infections can cause splenomegaly: liver disease as cirrhosis, bacterial infections: septicemia, typhoid and paratyphoid, brucellosis, tuberculosis, systemic diseases: lupus erythematosus, sarcoidosis or amyloidosis, haematological diseases: leukemia or myeloid splenomegaly, parasitic diseases like malaria, viral diseases: infectious mononucleosis. Splenomegaly may be caused by certain diseases such as blood diseases, viral diseases, liver diseases, parasites, bacteria, cysts and tumors.
Splenomegaly may be confused sometimes with a large left kidney, a tumor of the colon or left liver lobe hypertrophy. It can also be caused by infectious diseases such as typhoid fever, endocarditis, infectious mononucleosis, streptococcal septicemia and parasitic splenomegaly (malaria, spleen hydatid cyst), splenic tumors, hypersplenism (exaggerated destruction of red blood cells and platelets), cirrhosis, haemolytic anemia , septicemia, brucellosis, tuberculosis, lupus erythematosus, leukemia or myeloid splenomegaly, infectious mononucleosis. The diagnosis of splenomegaly is achieved by X-rays, echography, chest puncture, blood examination, splenic puncture, liver tests, etc..
Treatment depends on the disease that lead to splenomegaly. Chemotherapy in splenomegaly is used in the case of hematological malignancies, antibiotics in infections, and surgery in the case of splenic abscess. Voluminous spleen predisposes to a ruptured spleen by abdominal wounds or chest trauma. Morbidity and mortality in case of splenomegaly results from associated diseases and surgical procedures.
Senin, 28 November 2011
Coffee linked to heart attack for persons with certain gene variation
Related
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Individuals who have a genetic variation associated with slower caffeine metabolism appear to have an increased risk of non-fatal heart attack associated with higher amounts of coffee intake, according to a study in the March 8 issue of JAMA.
Studies examining the association between coffee consumption and risk of myocardial infarction (MI � heart attack) have been inconclusive. Coffee is a major source of caffeine, which is the most widely consumed stimulant in the world and has been implicated in the development of cardiovascular diseases such as heart attack, according to background information in the article. However, coffee contains a number of other chemicals that have variable effects on the cardiovascular system. It is not clear whether caffeine alone affects the risk of heart attack or whether other chemicals found in coffee may be responsible. Caffeine is metabolized primarily by the enzyme cytochrome P450 1A2 (CYP1A2) in the liver. Variations of the gene for this enzyme can slow or quicken caffeine metabolism. Carriers of the gene variant CYP1A2*1F allele are "slow" caffeine metabolizers, while individuals with the gene variant CYP1A2*1A allele are "rapid" caffeine metabolizers.
Ahmed El-Sohemy, Ph.D., of the University of Toronto, and colleagues conducted a study to determine whether gene variations of CYP1A2 modifies the association between consumption of caffeinated coffee and risk of nonfatal heart attack. The study included 2,014 case patients with a first acute nonfatal heart attack and 2,014 controls, living in Costa Rica between 1994 and 2004. The genotypes of the participants were determined. A food frequency questionnaire was used to assess the intake of caffeinated coffee.
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Fifty-five percent of cases (n = 1,114) and 54 percent of controls (n = 1,082) were carriers of the slow *1F allele. For carriers of the slow *1F allele, those who drank 2 to 3 cups of coffee a day had a 36 percent increased odds of heart attack; those who drank 4 or more cups per day had a 64 percent increased odds of heart attack. Corresponding consumption for individuals with the rapid *1A/*1A genotype resulted in the reduced odds of heart attack by 22 percent and 1 percent, respectively.
Among the slow metabolizers, younger individuals showed an increased risk. The risk associated with drinking 4 cups/d or more compared with less than 1 cup/d increased from 2-fold for individuals younger than 59 years to more than 4-fold for those younger than 50 years. Among the fast metabolizers who were younger than 59 years of age, those who drank 1 cup/d or 2 to 3 cups per day had a reduced odds of a heart attack by 52 percent and 43 percent, respectively.
"In summary, consistent with most case-control studies, we found that increased coffee intake is associated with an increased risk of nonfatal MI. The association between coffee and MI was found only among individuals with the slow CYP1A2*1F allele, which impairs caffeine metabolism, suggesting that caffeine plays a role in the association," the authors conclude.
L-arginine supplement following a heart attack may be harmful
Individuals who have a genetic variation associated with slower caffeine metabolism appear to have an increased risk of non-fatal heart attack associated with higher amounts of coffee intake, according to a study in the March 8 issue of JAMA.
Studies examining the association between coffee consumption and risk of myocardial infarction (MI � heart attack) have been inconclusive. Coffee is a major source of caffeine, which is the most widely consumed stimulant in the world and has been implicated in the development of cardiovascular diseases such as heart attack, according to background information in the article. However, coffee contains a number of other chemicals that have variable effects on the cardiovascular system. It is not clear whether caffeine alone affects the risk of heart attack or whether other chemicals found in coffee may be responsible. Caffeine is metabolized primarily by the enzyme cytochrome P450 1A2 (CYP1A2) in the liver. Variations of the gene for this enzyme can slow or quicken caffeine metabolism. Carriers of the gene variant CYP1A2*1F allele are "slow" caffeine metabolizers, while individuals with the gene variant CYP1A2*1A allele are "rapid" caffeine metabolizers.
Ahmed El-Sohemy, Ph.D., of the University of Toronto, and colleagues conducted a study to determine whether gene variations of CYP1A2 modifies the association between consumption of caffeinated coffee and risk of nonfatal heart attack. The study included 2,014 case patients with a first acute nonfatal heart attack and 2,014 controls, living in Costa Rica between 1994 and 2004. The genotypes of the participants were determined. A food frequency questionnaire was used to assess the intake of caffeinated coffee.
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Fifty-five percent of cases (n = 1,114) and 54 percent of controls (n = 1,082) were carriers of the slow *1F allele. For carriers of the slow *1F allele, those who drank 2 to 3 cups of coffee a day had a 36 percent increased odds of heart attack; those who drank 4 or more cups per day had a 64 percent increased odds of heart attack. Corresponding consumption for individuals with the rapid *1A/*1A genotype resulted in the reduced odds of heart attack by 22 percent and 1 percent, respectively.
Among the slow metabolizers, younger individuals showed an increased risk. The risk associated with drinking 4 cups/d or more compared with less than 1 cup/d increased from 2-fold for individuals younger than 59 years to more than 4-fold for those younger than 50 years. Among the fast metabolizers who were younger than 59 years of age, those who drank 1 cup/d or 2 to 3 cups per day had a reduced odds of a heart attack by 52 percent and 43 percent, respectively.
"In summary, consistent with most case-control studies, we found that increased coffee intake is associated with an increased risk of nonfatal MI. The association between coffee and MI was found only among individuals with the slow CYP1A2*1F allele, which impairs caffeine metabolism, suggesting that caffeine plays a role in the association," the authors conclude.
Selasa, 15 November 2011
Neurological Manifestations Of Aids
What are the neurological manifestations of AIDS?
DESCRIPTION: Acquired immune deficiency syndrome (AIDS) is the result of an infection with the human immunodeficiency virus (HIV). This virus attacks selected cells of the immune, nervous, and other systems impairing their proper function. HIV infection may cause damage to the brain and spinal cord, causing encephalitis (inflammation of the brain), meningitis (inflammation of the membranes surrounding the brain), nerve damage, difficulties in thinking (i.e., AIDS dementia complex), behavioral changes, poor circulation, headache, and stroke. AIDS-related cancers such as lymphoma and opportunistic infections (OI) may also affect the nervous system. Neurological symptoms may be mild in the early stages of AIDS, but may become severe in the final stages. Complications vary widely from one patient to another. Cerebral toxoplasmosis, a common OI in AIDS patients, causes such symptoms as headache, confusion, lethargy, and low-grade fever. Other symptoms may include weakness, speech disturbance, ataxia, apraxia, seizures, and sensory loss. Progressive multifocal leukoencephalopathy (PML), a disorder that can also occur in AIDS patients, causes weakness, hemiparesis or facial weakness, dysphasia, vision loss, and ataxia. Some patients with PML may also develop compromised memory and cognition.
Is there any treatment?
TREATMENT: There is no cure for AIDS but recently developed, experimental treatments appear very promising. Some symptoms and complications may improve with treatment. For example, antidementia drugs may relieve confusion and slow mental decline. Infections may be treated with antibiotics. Radiation therapy may be needed to treat AIDS-related cancers present in the brain or spinal cord.
What is the prognosis?
PROGNOSIS: The prognosis for individuals with AIDS in recent years has improved significantly because of new drugs and treatments, and educational and preventive efforts.
What research is being done?
RESEARCH: The NINDS supports a broad spectrum of basic and clinical research studies on the neurological complications of AIDS. Much of this research is conducted at leading biomedical research institutions across the country.
Where can I find more information?
These articles, available from a medical library, are sources of in-depth information on the neurological manifestations of AIDS:
McArthur, J. "Neurologic Manifestations of Human Immunodeficiency Virus Infection." In Diseases of the Nervous System: Clinical Neurobiology, W.B. Saunders Co., Philadelphia, pp. 1312-1330 (1992).
Mintz, M, and Epstein, L. "Neurologic Manifestations of Pediatric Acquired Immunodeficiency Syndrome: Clinical Features and Therapeutic Approaches." Seminars in Neurology, 12:1; 51-56 (March 1992).
Newton, H. "Common Neurologic Complications of HIV-1 Infection and AIDS." American Family Physician, 51:2; 387-398 (February 1, 1995).
Pajeau, A, and Roman, G. "HIV Encephalopathy and Dementia." Psychiatric Clinics of North America, 15:2; 455-466 (June 1992).
Simpson, D, and Tagliati, M. "Neurologic Manifestations of HIV Infection." Annals of Internal Medicine, 121:10; 769-785 (November 1994).
Additional information or services are available from the following organizations
(last updated April 7, 1998):
American Foundation for AIDS Research
733 Third Ave., 12th Flr.
New York, NY 10017
(212) 682-7440
Pediatric AIDS Foundation.
1311 Colorado Avenue
Santa Monica, CA 90404
(310) 395-9051
DESCRIPTION: Acquired immune deficiency syndrome (AIDS) is the result of an infection with the human immunodeficiency virus (HIV). This virus attacks selected cells of the immune, nervous, and other systems impairing their proper function. HIV infection may cause damage to the brain and spinal cord, causing encephalitis (inflammation of the brain), meningitis (inflammation of the membranes surrounding the brain), nerve damage, difficulties in thinking (i.e., AIDS dementia complex), behavioral changes, poor circulation, headache, and stroke. AIDS-related cancers such as lymphoma and opportunistic infections (OI) may also affect the nervous system. Neurological symptoms may be mild in the early stages of AIDS, but may become severe in the final stages. Complications vary widely from one patient to another. Cerebral toxoplasmosis, a common OI in AIDS patients, causes such symptoms as headache, confusion, lethargy, and low-grade fever. Other symptoms may include weakness, speech disturbance, ataxia, apraxia, seizures, and sensory loss. Progressive multifocal leukoencephalopathy (PML), a disorder that can also occur in AIDS patients, causes weakness, hemiparesis or facial weakness, dysphasia, vision loss, and ataxia. Some patients with PML may also develop compromised memory and cognition.
Is there any treatment?
TREATMENT: There is no cure for AIDS but recently developed, experimental treatments appear very promising. Some symptoms and complications may improve with treatment. For example, antidementia drugs may relieve confusion and slow mental decline. Infections may be treated with antibiotics. Radiation therapy may be needed to treat AIDS-related cancers present in the brain or spinal cord.
What is the prognosis?
PROGNOSIS: The prognosis for individuals with AIDS in recent years has improved significantly because of new drugs and treatments, and educational and preventive efforts.
What research is being done?
RESEARCH: The NINDS supports a broad spectrum of basic and clinical research studies on the neurological complications of AIDS. Much of this research is conducted at leading biomedical research institutions across the country.
Where can I find more information?
These articles, available from a medical library, are sources of in-depth information on the neurological manifestations of AIDS:
McArthur, J. "Neurologic Manifestations of Human Immunodeficiency Virus Infection." In Diseases of the Nervous System: Clinical Neurobiology, W.B. Saunders Co., Philadelphia, pp. 1312-1330 (1992).
Mintz, M, and Epstein, L. "Neurologic Manifestations of Pediatric Acquired Immunodeficiency Syndrome: Clinical Features and Therapeutic Approaches." Seminars in Neurology, 12:1; 51-56 (March 1992).
Newton, H. "Common Neurologic Complications of HIV-1 Infection and AIDS." American Family Physician, 51:2; 387-398 (February 1, 1995).
Pajeau, A, and Roman, G. "HIV Encephalopathy and Dementia." Psychiatric Clinics of North America, 15:2; 455-466 (June 1992).
Simpson, D, and Tagliati, M. "Neurologic Manifestations of HIV Infection." Annals of Internal Medicine, 121:10; 769-785 (November 1994).
Additional information or services are available from the following organizations
(last updated April 7, 1998):
American Foundation for AIDS Research
733 Third Ave., 12th Flr.
New York, NY 10017
(212) 682-7440
Pediatric AIDS Foundation.
1311 Colorado Avenue
Santa Monica, CA 90404
(310) 395-9051
Kamis, 03 November 2011
Lack of sleep linked to increased risk of high blood pressure
Middle aged people who sleep 5 hours or less, may be increasing their risk of developing high blood pressure.
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Related
Tenormin may not be effective in protecting against heart disease
If you're middle age and sleep five hours or less a night, you may be increasing your risk of developing high blood pressure, according to research reported in Hypertension: Journal of the American Heart Association.
"Sleep allows the heart to slow down and blood pressure to drop for a significant part of the day," said James E. Gangwisch, Ph.D., lead author of the study and post-doctoral fellow at Columbia University's Mailman School of Public Health.
"However, people who sleep for only short durations raise their average 24-hour blood pressure and heart rate. This may set up the cardiovascular system to operate at an elevated pressure."
Gangwisch said that 24 percent of people ages 32 to 59 who slept for five or fewer hours a night developed hypertension versus 12 percent of those who got seven or eight hours of sleep. Subjects who slept five or fewer hours per night continued to be significantly more likely to be diagnosed with hypertension after controlling for factors such as obesity, diabetes, physical activity, salt and alcohol consumption, smoking, depression, age, education, gender, and ethnicity.
The researchers conducted a longitudinal analysis of data from the Epidemiologic Follow-up Studies of the first National Health and Nutrition Examination Study (NHANES I). The analysis is based on NHANES I data from 4,810 people ages 32 to 86 who did not have high blood pressure at baseline. The 1982-84 follow-up survey asked participants how many hours they slept at night. During eight to 10 years of follow-up, 647 of the 4,810 participants were diagnosed with hypertension.
Compared to people who slept seven or eight hours a night, people who slept five or fewer hours a night also exercised less and were more likely to have a higher body mass index. (BMI is a measurement used to assess body fatness). They were also more likely to have diabetes and depression, and to report daytime sleepiness.
"We had hypothesized that both BMI and a history of diabetes would mediate the relationship between sleep and blood pressure, and the results were consistent with this," Gangwisch said.
Sleep deprivation has been shown previously to increase appetite and compromise insulin sensitivity.
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Short sleep duration was linked to a new diagnosis of high blood pressure among middle-aged participants, but the association was not observed among people age 60 or older, he said. Gangwisch said the differences between the younger and older subjects might be explained by the fact that advanced age is associated with difficulties falling and staying asleep. Another factor could be that subjects suffering from hypertension, diabetes, and obesity would be less likely to survive into their later years.
Among study limitations, researchers found that high blood pressure often goes undetected. An analysis of NHANES III data showed that over 30 percent of people who had high blood pressure didn't know they had it.
Since the study is based on observational data, Gangwisch said more research is needed to confirm the association between short sleep duration and high blood pressure. "We need to investigate the biological mechanisms and, if confirmed, design interventions that will help people modify sleep behavior," he said.
Gangwisch said the study's main message is clear: "A good night's sleep is very important for good health."
tellfrnd.gif (30x26 -- 1330 bytes)send to a friend
prntfrnd.gif (30x26 -- 1309 bytes)printer friendly version
Related
Tenormin may not be effective in protecting against heart disease
If you're middle age and sleep five hours or less a night, you may be increasing your risk of developing high blood pressure, according to research reported in Hypertension: Journal of the American Heart Association.
"Sleep allows the heart to slow down and blood pressure to drop for a significant part of the day," said James E. Gangwisch, Ph.D., lead author of the study and post-doctoral fellow at Columbia University's Mailman School of Public Health.
"However, people who sleep for only short durations raise their average 24-hour blood pressure and heart rate. This may set up the cardiovascular system to operate at an elevated pressure."
Gangwisch said that 24 percent of people ages 32 to 59 who slept for five or fewer hours a night developed hypertension versus 12 percent of those who got seven or eight hours of sleep. Subjects who slept five or fewer hours per night continued to be significantly more likely to be diagnosed with hypertension after controlling for factors such as obesity, diabetes, physical activity, salt and alcohol consumption, smoking, depression, age, education, gender, and ethnicity.
The researchers conducted a longitudinal analysis of data from the Epidemiologic Follow-up Studies of the first National Health and Nutrition Examination Study (NHANES I). The analysis is based on NHANES I data from 4,810 people ages 32 to 86 who did not have high blood pressure at baseline. The 1982-84 follow-up survey asked participants how many hours they slept at night. During eight to 10 years of follow-up, 647 of the 4,810 participants were diagnosed with hypertension.
Compared to people who slept seven or eight hours a night, people who slept five or fewer hours a night also exercised less and were more likely to have a higher body mass index. (BMI is a measurement used to assess body fatness). They were also more likely to have diabetes and depression, and to report daytime sleepiness.
"We had hypothesized that both BMI and a history of diabetes would mediate the relationship between sleep and blood pressure, and the results were consistent with this," Gangwisch said.
Sleep deprivation has been shown previously to increase appetite and compromise insulin sensitivity.
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Short sleep duration was linked to a new diagnosis of high blood pressure among middle-aged participants, but the association was not observed among people age 60 or older, he said. Gangwisch said the differences between the younger and older subjects might be explained by the fact that advanced age is associated with difficulties falling and staying asleep. Another factor could be that subjects suffering from hypertension, diabetes, and obesity would be less likely to survive into their later years.
Among study limitations, researchers found that high blood pressure often goes undetected. An analysis of NHANES III data showed that over 30 percent of people who had high blood pressure didn't know they had it.
Since the study is based on observational data, Gangwisch said more research is needed to confirm the association between short sleep duration and high blood pressure. "We need to investigate the biological mechanisms and, if confirmed, design interventions that will help people modify sleep behavior," he said.
Gangwisch said the study's main message is clear: "A good night's sleep is very important for good health."
