Sunday, January 27, 2008

Cancer - acute childhood leukemia


Alternative Names ALL; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)

Definition Acute lymphocytic leukemia (ALL) is a fast-growing cancer in which the body produces a large number of immature white blood cells (lymphocytes). These cells can be found in the blood, bone marrow, lymph nodes, spleen, and other organs.

Causes ALL makes up 80% of childhood acute leukemias. Most cases occur in children between ages 3 and 7. The disease may also occur in adults.

In acute leukemia, cancerous cells multiply quickly and replace normal cells. Cancerous cells take over normal parts of bone marrow, causing bone marrow failure. A person with ALL is more likely to bleed and have infections because there are fewer normal blood cells.Most cases of ALL have no obvious cause. However, chromosome problems, radiation, toxins such as benzene, and some chemotherapy drugs may play a role in the development of leukemia. Persons with Down syndrome or who have a brother or sister with leukemia have an increased risk for ALL.

Symptoms

  • Bleeding gums
  • Bone pain or tenderness
  • Easy bruising
  • Excessive or prolonged bleeding
  • Fatigue
  • Fever
  • Joint pain
  • Infection
  • Menstrual irregularities
  • Nosebleeds
  • Paleness
  • Palpitations
  • Pinpoint red spots on the skin
  • Shortness of breath (made worse by exercise)
  • Swollen glands (lymphadenopathy)
  • Swollen gums
  • Unintentional weight loss

Exams and Tests A physical exam may reveal the following:

  • Bruising
  • Enlarged liver and spleen
  • Signs of bleeding (petechiae, purpura)

Blood tests may show the following:

  • Abnormal WBC count
  • Anemia on a CBC
  • Low platelet count

A bone marrow aspiration may be show abnormal levels of certain cells.

ALL may also change the results of the following tests:

  • T-lymphocyte count
  • B-cell leukemia/lymphoma panel
  • White blood cell differential

If you are diagnosed with ALL, genetic tests will be done to determine the specific type of ALL. Doctors can look for chromosome changes in the cells of some leukemias. Leukemias with certain types of chromosome changes have a poor outlook, while those with other types of genes can have a very good outlook.

Treatment The goal of treatment is to get the blood counts and the bone marrow to normal. If this occurs, the cancer is considered to be in remission.

If you have acute lymphocytic leukemia, you'll need chemotherapy. For the first round of chemotherapy, you may need to go to the hospital for 3 to 6 weeks, but may later get chemotherapy on an outpatient basis. If you have a low white blood cell count, you may need to be placed in a room by yourself so you do not catch an infection.

Additional treatments depend on other symptoms. They may include:

  • Transfusion of blood products, such as platelets or special red blood cells, to fight anemia
  • Antibiotics to fight infection

If you go into remission, you may receive additional chemotherapy or radiation therapy to kill any cancer cells that are in the spinal fluid. You may also receive chemotherapy from time to time to prevent relapse.

If your leukemia returns or does not respond to other treatments, your doctor may recommend a bone marrow transplant after high-dose chemotherapy.

Support Groups Patients can ease the stress of their illness by joining a support group where members share common experiences and problems.

Outlook (Prognosis) Children usually have a better outcome than adults. The majority of adults go into complete remission. Without treatment, a person with ALL can expect to live for about 3 months.

Possible Complications DIC (disseminated intravascular coagulation)

  • Relapse of ALL
  • Severe infection

When to Contact a Medical Professional Call your health care provider if you develop ALL-like symptoms, or if you have ALL and you have a persistent fever or other signs of infection.

Prevention Because the cause is usually unknown, it is not possible to prevent most cases. You may reduce your risk of ALL by avoiding exposure to toxins, radiation, and chemicals.

References Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004.

Hoffman R, Benz EJ, Shattil SS, et al. Hematology: Basic Principles and Practice. 4th ed. Orlando, Fl: Churchill Livingstone; 2005.

American Cancer Society. Cancer Facts and Figures 2007. Atlanta, GA: American Cancer Society; 2007.

Thursday, January 17, 2008

Safe Sex


Know for safe sex

Safe sex is way of lowering your chances of catching a sexually transmitted disease. This class of diseases, called STDs for short, includes any infection spread during sex. STDs include gonorrhea, syphilis, HIV (the AIDS virus), Chlamydia, trichomoniasis, herpes, pubic lice, and genital warts. Many sexually transmitted diseases can be cured with a week or two of treatment. If not treated, however, some of these diseases can cause infertility. Others eventually can be fatal. You can't tell by looking whether someone has an STD, and many people don't know they are infected. Practicing safe sex keeps you and your partner from sharing body fluids, such as vaginal fluids and semen. These fluids typically carry STDs. Safe sex does not guarantee that you'll avoid infection. The only 100-percent certain way to protect yourself is to never have sex or to sleep with only one person who is completely faithful to you. However, if you do have sex with more than one person, having safe sex EVERY TIME will improve your odds of remaining infection-free.

DO

  • Limit your activity to things that do not involve exchange of body fluids. For example, safe sex includes:
    • Hugging and body-to-body rubbing
    • Masturbation alone or with someone else
    • Massage
    • Dry kissing
    • Sex with the use of a condom
  • Avoid activities that will result in an exchange of body fluids. The following things are NOT safe:
    • Mouth-to-mouth kissing (French kissing)
    • Sharing sex toys
    • Using saliva as a lubricant
    • Sex without the use of a condom

Tuesday, January 15, 2008

Abdominal Ultrasound


Ultrasound - abdomen; abdominal sonogram

Abdominal ultrasound is an imaging procedure used to examine the internal organs of the abdomen including the liver, gallbladder, spleen, pancreas, and kidneys. The blood vessels to some of these organs can also be evaluated with the use of ultrasound techniques.

The ultrasound machine sends out high-frequency sound waves that reflect off body structures to create a picture. Unlike with x-rays, there is no ionizing radiation exposure with this test.

The test is done in the ultrasound or radiology department. You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the area being examined to help with the transmission of the sound waves. The ultrasound transducer (a handheld probe) is then moved over the abdomen.

You may be asked to move to other positions so the health care provider can examine different areas. You may also be asked to hold your breath for short periods of time during the examination.

The procedure usually takes less than 30 minutes.

Preparation for the procedure depends on the nature of the problem and your age. Usually patients are asked to not eat or drink for several hours before the examination. Your health care provider will advise you about specific preparation.

There is little discomfort. The conducting gel may feel slightly cold and wet.

There are many reasons for performing an abdominal ultrasound, including looking for the following:

  • A cause of abdominal pain
  • Stones in the gallbladder or kidney
  • A cause for enlargement of an abdominal organ

The reason for the examination will depend on your symptoms.

The organs examined are normal in appearance.

The significance of abnormal results depends on the organ being examined and the nature of the problem. You should consult your health care provider with any questions and concerns.Many possible conditions could be revealed by an abdominal ultrasound. Some of these include:

  • Gallstones
  • Kidney stones
  • Cholecystitis
  • Hydronephrosis
  • Splenomegaly
  • Pancreatitis

Thursday, January 10, 2008

Polycystic kidney disease:



Polycystic kidney disease:

Cysts - kidneys; Kidney - polycystic; Autosomal dominant polycystic kidney disease; ADPKD

Definition Polycystic kidney disease is a kidney disorder passed down through families in which multiple cysts form on the kidneys, causing them to become enlarged.

Causes Polycystic kidney disease (PKD) is passed down through families (inherited), usually as an autosomal dominant trait. If one parent carries the gene, the children have a 50% chance of developing the disorder.Autosomal dominant PKD occurs in both children and adults, but it is much more common in adults, with symptoms often not showing up until middle age. It affects nearly 1 in 1,000 Americans. The actual number may be more, as some people do not have symptoms. The disorder may not be discovered unless tests revealing the disease are performed for other reasons.

An autosomal recessive form of polycystic kidney disease also exists and appears in infancy or childhood. This type tends to be very serious and progresses rapidly, resulting in end-stage kidney failure and generally causing death in infancy or childhood.

Persons with PKD have multiple clusters of cysts form on the kidneys. The exact action that triggers cyst formation is unknown. In early stages of the disease, the cysts cause the kidney to swell, disrupting kidney function and leading to chronic high blood pressure and kidney infections. The cysts may cause the kidneys to increase production of erythropoietin, a hormone that stimulates production of red blood cells. This leads to too many red blood cells, rather than the anemia seen in chronic kidney disease.

Bleeding in a cyst can cause flank pain. Kidney stones are more common in people with PKD.PKD is associated with the following conditions:

  • Brain aneurysms
  • Cysts in the liver, pancreas, and testes
  • Diverticula of the colon

As many as half of people with PKD have cysts on the liver. A personal or family history of PKD increases your risk for the condition.

Symptoms

  • Abdominal pain or tenderness
  • Blood in the urine
  • Excessive urination at night
  • Flank pain on one or both sides

Additional symptoms that may be associated with this disease include the following:

  • Drowsiness
  • High blood pressure
  • Joint pain
  • Nail abnormalities
  • Painful menstruation

Exams and Tests Examination may show high blood pressure, kidney or abdominal masses, abdominal tenderness over the liver, and enlarged liver.

There may be heart murmurs or other signs of aortic insufficiency or mitral insufficiency.

  • A urinalysis may show urine protein or blood in the urine.
  • A CBC may show decreased or increased RBCs and hematocrit.
  • Cerebral angiography may show associated aneurysms.

Those with a personal or family history of PKD should be evaluated to determine if cerebal aneurysms are a cause of headaches.

Polycystic kidney disease and associated cysts on the liver or other organs may be detected with the following tests:

  • Abdominal ultrasound
  • Abdominal CT scan
  • Abdominal MRI scan
  • IVP

In a family with several members with PKD, genetic tests can be done to determine whether a person at risk carries the PKD gene.

Treatment

The goal of treatment is to control symptoms and prevent complications. High blood pressure may be difficult to control, but control of it is the most important aspect of treatment.

Treatment may include:

  • Blood pressure medicines
  • Diuretics
  • Low-salt diet

Any urinary tract infection should be treated promptly with appropriate antibiotics.

Cysts that are painful, infected, bleeding or causing an obstruction may need to be drained. (There are usually too many cysts to make removal a feasible alternative.)

Surgical removal of one or both kidneys may be required. Treatment of end-stage kidney disease may include kidney dialysis or kidney transplantation.

Support Groups

The stress of an illness can often be helped by joining a support group where members share common experiences and problems.

See: Kidney disease - support group

Outlook (Prognosis)

The disease gets worse slowly, eventually resulting in end-stage kidney failure. It is also associated with liver disease, including infection of liver cysts.

Medical treatment may provide relief of symptoms for many years.

The absence of systemic disease or autoimmune disease makes people with polycystic kidney disease good candidates for kidney transplantation.

Possible Complications

  • High blood pressure
  • Anemia
  • Recurrent urinary tract infection
  • Recurrent kidney infection
  • Kidney stones
  • Kidney failure, mild to severe
  • End-stage kidney disease
  • Bleeding or rupture of cysts
  • Infection of liver cysts
  • Liver failure, mild to severe

When to Contact a Medical Professional

Call your health care provider if symptoms indicate polycystic kidney disease may be present.

Call for an appointment with your health care provider if there is a family history of polycystic kidney disease or associated disorders and children are planned. Genetic counseling may be offered.

Prevention

Currently, no treatment can prevent the cysts from forming or enlarging.

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