What is a brain tumour ?

A brain tumour is a heap of anomalous tissue growing in any part of the brain. For some indefinite reason, some brain cells grow in an uncontrolled manner and develop these tumours. These tumours can occur from any part of the brain, spinal cord or the nerves. Generally these tumours can be separated into benign and malignant tumours.

Benign tumours develops slowly and never reach to other parts. However, as they gradually expand in size they can produce stress the normal brain and disturb mental and bodily functions. A few of the benign tumours known are: meningiomas, pituitary adenoma, craniopharyngioma, epidermoid cysts, neurocytoma, haemangioma, pilocytic astrocytoma, etc.
Malignant tumours or cancers are hostile tumours that develops fast and penetrate into the surrounding brain and at times reach to the other parts of the brain or spine. There are several types of malignant brain tumours similar to High Grade Astrocytoma/Glioma, ependymoma, PNET, medulloblastoma, lymphoma, Germ cell tumours. By insistent and timely therapy some of these can be cured.

Symptoms Commonly Observed:

• Limb weakness and some abnormal feeling in the limbs can be a symptom of a tumour in particular parts of the brain mainly in and around the motor or sensory cortex. Usually the opposite side gets affected i.e right-sided weakness by a tumour in the left motor cortex.
• Wobbly walking or imbalance (ataxia) can occur if the tumour is in the cerebellum or any other part of the brain.
• Eyesight could become unclear or sometimes lost if the optic nerve is squashed or enlarged (Papilloedema).
• Sometimes a squint or dual vision (diplopia) can develop if the nerves moving the eyes be exaggerated.
• Current or long term memory could get faint.
• Speech: Capacity to grasp (sensory aphasia) or express (motor aphasia) could be affected by tumours in particular parts of the brain. At times the person can understand but can not express in proper way and can not get the correct words.
• Distorted behaviour, exhaustion, sleepiness, and loss of consciousness are several other symptoms of brain tumours.

Methods to detect a brain tumour:
The majority symptoms explained above are vague and can be caused by various other diseases. A thorough history and medical investigation is initialy done by the doctor and if a brain tumour is alleged then more tests as CT or MRI scan, angiogram, CSF test, hormonal blood test or EEG can be done.
CT or MRI Scan makes special X-ray films that show the complete structure of the brain and spine and pick up any malformation. To obtain a clearer picture, Iodine or Gadolinium diverge dyes are given intravenously. A number of people can develop an allergic effect to the iodine contrast agent and you must every time tell the doctor if you get any allergies. The extra expensive non-ionic diverge agents diminish the risk of allergic reaction. There is a strong magnetic field during the MRI scan and you should tell the doctor if you have any Pacemaker or metallic clip or prostheses inside your body. For these scans which require about half an hour, the patient lies down on the couch of thes CT or MRI machines. The couch moves the patient in the large hole or tunnel of these machines. The entire procedure is painless but the sound produced by the MRI machines can be disturbing for some patients. Through the scan the patient shouldn”t move and for kids who may move a lot, sometimes a slight anaesthesia is given.

• Angiogram is an X-ray taken after injecting an iodine dye in catheters positioned into the arteries. This shows the particulars of the blood supply to the tumour. For vascular deformity like AVM it is necessary to plan embolisation, surgery or stereotactic radiation.
• Cerebro Spinal Fluid (CSF) Study is done subsequent to removal the CSF from the spine with a long needle (lumbar puncture). This is done in specific tumours which have a high possibility of diffusion to the spine or to prohibit infections or bleeding.
• Hormonal Blood Tests are done for tumours such as pituitary adenoma, craniopharyngioma, optic chiasmal or hypothalamic glioma.
• Electroencephalogram (EEG) is seldom done to examine the sample of seizures.

Lung cancer is a malevolent tumour of the lungs. Generally it is bronchogenic carcinoma (about 90%). Lung cancer is the most poisonous malevolent tumour universally, causing up to 3 million deaths.
Disclosure to carcinogens, such as those present in tobacco smoke, immediately causes small changes to the tissue lining the bronchi of the lungs. This result is increasing, and ultimately with constant exposure more and more tissue becomes damaged until a tumour grows. If the tumour developes inwards it can hinder the air passageway, results in breathing difficulties. The lungs can then failed and infections can increase, leading to lung abscess. The patient here would begin to cough up blood-stained substance. Though, if the tumour grows outwards in to the lung it can not even be observed by the patient before it begin s to spread to other portion of the body.
Symptoms of Lung Cancer -
Initial symptoms of lung cancer can be like to those of later signs. Usual symptoms include:

• coughing up blood
• a bad, constant cough
• panting
• chest pains
• weight loss or loss of appetite
• short breathing
• a croaky voice
• Exhaustion

Depending on the kind of tumor, so-called paraneoplastic phenomena can primarily draw attention to the disease. In lung cancer, this sign can be Lambert-Eaton myasthenic syndrome which is a muscle weakness due to auto-antibodies, hypercalcemia and SIADH. Tumors in the upper (apex) of the lung, identified as Pancoast tumors, can attack the local part of the concerned nervous system, leading to altered sweating patterns and eye muscle harms (a combination known as Horner’s syndrome), as well as muscle weakness in the hands due to assault of the brachial plexus.
Different Forms of lung cancer
There are two key types of lung cancer categorised by the mass and manifestation of the malevolent cells seen by a histopathologist under a microscope: small and non-small cell lung cancer. This classification while based on plain pathomorphological criteria has very significant implications for clinical administration and prediction of the disease.

Metastatic Lung Cancer
Small cell lung cancer
Small cell carcinoma which is also known as oat cell carcinoma is the unusual type of lung cancer, making up 20% of cases. It tends to found in the larger breathing tubes and develops rapidly becoming very large. The oncogene most usually involved is the L-myc. The “oat” cell contains solid neurosecretory granules which produce this an endocrine/paraneoplastic syndrome organization.
Non-small cell lung cancer
Epidermoid carcinoma (or Squamous cell carcinoma) too begins in the bigger breathing tubes but developes slower meaning that the mass of these tumours differs when on diagnosis.
Adenocarcinoma or for slower growing types alveolar cell cancer is a type which begins by the gas-exchanging surface of the lung. It is less densely related to smoking.
Large cell carcinoma is a quick -developing type that develops by the surface of the lung.

Blood cancer- also know as Leukemia or leukaemia (notice spelling differences) or a bone marrow having characteristics of an abnormal production (multiplied production) of white blood cells called as leukocytes in medical terms. It belongs to the wide group of disease called hematological neoplasms.
Symptoms

White blood cells, are involved in fighting pathogens, can be concealed or dysfunctional. This could trigger the patient’s immune system (white blood cells etc.) to begin attacking other body cells.

Displacement of the normal bone marrow cells with higher numbers of immature white blood cells can damage the bone marrow can further cause a lack of blood platelets, which are very important in the blood clotting process. It makes sense that people with leukemia can turn out to be bruised, bleed terribly, or grow pinprick bleeds (petechiae).

Ultimately, the red blood cell deficiency leads to anemia, which may produce dyspnea. The entire symptoms can be accredited to other diseases; for analysis, blood tests and a bone marrow inspections are required.

Some other related symptoms

• Fervor, chills, night sweats and other symptoms similar to flu
• Feebleness and fatigue
• Loss of appetite and/or weight
• Puffy or bleeding gums
• Extra bleeding from a small cut
• Neurological symptoms like headache
• Swollen liver and annoyance
• Easy streak
• Frequent viral infection
• Bone pain
• Joint pain
• Enlarged tonsils

The word leukemia, called ‘white blood,’ is consequent of the disease’s namesake excessive white blood cell counts that nearly all leukemia patients suffer before medication. The great number of white blood cells are evident when a blood sample is viewed under a microscope. Often, these additional white blood cells are immature or dysfunctional. The extreme number of cells can also hinder with the normal performance of other cells.

A few leukemia patients do not have high white blood cell counts able to be seen through a regular blood count. This rare condition is called a leukemia. The bone marrow even contains cancerous white blood cells, and they are upsetting the normal production of blood cells. Though, they are residing in the marrow instead of inflowing the blood flow, where they would be detectable in a blood test. For an a leukemia patient, the white blood cell counts in the blood flow can be natural or low. A leukemia can arise in one of the four key types of leukemia, and is specifically common in hairy cell leukemia.
Four key types :

Leukemia is a big term covering a range of diseases.

Leukemia is medically and pathologically divided into its acute and chronic forms.
Acute leukemia having the characteristics of hasty production of young blood cells. This grouping makes the bone marrow incapable to yield vigorous blood cells. Acute forms of leukemia may arise in children and young adults.
Instant medication is necessary for acute leukemia because of the hasty progression and gathering of the malignant cells, which then slick over into the bloodflowm and increase in other organs of the body. Yet, CNS participation is unusual, although the disease seldom causes cranial nerve palsies.
Chronic leukemia is eminent to the unnecessary increase of relatively adult, but yet abnormal, blood cells. Usually taking months to years to develop, the cells are formed at a much higher rate than normal cells, ensuing in several abnormal white blood cells in the blood. Chronic leukemia typically occurs in older people, but can hypothetically arise in any age group. While acute leukemia have to be treated instantly, chronic forms are occasionally monitored for a bit before treatment to make sure maximum success of therapy.

Causes

There is no particular proven cause for all of the various types of leukemia. The various leukemias probably have several causes, and not much is certain regarding what causes them. Researchers have strong doubts about four possible causes:
natural or artificial ionizing radiation
particular kinds of chemicals
some viruses
inherited predispositions
Leukemia, similar to other cancers, be caused by somatic mutations in the DNA which trigger oncogenes or deactivate tumor suppressor genes, and upset the control of cell death, separation or split. These mutations can arise instinctively or consequently disclosure to emission or carcinogenic substances and are probably to be prejudiced genetic factors. Legion and case-control studies have connected disclosure to petrochemicals, for example benzene, and hair dyes to the expansion of some forms of leukemia.

Viruses have also been allied to various forms of leukemia. Such as, particular cases of ALL are related with viral infections by any human immunodeficiency virus (HIV, responsible for AIDS) or human T-lymphotropic virus (HTLV-1 and -2, causing adult T-cell leukemia/lymphoma).

Until the reason or reasons of leukemia are found, there is no means to prevent the disease. While the causes be revealed, they possibly will prove to be things which are not easily controllable, such as naturally occurring background radiation, and so not notably helpful for prevention purposes.

What is Breast Cancer

Ductal Carcinoma of the Breast is one of the main types of breast cancer. The breast is an organ designed to manufacture and deliver milk to the infant. The majority of the breast is composed of fatty tissue. Milk glands lie within this fatty tissue and are connected to the nipple via a series of ducts. The breast is also rich in blood vessels and lymphatic channels.

There are various types of breast cancer categorised by the way the cells appear under the microscope. The main types are:
* Ductal carcinoma (70-80%): cancer cells that resemble the ducts of the breast
* Lobular carcinoma (5-10%): cancer cells that resemble the lobules or glands of the breast
* Medullary carcinoma (1 to 5%)
* Mucinous (1 to 6%)
* Tubular carcinoma (2%)

The types of breast cancer vary in their prognosis and the way in which they present. Ductal carcinoma (in situ and invasive) will be discussed here. The term ‘in situ’ refers to pre-invasive breast cancer. This is breast cancer which has not yet penetrated (’invaded’) through the basement membrane (the membrane at the base of the epithelial lining of ducts or glands). In situ carcinoma has the potential to become invasive carcinoma, and so is treated as an early form of breast cancer. In the left-hand image below, you can see how the normal cells which line the ducts of the breast might look. In ductal carcinoma in situ (DCIS, the image to the right), the duct cells have developed the ability to multiply out of control - one of the characteristics of cancer. The cancerous cells are filling the duct, but have not yet spread beyond the lining of the duct. This is known as DCIS.

The next set of images below show the cells of invasive breast cancer. These cells have not only multiplied out of control, filling the duct, but have also developed the ability to spread, or invade, beyond the lining of the ducts. This is invasive ductal carcinoma, or IDC.

Who gets Breast Cancer?

Breast cancer is common. Breast cancer is one of the top two causes of cancer deaths together with lung cancer in most developed countries. 99% of breast cancers occur in women with 1% in men. Incidence increases with age. Breast cancer is rare in those under the age of 30, but presents in up to 1 in 14 women over the age of 70. 15-30% of breast cancers are of the in situ type whilst 70-85% are of the invasive type. Ductal carcinoma is the most common making up 80% of all breast cancers. DCIS has increased in incidence since the introduction of mammographic screening. It is now seen in 20-25% of women over 50 screened with mammography. Geographically, breast cancer is found worldwide.

Predisposing Factors

The main risk factors for breast cancer are:

* Increasing age
* A family history of breast cancer
* Proliferative breast disease
* Hormonal factors: women who begin menstruation early, women who have a late menopause, late or few pregnancies, or who are obese. Some evidence is emerging that long term oestrogen therapy (for example, long-term use of the oral contraceptive pill, or hormone replacement therapy (HRT)) may increase risk, as may a diet which is high in fat.
* Others: exposure to radiation; geographical factors.

Progression

Ductal carcinoma in situ (DCIS) is an ‘early’ form of breast cancer. In this case, cells lining the ducts of the breast have become abnormal and are growing more rapidly than usual, but are not able to spread beyond the ducts. Women with DCIS are at higher risk of developing invasive ductal carcinoma. Invasive ductal carcinoma has developed the ability to spread beyond the ducts of the breast. Ductal carcinoma of the breast spreads initially by direct invasion of overlying skin and adjacent fat. Spread into lymphatics and to lymph nodes in the axilla is the most important step, since from there it can spread to lymph nodes in the neck and supraclavicular region and into blood vessels. Once in the blood vessels, spread is possible to distant organs such as the bones, lung or liver.

Probable Outcomes

Early breast cancer has a good (greater than 80%) 5 year survival. Important prognostic factors which can help predict survival include involvement of lymph nodes, the size of the tumour, and how aggressive the tumour cells are. If the cancer has metastasised (spread) to lung, liver or bone at diagnosis, 5-year survival rates are significantly lower. As mentioned above, women with DCIS are at increased risk of developing invasive breast cancer in the future. However, as most cases of DCIS are now treated, it is not known exactly how high this risk is, or how quickly the progression from in situ to invasive cancer is likely to occur.

How is Breast Cancer Diagnosed?

Any breast symptom, such as a lump or nipple discharge, is assessed with the ‘triple test’. This includes examination of the breast, imaging of the breast through mammography or ultrasound, and sampling of the breast tissue with fine needle aspiration (FNA), core biopsy or open biopsy. Following a diagnosis of breast cancer, blood tests including Full Blood Count and Liver Function Tests may be used to assess the possibility that the cancer may have spread to the liver or bone marrow. Other imaging tests, including chest x-rays, bone scan, abdominal CT or liver ultrasound may also be used if symptoms suggest that the cancer has spread.

How is Breast Cancer treated?

Surgical treatment of breast cancer aims to achieve total disease control through removal of the primary breast tumour, along with any local extension.
Virtual Medical Centre Video

Surgical treatment can be divided into two major streams:

* Breast conserving surgery with complete local excision (CLE) and axillary dissection, or
* Total mastecomy with axillary dissection.

These two procedures are considered similar in terms of 5- and 10-year survival rates. The decision as to which procedure is more appropriate is therefore based on clinical features, such as the size and location of the tumour, and patient preference.

* Larger, widespread cancers or cancer near the nipple may usually require mastectomy (removal of the whole breast). This can be followed by reconstructive surgery.
* Smaller tumours, or tumours located in the outer quadrant in larger breasts may be removed by lumpectomy or partial mastectomy. Radiotherapy usually follows the procedure.
* Axillary dissection refers to the removal of lymph nodes in the axilla (armpit). These lymph nodes are commonly the first site of metastasis (spread) of a breast tumour, and axillary dissection is routinely done to ensure all cancer cells are removed. Rarely, with some very small and well-defined cancers, axillary dissection may not be necessary.

Adjuvant therapy refers to chemotherapy, radiotherapy or hormone therapy which is done with the aim of destroying any cancer cells not removed by surgery. Chemotherapy protocols include:

1. CMF:
* Cyclophosphamide 100mg/m2 PO days 1-14
* Methotrexate 40mg/m2 IV days 1+8
* 5-Fluorouracil 600mg/m2 IV days 1+8 (repeat every 4 weeks for 6 cycles)
ALL I.V. CMF:
* Cyclophosphamide 750mg/m2 IV day 1 (or 150mg/day)
* Methotrexate 60mg/m2 IV day 1
* 5-Fluorouracil 750mg/m2 IV day 1 (repeat every 3 weeks)
2. AC:
* Doxorubicin 60 mg/m2
* Cyclophosphamide 600 mg/m2
3. For High Risk Patients:
* TAC
* FEC 75
* FEC 100
* Docetaxel
* Paclitaxel
Modifications:
1. Post menopausal:
* Tamoxifen 20 mg PO daily
2. Locally Advanced FAC:
* 5-Fluorouracil 600 mg/m2 IV day 1 + 8
* Doxorubicin 60mg/m2 IV day 1 (vesicant)
* Cyclophosphamide 600mg/m2 IV day 1 (repeat every 4 weeks)
4. Stage IV: First line chemotherapy:
* CMFP (oral or IV) (add prednisolone 40mg/m2 PO days 1-14 to CMF)
Reassess every 3 courses Treat until maximum response
* Trastuzumab (Herceptin) and Taxanes
* Herceptin 4 mg/kg IV over 90 minutes then 2mg/kg/week over 30 minutes until progression
o WITH Docetaxel 75 mg/m2 IV over 1 hour every 3 weeks for 6 cycles OR
o Paclitaxel 90 mg/m2 IV over 60 minutes weekly
5. Herceptin single agent:
* Herceptin 4 mg/kg IV over 90 minutes then 2mg/kg/week over 30 minutes until progression
6. Second line chemotherapy:
* Doxorubicin 60mg/m2 IV day 1 (vesicant) (repeat every 3 weeks)
7. Third line chemotherapy:
* Docetaxel 75 mg/m2/day over 1 hour as starting dose can escalate to 100mg.m2/day IV over 1 hour. In heavily pretreated patients or those with poor liver function can start at 60 mg/m2. (repeat every 3 weeks)
* Docetaxel (weekly) 36 mg/m2/week over 1 hour for 6 weeks then 2 weeks off
* Paclitaxel 175mg/m2/day over 3 hours IV (repeat every 3 weeks)
* Paclitaxel (weekly) 100 mg/m2 IV over 1 hour
8. Fourth line chemotherapy:
* Capecitabine 2500 mg/m2 divided into 2 doses daily po 2 weeks every 3 weeks
* Mitomycin C 10 mg/m2 IV Day 1 (vesicant)
* Vinblastine 5 mg/m2 IV Day 1 and 15 (vesicant) (repeat every 4 weeks)
9. Hormonal Therapy:
* Tamoxifen 20 mg. po daily or Anastrozole 1mg po daily
* Then Medroxyprogesterone acetate 500 mg po daily Or Exemestane 25 mg/day
10. Premenopausal Advanced Breast Cancer:
* Zoladex 3.6 mg SC every month
* Tamoxifen 20 mg/day
11. Bone metastases: When the tumour has spread to bone, zoledronic acid can be used to help prevent fractures.
* Zoledronic acid 4mg iv over 15mins every 28 days
12. Breast Cancer (Bone Predominant):
* Pamidronate 90mg IV over 2 hours.

If the tumour has spread to bone, treatment with zoledronic acid can help prevent tumour growth in bone and subsequent bone fractures. Symptoms that may require attention include bone pain from bone metastases, visceral (organ) pain from liver or lung metastases and neurogenic (nerve) pain if nerve tissue is compressed. Improvement in symptoms is an important measurement. Hormone therapies: Women with hormone receptor-positive tumours (eg. oestrogen-receptor positive tumours) should be offered adjuvant hormone therapies such as tamoxifen or ovarian ablation therapy. Click the links below to see for information on other breast cancers:

* Breast cancer - Adenocarcinoma of the breast
* Breast pain
* Male breast cancer
* Breast cancer - Lobular carcinoma of the breast
* Inflammatory breast cancer

Breast Cancer References

1. Australian Institute of Health and Welfare & National Breast Cancer Centre 2006. Breast cancer in Australia: an overview, 2006. Cancer series no. 34. cat. no. CAN 29. Canberra: AIHW.
2. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 16th Edition. McGraw-Hill. 2001
3. Cotran RS, Kumar V, Collins T. Robbins Pathological Basis of Disease Sixth Ed. WB Saunders Company 1999.
4. Dr Guy Van Hazel, Oncologist, Mount Hospital, Perth
5. Kumar P, Clark M. Clinical Medicine. Fourth Edition. WB Saunders, 1998.
6. National Breast Cancer Centre. 2003. ‘The clinical management of ductal carcinoma in situ, lobular carcinoma in situ and atypical hyperplasia of the breast,’ First Edition. National Breast Cancer Centre, Camperdown,NSW. [online] Available from: http://www.nbcc.org.au/bestpractice/resources/CMW_dcisbook.pdf
7. National Breast Cancer Centre. 2001. ‘Clinical practice guidelines for the management of early breast cancer:Second edition’. National Breast Cancer Centre, Camperdown,NSW. [online] Available from: http://www.nhmrc.gov.au/publications/synopses/cp74syn.htm
8. Schwartz, GF, Solin, LJ, Olivotto, IA, et al. Consensus Conference on the Treatment of In Situ Ductal Carcinoma of the Breast, April 22-25, 1999. Cancer 2000; 88:946.
9. Talley NJ, O’Connor Simon. Clinical Examination. Fourth Edition. MacLennan & Petty, 2001

Related Documents:

* For a PPT presentation titled ‘NCCTG N9831: Whether Trastuzumab adds to the benefit of adjuvant paclitaxel in resected HER-2 positive breast cancer’ please click here.
* For a PPT presentation titled ‘The Role of Bevacizumab in the Treatment of Metastatic Breast Cancer’ please click here.
* For a PPT presentation titled ‘A Randomized Phase III Trial of Paclitaxel versus Paclitaxel plus Bevacizumab as First-Line Therapy for Locally Recurrent or Metastatic Breast Cancer’ please click here.
* For a PPT presentation titled ‘Doxorubicin and Cyclophosphamide Followed by Paclitaxel with or without Trastuzumab as Adjuvant Therapy for Patients with Her-2 Positive Operable Breast Cancer’ please click here.
* For a PPT presentation titled ‘Targeting HER-2 in the Adjuvant Setting’ please click here.
* To view these PPT slides with a free PowerPoint viewer 2003, please click here.

Regimens Used in the Treatment of This Disease:

* 5-Fluorouracil
* AC (Doxorubicin + Cyclophosphamide)
* ACE (Doxorubicin + Cyclophosphamide + Etoposide)
* Capecitabine + Docetaxel
* Capecitabine + Paclitaxel
* CMF (Cyclophosphamide + Methotrexate + 5-Fluorouracil)
* Docetaxel
* Doxorubicin
* Doxorubicin (Liposomal)
* EC (Epirubicin + Cyclophosphamide)
* Epirubicin
* FEC 100 (5-Fluorouracil + Epirubicin + Cyclophosphamide)
* FEC 75 (5-Fluorouracil + Epirubicin + Cyclophosphamide)
* Gemcitabine + Paclitaxel
* Mitomycin
* Mitozantrone
* Paclitaxel + Trastuzumab
* TAC (Docetaxel + doxorubicin + cyclophosphamide)

Treatments Used in This Disease:

* Breast Conserving Surgery
* Mastectomy

Drugs/Products Used in the Treatment of This Disease:

* Methotrexate Injection BP
(Methotrexate)

* Arimidex
(Anastrozole)

* Aromasin
(Exemestane)

* Avastin
(Bevacizumab)

* Femara
(Letrozole)

* Gemzar
(Gemcitabine hydrochloride)

* Haldol Decanoate
(Haloperidol decanoate)

* Herceptin
(Trastuzumab)

* Megace
(Megestrol acetate)

* Onkotrone
(Mitozantrone hydrochloride)

* Pamisol
(Disodium pamidronate)

* Provera
(Medroxyprogesterone acetate)

* Tamoxifen-BC
(Tamoxifen citrate)

* Taxotere
(Docetaxel)

* Tykerb
(Lapatinib Ditosylate)

* Xeloda
(Capecitabine)

* Zoladex 3.6mg and 10.8 mg Implant
(Goserelin acetate)

* Zometa
(Zoledronic acid)

What is Anorexia Nervosa

Anorexia nervosa is a psychological disease.

This condition is hallmarked by an extreme reluctance to consume food as a result of a psychological disturbed body image. This may lead to extreme malnutrition and weight loss. Anorexia nervosa is potentially life-threatening.

Who gets Anorexia Nervosa?

The incidence of anorexia nervosa is 1-10 per 100 000 females aged between 15 and 34 years. There is a prevalence rate of 1-2% among schoolgirls and university students. Anorexia nervosa is much less common among men with a 1:10 ratio of boys:girls. The onset of anorexia nervosa disease usually occurs between the ages of 10 and 30 years, initiated by a stressful life event. Anorexia nervosa occurs mostly in those individuals striving for success in industries that demand a slim body image such as modelling and dancing. There is also a higher prevalence of anorexia nervosa in higher social classes.

Predisposing Factors

Several theories have been put forward to explain the origin of anorexia nervosa, but none have stood the test of time.

The following are important important associations of anorexia nervosa:

1. Stressful life events: The condition most commonly follows a stressful situation or event in the patient’s life.
2. Genetic: There is a higher rate of anorexia nervosa in those with a family history of this anorexia. An increased occurrence has beenshown to exist in full-blood sisters.
3. Turbulent family relationships: Overprotective parents, and a pattern of conflict avoidance is shown to increase the risk of developing anorexia in children. Children are thought to use anorexia nervosa as a kind of hunger strike. The child then gains power in the family dynamic for it is the child who recieves the attention and decides the outcome of a family dilemma.

Progression

The age of onset of anorexia in women is usually between 10 and 30 years of age, seldom occurring after the age of 30 years.

The onset of this anorexia nervosa usually goes unnoticed until a significant amount of weight has been lost. Weight loss is achieve with severe diet restriction and excessive amounts of exercise. Weight loss may be also occur with self-stimulation of vomiting and excessive use of laxatives. With further weight loss, a woman’s period may cease, and the patient may develop low blood pressure, slow heart rate, and become very sensitive to the cold. Throughout any stage of the disease, the patient may exhibit psychological symptoms of depression and anxiety, related to their distorted body image of being “fat.”

Probable Outcomes

Anorexia nervosa runs a fluctuating course, with exacerbations and partial remissions. Long-term follow up suggests that about two-thirds of patients maintain normal weight and that the remaining one-third are split between those who are moderately underweight and those who are seriously underweight.

Indicators of a poor anorexia nervosa outcome include:

* A long initial illness;
* Severe weight loss;
* Older age at onset;
* Bulimia, vomiting or purging;
* Personality difficulties; and
* Difficulties in relationships.

Suicide has been reported in 2-5% of patients with chronic anorexia nervosa. The mortality rate per year is 0.5% from all causes. More than one-third have recurrent affective illness, and various family, genetic and endocrine studies have found associations between eating disorders and depression.

50% of patients make a full recovery, 30% a partial recovery and 20% none.

How is Anorexia Nervosa Diagnosed?

Fecal occult blood may be indicative of esophagitis, gastritis, or repetitive colonic trauma from laxative abuse as well as a bleeding disorder or severe protein malnutrition.

How is Anorexia Nervosa treated?

Anorexia nervosa treatment can be conducted on an outpatient basis unless the weight loss is severe and accompanied by marked physical symptoms such as dizziness, weakness and/or electrolyte and vitamin disturbances. Hospital admission may then be unavoidable and may need to be on a medical ward initially. Rarely the patient’s weight loss may be so severe as to be life-threatening. If the patient cannot be persuaded to enter hospital, compulsary admission may have to be used.

Inpatient treatment goals include:

* Establishing a good relationship with the patient;
* Restoring the weight to a level between the ideal bodyweight and the patient’s ideal weight;
* The provision of a balanced diet, building up to 12.6MJ (3000 calories) in 3 to 4 meals per day;
* The elimination of purgaitve and/or laxative use and vomiting.

Outpatient treatment can be conducted on either or both of cognitive behavioural psychotherapeutic lines or dynamic psychotherapeutive lines. It is vital to set up a therapeutic alliance. Individual psychotherapy is better than family therapy if the patient has left home and vice versa.

Motivational enhancement techniques have been used with some success.

Drug treatment has met with limited success, except to symptomatically treat insomnia and depressive illness.

Article kindly reviewed by:

The DAA WA Oncology Interest Group
and
Food4Health (Helen Baker Dietitian-APD)

Anorexia Nervosa References

1. Bochereau D, Clervoy P, Corcos M, Girardon N: [Eating disorders. Anorexia nervosa in adolescents]. Presse Med 1999 Jan 16; 28(2): 89-99[Medline].
2. Deep AL, Nagy LM, Weltzin TE, et al: Premorbid onset of psychopathology in long-term recovered anorexia nervosa. Int J Eat Disord 1995 Apr; 17(3): 291-7
3. Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
4. eMEDICINE.

Symptoms of This Disease:

* Impulsivity

Treatments Used in This Disease:

* Parent Training/ Parent Therapy
* Individual Therapy
* Psychoeducation

What is Anaphylaxis

Anaphylaxis is a sudden, severe allergic reaction to a substance (called an allergen) that can be life-threatening. Common substances which can cause as severe allergic reaction include bee stings, insect bites, peanuts, eggs, drugs given to the body, etc. Anaphylaxis suddenly affects the whole body, with severe allergic symptoms including: difficulty breathing, rash, swelling, tummy pain, and reduced blood pressure leading to shock. Anaphylaxis is a medical emergency where immediate treatment is needed to prevent potential death.

When exposed to a foreign substance, some people suffer reactions identical to anaphylaxis, but in which no allergy is involved. These reactions are called anaphylactoid, meaning anaphylaxis-like reactions. In anaphylaxis, the immune system must be “primed” by previous allergen exposure. But in anaphylactoid reactions can occur with no previous allergen exposure at all. An example of something that can bring on a severe allergic reaction is radiographic contrast material (the dye injected into arteries and veins to make them show up on an x-ray).

Although the mechanism of an anaphylactoid reaction is different. The allergy treatment is the same.

Who gets Anaphylaxis?

Anaphylaxis occurs infrequently. However, it is life-threatening and can occur at any time. Milder forms of anaphylaxis occur much more frequently than fatal anaphylaxis.

The frequency of anaphylaxis is increasing and this has been attributed to the increasing number of potential allergens to which people are exposed.

In the US, anaphylaxis causes approximately 500-1000 deaths in a year. However the figure is difficult to determine accurately because of underdiagnosis and underreporting.

No major differences have been reported in the incidence and prevalence of severe allergic reactions between men and women.

Anaphylaxis occurs in all age groups. While prior exposure to allergens is essential for the development of true anaphylaxis, severe allergic reactions occur even when no documented prior exposure exists. Thus, patients may react to a first exposure to an antibiotic or insect sting. Adults are exposed to more potential allergens than are pediatric patients. The elderly have the greatest risk of mortality from severe allergic reactions due to the presence of other diseases usually suffered by elderly population.

Predisposing Factors

The likelihood of an individual having anaphylaxis is influenced by the following:
# age
# gender
# atopy (genetic tendency to develop classic allergic diseases)
# route of exposure
# history of prior exposure
# history of prior anaphylactic episodes

Other risks include prior history of any type of allergic reaction. After an initial exposure to a substance like bee sting toxin, the person’s immune system becomes sensitized to that allergen. On a subsequent exposure, an allergic reaction occurs.

Severe allergic reactions are usually triggered by a limited number of allergic exposures. These include injection, swallowing, inhaling or skin contact with an allergen by a severely allergic individual.

Examples of injected allergens are bee, hornet, wasp and yellow jacket stings; certain vaccines which have been prepared on an egg medium; and allergen extracts used for diagnosis and treatment of allergic conditions. Antibiotics such as penicillin can trigger a reaction by injection or swallowing.

Typically, a severe reaction caused by a food allergy occurs after eating that particular food, even a small bite. Allergy to peanuts is an example. Skin contact with the food rarely causes anaphylaxis. Foods most commonly associated with anaphylaxis are peanuts, seafood, nuts and, in children particularly, eggs and cow’s milk.

A severe allergic reaction from an inhaled allergen is rare. An increasingly recognizable example is when an allergic individual inhales particles from rubber gloves or other latex products.

Progression

The signs and symptoms of anaphylaxis may occur almost immediately after exposure or within the first 20 minutes after exposure. Rapid onset and development of potentially life threatening symptoms are characteristic markers of anaphylaxis.

Allergic symptoms
may initially appear mild or moderate but can progress rapidly. The most dangerous allergic reactions involve the lungs and/or heart/vessel system.

Probable Outcomes

Anaphylaxis is a severe disorder which has a poor prognosis without prompt treatment.

Symptoms, however, usually resolve with appropriate treatment, therefore highlighting the importance of immediate action. There are no long-term effects of anaphylaxis other than the possibility of recurrence or the occurrence of this disease.

How is Anaphylaxis Diagnosed?

The diagnosis of anaphylaxis is based on the signs and symptoms of the patient, and the history of exposure to allergens, and therefore does not rely on laboratory testing.

How is Anaphylaxis treated?

Immediate management:

Anaphylaxis is an emergency condition requiring immediate professional medical attention. Assessment of the ABC’s (Airway, Breathing, and Circulation) should be done in all suspected anaphylactic reactions.

Adrenaline is a drug that should be given by injection without delay. This opens the airways and raises the blood pressure by constricting the blood vessels. Adrenaline comes in multiple formats, one of them called Epi-pen that might be carried by individuals.

CPR (cardiopulmonary resuscitation) should be initiated if needed. People with known severe allergic reactions may carry an Epi-Pen or other allergy kit, and should be assisted if necessary. Emergency interventions by paramedics or physicians may include placing a tube through the nose or mouth into the airway (endotracheal intubation) or emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy).

Treatment for shock includes giving fluids into the patient through the veins and medications that support the actions of the heart and circulatory system.

Antihistamines and steroids may be given to further reduce symptoms (after lifesaving measures and adrenaline are administered).

Prevention of anaphylaxis:

Prevention involves avoidance of known allergens. Any person experiencing an allergic reaction should be monitored, although monitoring may be done at home in mild cases.

Occasionally, people who have a history of drug allergies may safely be given the offending medication after pretreatment with corticosteroids (prednisone) and antihistamines (diphenhydramine).

People who have a history of allergy to insect bites/stings should be instructed to carry (and use) an emergency kit consisting of injectable adrenaline and chewable antihistamine. They should also wear a Medic-Alert or similar bracelet/necklace stating their allergy.

Anaphylaxis References

1. Anaphylaxis Action Plan - generic - Australian version [online]. 2005. [Cited 2005 October 6th]. Available from: URL: http://www.allergy.org.au/aer/infobulletins/posters/Anaphylaxis_plan_(gen)_Au.pdf
2. eMedicine: Anaphylaxis [online]. 2005. [Cited 2005 October 6th]. Available from: URL: http://www.emedicine.com/EMERG/topic25.htm
3. Pumphrey, R. Anaphylaxis: can we tell who is at risk of a fatal reaction?. Curr Opin Allergy Clin Immunol 2004; 4:285.
4. Sampson, HA, Munoz-Furlong, A, Bock, SA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol 2005; 115:584.
5. Up to Date: Anaphylaxis [online]. 2005. [Cited 2005 October 6th]. Available from: URL: http://www.utdol.com/application/topic.asp file=cc_medi/5448&type=A&selectedTitle=1~59

Symptoms of This Disease:

* Allergy
* Skin Rashes

Drugs/Products Used in the Treatment of This Disease:

* Adrenaline Injection
(Adrenaline acid tartrate)

* Albay Bee/Wasp/Yellow Jacket Venom
(Allergen extracts)

* Allergenic Aqueous Extracts
(Allergen extracts)

* Allergenic Extracts for Scratch & Prick Testing

* Allpyral Allergen Extracts
(Allergen extracts)

* EpiPen
(Adrenaline)

* Phenergan Injection
(Promethazine hydrochloride)

* Promethazine Hydrochloride Injection BP (DBL)
(Promethazine hydrochloride)

What is Appendicitis

Appendicitis is sudden onset of inflammation of the appendix, which is a small, finger-shaped blind-ending sac that branches off the first part of the large intestine (caecum).
Appendicitis

Who gets Appendicitis?

Except for a hernia, acute appendicitis is the most common cause in the USA of an attack of severe, acute abdominal pain that requires abdominal operation.

The incidence of acute appendicitis is around 7% of the population in the United States and in European countries. In Asian and African countries, the incidence is probably lower because of the dietary habits of the inhabitants of these geographic areas.

Appendicitis occurs more frequently in men than in women, with a male-to-female ratio of 1.7:1. Appendicitis can effect any age but is more commom before 40 years of age, particularly in young people between 8 and 14 years. Rare cases of neonatal and prenatal appendicitis have been reported.

Predisposing Factors

Appendicitis generally occurs following the obstruction of the appendix by faeces, another foreign body, or on rare occasions, a tumour. The first symptom is cramp like pain around the navel.

There is usually a marked decrease or total lack of appetite, often accompanied by nausea and occasionally, vomiting and fever.

Progression

Appendicitis can sometimes be hard to diagnose as its symptoms vary widely between patients. However, typical symptoms and signs that suggest appendicitis is the sudden onset of central abdominal pain followed by nausea and vomiting.

After a few hours the pain then shifts to the right lower abdomen, and can be localised. The patient generally also has a low grade fever and will have a raised white blood cell count when blood tests are taken.

Probable Outcomes

Appendicitis is a serious medical condition that needs urgent medical attention. If left untreated life-threatening peritonitis may develop.

With early surgery, the mortality rate is very low, the patient is usually discharged within a few days, and the recovery period is normally rapid and complete. With complications (such as rupture and either formation of an abscess or peritonitis), the prognosis is more serious; and although antibiotics have lowered mortality to nearly zero in many institutions, patients may need further surgery and therefore their recovery period will be longer.

How is Appendicitis Diagnosed?

The doctor may investigate appendicitis by performing the following tests:

* A blood test called a full blood count or FBC (which counts all your cells in the blood), which would often show an increased white blood cell count.
* An abdominal x-ray.

In cases where the diagnosis is uncertain, an ultrasound or CT scan of the abdomen may be useful.

How is Appendicitis treated?

For definitive appendicitis, surgery (called an appendectomy or appendicectomy which removes the appendix) is performed as soon as possible after the diagnosis is made. Little preparation is required.

An appendectomy should be preceded by antibiotics, which are again given during the operation and continued during the early postoperative period. Suspected acute appendicitis should not be treated by antibiotics alone unless an operation is impossible.

In cases where the diagnosis of appendicitis is uncertain, hospital admission for a period of 12 to 24 hours for further observation may be undertaken. This time frame allows for the true clinical characterisitics of the illness to become evident.

Appendicitis

Appendicitis References

1. Azaro EM, Amaral PC, Ettinger JE: Laparoscopic versus open appendicectomy: a comparative study. JSLS 1999 Oct-Dec; 3(4): 279-83.
2. Burkitt G, Quick C. Essential Surgery. 3rd Edition. Churchill Livingstone, 2002.
3. Kraemer M, Franke C, Ohmann C: Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature. Langenbecks Arch Surg 2000 Nov; 385(7): 470-81
4. Longmore, Wilkinson, Rajagopalan. Oxford Handbook of Clinical Medicine, 6th ed, Oxford University Press, United Kingdom 2004.
5. Morris PJ, Wood WC. Oxford Textbook of Surgery. 2nd Edition. Oxford University Press 2000.
6. The Merck Manual.

Symptoms of This Disease:

* Abdominal Pain

Treatments Used in This Disease:

* Appendicectomy

Drugs/Products Used in the Treatment of This Disease:

* Panamax Co.
(Codeine phosphate, Paracetamol)

* Paracetamol/Codeine
(Codeine phosphate; Paracetamol)

What is Generalised Anxiety Disorder

Generalised Anxiety Disorder (GAD) is a psychological disease.

This condition is characterised by excessive worry about actual circumstances, events or conflicts that occur in everyday life.

Anxiety disorders are classified according to whether the anxiety is persistent (general anxiety) or episodic, with the episodic conditions classified according to whether the episodes are regularly triggered by the same cue (phobia) or not (panic disorder).

Who gets Generalised Anxiety Disorder?

General anxiety disorder occurs in 3-8% of the population. The disorder may start at any time in life, including childhood. The majority of patients presenting with the disorder report that they have been anxious for as long as they can remember. GAD occurs somewhat more often among women than among men.

Predisposing Factors

The most important risk factor for the development of any anxiety disorder is a family history of anxiety disorder. It is estimated that this condition affects 25% of first degree relatives of a person with GAD.

Behavioral inhibition1, an early temperament associated with aversion to novel situations, has been found to be associated with later development of anxiety disorders.

Progression

This condition begins at variable ages, most commonly in early childhood. The course is usually long-term with the severity of symptoms decreasing as the patient gets older. As the duration of illness increases, the patient becomes more likely to develop depression, especially if the condition remains untreated.

Probable Outcomes

If the condition remains untreated, the prognosis is poor. Most patients will develop secondary depression, requiring medical and psychological therapy for the management of depression. With treatment the prognosis is good, as the risk of developing secondary depression is reduced.

How is Generalised Anxiety Disorder Diagnosed?

Investigation of anxiety disorders is largely inappropriate as the test itself may become a source of anxiety for the patient. The condition is only investigated if there is strong suspicion of a medical cause of anxiety following history and physical examination. Investigat6ion may involve performing an ECG and blood tests for thyroid disease, adrenal disease and blood sugar levels.

How is Generalised Anxiety Disorder treated?

As with most psychiatric illness, generalised anxiety disorder is best treated with both psychotherapy and anti-anxiety medications. There are a number of types of psychotherapy suitable for the treatment of panic disorder. These include relaxation therapy, behaviour therapy and cognitive behavioural therapy.

Medications are used to assist psychotherapy as a primary form of treatment. Medications such as sedatives and antidepressants are used in this setting to reduce the frequency and severity of panic attacks. The most commonly used sedatives are the benzodiazepines such as diazepam, however their use beyond 4-6 weeks is discouraged with the emergence of dependence beyond this duration. The most commonly used antidepressant for this condition are the SSRI’s such as flluoxetine and sertraline. Antidepressant medications will usually require three months of therapy to achieve adequate effect, but have the advantage that they do not induce patient dependency.

Another class of drugs commonly used for generalised anxiety disorder are the beta-blockers. These drugs block the body’s response to anxiety, preventing the occurrence of palpitations, sweating and tremor in the event of a panic attack. They can also be taken in anticipation of a stressful situations to reduce the effect of anxiety on the body.

Generalised Anxiety Disorder References

[1] Kagan J: Temperamental contributions to social behavior. American Psychologist 1989;44:668-674.
[2] Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
[3] Sadock BJ., Sadock VA. Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry 3rd edition. Lippincott Williams and Wilkins 1996.

Symptoms of This Disease:

* Inattention
* Hyperactivity
* ADHD: Recognising the Symptoms

Drugs/Products Used in the Treatment of This Disease:

* Cipramil
(Citalopram hydrobromide)

* Inderal
(Propranolol hydrochloride)

* Prozac
(Fluoxetine hydrochloride)

* Valium
(Diazepam)

* Zoloft
(Sertraline hydrochloride)

What is Syphilis

Syphilis is a sexually transmitted or congenital infection caused by the bacterium Treponema pallidum.

Although it begins as a genital infection, it becomes a systemic disease in the second (secondary syphilis), third (tertiary syphilis) or fourth stage (quaternary syphilis) and can affect most organs of the body including the bones and joints, liver, heart and brain.

Who gets Syphilis?

Syphilis is found worldwide and is still the third most common sexually transmitted bacterial infection in the United States despite being easily treatable. Almost 50, 000 new cases are reported each year in the United States, although the actual incidence is likely to be higher as not all cases are necessarily reported. Syphilis tends to affect men and women betwen 15 and 40 years of age with the highest rates in sexually active adults between 20-29 years of age.

The incidence of syphilis has fortunately tended to decrease since the introduction of penicillin therapy and screening methods. However, in some groups such as homosexual men, the rates continue to increase. Periods of high illegal drugs use also correspond with higher rates of syphilis due to risk taking behaviour and needlestick transmission.

Men traditionally have higher rates of syphilis infection despite higher levels of screening than women. There are approximately 4.7 cases of primary and secondary syphilis per 100,000 men in the United States each year (2004 statistics). In particular, homosexual men are at high risk. A study conducted in 2004 showed approximately 64% of all adult primary and secondary syphilis cases were among men who have sex with men.

Women in general have lower rates of syphilis infection than men. In the United States there are approximately 0.9 cases per 100,000 women (2004 statistics). Fortunately these rates have continued to decrease over recent years.

Children: Most syphilis in children is congenital which occurs due to transmission of bacteria across the placenta from infected mothers. The risk of transmission to the fetus is very high particualrly in the earlier stages of the mother’s disease. The effects of congenital infection are usually apparent within 2-6 weeks after birth and signs of late syphilis develop beyond two years of age.

Predisposing Factors

Syphilis is an infectious disease caused by a bacteria Treponema pallidum, which penetrates broken skin or mucous membranes.

* Transmission occurs most frequently by sexual contact- People who commonly engage in unprotected sex, sex workers, IV drug users and health care workers are at increased risk.
* Syphilis can also be transmitted to the fetus during any stage in pregnancy.

Progression

The bacteria enters the body through breaches in epithelium (lining of cells).There are 4 main stages of disease and congenital syphilis which is viewed separately:

1. Primary: between 10 and 90 days after infection. The primary lesion (called a chancre) develops at the site of entry of bacteria on the penis, cervix, vagina wall or anus. This starts as a lump and later bcomes an ulcer. This primary lesion heals spontaneously within 2-3 weeks but by this stage the bacteria has already spread through the bloodstream.
2. Secondary: 4-10 weeks after the appearance of the primary lesion there are systemic symptoms such as fever, malaise, characteristic rash, arthralgia (pain in joints) and generalised lymphadenopathy. In pregnant women, untreated early syphilis will result in fetal infection in over 70% of cases and stillbirth in up to 30%. The chancre and rash are highly infectious.
3. Latent: In about 20% of individuals who do not undergo treatment, the disease may recur for a period of up to 2 years; and
4. Tertiary: (also called late benign syphilis). This late form of syphilis can cause destruction of virtually any organ in the body. Granulomas (gummas) are found in bone, skin and other tissues. The heart and blood vessels, and central nervous system are usually the most severely affected (called cardiovascualr syphilis and neurosyphilis respectively).

Congenital syphilis:
Symptoms start to appear in the 2nd to 6th week after birth including nasal discharge, lesions of the skin and mucous membranes and failure to thrive. Signs of late syphilis appear after 2 years of age and affect developing structures particularly teeth and long bones.

Probable Outcomes

Prognosis depends on the stage at which infection is treated. Early and early latent syphilis have a good prognosis because no irreversible damage has occurred yet. If left untreated approximately one third will progress to tertiary syphilis which is characterised typically by irreversible damage. Damage due to cardiovascular and neurosyphilis will be halted with treatment, but not reversed.

How Will Syphilis Affect Me?

Sometimes syphilis is hard to diagnose. Your doctor will ask you questions about:

* Sexual history- Number of partners, previous STDs etc.
* Social history- Drugs use and risky behaviour.
* In children history of syphilis in mother, exposure to syphilis and blood products is very important.
* Symptoms and presenting complaints.

General symptoms of each different stage are listed below:

* Primary: Chancre lesion- rounded, elevated lump that ulcerates and dissappears after a few weeks. In men the chancre appears on the penis or scrotum and in women the chancre is found on the vulva or cervix.
* Secondary: General flu-like symptoms (fever, sore throat, malaise, arthralgia) and widespread rash. een felt.
* Latent: No symptoms but patients may recall previous symptoms of syphilis.
* Tertiary: (also called late benign syphilis) is slowly progressive. If the cardiovascular system is involved- shortness of breath, ankle swelling, palpitations, or chest pain. If neurosyphilis- difficulty walking, weakness and dementia (loss of memory).
* Congenital syphilis: Nasal discharge, lesions on the skin and mucous membranes and failure to thrive (slow growth) in 2-6 weeks following birth. Late congenital syphilis occurs after 2 years.>

Clinical Examination

The doctor will perform a careful genital examination looking for a chancre lesion and enlarged lymph nodes. The skin will be examined for evidence of rash found in secondary syphilis or ulcerating lesions of tertiary syphilis. A thorough neurological and cardiovscular examination will be performed.

How is Syphilis Diagnosed?

FBC may reveal an elevated WCC count or anaemia due to chronic infection in the secondary stage. Elevated ESR may also be seen. More specific investigations include taking swabs of lesions to identify the bug and special blood tests looking for antibodies (agents that fight infection) against Treponema. Lumbar puncture, CXR and echocardiogram (looking at the heart) may be performed in later stages of the disease.

How is Syphilis treated?

Once the diagnosis is confirmed early infection tends to respond well to antibiotic treatment with specific types of penicillins. The duration of treatment varies depending on which type of penicillin is used, your history of allergies and the severity of the disease. Late stage disease (tertiary syphilis) requires specialist treatment and antibiotics are given intravenously whilst you are an in-patient in hospital.

For treatment of early disease, you should avoid sexual contact until the initial lesions are completely healed. All sexual partners within the last three months should be told to get tested. They are often treated with similar drugs even if blood tests are negative due to the possible severity of the disease. Babies of current or previously infected mothers need to be investigated and treated by specialists.

Visit our information on Protecting against Sexually Transmitted Infections.

Syphilis References

1. Commonwealth Department of Health and Aging, Communicable Diseases in Australia, National Notifiable Diseases Surveillance System, 2006.
2. Cotran RS, Kumar V, Collins T. Robbins Pathological Basis of Disease Sixth Ed. WB Saunders Company 1999.
3. Fairly C, Hocking J, Medland N, Syphilis: back on the rise, but not unstoppable, MJA 2005; 183 (4): 172-173.
4. Hicks C, Pathophysiology and natural history of syphilis, UpToDate, 2006.
5. Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
6. Longmore, Wilkinson, Rajagopalan. Oxford Handbook of Clinical Medicine. Sixth Ed. Oxford University Press, 2004.
7. Liu P, Euerle B, Syphilis, eMedicine, Web MD, 2006. Availale [online] from URL: http://www.emedicine.com/med/topic2224.htm
8. Murray PR., Rosenthal KS., Kobayashi GS., Pfaller MA., Medical Microbiology 3rd Ed., Mosby 1998.
9. Therapeutic Guidelines: Antibiotic Version 12. Therapeutic Guidelines Limited, 2003.

Symptoms of This Disease:

* Inflammation
* Memory Loss

Drugs/Products Used in the Treatment of This Disease:

* BenPen
(Benzylpenicillin sodium)

* Erythrocin IV
(Erythromycin lactobionate)

* Erythromycin Lactobionate for Intravenous Infusion (DBL)
(Erythromycin lactobionate)

What is Common Cold

The common cold, or acute coryza rhino-viral infection of the nasal passages and pharynx. Although the common cold causes generalised symptoms (malaise, tiredness), the rhinoviral infection itself is restricted to these areas.

Who gets Common Cold?

On average, individuals suffer two to three colds per year; young children may suffer more colds, and the elderly may suffer less colds.

Predisposing Factors

Young age, and close contact with individuals suffering from a cold, increases the likelihood of infection. Nasal mucus (for example on hands) or droplets are highly infectious, and spread is facilitated by overcrowding and poor ventilation.

Progression

60% of common colds are caused by rhinoviruses. The rest occur due to infection by coronavirus, influenza viruses, parainfluenza virus, respiratory syncytial virus, adenovirus, and enterovirus. In addition, the bacteria Mycoplasma pneumoniae and Chlamydia pneumoniae may cause common cold symptoms.

After cold infection, the viruses have an ‘incubation period’, during which they don’t cause cold symptoms, lasting from 12 hours to up to 5 days. Then a watery nasal discharge occurs, which becomes thick and yellowish in about 24 hours, and may last for up to a week. Uncommonly, secondary cold infection by bacteria may occur.

Other complications of the common cold include: nasal stuffiness, which may impair suckling in infants, spread of infection to sinuses (sinusitis) and middle ear (otitis media), and inflammation of the larynx (voice box), trachea or bronchi, causing a hoarse voice or a cough.

Probable Outcomes

The cold itself is a relatively mild, self-limiting disease. However, spread of the causative microbes to the lower respiratory tract may cause serious, even life-threatening disease in at-risk patients (very young or elderly, immunosuppressed). Secondary bacterial infection with subsequent spread may also cause serious disease in these populations.

How is Common Cold Diagnosed?

Investigations are generally not required for common cold symptoms lasting around 7 days or less. However, the cold symptom of a sore throat can pose difficulties in diagnosis of a cold, as it is not always clear whether the cause is bacterial or viral, nor whether the virus involved is a common cold virus or another such as Epstein Barr virus (glandular fever).

If the diagnosis of a cold is unclear, and it is important to make a definitive diagnosis, the following investigations may be done:

* Throat swab (to look for bacterial infection. Its use is controversial)
* Haemoglobin, blood film and white cell count
* Test for Epstein Barr virus (Paul Bunnel or monospot test)
* Random blood sugar (if diabetes causing repeated infection is suspected)

How is Common Cold treated?

The following common cold treatment is useful and commonly prescribed by Australian GPs:

* Adequate sleep and rest
* Paracetamol or aspirin
* Steam inhalations for a blocked nose
* Cough mixture for a dry cough
* Gargling aspirin in water or lemon juice for a sore throat

Unfortunately, most ‘cold’ medications available at the chemist (antihistamines, pseudoephidrine) have not been shown to be of proven benefit. Antibiotics do not limit the duration of common cold symptoms, nor do they decrease the likelihood of secondary bacterial infection.

Common Cold References

1. Cotran RS, Kumar V, Collins T. Robbins Pathological Basis of Disease Sixth Ed. WB Saunders Company 1999. pp347-48
2. Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 1998. p769
3. Murtagh, J. General Practice. Second Ed. McGraw-Hill, 1998. pp 377-78 [4] Robinson MJ, Roberton DM. Practical Paediatrics. Fourth Ed. Churchill Livingstone, 1998. p422.

Drugs/Products Used in the Treatment of This Disease:

* Actacode
(Codeine phosphate)

* Actifed
(Pseudoephedrine hydrochloride; Triprolidine hydrochloride)

* Actifed CC Dry Cough
(Pholcodine)

* Action Cold and Flu Effervescent

* Actuss

* Avil Decongestant
(Ammonium chloride; Menthol; Pheniramine maleate)

* Benadryl Family Chesty Cough & Nasal Congestion
(Guaifenesin; Pseudoephedrine hydrochloride)

* Benadryl Family Dry Forte
(Dextromethorphan hydrobromide)

* Nurofen
(Ibuprofen)

* Sudafed Daytime/Nightime Relief Tablets
(Paracetamol, Pseudoephedrine hydrochloride, Triprolidine hydrochloride)

* Tamiflu
(Oseltamivir phosphate)

* Voltaren Rapid 12.5/ 25/ 50
(Diclofenac potassium)