О язве двенадцатиперстной кишки-About duodenal ulcer

Genital warts (also called condylomata accuminata) are caused by infection with the human papilloma virus (HPV). More than 60 different types of HPV have been identified so far, but only a dozen or so of these are found in the genital area. Fewer still cause genital warts. Different types cause common skin warts and warts on the soles of the feet.

Our knowledge about HPV has only begun to grow since the mid-1970s: before then it was believed that all warts were caused by the same virus. Today, every month scientific journals report new discoveries about HPV, and the more we learn about it, the more we realize is still unknown. There are many questions about the wart virus that can’t yet be answered.

HPV can invade and multiply in the cells of stratified squamous epithelium anywhere in the body (including the skin, external genitals, vagina, anus, oral cavity and larynx), causing the cells to overgrow and form warty lesions.

Some HPV types cause changes that can’t be seen with the naked eye in moist membranes such as linings of the vagina, ecto-cervix, mouth and larynx.

Genital HPV is the most common sexually transmitted viral infection; more than three times more common than genital herpes. Experts believe that the number of people infected is increasing.

Genital warts are lumps formed by clusters of finger-like projections of overgrown skin with a cauliflower-like surface. Some types of HPV cause flat-surfaced lumps (plane warts); others cause pimple-shaped lumps (papular warts). Genital warts usually feel softer than skin warts.

If you have warts that can be seen or felt it is called a clinical or macroscopic (able to be seen with the naked eye) infection. It’s thought that there are many more people with infections that can’t be seen (these are called subclinical).

You may have a single wart, but usually there are more. They can vary in size from just visible up to 1 cm across (rarely bigger). They may all look the same, or you may have a mixture of cauliflower-like, flat and pimple-shaped warts.

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Urinary problems often cause ill health among women. The anatomy of our lower urinary and genital systems, some consequences of pregnancy and childbirth and a shortage of oestrogen after the menopause make us more vulnerable than men to certain problems. The most common are cystitis, kidney infections and incontinence.

Here are some of the most common symptoms of urinary disorders.

Frequency

This means that you feel the need to empty your bladder more often than is usual for you, or more than about six times during the day. Of course you’ll have extra urine to pass if you drink a large volume of fluid in a short time, especially if the drinks contain caffeine or alcohol (both increase urine production).

Urgency This means that when you get the urge to pass urine, it strikes suddenly with little or no warning, and it really is overwhelmingly urgent.

Dysuria This is pain or difficulty when passing urine.

Nocturia This is having to empty your bladder more than once during the night.

Urinary incontinence This scribes the involuntary escape of urine from the bladder. Incontinence can range from loss of one or two drops when уou cough or sneeze through a slight dribble before you reach the toilet to total loss control.

Other urinary symptoms include pain above the pubic bone, pain in the loins (small of the back), burning of the skin of
the genitals on passing urine and blood-stained, cloudy or strong-smelling urine.

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Many cells of our bodies (and especially those that form covering or lining me branes, and glands) divide often to place ‘worn-out’ or shed cells. In health, cell division is well controlled so that just as many new cells are formed as are needed. When cell division becomes uncontrolled, too many new cells are produced. These cells are usually abnormal in appearance and function. This is primary cancer.

At first the cancer is small and remains within normal tissue boundaries, but with time the mass of cells outgrows its site
and breaks through these boundaries to invade nearby tissues and organs. This is invasive cancer.

If the cancer cells invade blood lymph vessels, they may travel and set down to grow in distant parts of the body. This is metastatic cancer, and the growths that spread to distant parts of the body are called metastases or secondary cancers. The time taken for cancers to and spread is very variable, depending on the type of cells affected, the age of the patient, and many other factors not well understood.

Cervical cancer is the sixth most common cancer in Australian women, after breast, bowel, lung and two types of skin cancer. About one in a hundred women will die of cancer of the cervix: eight times as many women die of breast cancer. The highest rate of cervical cancer occurs in women aged 50-54 years.

There are two types of cervical cancer. By far the most common begins in the squamous cells that cover the ectocervix. Less common (though recently seen more frequently, especially in younger women) is cancer that begins in the lining of the cervical canal.

What causes cancer of the cervix?

We don’t know. Some factors are suspected because they are often found in women who develop cervical cancer.

Sexual behaviour

Women who don’t have sex rarely develop squamous cervical cancer. The greatest number of cancers and abnormal Pap smears (possibly pre-cancerous) are found in women who began sex early and/or have many partners. However, the majority of women with similar sexual behaviour don’t develop abnormal Pap smears or cancer.

The wart virus

Evidence of wart virus can be found in some women with cervical cancer. However, in older women with cervical cancer associated wart virus is rare. It is suspected that certain types of HPV are more likely to cause abnormal cell divisions in younger women. The majority of women with HPV don’t get cervical cancer.

Immunodeficiency

Smoking and dietary deficiencies are known to alter immune resistance. Cancerous cells are more likely to survive and grow in some types of reduced immunity. Development of cancer of the cervix is now counted as a sign that women with HIV infection have progressed to AIDS.

Symptoms

It is believed that it can take up to 30 years to progress from the earliest precancerous cell changes to cancer of the cervix. Before it becomes invasive, squamous cervical cancer rarely causes symptoms and is seldom detected by looking at or feeling the cervix; after invasion, the most common symptoms are bleeding between periods and after sex, and pelvic pain. Any woman with these symptoms should always be checked to exclude cervical cancer, even if the Pap smear is normal. Sometimes the first symptoms come from organs that have been invaded, such as bleeding or other symptoms from the bladder or bowel.

Treatment

Hysterectomy is always advised, plus removal of as much as possible of any cancerous spread beyond the uterus. Radiotherapy may be given after surgery to destroy spread to parts that can’t be removed by surgery.

Treatment of cervical cancer after it becomes invasive is difficult and not always successful. However, it can’t be repeated too often that pre-invasive cancer and the cell abnormalities that precede it can, in almost every case, be completely removed by simple means, and the progress of the invasive cancer stopped. Established cancer is much more likely to be cured by treatment if it is picked up early by Pap smear. Hence if all women were screened by regular Pap smears, most deaths from cervical cancer could be prevented.

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Feminization of male genitals

‘Testicular feminization’ sounds like a contradiction, and in a way it is. It is a rare inherited enzyme deficiency in males that prevents body tissues from responding to male hormones. Those affected have normal male chromosomes (XY) and -because the Y determines testicular development – normal testes (though often within the abdomen or in other abnormal sites) producing normal amounts of androgens and MIH. But because tissues can’t be influenced by androgens, the external genitals develop in the female pattern. However, because Müllerian tissue can respond to MIH, there are no tubes, uterus or upper vagina. When the genitals are inspected at birth, female sex is generally wrongly assigned. What’s more, because the testis produces oestrogen as well as androgens, bale secondary sexual characteristics (breast enlargement, widening of hips, female body hair pattern and female voice) develop at puberty. People with testicular feminization are usually raised as females and the problem may not be suspected until there is failure to menstruate during puberty. The diagnosis is confirmed by the buccal smear test and finding the testes (which are usually removed because they can become malignant if left within the abdomen). Because no treatment is possible, they usually continue their adult lives as females. After the testes are removed, oestrogen replacement therapy must be continued until at least 50 years of age. A vagina can be created to allow sexual intercourse.

I’ve described these unusual congenital conditions as examples of how sex may be wrongly assigned at birth. Errors in sex identification in infancy can have devastating consequences in later life. Unfortunately, most errors aren’t discovered until puberty or later, when gender identification and attitudes to sex are usually established beyond correction. It is always extremely disturbing for a young person to learn that they have been brought up as the wrong sex. Expert initial and follow-up counselling are always needed.

‘Ectopic’ means ‘out of place’. Ectopic gestation is a pregnancy that implants outside the uterus, usually in the fall tube; rarely, on the ovary or in the abdominal cavity. It is common in women whose tubes been damaged by previous surgery or infection, but often no cause can be found.

Though there are a few bizarre reports of ectopic pregnancy being maintained for long enough for a live baby to be delivered by abdominal surgery, the usual come is rapture of the pregnancy sac or death of the pregnancy within the first three months.

When the ectopic sac ruptures suddenly, it often causes severe abdominal and profuse internal bleeding that can lead to shock. This emergency needs immediate surgery to remove the pregnancy and the damaged part of the tube in order stop bleeding. Blood transfusion may necessary to save the mother’s life.

Sometimes the symptoms may be less
dramatic because blood leaks more slowly from the ectopic or because it just dies slowly without bleeding at all. This can lead to an assortment of puzzling symptoms that may include erratic bleeding from the vagina, dizziness or fainting, recurrent abdominal pain, pain in the shoulder tip and pain on intercourse. Diagnosis can then be particularly difficult in women who don’t suspect that they’re pregnant (the faulty gestation results in lower-than-usual pregnancy hormones in the blood and often no pregnancy symptoms). Today, the use of ultrasound and highly sensitive pregnancy tests make diagnosis easier. If the pregnancy test is positive and ultrasound doesn’t show a pregnancy in the uterus, an ectopic pregnancy must be ruled out (the other possible cause is complete or incomplete miscarriage within the last few days before the test).