О язве двенадцатиперстной кишки-About duodenal ulcer

A child becomes dehydrated in one of two situations — either there is excessive loss of body fluids (usually due to diarrhoea and/or vomiting) or there is insufficient intake of fluids (for example, when the sick child is unable or unwilling to drink). If the illness is prolonged or severe, dehydration can become a problem, and the child may need medical assessment and treatment.

Cause

Gastroenteritis is by far the commonest cause of dehydration. Any illness which results in persistent diarrhoea, vomiting, or reduced fluid intake can result in dehydration.

Clinical features

Apart from the features of the illness itself, the young child will pass urine less frequently (few wet nappies), or the volume will be less; his eyes may look sunken and dark; his tongue and mouth will be coated and dry; he will look gaunt and pasty; and will often be tired and lethargic. The child will have lost weight because of the fluid lost from the body.

Treatment

Mild cases of dehydration are treated by increasing the amount of fluid given to the child, or giving him oral rehydration fluid. In more severe cases, the child may need fluids to be given intravenously. This usually necessitates admission to hospital.

When to see your doctor

• if vomiting and diarrhoea persist;

• if any of the clinical features described above are present;

• if you are worried.

Prevention

Mild dehydration is a common consequence of many childhood illnesses. Significant dehydration can often be prevented by seeking prompt medical treatment when illness causes excess fluid loss or diminished intake.

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It is difficult to obtain a reliable urine sample from a baby or young toddler using the above methods, and the likelihood of contamination is high. If there is a high possibility that the child has a urinary tract infection, your doctor may recommend doing a suprapubic bladder tap.

This is a simple procedure, performed under sterile conditions, in which a fine needle is introduced into the child’s bladder when it is full and a sterile sample of urine removed and sent to the laboratory for identification of the germ. (A full bladder sits in the region above the pubic bone, hence the name suprapubic.)

Only persons who are experienced in doing this procedure should perform it. Your doctor is likely to refer you to a paediatric specialist or paediatric hospital department.

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If you listen carefully to pre-adolescents today, kids about nine or ten years old, you will hear the word «gay» used quite frequendy. We all have sexual feelings about both genders, and all the men and women I interviewed had clear memories of their first sexual encounters and feelings about the opposite- and same-gender friends. We learn to accept our sexual feelings for both genders and the strong ones most of us feel for the opposite gender, or we learn to fear them. In all of my interviews, the stronger the fear of homosexual concerns, the stronger the underlying fear of sexual interaction with the opposite gender. These feelings develop in tandem, and when we or our culture imposes sanctions against same-gender and/or opposite-gender sexual feelings, our natural flow of sexual development becomes disrupted.

Most research indicated that by this age gender orientation is pretty well developed anyway, so fears that same-gender interest will cause «homosexual tendencies» or «perversion» or promiscuity are unfounded. If we cannot accept a range of feeling about everybody, we will always have trouble accepting any feelings about a special somebody.

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Why is surgery recommended at all for extensive cases of these types of cancer if they are so sensitive to chemotherapy or radiotherapy? Basically the chance of chemotherapy or radiotherapy completely eradicating every cancer cell depends very much on the number of cancer cells there are to start with. It also depends on the size of the individual growths. Surgery can improve the chances of cure by reducing the number and size of cancer growths. The less cells there are to start with, the less likely that some of them will be resistant to the chemotherapy or radiotherapy treatment. The smaller the individual cancer growths, the less likely that the cancer cells in the middle of them will escape being killed by the chemotherapy or radiotherapy. Cancer cells can escape being killed by these treatments if they are situated where there is a poor blood supply and very little oxygen—conditions which occur in the middle of large tumour growths.

Occasionally surgeons recommend the removal of blood-borne secondary cancer growths when the cancer is one that is not sensitive to chemotherapy or radiotherapy treatment. The chance of being cured in these circumstances is minute. Blood-borne secondary deposits are usually multiple. The very fact that one is detected is proof that cancer cells have been in the bloodstream and are likely to be lying hidden in tiny clumps in other parts of the body. Simply removing detectable blood-borne secondary deposits without doing anything else is very unlikely to cure any cancer.

There is one very special set of circumstances where removal of secondary growths may produce a long remission, although very rarely a cure. These are the conditions. There should be no more than two or three secondary growths. They should have appeared a long time, several years at least, after treatment of the primary. They should be proved to be slow growing by observation over several months. These conditions very rarely occur. Examples I have seen include melanoma, Grawitz tumours (kidney) and slow growing soft tissue sarcomas.

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Rabbits may have cysts present in their livers. These are often called hydatids, but they are not the cysts of the E. granulosis, the dog tapeworm.

Sometimes the very commonplace nature of some things may lead to complacency.

Both city and country people need to be reminded that human hydatid disease is still common. Hydatid cysts are still widespread in animals, especially sheep, and in New South Wales, the worst affected state, the incidence in many areas has not changed in the past 20 years and in many cases is as high as 30 per cent.

Before any problem can be solved, those who take the decisions must be aware that a problem does exist and need to be informed about how to go about solving that problem.

At present, it seems that many of us in Australia are not aware that hydatid disease in man and in animals is still a problem.

If you are a country reader, ask what your shire or state is doing to eradicate hydatids. If you live in the city, indicate to your local Member that you are concerned that hydatids are still a problem.

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Diagnosis of this condition is rarely made in the simple cases and, in the more difficult ones, often only when other conditions have been excluded.

When the lymph glands are affected and associated with the red rash, glandular fever or infectious mononucleosis is often suspected. However, the specific blood tests are usually negative.

The disease may be mistaken for some other feverish illness and the diagnosis is difficult to make on clinical grounds alone, but biopsy or removal of infected tissue for examination under the microscope may show the parasite.

Although toxoplasmosis is such a common condition, serious effects from the parasite are rare. Its threat to the welfare of the foetus is its most serious complication.

If a woman has not previously come into contact with toxoplasma and picks up the infection during pregnancy, the parasite appears to be able to cross the placenta and affect the developing foetus.

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You may have something in common with Charlotte other than the physical symptoms of the disease. You may be striving, working woman in your twenties or thirties who has put off childbearing to pursue a career. A surprising third portrait reveals you as a teenage girl, highly sensitive, but with a strong sense of competition that may or may not be fully expressed.

What do personal issues of fulfillment through work, or work as a matter of sheer economic survival, have to do with endometriosis? Don’t unambitious, nonstriving women—even altruistic, spiritual women—develop the disease? Certainly they do! But they are not the most vulnerable. In these transitional times, working women are most likely to succumb to endometriosis.

In the 1980s it is nearly impossible for a gynecologist and obstetrician to care sensibly for a patient without identifying, describing, and fully examining some crucial details of her personal life. As part of treating the person, not just the symptoms, we must examine the external influences—physiological and psychological—that create changes in her health.

These are exciting times for women with professional aspirations, with greater chances than ever for taking on new responsibilities. In 1985, one-third of American earning power was a result of women’s work on every level. In 1970, 26 percent of women between eighteen and twenty-four years of age were unmarried. In 1986, 56 percent of the same age group were single—most of them in the work force. More relevant to our story, in 1950, 80 percent of women had borne at least one child by the age of thirty, whereas today, the figure has dropped to 60 percent.

Beyond job stress, women are juggling the minute-to-minute priorities of work and intimacy, confronting any ambivalence about achievement along with conflicts over dependency on men, figuring out how to achieve a balance on a day-to-day basis—and they are postponing childbirth.

Endometriosis isn’t fair. It isn’t interested in bow hard a woman works and it doesn’t care why a woman has not had children early in life, when there are fewer chances of organic complications. It thrives on stress-related immune system weakness, which, along with other factors that I will discuss in great detail later on, can control a woman’s body and her life. But it needn’t happen this way. With my plan, you eon learn to control endometriosis and not feel that you must choose between your work and your health.

Describing endometriosis as the «career woman’s» or working woman’s disease may be the switch that turns on a highly charged debate among doctors, scientists, and even victims of the disease. But whatever else may be so, the change in life-style is here to stay, and it is every women’s right to pursue the optimal health she desires in order to live a fully productive life.

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These are also sometimes called sensitivity groups, and are not to be confused with more orthodox group therapy. Encounter groups are larger, up to say 18 members, and sometimes have no official leader, whilst there is always a qualified therapist running the more orthodox groups. Encounter groups focus on ‘personal difficulties’, and often specialize in specific problem areas, such as stress in a corporate situation or in a bad marriage.

These groups commenced in the United States in the 1960s, and have been described as treatment for people who are not sick but simply seeking fulfilment. Nevertheless, their aims are decidedly therapeutic. They seek to make the individual feel human again, at ease with his own emotions and those of the people around him; they seek to counter the depersonalizing effects of the industrial society in which many of us live. They consituto a kind of mass folk therapy, and it is estimated that some two million Americans have so far been moved to join them.

Within these groups, the veneer of politeness has to be lifted, masks must disappear. It is the opposite of the usual cocktail party situation. Physical routines may be used to get things started, such activities as closing one’s eyes and groping, letting oneself fall backwards into another’s arms, and hand wrestling. When doing psychodrama the group members are told to act out experiences that have given them distress in the past— perhaps, a family quarrel. Then the group rotates roles, and so each member may move from acting out his problems to getting to see himself from other angles. There are limits to what encounter groups can accomplish and, very occasionally, there are dangers involved. Psychotic breakdowns under group pressure, though rare, have happened. The grouper who returns alone into the everyday world can carry with him certain misconceptions of reality. He has changed, but the world has not. It is possible that Alcoholics Anonymous bears out what Dr Pratt discovered in Boston: that the greatest benefit from groups is gained by those people caught in the same specific stress problem, be it alcohol, skin disorders, or alienation.

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Biological factors which influence body fat levels are generally not amenable to modification. The main biological factors known to influence obesity are genetic (including sex and race), age, hormone status, illness and disability.

Heredity accounts for about 25-40 per cent of the variance of body mass index suggesting that obesity has a strong genetic base, and according to evidence to date, is polygenic (influenced by many genes rather than a few). Sex differences are also known to affect fat/energy balance. In general, adipose stores are more hormonally controlled in females, particularly during the reproductive years. Fat loss and maintenance of lower equilibrium fat stores also becomes more difficult with age. Differences occur between the sexes early in life, become greatest with the onset of menses, then tend to decrease with the changes in female hormone status in post-menopausal women. Finally, there is increasing evidence of racial influences on body composition. The implications of these biological influences are in accepting factors beyond the wilful control of the obese person. Obesity should no longer be thought of as being due solely to either sloth and/or gluttony.

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Transcutaneous electrical nerve stimulation, commonly known as TENS, is a treatment developed when it was observed that pain symptoms eased when electricity was applied to the skin at the site of pain.

A TENS unit is a small battery-operated machine (about 10 centimetres by 8 centimetres) that is usually clipped to a belt or placed in a pocket. Two small electrodes that are stuck on to the skin with paste at the site of the pain run from this battery. The small electrical impulses emitted from the battery are transmitted through the electrodes and stimulate the nerves which, in turn, control the pain symptoms. The intensity and rate of the impulses can be regulated by a dial located on the machine.

It is thought that TENS may work in two ways. Firstly, the electrical currents may stimulate the nerves to prevent the pain messages from the area reaching the brain. Secondly, it may increase the production of endorphins — pain-killing chemicals produced by the body.

During the treatment women have said that they experience a tingling or pulsating sensation under the electrodes.

There is no evidence that TENS is addictive and during the day it can be used continuously or intermittently.

It appears that the effect of the TENS may be such that after a time you will be able to decrease the amount of time that you need to use it.

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Once the fragments of endometrium have implanted they begin to respond to the fluctuating levels of the menstrual cycle hormones in the same way as the endometrium lining the uterus. Thus, the implants thicken and swell with blood and then break down and bleed each month. This blood then cannot escape from the body so it bleeds directly onto the surface of the surrounding organs, causing irritation which leads to inflammation, scarring and, sometimes, the development of adhesions.

As the disease progresses the implants gradually enlarge in size and may form small cysts.

As a cyst enlarges, the pressure within the cyst may cause it to rupture during menstruation, spilling the contents onto the adjacent tissues. This may in turn lead to the development of new implants.

What does endometriosis look like

Classical implants-Until recently, endometrial implants were thought to be fairly uniform in appearance. However, in the last few years there has been a growing appreciation that they have a range of characteristic appearances.

It is now understood that what were traditionally recognized as being classical implants are, in fact, probably only one end of the spectrum of appearances and that they are probably only typical of older implants.

Classical implants usually appear as tiny dots, or clusters of dots, on the surface of the organ or ligament on which they have implanted. They are usually only pinhead in size but they may be up to a centimetre or more in diameter. They range in colour from brown to black depending on how much old blood they contain. When magnified they may look like clusters of black grapes.

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