Brain Tumor

A brain tumor is any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors). Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain.

Diagnosis

Although there is no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, sudden intracranial hypertension (this may be due to bleeding within the tumor, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Symptoms include phantom odors and tastes. Often, in the case of metastatic tumors, the smell of galvanised vulcan rubber is prevalent.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is due to the fact that these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histologic examination is essential for determining the appropriate treatment and the correct prognosis.

Types of brain tumour

-        Acoustic neuroma

-        Astrocytic tumours

-        CNS lymphoma

-        Ependymoma

-        Haemangioblastoma

-        Medulloblastoma

-        Meningioma

-        Mixed gliomas

-        Oligodendroglioma

-        Pineal region tumours

-        Pituitary tumours

Treatment and prognosis

Meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically, but the chances are less than 50%. In more difficult cases, stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option.

Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases. However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors

Patients with benign gliomas may survive for many years while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosis.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

A shunt operation is used not as a cure but to relieve the symptoms. The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

Head Injuries

What are the main causes of head injuries?

-        Road traffic accidents

-        Fall from height

-        Assault

-        Any blunt trauma to the head

Are head injuries serious?

They can be. Bleeding, tearing of tissues and brain swelling can occur when the brain moves inside the skull at the time of an impact. But most people recover from head injuries and have no lasting effects.

Types of head injuries

-        A concussion is a jarring injury to the brain. A person who has a concussion usually, but not always, passes out for a short while. The person may feel dazed and may lose vision or balance for a while after the injury.

-        A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling.

-        A skull fracture is when the skull cracks. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury.

-        A hematoma is bleeding in the brain that collects and clots, forming a bump. A hematoma may not be apparent for a day or even as long as several weeks. So it's important to tell your doctor if someone with a head injury feels or acts oddly. Watch out for headaches, listlessness, balance problems or throwing up.

How can the doctor tell how bad the damage is?

The doctor will ask about how the injury occurred, about past medical problems, and about vomiting, seizures (fits) or problems breathing after an injury.

The injured person may need to stay in the hospital to be watched. Sometimes, tests such as a computerized tomography (CT) or a magnetic resonance imaging (MRI) scan that take pictures of the brain are needed to find out more about possible damage.

What happens after a head injury?

It's normal to have a headache and nausea, and feel dizzy right after a head injury. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired.

The person who has had a head injury may also have problems concentrating, remembering things, putting thoughts together or doing more than one thing at a time.

These symptoms usually go away in a few weeks, but may go on for over a year if the injury was severe.

Will the head injury cause permanent brain damage?

This depends on how bad the injury was and how much damage it did. Most head injuries don't cause permanent damage.

What about memory loss?

It's common for someone who's had a head injury to forget the events right before, during and right after the accident. Memory of these events may never come back. Following recovery, the ability to learn and remember new things almost always returns.

Get help if you notice the following symptoms:

-        Any symptom that is getting worse, such as headaches, nausea or sleepiness

-        Nausea that doesn't go away

-        Changes in behavior, such as irritability or confusion

-        Dilated pupils (pupils that are bigger than normal) or pupils of different sizes

-        Trouble walking or speaking

-        Drainage of bloody or clear fluids from ears or nose

-        Vomiting

-        Seizures

-        Weakness or numbness in the arms or legs

Allergy

The body’s defence mechanism works over time to react against foreign particles which may pose danger to normal functioning of the human system. These foreign particles are known as Allergens.

People who are known to be allergic, respond to harmless allergens in an exaggerated manner thus resulting in irritations and discomfort to the body.There are several types of allergies like: Hay Fever, Asthma, Eczema, Food allergy, Contact Dermatitis (Skin Reactions), Conjunctivitis (Red eye), Sinusitis, Anaphylaxis (Life-Threatening Reaction).

Anything can act as an allergen if your system is sensitive to it, but the most common allergens are pollen, dust, dust mites, mold, mildew, cat and dog dander, foods (such as peanuts, milk and shellfish), drugs (such as penicillin and anesthetics) and certain chemicals.

Signs and symptoms
Allergy is a local or systemic inflammatory response to allergens. Local symptoms are:

• Nose: swelling of the nasal mucosa (allergic rhinitis)
• Eyes: redness and itching of the conjunctiva (allergic conjunctivitis)
• Airways: Sneezing, bronchoconstriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe cases the airway constricts due to swelling known as anaphylaxis.
• Ears: feeling of fullness, possibly pain, and impaired hearing due to the lack of eustachian tube drainage.
• Skin: various rashes, such as eczema and hives (urticaria)

 Systemic allergic response is also called anaphylaxis; multiple systems can be affected including the digestive system, the respiratory system, and the circulatory system. Depending of the rate of severity, it can cause cutaneous reactions, bronchoconstriction, edema, hypotension, coma and even death. This type of reaction can be triggered suddenly or the onset can be delayed. The severity of this type of allergic response often requires injections of epinephrine. The nature of anaphylaxis is such that the reaction can seemingly be subsiding, but may recur throughout a prolonged period of time.

Etiology
The exact cause of the IgE malfunctions that result in allergic reactions are not always apparent, however, and several arguments from genetic-basis, environmental-basis and intermediate proponents exist with varying validity and acceptance.

Genetic basis
There is much evidence to support the genetic basis of allergy. Allergic parents are more likely to have allergic children, and their allergies are likely to be stronger than those from non-allergic parents. However some allergies are not consistent along genealogies with parents being allergic to peanuts, but having children allergic to ragweed, or siblings not sharing the same allergens. It seems that the likelihood of developing allergies is inherited (due to some irregularity in the way the immune system works) but the developing of an allergy to a specific allergen is not.
Ethnicity has also been shown to play a role in some allergies. Interestingly, in regard to asthma, it has been suggested that different genetic loci are responsible for asthma in people of Caucasian, Hispanic, Asian, and African origins. It has also been suggested that there are both general atopy genes and tissue-specific allergy genes that target the allergic response to specific mucosal tissues. Potential disease associated alleles include both coding region variation and SNPs. Caucasians display the greatest incidence of asthma.

Relationship with parasites
Some recent research has also begun to show that some kinds of common parasites, such as intestinal worms (e.g. hookworms), secrete immunosuppressant chemicals into the gut wall and hence the bloodstream which prevent the body from attacking the parasite. This gives rise to a new slant on the "hygiene hypothesis" — that co-evolution of man and parasites has in the past led to an immune system that only functions correctly in the presence of the parasites. Without them, the immune system becomes unbalanced and oversensitive. In particular, research suggests that allergies may coincide with the delayed establishment of infant gut flora. Gutworms and similar parasites are present in untreated drinking water in undeveloped countries, and in developed countries until the routine chlorination and purification of drinking water supplies. This also coincides with the time period in which a significant rise in allergies has been observed. So far, there is only sporadic evidence to support this hypothesis — one scientist who suffered from seasonal allergic rhinitis (hayfever) infected himself with gutworms and was immediately 'cured' of his allergy with no other ill effects. Full clinical trials have yet to be performed however. It may be that the term 'parasite' could turn out to be inappropriate, and in fact a hitherto unsuspected symbiosis is at work.

Pathophysiology
The pathophysiology of allergic responses can be divided into two phases; firstly the acute response, which can then either subside or progress into a "late phase response" which can substantially prolong the symptoms of a response.

Acute response
Degranulation process in allergy.1 - antigen; 2 - IgE antibody; 3 - FcεRI receptor; 4 - preformed mediators (histamine, proteases, chemokines, heparine); 5 - granules; 6 - mast cell; 7 - newly formed mediators (prostaglandins, leukotrienes, thromboxanes, PAF)
A type I hypersensitivity reaction against an allergen via the normal humoral response against a foreign body results after plasma cells secrete IgE as opposed to other classes of immunoglobulins such as IgM (against novel antigens) or IgG (against immunized antigens). IgE binds to Fc epsilon R1 (high affinity) receptors on the surface of mast cells and basophils, both involved in the acute inflammatory response. The class switch in the plasma cell leading to IgE is tightly regulated by the immune system. CD45 plays a critical regulatory role in receptor signaling through its protein tyrosine phosphatase and Janus kinase (JAK) phosphatase activities. IL-4 is the primary interleukin which induces switch recombination. Class switch recombination to IgE can also be triggered by the TH2 cytokine IL-13. CD45 is able to function as JAK phosphatase in human B cells, and this activity is directly associated with negative regulation of the class switch recombination to IgE. IgE-bearing epidermal dendritic cells have also been found.
When IgE is first secreted it binds to the Fc receptors on a mast cell or basophil, and such an IgE-coated cell is said to be sensitized to the allergen in question. A later exposure by the same allergen causes reactivation of these IgE, which then signals for the degranulation of the sensitized mast cell or basophil. There is now strong evidence that mast cells and basophils require costimulatory signals for degranulation in vivo, derived from GPCRs such as chemokine receptors. These granules release histamine and other inflammatory chemical mediators (cytokines, interleukins, leukotrienes, and prostaglandins) into the surrounding tissue causing several systemic effects, such as vasodilation, mucous secretion, nerve stimulation and smooth muscle contraction. This results in the previously described symptoms of rhinorrhea, itchiness, dyspnea, and anaphylaxis. Depending on the individual, allergen, and mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems (for example, asthma to the respiratory system; eczema to the dermis).

Late-phase response
After the chemical mediators of the acute response subside, late phase responses can often occur. This is due to the migration of other leukocytes such as neutrophils, lymphocytes, eosinophils and macrophages to the initial site. The reaction is usually seen 4-6 hours after the original reaction and can last from 1-2 days. Cytokines from mast cells may also play a role in the persistence of long-term effects. Late phase responses seen in asthma are slightly different from those seen in other allergic responses.

Diagnosis
Before a diagnosis of allergic disease can be confirmed, possible differential causation should be carefully considered and included or excluded. Vasomotor rhinitis is one of many maladies that can mimic many of the symptoms of allergic rhinitis, underscoring the need for professional differential diagnosis.
Once a diagnosis of asthma, rhinitis, anaphylaxis, or some other allergic disease has been made, there are several methods for finding out what the patient is allergic to.

Skin testing
For assessing the presence of specific IgE antibodies, allergy skin testing, when possible, is the preferred method in comparison with various blood allergy tests because it is more sensitive and specific, simpler to use, and less expensive. Different blood allergy testing methods are currently available; the radioallergosorbent test (RAST) test method, which uses radioactive isotopes for testing, has largely been replaced by more modern methods.
The typical method of diagnosis and monitoring of Type I Hypersensitivity is skin testing, also known as "puncture testing" and "prick testing" due to the series of tiny puncture or pricks made into the patient's skin. Small amounts of suspected allergens and/or their extracts (pollen, grass, mite proteins, peanut extract, etc.) are introduced to sites on the skin marked with pen or dye (the ink/dye should be carefully selected, lest it cause an allergic response itself). A small plastic or metal device is used to puncture or prick the skin. Sometimes, the allergens are injected "intradermally" into the patient's skin, with a needle and syringe. Common areas for testing include the inside forearm and the back. If the patient is allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes. This response will range from slight reddening of the skin to a full-blown hive (called "wheal and flare") in more sensitive patients.
The skin prick test is the preferred means of testing because of its simplicity, cost, and its accuracy relative to other available tests.
Interpretation of the results of the skin prick test is normally done by allergists on a scale of severity, with +/- meaning borderline reactivity, and 4+ being a large reaction. Increasingly, allergists are measuring and recording the diameter of the wheal and flare reaction.
Theoretical concerns include how to choose patients, interpret results, and maintain safety. If a serious life threatening anaphylactic reaction has brought a patient in for evaluation, some allergists will prefer an initial blood test prior to performing the skin prick test. Skin tests may not be an option if the patient has widespread skin disease or has not avoided antihistamines for several days. Additionally, some patients may believe they have determined their own allergic sensitivity from observation, but a skin test has been shown to be much better than patient observation to detect allergy.
Some people may display a small, delayed reaction that can occur up to 6 hours after application of the allergen and last up to 72 hours. It is often easily treated with anti-inflammatory creams. Interpretation by well-trained allergists is often guided by relevant literature which can offer calculation of 95% and 99% predicted probabilities using logistic regression revealed predictive decision points.
Another consideration with the application of previously un-encountered insect venom allergen is the theoretical possibility that this minute exposure can actually sensitize one to these allergen, causing the inception of a new sensitivity, but such a development is almost unheard of in clinical experience. For all these reasons skin testing should be offered by individuals with advanced training in the diagnosis and treatment of allergic disease.

Blood testing
This kind of testing is also known as a "total IgE level". This method measures the total amount of IgE contained within the patient's serum. This can be determined through the use of radiometric and colormetric immunoassays. The levels of IgE specific to certain allergens can be measured through use of various blood allergy test methods. The radioallergosorbent test (RAST) method uses radioactive isotopes for the measuring process. Other newer methods use colorimetric or fluorometric technology. Some "screening" test methods are intended to provide qualitative test results, giving a "yes" or "no" answer in patients with suspected allergic sensitization. One such method has a sensitivity of about 70.8% and a positive predictive value of 72.6% according to a large study.
A low total IgE level is not useful to rule out sensitization to common inhalant allergens. Statistical methods, such as ROC curves, predictive value calculations, and likelihood ratios have been used to examine the relationship of various testing methods to each other. These methods have shown that patients with a high total IgE have a high probability of allergic sensitization, but further investigation with specific allergy tests for a carefully chosen allergens is often warranted.

Signs of anaphylactic shock
When one goes into anaphylactic shock, the blood vessels dilate and begin to leak into the surrounding tissues, which may affect some organs. Below are signs and symptoms to look for.
· The skin is the first place to look. Hives, itching, swelling, redness and a stinging or burning sensation may appear. On the flip side, skin may also appear extremely pale.
· Because the blood vessels are leaking a person may feel lightheaded or faint. Some people will lose consciousness because of a rapid drop in blood pressure.
· Sometimes the throat, nose, and mouth become swollen and breathing passages become obstructed. The first signs of this are usually hoarseness or a lump in the throat. In some cases the swelling is so bad the air supply is cut off and the person experiences severe respiratory distress.
· Another respiratory problem could be the constricting of the airways, giving someone the chest  tightness, wheezing and shortness of breath commonly associated with asthma
             There have been enormous improvements in mainstream medical treatments developed by allergists. Recently, advances in anaphylaxis and hypersensitivity reactions to foods, drugs, and insects and in allergic skin disease include: the identification of food proteins to which IgE binding is associated with severe reactions, improvements in skin prick test predictions; evaluation of the atopy patch test; and advances in yellow jacket sting outcomes predictions and a rapidly disintegrating epinephrine tablet and development of low-allergen foods, and anti-IL-5 for eosinophilic diseases.
            Traditionally treatment and management of allergies revolved around simply avoiding the allergen in question or otherwise reducing exposure to said allegern. For instance, people with cat allergies were encouraged not to own cats and to avoid them as best as possible. While this had some effectiveness in reducing symptoms and avoiding life-threatening anaphylaxis for some, it was not always possible for those with pollen or similar air-borne allergies. For most allergies it is simply easier to reduce exposure rather than avoiding the allergens altogether. Strict avoidance still has a role in management though and is often used in managing food allergies
Causes of Sinus Allergies
 
               There are several airborne substances that we inhale through our mouth and nose. Many of these irritate the sinuses and can lead to allergies. For example, Pollen, which is nothing but a small particle released by flowering plant, enters our body while breathing. The mucus that is present in sinuses ambushes that dirt as a defense mechanism to prevent it from entering our lungs.
               However, the mucus cannot cope with the relentless onslaught. Over time, these pollen allergens prevent the mucus from draining properly, which then accumulates and becomes the perfect breeding ground for viruses and bacteria. This leads to nasal blocks and infections.
             Over time, ragweed and pollen lead to allergies. Hay Fever, which is a serious problem, starts with ragweed and pollen allergy but is often ignored because the symptoms are very similar - itchy and flowing nose etc. If not cured on time, it can lead to major disorders.
Other allergens that can cause sinus inflammation are dirt, pollution, animal hair, food particles cloth fibers, mold, dead insects remains and wastes, and other remains.

When do the allergy symptoms occur?
 While everything in our environment can create allergic problems round the year, most sinus allergies occur mostly in spring, late summer and early fall seasons. During this time, the air is dry and moisture free and it's the right time for airborne particles like pollen and ragweed to flow in the air. Therefore, this time is very critical for diseases concerned with allergies. These allergies usually end by the starting of winter because of frost etc.

Symptoms of Allergies
 
Some of the symptoms of these allergies are very common but should not be ignored - a runny nose, excessive sneezing (it can be 8 to 10 times in a row), itching nose (feel like scratching), sore throat, bad breath, watery eyes, postnasal drips which can be very irritating, loss of taste and smell and excess coughing, specially in the night. Any one or more of these symptoms are enough to make a person weak and fatigued all the time.
Caution: If the behavioral changes, mind disturbances, headache, eyesight problems, or seizures are long lasting and are not cured, infection may spread and lead to other allergic problems.

Treating sinus allergies at the first appearance of symptoms... or even before
Usually symptoms of sinus allergies can be mitigated at the first instance through a completely natural irrigation process.
This process, called 'neti' (in yoga) or simply saline nasal irrigation is so effective, that thousands of people suffering for years -- have experienced miraculous relief.
Antihistaminics help to relieve the symptoms.
               Hay fever" is a misnomer. Hay is not a usual cause of this problem and it does not cause fever. Early descriptions of sneezing, nasal congestion, and eye irritation while harvesting field hay promoted this popular term. Many substances cause the allergic symptoms noted in hay fever and hay represents only a small percentage. "Allergic rhinitis" is the correct term used to describe this allergic reaction. Rhinitis means "irritation of the nose" and is a derivative of "Rhino," meaning nose. Allergic rhinitis which occurs during a specific season is called "seasonal allergic rhinitis". When it occurs throughout the year, it is called "perennial allergic rhinitis."
Symptoms of allergic rhinitis, or hay fever, frequently include nasal congestion, a clear runny nose, sneezing, nose and eye itching, and tearing eyes. Post nasal dripping of clear mucus frequently causes a cough. Loss of smell is common and loss of taste occurs occasionally. Nose bleeding may occur if the condition is severe. Observers of the person experiencing allergic rhinitis will commonly notice frequent rubbing of the nose using the index finger. This is the so called "allergic salute." Eye itching, redness, and tearing frequently accompany the nasal symptoms. The eye symptoms are referred to as "allergic conjunctivitis" (inflammation of the whites of the eyes). These allergic symptoms often interfere with one's quality of life and total health. Allergic rhinitis can lead to other diseases such as sinusitis and asthma. Many allergic people have difficulty with social and physical activities. For example, concentration is often difficult while experiencing allergic rhinitis.
Food allergy is caused by immunological reactions to foods, sometimes in individuals or families predisposed to allergies. A number of foods, especially shellfish, milk, eggs, peanuts, and fruit can cause allergic reactions (notably hives, asthma, abdominal symptoms, lightheadedness, and anaphylaxis) in adults or children. When a food allergy is suspected, a medical evaluation is the key to proper management. The differential diagnosis comprises other abnormal responses to food, that is, food intolerances, which actually are far more common than food allergy. Once the diagnosis of food allergy is made (primarily by the medical history) and the allergen is identified (usually by skin tests), the treatment basically is to avoid the offending food. People with food allergies should work with their physicians and become knowledgeable about allergies and how they are diagnosed and treated

Eczema is a general term for many types of skin inflammation, also known as dermatitis. The most common form of eczema is atopic dermatitis (some people use these two terms interchangeably). However, there are many different forms of eczema.
Eczema can affect people of any age, although the condition is most common in infants. Eczema will permanently resolve by age three in about half of affected infants. In others, the condition tends to recur throughout life. People with eczema often have a family history of the condition or a family history of other allergic conditions, such as asthma or hay fever.

What are the causes of eczema?
Doctors do not know the exact cause of eczema, but an abnormal function of the immune system is believed to be a factor. Some forms of eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewelry, or sweat. Environmental allergens (substances that cause allergic reactions) may also cause outbreaks of eczema. Changes in the weather, or even psychological stress for some people lead to outbreaks of eczema.

What are the symptoms of eczema?
Eczema most commonly causes dry, reddened skin that itches or burns, although the appearance of eczema varies from person to person and varies according to the specific type of eczema. Intense itching is generally the first symptom in most persons with eczema. Sometimes, eczema may lead to blisters and oozing lesions, but eczema can also result in dry and scaly skin. Repeated scratching may lead to thickened, crusty skin.
While any region of the body may be affected by eczema, in children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.

The goals for the treatment of eczema are to prevent itching, inflammation, and worsening of the condition. Treatment of eczema may involve both lifestyle changes and the use of medications. Treatment is always based upon an individual's age, overall health status, and the type and severity of the condition.
Keeping the skin well hydrated through the application of creams (with a low water and high oil content) as well as avoiding overbathing is an important step in treatment. Lifestyle modifications to avoid triggers for the condition are also recommended.
Corticosteroid creams are sometimes prescribed to decrease the inflammatory reaction in the skin. These may be mild-, medium-, or high-potency corticosteroid creams, depending upon the severity of the symptoms. If itching is severe, oral antihistamines may be prescribed. To control itching, the sedative type antihistamine drugs (e.g. diphenhydramine, hydroxyzine, and cyproheptadine) appear to be most effective.
In some cases, a short course of oral corticosteroids (such as prednisone) is prescribed to control an acute outbreak of eczema, although their long-term use is discouraged in the treatment of this non life-threatening condition because of unpleasant and potentially harmful side effects. The oral immunosuppressant drug cyclosporine has also been used to treat some cases of eczema. Ultraviolet light therapy (phototherapy) is another treatment option for some people with eczema.

Bangalore Cardiology Hospital Phone Numbers

HEARTLINE	PHONE
JAYADEVA HEART BRIDAGE	1051
CARDIAC CRIRICAL CARE UNIT(MANIPAL HOSPITAL)	25024512
KIMS HOSPITAL	26673056 / 26624870
M S RAMAIA MEMORIAL HOSPITAL	2360888/23609999
MANIPAL HOSPITAL & HEART FOUNDATION	25024300 /25024512
NARAYAN HRADAYALAYA	7835000 / 7835001
SAGAR APOLLO HOSPITAL	26556666 / 26536700
THE BANGALORE HOSPITAL	26562753 / 26565494
TRINITY ART FOUNDATION	26563994 / 26563996
WOCKHARDT- CARDIAC LINE	2226 8888

Artery

Arteries are muscular blood vessels that carry blood away from the heart. All arteries, with the exception of the pulmonary and umbilical arteries, carry oxygenated blood.

The circulatory system is extremely important for sustaining life. Its proper functioning is responsible for the delivery of oxygen and nutrients to all cells,

as well as the removal of carbon dioxide and waste products, maintenance of optimum pH, and the mobility of the elements, proteins and cells of the immune system. In developed countries, the two leading causes of death, myocardial infarction and stroke each may directly result from an arterial system that has been slowly and progressively compromised by years of deterioration.

The heart pumps blood out through one main artery called the dorsal aorta. The main artery then divides and branches out into many smaller arteries so that each region of your body has its own system of arteries supplying it with fresh, oxygen-rich blood.

Arteries are tough on the outside and smooth on the inside. An artery actually has three layers: an outer layer of tissue, a muscular middle, and an inner layer of epithelial cells. The muscle in the middle is elastic and very strong. The inner layer is very smooth so that the blood can flow easily with no obstacles in its path.

The muscular wall of the artery helps the heart pump the blood. When the heart beats, the artery expands as it fills with blood. When the heart relaxes, the artery contracts, exerting a force that is strong enough to push the blood along. This rhythm between the heart and the artery results in an efficient circulation system.

You can actually feel your artery expand and contract. Since the artery keeps pace with the heart, we can measure heart rate by counting the contractions of the artery. That's how we take our pulse.

The arteries deliver the oxygen-rich blood to the capillaries where the actual exchange of oxygen and carbon dioxide occurs. The capillaries then deliver the waste-rich blood to the veins for transport back to the lungs and heart.

High blood pressure or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre–hypertension", and a blood pressure of 140/90 or above is considered high.

The top number, the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed.

An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage).

These complications of hypertension are often referred to as end–organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications.

It was previously thought that rises in diastolic blood pressure were a more important risk factor than systolic elevations, but it is now known that in people 50 years or older systolic hypertension represents a greater risk.

Uncomplicated high blood pressure usually occurs without any symptoms (silently) and so hypertension has been labeled "the silent killer." It is called this because the disease can progress to finally develop any one or more of the several potentially fatal complications of hypertension such as heart attacks or strokes. Uncomplicated hypertension may be present and remain unnoticed for many years, or even decades. This happens when there are no symptoms, and those affected fail to undergo periodic blood pressure screening.

Some people with uncomplicated hypertension, however, may experience symptoms such as headache, dizziness, shortness of breath, and blurred vision. The presence of symptoms can be a good thing in that they can prompt people to consult a doctor for treatment and make them more compliant in taking their medications. Often, however, a person's first contact with a physician may be after significant damage to the end–organs has occurred. In many cases, a person visits or is brought to the doctor or an emergency room with a heart attack, stroke, kidney failure, or impaired vision (due to damage to the back part of the retina). Greater public awareness and frequent blood pressure screening may help to identify patients with undiagnosed high blood pressure before significant complications have developed.

About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor. In these patients, the diastolic blood pressure (the minimum pressure) exceeds 140 mm Hg! Affected persons often experience severe headache, nausea, visual symptoms, dizziness, and sometimes kidney failure. Malignant hypertension is a medical emergency and requires urgent treatment to prevent a stroke (brain damage).

Lifestyle modification

Doctors recommend weight loss and regular exercise as the first steps in treating mild to moderate hypertension. These steps are highly effective in reducing blood pressure, although most patients with moderate or severe hypertension end up requiring indefinite drug therapy to bring their blood pressure down to a safe level. Discontinuing smoking does not directly reduce blood pressure, but is very important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. An increase in daily calcium intake has also been shown to be highly effective in reducing blood pressure.

Mild hypertension is usually treated by diet, exercise and improved physical fitness. A diet rich in fruits and vegetables and low fat or fat-free dairy foods and moderate or low in sodium lowers blood pressure in people with hypertension. This diet is known as the DASH diet (Dietary Approaches to Stop Hypertension), and is based on National Institutes of Health sponsored research. Dietary sodium (salt) may worsen hypertension in some people and reducing salt intake decreases blood pressure in a third of people. Many people choose to use a salt substitute to reduce their salt intake. Regular mild exercise improves blood flow, and helps to lower blood pressure. In addition, fruits, vegetables, and nuts have the added benefit of increasing dietary potassium, which offsets the effect of sodium and acts on the kidney to decrease blood pressure.

Reduction of environmental stressors such as high sound levels and over-illumination can be an additional method of ameliorating hypertension. Biofeedback is also used particularly device guided paced breathing

There are many classes of medications for treating hypertension, together called antihypertensives, which — by varying means — act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.

The aim of treatment should be blood pressure control to <140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg). Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.

Commonly used drugs include:

· ACE inhibitors such as captopril, enalapril, fosinopril (Monopril), lisinopril (Zestril), quinapril, ramipril (Altace)

· Angiotensin II receptor antagonists: eg, telmisartan (Micardis, Pritor), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan), candesartan (Atacand)

· Alpha blockers such as doxazosin, prazosin, or terazosin

· Beta blockers such as atenolol, labetalol, metoprolol (Lopressor, Toprol-XL), propranolol.

· Calcium channel blockers such as amlodipine (Norvasc), diltiazem, verapamil

· Direct renin inhibitors such as aliskiren (Tekturna)

· Diuretics: eg, bendroflumethiazide, chlortalidone, hydrochlorothiazide (also called HCTZ)

· Combination products (which usually contain HCTZ and one other drug)

White coat hypertension is a phenomenon in which patients exhibit elevated blood pressure in a clinical setting but not when recorded by themselves at home. It is believed that this is due to the anxiety some people experience during a clinic visit.

Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to buildup of a material called plaque (plak) on their inner walls. The buildup of plaque is known as atherosclerosis (ATH-er-o-skler-O-sis). As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs. Reduced or cutoff blood flow and oxygen supply to the heart muscle can result in:

• Angina (AN-ji-na or an-JI-na). Angina is chest pain or discomfort that occurs when the heart does not get enough blood.
• Heart attack. A heart attack happens when a blood clot develops at the site of plaque in a coronary artery and suddenly cuts off most or all blood supply to that part of the heart muscle. Cells in the heart muscle begin to die if they do not receive enough oxygen-rich blood. This can cause permanent damage to the heart muscle.

Over time, CAD can weaken the heart muscle and contribute to:

• Heart failure. In heart failure, the heart can’t pump blood effectively to the rest of the body. Heart failure does not mean that the heart has stopped or is about to stop. Instead, it means that the heart is failing to pump blood the way that it should.
• Arrhythmias (a-RITH-me-as). Arrhythmias are changes in the normal beating rhythm of the heart. Some can be quite serious.

CAD is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

Arm Artery Disease

What is arm artery disease?

Your arteries carry blood rich in oxygen and nutrients from your heart to the rest of your body. When an artery between your chest and your hand becomes blocked, your arm or hand does not receive enough blood or oxygen. You may have a condition called arm artery disease.

Arm artery disease is an uncommon form of peripheral arterial disease (PAD). Most people with PAD have blocked leg arteries, called leg artery disease. Although arm artery disease can come on quickly, it usually starts slowly and gets worse over a long period of time. If you have mild arm artery disease, you may not notice any symptoms. As the disease advances, you may experience pain in the arm with activity and, if it becomes more severe, you eventually may develop sores or gangrene in your arm. Gangrene is tissue death and occurs when tissues in your body do not receive enough oxygen and blood.

Like other types of PAD, arm artery disease can be caused by atherosclerosis, which means hardening of the arteries. Your arteries are normally smooth and unobstructed on the inside, but as you age, a sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. In atherosclerosis, your arteries narrow or become blocked as plaque builds up on your artery walls.

What are the symptoms?

You may not feel any symptoms from mild arm artery disease. The most common initial symptom is intermittent claudication (IC). IC is discomfort or pain in your arms that happens when you are using your arm and goes away when you rest your arm muscles. Activities that can trigger IC include combing or your washing hair or lifting your arms above your head. You may not always feel pain; instead you may feel tightness, heaviness, cramping, or weakness in your arm.

Other symptoms of arm artery disease include finger pain, sensitivity to cold in your hands, fingers that turn blue or pale, and lack of a pulse in your wrist or your hand.

As the disease gets worse, you may experience pale, cool skin on your arm or hand, blue, slow-growing fingernails, slow-growing arm hair, sores on your fingers, and, eventually, gangrene in your arm or hand.

What causes arm artery disease?

Atherosclerosis is the main cause of arm artery disease. However, several uncommon conditions that can also cause arm artery disease include:

· Buerger’s disease, an inflammation of the small blood vessels and nerves in your hands and feet that usually affects male smokers

· Takayasu’s disease, an autoimmune disease that mostly affects young Asian women. An autoimmune disease means that your immune system attacks your body's organs or tissues

· Raynaud’s disease, in which your hands are extremely sensitive to cold and your fingers turn blue, white, and red in a cool environment

· Diseases such as lupus, scleroderma, and rheumatoid arthritis

· Thoracic outlet syndrome, which is sometimes associated with repetitive motions like pitching in major league baseball

· Embolism, which is a blood clot that travels from one area of your body and blocks a blood vessel in your arm

Rarely, frostbite, radiation therapy for breast cancer, and repeated injury, for example, to the pad of your hand, or other forms of injury, can cause arm artery disease.

Arm artery disease is more likely to affect you if you smoke and are older than age 60. Other risk factors include having high cholesterol or high blood pressure.

What tests will I need?

First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. As part of your history, your physician will ask you if you smoke or have high blood pressure. Your physician will also want to know when and how often your symptoms occur as well as their location.

As part of your exam, your physician will take your blood pressure in both arms. If your blood pressure is significantly lower in one arm, that arm most likely has a blockage. Your physician will feel for a pulse below the suspected blockage. If you have arm artery disease, this pulse will be weak or even missing. Your physician will also listen to your arm arteries with a stethoscope. Abnormal whooshing sounds, called bruits, may suggest blood is flowing through a narrowed artery.

After your exam, if your physician suspects arm artery disease, he or she may perform tests, such as:

· Segmental blood pressures, or taking many blood pressure readings along your arms, hands, and fingers

· Duplex ultrasound

· Chest or neck x-rays

· Computerized axial tomography (CT or CAT scan)

· Magnetic resonance angiography (MRA)

· Angiography (takes x-rays of your arteries)

How is arm artery disease treated?

Your treatment for arm artery disease will depend on the underlying cause, as well as the location and severity of any blockages. If you have high blood pressure, your physician may prescribe medications that treat those conditions. Some prescription medications may help Raynaud's disease. If you have Buerger’s disease, quitting smoking is the most important treatment.

Some physicians use an anesthetic injection, called a sympathetic block, to block certain nerves in the hands. If this procedure relieves your symptoms, your physician may recommend cervical sympathectomy. Cervical sympathectomy can be done surgically or sometimes by chemical injection. This procedure interrupts the nerves that cause your arteries to spasm.

If a large blood vessel in your arm is blocked, your physician may be able to treat it with an angioplasty procedure, depending upon the location and how much of the blood vessel is blocked. During an angioplasty procedure, which is sometimes performed at the same time as an angiogram, a long, thin, flexible tube, called a catheter, is inserted into a small puncture and is guided through your arteries to the blocked area. Once there, a special balloon attached to the catheter is inflated and deflated, several times if needed. The balloon pushes the plaque in your artery against your artery walls, widening the vessel. In some circumstances, a tiny mesh-metal tube called a stent may then be placed into the narrowed area of your artery to keep it open. The stent remains permanently in your artery. After successful angioplasty, blood flows more freely through your artery.

For more extensive blockages, you may need a surgical repair such as endarterectomy or bypass. An endarterectomy is a way for your surgeon to remove the plaque from your artery. To perform an endarterectomy, your vascular surgeon makes an incision and removes the plaque contained in the inner lining of the diseased artery. This leaves a wide-open artery and restores blood flow through it. To perform a bypass, your vascular surgeon creates a detour around your blocked artery with a synthetic tube or a vein from your body.

If the arm blood vessel blockage is associated with Thoracic Outlet Syndrome (see the associated article on Thoracic Outlet Syndrome), a surgical procedure to remove an extra rib or to relieve pressure on the vessel may also be required.

The best choice of the treatment depends upon several considerations including your general health, the pattern and particular cause of the obstruction, and how much blockage that you have. Your vascular surgeon will help you determine which method of treatment is best for your particular situation.

What can I do to stay healthy?

Although many treatments are available for arm artery disease, there is no cure. Lifestyle changes that help you manage risk factors for arm artery disease include:

· Quitting smoking

· Maintain your ideal body weight

· Eating foods low in saturated fat and calories

· Controlling blood cholesterol and lipid (fat) levels

· Exercising and walking regularly, for instance walking at least 30 minutes 3 times each week