Bogart-Bacall syndrome

Bogart-Bacall Syndrome is a vocal misuse disorder.

People who speak or sing out of their normal range can experience vocal fatigue, which is one cause of dysphonia. The people most commonly afflicted are those who speak in a low-pitched voice, particularly if they have poor breath and vocal control. The syndrome can affect both males and females.

Despite the name of the syndrome, neither Humphrey Bogart nor Lauren Bacall was known to suffer from this syndrome; rather, it is named after them for their low-pitch manner of speaking.

Treatment usually involves voice therapy by a Speech Language Pathologist.

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Central venous pressure

Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. It is a good approximation of right atrial pressure, which is a major determinant of right ventricular end diastolic volume. Normal CVP is 4-8 cm H20.

CVP can be measured by connecting the patient's central venous catheter to a special infusion set which is connected to a small diameter water column. If the water column is calibrated properly the height of the column indicates the CVP.

In most progressive Intensive Care Units in the U.S., specialized monitors are available to continuiously measure CVP as well other hemodynamic values.

Factors which increase CVP include:

Hypervolemia
forced exhalation
Tension pneumothorax
Heart failure
Pleural effusion
Decreased cardiac output
Factors which decrease CVP include:

Hypovolemia
Deep inhalation

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Cervical

In anatomy, 'cervical' is an adjective that has two meanings:

of or pertaining to any neck.
of or pertaining to the female cervix: i.e., the neck of the uterus.
Commonly used medical phrases involving the neck are...
cervical lymph nodes
Cervical vertebrae
cervical disc
Phrases that involve the cervix include...
cervical cancer
cervical smear or Pap smear
cervical prolapse

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Chronic (medical)

In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between. As an adjective, chronic can refer to a persistent and lasting medical condition. Chronicity is usually applied to a condition that lasts more than three months. Diabetes is a good example.



The definition of a disease or causative condition may depend on the disease being chronic, and the term chronic will often, but not always appear in the description:

Arthritis
Chronic fatigue syndrome
Chronic obstructive pulmonary disease
Chronic renal failure
Hepatitis
Leukemia
lupus erythematosus
POTS

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Cluttering

Cluttering (also called tachyphemia) is a speech disorder and a communication disorder characterized by speech that is difficult for listeners to understand due to rapid speaking rate, erratic rhythm, poor syntax or grammar, and words or groups of words unrelated to the sentence. Cluttering has in the past been viewed as a fluency disorder .

Presentation
The person with cluttering may experience a short attention span, poor concentration, poorly organized thinking, inability to listen, and a lack of awareness that one's speech is unintelligible.

Cluttering is sometimes confused with stuttering. Both communication disorders break the normal flow of speech. However, while stuttering is most often analyzed as a speech disorder, cluttering is a language disorder. In other words, a stutterer has a coherent pattern of thoughts, but can't say it; in contrast, a clutterer has no problem putting thoughts into words, but those thoughts become disorganized during speaking. Cluttering not only effects speech, but affects thought patterns, writing, typing, and conversation .

Stutterers are usually dysfluent on initial sounds, when beginning to speak, and become more fluent towards the ends of utterances. In contrast, clutterers are most clear at the start of utterances, but their speaking rate increases and intelligibility decreases towards the end of utterances.

Stuttering is characterized by struggle behavior, such as overtense speech production muscles. Cluttering, in contrast, is effortless.

To compare, a stutterer trying to say "I want to go to the store," might sound like "I wa-wa-want to g-g-go to the sssssssssstore." In contrast, a clutterer might say, "I want to go to the st...uh...place where you buy...market st-st-store."

Cluttering is also characterized by slurred speech, especially dropped or distorted /r/ and /l/ sounds; and monotone speech that starts loud and trails off into a murmur.

Clutterers often also have reading and writing disorders, especially sprawling, disorderly handwriting, which poorly integrate ideas and space. A clutterer described the feeling associated with a clutter as:

“ It feels like 1) about twenty thoughts explode on my mind all at once, and I need to express them all, 2) that when I'm trying to make a point, that I just remembered something that I was supposed to say, so the person can understand, and I need to interrupt myself to say something that I should have said before, and 3) that I need to constantly revise the sentences that I'm working on, to get it out right. ”

Another clutterer wrote on an Internet support group:

“ I just seem to rush through the words, and often slur words together and/or mumble—and as a result I often have to slow down, concentrate, and repeat myself. ”


Related Disorders
Cluttering can often be confused with language delay, language disorder, learning disabilities, and attention deficit disorder.


Cluttering versus Stuttering
Cluttering and stuttering sound very similar to the lay ear, especially when they are at their worst. However, they are markedly different disorders and clutterers and stutterers are very different.

Stutterers:

Are very aware of their disorder
Perform worse when speaking under stress
Have a hard time fluently giving short answers
Often have inhibited, neat handwriting
Therapy focuses on relaxation techniques, calling attention away from speech
Are typically withdrawn, shy, or introverted
Typically were fluent, but then started stuttering
Know exactly what they want to say but cannot say it
Have organized speech
Have good listening skills

Clutterers:

Are very unaware of their disorder
Perform better when speaking under stress
Have a hard time fluently giving long answers
Have hasty, repetitious, uninhibited, messy handwriting
Have little to no fear of their speech and are careless in speech
Therapy focuses on calling attention to speech details
Are typically outgoing or extroverted
Typically were never very fluent
Do not know exactly what they want to say, but say it anyway
Have disorganized, tangential, grammatically incorrect speech with word substitutions
Are impatient listeners, frequently interrupt, and have poor turn-taking skills in conversation

Treatment
Because clutterers have poor awareness of their disorder, they may be indifferent or even hostile to speech-language pathologists. Treatment for cluttering usually takes longer than stuttering treatment. Delayed auditory feedback (DAF) is usually used to produce a more deliberate, exaggerated oral-motor response pattern. Other treatment components include improving narrative structure with story-telling picture books, turn-taking practice, pausing practice, and language therapy.


History
Battaros was a legendary Libyan king who spoke quickly and in a disorderly fashion. Others who spoke as he did were said to suffer from battarismus.
This is the earliest record of the speech disorder of cluttering.

In the 1960's, cluttering was called tachyphemia, a word derived from the Greek for "fast speech." This word is currently not used to describe cluttering because fast speech is not a required element of cluttering.

Deso Weiss described cluttering as the outward manifestation of a "central language imbalance." In Weiss's book on cluttering, he used Central Language Imbalance or CLI as synonymous with what cluttering is described as today.


Over the past twenty years, Kenneth O. St. Louis, Lawrence J. Raphael, Florence L. Myers, and Klaas Bakker have been working to standardize a definition of cluttering. Judith Kuster maintains a robust section of cluttering resources and articles in her Stuttering Homepage.

The first conference held specifically on cluttering was held in May of 2007 in Razlog, Bulgaria. It was called, "The First World Conference on Cluttering," and had over 60 participants from across North America, Europe, the Middle East and Asia. It was held in Bulgaria partly because of cluttering research efforts by Professors Dobrinka Georgieva and Katya Dionissieva of Neofit Rilski. Part of the conference was awarding the first Deso Weiss Award for Excellence in Cluttering, which went to Kenneth St. Louis for his contributions for understanding and knowledge about cluttering.


Cluttering Confusion
Spoonerisms, malapropisms, Colemanballs, and Freudian slips are examples of cluttering. Stuttering as a common term often refers the speech disorder of cluttering, rather than to the speech disorder of stuttering. Cluttered speech is exhibited by normal speakers, and is often referred to as stuttering--this is especially true when the speaker is nervous, where nervous speech more closely resembles cluttering than stuttering.

People with ADD or ADHD may have many of the same symptoms as clutterers, including being inattentive, restless, short tempered, and impatient.


Famous Clutterers
Weiss claimed that Battaros, Demosthenes, Pericles, Justinian, Bismarck, and Winston Churchill and Mark T. Mojesky were clutterers. He says about these people, "Each of these contributors to world history viewed his world holistically, and was not deflected by exaggerated attention to small details. Perhaps then, they excelled because of, rather than in spite of, their [cluttering]."

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Complication (medicine)

Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A medical treatment, such as drugs or surgery may produce adverse effects and/or produce new health problem(s) by itself. A new disease may also appear as a complication to a previous existing disease. Therefore, a complication may be iatrogenic, i.e., literally brought forth by the physician.

Medical knowledge about a disease, procedure or treatment usually entails a list of the most common complications, so that they can be foreseen, prevented or recognized more easily and speedily.

Depending on the degree of vulnerability, susceptibility, age, health status, immune system condition, etc. complications may arise more easily. Complications affect adversely the prognosis of a disease. Non-invasive and minimally invasive medical procedures usually favor less complications in comparison to invasive ones.


Examples of complications
Generalized septicemia (infection of the blood) may occur as a complication of an infected wound or abscess
Allergic shock can be a reaction to several kinds of anesthetics, as a complication in a surgery
Fractured ribs and sternum may be a complication of cardiopulmonary resuscitation attempts in people suffering severe osteoporosis
Puerperal fever may be a common complication of childbirth and used to kill a large proportion of mothers before the advent of antisepsis and antibiotics
Diabetes mellitus may present a series of complications in an advanced or more severe stage, such as gangrene, diabetic foot, blindness, infections, etc.
Thrombosis in the heart or brain, causing stroke or acute myocardial infarction can be complications of blood coagulation disorders, phlebitis (inflammation of the veins), endocarditis and artificial heart valves
Eczema vaccinatum is a rare and severe complication of smallpox vaccination in people with eczema
Hepatotoxic dementia is a possible complication of hepatitis and liver cirrhosis
Mental retardation is a common complication of untreated hydrocephalus
A paradoxical reaction to a drug that is the totally the opposite effect of the intended purpose of the drug. As in "benzodiazepines" (pronounced [ˌbenzəʊdaɪˈæzəpiːnz], or "benzos" for short) a class of psychoactive drugs considered a minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, and muscle relaxant drug that may create exactly the opposite effect (paradoxical reaction) on susceptible individuals.

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Consensus (medical)

Medical consensus is a public statement on a particular aspect of medical knowledge available at the time it was written, and that is generally agreed upon as the evidence-based, state-of-the-art (or state-of-science) knowledge by a representative group of experts in that area. Its main objective is to counsel physicians on the best possible and acceptable way to diagnose and treat certain diseases or how to address a particular decision-making area. Therefore, it can be considered an authoritative, community-based consensus decision-making and publication process.

There are many ways of producing medical consensus, but the most usual way is to convene an independent panel of experts, either by a medical association or by a governmental authority. In the United States, for example, the National Institutes of Health promotes about five to six consensus panels per year, and organizes this knowledge by means of a special Consensus Development Program, managed by its NIH Office of Medical Applications of Research (OMAR). The statements are available in printed form as well as for downloading from the Internet .

Since consensus statements provide a "snapshot in time" of the state of knowledge in a particular topic, it must periodically be re-evaluated and published again, substituting the previous consensus statement.

Consensus statements differ from medical guidelines, another form of state-of-science public statements. According to the NIH, "Consensus statements synthesize new information, largely from recent or ongoing medical research, that has implications for reevaluation of routine medical practices. They do not give specific algorithms or guidelines for practice. Such policy decisions often depend on cost, available expertise and technology, and local practice circumstances."

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Cosmesis

Cosmesis is the preservation, restoration, or bestowing of bodily beauty. In the medical context, it usually refers to the surgical correction of a disfiguring defect, or the cosmetic improvements made by a surgeon following incisions. Its usage is generally limited to the additional, usually minor, steps that the surgeon (who generally is operating for non-cosmetic indications) takes to improve the aesthetic appearance of the scars associated with the operation. Typical actions include removal of damaged tissue, mitigation of tension on the wound and/or using fine (thin) sutures to close the outer layer of skin.

Cosmetic surgery is the portion of plastic surgery that concerns itself with the elective improvement of cosmesis.

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Cystitis

Cystitis is inflammation of the urinary bladder. The condition more often affects women, but can affect either gender and all age groups.

Types
There are several types of cystitis:

bacterial cystitis, the most common type, which is most often caused by coliform bacteria being transferred from the bowel through the urethra into the bladder
interstitial cystitis (IC) is considered more of an injury to the bladder and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown. However, there is hope. Several therapies are now available.
eosinophilic cystitis is a rare form of cystitis that is diagnosed via biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC is also unknown though it has been triggered in children by certain medications.
radiation cystitis often occurs in patients undergoing radiation for the treatment of cancer.
hemorrhagic cystitis

Causes, incidence and risk factors
Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria and becomes irritated and inflamed. It is very common.

The condition frequently affects sexually active women ages 20 to 50 but may also occur in those who are not sexually active or in young girls. Older adults are also at high risk for developing cystitis, with the incidence in the elderly being much higher than in younger people.

Cystitis is rare in males. Females are more prone to the development of cystitis because of their relatively shorter urethra—bacteria do not have to travel as far to enter the bladder—and because of the relatively short distance between the opening of the urethra and the anus.

More than 85% of cases of cystitis are caused by escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract. Sexual intercourse may increase the risk of cystitis because bacteria can be introduced into the bladder through the urethra during sexual activity. Once bacteria enter the bladder, they are normally removed through urination. When bacteria multiply faster than they are removed by urination, infection results.

Risks for cystitis include obstruction of the bladder or urethra with resultant stagnation of urine, insertion of instruments into the urinary tract (such as catheterization or cystoscopy), pregnancy, diabetes, HIV, and a history of analgesic nephropathy or reflux nephropathy.

The elderly of both sexes are at increased risk for developing cystitis due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia (BPH), prostatitis and urethral strictures. Also, lack of adequate fluids, bowel incontinence, immobility or decreased mobility and placement in a nursing home, all put people at increased risk for cystitis.

Symptoms
Pressure in the lower pelvis
Painful urination (dysuria)
Frequent or urgent need to urinate
Need to urinate at night (nocturia, similar to prostate cancer or BPH)
Abnormal urine color (cloudy), similar to a urinary tract infection
Blood in the urine (hematuria) (similar to a female's period or bladder cancer)
Foul or strong urine odor

Signs and Tests
A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs).
A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.

Treatment
Because of the risk of the infection spreading to the kidneys (complicated UTI) and due to the high complication rate in the elderly population and in diabetics, prompt treatment is almost always recommended.


Medication
Antibiotics are used to control bacterial infection. It is vital that one finish an entire course of prescribed antibiotics. Commonly used antibiotics include:

Nitrofurantoin
Trimethoprim-sulfamethoxazole
Amoxicillin
Cephalosporins
Ciprofloxacin or levofloxacin
Doxycycline
The choice of antibiotic should preferably be guided by the result of urine culture.

Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics control the bacterial infection. They may be required for long periods of time. Prophylactic low-dose antibiotics are sometimes recommended after acute symptoms have subsided.

Pyridium may be used to reduce the burning and urgency associated with cystitis. In addition, common substances that increase acid in the urine, such as ascorbic acid or cranberry juice, may be recommended to decrease the concentration of bacteria in the urine.

An effective, but old fashioned treatment (that seems to have been forgotten) is a salt water douche. Dissolve plenty of salt in warm water and bathe the affected region until symptoms subside.


Monitoring
Follow-up may include urine cultures to ensure that bacteria are no longer present in the bladder.


Outcomes
Most cases of cystitis are uncomfortable but disappear without complication after treatment.


Possible complications
Chronic or recurrent urinary tract infection
Complicated UTI (pyelonephritis)
Acute renal failure

Prevention
Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of introducing bacteria from the rectal area to the urethra.

Increasing the intake of fluids may allow frequent urination to flush the bacteria from the bladder. Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for long periods of time may allow bacteria time to multiply, so frequent urinating may reduce risk of cystitis in those who are prone to urinary tract infections.

Drinking cranberry juice prevents certain types of bacteria from attaching to the wall of the bladder and may lessen the chance of infection. Cranberry extract tablets have also been found to be effective in preventing cystitis, and avoid the taste of cranberry juice, which some find unpleasant. [proof still needed]

[Plz consult your texts for details]

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Diverticulum

A diverticulum (plural: diverticula) is medical term for an outpouching of a hollow (or a fluid filled) structure in the body. It usually implies that the structure is not normally present, i.e. pathological. However, embryologically, some normal structures begin development as a diverticulum arising off of another structure.

An alphabetical listing of some frequently encountered diverticula follows:


Pathological :

Bladder diverticulum: Balloon-like growths on the bladder commonly associated with a chronic outflow obstruction, such as benign prostatic hypertrophy in older males. Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer.

Colonic diverticula: These can become infected (see diverticulitis) and can perforate, requiring surgery

Diverticulum of Kummerall: unusual nomenclature, in that focal dilatations of a blood vessel are properly referred to as aneurysms

Duodenal & Jejunal diverticul(um|a): congenital lesions, may be a source of bacterial overgrowth

Epiphrenic diverticulum: due to dysfunction of the lower esophageal sphincter, as in achalasia

Killian-Jamieson diverticulum
Meckel's diverticulum: a persistent portion of the omphalomesenteric duct present in 2% of the population

Rokitansky-Aschoff sinuses: in the gallbladder due to chronic cholecystitis

Traction esophageal diverticulum: due to scarring from mediastinal or pulmonary tuberculosis

Urethral diverticulum: congenital in males, post-infectious in females

Zenker's diverticulum: a diverticulum of the mucosa of the pharynx affecting adults

Embryological :

The Kidneys, originally diverticuli in the development of the urinary and reproductive organs
The lungs, originally diverticuli forming off of the ventral foregut.

[For details plz consult your text]

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