ABLATION :

Ablation is defined as the removal of material from the surface of an object by vaporization, chipping, or other erosive processes. The term occurs in space physics associated with atmospheric reentry, in glaciology, medicine and passive fire protection.

Medicine

In medicine, ablation is the same as removal of a part of biological tissue, usually by surgery, and more recently using other modalities such as radiofrequency ablation and cryoablation. The American Heritage Stedman's Medical Dictionary defines ablation as "Removal of a body part or the destruction of its function, as by a surgery, disease, or noxious substance."

Surface ablation in the skin (also called resurfacing, because it induces regeneration) can be carried out by chemicals (peeling) or by lasers. Its purpose is to remove skin spots, aged skin, wrinkles, thus rejuvenating it. Surface ablation is also employed in otolaryngology for several kinds of surgery, such as for snoring. Ablation therapy using radiofrequency waves on the heart is used to cure a variety of cardiac arrhythmias such as supraventricular tachycardia, Wolff-Parkinson-White syndrome, ventricular tachycardia and more recently atrial fibrillation. The term is often used in the context of laser ablation, a process by which the molecular bonds of a material are dissolved by a laser.

Rotoablation is a type of arterial cleansing that consists of inserting a tiny, diamond-tipped, drill-like device into the affected artery to remove fatty deposits or plaque. The procedure is used in the treatment of coronary heart disease to restore blood flow.

Bone marrow ablation is a process whereby the human bone marrow cells are eliminated in preparation for a bone marrow transplant. This is performed using high-intensity chemotherapy and total body irradiation. As such it has nothing to do with the vaporization techniques described in the rest of this article.

Recently, some researchers reported successful results with genetic ablation. In particular, genetic ablation is potentially a much more efficient method of removing unwanted cells, such as tumor cells, because large numbers of animals lacking specific cells could be generated. Genetically ablated lines can be maintained for a prolonged period of time and shared within the research community. Researchers at Columbia University report of reconstituted caspases combined from C. elegans and humans, which maintain a high degree of target specificity. The genetic ablation techniques described could prove useful in battling cancer.

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ACUTE ABDOMEN:

The term acute abdomen refers to a sudden, severe pain in the abdomen that is less than 24 hours in duration. It is in many cases an emergent condition requiring urgent and specific diagnosis. Treatment usually involves surgery.

CAUSES:

The differential diagnosis of acute abdomen includes but is not limited to:

Acute appendicitis.
Acute peptic ulcer and its complications.
Acute gall bladder pathology, such as an impacted gallstone.
Acute pancreatitis.
Acute intestinal ischemia (See Section Below.)
Diabetic Ketoacidosis.
Acute Diverticulitis.
Ectopic Pregnancy with tubal rupture.


PERITONITIS:

Acute abdomen is occasionally used synonymously with peritonitis. This is not incorrect; however, peritonitis is the more specific term, referring to inflammation of the peritoneum. It is diagnosed on physical examination as rebound tenderness, or pain upon removal of pressure rather than application of pressure to the abdomen. Peritonitis may result from several of the above diseases, notably appendicitis and pancreatitis.


ISCHEMIC ACUTE ABDOMEN:

Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries, (SMA and IMA respectively) both of which are direct branches of the aorta.

The SMA supplies:

Small bowel.
Ascending and proximal 2/3 of the Transverse colon.
The IMA supplies:

Distal 1/3 of the Transverse colon.
Descending colon
Sigmoid colon.
Of note, the splenic flexure, or the junction between the transverse and descending colon, is supplied by the most distal portions of both the IMA and SMA, and is thus referred to medically as a watershed area, or an area especially vulnerable to ischemia during periods of systemic hypoperfusion, such as in shock (medical).

Acute abdomen of the ischemic variety is usually due to:

A thromboembolism from the left side of the heart, such as may be generated during atrial fibrillation, occluding the SMA.
Nonocclusive ischemia, such as that seen in hypotension secondary to heart failure may also contribute, but usually results in a mucosal or mural infarct, as contrasted with the typically transmural infarct seen in thromboembolus of the SMA.
Primary mesenteric vein thromboses may also cause ischemic acute abdomen, usually precipitated by hypercoagulable states such as polycythemia vera.
Clinically, patients present with diffuse abdominal pain, bowel distention, and bloody diarrhea. On physical exam, bowel sounds will be absent. Laboratory tests reveal a neutrophilic leukocytosis, sometimes with a left shift, and increased serum amylase. Abdominal radiography will show many air-fluid levels, as well as widespread edema.

Acute ischemic abdomen is a surgical emergency. Typically, treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.


WORKUP:

Patients presenting to A&E or the ER with severe abdominal pain will almost always have an Abdominal x-ray and / or a CT scan. These tests can provide a differential diagnosis between simple and complex pathologies. It can also provide evidence to the doctor whether surgical intervention is necessary.

Patients will also most likely receive a CBC/Diff, looking for characteristic findings such as neutrophilia in appendicitis.

[This is in short , plz read complete text for detailed answers]

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Acute pericarditis:

Acute pericarditis is an inflammation of the sac surrounding the heart --- the pericardium --- usually lasting < 6 weeks. It is by far the most common condition affecting the pericardium.


Causes:

According to a recent article[1], the most common causes of acute pericarditis includes:

(35%) Neoplastic
(23%) Autoimmune
(21%) Viral - adenovirus, enterovirus, cytomegalovirus, influenza virus, hepatitis B virus, and herpes simplex virus, etc
( 6%) Bacterial (other than tuberculosis)
( 6%) Uremia
( 4%) Tuberculosis
( 4%) Idiopathic
(remaining) trauma, drugs, post-AMI, myocarditis, dissecting aortic aneurysm, radiation

Symptoms and Signs:

Chest pain is one of the common symptoms of acute pericarditis. It is usually of sudden onset, occurring in the anterior chest and may be pleuritic in nature --- that is, sharp and worsens with inspiration, due to concomitant pleural inflammation. The pain may be alleviated with sitting up and leaning forward while worsened with lying down, and also may radiate to the back, to one or both trapezius ridges. However, the pain can also be dull and steady, resembling the chest pain in an acute myocardial infarction. As with any chest pain, other causes must also be ruled out, such as GERD, pulmonary embolism, muscular pain, etc.

Pericardial rub: is a very specific sign of acute pericarditis, meaning the presence of this sign invariably indicates presence of disease. However, absence of this sign does not rule out disease. This rub can be best heard by the diaphragm of the stethoscope at the left sternal border arising as a squeaky or scratching sound, resembling the sound of leather rubbing against each other. This sound should be distinguished from the sound of a murmur, which is similar but sounds more like a "swish" sound than a scratching sound. The pericardial rub is said to be generated from the friction generated by the two inflamed layers of the pericardium; however, even a large pericardial effusion does not necessarily prevent a rub. The rub is best heard during the maximal movement of the heart within the pericardial sac, namely, during atrial systole, ventricular systole, and the filling phase of early ventricular diastole.

Fever may be present since this is an inflammatory process.

Complications:

One of the most feared complications of acute pericarditis is cardiac tamponade. Cardiac tamponade is accumulation of enough fluid in the pericardial space --- pericardial effusion --- to cause serious obstruction to the inflow of blood to the heart. This condition is fatal if not treated promptly.

Diagnostic tests, imaging:

Inflammatory markers. A CBC may show an elevated white count and a serum C-reactive protein may be elevated.

Molecular markers. Acute pericarditis is associated with a modest increase in serum creatine kinase MB (CK-MB)[2][3] and cardiac troponin I (cTnI)[4][5], both of which are also markers for myocardial injury. Therefore, it is imperative to also rule out acute myocardial infarction in the face of these biomarkers. The elevation of these substances is related to inflammation of the myocardium. Also, ST elevation on EKG (see below) is more common in those patients with a cTnI > 1.5 µg/L[5]. Coronary angiography in those patients should indicated normal vascular perfusion. The elevation of these biomarkers are typically transient and should return to normal within a week. Persistence may indicated myopericarditis.

Electrocardiogram (EKG). EKG changes in acute pericarditis mainly indicates inflammation of the epicardium (the layer directly surrounding the heart), since the fibrous pericardium is electrically inert. For example, in uremia, there is no inflammation in the epicardium, only fibrin deposition, and therefore the EKG in uremic pericarditis will be normal. Typical EKG changes in acute pericarditis includes.

stage 1 -- diffuse, positive, ST elevations with reciprocal ST depression in aVR and V1. Elevation of PR
stage 2 -- normalization of ST and PR
stage 3 -- diffuse T wave inversions (may not be present in all patients)
stage 4 -- EKG becomes normal OR T waves may be indefinitely inverted
Because the most common cause of ST elevation is an acute myocardial infarction, and since acute pericarditis can also be a short term complication after an acute myocardial infarction, steps must be taken to differentiate the two EKG readings.

Rarely, electrical alternans may be seen, depending on the size of the effusion.

Chest X-ray. Usually normal in acute pericarditis, but can reveal cardiomegaly (enlarged heart) if the pericardial effusion is more than 200 mL. Conversely, patients with unexplained new onset cardiomegaly should always be worked up for acute pericarditis.

Echocardiogram. Usually normal in acute pericarditis but can reveal pericardial effusion, the presence of which supports the diagnosis, although its absence does not exclude the diagnosis.


Treatment:

Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. However, those with high risk factors for developing complications (see above) will need to be admitted to an inpatient service, most likely an ICU setting. High risk patients include:

1.Subacute onset
2.high fever (> 100.4 F) and leukocytosis
3.development of cardiac tamponade
4.large pericardial effusion (echo-free space > 20 mm) resistant to NSAID treatment
5.immunocompromised
6.history of oral anticoagulation therapy
7.acute trauma
8.failure to respond to seven days of NSAID treatment

Pericardiocentesis is a procedure whereby the fluid in a pericardial effusion is removed through a needle. It is performed under the following conditions

a.presence of moderate or severe cardiac tamponade
b.diagnostic purpose for suspected purulent, tuberculosis, or neoplastic pericarditis
c.persistent symptomatic pericardial effusion .

NSAIDs in viral or idiopathic pericarditis. In patients with underlying causes other than viral, the specific etiology should be treated. With idiopathic or viral pericarditis, NSAID is the mainstay treatment. Goal of therapy is to reduce pain and inflammation. The course of the disease may not be affected. The preferred NSAID is ibuprofen because of rare side effects, better effect on coronary flow, and larger dose range. Depending on severity, dosing is between 300-800 mg every 6-8 hours for days or weeks as needed. An alternative protocol is aspirin 800 mg every 6-8 hours.Dose tapering of NSAIDs may be needed. In pericarditis following acute myocardial infarction, NSAIDs other than aspirin should be avoided since they can impair scar formation. As with all NSAID use, GI protection should be engaged. Failure to respond to NSAIDs within one week (indicated by persistence of fever, worsening of condition, new pericardial effusion, or continuing chest pain) likely indicates that a cause other than viral or idiopathic is in process.

Colchicine can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis. For patients with a first episode of acute idiopathic or viral pericarditis, they should be treated with an NSAID plus colchicine 1-2 mg on first day followed by 0.5 daily or BID for three months.

Corticosteroids are usually used in those cases that are clearly refractory to NSAIDs and colchicine and a specific cause has not been found. Systemic corticosteroids are usually reserved for those with autoimmune disease.
[Plz consult your texts for complete theory]

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Admission note;

An admission note is written for any patient to be admitted to a hospital. Admission notes are used by healthcare payors to determine billing; doctors use them to record a patient's baseline status and may write additional on-service notes, progress notes, discharge notes, preoperative notes, operative notes, postoperative notes, procedure notes, delivery notes, postpartum notes, and discharge notes. These notes constitute a large part of the medical record. Medical students often develop their clinical reasoning skills by writing admission notes.

An admission note may sometimes be incorrectly referred to as an HPI (history of present illness) or H and P (history and physical), which include only portions of an admission note. An admission note includes:

chief complaint
.history of present illness, including a separate paragraph summarizing related history
.review of systems
.allergies, including drug allergies (including antigens and responses)
.past medical history
.past surgical history
.family history, including health of siblings, parents, spouse, and children, living and dead
.social history
.medications
physical exam
labs
diagnostics studies
assessment
plan

Outline
Not every admission note explicitly discusses every item listed below, however, the ideal admission note would include:

Header
Patient identifying information (maybe located separately)
name
ID number
chart number
room number
date of birth
attending physician
sex
admission date
Date
Time
Service

Chief complaint (CC), typically one sentence including
age
race
sex
presenting complaint
example: "34 yo white male with right-sided weakness and slurred speech."
History of present illness (HPI)
statement of health status
detailed description of chief complaint
positive and negative symptoms related to the chief complaint based on the differential diagnosis the health care provider has developed.
emergency actions taken and patient responses if relevant
Review of Systems (ROS)
General
Head
Eyes
Ears
Nose and sinuses
Throat, mouth, and neck
Breasts
Cardiovascular system
Respiratory system
Gastrointestinal system
Urinary system
Genital system
Vascular system
Musculoskeletal system
Nervous system
Psychiatric
Hematologic system
Endocrine system
Allergies
first antigen and response
second antigen and response
etc
Past Medical History (PMHx)
Past Surgical History (PSurgHx)
Family History (FmHx): health or cause of death for
Parents
Siblings
Children
Spouse
Social History (SocHx)
Alcohol
Tobacco
illicit drugs
occupation
sexual preference (increased risk of various infections among prostitutes, johns, and males engaging in anal-receptive intercourse)
prison (especially if tuberculosis needs to be ruled out)
Medications
for each: generic name - amount - rate
medications on arrival (aspirin, Goody's medicated powder, herbal remedies, prescriptions, etc)
medications on transfer
Physical Exam
Review of Systems (ROS)
General
Head
Eyes
Ears
Nose and sinuses
Throat, mouth, and neck
Breasts
Cardiovascular system
Respiratory system
Gastrointestinal system
Urinary system
Genital system
Vascular system
Musculoskeletal system
Nervous system
Psychiatric
Hematologic system
Endocrine system
Labs, eg: electrolytes, arterial blood gases, liver function tests, etc
Diagnostics, eg: EKG, CXR, CT, MRI
Assessment and Plan
Assessment includes a discussion of the differential diagnosis and supporting history and exam findings.
The plan is typically broken out by problem or system. Each problem should include:
brief summary of the problem, perhaps including what has been done thus far
orders for medications, labs, studies, procedures and surgeries to address the problem.
problems are commonly derived from
chief complaint
history of present illness
review of systems rarely, these should have been picked up and incorporated as new chief complaints during the interview
physical exam rarely, these should have been picked up and incorporated as new chief complaints during the exam
social history, including counseling for smoking, alcohol, and illicit drug use
family history
medications may indicate problems that need to be addressed in the treatment of the other problems, such as dyslipidemia controlled with a statin.

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Agnosia

Agnosia (a-gnosis, "non-knowledge", or loss of knowledge) is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss. It is usually associated with brain injury or neurological illness, particularly after damage to the temporal lobe.

Types
Visual agnosia is associated with lesions of the left occipital lobe and temporal lobes. Many are the inability to recognize objects. Subtypes:

Form agnosia: Patients perceive only parts of details, not the whole object.

Simultanagnosia: Patients can recognize objects or details in their visual field, but only one at a time. They cannot make out the scene they belong to or make out a whole image out of the details. They literally cannot see the forest for the trees. Simultanagnosia is a common symptom of Balint's syndrome.

Associative agnosia: Patients can describe visual scenes and classes of objects but still fail to recognize them. He may, for example, know that a fork is something you eat with but may mistake it for a spoon. Patients suffering from associative agnosia are still able to reproduce an image through copying.

Apperceptive agnosia: Patients are unable to distinguish visual shapes and so have trouble recognizing, copying, or discriminating between different visual stimuli. Unlike patients suffering from associative agnosia, those with apperceptive agnosia are unable to copy images.

Mirror agnosia: Patients cannot recognize objects or activity on either their left or right field of view. Impairment can vary from mild inattention to complete inability to perform spatial reasoning with regard to the afflicted side. The disorder takes its name from an experiment in which a patient was shown objects reflected in a mirror and saw them, but was unable to find them when prompted.

Semantic agnosia: Those with this form of agnosia are effectively 'object blind' until they use non-visual sensory systems to recognise the object. For example, feeling, tapping, smelling, rocking or flicking the object, may trigger realisation of its semantics (meaning).

Agnosic alexia: Inability to recognize text.

Color agnosia: There is a distinction between color perception versus color recognition. Central achromatopsia and color blindness refer to deficiency in color perception.

Prosopagnosia also known as faceblindness and facial agnosia: Patients cannot consciously recognize familiar faces, sometimes even including their own. This is often misperceived as an inability to remember names. People with PA frequently (but not always) also suffer from: **topographical agnosia (poor sense of direction, get lost easily),

automobilia agnosia (an inability to recognize cars),

expressive agnosia (an inability to perceive people's moods from their facial expressions),

verbal agnosia (see below) and possibly

Verbal agnosia involve significant difficulty recognising words. Subtypes:

Verbal agnosia or Pure word deafness or simply word deafness: agnosia connected to the processing of language information. Patients may hear or read words, but they don't understand what they mean or may hear them simply as sound patterns. Verbal agnosia, is a form of [Language Processing Disorder] which is clinically distinguished from CAPD/APD where those with CAPD/APD can usually read with meaning but struggle to understand speech when there are extraneous sounds (ie fans) where those with Verbal Agnosia may or Language Processing Disorder will generally struggle to put meaning to both written and verbal speech. Nevertheless, whilst this would pose significant challenges, this should not be confused with the ability to develop verbal or written language skills which would be an expressive rather than receptive skill.
Aural agnosia involve significant difficulty recognising aspects of sound.

Subtypes:

Auditory agnosia refers to similar symptoms for sounds. This term is sometimes used with the limited reference to environmental, nonverbal auditory cues, as separate from verbal agnosia. With Auditory Agnosia there is difficulty distinguishing speech from non-speech sounds even though hearing is usually normal. There is a weakly defined link between these terms and CAPD/APD (originally Central Auditory Processing Disorder, the term Auditory Processing Disorder is now preferred).
Amusia or Receptive amusia is agnosia for music. It involves loss of the ability to recognize musical notes, rhythms, and intervals and the inability to experience music as musical.
Cortical deafness refers to people who do not respond to any auditory information but whose hearing is intact.
Phonagnosia is the inability to recognize familiar voices, even though the hearer can understand the words used.
Tactile agnosia involve significant difficulty recognising physical feedback.

Subtypes:

Somatosensory agnosia is connected to tactile sense - that is, touch. Patient finds it difficult to recognize objects by touch based on its texture, size and weight. However, they may be able to describe it verbally or recognize same kind of objects from pictures or draw pictures of them. Thought to be connected to lesions or damage in somatosensory cortex.
Pain agnosia is the difficulty perceiving and processing pain, thought to underpin some forms of self injury.
Finger agnosia is the inability to distinguish the fingers on the hand. It is present in lesions of the dominant parietal lobe, and is a component of Gerstmann syndrome.

Other agnosias :

integrative agnosia This is where one has the ability to recognize elements of something but yet be unable to integrate these elements together into comprehensible perceptual wholes.
Anosognosia This is the inability to gain feedback about one's own condition and can be confused with lack of insight but is caused by problems in the feedback mechanisms in the brain. It's caused by neurological damage and can occur in connection with a range of neurological impairments. Those with Anosognosia with multiple impairments may even be aware off some of their impairments but completely unable to perceive others.

Causes
Agnosia can result from strokes, dementia, or other neurological disorders. It may also be trauma-induced by a head injury, or hereditary. Some forms of agnosia have been found to be genetic.


Treatment
For all practical purposes, there is no direct cure. Patients may improve if information is presented in other modalities than the damaged one. In some cases, occupational therapy or speech therapy can improve agnosia, depending on its etiology.
[Plz refer your textbooks for further details]
rani

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Anhidrosis

Anhidrosis means lack of sweating. It is also known by a number of other names including Adiaphoresis, Ischidrosis, Hypohidrosis, Oligidria, Oligohidrosis and Sweating deficiency.

Causes
It may be caused by underactivity of the sympathetic nervous system. Eccrine sweat glands are innervated via muscarinic acetylcholine receptors. Hence antimuscarinic drugs cause anhidrosis.

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Aura (symptom)

According to Samer, an aura is the perceptual disturbance experienced by some migraine sufferers before a migraine headache, and the telltale sensation experienced by some people with epilepsy before a seizure. It often manifests as the perception of a strange light or an unpleasant smell.

An aura does not necessitate the onset of either a migraine or a seizure and not everyone who suffers from migraines or seizures will experience auras. Though auras tend to be an unpleasant and irritating sensation, they can be beneficial. Most injuries from seizures occur when there is no warning. Auras allow epileptics time to prevent injury to themselves. The time between the appearance of the aura and the onset of a migraine or seizure can be anything from a few seconds up to an hour. Most people who have auras have the same type of aura every time.

An aura sensation can include:

Visual Changes.
Bright lights.
Zigzag lines.
Distortions in the size or shape of object.
scintillating scotoma
Shimmering, pulsating patches, often curved.
Tunnel Vision
scotoma
Blind or dark spots in the field of vision.
Curtain like effect over one eye.
Slowly spreading spots.
Kaleidescope effects on visual field
Total temporary monocular (in one eye) blindness. (in retinal migraine)
Auditory changes
Hearing voices or sounds that don't exist: true auditory hallucinations.
Modification of voices or sounds in the environment: buzzing, tremolo, amplitude modulation or other modulations.
Strange smells (olfactory hallucinations).
Feelings of numbness or tingling on one side of the face or body.
Feeling separated from one's body.
Feeling as if your limbs are moving independently from your body.
Anxiety or fear.
Nausea.
Weakness, unsteadiness.
Being unable to understand or comprehend spoken words during and after the aura.
Being unable to speak properly, despite your brain grasping what you're trying to verbalize. (Aphasia)
Feeling of power or sense of euphoria (this symptom has been associated with discontinuation of seizure treatments - the sufferer may enjoy the experience and think it worth the seizure or migraine that follows)
The specific type of sensation associated with an aura can potentially be used in an attempt to localize the focus of a seizure.

Auras share similar symptoms with strokes, but onset is more gradual with auras.

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Autonomic dysreflexia

Autonomic dysreflexia,"AD" or "autonomic hyperreflexia" is a massive sympathetic discharge that can occur in association with spinal cord injury or disease (e.g. multiple sclerosis). It is triggered by a variety of noxious stimuli, including bladder distension, irritation to the urinary tract, skin ulcers, fractures, abdominal emergencies, bowel impaction and uterine contractions. Sometimes the triggering factor is obscure.

The risk is greatest with cervical spinal cord lesions and is rare with lesions below T6. It has rarely been reported in spinal cord lesions as low as T10. The first episode may occur weeks to years after spinal cord injury takes place, but most people at risk (80%)develop their first episode within the first year after injury. The diagnosis is usually not subtle, although asymptomatic events have been documented. This condition is distinct and usually episodic, with the patient experiencing remarkably high blood pressure (often with systolic readings over 200 mm. Hg), intense headaches, profuse sweating, facial erythema, goosebumps, nasal stuffiness, and a "feeling of doom". An elevation of 40 mm. Hg. over baseline systolic should be suspicious for dysreflexia.

Older patients with very incomplete spinal cord injuries and systolic hypertension without symptoms are usually experiencing essential hypertension, not autonomic dysreflexia. Aggressive treatment of these elderly patients with rapidly acting antihypertensive medications can have disastrous results.

Autonomic dysreflexia differs from autonomic instability, a term used to describe the variety of modest cardiac and neurological changes that accompany a spinal cord injury, including bradycardia, orthostatic hypotension, and ambient temperature intolerance.

Proper treatment of autonomic dysreflexia involves immediate determination and removal of the triggering stimuli. Often, sitting the patient up and dangling legs over the bedside can reduce blood pressures below dangerous levels and provide partial symptom relief. Tight clothing and stockings should be removed. Catheterization of the bladder, or relief of a blocked urinary catheter tube may resolve the problem. The rectum should be cleared of stool impaction, using anaesthetic lubricating jelly. If the noxious precipitating trigger cannot be identified, drug treatment is sometimes needed until further studies can identify the cause.

Drug treatment includes the rapidly acting vasodilators, including sublingual nitrates or oral clonidine. Topical nitropaste is a convenient and safe treatment -- an inch or two can be applied to the chest wall, and wiped off when blood pressures begin to normalize. Autonomic dysreflexia is abolished temporarily by spinal or general anaesthesia. These treatment are used during obstetric delivery of a woman with autonomic dysreflexia.

Autonomic dysreflexia can become chronic and recurrent, often in response to longstanding medical problems like soft tissue ulcers or hemorrhoids. Long term therapy may include alpha blockers or calcium channel blockers.

Autonomic dysreflexia is a medical emergency. Complications of severe acute hypertension can include seizures, pulmonary oedema, myocardial infarction or cerebral haemorrhage. The cause of autonomic dysreflexia itself can be life threatening, and must also be completely investigated and treated appropriately to prevent unnecessary morbidity and mortality.

The Consortium for Spinal Cord Medicine has developed evidence-based clinical practice guidelines for the management of autonomic dysreflexia in adults, children, and pregnant women. There is also a consumer version of this guideline.

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Benign

Benign (from the Latin roots bene- = "well" and -genus = "born"), a polyvalent term (refer benign), is employed with a specific denotation as a medical term in medical discourse to describe a mild and nonprogressive disease. The term is most familiar as a description of a non-cancerous (non-malignant) tumor or neoplasm, but may also refer to other mild health conditions.

Uses of "benign" in oncology:

Benign tumor, generally synonymous with benign neoplasm.
Non-oncologic disorders referred to as "benign":

Benign intracranial hypertension
Benign paroxysmal positional vertigo
Benign prostatic hyperplasia
Benign tertian malaria (Malaria caused specifically by Plasmodium vivax or Plasmodium ovale)

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Benign tumor

A benign tumor is a tumor that lacks all three of the malignant properties of a cancer. Thus, by definition, a benign tumor:

does not grow in an unlimited, aggressive manner
does not invade surrounding tissues
does not metastasize
Common examples of benign tumors include moles and uterine fibroids.

The term "benign" implies a mild and nonprogressive disease, and indeed, many kinds of benign tumor are harmless to the health. However, some neoplasms which are defined as 'benign tumors' because they lack the invasive properties of a cancer, may still produce negative health effects. Examples of this include tumors which produce a "mass effect" (compression of vital organs such as blood vessels), or "functional" tumors of endocrine tissues, which may overproduce certain hormones (examples include thyroid adenomas, adrenocortical adenomas, and pituitary adenomas).

Benign tumors typically are encapsulated, which inhibits their ability to behave in a malignant manner. Nonetheless, many types of benign tumors have the potential to become malignant and some types, such as teratoma, are notorious for this.

Classification
The term "tumor" literally means "swelling", and the broadest definition of "benign tumor" encompasses all abnormal tissue masses which are not cancers. In practice, most of these entities are neoplasms, meaning that they contain a discrete population of cells which proliferate in an independent manner, usually as the result of acquired genetic abnormalities. Entities which may be referred to as "tumors" but are non-neoplastic include developmental abnormalities, such as hamartomas and ectopic rests (normal tissue in an anatomically abnormal location).

Benign neoplasms are typically composed of cells which bear a strong resemblance to a normal cell type in their organ of origin. These tumors are named for the cell or tissue type from which they originate, followed by the suffix "-oma" (but not -carcinoma, -sarcoma, or -blastoma, which are generally cancers). For example, a lipoma is a common benign tumor of fat cells (lipocytes), and a chondroma is a benign tumor of cartilage-forming cells (chondrocytes). Adenomas are benign tumors of gland-forming cells, and are usually specified further by their cell or organ of origin, as in hepatic adenoma (a benign tumor of hepatocytes, or liver cells). There are a few cancers with 'benign-sounding' names which have been retained for historical reasons, including melanoma (a cancer of pigmented skin cells, or melanocytes) and seminoma (a cancer of male reproductive cells).

In some cases, certain "benign" tumors may later give rise to malignant cancers, which result from additional genetic changes in a subpopulation of the tumor's neoplastic cells. A prominent example of this phenomenon is the tubular adenoma, a common type of colon polyp which is an important precursor to colon cancer. The cells in tubular adenomas, like most tumors which frequently progess to cancer, show certain abnormalities of cell maturation and appearance collectively known as dysplasia. These cellular abnormalities and are not seen in benign tumors that rarely or never turn cancerous, but are seen in other pre-cancerous tissue abnormalities which do not form discrete masses, such as pre-cancerous lesions of the uterine cervix. Some authorities prefer to refer to dysplastic tumors as "pre-malignant", and reserve the term "benign" for tumors which rarely or never give rise to cancer.


Signs and symptoms
Benign tumors are very diverse, and may be asymptomatic or may cause specific symptoms depending on their anatomic location and tissue type. Symptoms or pathological effects of some benign tumors may include:

Bleeding or occult blood loss causing anemia
Pressure causing pain or dysfunction
Cosmetic changes
Itching
'Hormonal syndromes' resulting from hormones secreted by the tumor
Obstruction, e.g., of the intestines
Compression of blood vessels or vital organs

Treatment
Many benign tumors do not need to be treated at all. If a benign tumor is causing symptoms, presents a health risk, or causes a cosmetic concern for the patient, surgery is usually the most effective approach. Most benign tumors do not respond to chemotherapy or radiation therapy, although there are exceptions.

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