By W. Wilson. Arizona State University West.
In a subarachnoid hemorrhage generic mildronate 250 mg mastercard, the cell counts should be equal order 500 mg mildronate amex, and xanthochromia of the fluid should be present, indicating the presence of old blood. Instruct the patient to remain recumbent for 6–12 h, and encourage an increased fluid intake to help prevent “spinal headaches. Complications • Spinal headache: The most common complication (about 20%), this appears within the first 24 h after the puncture. It goes away when the patient is lying down and is aggravated when the patient sits up. It is usually characterized by a severe throbbing pain in the occipital region and can last a week. It is thought to be caused by in- tracranial traction caused by the acute volume depletion of CSF and by persistent leakage from the puncture site. To help prevent spinal headaches, keep the patient re- cumbent for 6–12 h, encourage the intake of fluids, use the smallest needle possible, and keep the bevel of the needle parallel to the long axis of the body to help prevent 13 a persistent CSF leak. If the patient suddenly complains of paresthesia (numbness or shooting pains in the legs), stop the procedure. ORTHOSTATIC BLOOD PRESSURE MEASUREMENT Indication • Assessment of volume depletion Materials • Blood pressure cuff and stethoscope T A B L E 1 3 – 4 D i f f e r e n t i a l D i a g n o s i s o f C e r e b r o s p i n a l F l u i d O p e n i n g P r o t e i n G l u c o s e P r e s s u r e ( m g / ( m g / C e l l s C o n d i t i o n C o l o r ( m m H O ) 1 0 0 m L ) 1 0 0 m L ) ( # / m m 3 ) 2 N O R M A L A d u l t C l e a r 7 0 – 1 8 0 1 5 – 4 5 4 5 – 8 0 0 – 5 l y m p h o c y t e s N e w b o r n C l e a r 7 0 – 1 8 0 2 0 – 1 2 0 2 / 3 s e r u m 4 0 – 6 0 l y m p h o c y t e s I N F E C T I O U S V i r a l i n f e c t i o n C l e a r o r N o r m a l o r N o r m a l o r N o r m a l 1 0 – 5 0 0 ( “ a s e p t i c m e n i n g i t i s ” ) o p a l e s c e n t s l i g h t l y s l i g h t l y l y m p h o c y t e s i n c r e a s e d i n c r e a s e d P M N s B a c t e r i a l O p a l e s c e n t I n c r e a s e d 5 0 – 1 0, 0 0 0 I n c r e a s e d, 2 5 – 1 0, 0 0 0 i n f e c t i o n y e l l o w, m a y u s u a l l y 2 0 P M N s c l o t G r a n u l o m a t o u s C l e a r o r O f t e n I n c r e a s e d, D e c r e a s e d, 1 0 – 5 0 0 i n f e c t i o n o p a l e s c e n t i n c r e a s e d b u t u s u a l l y u s u a l l y l y m p h o c y t e s ( T B, f u n g a l ) 5 0 0 2 0 – 4 0 N E U R O L O G I C G u i l l a i n – B a r r é C l e a r o r N o r m a l M a r k e d l y N o r m a l N o r m a l o r S y n d r o m e C l o u d y i n c r e a s e d i n c r e a s e d l y m p h o c y t e s ( c o n t i n u e d ) T A B L E 1 3 – 4 ( C o n t i n u e d ) O p e n i n g P r o t e i n G l u c o s e P r e s s u r e ( m g / 1 0 0 ( m g / 1 0 0 C e l l s C o n d i t i o n C o l o r ( m m H O ) m L ) m L ) ( # / m m 3 ) 2 M u l t i p l e s c l e r o s i s C l e a r N o r m a l N o r m a l o r N o r m a l 0 – 2 0 l y m p h o c y t e s i n c r e a s e d P s e u d o t u m o r c e r e b r i C l e a r I n c r e a s e d N o r m a l N o r m a l N o r m a l M I S C E L L A N E O U S N e o p l a s m C l e a r o r I n c r e a s e d N o r m a l o r N o r m a l o r N o r m a l o r x a n t h o c h r o m i c i n c r e a s e d d e c r e a s e d i n c r e a s e d l y m p h o c y t e s T r a u m a t i c t a p B l o o d y, n o N o r m a l N o r m a l S I i n c r e a s e d R B C = p e r i p h e r a l x a n t h o c h r o m i a b l o o d ; L e s s R B C i n t u b e 4 t h a n i n t u b e 1 S u b a r a c h n o i d B l o o d y o r U s u a l l y I n c r e a s e d N o r m a l W B C / R B C h e m o r r h a g e x a n t h o c h r o m i c i n c r e a s e d r a t i o s a m e a f t e r 2 – 8 h a s b l o o d A b b r e v i a t i o n s : W B C = w h i t e b lo o d c e ll; R B C = r e d b lo o d c e ll; P M N s = p o ly m o r p h o n u c le a r n e u t r o p h i ls. Changes in blood pressure and pulse when a patient moves from supine to the upright position are very sensitive guides for detecting early volume depletion. Even before a person becomes overtly tachycardic or hypotensive because of volume loss, the demon- stration of orthostatic hypotension aids in the diagnosis. If the patient is unable to stand, have the patient sit at the bedside with legs dangling. A drop in systolic BP greater than 10 mm Hg or an increase in pulse rate greater than 20 (16 if elderly) suggests volume depletion. A change in heart rate is more sensitive and occurs with a lesser degree of volume depletion. Other causes include peripheral vascular disease, surgical sympathectomy, diabetes, and medications (prazosin, hy- dralazine, or reserpine). PELVIC EXAMINATION Indications • Part of a complete physical examination in the female • Used to assist in the diagnosis of diseases and conditions of the female genital tract Materials • Gloves • Vaginal speculum and lubricant • Slides, fixative (Pap aerosol spray, etc), cotton swabs, endocervical brush and cervi- cal spatula prepared for a Pap smear • Materials for other diagnostic tests: Culture media to test for gonorrhea, Chlamy- 13 dia, herpes; sterile cotton swabs, plain glass slides, KOH, and normal saline solu- tions, as needed Procedure 1. The pelvic exam should be carried out in a comfortable fashion for both the patient and physician. The patient should be draped appropriately with her feet placed in the stirrups on the examining table. Pre- pare a low stool, a good light source, and all needed supplies before the exam begins. In unusual situations examinations are conducted on a stretcher or bed; raise the pa- tients buttocks on one or two pillows to elevate the perineum off the mattress. Observe the skin of the perineum for swelling, ulcers, condylomata (venereal warts), or color changes. Inspect the vaginal orifice for discharge, or protrusion of the walls (cystocele, rec- tocele, urethral prolapse). Use a speculum moistened with warm water not with lubricant (lubricant will in- terfere with Pap tests and slide studies). Because the anterior wall of the vagina is close to the urethra and bladder, do not exert pressure in this area. With the speculum directed at a 45-degree angle to the floor, spread the labia and insert the speculum fully, pressing posteriorly.
These symptoms may: • a throbbing sensation in various parts of the body • worsen after sleep and upon awakening • weak discount mildronate 500mg on line, irregular rapid pulse • worsen in the spring • palpitations • worsen after drinking hot beverages mildronate 250mg with visa, taking hot baths, • fainting or direct exposure to the sun The main nervous system complaint treated by lach- • worsen if touched or if the body is constricted by tight esis is cluster headaches. These are headaches that pro- clothes duce pulsating waves of pain, often on the left side, or • worsen with alcohol consumption beginning on the left side then moving to the right. They • produce surging waves of pain often precede menstruation and improve once menses begins. Petit mal seizures and angina are also treated • move from the left side to the right side of the body with lachesis. This personality type often talks about doing great things, but rarely follows through. No particular precautions have been reported when Lachesis is a major homeopathic remedy for hot flash- using lachesis, however, caution must be taken when es associated with menopause. Individuals menstrual and menstrual symptoms such as premenstrual should consult a licensed homeopath or physician. A sore throat that worsens when hot liquids are When taken in the recommended dilute form, no swallowed is a good example of the type of throat com- side effects have been reported. Simi- quantities of the venom cause paralysis and hemorrhag- larly, so is a sore throat with left-sided pain or pain in the ing, and can be fatal. Interactions Lachesis is used to alleviate certain mental or emo- Studies on interactions between lachesis given in tional symptoms. These include suspicion and distrust homeopathic doses and conventional pharmaceuticals that can border on paranoia, extreme talkativeness that are nonexistent. Resources Circulatory complaints treated with lachesis in- BOOKS Hammond, Christopher. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1177 monks of the Roman Catholic Church are vegetarian, as KEY TERMS are the Seventh Day Adventists, who form a group large. Some vegetarians maintain that there is evidence na usually refers to chest pain associated with a that Jesus and the early Christians were vegetarians as heart spasm. In ancient India, the idea of ahimsa developed, Petit mal seizures—A less severe form of epileptic which means “not doing harm. In the Hindu reli- gion, cows are considered sacred animals because Hindus Lockie, Andrew and Nicola Geddes. The Complete Guide to believe that milk is a nutritious and life-supporting gift Homeopathy. ORGANIZATIONS The yoga system of living and health is vegetarian, National Center for Homeopathy. Fairfax Street, Suite because its dietary practices are based on the belief that 306, Alexandria, VA 22314. Prana is the universal life OTHER energy, which yoga experts believe is abundant in fresh Homeopathic Internet Resources. Some Buddhists in Japan and China are vegetarian because of Tish Davidson their spiritual beliefs. Other traditional cultures, such as those in the Middle East and the Mediterranean regions, have evolved diets that consist mainly of lacto-ovo vege- tarian foods. Lacto-ovo vegetarianism The list of famous vegetarians forms an illustrious Definition group. The ancient Greek philosophers, including Socrates, Plato, and Pythagoras, advocated vegetarianism. Lacto-ovo vegetarians are people who do not eat Other famous vegetarians include Leonardo da Vinci, Sir meat, but do include dairy products (lacto) and eggs Isaac Newton, the physician Albert Schweitzer, writer (ovo) in their diets. Albert Einstein, although Origins not a strict vegetarian himself, stated that a vegetarian diet would be an evolutionary step forward for the human race. The term vegetarian was coined in 1847 by the founders of the Vegetarian Society of Great Britain, al- Vegetarianism in America has generally consisted of a though vegetarianism as a way of life has existed for small but vocal number of adherents.
Alterations in that is sometimes high when ovarian cancer is tumor-suppressor genes generic mildronate 250 mg mastercard, such as BRCA1 and BRCA2 purchase 250 mg mildronate mastercard, present. A blood sample can determine the level of would naturally lead to an increased risk of developing CA-125 present. Clinical breast exam (CBE)—Examination of the There are rare, genetic cancer syndromes that may breasts, performed by a physician or nurse. As a group, these comprise less Malignant—A tumor growth that spreads to than 1% of all breast cancer diagnoses. These health problems can initially doses of x rays, in an attempt to visualize the inner appear unrelated, but may be caused by alterations in a breast tissue. As an example, Cowden syndrome typi- Metastasis—The spreading of cancer from the cally involves early-onset thyroid and breast cancers, as original site to other locations in the body. An individual with Cowden syndrome may have Multifocal breast cancer—Multiple primary can- all or some of these symptoms. Primary cancer—The first or original cancer site, Other known cancer syndromes are caused by specific before any metastasis. Most cases of breast cancer occur in A small proportion of breast cancers is caused by women past the age of 50, and more commonly in indi- inherited genetic alterations. The discovery of BRCA2 (location 13q12) As of 2000, the prevalence of BRCA alterations in followed shortly in 1995. Women with alterations in the general population is estimated to be between 1/500 these genes have an increased risk for breast and ovarian and 1/1,000. However, there are specific alterations that cancer, and men have an increased risk for prostate are commonly found in certain ethnic groups. Men with a BRCA2 alteration have an increased Ashkenazi (Eastern European) Jewish population, two risk for breast cancer. Slightly increased risks for colon specific BRCA1 alterations and one BRCA2 alteration 174 GALE ENCYCLOPEDIA OF GENETIC DISORDERS are commonly seen and range in prevalence from 0. As a result, hereditary forms of breast Women in their 20s to 30s naturally have denser breasts, and ovarian cancer are more predominant in people of so mammograms may not be as effective in this age Ashkenazi Jewish ethnicity. A common BRCA1 alter- group because the increased breast density associated ation has been found in the Dutch population; a specific with a tumor is difficult to see. Additionally, common alterations have been helpful in younger women because breast density is not a identified in both BRCA1 and BRCA2 in French large factor in its effectiveness. A breast biopsy can deter- Canadians, and a BRCA1 alteration has often been seen mine specifically whether the breast tissue has undergone in West Africans. Sometimes biopsies Signs and symptoms are performed with a very thin needle (known as fine nee- dle aspiration), or with x ray guidance using a thicker Various symptoms may bring someone to medical needle (known as a core needle biopsy). Sometimes individu- the subject of research studies, but MRI often provides als may feel a breast lump or change while examining very detailed imaging of tumors. It is important to note that not all breast lumps or breast As of 2001, there is DNA-based genetic testing to changes signify cancer—they may be benign growths or identify a BRCA1 or BRCA2 alteration in an individual. In the United States, Myriad Laboratories in Utah is the only place to offer this costly testing (as of 2001, it is Signs of a possible BRCA1 or BRCA2 alteration in about $2,700 for initial analysis). A blood sample is used a family, signifying hereditary breast or ovarian cancer, and both BRCA genes are studied for alterations. There include: is also targeted testing for people in high-risk ethnic • several relatives with cancer groups (such as the Ashkenazi Jews) in which only the • close genetic relationships between people with cancer, common BRCA alterations can be tested; this testing is such as parent-child, sibling-sibling much less costly. Even with current technology (as of 2001), only certain regions of the BRCA genes can be • earlier ages of cancer onset, such as before ages 45-50 studied, which leaves some alterations unlocated. This is because tests are cancers in the same family more likely to find an alteration in a cancer survivor than • case(s) of breast cancer in men someone who has not had cancer.