Arthritis Australia

By T. Thordir. University of Nevada, Reno.

The causes of bladder outflow obstruction are shown in Surgical re-implantation of the ureter may be indi- Table 6 effective alli 60mg. Overtime cheap alli 60 mg amex,theblad- Benign prostatic hyperplasia der distends, then the ureters (causing hydroureters) and Definition finally the renal pelvises. Often there may be an un- Hyperplasiaoftheprostateisacommoncauseof bladder derlying chronic obstruction for example an enlarged outflow obstruction. Clinical features The symptoms depend on the speed of onset and degree Age of obstruction. Acute obstruction (acute urinary retention) causes se- vere discomfort, due to a wish to void urine, without Sex the ability to do so. There is complete anuria, although there may be small amounts of urine voided due to overflow in- Aetiology continence. However, polyuria and/or nocturia may Pathophysiology be symptoms of the loss of concentrating ability of the Androgens appear to act on the periurethral area of the tubules, which can occur in long-standing obstruc- prostate ‘McNeal’s transition zone’ to stimulate hyper- tion. At 30–40 years there is microscopic evidence, by 50 years it Macroscopy is macroscopically visible, by 60 years the clinical phase Dilation above the obstruction. The obstruction is due to both direct impingement Complications of the enlarged prostate on the urethra and also the dy- As aresultofchronicobstruction,thebladderdilatesand namic smooth muscle contraction of the prostate, pro- fails to empty fully, defined as >50 mL residual urine static capsule and bladder neck. Nodules Management formedofhyperplasticglandularacinidisplaceandcom- Relief of the obstruction is usually by insertion of a uri- press the true prostatic glands peripherally forming a nary catheter, followed by treatment of the underlying false capsule. Chapter 6: Disorders of the bladder and prostate 263 Microscopy symptoms than α-blockers. It seems to be more effec- Benign epithelial proliferation with large acini, smooth tive in those with very large prostates and its effects muscleandfibroblastproliferation. The procedure involves removal Complications of prostatic tissue using electrocautery via a resecto- Bladder decompensation – due to chronically increased scope from within the prostatic urethra, under general residualvolumes(urineretainedaftervoiding),theblad- or spinal anaethesia. Post-operatively patients require der may become less contractile, lowering flow rates fur- a three-way catheter and continuous bladder irrigation ther. Obstruction may lead to dilated ureters and kid- to reduce the risk of clot retention until haematuria is ney(hydroureter,andhydronephrosis). Investigations Antibiotic prophylaxis is usually given to prevent Itisimportanttoexcludeothercausesof bladderoutflow urinary tract infection. Between10and15mL/second,combined bladder neck contracture or urethral stricture requir- pressure/flow studies may be done to exclude those ing surgery or dilatation, incontinence. The disad- Other options (not widely available) include: vantage of the latter, is that urinary catheterisation is r Stent which is cost-effective in those with a short required. Definition r Finasteride is a 5 alpha reductase inhibitor which in- Urinary incontinence is the involuntary loss of urine hibits the conversion of testosterone to dihydrotestos- from the urethra. It is also useful, but generally less effective for and functional impact on the individual. This is mainly due to detrusor instability/over- 30% of women <65 years but only up to 5% of men <65 activity. Rates are much higher in certain settings such as care of r Overflow incontinence is continual or unprecipitated the elderly institutions (up to 45%) and psychiatric care leakage without urge. Bladder outflow obstruction may lead Age to overflow incontinence due to bladder decompen- Increases with age. Rare causes include spinal cord compression affecting the sacral segments (S2, 3 and 4) or the conus medullaris. F > M Acomprehensive examination is important and can avoid the need for specialist tests. It is important to as- Aetiology sess fluid balance, mobility, cognitive ability and relevant Incontinence has been associated with many conditions neurology. Rectal examination for constipation, rectal and risk factors such as chronic cough, depression, de- masses and vaginal speculum examination for atrophy, mentia, pregnancy, vaginal delivery (particularly with masses, cystocele or rectocele. Toremaincontinentthere r Avoiding diary is useful to record the time, volume must be: and relevant events, e. This is due to poor sphincter func- Stress incontinence: Initially non-surgical options tion. This r Pelvic floor (Kegel) exercises (with or without weigh- may be precipitated by the sound of running water, tedcones) may be used but are dependent on the Chapter 6: Urinary tract infections 265 motivation of the patient. Systemic or topical oestro- r Inspinalcordcompressionemergencydecompression gen therapy may be of benefit. Ring tions intermittent self-catheterisation is the preferred pessaries are useful for those with uterine prolapse. For vaginal cys- Urinary tract infections toceles (where the bladder herniates into the vaginal canal), a transvaginal approach may be used to re- pair the cystocele but this is generally less effective. In females, vaginitis is another syndrome Urge incontinence: unlike stress incontinence, be- which commonly overlaps.

This has become a huge market that does not require the approval of the drug controllers generic alli 60 mg online, and hence many pharmaceutical and biotechnology companies have extended the term nutraceutical to include pure compounds of natural origin like lovastatin (a lipid-lowering agent from Monascus ruber and Aspergillus terreus) [107] and curcumin (Curcuma longa) discount alli 60 mg fast delivery. Since herbal drugs/ formulations are based on traditional knowledge, the United States Food and Drug Administration banned the dietary supplement cholestin (i. Many of these nutraceuticals have anti-oxidant and chemopre- ventive properties; therefore, they have a direct bearing on disease prevention and consequently less burden on the health-care system. Chapter 18 The Indian Herbal Drugs Scenario in Global Perspectives 343 The major drawback with Indian herbal manufacturers, particularly small- scale industries, is that their products are not standardised. Adulterations are caused mostly at collection points, sometimes at trader level and rarely at the manufacturer level, thus affecting the effcacy of the formulation, and as a re- sult, faith in indigenous drugs has declined [108]. Illiterate tribal peoples and villagers collect raw materials and they do not understand the importance of quality and standards. There are several examples of substitution of highly priced material with a cheap product for example, bark of Holarrhena anti- dysenterica with Wrightia tinctoria, Saraca indica with Trema orientalis [109], roots of Cholorophytum borivilianum with Asparagus racemosus [78], and gum resin of Commiphora wightii with gum of Acacia arabica and Boswellia ser- rata. Identifcation of active molecules in a medicinal plant is an essential require- ment towards developing methods for quality controls. A serious problem in the country is that authentic compounds are usually not available for com- parison on various chromatographic techniques. Isolation and identifcation of compounds using nuclear magnetic resonance or mass spectrophotometry is not available to many small industries or universities, while a few national laboratories (in India) have their hands full with institutional work. It has been emphasised in ancient Ayurvedic literature that the season of harvest and the age of the plant affect the quality of herb. The amount and nature of secondary metabolites are not constant throughout the year. The age of the plant also affects the quantity and relative proportions of different constituents. The drying conditions, storage and processing of raw material need standardisation and control to maintain uniform quality. It has been shown that drugs such as Indian hemp and sarsa- parilla deteriorate even when carefully stored. This in- creased utilisation of herbs has direct repercussions on the collection of raw materials and consequently requires sustainable utilisation of these plants along with methods of conservation, and studies of reproductive biology, phytochemistry and pharmacological validation. Although herbal drugs have been used in the Indian system of medicine for last several hundred years, and they are prepared by a procedure prescribed in Ayurvedic text, their toxicity/safety must be evalu- ated on modern models for universal acceptance. Goyal are in the small sector, which need improvements regarding the processing of raw material, packaging, quality control (most have no research and develop- ment or quality control system) and technical know-how regarding global de- mand and marketing. Wang X, Greilberger J, Ledinski G, Kager G, Paigen B, Jurgens G (2004) Atheroscle- rosis 172:239 13. Paper presented at the International Seminar for the Chapter 18 The Indian Herbal Drugs Scenario in Global Perspectives 345 Protection of Traditional Knowledge, New Delhi. Dev S (2006) A Selection of Prime Ayurvedic Plant Drugs, Ancient-Modern Concor- dance. Pramyothin P, Samosorn P, Poungshompoo S, Chaichantipyuth C (2006) J Ethno- pharmacol 107:361 47. Pattanaik S, Hota D, Prabhakar S, Kharbanda P, Pandhi P (2006) Phytother Res 20:683 49. Senthilnathan P, Padmavathi R, Magesh V, Sakthisekaran D (2006) Cancer Sci 97:658 72. Ramakrishnappa K (2002) Impact of cultivation and gathering of medicinal plants on biodiversity: case studies from India. In: Biodiversity and the Ecosystem Approach in Agriculture, Forestry and Fisheries online. Lange D (1998) Europe’s Medicinal and Aromatic Plants: Their Use, Trade and Con- servation. Ahmad B (1998) Plant exploration and documentation in view of land clearing in Sabah. Proceedings of a seminar, 15–16 October 1998, Serdang, Malaysia, Faculty of Forestry, Universiti Putra Malaysia, p 161 93. Proceedings of the First Symposium on the Conservation of Medicinal Plants in Trade in Europe. Zhang X (1997) The International Symposium on Herbal Medicine, 25–27 March, King Fahad Hospital, Jeddah, Saudi Arabia 99. Agrobios (India), Jodhpur Chapter 19 Phytochemical Standardization of Herbal Drugs and Polyherbal Formulations M. Commercialization of the manufacture of these medicines to meet this increasing demand has resulted in a decline in their quality, primarily due to a lack of adequate regulations pertaining to this sector of medicine. The need of the hour is to evolve a systematic approach and to develop well-designed methodologies for the standardization of herbal raw materials and herbal formulations.

The nail matrix: the portion or root at the base of the nail under the cuticle that produces new cells for the nail plate alli 60 mg. You can see a portion of the matrix in the light half-moon (the “lunula”) visible at the base of the nail plate buy alli 60mg with mastercard. This determines the shape and thickness of the nail; a curved matrix produces a curved nail, a flat one produces a flat nail. Ordinarily, depending on the type of trauma, an x-ray would be performed to rule out a fracture of the digit; you won’t have this available if modern medical care is not available, but you can do this: Numb the area by providing a digital block (discussed earlier in this book). Clean the nail bed thoroughly with saline solution, if available, and irrigate out any debris. Cover the exposed (and very sensitive) nail bed with a non- adherent (telfa) dressing. If the nail plate is hanging on by a thread, remove it by separating it from the skin folds by using a small surgical clamp. You can consider placing the avulsed nail plate on the nail bed as a protective covering; it is dead tissue but may be the most comfortable option. If the nail bed is lacerated, suture (if clean) with the thinnest gauge absorbable suture available (6-0 Vicryl is good). Be sure to remove any nail plate tissue over the laceration so the suture repair will be complete. Some will immobilize the digit with a finger splint to protect it from further damage. In some crush injuries, such as striking the nail plate with a hammer, a bruise (also called an “ecchymosis”) or a collection of blood may form underneath (a “hematoma”). A hematoma, however, will continue to be painful even several hours after the event. A bruise will likely appear brownish or blue, but a hematoma may appear a deep blue-black. For a bruised nail, little needs to be done other than given oral pain relief, such as Ibuprofen. For a significant hematoma, however, some suggest a further procedure called “trephination”. In this instance, a very fine drill (or a hot 18 gauge needle or paper clip) is used to make a hole in the nail plate. This must be large enough to relieve pressure from the blood that has collected under the nail. This procedure should not be performed unless absolutely necessary, as the pain will eventually decrease over time by itself. The finger must be kept dry, splinted and bandaged for a minimum of 48 hours afterwards. It’s important to know that damage to the base of the nail (the germinal matrix) may be difficult to completely repair, and that future nail growth may be deformed in some way. In situations where modern medical care is available, a hand surgeon is often called in to give the injury the best chance to heal appropriately. If we find ourselves off the power grid, we will be cooking out in the open more frequently. The potential for significant burn injuries will rise exponentially, especially if the survival group includes small children; naturally curious, they may get too close to our campfires. A working knowledge of burns and their treatment will be a standard skill for every group’s medical provider. The severity of the burn injury depends on the percentage of the total body surface that is burned, and on the degree (depth) of the burn injury. Although assessing the surface percentage is helpful to burn units in major hospitals, this practice will likely be of limited helpfulness in a collapse. Before we discuss the different degrees of burn you might encounter, preventative measures should be put forth. If you cannot avoid extended exposure to sunlight, be certain to apply a sunblock. Besides the sun, injuries will most likely be related to cooking, especially by campfire. Using hand protection will prevent many of these burns, as will careful supervision of children near any cooking area. Now, let’s concentrate on learning to identify burns by their degree: First Degree Burns These burns will be very common, such as simple sunburn. These burns frequently affect large areas of the torso; immersion in a cool bath is a good idea or at least running cool water over the injury. Placing a cool moist cloth or Spenco Second Skin on the area will give some relief, as will common anti-inflammatory medicines such as Ibuprofen.