Health's Book

Definition

Gynecomastia is the development of abnormally large breasts in males. It is related to the excess growth of breast tissue, rather than excess fat tissue.

Symptoms

Breast growth is directed exclusively by female hormones—estrogens. Although men have some estrogen in their system, it is usually insufficient to cause much breast enlargement because it is counterbalanced by male hormones—androgens. Upsetting the balance, either by more of one or less of the other, results in the male developing female characteristics, breast growth being foremost.

At birth both male and female infants will have little breast buds from their mother's hormones. These recede until adolescence, when girls always, and boys sometimes, have breast growth. At this time, the boy's breast growth is minimal, often one-sided and temporary.

Extra or altered sex chromosomes can produce inter-sex problems of several kinds. Breast growth along with male genital development is seen in Klinefelter syndrome—the condition of having an extra X (female) chromosome—and a few other chromosomal anomalies. One of the several glands that produce hormones can malfunction for reasons other than chromosomes. Failure of androgen production is as likely to produce gynecomastia as overabundant estrogen production. Testicular failure and castration can also be a cause. Some cancers and some benign tumors can make estrogens. Lung cancer is known to increase estrogens.

If the hormone manufacturing organs are functioning properly, problems can still arise elsewhere. The liver is the principle chemical factory in the body. Other organs like the thyroid and kidneys also effect chemical processes. If any of these organs are diseased, a chemical imbalance can result that alters the manufacturing process. Men with cirrhosis of the liver will often develop gynecomastia from increased production of estrogens.

Finally, drugs can also cause breast enlargement. Estrogens are given to men to treat prostate cancer and a few other diseases. Marijuana and heroin, along with some prescription drugs, have estrogen effects in some men. On the list are methyldopa (for blood pressure), cimetidine (for peptic ulcers), diazepam (Valium), anti-depressants, and spironolactone (a diuretic).

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Definition

Guillain-Barre syndrome is a serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness.

Symptoms

Symptoms of Guillain-Barre can get worse very quickly. It may take only a few hours to reach the most severe symptoms, but weakness increasing over several days is also common.

Muscle weakness or the loss of muscle function (paralysis) affects both sides of the body. In most cases, the muscle weakness starts in the legs and then spreads to the arms. This is called ascending paralysis.

Patients may notice tingling, foot or hand pain, and clumsiness. If the inflammation affects the nerves to the diaphragm, and there is weakness in those muscles, the person may need breathing assistance.

Typical symptoms include:

* Loss of reflexes in the arms and legs
* Muscle weakness or loss of muscle function (paralysis)
o In mild cases, there may be no weakness or paralysis
o May begin in the arms and legs at the same time
o May get worse over 24 to 72 hours
o May occur in the nerves of the head only
o May start in the arms and move downward
o May start in the feet and legs and move up to the arms and head
* Numbness, decreased sensation
* Sensation changes
* Tenderness or muscle pain (may be a cramp-like pain)
* Uncoordinated movement

Additional symptoms may include:

* Blurred vision
* Clumsiness and falling
* Difficulty moving face muscles
* Muscle contractions
* Palpitations (sensation of feeling heartbeat)

Emergency symptoms (seek immediate medical help):

* Breathing temporarily stops
* Can't take a deep breath
* Difficulty breathing
* Difficulty swallowing
* Drooling
* Fainting
* Feeling light-headed when standing

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Definition

Graves disease is an autoimmune disorder that leads to overactivity of the thyroid gland (hyperthyroidism).

Symptoms

* Anxiety
* Breast enlargement in men (possible)
* Difficulty concentrating
* Double vision
* Eyeballs that stick out (exophthalmos)
* Eye irritation and tearing
* Fatigue
* Frequent bowel movements
* Goiter (possible)
* Heat intolerance
* Increased appetite
* Increased sweating
* Insomnia
* Menstrual irregularities in women
* Muscle weakness
* Nervousness
* Rapid or irregular heartbeat (palpitations or arrhythmia)
* Restlessness and difficulty sleeping
* Shortness of breath with exertion
* Tremor
* Weight loss (rarely, weight gain)

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Definition

Granuloma inguinale is a sexually transmitted disease that is rarely seen in the United States.

Symptoms

Symptoms can occur between 1 to 12 weeks after coming in contact with the bacteria that causes the disease.

* About half of infected men and women have lesions in the anal area.
* Small, beefy-red bumps appear on the genitals or around the anus.
* The skin gradually wears away, and the bumps turn into raised, beefy-red, velvety nodules called granulation tissue. They are usually painless, but bleed easily if injured.
* The disease slowly spreads and destroys genital tissue.
* Tissue damage may spread to the area where the legs meet the torso. This area is called the inguinal folds.
* Genitals and surrounding skin has a loss of skin color.

In its early stages, it may be difficult to tell the difference between granuloma inguinale and chancroid.

In the later stages, granuloma inguinale may look like advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis.

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Definition

Graft-versus-host disease (GVHD) is a complication that can occur after a bone marrow transplant in which the newly transplanted material attacks the transplant recipient's body.

See also: Transplant rejection

Symptoms

Symptoms in both acute and chronic GVHD range from mild to severe.

Common acute symptoms include:

* Abdominal pain or cramps
* Diarrhea
* Fever
* Jaundice
* Skin rash
* Vomiting
* Weight loss

Chronic symptoms may include:

* Dry eyes and dry mouth
* Hair loss
* Hepatitis
* Lung and digestive tract disorders
* Skin rash

In both acute and chronic GVHD, the patient is very vulnerable to infections.

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Definition

Gout is a form of acute arthritis that causes severe pain and swelling in the joints. It most commonly affects the big toe, but may also affect the heel, ankle, hand, wrist, or elbow. It affects the spine often enough to be a factor in lower back pain. Gout is often a recurring condition. An attack usually comes on suddenly and goes away after 5–10 days. Gout occurs when there are high levels of uric acid circulating in the blood, and the acid crystallizes and settles in the body. According to the National Institutes of Health (NIH), gout accounts for about 5% of all cases of arthritis reported in the United States.

Gout appears to be on the increase in the American population. According to a study published in November 2002, there was a twofold increase in the incidence of gout over the 20 years between 1977 and 1997. It is not yet known whether this increase is the result of improved diagnosis or whether it is associated with risk factors that have not yet been identified.

Description

Uric acid is formed in the bloodstream when the body breaks down waste products, mainly those containing purines. Purines can be produced naturally by the body, and they can be ingested from such high-purine foods as meat. Normally, the kidneys filter uric acid particles out of the blood and excrete it into the urine. If the body produces too much uric acid or the kidneys aren't able to filter enough of it out, there is a buildup of uric acid in the bloodstream. This condition is known as hyperuricemia.

Uric acid does not tend to remain dissolved in the bloodstream. Over the course of years, or even decades, hyperuricemia may cause deposits of crystallized uric acid throughout the body. Joints, tendons, ear tips, and kidneys are favored sites. When the immune system becomes alerted to the urate crystals, it mounts an inflammatory response that includes the pain, redness, swelling, and damage to joint tissue that are the hallmarks of an acute gout attack.

The body's uric acid production tends to increase in males during puberty. Therefore, it should come as no surprise that nine out of ten of those suffering from gout are men. Since it can take up to 20 years of hyperuricemia to have gout symptoms, men don't commonly develop gout until reaching their late 30s or early 40s. If a woman does develop gout, typically, it will be later in her life. According to some medical experts, this is because estrogen protects against hyperuricemia. It is not until estrogen levels begin to fall during menopause that urate crystals can begin to accumulate.

Hyperuricemia does not necessarily lead to gout. The tendency to accumulate urate crystals may be due to genetic factors, excess weight, or overindulgence in the wrong kinds of food. In addition, regular use of alcohol to excess, the use of diuretics, and the existence of high levels of cholesterol and triglycerides in the blood can increase the risk of developing the disease. In some cases, an underlying disease such as lymphoma, leukemia, or hemolytic anemia may also lead to gout.

Causes & symptoms

An acute episode of gout often starts without warning. The needle-like urate crystals may be present in the joints for a long time without causing symptoms. Then, there may be a triggering event such as a stubbed toe, an infection, surgery, stress, fatigue, or even a heavy drinking binge. Patients in intensive care units (ICUs) may have an acute flare-up of gout. In addition, it is now known that chronic occupational exposure to lead leads to decreased excretion of urates and an increased risk of developing gout.

In many cases, the gout attack begins in the middle of the night. There is intense pain, which usually involves only one joint. Often it is the first joint of the big toe. The inflamed skin over the joint is warm, shiny, and red or purplish, and the pain is often so excruciating that the sufferer cannot tolerate the pressure of bedcovers. The inflammation may be accompanied by a fever.

Acute symptoms of gout usually resolve in about a week, and then disappear altogether for months or years at a time. Eventually, however, the attacks may occur more frequently, last longer, and do more damage. The urate crystals may eventually settle into hard lumps under the skin around the joints, leading to joint deformity and decreased range of motion. These hard lumps, called tophi, may also develop in the kidneys and other internal organs, under the skin of the ears, or at the elbow. People with gout also face a heightened risk of kidney disease, and almost 20% of people with gout develop kidney stones. As of 2002, however, the relationship between gout and kidney stone formation is still not completely understood.

Diagnosis

Doctors can diagnose gout based on a physical examination and the patient's description of symptoms. In order to detect hyperuricemia, doctors can administer a blood test to measure serum urate levels. However, high urate levels merely point to the possibility of gout. Many people with hyperuricemia don't have urate crystal deposits. Also, it has been shown that up to 30% of gout

sufferers have normal serum urate levels, even at the time of an acute gout attack. The most definitive way to diagnose gout is to take a sample of fluid from an affected joint and test it for the presence of the urate crystals.

Treatment

The symptoms of gout will stop completely a week or so after an acute attack without any intervention. It is important, however, to be diagnosed and treated by a health care practitioner in order to avoid attacks of increasing severity in the future and to prevent permanent damage to the joints, kidneys, and other organs. During an acute attack, treatment should focus on relieving pain and inflammation. On an ongoing basis, the focus is on maintaining normal uric acid levels, repairing tissue damage, and promoting tissue healing.

Diet

Generally, gout is unheard of in vegetarians. It is a condition that responds favorably to improvements in diet and nutrition. Recurrent attacks can be avoided by maintaining a healthy weight and limiting the intake of purinerich foods. A diet high in fiber and low in fat is also recommended. Processed foods should be replaced by complex carbohydrates, such as whole grains. Protein intake should be limited to under 0.8g/kg of body weight per day.

Nutritional supplements

Vitamin E and selenium are recommended to decrease the inflammation and tissue damage caused by the accumulation of urates.

Folic acid has been shown to inhibit xanthine oxidase, the main enzyme in uric acid production. The drug allopurinol (see below) is used for this same purpose in the treatment of gout. The therapeutic use of folic acid for this condition should be prescribed and monitored under the supervision of a heath care practitioner. The recommended dosage range is 400–800 micrograms per day.

The amino acids alanine, aspartic acid, glutamic acid, and glycine taken daily improve the kidneys' ability to excrete uric acid. Bromelain, an enzyme found in pineapples, is an effective anti-inflammatory. It can be used as an alternative to NSAIDs and other prescription anti-inflammatory drugs. It should be taken between meals at a dosage of 200–300 mg, three times per day.

The bioflavonoid quercetin helps the body absorb bromelain. It also helps decrease uric acid production and prevents the inflammation that leads to the acute symptoms of gout and the resulting tissue destruction. Quercetin should be taken at the same time and dosage as bromelain: 200–400 mg, between meals at a three times per day.

Herbs

Dark reddish-blue berries such as cherries, blackberries, hawthorn berries, and elderberries are very good sources of flavonoid compounds that have been found to help lower uric acid levels in the body. Flavonoids are effective in decreasing inflammation and preventing and repairing the destruction of joint tissue. An amount of the fresh, frozen, dried, juiced, or otherwise extracted berries equal to half a pound (about 1 cup) fresh should be consumed daily.

Devil's claw, Harpagophytum procumbens, has been shown to be of benefit. It can be used to reduce uric acid levels and to relieve joint pain.

Gout represents a serious strain on the kidneys. The dried leaves of nettles, Urtica dioica, can be made into a pleasant tea and consumed throughout the day to increase fluid intake and to support kidney functions. However, some people are allergic to nettles.

Therapy

Colchicum is a general homeopathic remedy that can be used for pain relief during a gout attack. It is formulated from the same plant, Autumn crocus, as the drug colchicine, used in the conventional treatment of gout. Gout may be improved by having a constitutional remedy prescribed that is based on the tendency to develop the disease and its symptoms.

During the acute phase of gout, acupuncture can be helpful with pain relief.

Applications of ice or cold water can reduce pain and inflammation during acute attacks.

Allopathic treatment

Standard medical treatment of acute attacks of gout includes nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium (Aleve), ibuprofen (Advil), or indomethacin (Indocin). Daily doses until the symptoms have subsided are recommended. Colchicine (Colbenemid), is also used. Corticosteroids such as prednisone (Deltasone, prednisolone, and corticotropin [ACTH]) may be given orally or may be injected directly into the joint for a more concentrated effect. Because these drugs can cause undesirable side effects, they are used for only about 48 hours so as not to cause major problems. Aspirin and other salicylates should be avoided, because they can impair uric acid excretion and may interfere with the actions of other gout medications.

Once an acute attack has been successfully treated, doctors try to prevent future attacks of gout and long-term joint damage by lowering uric acid levels in the blood. Colchicine is the drug of choice to deter recurrence. This medication can be very hard on the vascular system and the kidneys, however, and it is incompatible with a number of antidepressants, tranquilizers, and antihistamines. It should be avoided by pregnant women and the elderly.

There are two types of drugs used for lowering uric acid levels. Sometimes these drugs resolve the problem completely. However, the use of low-level amounts may be required for a lifetime. Uricosuric drugs, such as probenecid (Benemid) and sulfinpyrazone (Anturane), decrease urates in the blood by increasing their excretion. These drugs may also promote the formation of kidney stones, and they are contraindicated for patients with kidney disease. Xanthine oxidase inhibitors block the production of urates in the body. They can dissolve kidney stones as well as treat gout. Allopurinol is the drug most used in this respect. Its adverse effects include reactions with other medications, and the aggravation of existing skin, vascular, kidney, and liver dysfunction.

Expected results

Gout cannot be cured, but it can be managed successfully. Prompt attention to diet and reducing uric acid levels will rectify many of the problems associated with gout. Kidney problems can also be reversed or improved. Tophi can be dissolved or surgically removed, and with the tophi gone, joint mobility generally improves. Gout is generally more severe in those whose initial symptoms appear before age 30. The coexistence of hypertension, diabetes, or kidney disease can make for a much more serious condition.

Prevention

For centuries, gout has been known as the "rich man's disease," a disease of overindulgence in food and drink. While this view is perhaps oversimplified, lifestyle factors clearly influence a person's risk of developing gout. For example, losing weight and limiting alcohol intake can help ward off gout. Since purines are broken down into urates by the body, consumption of foods high in purine should be limited. Foods that are especially high in purines are red meat, organ meats, meat gravies, shellfish, sardines, anchovies, mushrooms, cooked spinach, rhubarb, yeast, asparagus, beer, and wine.

Dehydration promotes the formation of urate crystals, so people taking diuretics, or "water pills," may be better off switching to another type of blood pressure medication. Increased intake of fluids will dilute the urine and encourage excretion of uric acid. Therefore, six to eight glasses of water should be consumed daily, along with plenty of herbal teas and diluted fruit juices.

Consumption of saturated fats impedes uric acid excretion, and consumption of refined carbohydrates, such as sugar and white bread and pasta, increases uric acid production. Both should be seriously limited.

The use of vitamin C should be avoided by people with gout, due to the high levels of acidity.

BOOKS

Parker, James N., M.D., and Philip M. Parker, Ph. D. The 2002 Official Patient's Sourcebook on Gout. San Diego, CA: ICON Health Publications, 2002.

PERIODICALS

Arromdee, E., C. J. Michet, C. S. Crowson, et al. "Epidemiology of Gout: Is the Incidence Rising?" Journal of Rheumatology 29 (November 2002): 2403–2406.

Conos, Juan J., and Robert Kalish. "Gout: Effective Drug Therapy for Acute Attacks and for the Long Term." Consultant (August 1996): 1752–55.

Emmerson, Bryan T. "The Management of Gout." New England Journal of Medicine (February 15, 1996): 445–451.

Hsu, C. Y., T. T. Shih, K. M. Huang, et al. "Tophaceous Gout of the Spine: MR Imaging Features." Clinical Radiology 57 (October 2002): 919–925.

Lin, J. L., D. T. Tan, H. H. Ho, and C. C. Yu. "Environmental Lead Exposure and Urate Excretion in the General Population." American Journal of Medicine 113 (November 2002): 563–568.

Perez-Ruiz, F., M. Calabozo, G. G. Erauskin, et al. "Renal Underexcretion of Uric Acid is Present in Patients with Apparent High Urinary Uric Acid Output." Arthritis and Rheumatism 47 (December 15, 2002): 610–613.

Raj, J. M., S. Sudhakar, K. Sems, and R. W. Carlson. "Arthritis in the Intensive Care Unit." Critical Care Clinics 18 (October 2002): 767–780.

Shekarriz, B., and M. L. Stoller. "Uric Acid Nephrolithiasis: Current Concepts and Controversies." Journal of Urology 168 (October 2002) (4 Pt 1): 1307–1314.

ORGANIZATIONS

Arthritis Foundation. 1330 W. Peachtree Street, P.O. Box 7669, Atlanta, GA 30357-0669. (800) 283-7800. http://www.arthritis.org.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). National Institutes of Health (NIH), 1 AMS Circle, Bethesda, MD 20892-3675. .

OTHER

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Questions and Answers About Gout. Bethesda, MD: NIAMS, 2002. NIH Publication No. 02-5027. .

Patience Paradox

Rebecca J. Frey, PhD

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Definition

Goodpasture syndrome is a rare disease that can involve rapidly progressive kidney failure along with lung disease.

However, some forms of the disease involve just the lung or kidney, not both.

Symptoms

Symptoms may occur very slowly over months or even years, but they often develop quickly over days to weeks.

Loss of appetite, fatigue, weakness are often seen at first.

Lung symptoms may include:

* Dry cough, may cough up blood (bloody sputum)
* Difficulty breathing after activity

Kidney and other symptoms include:

* Swelling (edema) in any area of the body
* Burning sensation when urinating
* Bloody urine
* High blood pressure
* Nausea and vomiting
* Pale skin

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Definition

Gonorrhea is a common sexually transmitted disease (STD).

See also: Disseminated gonococcemia

Symptoms

Symptoms of gonorrhea usually appear 2 - 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the disease, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.

Symptoms in men include:

* Burning and pain while urinating
* Increased urinary frequency or urgency
* Discharge from the penis (white, yellow, or green in color)
* Red or swollen opening of penis (urethra)
* Tender or swollen testicles
* Sore throat (gonococcal pharyngitis)

Symptoms in women can be very mild or nonspecific, and may be mistaken for another type of infection. They include:

* Vaginal discharge
* Burning and pain while urinating
* Increased urination
* Sore throat
* Painful sexual intercourse
* Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area)
* Fever (if the infection spreads to the fallopian tubes and stomach area)

If the infection spreads to the bloodstream, fever, rash, and arthritis-like symptoms may occur. See: Disseminated gonococcemia

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Definition

A goiter is an enlargement of the thyroid gland. It is not cancer.

See also:

* Colloid nodule goiter
* Toxic nodule goiter

Symptoms

The main symptom is a swollen thyroid gland. The size may range from a single small nodule to a large neck lump.

The swollen thyroid can put pressure on the windpipe and esophagus, which can lead to:

* Cough
* Hoarseness
* Swallowing difficulties
* Breathing difficulties (may rarely occur with very large goiters)

There may be neck vein swelling and dizziness when the arms are raised above the head.

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Definition

Glucagonoma is a very rare tumor of the islet cells of the pancreas, which release the hormones insulin and glucagon.

Symptoms

* Diarrhea
* Excess thirst
* Frequent urination
* Increased appetite
* Inflamed mouth and tongue
* Nighttime (nocturnal) urination
* Skin rash on face, abdomen, buttocks, or lower extremities that comes and goes, and moves around
o May be crusty or scaly
o May be raised sores (lesions) filled with clear fluid or pus
* Unintentional weight loss

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Definition

Glossitis is a condition in which the tongue is swollen and changes color. Finger-like projections on the surface of the tongue (called papillae) are lost, causing the tongue to appear smooth.

See also: Geographic tongue

Symptoms

* Tongue swelling
* Smooth appearance to the tongue
* Tongue color usually dark "beefy" red
o Pale, if caused by pernicious anemia
o Fiery red, if caused by deficiency of B vitamins
* Sore and tender tongue
* Difficulty with chewing, swallowing, or speaking

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Definition

A glomus jugulare tumor is a tumor that can affect the ear, upper neck, base of the skull, and the surrounding blood vessels and nerves.

Symptoms

Symptoms may include:

* Difficulty swallowing (dysphagia)
* Hearing problems
* Hoarseness
* Pain
* Weakness or loss of movement in the face (cranial nerve palsy)

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Definition

Glomerulonephritis is a type of kidney disease in which the part of your kidneys that helps filter waste and fluids from the blood is damaged.

Symptoms

Common symptoms of glomerulonephritis are:

* Blood in the urine (dark, rust-colored, or brown urine)
* Foamy urine
* Swelling (edema) of the face, eyes, ankles, feet, legs, or abdomen

Symptoms that may also appear include the following:

* Abdominal pain
* Cough
* Diarrhea
* General ill feeling
* Fever
* Joint aches
* Muscle aches
* Loss of appetite
* Shortness of breath

Chronic renal failure symptoms may gradually develop.

Other symptoms that may occur with this disease:

* Excessive urination
* Nosebleed
* Blood in the vomit or in stools

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Definition

Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain.

In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).

Alternative Names

Open-angle glaucoma; Chronic glaucoma; Closed-angle glaucoma; Congenital glaucoma; Angle closure glaucoma

Causes, incidence, and risk factors

Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:

* Open-angle (chronic) glaucoma
* Angle-closure (acute) glaucoma
* Congenital glaucoma
* Secondary glaucoma

The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made in the back of the eye. It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle.

Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. This pressure is called intraocular pressure (IOP). In most cases of glaucoma, this pressure is high and causes damage to the major nerve in the eye, called the optic nerve.

Open-angle (chronic) glaucoma is the most common type of glaucoma.

* The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve and the retina at the back of the eye
* Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease

Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure within the eye (intraocular pressure).

* Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision
* If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment
* Dilating eye drops and certain medications may trigger an acute glaucoma attack

Congenital glaucoma often runs in families (is hereditary).

* It is present at birth
* It results from the abnormal development of the fluid outflow channels in the eye

Secondary glaucoma is caused by:

* Drugs such as corticosteroids
* Eye diseases such as uveitis
* Systemic diseases

Symptoms


OPEN-ANGLE GLAUCOMA

* Most people have NO symptoms until they begin to lose vision
* Gradual loss of peripheral (side) vision (also called tunnel vision)

ANGLE-CLOSURE GLAUCOMA

* Symptoms may come and go at first, or steadily become worse
* Sudden, severe pain in one eye
* Decreased or cloudy vision
* Nausea and vomiting
* Rainbow-like halos around lights
* Red eye
* Eye feels swollen

CONGENITAL GLAUCOMA

* Symptoms are usually noticed when the child is a few months old
* Cloudiness of the front of the eye
* Enlargement of one eye or both eyes
* Red eye
* Sensitivity to light
* Tearing

Signs and tests

An eye exam may be used to diagnose glaucoma. The doctor will need to examine the inside of the eye by looking through the pupil, often while the pupil is dilated. The doctor will usually perform a complete eye exam.

Checking the intraocular pressure alone (tonometry) is not enough to diagnose glaucoma because eye pressure changes. Pressure in the eye is normal in about 25% of people with glaucoma. This is called normal-tension glaucoma. There are other problems that cause optic nerve damage.

Tests to diagnose glaucoma include:

* Gonioscopy (use of a special lens to see the outflow channels of the angle)
* Tonometry test to measure eye pressure
* Optic nerve imaging (photographs of the inside of the eye)
* Pupillary reflex response
* Retinal examination
* Slit lamp examination
* Visual acuity
* Visual field measurement

Treatment

The goal of treatment is to reduce eye pressure. Depending on the type of glaucoma, this is done using medications or surgery.

Open-angle glaucoma treatment:

Most people with open-angle glaucoma can be treated successfully with eye drops. Most eye drops used today have fewer side effects than those used in the past. You may need more than one type of drop. Some patients may also be treated with pills to lower pressure in the eye. Newer drops and pills are being developed that may protect the optic nerve from glaucoma damage.

Some patients will need other forms of treatment, such as a laser treatment, to help open the fluid outflow channels. This procedure is usually painless. Others may need traditional surgery to open a new outflow channel.

Angle-closure glaucoma treatment:

Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. Drops, pills, and medicine given through a vein (by IV) are used to lower pressure. Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new channel in the iris. The new channel relieves pressure and prevents another attack.

Congenital glaucoma treatment:

This form of glaucoma is almost always treated with surgery to open the outflow channels of the angle. This is done while the patient is asleep and feels no pain (with anesthesia).
Expectations (prognosis)

Open-angle glaucoma:

With good care, most patients with open-angle glaucoma can manage their condition and will not lose vision, but the condition cannot be cured. It's important to carefully follow up with your doctor.

Angle-closure glaucoma:

Rapid diagnosis and treatment of an attack is key to saving your vision. Seek emergency care immediately if you have symptoms of an angle-closure attack.

Congenital glaucoma:

Early diagnosis and treatment is important. If surgery is done early enough, many patients will have no future problems.

Calling your health care provider

Call your health care provider if you have severe eye pain or a sudden loss of vision, especially loss of peripheral vision.

Call for an appointment with your health care provider if you have risk factors for glaucoma and have not been screened for the condition.

Prevention

There is no way to prevent open-angle glaucoma, but you can prevent vision loss from the condition. Early diagnosis and careful management are the keys to preventing vision loss.

Most people with open-angle glaucoma have no symptoms. Everyone over age 40 should have an eye examination at least once every 5 years, and more often if in a high-risk group. Those in high-risk groups include people with a family history of open-angle glaucoma and people of African heritage.

People at high risk for acute glaucoma may opt to undergo iridotomy before having an attack. Patients who have had an acute episode in the past may have the procedure to prevent a recurrence.

References

Burr JM, Mowatt G, Hernández R, Siddiqui MA, Cook J, Lourenco T, et al. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess. 2007 Oct;11(41):iii-iv, ix-x, 1-190.

Kwon YH, Figert JH, Kuehn MH, Alward WL. Primary open-angle glaucoma. N Engl J Med. 2009 Mar 12;360(11):1113-24.

Vass C, Hirn C, Sycha T, Findl O, Bauer P, Schmetterer L. Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003167.

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Definition

Gingivitis is inflammation of the gums (gingiva).

Symptoms

* Bleeding gums (blood on toothbrush even with gentle brushing of the teeth)
* Bright red or red-purple appearance to gums
* Gums that are tender when touched, but otherwise painless
* Mouth sores
* Swollen gums
* Shiny appearance to gums

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Definition

Gigantism is abnormally large growth due to an excess of growth hormone during childhood, before the bone growth plates have closed.

Symptoms

The child will grow in height, as well as in the muscles and organs. This excessive growth makes the child extremely large for his or her age.

Other symptoms include:

* Delayed puberty
* Double vision or difficulty with side (peripheral) vision
* Frontal bossing and a prominent jaw
* Headache
* Increased sweating
* Irregular periods (menstruation)
* Large hands and feet with thick fingers and toes
* Release of breast milk
* Thickening of the facial features
* Weakness

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Definition

Giardiasis is an infection of the small intestine caused by a microscopic organism (protozoa), Giardia lamblia.

Symptoms

* Abdominal pain
* Diarrhea
* Gas or bloating
* Headache
* Loss of appetite
* Low-grade fever
* Nausea
* Swollen or distended abdomen
* Vomiting

The time between being infected and developing symptoms is 7 - 14 days. The acute phase lasts 2 - 4 weeks.

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Definition

Angioedema is a swelling, similar to hives, but the swelling is beneath the skin rather than on the surface. The hives are called welts. It is also possible to have angioedema without hives.

See also: Hereditary angioedema

Symptoms

The main symptom is the sudden development of swelling. You may also develop welts.

The welts usually occur around the eyes and lips. They may also be found on the hands, feet, and throat. They may form a line or be more spread out.

The welts are painful and may be itchy. They turn pale and swell if irritated.

Other symptoms may include:

* Abdominal cramping
* Breathing difficulty
* Swollen eyes and mouth
* Swollen lining of the eyes (chemosis)

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Definition

Gestational trophoblastic disease (GTD) refers to a group of abnormalities in which tumors grow inside a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta, the organ that develops during pregnancy to feed the fetus.

A baby may or may not develop during these types of pregnancies.

There are several types of GTD. They include:

* Choriocarcinoma (a type of cancer)
* Hydatiform mole (also called a molar pregnancy)

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Definition

Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy.

Symptoms

Usually there are no symptoms, or the symptoms are mild and not life threatening to the pregnant woman. Often, the blood sugar (glucose) level returns to normal after delivery.

Symptoms may include:

* Blurred vision
* Fatigue
* Frequent infections, including those of the bladder, vagina, and skin
* Increased thirst
* Increased urination
* Nausea and vomiting
* Weight loss in spite of increased appetite

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Definition

Rubella is a contagious infection in which there is a rash on the skin.

Symptoms

Children generally have few symptoms. Adults may experience a fever, headache, general discomfort (malaise), and a runny nose before the rash appears. They may not notice the symptoms.

Other symptoms may include:

* Bruising (rare)
* Inflammation of the eyes (bloodshot eyes)
* Muscle or joint pain

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Definition

Genital warts are soft wart-like growths on the genitals caused by a viral skin disease. Genital warts are a type of sexually transmitted disease (STD), also called a sexually transmitted infection (STI).

Symptoms

Genital warts are raised, flesh-colored lesions on the genitals, anus, or surrounding skin. They may appear as cauliflower-like growths around the anus or genitals. However, there are often no symptoms. Symptoms that may occur include:

* Abnormal vaginal bleeding (not associated with a menstrual period) after sexual intercourse
* Increased dampness or moisture in the area of the growths
* Itching of the penis, scrotum, anal area, or vulva
* Increased vaginal discharge

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Definition

Genital herpes is a sexually transmitted viral infection affecting the skin or mucous membranes of the genitals.

Symptoms

Many people with HSV-2 infection never have sores, or they have very mild symptoms that they do not even notice or mistake for insect bites or another skin condition.

If signs and symptoms do occur during the first outbreak, they can be quite severe. This first outbreak usually happens within 2 weeks of being infected.

Generalized or whole-body (systemic) symptoms may include:

* Decreased appetite
* Fever
* General sick feeling (Malaise)
* Muscle aches in the lower back, buttocks, thighs, or knees

Genital symptoms include the appearance of small, painful blisters filled with clear or straw-colored fluid. They are usually found:

* In women: on the outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks
* In men: on the penis, scrotum, around the anus, on the thighs or buttocks
* In both sexes: on the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body
* Before the blisters appear, the person may feel the skin tingling, burning, itching, or have pain at the site where the blisters will appear
* When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 - 14 days or more

Other symptoms that may occur include:

* Enlarged and tender lymph nodes in the groin during an outbreak
* Painful urination
* Women may have vaginal discharge or, occasionally, be unable to empty the bladder and require a urinary catheter

A second outbreak can appear weeks or months after the first. It is almost always less severe and shorter than the first outbreak. Over time, the number of outbreaks tends to decrease.

Once a person is infected, however, the virus hides within nerve cells and remains in the body. The virus can remain "asleep" (dormant) for a long period of time (this is called latency).

The infection can flare-up or reactivate at any time. Events that can trigger latent infection to become active and bring on an outbreak include:

* Fatigue
* Genital irritation
* Menstruation
* Physical or emotional stress
* Trauma

Attacks can recur as seldom as once per year, or so often that the symptoms seem continuous. Recurrent infections in men are generally milder and shorter than those in women.

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Genetic Disorders

Conditions with a link to the individual's genetic make-up.

Genetic disorders are conditions that can be traced to an individual's heredity. Many of these disorders are inherited and are governed by the same genetic rules that determine dimples and red hair. However, some genetic disorders result from a spontaneous mutation during embryonic development. If one parent can transmit the genetic information (in genes) that causes a child's disorder, then the disorder is said to be genetically dominant. However, if both parents lack the disorder and pass the disorder's gene to a child, then the genetic disorder is said to be recessive. But not all genetic diseases are completely determined by genes alone; some are promoted by environmental factors such as diet. Disorders that result from both genes and environment are called multi-factorial genetic diseases. In addition, some genetic disorders occur predominantly in males or females, due to the nature of the sex chromosomes, X and Y. Although many genetic diseases, such as cystic fibrosis and sickle-cell anemia, do not occur often, some more common genetic diseases include hypertension, diabetes, and certain forms of cancer.

Genetic inheritance

The principles of genetic inheritance can seem complicated to non-scientists. Basically, genetic information is organized into chromosomes in the cellular nucleus. Human cells have 46 chromosomes each—except for sperm and eggs (reproductive cells), which each have 23 chromosomes. Each person receives 23 chromosomes from their mother's egg and 23 chromosomes from their father's sperm. All but one of the 23 chromosomes are called autosomes, or non-sex chromosomes. These 22 chromosomes do not determine gender. The remaining chromosome is the sex chromosome and is either an X or a Y. Females have two Xs (XX), and males have one of each (XY). Females can only pass an X to their offspring, and males can pass either an X or a Y. Hence, the male sperm is responsible for gender selection. Because of their two X chromosomes, females can carry a disease gene on one X chromosome but not exhibit the disease since they have another X chromosome to compensate. However, males only have one X chromosome and can be affected by the same disease. Such genetic disorders are called X-linked.

The 44 autosomes have parallel coded information on each of the two sets of 22 autosomes, numbered 1 through 22, called homologous pairs. This coding is organized into genes. Individual genes are made of deoxyribonucleic acid (DNA), and code for particular proteins. Proteins play numerous critical structural and functional roles in the body. Each gene has a set locus, or position, on a particular chromosome. The genes with the same locus on corresponding chromosomes are called alleles. So, conventional terminology would describe one person as having two alleles of the same gene. Humans are called diploid organisms, because we have two alleles of each autosomal gene.

Genotype

A shorthand is used to portray alleles that make up a person's genotype for a single locus. Genotypes are usually written as lower or upper case letters of the alphabet (such as AA, aa or Aa), where capital letters define dominant genes and lower case letters define recessive genes. When an allele can be one of many types, several letters can represent the same gene. Genotypes are either homozygous or heterozygous. Having two identical alleles, such as AA or aa, makes a person homozygous for that locus. Having different alleles (for example, Aa) at a locus makes someone heterozygous. The actual trait observed in a person is called the phenotype. Examples of phenotypes include dimples, brown eyes, and tonguecurling. Some traits are dictated by a single gene; whereas other are the result of multiple genes (multi-genic). This is true whether the trait is disease-related or not.

Genetic dominance describes the ability of a single allele to control phenotype. However, this concept does not explain all genetic observations. For example, sickle-cell anemia is a genetic recessive disease characterized by abnormal hemoglobin production. However, sickle-cell heterozygous people also produce some abnormal hemoglobin, although they usually do not experience illness, due to their normal hemoglobin. The production of both allelically encoded forms is an example of codominance. Therefore, this phenotype is said to be codominant. Incomplete dominance also occurs. Height is a example of this type of dominance, where the offspring can have a height between the heights of their parents (which is not the same height as either parent). Height, however, is also determined by a number of other factors such as diet (environment) and hormonal regulation (genetic). Thus, it is apparent that several factors can contribute to final phenotype in a number of traits; this is also true for various diseases.

The autosomes can be distinguished from one another in size and staining patterns. Chromosomal analysis can be performed on cell samples from one person. Corresponding chromosomes 1 through 22 and the sex chromosomes can be lined up and visually inspected for abnormalities. Any obvious flaw can indicate or explain a diseased state. Sometimes it is apparent that a part of one chromosome was incorrectly combined with a different chromosome during cellular division. When other than two autosomes 1 through 22 are present, the aberrant result is called aneuploidy. Most aneuploidies are trisomies (three homologous autosomes), or the presence of extra sex chromosomes.

Dominant genetic disorders

If one parent has an autosomal dominant disease, then offspring have a 50% chance of inheriting that disease. There are roughly 2,000 autosomal dominant disorders (ADDs) with effects that range from inconvenience to death. These diseases may manifest early or late in life. ADDs include Huntington's disease (HD), polydactyly (extra toes or fingers), Marian's syndrome (extra long limbs), achondroplasia (a type of dwarfism), some forms of glaucoma, most forms of porphyrias, and hypercholesterolemia (high blood cholesterol). In most ADDs, the homozygous genotype elicits a more severe disorder; however, this is not true for Huntington's disease.

HD is one of the most debilitating ADDs. It is characterized by progressive chorea (involuntary, rapid, jerky motions) and mental deterioration. HD usually appears in affected individuals between the ages of 30 and 50, and leads to dementia and eventual death in about 15 years.

Marfan's syndrome, or arachnodactyly, is an ADD characterized by long, thin arms, legs, and fingers. People with Marfan's also tend to be stoop-shouldered and have blue sclera of the eyes. In addition, these individuals have a high incidence of eye and aortic heart problems. Statistics show some correlation between older fathers and offspring with Marfan's. Not all people with Marfan's inherit it from a parent; about 15% of Marfan's cases are caused by a fresh mutation in the same locus. Abraham Lincoln is believed to have been afflicted with Marfan's.

Recessive genetic disorders

Recessive genetic disorders (RGD) result from the acquisition of two recessive alleles of a gene—one from each parent. When both parents carry a harmful, recessive trait, one or both of them may be unaware that they are carriers. Hence, the birth of a child with the recessive disease may be a shock to the healthy parents. The probability of two heterozygous parents having an affected child is 25% each time they conceive. The chance that they will have a heterozygous (carrier) child is 50% for each conception, and the chance of having an unaffected homozygous child is also 25% for each pregnancy. About 1,000 confirmed RGDs exist with the better known diseases, including cystic fibrosis, phenylketonuria (PKU), galactosemia, retinoblastoma (Rb), albinism, sickle-cell anemia, thalassemia, Tay-Sachs disease, autism, growth hormone deficiency, adenosine deaminase deficiency (ADD), and Werner's syndrome (juvenile muscular dystrophy).

A number of eye disorders are RGDs, and are usually associated with a mutant gene on chromosome 13. The Rb gene was the first human gene to be located and identified as causing retinoblastoma, cancer of the retina. Most retinoblastomas are hereditarily transmitted; however, in some case, a heterozygous person develops a mutation of one gene, which makes them homozygous for the disease. Other recessive eye disorders include myopia (nearsightedness), albino eyes, day blindness, displaced pupils, and dry eyes. Some RGDs affect people of one particular ethnic background more than the rest of the population. Three such RGDs are cystic fibrosis (CF), sickle-cell anemia (SCA), and Tay-Sachs disease (TSD). CF is one of the most common autosomal recessive diseases in Caucasian children in the U.S. About 4-5% of Caucasians carry this recessive gene on chromosome 7, which causes exocrine mucus-producing glands to secrete an unusually thick mucus that clogs ducts and collects in lungs and other body areas. CF patients usually die before the age of 20, while some individuals live to the age of 30. SCA usually appears in the world's black and Hispanic populations; however, some cases also occur in Italian, Greek, Arabian, Maltese, southern Asian, and Turkish people. About 1 in 12 blacks carry the SCA gene. SCA is caused by mutations in two hemoglobin genes. Hemoglobin carries oxygen in red blood cells to tissues and organs throughout the body. SCA patients have red blood cells that live only a fraction of the normal life span of 120 days. The abnormal blood cells have a sickled appearance, which led to the disease's name. SCA patients also die early, before the age of 30. The TSD gene is carried by 1 in 30 Ashkenazi Jews. Children born with TSD seem normal for the first 5 months, but eventual cerebral degeneration progresses to blindness and death before the age of four.

Galactosemia and phenylketoniuria (PKU) are examples of metabolic RGDs that are caused by a defective gene important in metabolism. People with galactosemia cannot metabolize galactose, the sugar found in milk, and mental retardation may result if normal milk is not avoided by people with this rare disease. People with PKU cannot convert phenylalanine to tyrosine. The build-up of phenylalanine leads to severe mental retardation. PKU is carried by 1 in 50 Caucasians. It is one of the few severe genetic disorders that can be controlled by diet. A phenylalanine-free diet containing sufficient amino acids is available for people diagnosed with PKU. Since 1961, a test has been available to readily screen newborns for PKU from a blood test, and most states perform this test routinely.

ADD is one of few "curable" genetic diseases. ADD is caused by a single mutation on chromosome 20 in an enzyme important to the immune system. Not only are bone marrow transplants hopeful treatments, but now gene therapy has been successful at replacing these patients' defective gene with a healthy gene which enables their immune system to function effectively.

X-linked genetic disorders

X-linked genetic disorders (XLGDs) can be either dominant or recessive. Dominant XLGDs affect females, are usually lethal, and are severely expressed in those males that survive; a high percentage of male embryos with dominant XLGD will spontaneously abort in a miscarriage. Dominant XLGD's include: Albright's hereditary osteodystrophy (seizures, mental retardation, stunted growth), Goltz's syndrome (mental retardation), cylindromatosis (deafness and upper body tumors), oral-facial-digital syndrome (no teeth, cleft tongue, some mental retardation), and incontinentia pigmenti (abnormal swirled skin pigmentation).

Recessive XLGDs are passed to sons through their mothers, who are known or unknown carriers. Often, a carrier mother will have an affected male relative. Major XLGDs include: severe combined immune deficiency syndrome (SCID), color blindness, hemophilia, Duchenne's muscular dystrophy (DMD), some spinal ataxias, and Lesch-Nyhan syndrome. Roughly one third of these XLGDs result from a spontaneous mutation. Of these disorders, color blindness is the most benign.

Hemophilia is a more serious XLGD caused by failure of one of the clotting proteins that routinely prevent an injured person from bleeding to death. Hemophilia A, the most severe form of this disease, is characterized by extreme bleeding. It primarily affects males, although a few females have had hemophilia A (the offspring of a hemophiliac father and a carrier mother).

Other usually fatal XLGDs affect the immune, muscular, and nervous systems. SCID is an immune system disorder characterized by a very poor ability to combat infection. This illness is very rare, and its only likely cure is a near-match bone marrow transplant. DMD afflicts young boys and is apparent by age three or four; it is characterized by wasting leg and pelvic muscles. DMD victims are usually wheelchair bound by the age of 12, and die before the age of 20, often due to heart problems. Some spinal ataxias are XLGDs marked by degeneration of the brain and spinal chord.

Multifactorial genetic disorders

Statistics and studies of twins are often used to determine the genetic basis for multi-factorial genetic disorders (MFGDs). Because environment can play an important role in the development of these diseases, identical and fraternal twins who have been raised in different and identical homes are evaluated for these MFGDs. If fraternal twins have a higher than normal incidence and identical twins show an even higher rate of the disease, then genetic inheritance is believed to contribute to causing the disease. These disorders include some disorders associated with diet and metabolism, such as obesity, diabetes, alcoholism, rickets, and high blood pressure. Also included is the tendency to contract certain infections such as measles, scarlet fever, and tuberculosis. In addition, schizophrenia and some other psychological illnesses are strong MFGD candidates. Congenital hip, club foot, and cleft lip are also MFGDs. Various cancers are also correlated with genetic vulnerability.

Certain breast, colon, skin, and small-cell lung cancers have a genetic link. Familial breast cancer usually affects younger women, whereas some other types of breast cancer do not appear until later in life. Although familial breast cancer shows a very high degree of genetic dominance, it does not target every female relative and is thought to have another environmental or other unknown factor contribution. Familial colon cancer is attributed to polyposis—colon polyps that become cancerous. Some malignant melanomas of the skin are also highly heritable.

The tendency of some people to be more susceptible to a particular MFGD and not another is characteristic of human genetics. Although all healthy humans have a similar body form with very similar physiological functions, there is a tremendous diversity among humans that results from a diverse gene pool, which explains why certain groups of people with some genotypes in common would be more prone to a particular disease, while others would have resistance to the same disease. This diversity buffers the human race from being annihilated by a single agent.

Other genetic-linked disorders

The two most common aneuploidies, trisomies and extra sex chromosomes, can be due to maternal or paternal factors, including advanced age. A number of aneuploidies can be attributed to dispermy—where two sperm fertilized one egg. The resulting genetic disorders can occur due to a spontaneous mutation, and a familial tendency towards these disorders cannot always be found. Trisomies make up to 52% of chromosomal abnormalities, with trisomies 14, 15, 16, 18, 21, and 22 being the most frequent. Live-born children with autosomal aneuploidies have trisomy 13, 18, or 21, and all have some mental retardation. Trisomy 13 (Patau's syndrome) is characterized by retarded growth, cleft lip, small head and chin, and often polydactyly. Trisomy 18 (Edward's syndrome) is marked by severe, variable abnormalities of the head, thumbs, ears, mouth, and feet. Trisomy 21 (Down syndrome) occurs equally in all ethnic groups, and is closely related to increased maternal age. Children with Down syndrome can have poor muscle tone, a flattened face, extra folds of skin at the eyes, low-set ears, visible (Brushfield) spots on the iris of their eyes, and a single crease along the palm of their hands.

Aneuploidy of the sex chromosomes can cause abnormal genital development, sterility, and other growth problems. The most common such aberration are multiple X syndromes. Triple X females can bear normal children. Males with an XXY aneuploidy are afflicted with Klinefelter's syndrome, have small testes and cannot produce sperm. Men with XYY aneuploidy are born more frequently (about 1 in every 200-1,000 males) than most aneuploidies, and controversy exists as to whether these individuals have a higher criminal tendency than the rest of the male population.

Genetic testing and counseling

Tests exist that reveal varying degrees of genetic information. Most of these tests are performed by isolating chromosomes from cellular nuclei, or by measuring a detectable product linked with a known genetic disorder. These tests can be used prior to conception, to determine a couple's risk of having an affected child; during pregnancy, to identify possible genetic disorders; and at birth or later in life, to assess an individual's probability of developing a disorder.

The most successful widespread test for a genetic disorder is newborn testing for PKU, a condition treatable with a special diet. Newborn screening for hypothyroidism and galactosemia is also done in several states. Prenatal tests in embryos and fetuses include chorionic villus sampling (CVS), amniocentesis, and ultrasound. CVS can detect Down syndrome, hemophilia, DMD, CF, SCA, and sex chromosomal aberrations. Amniocentesis can detect Tay-Sachs disease, Down syndrome, hemophilia, spina bifida, and other abnormalities. Ultrasound is used to visualize the developing baby; it can detect spina bifida, anencephaly (no brain), and limb deformities.

Genetic counseling and testing can help people find out if they carry the gene for some disorders, or whether they will develop a late-onset genetic disorder themselves. Genetic probes can identify the genes for Huntington's disease, cystic fibrosis, Tay-Sachs, sickle-cell anemia, thalassemia, and abnormalities associated with growth hormones. Genetic testing capabilities increase each year as additional genetic disorder loci are found. Genetic disorders that are determined by multiple loci are more difficult to pin down for testing.

Books

Plomin, R. Nature and Nurture. Pacific Grove, CA: Brooks/Cole Publishing, 1990.

Stine, G., ed. The New Human Genetics, Dubuque, IA: Wm. C. Brown, 1989.

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Definition

Generalized anxiety disorder (GAD) is a pattern of frequent, constant worry and anxiety over many different activities and events.

Symptoms

Generalized anxiety disorder has the following symptoms:

* Difficulty concentrating
* Difficulty controlling worry
* Excess anxiety and worry that is out of proportion to the situation most of the time
* Excessive sweating, palpitations, shortness of breath, and stomach/intestinal symptoms
* Fatigue
* Irritability
* Muscle tension -- shakiness, headaches
* Restlessness or feeling keyed up or "on the edge"
* Sleep disturbance (difficulty falling or staying asleep; or restless, unsatisfying sleep)

Depression and substance abuse may occur with an anxiety disorder.

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Definition

Gaucher disease is a rare genetic disorder in which a person lacks an enzyme called glucocerebrosidase.

Symptoms

Symptoms vary depending on the type of disease, but may include:

* Bone pain and fractures
* Cognitive impairment
* Easy bruising
* Enlarged spleen (splenomegaly)
* Enlarged liver (hepatomegaly)
* Fatigue
* Heart valve problems
* Lung disease
* Seizures
* Severe swelling (edema) at birth
* Skin changes

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Definition

Gastroparesis is a condition that affects the ability of the stomach to empty its contents, but there is no blockage (obstruction).

Symptoms

* Abdominal distention
* Nausea
* Premature abdominal fullness after meals
* Unintentional weight loss
* Vomiting

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Definition

Gastrointestinal perforation is a hole that develops through the entire wall of the stomach, small intestine, large bowel, or gallbladder. This condition is a medical emergency.

Symptoms

Symptoms may include:

* Abdominal pain - severe
* Chills
* Fever
* Nausea
* Vomiting

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Alternative Names

Digestive disease - resources; Resources - gastrointestinal disorders

Information

The following organizations provide information on gastrointestinal disorders:

* American College of Gastroenterology - www.acg.gi.org
* American Gastroenterological Association - www.gastro.org
* International Foundation for Functional Gastrointestinal Disorders (IFFGD) - www.iffgd.org
* American Liver Foundation - www.liverfoundation.org
* National Digestive Diseases Information Clearinghouse - http://digestive.niddk.nih.gov

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Definition

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

Symptoms

More common symptoms are:

* Feeling that food may be left trapped behind the breastbone
* Heartburn or a burning pain in the chest (under the breastbone)
o Increased by bending, stooping, lying down, or eating
o More likely or worse at night
o Relieved by antacids
* Nausea after eating

Less common symptoms are:

* Cough or wheezing
* Difficulty swallowing
* Hiccups
* Hoarseness or change in voice
* Regurgitation of food
* Sore throat

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Definition

Gastritis is an inflammation (irritation and swelling) of the lining of the stomach.

Symptoms

* Abdominal pain
* Abdominal indigestion
* Dark stools
* Loss of appetite
* Nausea
* Vomiting
* Vomiting blood or coffee-ground like material

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Definition

Gangrene is the death of tissue in part of the body.

Symptoms

The symptoms depend on the location and cause of the gangrene. If the skin is involved, or the gangrene is close to the skin, the symptoms may include:

* Discoloration (blue or black if skin is affected; red or bronze if the affected area is beneath the skin)
* Foul-smelling discharge
* Loss of feeling in the area (which may happen after severe pain in the area)

If the affected area is inside the body (such as gangrene of the gallbladder or gas gangrene), the symptoms may include:

* Confusion
* Fever
* Gas in tissues beneath the skin
* General ill feeling
* Low blood pressure
* Persistent or severe pain

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Definition

A ganglion is a small, usually hard bump above a tendon or in the capsule that encloses a joint. A ganglion is also called a synovial hernia or synovial cyst.

Symptoms

Mild sprains or other repeated injuries can irritate and tear the thin membrane covering a tendon, causing fluid to leak into a sac that swells and forms a ganglion.

Ganglions are usually painless, but range of motion may be impaired. Flexing or bending the affected area can cause discomfort, as can continuing to perform the activity that caused the condition.

Cysts on the surface of the skin usually develop slowly but may result from injury or severe strain. An internal

ganglion can cause soreness or a dull, aching sensation, but the mass cannot always be felt. Symptoms sometimes become evident only when the cyst causes pressure on a nerve or outgrows the membrane surrounding it.

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Definition

Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.

See also: Chronic cholecystitis

Symptoms

The main symptom is abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:

* Be sharp, cramping, or dull
* Come and go
* Spread to the back or below the right shoulder blade
* Occur within minutes of a meal

Other symptoms that may occur include:

* Abdominal fullness
* Clay-colored stools
* Fever
* Nausea and vomiting
* Yellowing of skin and whites of the eyes (jaundice)

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Definition

Gallstones are hard, pebble-like deposits that form inside the gallbladder. Gallstones may be as small as a grain of sand or as large as a golf ball.

See also:

* Acute cholecystitis
* Choledocholithiasis

Symptoms

Many people with gallstones have never had any symptoms. The gallstones are often discovered when having a routine x-ray, abdominal surgery, or other medical procedure.

However, if a large stone blocks either the cystic duct or common bile duct (called choledocholithiasis), you may have a cramping pain in the middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the first part of the small intestine (the duodenum).

Symptoms that may occur include:

* Pain in the right upper or middle upper abdomen:
o May go away and come back
o May be sharp, cramping, or dull
o May spread to the back or below the right shoulder blade
o Occurs within minutes of a meal
* Fever
* Yellowing of skin and whites of the eyes (jaundice)

Additional symptoms that may occur with this disease include:

* Abdominal fullness
* Clay-colored stools
* Nausea and vomiting

It is important to see a doctor if you have symptoms of gallstones. Gallstones are found in many people with gallbladder cancer.

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Definition

Cancer of the gallbladder is cancer of the pear-shaped organ that lies on the undersurface of the liver.

Symptoms

Gallstones are the most significant risk factor for the development of gallbladder cancer. Roughly 75 to 90 percent of patients with gallbladder cancer also have gallstones. Larger gallstones are associated with a higher chance of developing gallbladder cancer. Chronic inflammation of the gallbladder from infection also increases the risk for gallbladder cancer.

Unfortunately, sometimes cancer of the gallbladder does not produce symptoms until late in the disease. When symptoms are evident, the most common is pain in the upper right portion of the abdomen, underneath the right ribcage. Patients with gallbladder cancer may also report symptoms such as nausea, vomiting, weakness, jaundice, skin itching, fever, chills, poor appetite, and weight loss.

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Definition

Cholecystitis refers to a painful inflammation of the gallbladder's wall. The disorder can occur a single time (acute), or can recur multiple times (chronic).

Description

The gallbladder is a small, pear-shaped organ in the upper right hand corner of the abdomen. It is connected by a series of ducts (tube-like channels) to the liver, pancreas, and duodenum (first part of the small intestine). To aid in digestion, the liver produces a substance called bile, which is passed into the gallbladder. The gallbladder concentrates this bile, meaning that it reabsorbs some of the fluid from the bile to make it more potent. After a meal, bile is squeezed out of the gallbladder by strong muscular contractions, and passes through a duct into the duodenum. Due to the chemical makeup of bile, the contents of the duodenum are kept at an optimal pH level for digestion. The bile also plays an important part in allowing fats within the small intestine to be absorbed.

Causes and symptoms

In about 95% of all cases of cholecystitis, the gallbladder contains gallstones. Gallstones are solid accumulations of the components of bile, particularly cholesterol, bile pigments, and calcium. These solids may occur when the components of bile are not in the correct proportion to each other. If the bile becomes overly concentrated, or if too much of one component is present, stones may form. When these stones block the duct leaving the gallbladder, bile accumulates within the gallbladder. The gallbladder continues to contract, but the bile cannot pass out of the gallbladder in the normal way. Back pressure on the gallbladder, chemical changes from the stagnating bile trapped within the gallbladder, and occasionally bacterial infection, result in damage to the gallbladder wall. As the gallbladder becomes swollen, some areas of the wall do not receive adequate blood flow, and lack of oxygen causes cells to die.

When the stone blocks the flow of bile from the liver, certain normal byproducts of the liver's processing of red blood cells (called bilirubin) build up. The bilirubin is reabsorbed into the bloodstream, and over time this bilirubin is deposited in the skin and in the whites of the eyes. Because bilirubin contains a yellowish color, it causes a yellowish cast to the skin and eyes that is called jaundice.

Gallstone formation is seen in twice as many women as men, particularly those between the ages of 20 and 60. Pregnant women, or those on birth control pills or estrogen replacement therapy have a greater risk of gallstones, as do Native Americans and Mexican Americans. People who are overweight, or who lose a large amount of weight quickly are also at greater risk for developing gallstones. Not all individuals with gallstones will go on to have cholecystitis, since many people never have any symptoms from their gallstones and never know they exist. However, the vast majority of people with cholecystitis will be found to have gallstones. Rare causes of cholecystitis include severe burns or injury, massive systemic infection, severe illness, diabetes, obstruction by a tumor of the duct leaving the gallbladder, and certain uncommon infections of the gallbladder (including bacteria and worms).

Although there are rare reports of patients with chronic cholecystitis who never experience any pain, nearly 100% of the time cholecystitis will be diagnosed after a patient has experienced a bout of severe pain in the region of the gallbladder and liver. The pain may be crampy and episodic, or it may be constant. The pain is often described as pushing through to the right upper back and shoulder. Because deep breathing increases the pain, breathing becomes shallow. Fever is often present, and nausea and vomiting are nearly universal. Jaundice occurs when the duct leaving the liver is also obstructed, although it may take a number of days for it to become apparent. When bacterial infection sets in, the patient may begin to experience higher fever and shaking chills.

Diagnosis

Diagnosis of cholecystitis involves a careful abdominal examination. The enlarged, tender gallbladder may be felt through the abdominal wall. Pressure in the upper right corner of the abdomen may cause the patient to stop breathing in, due to an increase in pain. This is called

Murphy's sign. Physical examination may also reveal an increased heart rate and an increased rate of breathing.

Blood tests will show an increase in the white blood count, as well as an increase in bilirubin. Ultrasound is used to look for gallstones and to measure the thickness of the gallbladder wall (a marker of inflammation and scarring). A scan of the liver and gallbladder, with careful attention to the system of ducts throughout (called the biliary tree) is also used to demonstrate obstruction of ducts.

Rare complications of cholecystitis include:

* massive infection of the gallbladder, in which the gallbladder becomes filled with pus (called empyema)
* perforation of the gallbladder, in which the build-up of material within the gallbladder becomes so great that the wall of the organ bursts, with a resulting abdominal infection called peritonitis
* formation of abnormal connections between the gallbladder and other organs (the duodenum, large intestine, stomach), called fistulas
* obstruction of the intestine by a very large gallstone (called gallstone ileus)
* emphysema of the gallbladder, in which certain bacteria that produce gas infect the gallbladder, resulting in stretching of the gallbladder and disruption of its wall by gas

Treatment

Initial treatment of cholecystitis usually requires hospitalization. The patient is given fluids, salts, and sugars through a needle placed in a vein (intravenous or IV). No food or drink is given by mouth, and often a tube, called a nasogastric or NG tube, will need to be passed through the nose and down into the stomach to drain out the excess fluids. If infection is suspected, antibiotics are given.

Ultimately, treatment almost always involves removal of the gallbladder, a surgery called cholecystectomy. While this is not usually recommended while the patient is acutely ill, patients with complications usually do require emergency surgery (immediately following diagnosis) because the death rate increases in these cases. Similarly, those patients who have cholecystitis with no gallstones have about a 50% chance of death if the gallbladder is not quickly removed. Most patients, however, do best if surgery is performed after they have been stabilized with fluids, an NG tube, and antibiotics as necessary. When this is possible, gallbladder removal is done within five to six days of diagnosis. In patients who have other serious medical problems that may increase the risks of gallbladder removal surgery, the surgeon may decide to leave the gallbladder in place. In this case, the operation may involve removing obstructing gallstones and draining infected bile (called cholecystotomy).

Both cholecystectomy and cholecystotomy may be performed via the classical open abdominal operation (laparotomy). Tiny, "keyhole" incisions, a flexible scope, and a laser device that shatters the stones (a laparoscopic laser) can be used to destroy the gallstones. The laparo-scopic procedure can also be used to remove the gallbladder through one of the small incisions. Because of the smaller incisions, laparoscopic cholecystectomy is a procedure that is less painful and promotes faster healing.

Prognosis

Hospital management of cholecystitis ends the symptoms for about 75% of all patients. Of these patients, however, 25% will go on to have another attack of cholecystitis within a year, and 60% will have another attack within six years. Each attack of cholecystitis increases a patient's risk of developing life-threatening complications, requiring risky emergency surgery. Therefore, early removal of the gallbladder, rather than a "wait-and-see" approach, is usually recommended. Cure is complete in those patients who undergo cholecystectomy.

Prevention

Prevention of cholecystitis is probably best attempted by maintaining a reasonably ideal weight. Some studies have suggested that eating a diet high in fiber, vegetables, and fruit is also protective.

BOOKS

Greenberger, Norton J., and Kirk J. Isselbacher. "Acute and Chronic Cholecystitis." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

PERIODICALS

Chung, Shing C. "Acute Acalculous Cholecystitis." Postgraduate Medicine 98, no. 3 (Sept. 1995): 199+.

Lewis, R. "Gallbladder: An Organ You Can Live Without." FDA Consumer 25, no. 4 (1991): 13+.

Lo, Chung-Mau, et al. "Early Decision for Conversion of Laparoscopic Cholecystectomy for Treatment of Acute Cholecystitis." American Journal of Surgery 173, no. 6 (June 1997): 513+.

ORGANIZATIONS

Digestive Disease National Coalition. 507 Capitol Court NE, Suite 200, Washington, DC 20003. (202) 544-7497. .

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389. .

Rosalyn Carson-DeWitt, MD

KEY TERMS

Bile—A substance produced by the liver, and concentrated and stored in the gallbladder. Bile contains many different substances, including bile salts, cholesterol, and bilirubin. After a meal, the gallbladder pumps bile into the duodenum (the first part of the small intestine) to keep the intestine's contents at the appropriate pH for digestion, and to help break down fats.

Bilirubin—Produced when red blood cells break down. It is a yellowish color and when levels are abnormally high, it causes the yellowish tint to eyes and skin known as jaundice.

Cholecystectomy—An operation to remove the gallbladder.

Cholecystotomy—An operation during which the gallbladder is opened, gallstones are removed, and excess bile is drained. The gallbladder is not removed.

Duct—A tube through which various substances can pass. These substances can travel through ducts to another organ or into the bloodstream.

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Definition

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is a hereditary condition in which red blood cells break down when the body is exposed to certain drugs or the stress of infection.

Symptoms

Persons with this condition do not display any signs of the disease until their red blood cells are exposed to certain chemicals in food or medicine, or to stress.

Symptoms are more common in men and may include:

* Dark urine
* Enlarged spleen
* Fatigue
* Paleness
* Rapid heart rate
* Shortness of breath
* Yellow skin color (jaundice)

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Definition

Fever of unknown origin (FUO) refers to the presence of a documented elevation in body temperature for a specified time, for which a cause has not been found after basic medical evaluation. FUO is categorized as classic, hospital acquired FUO; FUO associated with low white blood cell counts (immunosuppression); and HIV-associated (AIDS-related) FUO.

Symptoms

There are many possible causes of FUO; generally though, a diagnosis can be found. The most frequent cause of FUO is still infection, though the percentage has decreased in the early 2000s. Tuberculosis remains an important cause, especially when it occurs outside the lungs. The decrease in infections as a cause of FUO is due in part to improved culture techniques that allow more precise identification of organisms and, therefore, more appropriate treatment. In addition, advances in diagnostic technologies have made it easier to identify non-infectious causes. For example, tumors and autoimmune diseases were as of 2004 easier to diagnose. An autoimmune disease is one that arises when the body's immune system attacks its own tissue as if it were foreign. This happens when the immune system does not recognize protein markers (antigens) on its own cells. In some cases, reactions to medications can also cause prolonged fever.

In about 10 percent of cases, no definite cause is found. In another 10 percent, "factitious fevers" (either self induced or no fever at all) are identified.

General constitutional symptoms tend to occur along with fever, including muscle aches and pains (myalgias), chills, and headache. Sometimes symptoms such as a rash suggest an allergic reaction.

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Definition

Fungal nail infection is an infection of the nails by a fungus.

Symptoms

* Nail changes on one or more nails (usually toenails):
o Brittleness
o Change in nail shape
o Crumbling of the nail
o Debris trapped under the nail
o Discoloration
o Loosening (detaching) of the nail
o Loss of luster and shine
o Thickening

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Definition

Fungi are types of parasitic plants that include molds, mildew, and yeast. A fungal infection is an inflammatory condition in which fungi multiply and invade the skin, the digestive tract, the genitals, and other body tissues, particularly, the lungs and liver. Fungal infections of the skin are often called ringworm or tinea.

Description

Microscopic fungi, which are called dermatophytes, often live exclusively on such dead body tissues as hair, the outer layer of the skin, and the nails. The fungus grows best in moist, damp, dark places with poor ventilation and on skin that is irritated, weakened, or continuously moist. Superficial fungal infections include tinea capitis, an infection of the neck and scalp; tinea barbae, also called barber's itch, along the beard area in adult males; tinea corporis on parts of the body, such as the arms, shoulders, or face; tinea cruris, or jock itch, involving the groin; tinea pedis, or athlete's foot; tinea versicolor; and tinea unguium, or infection of the nails. The term tinea gladiatorum is sometimes used to describe ringworm infections in atheletes. Tinea gladiatorum is most common in swimmers, wrestlers, and athletes involved in other contact sports. Fungal infections of the skin and nails are very common in children, but they can affect all age groups.

Systemic fungal infections occur when spores are touched or inhaled, or there is an overgrowth of fungi in or on the body. Such infections are most often a serious problem in those with suppressed immune systems. Candidiasis is a rather common fungal infection. When it occurs in the mouth, it is called thrush. Less often, it occurs in the mucous membranes of other parts of the digestive system, or in the vagina, heart valves, urinary tract, eyes, or blood. Other systemic fungal infections include aspergillosis, which mostly affects the lungs and may also spread to the brain and kidneys; blastomycosis, a lung infection that may spread through the bloodstream; coccidioidomycosis, also known as San Joaquin or valley fever; mucormycosis, which can develop into a very serious, life-threatening infection; and histoplasmosis.

Causes & symptoms

Fungi are widespread in the environment, so it is not unusual that a certain amount of fungi and their spores end up being inhaled into the lungs or landing on the skin. Under conditions of moisture, warmth, irritation, or injury, these fungi grow rapidly and may cause illness. Superficial fungal infections may be due to an overgrowth of fungi already present, or the infection may be the result of contact with an infected person or with contaminated surfaces, bed sheets, towels, or clothing. Fungal infections can be spread from one part of the body to another by scratching or touching. Additionally, tinea unguium infections

have been linked to the use of methyl methacrylate, a glue used for attaching acrylic fingernails.

Fungal spores are often present in soil and are likely to be inhaled when the soil is dug up or otherwise disturbed. Systemic fungal infections are commonly contracted in this way. In addition, fungi that normally inhabit the intestines, such as Candida albicans, may multiply, causing an infection due to an overgrowth of the fungi.

Tinea infections usually cause itchy, red, scaly, ring-shaped patches on the skin that spread easily. Hairs in the area of infection often fall out or break off, and the skin may crack. The skin may also develop a secondary bacterial infection. In tinea unguium, the nails discolor, crack, and thicken. Tinea versicolor may cause pigment changes in the skin that persist for up to a year.

Systemic fungal infections develop slowly. Symptoms often may be nonexistent, or there may be only the feeling of having a cold or the flu. Coughing, a fever, chest pain, chills, weight loss, and difficulty with breathing may become evident. Additional symptoms depend on the type and site of the infection.

Fungal infections are more common and more severe in people taking antibiotics, corticosteroids, immunosuppressant drugs, and contraceptives. This is also the case in people with endocrine disorders, immune diseases, and other conditions such as obesity, AIDS, tuberculosis, major burns, leukemia, and diabetes mellitus. Fungal infections often occur due to the use of antibiotic drugs for other conditions, because antibiotics kill off the bacteria that normally keep fungi at bay.

Diagnosis

Fungal infections of the skin, hair, and nails often can be diagnosed based on the characteristic appearance of affected areas. A KOH (potassium hydroxide) prep is a simple laboratory test to confirm the diagnosis. The test uses tissue samples treated with a 20% potassium hydroxide solution to detect fungi. Examining the skin with a Wood's ultraviolet lamp is another easy and convenient method to determine the presence of a fungus. Culture and sensitivity testing can be used if a more definitive diagnosis is required. Systemic fungal infections may be initially diagnosed from blood tests. Confirmation is determined by cultures made from sputum, blood, urine, bone marrow, or infected tissue samples.

Treatment

Among the herbs that slow down or halt the growth of fungus are goldenseal (Hydrastis canadensis), myrrh (Commiphora molmol), garlic (Allium sativa), pau d'arco (Tabeebuia impestiginosa), turmeric (Curcuma longa), oregano (Origanum vulgare), cinnamon (Cinnamonum zeylanicum), jewelweed, sage (Salvia officinalis), Impatiens aurea, yellow dock (Rumex crispus), the lichen known as old man's beard (Usnea barbata), black walnut husks and bark (Juglans nigra), licorice (Glycyrrhiza glabra), and Calendula officinalis. These herbs can be applied to external fungus as infusions, salves, powders, or vinegars. Many of them can also be taken internally as capsules or tinctures. Antifungal herbs can be quite strong, however, and care should be taken that a given remedy is suitable for internal use.

When an infusion is used, the affected area should be washed or soaked in the herbal water for at least 15 minutes twice daily. Store-bought or homemade tea bags can be soaked in water or vinegar for about 10 minutes and then used as a poultice for the same effect. Herbal vinegars make excellent remedies for fungus, as vinegar is in itself antifungal. "Gourmet" vinegars with such antifungal ingredients as oregano and garlic are often readily available at grocery stores. The vinegar can be applied a few times daily with cotton or compresses. In addition, a bentonite clay dusting powder can be useful for drying out the environment of moist skin in which fungus thrives. It works best when mixed with powdered antifungal herbs such as myrrh or goldenseal. Dusting powder is especially helpful for athlete's foot.

Many herbs high in essential oils also have antifungal action, particularly tea tree (Melaleuca alternifolia), oregano, lavender (Lavandula officinalis), Eucalyptus spp., rose geranium (Pelargonium graveolens), peppermint (Mentha piperita), chamomile (Matricaria recutita), and myrrh. Peppermint oil is especially helpful in relieving the itching associated with many fungal infections. The simplest way to use aromatherapy to fight fungal infections is to add several drops of any single essential oil or combination of oils to bathwater. Essential oil can also be added to mixtures for soaking or compresses. Tea tree is the herb most frequently recommended for the treatment of superficial fungal infections. As with all essential oils, the full-strength oil should be diluted in a carrier. A dilution of tea tree oil can be made by adding the essential oil to a carrier oil. This mixture can be added directly to the site of a skin infection.

A healthy diet should be maintained. Foods that are high in yeast, such as beer and wine, breads, and baked goods should be avoided. Fermented foods and sugary foods, including honey and fruit juices, should also be avoided until symptoms have cleared. Antifungal culinary herbs such as garlic, tumeric, oregano, sage, and cinnamon should be used liberally in foods. Yogurt containing live cultures can be incorporated into the diet to supply needed gut bacteria, and help reduce digestive infections such as candidiasis and thrush. Lactobacillus acidophilus and Lactobacillus bulgaricus can also be taken directly as supplements.

Supplements that can be taken for fungal infections include vitamins A, B complex, C, and E. Caprylic acid, an extract of the coconut plant, is also recommended as an antifungal, as well as grapefruit seed extract. Essential fatty acids, contained in evening primrose oil, fish liver oil, or flaxseed oil, can help reduce the inflammation of systemic or superficial fungal infections. A dose of one of these oils is recommended as a daily supplement.

Allopathic treatment

Superficial fungal infections are usually treated with such antifungal creams or sprays as tolnaftate (Aftate or Tinactin), clotrimazole, miconazole nitrate (Micatin products), econazole, ketoconazole, ciclopirox, naftifine, itraconazole, terbinafine, fluconazole, or Whitfield's tincture made of salicylic acid and benzoic acid. If the infection is resistant, a doctor may prescribe an oral antifungal drug such as ketoconazole or griseofulvin. Drugs used for systemic infections include amphotericin B, which is highly toxic and is used for severe or life-threatening infections; the azoles, particularly fluconazole and itraconazole, which have been found to be the least toxic of these medications; and flucytosine alone or in combination with other antifungal medications. Fungal infections that become inflamed may be treated with a combination antifungal/steroid medication. Certain infections may require surgery.

Expected results

Infections usually respond to treatment within several weeks. However, many fungal infections are resistant to treatment, and it may take an extended time and repeated treatments to effect a cure. Infections may spread, and secondary bacterial infections may develop. Medications for fungal infections are often strong, and their use may cause such undesirable side effects as headache, dizziness, nausea, vomiting, or abdominal pain. Fungal infections are usually not serious in otherwise healthy individuals. However, a systemic fungal infection may be severe and life-threatening for those with compromised immune systems.

Prevention

Good personal hygiene should be maintained. In the case of superficial infections, the skin should be kept clean and dry, and care should be taken to avoid contact with other parts of the body. If someone in the household has a superficial fungal infection, bed sheets, towels, floors, shower stalls, and other contact surfaces should be washed with hot water and disinfected after use.

BOOKS

Duke, James A., Michael Castleman, and Alice Feinstein. The Green Pharmacy. Emmaus, PA: Rodale Press, 1997.

PERIODICALS

Farschian, M., R. Yaghoobi, and K. Samadi. "Fluconazole Versus Ketoconazole in the Treatment of Tinea Versicolor." Journal of Dermatologic Treatment 13 (June 2002): 73-76.

Kohl, T. D., et al. "Tinea gladiatorum: Pennsylvania's Experience." Clinical Journal of Sports Medicine 12 (May 2002): 165-171.

Lipozencic J., M. Skerlev, R. Orofino-Costa et al. "A Randomized, Double-Blind, Parallel-Group, Duration-Finding Study of Oral Terbinafine and Open-Label, High-Dose Griseofulvin in Children with Tinea Capitis Due to Microsporum Species." British Journal of Dermatology 146 (May 2002): 816-823.

Weinstein, A., and B. Berman. "Topical Treatment of Common Superficial Tinea Infections." American Family Physician 65 (May 15, 2002): 2095-2102.

ORGANIZATIONS

American Academy of Dermatology. 930 East Woodfield Rd., PO Box 4014, Schaumburg, IL 60168. (847) 330-0230. .

OTHER

drkoop.com Medical Encyclopedia. "Ringworm." http://www.drkoop.com/conditions/ency/article/001439.htm.

Merck & Co., Inc. The Merck Manual of Diagnosis and Therapy. http://www.merck.com/pubs/mmanual/section10/chapter113/113a.htm.

Merck & Co., Inc. The Merck Manual of Diagnosis and Therapy. http://www.merck.com/pubs/mmanual/section13/chapter158/158a.htm.

Patience Paradox

Rebecca J. Frey, PhD

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