• SPINAL CORD INJURY: UNDERSTANDING DISEASE

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    30 Dec 2010 /  Healthy bones Osteoporosis Rheumatic

    Because the spinal cord is the main connection between the brain and the nerves supplying the arms, legs, and trunk, spinal cord injury usually results in both motor and sensory loss. Motor loss refers to weakness or paralysis. Sensory loss refers to the absence of bodily sensation (such as the senses of pain, touch, and temperature), a condition called anesthesia, or to a reduction in this sensation. Both kinds of loss usually affect all or part of the body below the level of the injury. Other types of sensory changes include paresthesia, tingling or “pins and needles,” and dysesthesia, pain caused by damage to the nervous system. Bowel and bladder control may also be affected.
    The location of the spinal cord injury determines the parts of the body that are paralyzed or that lose sensation or function. To help you understand your injury, consider the effects of injury in the four main regions of the spinal cord.
    Cervical spinal cord (CI through C8) injury causes paralysis or weakness in both arms and legs (quadriplegia, sometimes also called tetraplegia). All regions of the body below the neck or the top of the back may be affected. Frequently, though not always, quadriplegia is accompanied by loss of physical sensation, loss of bowel and bladder control (incontinence or retention), and sexual dysfunction.
    Thoracic spinal cord (T1 through T12) injury is less common because the rib cage protects and stabilizes this middle area of the body. When these injuries do occur, they again affect the area below the level of injury. Thoracic spinal cord injuries may cause paralysis or weakness of the legs (paraplegia), loss of sensation, sexual dysfunction, and problems with bowel and bladder control. Arm and hand functions are usually unaffected.
    Lumbar spinal cord (LI through L5) injury usually results in paralysis or weakness of the legs (paraplegia), loss of sensation, sexual dysfunction, and problems with bowel and bladder control. Shoulder, arm, and hand function are unaffected by lumbar spinal cord injury.
    Sacral spinal cord (SI through S4) injury primarily causes loss of bowel and bladder control and sexual dysfunction. Some sacral injuries may also cause weakness or paralysis of the hips and legs.
    An incomplete spinal cord injury results in a large variety of neurological impairments. Most spinal cord injuries are incomplete, causing greater weakness and sensory loss in some areas of the body than others. Some individuals have only minor weakness and numbness but no bowel or bladder problems. In others, the spinal cord is damaged on one side only, producing weakness of muscles on the same side and a complex pattern of sensory loss. Injuries of the central region of the spinal cord typically result in greater weakness of the arms than the legs. Injuries of the cauda equina may cause weakness, paralysis, and sensory loss in the legs, as well as loss of bowel and bladder control.
    With this anatomical understanding, we can now discuss what is involved in the early treatment of spinal cord injury. The nature of early interventions corresponds mainly to the level of injury.

    *6/156/5*

  • DIETS FOR LOWER GASTROINTESTINAL CONDITIONS: GALL STONES, APPENDICITIS AND OTHERS

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    22 Dec 2010 /  Gastrointestinal

    Gall Stones
    Affect women twice as much as men and are common in obese and diabetes. These are cholesterol stones which could be present in gall bladder or biliary calculi. Removal of the gall bladder is the true treatment and dietary intervention involve in term of a progressive diet starting from clear liquid to semi-solid to normal diet. Since the function of the gall bladder is to store bile, due to non-availability of ready bile reserve, it is recommended that a regimen of low-fat diet is to be followed for 3-4 months then followed by a normal diet.

    Appendicitis
    Surgical procedure will follow a dietary regimen of clear liquid, semisolid and normal diet.

    Cholelithiasis (Inflammation of gall bladder)
    A diet low in fat and fibre is recommended. If the patient is overweight, weight reduction is advisable.

    Haitus hernia
    The heartburn and other symptoms of this condition often cause discomfort to the patients. To relieve these it is important to follow the following regime:
    (i)  Small meals (6-7) at frequent intervals.
    (ii) Soft, bland, low-fibre diet.
    (in) Very small quantities of fluid with meals not more than 1/2 cup.
    (iv) Early dinner.
    *5/356/5*

  • DIAGNOSING EPILEPSY: EEG TELEMETRY

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    15 Dec 2010 /  Epilepsy

    Sometimes it is important to know exactly which part of the brain is giving rise to seizures, and what type of electrical activity accompanies them. And sometimes, too, it is useful to be able to correlate what is going on in the brain with actual behaviour during a seizure. This can be helpful if it is thought that seizures may have an emotional cause and are not due to epilepsy. This kind of information can only be obtained by watching the changes in behaviour that occur during the seizure as it happens and at the same time recording the electrical activity going on in the brain.
    Unfortunately, seizures cannot be created to order. It is only by doing a continuous EEG recording over a long period and videoing the person the whole time that there is a good chance of capturing one or two seizures. This process of continuous seizure monitoring is called telemetry, and is carried out in a special telemetry unit. The telemetry unit is just like an ordinary EEG department but is sited in a hospital ward.
    Most units now use cable telemetry, which is felt to be more reliable than radiotelemetry. In cable telemetry the EEG electrodes are fixed to your head just as they are for an ordinary routine EEG recording. The wires from the electrodes are gathered together and lead to a little amplifier which is usually strapped to your chest. From this amplifier a cable leads to a plug in the wall and from here the signals are taken to an EEG machine and tape recorder. The lead is long enough for you to be able to get out of bed and wander around, but you are not encouraged to do too much wandering, as you always have to stay within the field of view of the video camera and it is best if you sit still in a chair as the quality of the recordings is diminished by movement.
    Most units will let you unplug the cable from the wall and replug it in the ward day-room so that you can at least have a change of scenery and sit and talk to other patients, though you will still be within range of a video camera. There are also video cameras monitoring the dining area. However, you are able to unplug yourself and have a few unmonitored moments of privacy if you want to have a bath or go to the lavatory. You will usually stay in the telemetry unit for one or two weeks, being recorded 24 hours a day. Obviously, this is a very expensive procedure and so it is not carried out unless there is a very good reason for it.
    Another form of telemetry, less popular but still sometimes used, is 24 hour cassette tape monitoring. Electrodes are placed on the head in exactly the same way as in cable telemetry, but the wires lead to a portable tape recorder strapped round your waist, which records your brain activity throughout the 24 hours. You can wear this anywhere, so it allows you to stay at home, or go to work or school.
    The disadvantage of this system is that because you are moving around normally all the time the recording is taking place, the quality of the recording is not as good as in cable telemetry. More important, if you have a seizure it will not be captured on video. Instead, you or some observer close to you will have to make an accurate and detailed seizure and activity log — a record of your activity throughout the 24 hours. This can then be correlated with the EEG recording, which has a time clock. It is a tedious and time-consuming process and the results are sometimes difficult to interpret. Inevitably, it does not yield as much information as cable telemetry.
    *19\193\2*

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