Combined therapy along with Homoeopathic treatment helps in combating Menopause
- Dr. S. Sabarirajan & Dr.S.R. Ameerkhan babu.
Introduction
Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates. Awareness about these changes is less in our country compared to developed nations. Patients seeking treatment for menopause is less, but we find such patients visiting for their menopause related symptoms like irregular bleeding, fatigue, night sweats, etc. Though we have many rubrics in the repertory for menopause and its symptoms, many a times we fail to provide desirable results. Many physicians find in such cases along with the indicated drug, other managing measures like food modifications, exercise, home remedies and herbs, supplements, micronutrients and vitamins are helpful. This article discusses about such combined therapies along with definition, symptoms, pathophysiology, investigations, rubrics and drugs for menopause.
Definition
The word "menopause" literally means the "end of monthly cycles" from the Greek word pausis (cessation) and the root men- (month), because the word "menopause" was created to describe this change in human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or menses. Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining. Menopause typically (but not always) occurs in women in midlife, during their late 40s or early 50s, and signals the end of the fertile phase of a woman's life. It is not uncommon however to see a women menstruate well beyond the age of 50.
Perimenopause refers to the time before menopause when vasomotor symptoms and irregular menses often commence. Perimenopause can start 5-10 years or more before menopause.
Menopause is characterized by a continuation of vasomotor symptoms and by urogenital symptoms such as vaginal dryness and dyspareunia.
The cause of menopause is “burning out” of the ovaries. Throughout a woman’s reproductive life, about 400 of the primordial follicles grow into mature follicles and ovulate, and hundreds of thousands of ova degenerate. At about age 45 years, only a few primordial follicles remain to be stimulated by FSH and LH, and, the production of estrogens by the ovaries decreases as the number of primordial follicles approaches zero. When estrogen production falls below a critical value, the estrogens can no longer inhibit the production of the gonadotropins FSH and LH. Instead, the gonadotropins FSH and LH (mainly FSH) are produced after menopause in large and continuous quantities, but as the remaining primordial follicles become atretic, the production of estrogens by the ovaries falls virtually to zero.
SIGNS AND SYMPTOMS
The menopausal transition can cause
Vascular instability
• Hot flashes or hot flushes, including night sweats and, in a few people, cold flashes
• Possible but contentious increased risk of atherosclerosis
• Migraine
• Rapid heartbeat
Urogenital atrophy
• Thinning of the membranes of the vulva, the vagina, the cervix, and also the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas.
• Itching
• Dryness
• Bleeding
• Watery discharge
• Urinary frequency
• Urinary incontinence
• Urinary urgency
• Increased susceptibility to inflammation and infection, for example vaginal candidiasis, and urinary tract infections
Skeletal
• Back pain
• Joint pain, Muscle pain
• Osteopenia and the risk of osteoporosis gradually developing over time
Skin, soft tissue
• Breast atrophy
• breast tenderness +/- swelling
• Decreased elasticity of the skin
• Formication (itching, tingling, burning, pins and needles, or sensation of ants crawling on or under the skin)
• Skin thinning and becoming drier
Psychological
• Depression and/or anxiety
• Fatigue
• Irritability
• Memory loss, and problems with concentration
• Mood disturbance
• Sleep disturbances, poor quality sleep, light sleep, insomnia
Sexual
• Dyspareunia or painful intercourse
• Decreased libido
• Problems reaching orgasm
• Vaginal dryness and vaginal atrophy
PATHOPHYSIOLOGY
During climacteric, ovarian activity declines. Initially, the ovulation fails, no corpus luteum is formed and no progesterone is secreted by the ovary. Thus the menstrual cycles tend to become anovulatory and irregular (Metropathia haemorraghica).Later oestrogenic activity also diminishes and atrophic endometrium ensues, leading to menopause. As a result of cessation of ovarian activity, and fall in estrogen level, there is a rebound increase in secretion of FSH by the anterior pituitary gland. FSH level may rise as much as 50 fold, thus making menopausal urine a commercial source of Gonadotrophin(HMG). With further advancing years, gonadotrophin activity of the anterior pitiuitary also ceases and a fall in the level of FSH is eventually noticed .
CHANGES IN THE GENITAL TRACT
These changes are of atrophic type and affect the external genitalia as well as the internal organs. They take time to occur – over a number of years. Not only the main pelvic structures reduced in size but, more importantly, the fascial framework and the intra pelvic ligaments supporting the bladder and the genitalia are weakened;this may lead to complications.
Vulva: This shows the flattening of the labia majora, the minor labia becoming more evident. Sexual hair become grey and sparse. The clitoris shrinks.
Uterus: The uterus becomes small with a relatively large cervix- return to infantile proportions.
Tubes and ovaries: These show great shrinkage, the tubes becoming thin, while the ovaries are reduced to small white wrinkled bodies 2-3 cm in length. In addition to the shrinkage of the vaginal introitus, the vagina diminishes in length and its secretions are limited, leading to sexual problems. Changes in the vaginal epithelium increase these problems.
PRINCIPAL CHANGES IN THE SERUM HORMONE LEVELS
Once menopause is well established , the plasma estrogen level may remain low at 10 to 20 pg/ml. Oestrone level varies between 30 and 70 Pg/ml. the ovary also secretes a small amount of testosterone which may be responsible for mild hirsutism noticed after the menopause. The gonadotrophin hormone (FSH) appears in high concentration at menopause, because it is not inhibited by the prevailing low levels of estrogen.
Mensturation may gradually decrease, suddenly cease or become irregular. Oestrogen levels fall over the 5 years preceding ovarian failure which occurs usually between 45 and 50 years of age, with an average around 50 years. The fall in oestrodiol has a positive feedback on the pitiuitary, increasing production of FSH and LH.
The ovaries eventually produce androstenidione, which is also produced by the adrenals, and is converted in peripheral fat into weak oestrogen oestrone
INVESTIGATIONS
Assessment and evaluation prior to initiating treatment:
The following plan is recommended, it helps in finding the actual pathology and progress of symptoms, which helps in finding the constitutional or antimiasmatic remedies and further way of treatment.
1. Detailed family and personal history, physical examination - height , weight and BP.
2. Examination of breast.
3. Pelvic examination.
4. Evaluation of menopausal symptoms and need for medication.
5. Evaluation of the individual risks versus benefits from treatment.
6. Routine screening tests like blood routine, urine routine, Fasting and post prandial blood sugars.
7. Lipid profile and cardiovascular risk assessment. (Plasma lipids have been known to be altered by the with in month variations in the female hormonal system. The early menopausal subjects shows a significant increase in the total cholesterol level and slightly higher in late menopausal subjects.)
8. Transvaginal sonography and assessment of endometrial thickness.
9. Routine mammography.
10. Endometrial histology – in cases of post menopausal bleeding or family history of uterine cancer. Or past history of late menopause, infertility, and PCOD.
HORMONE REPLACEMENT AND ALLIED THERAPY
The basic objective of oestrogen replacement therapy is to increase the circulating levels of oestrogen to physiological levels of 45- 200 pg / ml to alleviate the climacteric symptoms resulting from oestrogen deficiency. Semi- synthetic hormones are used for hormone replacement therapy (HRT) because they are more physiologic in their actions. HRT can be administered in the form of oral medications, dermal patches or gels for local application, depending on the patients needs.
There are many contraindications to HRT as follows:
Conventional therapy majorly depends on the Hormone replacement therapy (HRT). But many studies suggest that HRT has got many unwanted side effects. For example, the results of a major study, called women’s health initiative (established by the Government of United States of America), had explored many health risks. In fact this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones greatly increased their risk for breast cancer, heart attacks, strokes and blood clots. However all hormone replacement therapies probably do carry some health risks, including high blood pressure, blood clots, and increased risks of breast and uterine cancers.
1. Presence of active endometrial cancer and hormone dependent tumours.
2. Active breast cancer and oestrogen progesterone receptor positive cancers.
3. Presence of or suspicion of pregnancy.
4. Undiagnosed vaginal bleeding.
5. Severe liver disease or abnormal liver function tests.
6. Acute vascular thrombosis.
7. History of thrombo embolism.
8. Estrogen dependent vascular thrombosis.
Other relative symptoms are - Strong family history of breast cancer, History of migraine and severe headaches. Thrombo phlebitis, uterine fibroids, Endometriosis, Gall bladder disease, Glucose intolerance.
HOLISTIC APPROACH TO MENOPAUSE
A holistic approach considering the lifestyle, personal habits, food habits, inclusion of nutrients and herbal diet, etc. along with homoeopathic treatment helps in overcoming menopausal symptoms. Information on each such intervention has been given under respective titles.
I. Life style changes and personal habits:
1. Exercises- Brisk walking fro 40 – 60 minutes atleast 5 times/week.
2. Physical workouts-Weight bearing exercises for limbs and back strengthening.
3. Yoga and meditation- Breathing exercises (Pranayama) beneficial in reducing stress.
4. Simple diet- Containing liberal amounts of vegetables and fruits (fibres and vitamins) lower contents of saturated fats and restricted sugar content.
5. Fluid intake- Consume fluids liberally to maintain tissue hydration.
6. Control or abstain- Smoking , alcohol intake, unrestricted consumption of tea / coffee.
II. Herbs and plant products:
Plants are a source of phyto oestrogens which have mild oestrogenic and some anti estrogenic effects. Soya has been the most extensively investigated plant. Phytooestrogens are a source of aglycones and isoflavones, coumestones and lignans.common Indian foods rich in phytooestrogens- isoflavons are found in Bengal grams, cereals fruits like apples and berries,and red clover. Lignans in whole grain, pulses, legumes and beans, sunflower seeds and saponins in herbs like turmeric fenugreek or methi ginger and also in root vegetables yam and grains.
An intake of 50 mg of isoflavones per day has been beneficial in reducing hot flushes, preventing osteoporosis, reducing ldl cholesterol. Also there is an evidence that soya exerts a protective action against breast cancer. The hot flushes can be managed with Wearing cool clothing, Drinking cold water or juice at the onset of flush, shower with tepid water.
III. Micronutrients and antioxidants:
These are essential to the body and required in very small amounts. These include vitamins minerals, essential amino acids, essential fatty acids. Many of these are antoxidants also. Antoxidants protects against the tissue damage. Menopausal women are vulnerable because of the loss of the protective effects of oestrogens and the age related effects.
IV. Calcium and vitamin D3:
In ageing women, the need for calcium supplementation increases to about 1000- 1500 mg / day Provided the calcium should be properly absorbed and utilized. Thus it slows down the process of age related osteoporosis.
This has been justified by Ried et al in 1993 in their research with supplementation of calcium carbonate and lactate- gluconate to post menopausal women in doses of 1 gm / 24 hours for 5 years and demonstrated significantly slowed axial and appendicular bone loss.
Chapuy et al in 1992 has demonstrated both suppression of bone loss and reduction of fracture.
IV. Calcitonin:
Many clinical studies have produced evidence to suggest that calcitonin is able to prevent bone loss in the spine in post menopausal women. Calcitonin injection has been known to cause side effects like nausea and vomiting , flushing and intertrigo, intranasal administration remains another alternative.
V. Biphosphonates:
These are stable active analogues of pyrophosphate, which act by inhibiting bone resorption. These compounds are worth considering in women in whom oestrogens are contraindicated, or for those averse to Hormone Replacement Therapy.
Aroma therapy, Herbalism, Accupressure, Accupuncture, Nutrition and supplements can be suggested as the supportive line of treatments for menopausal complaints.
HOMOEOPATHIC APPROACH
The advantage of homoeopathy is that it considers the patient as whole. Since the symptoms of menopause are not limited to one system or location, a drug selected on the totality is of more helpful than the “single complaint specific drugs”. Our repertory has covered the menopausal symptoms directory or indirectly. Below is a reportorial analysis on the common symptoms of menopause. Therapeutics of menopause follows the analysis.
THERAPEUTICS
Many authors have discussed about the drugs that are commonly indicated during the time of menopause or the climaxis, as referred to in many of the writings. The commonly indicated remedies for General Menopausal symptoms are Amyl Nitrosum, Belladona, Bellis perennis, Cactus grandiflorus, Calcarea carbonicum., Caulophyllum, Cimicifuga racemosa, Castoreum, Conium ,Crotalus Horridus, Erigeron, Gelsemium, Glonine, Graphitis., Kali-carbonicum, Kreosotum, LACHESIS, Manganum, Mag.phos , Murex., Nux-vomica, Nux moschata, Oophorinum, Psorinum, Pulsatilla , Sabina, Sangunaria, Sepia, Sulphur, Sulphuric acid, Thlasi bursa , Tuberculinum, Ustiligo, Vibrunum opulus and Zincum Valerianum.
Aliments from menopause
Lachesis. (It’s a Well Specific Remedy for Menopause)
Ailments during menopause
For hot flashes and night sweats: Amyl nitrosum, Belladonna, Ferrum metallicum, Lachesis, Pulsatilla, Pilocarpus microphyllus, Sepia and Valeriana.
For sleeplessness (insomnia): Aconitum napellus, Arsenicum album, Belladonna, Chamomilla, Coffea crude, Lycopodium clavatum ,Passiflora incarnata, Sulphur and Viburnum opulus.
For constipation: Hydrastis, Iris versicolor. Magnesia muriatica, Magnesia phosphorica and Sepia
For incontinence of urine: Pulsatilla and Zincum metallicum.
For vaginal dryness: Aconitum napellus, Apis mellifica, Belladonna, Bryonia, Ferrum phosphoricum Hydrophobinum, Lycopodium, Natrum muriaticum and Spiranthes.
For depression, fear, nervous or irritability: Aconitum napellus, Amyl nitrosum, Arum Metallicum, Borax, Chamomilla, Ignatia amara, Lachesis, Nux vomica, Passiflora incarnata, Sepia, Stramonium and Viburnum opulus.
For bone related problems like Osteophorosis: Bellis perennis and Calcarea carbonica
For menorrhagia: Lachesis, Sepia, Argentum mettalicum and Cimicifuga racemosa
For painful and enlarged breast: Sangunaria
For painful breast: Cimicifuga racemosa
For burning, palm, sole and vertex: Sulphur, Sangunaria and Lachesis
For excessive perspiration: Sepia
For earache: Gelsimium
For rheumatic pain: Caulophyllum
For headache: Glonine, Sangunaria, Sepia and Cimicifuga racemosa
Saturday, 24 September 2011
Wednesday, 27 July 2011
COPD
OBSTRUCTIVE AIR WAY DISORDERS
DEFINITION
In this Condition there is chronic obstruction to the alveolar in flow of air either due to chronic Bronchitis and / or emphysema and / or Bronchial Asthma.
Chronic Bronchitis may be complicated with emphysema but there may be predominance of any of them. Bronchial asthma also causes generalized airway obstruction and is dealt with separately. There may be considerable over lapping of these three diseases.
CHRONIC BRONCHITIS
DEFINITION
Ch. Bronchitis may be defined as a disease characterized by cough and sputum for at least 3 consecutive months in a year for more than 2 successive Years.
AETIOLOGY
Smoking
Atmospheric Pollution
Infection
Occupation (Coal miners)
Familial and genetic abnormalities associated with alpha1 , antitrypsin deficiency -may also be present.
Pathology
Develops airway wall inflammation
Hypertrophy of mucus secreting Glands and increases in the number of Goblet cells in bronchi and bronchioles with consequent
Decrease in ciliated cells,
Obstruction of air flow.
Pathology for Cyanosis
Due to uneven distribution of the inspired air
There may be diminished diffusing capacity
Airway obstruction gives rise to ventilation perfusion in equality.
Resulting in increased paco2 and decreased pao2 with severe ventilatory failure there is falling pH together with compensatory decrease in plasma bicarbonate and respiratory acidosis.
Cyanosis
Clinical Features
Gradual onset
Cough with expectoration: It is usually starts as attacks of “winter cough” and “Smoker’s cough”. Gradually increasing in severity and duration, the expectoration is mucoid (or) mucopurulent depending on the presence of infection.
Some time there may be haemoptysis.
Shortness of breath due to airway obstruction.
SIGNS
Respiratory rate is hurried
Central cyanosis may be present.
Chest may show no signs on examinations (or) there may be prolonged expiration with transient rhonchi present.
INVESTIGATION
Blood Count: May show leucocytosis in presence of acute infection.
Polycythaemia may develop in long standing cases.
X Ray Chest
Does not show any characteristics change.
Bronchography
May show irregularities of Bronchial lumen,
Pulmonary function test: May chow some impairment due to development of emphysema, simple measurement of ventilatory capacity and arterial Paco2 may help to determine the severity of airway obstruction.
Complication
- Emphysema
- Bronchiolar Spasm
- Bronchiectasis
- Rt heart failure (ch. Cor pulmonale).
EMPHYSEMA
Def:
It is a condition of generalized over distension of the lung alveoli with Rupture of interalveolar septae, over aeration of the alveoli, loss of alveolar elasticity, impairment of pulmonary function and increased lung volume due to various causes.
Aetiology:
- Chronic Bronchitis and chronic Bronchial asthma are common predisposing causes.
- In association with fibrotic pulmonary disease such as silicosis.
C/F:
- Breathlessness (exertional dyspnoea)
- Cough with expectoration are due to associated chronic bronchitis, they usually develop before the onset of breathlessness.
- Wheezing sound present.
Sign:
- Pink buffer cyanosis is present
- Clubbing of finger present
- Respiration rate hurried.
Examination:
Inspection : Barrel shaped chest
Palpation : Vocal fermitus is diminished
Percussion : Hyper Resonant note present
Auscultation : Rhonchi present
- X Ray Chest:
- Marked radio translucent lung fields with the fine vascular striations particularly at the periphery.
- Low and flat diaphragm.
Lung Function Tests:
Blood gas analysis shows Pao2 less than 50 torr and Paco2 more than 50 torr indicative of Respiratory failure.
Complication:
- Rt heart failure
- Spontaneous pneumothorax
BRONCHIAL ASTHMA
Def:
Asthma is defined as a chronic inflammatory disorder of the airways, characterized by Reversible airflow obstruction causing cough, wheeze, chest tightness and shortness of Breath.
Types:
- Early onset asthma (or) atopic
- Late onset asthma (or) Non-atopic
1. Early Onset Asthma:
- Commonly encountered in child hood.
- Family History of this disorder present.
- These individuals are usually atopic.
- Allergic skin tests positive
- IgE level raised
- H/o Allergy present
2. Late Onset Asthma:
- It occurs in any age.
- No family history disorders.
- Non-atopic individuals
- Extrinsic allergens play no part.
- Skin Hyper sensitivity test negative
- IgE level normal.
Aetiology:
- Infections
- Cigarette Smoking
- Temperature and Humidity
- Psychological factors
- Exercise
- Allergy
Triggers of the Asthmatic Response:
- Cold Air, Tobacco, Smoking, Dust, Acid Fumes, Resp. Viral infection and emotional stress.
- In children and young adults exposure to cold air and excretion.
- Previous exposure to antigents stimulate the formation of IgE antibody in the brochi, further on exposing in the allergens.
C/F:
- Episodic Asthma
- Chronic Asthma
- Severe Acute Asthma
1. Episodic:
- Paroxysms of wheeze and breathlessness may occur at any time and can be of sudden onset.
- Episodic asthma may be triggered by Allergens, exercise and Viral infections.
- The attacks may be mild (or) severe lasting for few hours, days (or) weeks.
- Atopic individuals with episodic asthma are worse in summer, when they are heavily exposed to allergens.
2. Chronic Asthma:
- Symptoms of chest tightness, wheeze and Breathlessness on exertion together with spontaneous cough and wheeze during night.
- Cough with mucoid sputum with recurrent episodes of Resp. infection is common.
- Chronic asthma pt. Are worse in winter due to increased exposure to viral infection.
3. Severe Acute Asthma (or) “Status Asthmaticus”
This term has replaced status asthmaticus which in life threatening at time of asthma.
- The patient often has an unproductive cough.
- Respiratory symptoms such as chest tightness and breadthlessness are accompanied by tachycardia, Pulsus Paradoxis, Sweating, and Central Cyanosis.
- The Pt adopts an upright position fixing the shoulder muscle to assist the accessory muscles of respiration.
Signs:
- During an attack when the chest is held in full inspiration, the percussion note is hyper resonance.
- Broncho vesicular Breath sound present.
- Added sounds – Rhonchi, High pitched polyphonic inspiratory and expiratory Rhonchi.
- In severe asthma airflow may be insufficiency of produce a Rhonchi and chest remains silent – it is a “Ominous Sign”.
INVESTIGATION
X ray chest
In an acute attack the lungs appears hyper inflated.
In between the episodes the chest x ray is normal.
Pigeon shaped deformity can be demonstrated on a lateral view x ray.
In severe acute asthma pneumothorax may be seen.
X ray may show mediastinal (or) subcutaneous emphysema.
Pulmonary Function Test:
- Measurement of force expiratory volume in one second, vital capacity and peak expiratory volume with given indication to the degree of airflow obstruction.
Arterial Blood Gas Analysis:
Measurement of partial pressure of PO2 and PCO2 is required in the management sever acute asthma.
Skin hypersensitivity test: It is depends upon the individuals.
Complications:
- Status asthmaticus
- Secondary infection – Bronchitis, Tuberculosis.
- Emphysema of lung
- Rt. Heart failure
- Bronchiectasis.
Homoeopathic Management (Murphy repertory)
Bronchitis. Chronic
Ant.tart hep
Am.carb hydr
ant .s ipecac
ars.alb kali bic
ars.iod kaliod
bac lyco
bar.m nit.ac
calc puls
canth seneg
carb. v stann
cop sulph
Emphysema
Am.carb calc.s
Ant.ars camph
Ant.Tart carb.veg
Hepar chlor
Lachesis dig
Loblia ip
Sil lyc
Ars merc
aur.m Nat.m
bell phos
brom stry
calc.p
From, smoking
am.c
calad
Bronchial asthma
Ambr lobil
Arg. Nit Nat.s
Ars puls
Ars.iod samb
Baltta sil
Carci spong
Cupr stram
Ip sulph
Kali ars visc
Kali carb Grindilia
Kali Nit
DEFINITION
In this Condition there is chronic obstruction to the alveolar in flow of air either due to chronic Bronchitis and / or emphysema and / or Bronchial Asthma.
Chronic Bronchitis may be complicated with emphysema but there may be predominance of any of them. Bronchial asthma also causes generalized airway obstruction and is dealt with separately. There may be considerable over lapping of these three diseases.
CHRONIC BRONCHITIS
DEFINITION
Ch. Bronchitis may be defined as a disease characterized by cough and sputum for at least 3 consecutive months in a year for more than 2 successive Years.
AETIOLOGY
Smoking
Atmospheric Pollution
Infection
Occupation (Coal miners)
Familial and genetic abnormalities associated with alpha1 , antitrypsin deficiency -may also be present.
Pathology
Develops airway wall inflammation
Hypertrophy of mucus secreting Glands and increases in the number of Goblet cells in bronchi and bronchioles with consequent
Decrease in ciliated cells,
Obstruction of air flow.
Pathology for Cyanosis
Due to uneven distribution of the inspired air
There may be diminished diffusing capacity
Airway obstruction gives rise to ventilation perfusion in equality.
Resulting in increased paco2 and decreased pao2 with severe ventilatory failure there is falling pH together with compensatory decrease in plasma bicarbonate and respiratory acidosis.
Cyanosis
Clinical Features
Gradual onset
Cough with expectoration: It is usually starts as attacks of “winter cough” and “Smoker’s cough”. Gradually increasing in severity and duration, the expectoration is mucoid (or) mucopurulent depending on the presence of infection.
Some time there may be haemoptysis.
Shortness of breath due to airway obstruction.
SIGNS
Respiratory rate is hurried
Central cyanosis may be present.
Chest may show no signs on examinations (or) there may be prolonged expiration with transient rhonchi present.
INVESTIGATION
Blood Count: May show leucocytosis in presence of acute infection.
Polycythaemia may develop in long standing cases.
X Ray Chest
Does not show any characteristics change.
Bronchography
May show irregularities of Bronchial lumen,
Pulmonary function test: May chow some impairment due to development of emphysema, simple measurement of ventilatory capacity and arterial Paco2 may help to determine the severity of airway obstruction.
Complication
- Emphysema
- Bronchiolar Spasm
- Bronchiectasis
- Rt heart failure (ch. Cor pulmonale).
EMPHYSEMA
Def:
It is a condition of generalized over distension of the lung alveoli with Rupture of interalveolar septae, over aeration of the alveoli, loss of alveolar elasticity, impairment of pulmonary function and increased lung volume due to various causes.
Aetiology:
- Chronic Bronchitis and chronic Bronchial asthma are common predisposing causes.
- In association with fibrotic pulmonary disease such as silicosis.
C/F:
- Breathlessness (exertional dyspnoea)
- Cough with expectoration are due to associated chronic bronchitis, they usually develop before the onset of breathlessness.
- Wheezing sound present.
Sign:
- Pink buffer cyanosis is present
- Clubbing of finger present
- Respiration rate hurried.
Examination:
Inspection : Barrel shaped chest
Palpation : Vocal fermitus is diminished
Percussion : Hyper Resonant note present
Auscultation : Rhonchi present
- X Ray Chest:
- Marked radio translucent lung fields with the fine vascular striations particularly at the periphery.
- Low and flat diaphragm.
Lung Function Tests:
Blood gas analysis shows Pao2 less than 50 torr and Paco2 more than 50 torr indicative of Respiratory failure.
Complication:
- Rt heart failure
- Spontaneous pneumothorax
BRONCHIAL ASTHMA
Def:
Asthma is defined as a chronic inflammatory disorder of the airways, characterized by Reversible airflow obstruction causing cough, wheeze, chest tightness and shortness of Breath.
Types:
- Early onset asthma (or) atopic
- Late onset asthma (or) Non-atopic
1. Early Onset Asthma:
- Commonly encountered in child hood.
- Family History of this disorder present.
- These individuals are usually atopic.
- Allergic skin tests positive
- IgE level raised
- H/o Allergy present
2. Late Onset Asthma:
- It occurs in any age.
- No family history disorders.
- Non-atopic individuals
- Extrinsic allergens play no part.
- Skin Hyper sensitivity test negative
- IgE level normal.
Aetiology:
- Infections
- Cigarette Smoking
- Temperature and Humidity
- Psychological factors
- Exercise
- Allergy
Triggers of the Asthmatic Response:
- Cold Air, Tobacco, Smoking, Dust, Acid Fumes, Resp. Viral infection and emotional stress.
- In children and young adults exposure to cold air and excretion.
- Previous exposure to antigents stimulate the formation of IgE antibody in the brochi, further on exposing in the allergens.
C/F:
- Episodic Asthma
- Chronic Asthma
- Severe Acute Asthma
1. Episodic:
- Paroxysms of wheeze and breathlessness may occur at any time and can be of sudden onset.
- Episodic asthma may be triggered by Allergens, exercise and Viral infections.
- The attacks may be mild (or) severe lasting for few hours, days (or) weeks.
- Atopic individuals with episodic asthma are worse in summer, when they are heavily exposed to allergens.
2. Chronic Asthma:
- Symptoms of chest tightness, wheeze and Breathlessness on exertion together with spontaneous cough and wheeze during night.
- Cough with mucoid sputum with recurrent episodes of Resp. infection is common.
- Chronic asthma pt. Are worse in winter due to increased exposure to viral infection.
3. Severe Acute Asthma (or) “Status Asthmaticus”
This term has replaced status asthmaticus which in life threatening at time of asthma.
- The patient often has an unproductive cough.
- Respiratory symptoms such as chest tightness and breadthlessness are accompanied by tachycardia, Pulsus Paradoxis, Sweating, and Central Cyanosis.
- The Pt adopts an upright position fixing the shoulder muscle to assist the accessory muscles of respiration.
Signs:
- During an attack when the chest is held in full inspiration, the percussion note is hyper resonance.
- Broncho vesicular Breath sound present.
- Added sounds – Rhonchi, High pitched polyphonic inspiratory and expiratory Rhonchi.
- In severe asthma airflow may be insufficiency of produce a Rhonchi and chest remains silent – it is a “Ominous Sign”.
INVESTIGATION
X ray chest
In an acute attack the lungs appears hyper inflated.
In between the episodes the chest x ray is normal.
Pigeon shaped deformity can be demonstrated on a lateral view x ray.
In severe acute asthma pneumothorax may be seen.
X ray may show mediastinal (or) subcutaneous emphysema.
Pulmonary Function Test:
- Measurement of force expiratory volume in one second, vital capacity and peak expiratory volume with given indication to the degree of airflow obstruction.
Arterial Blood Gas Analysis:
Measurement of partial pressure of PO2 and PCO2 is required in the management sever acute asthma.
Skin hypersensitivity test: It is depends upon the individuals.
Complications:
- Status asthmaticus
- Secondary infection – Bronchitis, Tuberculosis.
- Emphysema of lung
- Rt. Heart failure
- Bronchiectasis.
Homoeopathic Management (Murphy repertory)
Bronchitis. Chronic
Ant.tart hep
Am.carb hydr
ant .s ipecac
ars.alb kali bic
ars.iod kaliod
bac lyco
bar.m nit.ac
calc puls
canth seneg
carb. v stann
cop sulph
Emphysema
Am.carb calc.s
Ant.ars camph
Ant.Tart carb.veg
Hepar chlor
Lachesis dig
Loblia ip
Sil lyc
Ars merc
aur.m Nat.m
bell phos
brom stry
calc.p
From, smoking
am.c
calad
Bronchial asthma
Ambr lobil
Arg. Nit Nat.s
Ars puls
Ars.iod samb
Baltta sil
Carci spong
Cupr stram
Ip sulph
Kali ars visc
Kali carb Grindilia
Kali Nit
Thursday, 16 June 2011
Nails- Importance in diagnosis
Nails- Importance in diagnosis
Our nails are a sign of our health. The colour shape, contour of our nails can tell us if our body is in a healthy state.
Nail disorders
Changes in nail are generally not diagnostic of a specific systemic or skin disease .all of the nail changes of systemic disorders may be seen without systemic disease.
Examination of nails helps us sometimes to diagnose a case clinically. Simultaneously we should not forget the value of study of nail changes in Homoeopathic practice
Different nail abnormalities Associated conditions
Platynychia (flat nails) Iron deficiency anemia
Koilonychia (spoon shaped nails) Iron deficiency anemia
Leuconychia (white nails) congenital or acquired
Hypoalbuminemea,
Nephrotic Syndrome
Chronic liver disease
Protein loosing enteropathy.
Onycholysis (Separation of nail from bed) Lichen planus, thyrotoxicosis Psoriasis.
Missing nail Nail patella syndrome.
Half & Half nail Proximal half- white and distal half
pink or red seen in chronic renal failure
Beau’s line
(Transverse ridges over the nails) Indicates stoppage of nail Growth temporarily. Affects all nails and appear after few week of illness. As the nail growth ridges also move to the distal part.
Mee’s line single or multiple which transverse bands on the nail- inorganic arsenic poisoning
Muehrcke’s line Narrow, white transverse bands occurring in pairs - associated with hypoalbuminaemia, they may disappear when serum albumin level is normalized
Longitudinal ridges Seen in lichen plannus and rheumatoid arthritis.
Nail bed infarct Vasculitis syndromes
Pitted Nails Psoriasis, Alopecia, eczema, ring worm infestation.
Blue Seen in cyanosis, antimalarial drugs, haematoma
Blue green In pseudomonas infection in chronic paronychia
Brown longitudinal streaks In fungal infections, staining from cigarettes
Red streaks
(Splinter hemorrhages) Infective endocarditis, trauma.
Yellow In psoriasis, fungal infections, trauma, jaundice,
* Clubbing Bulbous enlargements of distal segments of fingers and toes.
Causes;
a) Cardiovascular:
Acquired --- infective endocarditis.
Congenital---cyanotic congenital heart disease.
b) Respiratory;
-Brochiectasis
- Lung abscess.
-Bronchogenic carcinoma.
-Tuberculosis with secondary infection.
-Empyema
-Interstitial lung disease
c) Gastrointestinal;
-ulcerative colitis,
-Crohns’disease.
-Malabsorbtion syndrome.
d) Hepatic
-cirrhosis of liver.
e) Endocrine;
-Myxedema.
- Acromegaly.
-Thyroid acropachy,
f) Congenital & idiopathic clubbing.
Homoeopathic drugs according to the Nail colour, changes.
Discoloration, Nails _ Ant. c, Ars, Graph, Nit.ac, Thuja.
Black - Ars, Graph, Lept, Nat-m.
Blood, settles under Nails _ Apis.
Blueness _ Arg.n, Ars, Aur, camph, Carb.v, Chel,Chin, chin.s, Cupr, Dig, Dros, Ferr, Graph, Mez,
Nat.m, Nit.a, Nux.v, Ox.ac, Pet, Sil, Sulph,Thuja, Verat.
Dark _ Morp, Ox.ac,
Gray _ Mer.c, Sil,
Purple _ Apis, Ars, Op, samb, sec, stram,
Red _ Ars, Crot.c, Lith,
-Then black - Ars.
White - Cup, Nit.ac.
-Spots - Alum, Ars, Nit.ac, Sep, Sil, sulph,
Yellow - Ambr, Bry, Carbo.v, Con, Lyco, mer Nit.ac, Nux.v. Op, Sep, Sil, Sipg, Sulp,
Cracked Nails - Ant.c, Ars, Nat.m, Sil,
Curved finger Nails - Nit.ac.
Distorted, Nails - Alum, Fl.ac, Graph, Merc, Sep, Sil, Thuja.
In growing, Nails - Caust, Graph, Mag-aust, Nat.M, Nit.ac, Ph.ac, sil, Sulph, Teucr, Thuja,
Splinters, Nails - Alum, Ars, Nit.ac, Ph.ac, Sep, Sil, Sulph, Tub.
Spotted, Nails - Alum, Ars, Nit.ac, Ph.ac, Sep, Sil, Sulph, Tub.
Ulcers, fingernails - Bov, Hep, Merc, Nat.M, Sil, sulph, thuja,
Panaritium nails - All.c, Am.c,Am.m, Anac, Anthr, Apis, Benz.ac, Bufo, Calc, Caust, Cist, Dios, Fl.ac, Hep, Hyper, iod, iris, lach, lyc, Merc, nat.c, Nat.m, Nat.s, Nit.ac, Phyt, Rhus.tox, Sang, Sep, sil, Sulph, Tarent.c,
NOTE: Close observation and minute study about the nails is important for clinical diagnosis and also to select a remedy while treating homeopathically
Saturday, 2 April 2011
IMPOTENCE
Sex is important for the normal physical and mental development of an individual. Thus sexual disorders of any type will have some deleterious effects.
IMPOTENCY
This is a male sexual disorder, whereby a male cannot maintain an erection of penis during copulation.
Impotence is a very delicate yet complex topic for a practitioner. Although a lot of passions are involved around the sexual life of a human being, this topic is poorly understood and requires thorough education of the patient. An attempt has been made here to resolve the mysteries regarding impotence.
Above the age of 65 years about 25% males develop impotence. Most of the cases have a psychogenic cause.
NORMAL CHANGES WITH AGE
Although sexual activity normally continues throughout man’s life time, the response varies with age. He takes longer to climax and his erections may come and go. He needs more recycling time before he can get another erection.
The 20’s: A young man needs little stimulation and can get an erection in a few minutes. He usually climaxes quickly but he can regain his erection in minutes.
The 40’s: With age there is more need of direct stimulation and fantasy. An erection takes several minutes, climax is slower and erection can be regained only after an hour or so.
The 60’s: An older man needs even more direct stimulation and fantasy. He takes longer to get an erection, can maintain it longer. But may take a day (or) more to regain it.
PHYSIOLOGY OF A PENILE ERECTION
The penis consists of corpus cavernosum; two spongy paired cylinders contained in a thick envelope, the tunica albuginea, and corpus spongiosum and glans with very thin tunica, in both the structures, with in the tunica are numerous sinusoids among the interwoven trabeculae of the smooth muscles and supporting connective tissue that harbour the terminal cavernous nerves and arterioles, the paired internal pudendal artery is the main source of blood supply to the penis while venous drainage is through multiple small veins to dorsal vein and then internal pudendal vein.
The nerve supply of the penis plays an important role in erection. The penis is innervated by 2 sets of nerves; autonomic nervous system (sympathetic and parasympathetic) and somatic nerves (sensory and motor). From the neurons in the spinal cord and peripheral ganglia the sympathetic and parasym-pathetic nerves merge to form the cavernous nerves and these nerves are responsible for neurovascular events during erection and detumescence. The somatic nerves are responsible for sensation of penis and contraction of the bulbocavernous and ischiocavernous muscles.
The parasympathetic supply comes from 2,3 and 4 sacral spinal cord segments which is responsible for tumescence (erection) while sympathetic supply comes from thoracic 11 to lumbar 2 spinal segment, which is responsible for detumencence (ejaculation). The sensory pathways go via dorsal nerves of penis to internal pudendal nerve to dorsal roots of 2nd to 4th nerves of spinal cord and spino thalamic tract to the thalamus and sensory cortex of brain. Onuf’s nucleus is the centre of somatomotor penile innervation. These nerves travel in the sacral nerves to the pudendal nerves to innervate bulbocavernosus and ischioca-vernosus muscles.
The contraction of the ischiocavernosus muscle causes rigid erection phase while rhythmic contractions of the bulbocavernous muscles expels the semen down the narrowed urethral lumen and results in external ejaculation from the meatus.
The spinal erection centres are located at intermedilateral column of the sacral cord and sends processes in to the areas of laminate 5 and 7 and the dorsal commissure. In the brain medial preoptic area (MPOA) is the important integration centre for sexual drive and penile erection.
According to nature of stimulus there are 3 types of erections.
1. Reflexogenic Erection
This erection is provided by tactile stimulus to the genitalia and is mediated through lower spinal centres.
2. Psychogenic Erection
This erection originates from audiovisual impulses and fantasies and signals are mediated through brain to spinal centres.
3. Nocturnal Erection
This type of erection occurs during REM sleep through unknown mechanism.
PATHOPHYSIOLOGY OF IMPOTENCE
1. Psychogenic Importance
Psychogenic stimuli (Visual impulses, fantasies) themselves are very strong inducers of erection and also can enhance the erection induced by Genital Stimulus. On the other hand, anxiety (or) depression, religious inhibitions, sexual phobias or deviation, obsessive compulsive personality or a traumatic past experience can send strong messages from brain to inhibit or to terminate erection. This inhibition is through a direct inhibition from brain to the spinal centres or through increased level of peripheral catecholamine that renders cavernous smooth muscles less sensitive to neuro-transmitters.
2. Neurogenic Impotence
Lesions affecting brain like cerebrovascular accidents, park-inson or Alzheimer’s disease, tumors, injury etc, act through direct central hypothalamic suppression or over inhibition of spinal centres.
A dysfunction at spinal level e.g. spinabifida, disc herniation, syringomyelia, tumor and multiple sclerosis may affect either efferent or afferent nerve pathways.
Neuropathy such as seen in alcoholism, vitamin deficiency or diabetes may affect cavernous nerve terminals leading to impotency. Injury to cavernous nerve or pudendal nerve from pelvic injury or surgery may disrupt the neural pathway causing impotence.
3. Arteriogenic Impotence
Diseases of terminal aorta or the hypogastric, pudendal, or penile arteries can results in erectile failure; trauma or congenital anomaly can cause arterial insufficiency. But generalized atherosclerotic process due to hypercholesterolemia, cigarette smoking, diabetes, radiation, hypertension and perineal trauma are more common cause of arteriolar impotence.
4. Venous Impotence
Abnormal venous channel following a shunting operation for priapism. Tunical abnormality as in pyronie’s disease or functional impairment of the cavernous erectile tissue can cause venous impotence.
5. Hormonal Impotence
Diabetes mellitus in an important cause for impotence but acts not mainly through hormonal changes but through vascular, neurologic and psychologic causes.
Androgens are essential for male sexual maturity but testosterone is not absolutely essential for erection. Therefore androgen replacement therapy is absolutely indicated in cases of hypogonadism only.
Hypothalamic pituitary Gonadal axis dysfunction can result in hypogonadism, Hypogonadotrophic hypogonadism can be due to malignancy, injury or aging while hypergonadotrophic Hypogondism can be due to diseases of testes like malignancy, surgery, injury or mumps.
Hyperprolactinemia caused by pituitary adenoma, chronic renal failure, or medication can result in lowered testosterone levels leading to impotence. Hyperthyroidism and hypothyroidism can also affect sexual function.
6. Erectile tissue dysfunction
Pyronie’s disease, trauma, diabetes, tumor infiltration, scleroderma, and priapism all these lead to gross microscopic changes as well as macroscopic changes in erectile tissues of penis.
7. Impotence from aging, systemic disease and other causes.
Hypothalamic pituitary dysfunction leading to testosterone deficiency is responsible for impotence of old age, the other factors like psychogenic, vascular, neurogenic etc. also add to the problem.
Chronic renal disease needing dialysis also leads to impotence in around 50% patients. Myocardial infarction, angina, heart failure, and Emphysema patients develop impotence. One of the reasons being, they fear aggravation of the disease following intercourse. Others diseases like liver cirrhosis, sclerdoderma, chronic debility and cachexia also can cause impotence.
CAUSES OF IMPOTENCY
The normal sexual function can be divided into five events each of which is under diverse regulation, libido, erection, ejaculation, orgasm and detumescence. Hence anything hampering the normal sexual functions will give rise to impotency as stated below;
1. Loss of desire
In a small percentage of organic cases, pituitary or testicular disease gives rise to androgen deficiency which in turn causes a decreased libido; hypogonadism also gives rise to such states.
2. Failure of erection
Which may arise from the following conditions.
a. Endocrine causes
Pituitary tumors which give rise to hyperprolactinemia.
b. Neurologic causes
Lesions of anterior temporal lobe, spinal cord disorders; loss of sensory input in diabetics; neuropathies; tabes dorsalis and damage to parasympathetic nerves following surgical procedure, such as total prostatectomy, retro sigmoid operations and aortic bypass surgery if autonomic nerve supply to penis is damaged.
c. Vascular causes
Leriche syndrome
d. Penile diseases
Peyronie’s disease, priapism and penile trauma.
e. Drug induced
Prolonged use of antihistamines, antihypertensive etc., which are potentially correctable, causes of impotency.
3. Premature ejaculation
Always related to anxiety states or emotional disorder and unreasonable expectations about performance, it may rarely have an organic cause.
4. Absence of Emission
It may be due to the following conditions.
a. Retrograde ejaculation
Following surgery on the bladder neck or may develop spontaneously in diabetics.
b. Sympathetic Denervation
May occur following sympathectomy.
c. Androgen deficiency
Results in a decrease in secretions of the prostrate and seminal vesicles and diminution of the volume of ejaculate.
d. Drugs
Such as phenoxy benzamine.
e. Absence of orgasm
It is always almost due to psychological disorder if the libido and erectile functions are normal.
f. Failure of detumensence
It is due to priapism but can be associated with sickle cell anemia, chronic granulocytic leukemia or spinal cord injury.
EVALUATION OF IMPOTENCY
The central issue of Evaluating impotency is to separate those instances due to psychological factors from those due to organic causes. A good case-taking usually makes the separation possible.
The commonest cause is an anxiety or depressed state. Psychological factors like disinterest in sexual partner, marital discord etc reduce the sexual impulse.
However, if organic cause is deduced, its aetiology should be well known.
INVESTIGATION AND EXAMINATION
a. Laboratory investigation
Laboratory evaluation is probably of minimal value. Measurement of serum testosterone in the absence of evidence of feminization or hypogonadism is seldom helpful. If there is an indication from either history (or) physical examination of vascular aetiology, a doppler procedure or arteriography may be indicated.
b. Physical examination
Thorough genital examination to identify abnormalities of the penis; testicular size and abnormal masses. Evidence of feminization such as gynaecomastia and abnormal body hair distribution should be sought. All pulses should be palpated, including the penile pulse, to exclude the presence of deep cavernous arterial occlusion.
c. Systemic examination
Neurological examination is necessary for detecting peripheral neuropathy and also to assess the perianal sensation, anal sphincter tone and bulbo cavernous reflex.
DIAGNOSIS OF IMPOTENCE
Apart from history and clinical examination, Duplex and color Doppler sonography can give a complete status of the erectile function of penis; X-rays, caverno-sonography and selective pundendal arteriography have become obsolete.
PLAN OF TREATMENT
It can be broadly classified as follows;
1. Ancillary or extra medial line of treatment.
2. Surgical line of treatment.
3. Treatment with homoeopathic medicines like constitutional, inter-current medicines, mother tinctures, organopathic and rare medicines.
1. Ancillary or extra remedial line of treatment
a. Giving reassurance to the patients of anxiety states and corrective measures to depressive patients may restore sexual potency.
b. Sexual counseling, education and psychotherapy are also beneficial in alleviating psychogenic factors.
2. Surgical line of treatment
a. In case of hyperprolactinemia where prolactin secreting pituitary tumor is present; surgical removal usually results in return of potency.
b. Surgical therapy is also useful in treatment of decreased potency related to aortic obstruction.
c. Implantation of penile prosthetic by a small, blunt silastic rod (or) alternatively by an inflatable prosthetic device, can be advised. In refractory cases which are not improving with the allopathic mode of treatment or patients who are skeptical about the homoeopathic mode of treatment. However it should be remembered that these procedures are extremely costly and have a high risk of complications.
THERAPEUTICS OF IMPOTENCE
In homoeopathic prescribing, even after Repertorization, the final court of decision is the Materia Medica. Therefore I would like to suggest a few important remedies for impotency with their indications.
Abroma
Absence of sexual desire, exhausted after coitus, swelling and hanging of testicles impotency.
Adrenalin
Sexual desire increased with out erections.
Agnuscastus
Impotency after frequent attacks of gonorrhea. No erection, parts cold, relaxed desire gone.
Ant. Crud
Impotency, atrophy of penis and testicles.
Arg. Nit
Impotence, erections fail when attempt is made. Sexual desire wanting.
Avena. Sat
Impotency after too much of indulgence in sex.
Baryta .Carb
Diminished desire, premature impotency.
Baryta. Iod
Impotency, erections wanting.
Baryta. Sulph
No desire, wanting erections.
Caladium
No erection even after caress. Impotence, relaxation of parts even when excited, parts cold. No emission or orgasm after embrace.
Cal.iod
Erections wanting, sexual passions without erections.
Capsicum
Coldness of penis and scrotum with impotency, atrophied testicles.
Cal. sil
Sexual passion increased sexual desire strong without erections, swollen testicles.
Carbo. Sulph
Desire lost, parts atrophied.
Coca
Diabetes mellitus with impotency.
Chloral
Sudden impotency.
Conium
Desire increased, power decreased, sexual nervousness with feeble erections. Effects of suppressed sexual appetite.
Flour acid
Sexual passion increased with erections only at night.
Graph
Sexual debility with increased desire.
Hydrastis
Indifference to coitus, impotence.
Hyoscyamus
Impotence with lasciviousness.
Iodum
Loss of sexual power with atrophied testes.
Kali.br
Debility with impotency, effects of sexual excesses. Excitement during partial slumber.
Kali. Carb
Deficient sexual instincts.
Kali. Phos
Sexual power decreased.
Lecithin
Male power lost or enfeebled.
Lycopodium
No erectile power, impotence, premature impotence. Emissions premature. Old men with strong desire but with imperfect erections, falls asleep during an embrace.
Moschus
Impotence associated with diabetes mellitus, violent desire.
Nat. M
Impotence with retarded erections, impotence from spinal irritation.
Nat. P
Desire without erections.
Nuphar. L
Complete absence of sexual desire, parts relaxed and penis retracted.
Nux. V
Impotency with involuntary emissions during stool, when urinating, bad effect of excess of all kinds.
Onosomod
Constant sexual excitement, psychical impotency, loss of sexual desire, speedy emission. Deficient erections.
Phos. ac
Sexual powers deficient, testicles tender, swollen, parts relaxed during embrace.
Sabal. Serr
Loss of sexual power with wasting of testicles, sexual neurotics. Organs feel cold.
Selenium
Loss of sexual power with lascivious fancies penis relaxed on attempting coitus.
Staphysagria
Organs relaxed and powerless.
Sulphur
Organs relaxed and powerless, ejaculation before intromission.
Uran. N
Impotency with nocturnal emissions, organs cold, relaxed and sweaty.
X-Ray
Sexual desire lost. Testes relaxed, Feeling of impotence.
Yohimbinum
Neurastshenic impotency.
IMPOTENCY
This is a male sexual disorder, whereby a male cannot maintain an erection of penis during copulation.
Impotence is a very delicate yet complex topic for a practitioner. Although a lot of passions are involved around the sexual life of a human being, this topic is poorly understood and requires thorough education of the patient. An attempt has been made here to resolve the mysteries regarding impotence.
Above the age of 65 years about 25% males develop impotence. Most of the cases have a psychogenic cause.
NORMAL CHANGES WITH AGE
Although sexual activity normally continues throughout man’s life time, the response varies with age. He takes longer to climax and his erections may come and go. He needs more recycling time before he can get another erection.
The 20’s: A young man needs little stimulation and can get an erection in a few minutes. He usually climaxes quickly but he can regain his erection in minutes.
The 40’s: With age there is more need of direct stimulation and fantasy. An erection takes several minutes, climax is slower and erection can be regained only after an hour or so.
The 60’s: An older man needs even more direct stimulation and fantasy. He takes longer to get an erection, can maintain it longer. But may take a day (or) more to regain it.
PHYSIOLOGY OF A PENILE ERECTION
The penis consists of corpus cavernosum; two spongy paired cylinders contained in a thick envelope, the tunica albuginea, and corpus spongiosum and glans with very thin tunica, in both the structures, with in the tunica are numerous sinusoids among the interwoven trabeculae of the smooth muscles and supporting connective tissue that harbour the terminal cavernous nerves and arterioles, the paired internal pudendal artery is the main source of blood supply to the penis while venous drainage is through multiple small veins to dorsal vein and then internal pudendal vein.
The nerve supply of the penis plays an important role in erection. The penis is innervated by 2 sets of nerves; autonomic nervous system (sympathetic and parasympathetic) and somatic nerves (sensory and motor). From the neurons in the spinal cord and peripheral ganglia the sympathetic and parasym-pathetic nerves merge to form the cavernous nerves and these nerves are responsible for neurovascular events during erection and detumescence. The somatic nerves are responsible for sensation of penis and contraction of the bulbocavernous and ischiocavernous muscles.
The parasympathetic supply comes from 2,3 and 4 sacral spinal cord segments which is responsible for tumescence (erection) while sympathetic supply comes from thoracic 11 to lumbar 2 spinal segment, which is responsible for detumencence (ejaculation). The sensory pathways go via dorsal nerves of penis to internal pudendal nerve to dorsal roots of 2nd to 4th nerves of spinal cord and spino thalamic tract to the thalamus and sensory cortex of brain. Onuf’s nucleus is the centre of somatomotor penile innervation. These nerves travel in the sacral nerves to the pudendal nerves to innervate bulbocavernosus and ischioca-vernosus muscles.
The contraction of the ischiocavernosus muscle causes rigid erection phase while rhythmic contractions of the bulbocavernous muscles expels the semen down the narrowed urethral lumen and results in external ejaculation from the meatus.
The spinal erection centres are located at intermedilateral column of the sacral cord and sends processes in to the areas of laminate 5 and 7 and the dorsal commissure. In the brain medial preoptic area (MPOA) is the important integration centre for sexual drive and penile erection.
According to nature of stimulus there are 3 types of erections.
1. Reflexogenic Erection
This erection is provided by tactile stimulus to the genitalia and is mediated through lower spinal centres.
2. Psychogenic Erection
This erection originates from audiovisual impulses and fantasies and signals are mediated through brain to spinal centres.
3. Nocturnal Erection
This type of erection occurs during REM sleep through unknown mechanism.
PATHOPHYSIOLOGY OF IMPOTENCE
1. Psychogenic Importance
Psychogenic stimuli (Visual impulses, fantasies) themselves are very strong inducers of erection and also can enhance the erection induced by Genital Stimulus. On the other hand, anxiety (or) depression, religious inhibitions, sexual phobias or deviation, obsessive compulsive personality or a traumatic past experience can send strong messages from brain to inhibit or to terminate erection. This inhibition is through a direct inhibition from brain to the spinal centres or through increased level of peripheral catecholamine that renders cavernous smooth muscles less sensitive to neuro-transmitters.
2. Neurogenic Impotence
Lesions affecting brain like cerebrovascular accidents, park-inson or Alzheimer’s disease, tumors, injury etc, act through direct central hypothalamic suppression or over inhibition of spinal centres.
A dysfunction at spinal level e.g. spinabifida, disc herniation, syringomyelia, tumor and multiple sclerosis may affect either efferent or afferent nerve pathways.
Neuropathy such as seen in alcoholism, vitamin deficiency or diabetes may affect cavernous nerve terminals leading to impotency. Injury to cavernous nerve or pudendal nerve from pelvic injury or surgery may disrupt the neural pathway causing impotence.
3. Arteriogenic Impotence
Diseases of terminal aorta or the hypogastric, pudendal, or penile arteries can results in erectile failure; trauma or congenital anomaly can cause arterial insufficiency. But generalized atherosclerotic process due to hypercholesterolemia, cigarette smoking, diabetes, radiation, hypertension and perineal trauma are more common cause of arteriolar impotence.
4. Venous Impotence
Abnormal venous channel following a shunting operation for priapism. Tunical abnormality as in pyronie’s disease or functional impairment of the cavernous erectile tissue can cause venous impotence.
5. Hormonal Impotence
Diabetes mellitus in an important cause for impotence but acts not mainly through hormonal changes but through vascular, neurologic and psychologic causes.
Androgens are essential for male sexual maturity but testosterone is not absolutely essential for erection. Therefore androgen replacement therapy is absolutely indicated in cases of hypogonadism only.
Hypothalamic pituitary Gonadal axis dysfunction can result in hypogonadism, Hypogonadotrophic hypogonadism can be due to malignancy, injury or aging while hypergonadotrophic Hypogondism can be due to diseases of testes like malignancy, surgery, injury or mumps.
Hyperprolactinemia caused by pituitary adenoma, chronic renal failure, or medication can result in lowered testosterone levels leading to impotence. Hyperthyroidism and hypothyroidism can also affect sexual function.
6. Erectile tissue dysfunction
Pyronie’s disease, trauma, diabetes, tumor infiltration, scleroderma, and priapism all these lead to gross microscopic changes as well as macroscopic changes in erectile tissues of penis.
7. Impotence from aging, systemic disease and other causes.
Hypothalamic pituitary dysfunction leading to testosterone deficiency is responsible for impotence of old age, the other factors like psychogenic, vascular, neurogenic etc. also add to the problem.
Chronic renal disease needing dialysis also leads to impotence in around 50% patients. Myocardial infarction, angina, heart failure, and Emphysema patients develop impotence. One of the reasons being, they fear aggravation of the disease following intercourse. Others diseases like liver cirrhosis, sclerdoderma, chronic debility and cachexia also can cause impotence.
CAUSES OF IMPOTENCY
The normal sexual function can be divided into five events each of which is under diverse regulation, libido, erection, ejaculation, orgasm and detumescence. Hence anything hampering the normal sexual functions will give rise to impotency as stated below;
1. Loss of desire
In a small percentage of organic cases, pituitary or testicular disease gives rise to androgen deficiency which in turn causes a decreased libido; hypogonadism also gives rise to such states.
2. Failure of erection
Which may arise from the following conditions.
a. Endocrine causes
Pituitary tumors which give rise to hyperprolactinemia.
b. Neurologic causes
Lesions of anterior temporal lobe, spinal cord disorders; loss of sensory input in diabetics; neuropathies; tabes dorsalis and damage to parasympathetic nerves following surgical procedure, such as total prostatectomy, retro sigmoid operations and aortic bypass surgery if autonomic nerve supply to penis is damaged.
c. Vascular causes
Leriche syndrome
d. Penile diseases
Peyronie’s disease, priapism and penile trauma.
e. Drug induced
Prolonged use of antihistamines, antihypertensive etc., which are potentially correctable, causes of impotency.
3. Premature ejaculation
Always related to anxiety states or emotional disorder and unreasonable expectations about performance, it may rarely have an organic cause.
4. Absence of Emission
It may be due to the following conditions.
a. Retrograde ejaculation
Following surgery on the bladder neck or may develop spontaneously in diabetics.
b. Sympathetic Denervation
May occur following sympathectomy.
c. Androgen deficiency
Results in a decrease in secretions of the prostrate and seminal vesicles and diminution of the volume of ejaculate.
d. Drugs
Such as phenoxy benzamine.
e. Absence of orgasm
It is always almost due to psychological disorder if the libido and erectile functions are normal.
f. Failure of detumensence
It is due to priapism but can be associated with sickle cell anemia, chronic granulocytic leukemia or spinal cord injury.
EVALUATION OF IMPOTENCY
The central issue of Evaluating impotency is to separate those instances due to psychological factors from those due to organic causes. A good case-taking usually makes the separation possible.
The commonest cause is an anxiety or depressed state. Psychological factors like disinterest in sexual partner, marital discord etc reduce the sexual impulse.
However, if organic cause is deduced, its aetiology should be well known.
INVESTIGATION AND EXAMINATION
a. Laboratory investigation
Laboratory evaluation is probably of minimal value. Measurement of serum testosterone in the absence of evidence of feminization or hypogonadism is seldom helpful. If there is an indication from either history (or) physical examination of vascular aetiology, a doppler procedure or arteriography may be indicated.
b. Physical examination
Thorough genital examination to identify abnormalities of the penis; testicular size and abnormal masses. Evidence of feminization such as gynaecomastia and abnormal body hair distribution should be sought. All pulses should be palpated, including the penile pulse, to exclude the presence of deep cavernous arterial occlusion.
c. Systemic examination
Neurological examination is necessary for detecting peripheral neuropathy and also to assess the perianal sensation, anal sphincter tone and bulbo cavernous reflex.
DIAGNOSIS OF IMPOTENCE
Apart from history and clinical examination, Duplex and color Doppler sonography can give a complete status of the erectile function of penis; X-rays, caverno-sonography and selective pundendal arteriography have become obsolete.
PLAN OF TREATMENT
It can be broadly classified as follows;
1. Ancillary or extra medial line of treatment.
2. Surgical line of treatment.
3. Treatment with homoeopathic medicines like constitutional, inter-current medicines, mother tinctures, organopathic and rare medicines.
1. Ancillary or extra remedial line of treatment
a. Giving reassurance to the patients of anxiety states and corrective measures to depressive patients may restore sexual potency.
b. Sexual counseling, education and psychotherapy are also beneficial in alleviating psychogenic factors.
2. Surgical line of treatment
a. In case of hyperprolactinemia where prolactin secreting pituitary tumor is present; surgical removal usually results in return of potency.
b. Surgical therapy is also useful in treatment of decreased potency related to aortic obstruction.
c. Implantation of penile prosthetic by a small, blunt silastic rod (or) alternatively by an inflatable prosthetic device, can be advised. In refractory cases which are not improving with the allopathic mode of treatment or patients who are skeptical about the homoeopathic mode of treatment. However it should be remembered that these procedures are extremely costly and have a high risk of complications.
THERAPEUTICS OF IMPOTENCE
In homoeopathic prescribing, even after Repertorization, the final court of decision is the Materia Medica. Therefore I would like to suggest a few important remedies for impotency with their indications.
Abroma
Absence of sexual desire, exhausted after coitus, swelling and hanging of testicles impotency.
Adrenalin
Sexual desire increased with out erections.
Agnuscastus
Impotency after frequent attacks of gonorrhea. No erection, parts cold, relaxed desire gone.
Ant. Crud
Impotency, atrophy of penis and testicles.
Arg. Nit
Impotence, erections fail when attempt is made. Sexual desire wanting.
Avena. Sat
Impotency after too much of indulgence in sex.
Baryta .Carb
Diminished desire, premature impotency.
Baryta. Iod
Impotency, erections wanting.
Baryta. Sulph
No desire, wanting erections.
Caladium
No erection even after caress. Impotence, relaxation of parts even when excited, parts cold. No emission or orgasm after embrace.
Cal.iod
Erections wanting, sexual passions without erections.
Capsicum
Coldness of penis and scrotum with impotency, atrophied testicles.
Cal. sil
Sexual passion increased sexual desire strong without erections, swollen testicles.
Carbo. Sulph
Desire lost, parts atrophied.
Coca
Diabetes mellitus with impotency.
Chloral
Sudden impotency.
Conium
Desire increased, power decreased, sexual nervousness with feeble erections. Effects of suppressed sexual appetite.
Flour acid
Sexual passion increased with erections only at night.
Graph
Sexual debility with increased desire.
Hydrastis
Indifference to coitus, impotence.
Hyoscyamus
Impotence with lasciviousness.
Iodum
Loss of sexual power with atrophied testes.
Kali.br
Debility with impotency, effects of sexual excesses. Excitement during partial slumber.
Kali. Carb
Deficient sexual instincts.
Kali. Phos
Sexual power decreased.
Lecithin
Male power lost or enfeebled.
Lycopodium
No erectile power, impotence, premature impotence. Emissions premature. Old men with strong desire but with imperfect erections, falls asleep during an embrace.
Moschus
Impotence associated with diabetes mellitus, violent desire.
Nat. M
Impotence with retarded erections, impotence from spinal irritation.
Nat. P
Desire without erections.
Nuphar. L
Complete absence of sexual desire, parts relaxed and penis retracted.
Nux. V
Impotency with involuntary emissions during stool, when urinating, bad effect of excess of all kinds.
Onosomod
Constant sexual excitement, psychical impotency, loss of sexual desire, speedy emission. Deficient erections.
Phos. ac
Sexual powers deficient, testicles tender, swollen, parts relaxed during embrace.
Sabal. Serr
Loss of sexual power with wasting of testicles, sexual neurotics. Organs feel cold.
Selenium
Loss of sexual power with lascivious fancies penis relaxed on attempting coitus.
Staphysagria
Organs relaxed and powerless.
Sulphur
Organs relaxed and powerless, ejaculation before intromission.
Uran. N
Impotency with nocturnal emissions, organs cold, relaxed and sweaty.
X-Ray
Sexual desire lost. Testes relaxed, Feeling of impotence.
Yohimbinum
Neurastshenic impotency.
Monday, 21 March 2011
THE DISEASES NAMED BY THE SCIENTIST’S NAME
THE DISEASES NAMED BY THE SCIENTIST’S NAME
1. Adams – stokes attacks: Symptoms such as ORS Complex in ECG, absent pulse, vertigo, convulsion & cheynestock respiration usually as a result of heart block.
2. Addision’s disease: Chronic adreno cortical insufficiency
3. Albinism: Tyrosinase deficiency leading to little or no melanin synthesis in the skin & eyes.
4. Alzheimer’s disease: Per-Senile dementia
5. Alport’s syndrome: Hereditary nephritis
6. Argyll Robertson’s: Most important and characteristic pupillary changes in tabes dorsalis, this is characterized by miosis, eccentric pupil irregularity of the pupil due to atrophy of the iris, pigmentation of iris, light reflex is lost, Accommodation reflex is present & brisk.
7. Austin flint’s murmur: In aortic incompetence some times a functional mid – diastolic and pre systolic murmur may be heard over mitral area, called Austin flint’s murmur.
8. Bell’s palsy: LMN type of Facial nerve paralysis.
9. Bence-Jone’s Myeloma: Proteinuria occurring in multiple myeloma, also known as Plasma cell cancer.
10. Budd - chiari syndrome: Thrombosis of the hepatic vein with Hepatomegaly, ascitis and portal Hypertension.
11. Bitot’s spots: Grayish white triangular deposits on the conjunctiva due to vit A deficiency.
12. Burkit’s lymphoma: Malignant condition of lymphoid tissue involving facial bones and abdominal lymph nodes.
13. Brown – Sequard syndrome: Hemi paraplegia & hyper aesthesia but with loss of joint & muscle sence on the side of lesion and hemi anesthesia on the opposite side. (In case of unilateral spinal cord involvement)
14. Cushing’s syndrome: Hyper adrenocorticosism.
15. Conn’s syndrome: Primary Hyper aldosteronism.
16. Crohn’s disease : Regional enteritis (Type of inflammatory Bowel disease)
17. Caisson disease: A symptom complex occurring in men working under high air pressure when too suddenly released to normal atmosphere.
18. Caplan’s syndrome: Intra pulmonary nodules like rheumatoid nodule and pneumoconiosis in coal workers.
19. Carey–coombs murmur: Mid diastolic murmur observed in mitral stenosis.
20. Charcot – leydon crystals: crystal deposition arthritis associated with tertiary syphilis.
21. Curling’s ulcer: ulcer of the duodenum in a patient due to burns & Body injury.
22. Dandy Walkersyn: congenital hydrocephalus associated with Artesia of foramen of megendie.
23. Deputytran’s contracture : Permanent flexion of the fingers (especially 4th & 5th )
24. Duckett– Jones criteria: Diagnostic criteria for Rheumatic fever.
25. Down’s syndrome: Trisomy 21. One excessive chromosome in the 21st pair.
26. Edward’s syndrome: This is one of the chromosomal of abnormality trisomy 18 and trisomy E, characterized by low birth weight gross mental retardation, congenital heart disease, long & narrow skull with prominent occiput, flexion deformities & the fingers are present
27. Ehlers – Danlos syndrome: Congenital condition characterized by over elasticity & friability of skin, increased extensibility of the joint & fragility of the vessels.
28. Ewing’s tumor: Ewing’s sarcoma – neoplasm of the bone occurs 75 % in the extremities including shoulder girdle.
29. Fallot’s tetra logy: Most common form of congenital cyanotic heart disease (1) pul.stenosis 2). V.S.D 3). R.V.H 4). Dextro position of the aorta)
30. Fried riech’s ataxaia: A type of spino cerebellar degeneration.
31. Fournier’s Gangrene: Gangrene of the testis & scrotum.
32. Good pasture’s syndrome: A form of rapidly progressive Glom. Nephritis ± Hemoptysis.
33. Grave’s disease: Hyper thyroidism (Auto immune type)
34. Graham steel’s murmur: An early systolic murmur associated with pulmonic insufficiency caused by pulmonary hypertension.
35. Gullian barr syndrome: Acute infective poly neuritis
36. Hansen’s disease: Leprosy.
37. Hashimato’s thyroiditis: Hypo thyrodism due to auto immune thyroiditis.
38. Heberden’s node: Nodular growth, which affecting the distal interphalangeal joints in osteo arthritis.
39. Horner’s syndrome: Ptosis, myosis and exophthalmos due to paralysis of the cervical sympathetic nerves.
40. Huntington’s chorea: A disease of CNS (onset 30 -50 Yrs.) characterized by dementia, psychosomatic disturbances with bizarre involuntary movement characteristic of chorea.
41. Hodgkin’s lymphoma: malignant enlargement of the lymph node often cervical at the onset then generalized with hepatosplenomegally.
42. Jacksonian epilepsy: Secondarily generalized seizure.
43. Kartagener’s syndrome: Complete situs inversus associated with bronchiectasis & chronic sinusitis.
44. Kaposi’s sarcoma: Multiple areas of Neoplastic cell proliferation mainly in the skin & also in other body organ ( mainly associated with AIDS)
45. Kayser – Fleischer ring: Greenish brown discoloration of corneal margin occurring in Wilson’s disease.
46. Koch’s disease: Tuberculosis.
47. Kelly – Paterson syndrome (or) Plummer Vinson syndrome: The association of chronic iron deficiency anaemia with koilonychia, glossitis, dysphagia and splenomegaly is called Plummer Vinson syndrome.
48. Kussmaul’s respiration: Deep rapid respiration chiefly in air Hunger, Diabetic acidosis and coma.
49. K.W. Syndrome (Kilmmlstiel – Wilson syndrome): Diabetic nephropathy.
50. Marfan’s syndrome: A hereditary condition characterized by arachynodactyly, excessive length of extremities and laxness of joints.
51. Meniere’s disease: Recurrent idiopathic attack of vertigo. Nausea, vomiting, tinnitus and progressive deafness.
52. Osler’s Node: A small, raised, red, tender area present in fingers & toes due to infected emboli from the heart in infective endocarditis.
53. Osler’s disease: (Erythremia or polycythemia Vera) Increased R.B.C with splenomegally, Face is deep red rather than truly cyanotic.
54. Parkinsonism: A syndrome due to defective release of neurotransmitor dopamine in the corpus striatum.
55. Parkinson’s disease: Idiopathic Parkinsonism.
56. Patterson – Kelly syndrome: Post cricoid web due to iron deficiency anaemia producing dysphagia.
57. Paget’s disease: A Generalized skeletal disease characterized by thickening & softening of the bone as in the skull and bending of weight bearing joint.
58. Pott’s spine: T.B Spine
59. Peutz – jehers syndrome: Generalized multiple polyposis of the intestinal tract.
60. Pick’s disease: Non- Alzeimer’s degenerative dementia characterized by fronto – temporal atrophy.
61. Ramsay Hunt syndrome: Herpes zoster affecting geniculate ganglion in 7th nerve lesion, characterized by LMN type of facial palsy, loss of taste in anterior 2/3 rd of tongue, serous discharge through ear, multiple vesicles in pinna of ear and posterior tonsils.
62. Raynaud’s disease: Idiopathic paroxysmal bilateral cyanosis of the digits due to arterial contraction brought on by cold or emotion.
63. Reiter’s syndrome: A triad of urithritis, conjunctivitis and arthritis which appear on that order.
64. Reye’s syndrome: Sudden loss of consciousness or death in children following infection characterized by cerebral oedema, fatty changes in the liver and renal tubules.
65. St. Vitu’s dance (Sydenham’s chorea): this is an acute episode of involuntary movement due to a lesion in the basal ganglia associated with acute rheumatism.
66. Sheehan’s syndrome: Hypo pituitarism arising from a severe post partum circulatory collapse with resultant pituitary necrosis.
67. Shy- Drager syndrome: A type of spino cerebellar degeneration.
68. Sjogren’s syndrome: Kerato conjunctivitis sicca (or) purpuric spots on the face and bilateral parotitis seen in menopausal women.
69. Steven Johnson syndrome: Erythema multiformae exudativatum.
70. Still’s disease: Juvenile Rheumatoid Arthritis.
71. Sydenham’s chorea: childhood chorea mainly in Rheumatic fever.
72. Suzman’s sign: In coarctation of the Aorta the collateral arterial pulsations are present around the scapulae, trunk and in the axilla, this is called suzman’s sign.
73. Takayasu’s disease: pulse less disease.
74. Todd’s palsy: Temporary paralysis of the limbs after the epilepsy.
75. Turner’s syndrome: A chromosomal anomaly with chromosome count 45 including only a single X chromosome.
76. Vincent’s angina: in stomatitis Vincent’s spirochaete and fusiform bacilli are found from the ulcer and this type is known as Vincent’s angina.
77. Von reckling housen’s disease: Neuro fibromatoses.
78. Von-wille brand’s disease: Angio hemophilia or hereditary pseudo hemophilia.
79. Wilms tumor: Nephroblastoma. Common intra- abdominal malignancy in childhood.
80. Wilson’s disease: Hepto lenticular degeneration. Decreased serum ceruloplasmin and increased accumualation of copper in the body.
81. Wernicke’s Korsakoff’s psychosis: Wernicke’s encephalopathy – A syndrome charecterised by confusion and several loss of memory.
82. Walff Parkinson white syndrome: supraventricular tachycardia. ( Diagnosis made by ECG)
83. Weil’s disease: lctero – Hemorrhagica jaundice due to Leptospirosis
84. Zollinger – Ellision syndrome: Excessive acid HCL secretion (due to Gastrinoma) also with multiple ulceration in esophagus stomach, duodenum & small intestine.
1. Adams – stokes attacks: Symptoms such as ORS Complex in ECG, absent pulse, vertigo, convulsion & cheynestock respiration usually as a result of heart block.
2. Addision’s disease: Chronic adreno cortical insufficiency
3. Albinism: Tyrosinase deficiency leading to little or no melanin synthesis in the skin & eyes.
4. Alzheimer’s disease: Per-Senile dementia
5. Alport’s syndrome: Hereditary nephritis
6. Argyll Robertson’s: Most important and characteristic pupillary changes in tabes dorsalis, this is characterized by miosis, eccentric pupil irregularity of the pupil due to atrophy of the iris, pigmentation of iris, light reflex is lost, Accommodation reflex is present & brisk.
7. Austin flint’s murmur: In aortic incompetence some times a functional mid – diastolic and pre systolic murmur may be heard over mitral area, called Austin flint’s murmur.
8. Bell’s palsy: LMN type of Facial nerve paralysis.
9. Bence-Jone’s Myeloma: Proteinuria occurring in multiple myeloma, also known as Plasma cell cancer.
10. Budd - chiari syndrome: Thrombosis of the hepatic vein with Hepatomegaly, ascitis and portal Hypertension.
11. Bitot’s spots: Grayish white triangular deposits on the conjunctiva due to vit A deficiency.
12. Burkit’s lymphoma: Malignant condition of lymphoid tissue involving facial bones and abdominal lymph nodes.
13. Brown – Sequard syndrome: Hemi paraplegia & hyper aesthesia but with loss of joint & muscle sence on the side of lesion and hemi anesthesia on the opposite side. (In case of unilateral spinal cord involvement)
14. Cushing’s syndrome: Hyper adrenocorticosism.
15. Conn’s syndrome: Primary Hyper aldosteronism.
16. Crohn’s disease : Regional enteritis (Type of inflammatory Bowel disease)
17. Caisson disease: A symptom complex occurring in men working under high air pressure when too suddenly released to normal atmosphere.
18. Caplan’s syndrome: Intra pulmonary nodules like rheumatoid nodule and pneumoconiosis in coal workers.
19. Carey–coombs murmur: Mid diastolic murmur observed in mitral stenosis.
20. Charcot – leydon crystals: crystal deposition arthritis associated with tertiary syphilis.
21. Curling’s ulcer: ulcer of the duodenum in a patient due to burns & Body injury.
22. Dandy Walkersyn: congenital hydrocephalus associated with Artesia of foramen of megendie.
23. Deputytran’s contracture : Permanent flexion of the fingers (especially 4th & 5th )
24. Duckett– Jones criteria: Diagnostic criteria for Rheumatic fever.
25. Down’s syndrome: Trisomy 21. One excessive chromosome in the 21st pair.
26. Edward’s syndrome: This is one of the chromosomal of abnormality trisomy 18 and trisomy E, characterized by low birth weight gross mental retardation, congenital heart disease, long & narrow skull with prominent occiput, flexion deformities & the fingers are present
27. Ehlers – Danlos syndrome: Congenital condition characterized by over elasticity & friability of skin, increased extensibility of the joint & fragility of the vessels.
28. Ewing’s tumor: Ewing’s sarcoma – neoplasm of the bone occurs 75 % in the extremities including shoulder girdle.
29. Fallot’s tetra logy: Most common form of congenital cyanotic heart disease (1) pul.stenosis 2). V.S.D 3). R.V.H 4). Dextro position of the aorta)
30. Fried riech’s ataxaia: A type of spino cerebellar degeneration.
31. Fournier’s Gangrene: Gangrene of the testis & scrotum.
32. Good pasture’s syndrome: A form of rapidly progressive Glom. Nephritis ± Hemoptysis.
33. Grave’s disease: Hyper thyroidism (Auto immune type)
34. Graham steel’s murmur: An early systolic murmur associated with pulmonic insufficiency caused by pulmonary hypertension.
35. Gullian barr syndrome: Acute infective poly neuritis
36. Hansen’s disease: Leprosy.
37. Hashimato’s thyroiditis: Hypo thyrodism due to auto immune thyroiditis.
38. Heberden’s node: Nodular growth, which affecting the distal interphalangeal joints in osteo arthritis.
39. Horner’s syndrome: Ptosis, myosis and exophthalmos due to paralysis of the cervical sympathetic nerves.
40. Huntington’s chorea: A disease of CNS (onset 30 -50 Yrs.) characterized by dementia, psychosomatic disturbances with bizarre involuntary movement characteristic of chorea.
41. Hodgkin’s lymphoma: malignant enlargement of the lymph node often cervical at the onset then generalized with hepatosplenomegally.
42. Jacksonian epilepsy: Secondarily generalized seizure.
43. Kartagener’s syndrome: Complete situs inversus associated with bronchiectasis & chronic sinusitis.
44. Kaposi’s sarcoma: Multiple areas of Neoplastic cell proliferation mainly in the skin & also in other body organ ( mainly associated with AIDS)
45. Kayser – Fleischer ring: Greenish brown discoloration of corneal margin occurring in Wilson’s disease.
46. Koch’s disease: Tuberculosis.
47. Kelly – Paterson syndrome (or) Plummer Vinson syndrome: The association of chronic iron deficiency anaemia with koilonychia, glossitis, dysphagia and splenomegaly is called Plummer Vinson syndrome.
48. Kussmaul’s respiration: Deep rapid respiration chiefly in air Hunger, Diabetic acidosis and coma.
49. K.W. Syndrome (Kilmmlstiel – Wilson syndrome): Diabetic nephropathy.
50. Marfan’s syndrome: A hereditary condition characterized by arachynodactyly, excessive length of extremities and laxness of joints.
51. Meniere’s disease: Recurrent idiopathic attack of vertigo. Nausea, vomiting, tinnitus and progressive deafness.
52. Osler’s Node: A small, raised, red, tender area present in fingers & toes due to infected emboli from the heart in infective endocarditis.
53. Osler’s disease: (Erythremia or polycythemia Vera) Increased R.B.C with splenomegally, Face is deep red rather than truly cyanotic.
54. Parkinsonism: A syndrome due to defective release of neurotransmitor dopamine in the corpus striatum.
55. Parkinson’s disease: Idiopathic Parkinsonism.
56. Patterson – Kelly syndrome: Post cricoid web due to iron deficiency anaemia producing dysphagia.
57. Paget’s disease: A Generalized skeletal disease characterized by thickening & softening of the bone as in the skull and bending of weight bearing joint.
58. Pott’s spine: T.B Spine
59. Peutz – jehers syndrome: Generalized multiple polyposis of the intestinal tract.
60. Pick’s disease: Non- Alzeimer’s degenerative dementia characterized by fronto – temporal atrophy.
61. Ramsay Hunt syndrome: Herpes zoster affecting geniculate ganglion in 7th nerve lesion, characterized by LMN type of facial palsy, loss of taste in anterior 2/3 rd of tongue, serous discharge through ear, multiple vesicles in pinna of ear and posterior tonsils.
62. Raynaud’s disease: Idiopathic paroxysmal bilateral cyanosis of the digits due to arterial contraction brought on by cold or emotion.
63. Reiter’s syndrome: A triad of urithritis, conjunctivitis and arthritis which appear on that order.
64. Reye’s syndrome: Sudden loss of consciousness or death in children following infection characterized by cerebral oedema, fatty changes in the liver and renal tubules.
65. St. Vitu’s dance (Sydenham’s chorea): this is an acute episode of involuntary movement due to a lesion in the basal ganglia associated with acute rheumatism.
66. Sheehan’s syndrome: Hypo pituitarism arising from a severe post partum circulatory collapse with resultant pituitary necrosis.
67. Shy- Drager syndrome: A type of spino cerebellar degeneration.
68. Sjogren’s syndrome: Kerato conjunctivitis sicca (or) purpuric spots on the face and bilateral parotitis seen in menopausal women.
69. Steven Johnson syndrome: Erythema multiformae exudativatum.
70. Still’s disease: Juvenile Rheumatoid Arthritis.
71. Sydenham’s chorea: childhood chorea mainly in Rheumatic fever.
72. Suzman’s sign: In coarctation of the Aorta the collateral arterial pulsations are present around the scapulae, trunk and in the axilla, this is called suzman’s sign.
73. Takayasu’s disease: pulse less disease.
74. Todd’s palsy: Temporary paralysis of the limbs after the epilepsy.
75. Turner’s syndrome: A chromosomal anomaly with chromosome count 45 including only a single X chromosome.
76. Vincent’s angina: in stomatitis Vincent’s spirochaete and fusiform bacilli are found from the ulcer and this type is known as Vincent’s angina.
77. Von reckling housen’s disease: Neuro fibromatoses.
78. Von-wille brand’s disease: Angio hemophilia or hereditary pseudo hemophilia.
79. Wilms tumor: Nephroblastoma. Common intra- abdominal malignancy in childhood.
80. Wilson’s disease: Hepto lenticular degeneration. Decreased serum ceruloplasmin and increased accumualation of copper in the body.
81. Wernicke’s Korsakoff’s psychosis: Wernicke’s encephalopathy – A syndrome charecterised by confusion and several loss of memory.
82. Walff Parkinson white syndrome: supraventricular tachycardia. ( Diagnosis made by ECG)
83. Weil’s disease: lctero – Hemorrhagica jaundice due to Leptospirosis
84. Zollinger – Ellision syndrome: Excessive acid HCL secretion (due to Gastrinoma) also with multiple ulceration in esophagus stomach, duodenum & small intestine.
Friday, 18 March 2011
HAVOC OF ALCOHOLISM
HAVOC OF ALCOHOLISM
“LIQUOR RUINS THE COUNTRY, FAMILY & LIFE”
“Alcohol is a kicker,
But it is a killer”
The term alcoholism is a confusing one and this is replaced by the current nomenclature “alcohol dependence”.
Drinking habit is gradually increasing in our society.
An alcohol addiction can be defined as one who has lost control over his drinking and has a compulsion to keep on drinking with deterioration of emotional, social and work activities.
Alcohol dependence is usually believed that drinking up to 20 units of alcohol for men and 13 units for women per week is not associated with health hazard. Definite health hazard occurs when consumption of alcohol is more than 50 units for men and 35 units for women in a week.
CAUSES FOR ADDICTION
Alcohol environment – members of a society where most of the people are alcoholics are prone to alcohol addiction.
Anxiety and depression.
Psychopathic persons.
SYMPTOMS OF ALCOHOLISM
Early symptoms – euphoria, Talkativeness
Later on – concentration is impaired and the subject becomes forgetful,
gradually power of thinking, Judgement and memory fail.
BAD EFFECTS OF CHRONIC ALCOHOLISM:
Psychological Problem :
Loss of concentration
Recent loss of memory
Delirium tremens
Dipsomania
Wernicke korsakoffs psychosis
Cardiovascular system
Alcohol is generally a peripheral vasodilatator
Daily taking one oz of French wine prevents ischemic heart disease.
Bad effects – alcoholic cardiomyopathy.
Respiratory system :
Due to chronic alcohol- in sufficient in take of food ,it produces decreased immune power ,leads for recurrent respiratory infection.
After large quantity of alcohol and heavy meal with un consciousness cause aspiration pneumonia .
Central nervous system:
Alcoholic peripheral neuropathy
Alcoholic hallucinosis
Cerebellar degeneration
Alcoholic myopathy
Hyper tropic Poly neuritis
Hepatobiliary system :
Chronic alcohol produced low immunity – amebic liver abscess
Cirrhosis
Acute and chronic gastritis
Pancreatitis
Connective tissue disorder :
Gout
Sexual:
Impotence
Management:
Admission in hospital with full with drawl of alcohol.
Adequate diet supplemented with vitamin B complex.
If with drawl leads to marked tremulousness and restlessness, large
dose of Vit.B complex I /v
Drug for with drawl systems (chlorpromazine, prochlorperazine)
Psychotherapy.
Homoeopathic management:
Nux vomica:
For anti doting bad effects of liquor such as gastric trouble,restlessness,
Bad effects of alcohol
Dipsomania
Petroleum:
Drunkard with out energy ,with out strength of will, unable to refuse wine,vomiting after the least excess in drinks , dipsomania,
Sulphuric acid :
One part with 3 parts of alcohol , 10 to 15 drops ,3 times daily for 3 or 4
weeks,has been subdue the craving for liquor ( dr. hering)
Sterculia:
The remedy for the drinking habit. It promotes the appetite and digestion, and lessens the craving for liquor.
Capsicum:
Prostration and feeble digestion of alcoholics.
Syphilinum:
Craving alcohol, in any form. Hereditary tendency to alcoholism.
Loss of memory, cannot remember names of books, persons or places.
Sensation as if going insane, as if about to be paralyzed, of apathy and indifference.
Zincum. Met:
Persons suffering from cerebral and nervous exhaustion.
Defective vitality, brain or nerve power wanting too weak to develop
exanthemata.
Quercus:
Used first by Rademacher for chronic spleen affections, spleen dropsy.
Antidotes effects of alcohol.
Takes away craving for alcoholics, give dose as below for several months.
Dropsy and lever affections.
Alcoholism, General Dipsomania:
Agar, Crot.H, Lach, Chin, Nux.Vom, Ran.B, Sulph. Acid, Sulph., Verat, Syph., Zinc, Ledum.
Ailments from Beer:
Kali. Bich, Rhus. Tox, Thuja.
Ailments form Brandy:
Carbo. Veg, Nux. Vom, Opium, Sulph.
Ailments from Wine:
Carbo .Veg, Coff, Lyco, Nat. Mur., Zinc.
“LIQUOR RUINS THE COUNTRY, FAMILY & LIFE”
“Alcohol is a kicker,
But it is a killer”
The term alcoholism is a confusing one and this is replaced by the current nomenclature “alcohol dependence”.
Drinking habit is gradually increasing in our society.
An alcohol addiction can be defined as one who has lost control over his drinking and has a compulsion to keep on drinking with deterioration of emotional, social and work activities.
Alcohol dependence is usually believed that drinking up to 20 units of alcohol for men and 13 units for women per week is not associated with health hazard. Definite health hazard occurs when consumption of alcohol is more than 50 units for men and 35 units for women in a week.
CAUSES FOR ADDICTION
Alcohol environment – members of a society where most of the people are alcoholics are prone to alcohol addiction.
Anxiety and depression.
Psychopathic persons.
SYMPTOMS OF ALCOHOLISM
Early symptoms – euphoria, Talkativeness
Later on – concentration is impaired and the subject becomes forgetful,
gradually power of thinking, Judgement and memory fail.
BAD EFFECTS OF CHRONIC ALCOHOLISM:
Psychological Problem :
Loss of concentration
Recent loss of memory
Delirium tremens
Dipsomania
Wernicke korsakoffs psychosis
Cardiovascular system
Alcohol is generally a peripheral vasodilatator
Daily taking one oz of French wine prevents ischemic heart disease.
Bad effects – alcoholic cardiomyopathy.
Respiratory system :
Due to chronic alcohol- in sufficient in take of food ,it produces decreased immune power ,leads for recurrent respiratory infection.
After large quantity of alcohol and heavy meal with un consciousness cause aspiration pneumonia .
Central nervous system:
Alcoholic peripheral neuropathy
Alcoholic hallucinosis
Cerebellar degeneration
Alcoholic myopathy
Hyper tropic Poly neuritis
Hepatobiliary system :
Chronic alcohol produced low immunity – amebic liver abscess
Cirrhosis
Acute and chronic gastritis
Pancreatitis
Connective tissue disorder :
Gout
Sexual:
Impotence
Management:
Admission in hospital with full with drawl of alcohol.
Adequate diet supplemented with vitamin B complex.
If with drawl leads to marked tremulousness and restlessness, large
dose of Vit.B complex I /v
Drug for with drawl systems (chlorpromazine, prochlorperazine)
Psychotherapy.
Homoeopathic management:
Nux vomica:
For anti doting bad effects of liquor such as gastric trouble,restlessness,
Bad effects of alcohol
Dipsomania
Petroleum:
Drunkard with out energy ,with out strength of will, unable to refuse wine,vomiting after the least excess in drinks , dipsomania,
Sulphuric acid :
One part with 3 parts of alcohol , 10 to 15 drops ,3 times daily for 3 or 4
weeks,has been subdue the craving for liquor ( dr. hering)
Sterculia:
The remedy for the drinking habit. It promotes the appetite and digestion, and lessens the craving for liquor.
Capsicum:
Prostration and feeble digestion of alcoholics.
Syphilinum:
Craving alcohol, in any form. Hereditary tendency to alcoholism.
Loss of memory, cannot remember names of books, persons or places.
Sensation as if going insane, as if about to be paralyzed, of apathy and indifference.
Zincum. Met:
Persons suffering from cerebral and nervous exhaustion.
Defective vitality, brain or nerve power wanting too weak to develop
exanthemata.
Quercus:
Used first by Rademacher for chronic spleen affections, spleen dropsy.
Antidotes effects of alcohol.
Takes away craving for alcoholics, give dose as below for several months.
Dropsy and lever affections.
Alcoholism, General Dipsomania:
Agar, Crot.H, Lach, Chin, Nux.Vom, Ran.B, Sulph. Acid, Sulph., Verat, Syph., Zinc, Ledum.
Ailments from Beer:
Kali. Bich, Rhus. Tox, Thuja.
Ailments form Brandy:
Carbo. Veg, Nux. Vom, Opium, Sulph.
Ailments from Wine:
Carbo .Veg, Coff, Lyco, Nat. Mur., Zinc.
BAD EFFECTS OF SMOKING
BAD EFFECTS OF SMOKING
“Cigarette smoking is injurious to health”
Smoking habits commonly seen in young age group
What are the diseases come due to smoking
Respiratory system
Why it is bad , nicotine causes bronchial constriction lead to early development of chronic bronchitis.
-bronchogenic carcinoma usually in old age (above 60 yrs)
- chronic bronchitis ( 30-40 yrs)
cardio vascular system:
nicotine is a vasoconstrictor , it injures the coronary vessels ,finally produces atheromatous deposition leading to ischemic heart disease . commonly in young age group.
Central nervous system:
Narrowing of cerebral vessels cause atheromatous plaque .which produces thrombosis in turn produces hemiplegia.
Others :
Peptic ulcer
Throat cancer.
Impotence
Homoeopathic management:
Destroys craving for tobacco, Cancer from smoking – Caladium.
Tobacco craving – daphne indica,
Tobacco heavy smokers- nicotine poisoning causing damage to heart, lung, and blood vessels- tabaccum.
After smoking thirst increased –ars,calad,con,phos,
Abdomen pain after smoking –bufo,
Pain in bowels, better after smoking-coloc
Addiction, nicotine –aven,calad,ign,nicot,nux.vom,tab,
Angina pectoris from tobacco –nux.vom,
Desire for smoking- calad, tab, ars, cal.p, camph, china, coca, glon, nicot, nux vom, phos, staph.
Heart, symptoms of circulation worse after smoking ¬– spongia
Hic cough during smoking – puls, sang.
Hic cough after smoking – calen, ign, puls.
Intoxicated , feeling after smoking – asc.t,
Paralysis, from abuse of nicotine – nux vom.
Smoking causes urging to stool – caladium.
“Cigarette smoking is injurious to health”
Smoking habits commonly seen in young age group
What are the diseases come due to smoking
Respiratory system
Why it is bad , nicotine causes bronchial constriction lead to early development of chronic bronchitis.
-bronchogenic carcinoma usually in old age (above 60 yrs)
- chronic bronchitis ( 30-40 yrs)
cardio vascular system:
nicotine is a vasoconstrictor , it injures the coronary vessels ,finally produces atheromatous deposition leading to ischemic heart disease . commonly in young age group.
Central nervous system:
Narrowing of cerebral vessels cause atheromatous plaque .which produces thrombosis in turn produces hemiplegia.
Others :
Peptic ulcer
Throat cancer.
Impotence
Homoeopathic management:
Destroys craving for tobacco, Cancer from smoking – Caladium.
Tobacco craving – daphne indica,
Tobacco heavy smokers- nicotine poisoning causing damage to heart, lung, and blood vessels- tabaccum.
After smoking thirst increased –ars,calad,con,phos,
Abdomen pain after smoking –bufo,
Pain in bowels, better after smoking-coloc
Addiction, nicotine –aven,calad,ign,nicot,nux.vom,tab,
Angina pectoris from tobacco –nux.vom,
Desire for smoking- calad, tab, ars, cal.p, camph, china, coca, glon, nicot, nux vom, phos, staph.
Heart, symptoms of circulation worse after smoking ¬– spongia
Hic cough during smoking – puls, sang.
Hic cough after smoking – calen, ign, puls.
Intoxicated , feeling after smoking – asc.t,
Paralysis, from abuse of nicotine – nux vom.
Smoking causes urging to stool – caladium.
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