Archive for May 12th, 2009

ANOREXIA NERVOSA – CASES

Tuesday, May 12th, 2009

Many cases seem to follow some sexual difficulty. This may only be the development of sexuality which comes with puberty or it may follow episodes of petting or intercourse which the girl cannot handle psychologically.

When the family is examined it is often found that there is a disturbance in family relationships. The outward appearance may be one of family harmony but beneath this calm lies well controlled hostility.

The mothers are usually domineering and rigid in outlook; both parents are intense and seek affection and approval from the girl to compensate for their hostility to each other.

Many theories have been advanced for the cause of this disorder, but at the moment there is no proof which is convincing. Freudian theory sees this as a rejection of sexuality or of pregnancy. Other psychiatrists see it as part of the obsessive-compulsive personality disorder or of depression. Whatever the cause, the treatment is difficult.

There does appear to be a disturbance in the body image the girl has of herself. A few start off being overweight, many are of normal weight, a few are underweight.

Despite the fact that the girl is obviously underweight to all other observers, she may insist that she is “just right” or “not too thin.”

*3/71/1*

ASSESSMENT OF LYMPHATIC INVOLVEMENT

Tuesday, May 12th, 2009

You remember the lymph node system that I described in Chapter 2? How can we check whether or not the cancer has spread through this system?

Normal lymph channels are like cotton threads. Normal lymph nodes (glands) are soft, smaller than a pea and cannot be felt through the skin. If cancer gets into the lymphatic system it usually grows in the lymph nodes, making them bigger and harder. This is usually painless.

Much less often, lymph spread takes a different form—the cancer can actually grow in the lymph channels. If the affected channels are in the skin, the appearance is usually that of a raised, red ‘rash’. One of the most troublesome sites for this type of spread is in the lungs. The solid cores of cancer cells running through the lymphatic vessels make the lungs very stiff. This causes cough and shortness of breath. Unfortunately this problem can be hard to diagnose, because it is often difficult to see on an X-ray in the early stages.

If the cancer fills the nodes or blocks the lymph channels, it prevents that part of the lymph system from carrying out its usual job. One of these is to drain excess fluid from the tissues. So, for example, if the affected nodes are in the armpit, the arm may swell up.

*92/40/1*

MEASLES – THE VACCINE

Tuesday, May 12th, 2009

If all women who are likely to conceive receive the vaccine, the complications from this disease will disappear. But each new group of girls should continue to be immunised. Constant reminders will be necessary as it becomes rarer.

Measles or morbilli, is a serious viral infection. Most children in cities have developed it before the age of 10. The incubation period is around 10 days.

The onset is abrupt, usually with a high temperature, cold-like symptoms, watery eyes and a harsh, dry cough. This cough is a marked feature and may suggest the diagnosis before the appearance of the rash.

The rash does not appear until the fourth day. It starts on the forehead and behind the ears and spreads to the face, trunk and limbs.

It is dusky pink, discrete and flat at the start, then becomes red, raised and blotchy. Koplik’s spots may be seen in the mouth before the rash and lead to a diagnosis. These are red with a bluish-white centre.

Complications are common with measles. Middle ear infection, bronchitis and pneumonia occur frequently. The potentially severe inflammation of the brain, encephalitis, can affect one case in 2000.

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