Kaposi Sarcoma : Horror of AIDS

Definition of Kaposi's Sarcoma

Kaposi's sarcoma (KS) is a disease in which cancer cells are found in the tissues under the skin or mucous membranes that line the mouth, nose, and anus.
KS causes red or purple patches (lesions) on the skin and/or mucous membranes and spreads to other organs in the body, such as the lungs, liver, or intestinal tract.

Description of Kaposi's Sarcoma

consists of characteristic skin lesions that range from flat to raised purple plaques. These tumors have a rich network of small blood vessels, and red blood cells moving slowly through these channels lose their oxygen, changing from red to blue. The mixture of red and blue cells gives the KS lesion a characteristic purple color.
There are several forms of KS, based on cause rather than appearance. The "classic" Kaposi's sarcoma, found mainly in Mediterranean males and mid-European Jews, has always been rare. In the 1950s a large number of cases were found in Africa, and the incidence has dramatically increased since then. KS was later found to be a common result of an alteration of body immunity.

There are two circumstances under which this alteration takes place.

The first is when depression of the immune system is part of some treatment, for example in kidney or other organ transplants. To prevent the foreign organ from being rejected, powerful drugs are given to shut down the immune system.
The second circumstance is associated with Acquired Immune Deficiency Syndrome (AIDS).
Types Of Tumors
KS tumors are divided into three groups, based on appearance, with much overlap.
Nodular lesions are of varying size and thickness. They are purple and will at times have a halo of brown or yellow pigment around them.
Infiltrating lesions may be quite large, may be raised, or grow downward beneath the skin.
Lymphatic lesions can mimic other causes of swollen lymph nodes and may require a biopsy to rule out infection.
Under the microscope, all three types of KS appear similar. But three sub-types have been identified, all of which are treated much the same. The spindle cell variety is the slowest growing, the anaplastic is the most aggressive, and the mixed cell has a somewhat intermediate growth rate.

Causes and Risk Factors of Kaposi's Sarcoma

The epidemic KS, occurring as a disease that accompanies AIDS, is thought to have a cause - the virus named HIV (Human Immunodeficiency Virus). If given a blood test for HIV, nearly all patients with epidemic KS will show evidence of being infected.
Various ideas have been advanced to explain how this virus causes KS. One theory is that it causes a normal cell to become malignant either directly or by initiating a chain of events. Various agents that may be involved in such a change have been identified.
Yet another idea has to do with the body's T cells, some of which hunt for malignant cells that have developed spontaneously and kill them off before they can become cancers. The T cell is known to be infected with the virus and cannot kill the malignant cells.

Symptoms of Kaposi's Sarcoma

There are no general symptoms of early KS. In the epidemic form, KS may be the first sign of AIDS, or, the first lesion may follow an illness of months or years. During this time, the patient may have had non-specific symptoms such as fever, weight loss and sweating. Possibly there were other illnesses, such as lymphoma or tuberculosis, before the first KS lesion developed.
Once the disease occurs, symptoms relate to the site of involvement. Early and more advanced skin lesions are usually only mildly uncomfortable, although painful ulcers may occur.
Lesions in the gastrointestinal tract are very common but rarely cause significant symptoms. Early lesions in the lung have no symptoms either, but severe lung involvement produces a profound air hunger.

Treatment of Kaposi's Sarcoma

KS is not considered curable. Neither surgical removal of the first-detected lesion nor obtaining a complete remission of multiple sites with chemotherapy or other techniques results in cure. Long-term survival does occur both with or without treatment, however.
Survival in classic KS is usually years and sometimes decades. Some patients with AIDS-related KS are still alive after 10 years, though most survive only a few years and treatment decisions are usually aimed at palliation.
All forms of KS are sensitive to radiation therapy. Radiation is especially useful for lesions that are cosmetically disturbing, painful, involve the mouth extensively, block lymphatics, bleed, or protrude from the skin. Response rates are quite high and treatment is well tolerated.
Chemotherapy can be used in treatment but there is concern that aggressive treatment might further depress the immune system. The disease does respond to chemotherapy, both with single agents and combinations of drugs.
KS is one of the few tumors that responds to local injections of chemotherapy. Many anticancer drugs cause intense local damage if they are accidentally injected into tissue. This undesirable effect has been used in a positive way to treat skin lesions.
Biological therapy involves immunologic treatment of KS primarily with the interferons, mainly alpha. Other agents, especially interleukin-2 are being studied.

Insurance : Need of health insurance for life

A Health insurance policy
is a contract between an insurance company and an individual. The
contract can be renewable annually or monthly. The type and amount of health care costs that will
be covered by the health plan are specified in advance, in the member contract or Evidence of
Coverage booklet. The individual policy-holder's payment obligations may take several forms[4]:

Premium: The amount the policy-holder pays to the health plan each month to purchase health
coverage.

Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays
its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of
their health care is covered by the health plan. It may take several doctor's visits or prescription
refills before the policy-holder reaches the deductible and the health plan starts to pay for care.

Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays
for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a
doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service
is obtained.

Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a
surgery, while the health plan pays the other %80. Because there is no upper limit on
coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on
the actual costs of the services they obtain.

Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket. Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The
policy-holder may be expected to pay any charges in excess of the health plan's maximum
payment for a specific service. In addition, some plans have annual or lifetime coverage
maximums. In these cases, the health plan will stop payment when they reach the benefit
maximum, and the policy-holder must pay all remaining costs. Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.

Prescription drug plans are a form of insurance offered through many employer benefit plans in
the U.S., where the patient pays a copayment and the prescription drug insurance pays the rest.
Some health care providers will agree to bill the insurance company if patients are willing to sign
an agreement that they will be responsible for the amount that the insurance company doesn't
pay, as the insurance company pays according to "reasonable" or "customary" charges, which
may be less than the provider's usual fee.
Health insurance companies also often have a network of providers who agree to accept the
reasonable and customary fee and waive the remainder. It will generally cost the patient less to
use an in-network provider.

Health Insurance companies are now offering Health Incentive accounts (HIA)[5], to reward users
for living healthy and making healthy choices, like stop smoking and/or losing weight, may get you
funds added into your Health Incentive Account, which may lower your out of pocket costs. The
health incentive accounts also carry over from year to year but once you leave the program you
lose those benefits in the HIA.
[edit]

Private: individually purchasedPolicies of health insurance obtained by individuals not otherwise covered under policies or programs elsewhere classified. Generally major medical, short term medical, and student policies. According to the U.S. Census Bureau, about 9% of Americans are covered under health insurance purchased directly.[14] The range of products available is similar to those provided through employers. Average premiums are generally somewhat lower than those for employer-sponsored coverage, but vary by age. Deductibles and other cost-sharing are also higher, on average, and the individual consumer pays the entire premium without benefit of an employer contribution.[21] Many states allow medical underwriting of applicants for individually purchased health insurance by insurance companies.
[edit] Private: long-term care insuranceLong-term care (LTC) insurance is growing in popularity in the U.S. Premiums have remained relatively stable in recent years. However, the coverage is quite expensive, especially when consumers wait until retirement age to purchase it. The average age of new purchasers was 61 in 2005, and has been dropping.

New types of medical plans in the U.S.One approach to addressing increasing premiums, dubbed "consumer driven health care," received a boost in 2003, when President George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act. The law created tax-deductible Health Savings Accounts (HSAs). An HSA is a private bank account which is un-taxed and only penalized if spent on non-medical items or services. It must be paired with a high-deductible insurance plan. HSAs enable mostly healthy people to pay less for insurance and bank money for their own health care expenses.[23] HSAs are one form of tax-preferrenced health care spending account. Others include Archer Medical Savings Accounts (MSAs), which have been superseded by the new HSAs (although existing MSAs are grandfathered), Flexible Spending Arrangments (FSAs) and Health Reimbursement Accounts (HRAs). FSAs and HRAs are typically used as part of an employee-benefit plan.[24]
Limited Medical Benefit Plans pay for routine care and do not pay for catastrophic care. As such, they do not provide equivalent financial security to a major medical plan. Annual benefit limits can be as low as $2,000. Lifetime maximums can be very low as well.

Mesothelioma, The curse of Asbestos

Mesothelioma is a cancer of the cells that make up the lining around the outside of the lungs and inside of the ribs (pleura), or around the abdominal organs (peritoneum).


The only known cause of mesothelioma in the U.S. is previous exposure to asbestos fibers. Asbestos manufacturers knew about the hazards of asbestos seventy years ago - but they kept this knowledge to themselves. The first warnings to workers exposed to asbestos were given in the mid-1960s, and they were terribly inadequate. Even today, workers are not always told they are working around asbestos and are at risk for asbestos disease.


Do these:

Seek out the best and most up-to-date information.
Seek out the best medical care.
Early screening for mesothelioma diagnosis.
Stay in close contact with your doctor.
Consider whether or not you want to bring a lawsuit because of this asbestos-related injury.
Remember that resources are available to you through community and medical support groups, asbestos victims' organizations, your place of worship, as well as your family and friends.
Do you want more information about mesothelioma?
Please explore our website or contact us to request additional information

Pleural Mesothelioma
Pleural mesothelioma is of two kinds: (1) diffuse and malignant (cancerous), and (2) localized and benign (non-cancerous.)

Benign mesotheliomas can often be removed surgically, are generally not life-threatening, and are not usually related to asbestos exposure. Malignant mesotheliomas, however, are very serious. Fortunately, they are rare - about two thousand people are diagnosed with mesothelioma in the U.S. each year.

The remainder of this section is about diffuse malignant pleural mesothelioma.

Pleural mesothelioma is a cancer of the cells that make up the pleura or lining around the outside of the lungs and inside of the ribs. Its only known cause in the U.S. is previous exposure to asbestos fibers, including chrysotile, amosite or crocidolite. This exposure is likely to have happened twenty or more years before the disease becomes evident, since it takes many years for the disease to "incubate." It is the most common type of mesothelioma, accounting for about 75% of all cases.

Mesothelioma is sometimes diagnosed by coincidence, before there are any symptoms. For instance, tumors have been discovered through routine chest x-rays. However, when symptoms occur, they may include shortness of breath, weakness, weight loss, loss of appetite, chest pains, lower back pains, persistent coughing, difficulty in swallowing, alone or in combination. An initial medical examination often shows a pleural effusion, which means an accumulation of fluid in the pleural space - the area between the lungs and the chest wall.

The first step in detecting pleural mesothelioma is, typically, a chest x-ray or CT scan. This is often followed by a bronchoscopy, using a viewing scope to look inside the lungs.

The actual diagnosis usually requires obtaining a piece of tissue through a biopsy. This could be a needle biopsy, an open biopsy, or through a tube with a camera (thoracoscopy or chest scope.) If an abnormality is seen through the camera then a tissue sample can be taken at the same time, using the same tube. This is a hospital procedure that requires anesthesia, but is not usually painful. The tissue sample is tested by a pathologist.

Fluid build-up from the pleural effusion can generally be seen on a chest x-ray and heard during a physical examination, but a firm diagnosis of mesothelioma can only be made through a biopsy and pathological testing. This is important because there are also benign pleural effusions and other tumors that have a similar appearance to mesothelioma. Diagnosing mesothelioma can be quite difficult; it requires special lab stains, and much experience in understanding them.

The spread of the tumor over the pleura causes pleural thickening. This can reduce the flexibility of the pleura and encase the lungs in an increasingly restrictive girdle. With the lungs restricted, they get smaller and less functional, and breathing becomes more difficult. At first a person with mesothelioma may be breathless only when he or she exercises, but as lung function drops, he or she can become short of breath even while resting.

The tumor spreads by direct invasion of surrounding tissue. As it spreads inward it can compress the lungs. As the tumor spreads outward it can invade the chest wall and ribs, and this can be extremely painful.

Current medical science does not know exactly how and why, at a cellular level, asbestos fibers cause mesothelial cells to become abnormal (malignant or cancerous.) Thus it is not known whether only one fiber causes the tumor or whether it takes many fibers. It seems that asbestos fibers in the pleura can start a tumor as well as promote its growth; the tumor does not depend on any other processes for its development.

There is as yet no known cure for malignant mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, the extent of the tumor, the cell type, and whether or not the tumor responds to treatment. The Firm has represented many clients who lived for five to ten years after diagnosis, most of them in good health for a majority of those years. Some mesothelioma victims succumb within a few months; the average survival time is about a year.

The treatment options for people with mesothelioma have improved significantly, especially for those whose cancer is diagnosed early and treated vigorously. Many people are treated with a combination of therapies, sometimes known as multimodal therapy.

Specific types of treatment include:

Chemotherapy and other drug-based therapies
Radiation therapy
Surgery and
Intra-operative photodynamic therapy.
There are also experimental treatments like gene therapy and immunotherapy, angiogenesis inhibitors, and clinical trials for various new treatments and combinations of treatments.

Treatments that reduce pain and improve lung function, are becoming more successful (although they cannot cure mesothelioma.) Pain control medications have become easier to administer. Debulking is a surgical process of removing a substantial part of the tumor and reducing the pleural thickening; this can provide significant relief. X-ray therapy has also been successfully used to control the tumor and the pain associated with it for a while.

Further Resources
More information about pleural mesothelioma and treatments:

Malignant Pleural Mesothelioma: Update, Current Management, and Newer Therapeutic Strategies, by M. Pistolesi, MD & J. Rusthoven, MD; Chest October 2004; 126(4):1318-1329
National Cancer Institute
University of Pennsylvania/OncoLink
American Cancer Society
Medicine Online
Froedtert Medical College - Thoracic oncology program offers a comprehensive range of treatment options, with special expertise in treament of mesothelioma.


Diagnosis for Malignant Mesothelioma Cancer: Screening
The National Cancer Institute's definition of screening for cancer is the examination or testing of people for early signs of certain type of cancer even though they have no symptons - this is the best way to achieve a diagnosis as early as possible. Early detection and diagnosis is particularly important for people with historical exposure to asbestos due to the latency period (up to 30 years) before which symptoms of malignant mesothelioma cancer may become apparent.

Early Signs of Mesothelioma Aid Diagnosis:

Recognizing early symptoms of malignant mesothelioma may aid in diagnosis. Symptoms include difficulty in breathing (dyspnea) and/or chest pains, fever, nausea or anemia; other signals are hoarseness, difficulty swallowing (dysphagia), or coughing up blood (hemoptysis). For many suffering from pleural mesothelioma, there may be pain in the chest or lower back. Those people with peritoneal mesothelioma may experience an expanding waist size or abdominal pain resulting from the growth of cancer cells in the abdomen.

Since many of these symptoms are also caused by less serious illnesses, it can be difficult to recognize asbestos-related diseases in the early stages. Due to this difficulty of early diagnosis of asbestos cancer and mesothelioma, the best way to determine your health risk is to consult a doctor for an initial examination, which may include a pulmonary function test (PFT) and x-rays.

Screening Methods to Identify Asbestos-Related Disease:

After a preliminary physical examination, the doctor may need to look inside your chest cavity with a thorascope for accurate diagnosis. During this thoracoscopy procedure, a cut will be made in your chest and a small piece of tissue (biopsy) may removed for examination. While you may feel some pressure, there is usually no pain.

Another special tool that may be used is the peritoneoscope, which allows for examination inside your abdomen. This instrument is inserted into an opening made in the abdomen, and a biopsy specimen may also be taken.

If the presence of fluid is indicated by either of these procedures, the doctor may drain it by inserting a needle into the affected area. Removal of chest fluid is called thoracentesis; removal of abdominal fluid is call paracentesis.

Other screening methods for diagnosis of asbestos-related disease include various imaging tests. In addition to X-rays, methods include magnetic resonance imaging (MRI) or positron emission tomography (PET). A more recent and promising screening method is the computed tomography (CT) scan.

Computed Tomagraphy / CT Scan:

Top Deadliest Diseases

Q: What is the deadliest disease in the world?
A: The results of ranking the leading causes of death are subject to the cause categories used. The broader the cause categories used, the more likely they will rank among the top leading causes of death.According to the estimates in The world health report 2004, there were 57 million deaths in the world in 2002. The broad category of all "noncommunicable diseases" killed 33.5 million people; communicable diseases, maternal and perinatal conditions, and nutritional conditions killed 18.3 million people worldwide; and external causes of injuries killed 5.2 million people.When analysing at disaggregated level, the following are the leading causes of death:No.CauseEstimated number of deaths (in millions)

1. Heart disease
2. Cerebrovascular disease
3. Lower respiratory infections
4. HIV/AIDS
5. Chronic obstructive pulmonary disease
6. Perinatal conditions
7. Diarrhoeal diseases
8. Tuberculosis
9. Malaria
10. Trachea, bronchus, lung cancers
11. Road traffic accidents
12. Diabetes mellitus

GLAUCOMA: Facts

Glaucoma Facts and Stats

Glaucoma is a very misunderstood disease. Often, people don’t realize the severity or who is affected. We hope the following information is helpful to you.
Four Key Facts About Glaucoma.
Glaucoma is a leading cause of blindness
Glaucoma can cause blindness if it is left untreated. And unfortunately approximately 10% of people with glaucoma who receive proper treatment still experience loss of vision.
There is no cure (yet) for glaucoma
Glaucoma is not curable, and vision lost cannot be regained. With medication and/or surgery, it is possible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored for life.

Diagnosis is the first step to preserving your vision.

Everyone is at risk for glaucomaEveryone is at risk for glaucoma from babies to senior citizens. Yes, older people are at a higher risk for glaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the United States).
Young adults can get glaucoma, too. African-Americans in particular are susceptible at a younger age.
There may be no symptoms to warn youWith open angle glaucoma, the most common form, there are virtually no symptoms. Usually, no pain is associated with increased eye pressure.
Vision loss begins with peripheral or side vision. You may compensate for this unconsciously by turning your head to the side, and may not notice anything until significant vision is lost. The best way to protect your sight from glaucoma is to get tested. If you have glaucoma, treatment can begin immediately.
Some Statistics About GlaucomaSources are listed at the bottom of this page.
It is estimated that over 3 million Americans have glaucoma but only half of those know they have it. (1)
Approximately 120,000 are blind from glaucoma, accounting for 9% to 12% of all cases of blindness in the U.S. (2)
About 2% of the population ages 40-50 and 8% over 70 have elevated IOP.
Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization.
Glaucoma is the leading cause of blindness among African-Americans. (2)
Glaucoma is 6 to 8 times more common in African-Americans than Caucasians. (3)
African-Americans ages 45-65 are 14 to 17 times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group.
The most common form, Open Angle Glaucoma, accounts for 19% of all blindness among African-Americans compared to 6% in Caucasians. (4)
Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted.
Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide. (5)
Public Awareness and AttitudesA survey done for GRF by ICR, Inc. in Media, PA, found that:
74% of over 1,000 people interviewed said they have their eyes examined at least every two years. 61% of those (less than half of all adult Americans) are receiving a dilated eye exam (the best and most effective way to detect glaucoma). 16.1% of African-Americans were unfamiliar with glaucoma. 8.8% of Caucasians do not know anything about glaucoma. A Research To Prevent Blindness Survey found that:
Blindness ranked third (after cancer and heart disease) as people’s major fear. 20% of people knew that glaucoma was related to elevated pressure within the eye. Most of them mistakenly thought people could tell if they had glaucoma due to symptoms, or that it was easily cured, or that it did not lead to blindness. 50% had heard of glaucoma, but weren’t sure what it was. 30% had never heard of glaucoma.


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Diagnostic Tests

Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma.
It is important to have your eyes examined regularly. Your eyes should be tested at:
ages 35 and 40
age 40 to age 60, get tested every two to four years
after age 60, every one to two years
Anyone with high risk factors, should be tested every year or two after age 35.

Four Common Tests for Glaucoma
Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy.
1.Tonometry
Ttest he tonometry measures the inner pressure of the eye. Usually drops are used to numb the eye. Then the doctor or technician will use a special device that measures the eye’s pressure.

2.Ophthalmoscopy
Ophthalmoscopy is used to examine the inside of the eye, especially the optic nerve. In a darkened room, the doctor will magnify your eye by using an ophthalmoscope (an instrument with a small light on the end). This helps the doctor look at the shape and color of the optic nerve.
If the pressure in the eye is not in the normal range, or if the optic nerve looks unusual, then one or two special glaucoma tests will be done. These two tests are called perimetry and gonioscopy.
Perimetry
The perimetry test is also called a visual field test. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a “map” of your vision.

3.Gonioscopy
Gonioscopy is a painless eye test that checks if the angle where the iris meets the cornea is open or closed, showing if either open angle or closed angle glaucoma is present.
Optic Nerve Computer Imaging
In recent years three new techniques of optic nerve imaging have become widely available. These are scanning laser polarimetry (GDx), confocal laser ophthalmoscopy (Heidelberg Retinal Tomography or HRT II), and optical coherence tomography (OCT).
The GDx machine does not actually image the optic nerve but rather it measures the thickness of the nerve fiber layer on the retinal surface just before the fibers pass over the optic nerve margin to form the optic nerve. The HRT II scans the retinal surface and optic nerve with a laser. It then constructs a topographic (3-D) image of the optic nerve including a contour outline of the optic cup. The nerve fiber layer thickness is also measured. The OCT instrument utilizes a technique called optical coherence tomography which creates images by use of special beams of light. The OCT machine can create a contour map of the optic nerve, optic cup and measure the retinal nerve fiber thickness. Over time all three of these machines can detect loss of optic nerve fibers.

4.Your intraocular eye pressure

(IOP) is important to determining your risk for glaucoma. If you have high IOP, careful management of your eye pressure with medications can help prevent vision loss. Recent discoveries about the cornea, the clear part of the eye’s protective covering, are showing that corneal thickness is an important factor in accurately diagnosing eye pressure. In response to these findings, the Glaucoma Research Foundation has put together this brief guide to help you understand how your corneal thickness affects your risk for glaucoma, and what you can do to make sure your diagnosis is accurate.
Corneal Thickness
In 2002, the five-year report of the Ocular Hypertension Study (OHTS) was released. The study’s goal was to determine if early intervention with pressure lowering medications could reduce the number of ocular hypertensive (OHT) patients that develop glaucoma. During the study, a critical discovery was made regarding corneal thickness and its role in intraocular eye pressure and glaucoma development.

Why is Corneal Thickness Important?
Corneal thickness is important because it can mask an accurate reading of eye pressure, causing doctors to treat you for a condition that may not really exist or to treat you unnecessarily when are normal. Actual IOP may be underestimated in patients with thinner CCT, and overestimated in patients with thicker CCT. This may be important to your diagnosis; some people originally diagnosed with normal tension glaucoma may in fact be more accurately treated as having regular glaucoma; others diagnosed with ocular hypertension may be better treated as normal based on accurate CCT measurement. In light of this discovery, it is important to have your eyes checked regularly and to make sure your doctor takes your CCT into account for diagnosis.
A Thin Cornea—The Danger of Misreading Eye Pressure
Many times, patients with thin corneas (less than 555 µm) show artificially low IOP readings. This is dangerous because if your actual IOP is higher than your reading shows, you may be at risk for developing glaucoma and your doctor may not know it. Left untreated, high IOP can lead to glaucoma and vision loss. It is important that your doctor have an accurate IOP reading to diagnose your risk and decide upon a treatment plan.
A Thicker Cornea May Mean Less Reason to Worry About Glaucoma
Those patients with thicker CCT may show a higher reading of IOP than actually exists. This means their eye pressure is lower than thought, a lower IOP means that risk for developing glaucoma is lowered. However, it is still important to have regular eye exams to monitor eye pressure and stay aware of changes.
Pachymetry—A Simple Test to Determine Corneal Thickness
A pachymetry test is a simple, quick, painless test to measure the thickness of your cornea. With this measurement, your doctor can better understand your IOP reading, and develop a treatment plan that is right for your condition. The procedure takes only about a minute to measure both eyes.
Related Articles
What is Glaucoma?
Are You at Risk For Glaucoma?
Anatomy of the Eye
Glaucoma Facts and Stats
The Importance of Corneal Thickness

Diabetes: Our Problem

Type 1 Diabetes
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Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life.

Finding out you have diabetes is scary. But don't panic. Type 1 diabetes is serious, but people with diabetes can live long, healthy, happy lives.
Conditions & TreatmentArm yourself with information about conditions associated with type 1 diabetes, and how to prevent them. Conditions associated with type 1 diabetes include hyperglycemia, hypoglycemia, ketoacidosis and celiac disease. You will also find helpful information about insulin, choosing blood glucose meters, various diagnostic tests including the A1c test, managing and checking your blood glucose, kidney and islet transplantations, and tips on what to expect from your health care provider.
Further Reading . . .A Field Guide to Type 1 Diabetes gives checklists of what you need, what to do in different situations, and what kinds of provisions you need.
For more books on healthy living, click here ComplicationsHaving type 1 diabetes increases your risk for many serious complications. Some complications of type 1 diabetes include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). Learn more about these complications and how to cope with them.
Recently DiagnosedYou've just been diagnosed with diabetes. Chances are you have a million questions running through your head. To help you answer those questions, and take the first steps toward better diabetes care, visit the Recently Diagnosed area for people who have just been diagnosed with diabetes, or those needing basic information.
Your Body's Well BeingMake it a priority to take good care of your body. The time you spend now on eye care, foot care and skin care, as well as your heart health and oral health, could delay or prevent the onset of dangerous type 1 diabetes complications later in life. Plus, some of the best things you can do for your body are to stop smoking, and reduce the amount of alcohol you drink.
Common ConcernsThis section addresses various areas to help you live with type 1 diabetes. What do you do when you're sick? What do you do when you travel? Can you get a flu shot with diabetes? How do you cope with having type 1 diabetes? Are you being discriminated against because you have diabetes? You'll find answers to these questions, and more in this section.
Ask the PharmacistThe American Diabetes Association and Rite Aid "Ask the Pharmacist" area is where you can ask a pharmacist a question to help you manage your diabetes. Rite Aid and the ADA have partnered to allow you to access to Rite Aid's Drug Information Center from our Web site.
Women and DiabetesLearn how to ensure your own health and well-being.
Health Information For MenLearn how to ensure your own health and well-being.

Type 2 Diabetes
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Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:
Right away, your cells may be starved for energy. Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart. Finding out you have diabetes is scary. But don't panic. Type 2 diabetes is serious, but people with diabetes can live long, healthy, happy lives.
While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.
Further Reading . . .A Field Guide to Type 2 Diabetes is an excellent book for the patient or family member.
For more books on healthy living, click here Conditions & TreatmentArm yourself with information about conditions associated with type 2 diabetes, and how to prevent them. Conditions associated with type 2 diabetes include hyperglycemia and hypoglycemia. You will also find helpful information about insulin, oral medications, various diagnostic tests including the A1c test, managing and checking your blood glucose, and tips on what to expect from your health care provider.
ComplicationsHaving type 2 diabetes increases your risk for many serious complications. Some complications of type 2 diabetes include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). Learn more about these complications and how to cope with them.
Diabetes Learning Center for the Recently DiagnosedYou've just been diagnosed with diabetes. Chances are you have a million questions running through your head. To help you answer those questions, and take the first steps toward better diabetes care, visit the Diabetes Learning Center -- an area for people who are newly diagnosed with diabetes, or those needing basic information.
Your Body's Well BeingMake it a priority to take good care of your body. The time you spend now on eye care, foot care and skin care, as well as your heart health and oral health, could delay or prevent the onset of dangerous type 2 diabetes complications later in life. Plus, some of the best things you can do for your body are to stop smoking, and reduce the amount of alcohol you drink.
Common ConcernsThis section addresses various areas to help you live with type 2 diabetes. What do you do when you're sick? What do you do when you travel? Can you get a flu shot with diabetes? How do you cope with having type 2 diabetes? Are you being discriminated against because you have diabetes? You'll find answers to these questions, and more in this section.
Ask the PharmacistThe American Diabetes Association and Rite Aid "Ask the Pharmacist" area is where you can ask a pharmacist a question to help you manage your diabetes. Rite Aid and the ADA have partnered to allow you to access to Rite Aid's Drug Information Center from our Web site.
Women and DiabetesLearn how to ensure your own health and well-being.
Health Information For MenLearn how to ensure your own health and well-being.

How to Prevent Pre-Diabetes
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Pre-diabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.
While the DPP also showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.
The American Diabetes Association is developing materials that will help people understand their risks for pre-diabetes and what they can do to halt the progression to diabetes and even to, "turn back the clock" In the meantime, ADA has a wealth of resources for people with diabetes or at risk for diabetes that can be of use to people interested in pre-diabetes.
Nutrition
Making Healthy Food Choices
ADA's statement for health professionals on nutrition
The American Diabetes Association bookstore has award-winning books on nutrition, recipes, weight loss, meal planning and more.
Exercise
Tips on how to include a healthy amount of physical activity into your daily routine:
Exercise and Diabetes
ADA's statement for health professionals on exercise
You can get fit, reduce your risk for type 2 diabetes, and support the American Diabetes Association by participating in America's Walk for Diabetes.
Tools
Small Steps. Big Rewards. Prevent type 2 diabetes.The National Diabetes Education Program has designed a national awareness campaign to target people at risk for type 2 diabetes. The campaign will create awareness that type 2 diabetes can be prevented through modest lifestyle changes and losing about 5 to 7 percent of body weight.

Face Lift

Short Scar Face Lift
Short scar face lift, also known as minimal access cranial suspension lift (MACS), is a great alternative for people who want the benefits of a traditional face lift but with less recovery time and scarring. Short scar face lift is a very popular procedure at our St. Louis-area office.
The procedure addresses the areas of the face that show the most visible signs of age. Unlike traditional face lift where an incision is made along the length of the hairline and around the ear, during short scar face lift a short incision is made in front of the ear and along the hairline. The skin is then separated from the muscle and fat, the muscles are tightened and the skin is pulled back. Short scar face lift is becoming an increasingly popular option for our St. Louis-area patients.
This procedure can be performed under local or general anesthesia and can be performed in conjunction with other procedures to improve results. During a consultation, Dr. Jeffrey Copeland will discuss all of the potential risks and benefits of the procedure.
If you are interested in short scar face lift, contact our cosmetic surgery office in St. Peters today.

RHINOPLASTY: Cosmetic Surgery

Rhinoplasty
Rhinoplasty, also referred to as a ‘nose job,’ can reduce or increase the size of the nose, reshape the nose, or correct bumps on the bridge of the nose. For those who are self-conscious about the appearance of their nose, rhinoplasty at our St. Louis-area facility offers an excellent solution.
Several different approaches can be taken to perform rhinoplasty at our office near St. Louis. For instance, incisions can be made either inside or outside of the nose and several different reshaping or recontouring techniques can be used depending on each patient’s unique situation. Dr. Jeffrey Copeland will determine which surgical method will work best for you.
Rhinoplasty can be performed under general or local anesthesia and the surgery can usually be completed in one to two hours. Most people can return to sedentary activities within a few days following rhinoplasty surgery. Rhinoplasty patients at our St. Louis-area practice often choose to combine procedures to further enhance their results. During an initial consultation, Dr. Copeland will discuss the surgical procedure with you and will also go over the potential risks and benefits.
Contact our cosmetic surgery staff in St. Peters if you are interested in learning more about rhinoplasty.

Sony Errickson P1i : A complete Phone

The Phone: truly

Size 106 x 55 x 17 mm 4.1 x 2.1 x 0.7 inches

Weight 124 g 4.4 oz

Available colours Silver Black

Screen 262,144 color touchscreen240x320 pixel

Memory Memory Stick Micro™ (M2™) support

Phone memory 160MB**Actual free memory may vary due to phone pre-configuration Networks GSM 900GSM 1800GSM 1900UMTS 2100

Performance Talk time: Standby time:

Video call: UMTS 2100 3 hours 30 min 350 hours 2 hours GSM 900 10 hours 440 hours -

GSM 1800 10 hours 440 hours - GSM 1900 10 hours 440 hours - Battery performance may vary depending on network and phone usage. Camera

Auto focus Camera 3.2-megapixelDigital zoom 3xPhoto light Video record Music

Bluetooth™ stereo (A2DP) Media Player MegaBass™ Music tones PlayNow™ TrackID™

Internet

RSS feeds Web browser Opera™ Web browser Entertainment

3D games Java Radio Video Clip Video streaming Connectivity

Bluetooth™ Infrared port Modem Synchronisation PC USB mass storage USB support WLAN

Messaging

Email MMS (Multimedia Messaging) Predictive text input SMS long (Text Messaging) Sound recorder Communication

Polyphonic ringtones Speakerphone Vibrating Alert Video call Design

Jog Dial Picture wallpaper Wallpaper animation Organiser

Alarm clock Calculator Calendar Contacts Document editors Document readers Flight mode

Handwriting recognition Notes Phone book Stopwatch Symbian™ OS Tasks Timer Touch-screen

Nepal : The crown of the Queen

The Next Destination: NEPAL

Nepal : is the Country of Gods...

With 30 million gods, and Uncountable mountains to the North...

Attractions:

Birth Place of Buddha

EVEREST

Pokhara

Fewa LAke

Manang: Valley between Mountains

Many more

Images From Heaven:Nepal

Majestic Peaks

Everest

Monastery on the hill Swayambhu Kathmandu

www.jpmountainguide.com/nepal.html

Change : A rule Dr. Manish Pd. Sah

Change:A way of Life

Things change

thoughts change

people change

Times change

Friends change

Seasons change

Colors change

All Keep On Changing

Because Change Is Unchangeable

Dr. Manish

New Phone in the market.

The Samsung G600Samsung unleash the slimmest 5MP camera to hit the UK with their stunning G600. Sleek and compact it sure packs a punch with its astonishing 5MP camera built with autofocus and flash. There's also EDGE, GPRS, an MP3 Player, web browser and a microSD slot all crammed in as well for good measure!

Phone Features:

Weight: 105 grams
Quad Band
Dimensions: 102 x 47.8 x 14.9 mm
Stereo FM Radio
Messaging: SMS, MMS, Email
EDGE
microSD Card Slot (TransFlash)
MP3 Player
5 Megapixel Camera

Polithicsssssssssss

GOVERNMENT EXPLAINED:

FEUDALISM

You have two cows.Your lord takes some of the milk.

FACISM

You have two cows.The government takes both, hires you to take care of them, and sells you the milk.

RUSSIAN COMMUNISM

You have two cows.You count the cows and find that you have four cows. You count again and, you now have 40 cows. You count again and finally find out that you have two cows. You don't care and simply pour another shot of Vodka.

DICTATORSHIP

You have two cows.The government takes both the cows and drafts you.

PURE DEMOCRACY

You have two cows.Your neighors decide who gets the milk.

BUREAUCRACY

You have two cows.At fist the government regulates what you can feed them and when you can milk them.Then it pays you not to milk them. Then it takes both, shoots one, milks the other and pours the milk down the drain.Then it requires you to fill out forms accounting for the missing cows.

SURREALISM

You have two girrafes.The government requires you to take the harmonica lessons.

COMMUNISM

You have two cows.The government takes both and gives you the milk.

NAZISM

You have two cows.The government takes both and shoots you.

CAPITALIS

MYou have two cows.You sell one and buy a bull.

NEPALESE DEMOCRACY

You have two cows.You sell one, buy a bull;take out huge loan on the cow, and ignore both the cow and loan from that point on; then you try to milk the bull, and blame the Japanese for its lack of production.

Technique of palpation of liver

Techniques:
Liver
Approach the examination of the liver from the right side of the patient. Have the patient lying supine. Preserve the patient’s privacy by draping the top of their body with the gown and below the waist with a sheet. For the best exam, make sure the patient is warm and comfortable. Additionally make sure your hands are warm so as to not startle the patient.

InspectionLook for gross asymmetries across the abdomen. Look at the skin for signs of liver disease, such as caput medusa, or spider angiomata.

AuscultationFollow the inspection of the liver, as with the rest of the abdominal exam, with auscultation. Listen over the area of the liver for bruits or venous hums.

Percussion for the upper and lower margins of the liver. Place your non-dominant hand palm down flat on the abdomen with the fingers parallel to the lower costal margin pointed toward the midline. Percuss with the middle finger of your dominant hand on the middle finger of your non-dominant one.
Begin percussion over the lungs and move from the area of resonant lung sounds to the areas of dullness. Mark the area of change. Repeat the same process from below, moving again from resonance over the bowel to dullness and again mark the area of change. Start in the lower right quadrant so as to not miss a greatly enlarged liver. Measure the vertical distance from the top to the bottom. You can also use palpation to determine the lower border.

PalpationBegin palpation over the right lower quadrant, near the anterior iliac spine. Palpate for the liver with one or two hands palm down moving upward 2-3 cm at a time towards the lower costal margin. Have the patient take a deep breath. The liver will move downward due to the downward movement of the diaphragm. Feel for the liver to hit the caudal aspect of your palpating hand. Palpate the bottom margin of the liver for the texture of the liver, i.e. soft/ firm/hard/nodular.

Scratch TestSeveral different techniques have been described for this exam. One is to place the diaphragm over the area of the liver and then scratch parallel to the costal margin until the sound intensity drops off marking the edge of the liver. Other techniques involve different patterns of the scratching, for example as in spokes of a wheel and other places for placing the stethoscope such as over the abdomen.
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Memories Remain... Reality Fades away

Chief Complaint: A 49-year-old female presented with exercise intolerance and palpitations that have worsened over the past two years.

Past Medical History: Significant for tetralogy of Fallot (TOF) status/post repair at age 10; prior left Blalock-Taussig shunt at age 2
Physical FindingsAge: 49 Gender: Female Blood Pressure: 150/70 mm Hg Pulse: 75 bpm Head and Neck: Jugular venous pressure estimated at 10 mm Hg with a prominent V wave Chest and Lungs: Clear to auscultation bilaterally Cardiac Exam: Left parasternal heave; second heart sound was single; 3/6 holosystolic murmur at the left lower sternal border and a diastolic murmur 3/4 over the left upper sternal border Abdomen: Soft; no hepatosplenomegaly Extremities: Absent left radial pulse; no cyanosis or clubbing of the digits Additional Info: ECG revealed normal sinus rhythm with right bundle branch block. QRS duration: 140 ms

Options
A. Aortic insufficiency (AI) with a dilated aortic root.
B. Residual ventricular septal defect (VSD) with enlarged right ventricle (RV).
C. RV dysfunction due to severe pulmonary insufficiency and chronic volume overload of the RV.
D. Residual VSD with enlarged RV, and overriding aorta, and AI.

Eyes as u see ( med literature)

Each and every one has it in a pair. But nobody is sure if every of them percieve an object to be the same.Take it this way- if I see an object to be red you can not be sure a third person also percieves it as red. I mean he maybe perceiving it as blue but still saying it to be red as per his learnt habit since childhood. So the Biggest problem of the globe today is about belief. A belief which is created in ones mind as the influence of his/her environment.

As you Say:If little knowledge is dangerous then, show me a single man who has as much as to be out of danger.

Rabindra Nayak

Eyes-Nayak

EYES AS U SEE

Each and every one has it in a pair. But nobody is sure if every of them percieve an object to be the same.Take it this way- if I see an object to be red you can not be sure a third person also percieves it as red. I mean he maybe perceiving it as blue but still saying it to be red as per his learnt habit since childhood. So the Biggest problem of the globe today is about belief. A belief which is created in ones mind as the influence of his/her environment.

Rabindra Nayak

As you Say:If little knowledge is dangerous then, show me a single man who has as much as to be out of danger.

CASE IV

History
A 35-year-old man presented with with elevated blood pressure (188/112, seated) at a yearly physical exam. Previous exams noted blood pressures of 160/94 and 158/92. On questioning, he admitted episodes about twice a month of apprehension, severe headache, perspiration, rapid heartbeat, and facial pallor. These episodes had an abrupt onset and lasted 10-15 minutes.

Physical Exam
30 min after the initial blood pressure measurement, the seated blood pressure was 178/110 with a heart rate of 90. The blood pressure after 3 min of standing was 152/94 with a heart rate of 112. The optic fundi showed moderately narrowed arterioles with no hemorrhages or exudates.

Initial lab studiesRoutine hematology and chemistry studies were within the reference ranges and a chest film and EKG were essentially normal.

Questions
How would you assess this patient's presentation?

CASE III

History

A 50-year-old man presents with enlargement of left anterior neck. He has noted increased appetite over past month with no weight gain, and more frequent bowel movements over the same period.

Physical Exam

He is 5'8" tall and weighs 150 lb. The heart rate is 82 and the blood pressure is 110/76. There is an ocular stare with a slight lid lag. The thyroid gland is asymmetric to palpation, weighing an estimated 40g (normal = 15-20g). There is a 3 x 2.5 cm firm nodule in left lobe of the thyroid.

Questions

What do you think the patient's primary problem is?

Answer here or wait for next week

http://www.mcl.tulane.edu/classware/pathology/medical_pathology/endocrine_cases/c1q1.html

Case II

A 6-year-old boy born to consanguineous parents presented with short stature and deformity of chest and limbs. Clinical examination revealed a very short child with the height of 86 cm (height age 2½ years). He had mild coarse facies, clear corneas, short neck and normal intelligence. Other salient features were short trunk, kyphosis, pectus carinatum, protruded abdomen and knock knees (Fig. 1). Liver was palpable 6 cm below the right costal margin and spleen was 2 cm palpable. The blood picture was normal and urine was positive for mucopolysaccharides. X-ray spine showed marked platyspondyly typical of Morquio Syndrome. Echocardio-gram revealed grade II mitral valve prolapse.
Hint( a genetic cause of short stature)

Case Study I

CASE STUDY I

A 69 year-old male farmer, non-smoker, was admited to our department due to dyspnea on exertion, night sweats during the last two months and severe thrombocytopenia revealed during a routine screening by his general practitioner. The patient had a medical history of congestive heart failure, and osteoarthritis.

Physical examination revealed body temperature 36.8°C, pulse rate 80 beats/min, blood pressure 150/90 mmHg, respiratory rate 20 breaths/min and oxygen saturation 94% on room air. Auscultation disclosed decreased breath sounds at the right lower base, with dullness on percussion. In addition the patient had ecchymoses in his lower limps and trunk without petechiae. Laboratory work-up showed: hemoglobin 15.6 g/dL, white blood cell count 10,900 cells/µL (71% neutrophils and 18% lymphocytes), and platelet count 20,000 cells/µL. Prothrombin time and partial thromboplastine time where within normal limits, as well as the rest of the laboratory tests

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