One of your principal medical rights is to informed consent. That is, you have a right to an explanation of any treatment or procedure before it is performed on you, an explanation of the risks of that treatment or procedure, and an explanation of the alternatives to that treatment or procedure. "Treatment or procedure" means any drugs, any tests or surgeries—anything that involves something foreign entering your body. "Risks" means material risks, that is, anything that can reasonably be expected to happen. Your doctor is not necessarily obligated to inform you of an improbable risk, a one-in-a-million chance.     Informed consent also means that you can refuse any treatment or procedure. Anyone who attempts the treatment or procedure without your consent—assuming you are mentally competent to give consent—can be sued on grounds of assault. You also have the right to refuse medication. Your right to refuse food and water is still a matter of legal argument. Your right to refuse treatments, procedures, or medication can be overruled only if you are incompetent. Incompetent means that you are unable to comprehend what you have been told and are unable to make decisions. In principle, the courts, guided by the advice of the physician, decide when someone is incompetent. In practice, the court system takes a long time, and competence is decided by two concurring physicians, one of whom is your physician-of-record.     You can request treatments, procedures, or medication, but you cannot demand them.     You have a right to see your medical records. Your medical records are, however, the property of the hospital. As such, the hospital can dictate under what circumstances and in whose presence you can see your medical records. You have a right to copy your medical records. You may not remove the records from the hospital without the hospital's consent.      Hospitals, as public accommodations, cannot refuse to treat you on the grounds that you have HIV infection. Some hospitals, however, limit the kinds of treatment they offer and can refuse to treat anyone who requires services they do not offer. Any Health Maintenance Organization (HMO) to which you belong has a legal contract with you that outlines the rights and obligations of both parties.     In a hospital, you can request to be assigned another physician. The hospital is obliged to grant your request.     Some states have laws that prohibit a physician from refusing patients on the basis of race, sex, creed, color, or disability. In most states, HIV infection is defined as a disability. However, many physicians do not consider themselves competent to care for people with HIV infection and will refuse care—rightly—on this basis. Others are simply too busy to accept new patients. The first time you see a private physician, he or she can refuse to treat you. If you have previously been accepted as a patient by that physician for other medical conditions and the two of you have an ongoing relationship, she or he can still refuse to treat you, but cannot abandon you. Not abandoning you means that your physician must help you find another physician who can provide the care needed.     Similar rules apply to dental care. Many dentists are uncomfortable caring for people with HIV infection. The ethics of dental practice dictate that the dentist is obliged to provide continuing care to established patients, or at least refer them to another dentist who can provide more specialized care.     A Note on Lawsuits-The right to file lawsuits is a right no one can take away from you. But lawsuits often take years to settle. Some people decide not to file a suit because they do not want to take the time. Others decide not to file because their HIV status would then become public record. Many people go ahead and fight and win suits.*201\191\2*

Most people think of being overweight as a cosmetic problem. But important as appearance may be to some people, it is not the main drawback of obesity. Obesity may be a risk to your cardiovascular health. However, obesity is a bit different from other risk factors. There is a little film evidence that obesity in itself predisposes you to the development of coronary artery disease, the way high cholesterol or smoking does. Rather, it promotes the presence of other risk factors—such as high cholesterol, high blood pressure, and diabetes—that do increase your chances of heart disease. Also, heart disease that is already present is aggravated further by being overweight.One of every 3 or 4 Americans is overweight, and 1 in 10 is severely overweight. Approximately 34 million adults in this country qualify as being obese.        *262\252\8*

You are packed into a crowded airplane, bracing yourself for the 7-hour ride to your vacation or business destination. If you remain motionless in your seat for the duration, you increase your risk for the development of potentially dangerous blood clots.Blood clots interfere with blood flow and can break loose and travel to an artery in one of your lungs. Clots can form while you sit for extended periods in cramped quarters. This problem can happen during any form of travel, but it is more common on long airline flights, especially if you are sitting in the coach section. Doctors therefore have coined the term "economy class syndrome."Despite its name, "economy class syndrome" can develop regardless of whether you sit in first class or in the coach section. On long-distance flights or rides, follow these tips.Wear loose, comfortable clothing and shoes. Airlines often provide customers in the first-class cabin with bootie socks. It is easy to bring your own. They help keep your feet warm and are not as tight or confining as shoes.Stretch your legs occasionally, even while remaining in your seat.From time to time, tighten and loosen the muscles of your abdomen and buttocks.Take a few slow, deep breaths periodically.Get out of your seat and walk the aisle at least once an hour.Ask your doctor whether it is appropriate for you to use aspirin when you travel. Small doses of aspirin may help prevent clots from occurring. Remember to check with your doctor first, because aspirin is not recommended for everyone.If you have had problems with thrombophlebitis in the past, wear elastic support stockings when prolonged sitting is unavoidable. Elastic support stockings are available for both men and women.*204\252\8*

Children fear abandonment. Even young children seem to understand that they cannot feed and house themselves on their own, that they need parents to provide for them. Younger children, when faced with a parent's illness, will ask directly, "If you get sick, who is going to take care of me? Who will live with me if you go to the hospital?" Older children, though they are bothered by the same questions, try to tough it out, and often they will not ask.     Some children worry that their parents are not caring for themselves well enough. Helen's son, though he does not know she has HIV infection, sees that she occasionally loses weight and asks her, "You aren't getting high, are you? You're eating, aren't you? You're taking care of yourself, aren't you?" Other children worry not only about their parent's health, but about everything else the parent is normally responsible for: bills, rent, mortgage, car, groceries. These children are beginning to see themselves as their parent's caregivers, and they are trying to take on the role of a responsible adult.     Children often do not express their worries directly. Instead, they act their worries out; their worries are evident only in their behavior. Some children get depressed, some become withdrawn and stop talking, some become unusually aggressive. Parents who see this happening can try to encourage the child to express his or her worries directly. They can also get help from mental health professionals, especially those who deal specifically with families or children.
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During the early days of hospitalization, a variety of medications are used to control the extent of damage to the spinal cord, to relieve pain, to treat infections, and to prevent other medical complications. Some of these medications are for acute care only; others may be used for months or years.Recent research has shown that patients who receive intravenous steroids - usually methylprednisolone -in the first few hours after a spinal cord injury recover more function. Steroids reduce inflammation and may improve neurological recovery. They have a number of side effects, however, including changes in mood and thought processes that may require adjustment of the dose. Steroids are used only in the acute (immediate) management of spinal cord injury.Blood thinners such as heparin or enoxaparin are given to prevent blood clots in the large veins of the legs and are usually combined with special stockings that help promote blood flow (as described in the next section). Blood thinners maybe prescribed for several months.Most patients also take stool softeners to make bowel movements easier. Many also take medications to prevent stress ulcers of the stomach - a common consequence of the physical stress of spinal cord injury. Medications (such as ranitidine) that reduce acid production by the stomach can protect against ulcer formation.
*13/156/5*

The ovary sits at the rim of the pelvis underneath the fallopian tube and attached to the uterus by a short ligament.The ovary has two major functions. The first being to provide the egg for ovulation, and the second to produce the steroid hormones necessary for growth of breasts and the uterus so that a pregnancy can be achieved.There are three types of cancers of the ovary, each arising from a different cell.The most common type is epithelial cancer; less commonly occurring are germ cell tumours that are more common in younger womenRarest of all are tumours of the hormone-producing tissue within the ovary - 'sex cord-stromal tumours'. Epithelial ovarian cancer arises from the single layer of cells that cover the surface of the ovary. Medical scientists believe that when this single layer of cells is broken at the time of ovulation, a defect in the repair mechanism that heals the break occurs and eventually a cancer develops. This explains why cancers of the ovary are significantly less common in women who use the oral contraceptive — which stops ovulation - and in women who have had pregnancies since the total number of ovulations is reduced with the more number of pregnancies women has. In about 5% of cases, a strong family history is found and a gene mutation responsible, but in the remaining 95% of cases there is usually no reason as to why the cancer has occurred.Because the ovaries sit in the pelvis surrounded by bone and reasonably well away from other important body parts, cancer of the ovary can grow to quite a size before symptoms appear. Thus, in over three-quarters of cases the tumour has already spread outside the pelvis to other areas of the abdomen and the diagnosis is therefore delayed. It is often associated with vague symptoms which may mimic other benign and much more common diseases. It has been estimated that up to 24 months can go by before the cancer becomes detectable in its advanced stage.If cancer of the ovary is not treated early enough, it spreads to other areas and other organs within the abdominal cavity, particularly the bowel and lymph nodes. Bowel obstruction is common and pain due to lymph node enlargement can also be a feature in advanced cases. Fluid accumulation ('ascites') in advanced cancer of the ovary is very common indeed. This can lead to major abdominal swelling and often requires drainage, with a resultant loss of protein that in turn can lead to leg swelling.Just as fluid can accumulate within the abdominal cavity, if the disease spreads along the lymphatic and up through the lymph channels in the diaphragm to the pleura (the lining of the lungs), then fluid can accumulate in the space between the lining of the lungs and the lung tissue itself ('a pleural effusion'). This may require surgical drainage in many cases. If fluid accumulates in the chest, breathlessness can be a major problem.Germ cell tumours arise in cells in the ovary, which were destined to be part of the egg. Germ cell tumours are more likely to occur in younger women and they can be benign ('a dermoid') or malignant ('a teratoma'). The most common sort of germ cell tumour is the 'dysgerminoma which often spreads to the lymph glands and which is the only germ cell tumour which commonly affects both ovaries at the one time - in about 10-15% of cases.The average age of detection of such malignant germ cell tumours is 19 years. In most cases the diagnosis is made following pelvic pain and discomfort, when examination reveals a lump that can be easily felt in the lower part of the abdomen.If this cancer is not treated it can spread to the other organs within the pelvis and abdominal cavity, just as in epithelial tumours. Fortunately, these tumours are very sensitive to chemotherapy and every attempt is made by the doctor to preserve fertility by leaving at least one ovary intact during surgery.Sex Cord-Stromal Tumours are rarely malignant, except the granulosa cell tumour. The granulosa cells in the ovary are responsible for oestrogen production, so that such a tumour can present with the effects of excess oestrogen. For instance, in girls who have not reached puberty, breast development and vaginal bleeding can occur, whereas in the older women, bleeding following menopause may be the symptom.Since most of these tumours are benign, then simple removal of the tumour prevents any recurrence. For the malignant tumours, however, spread to the liver can occur, and left untreated it can result in liver enlargement with resultant pain under the right diaphragm. Sometimes bleeding into these tumours can happen with a sharp and sudden increase in pain.*5/144/5/*

Muscle wear and tearA strain is an injury to a muscle caused by over-stretching. Also called a "pulled muscle," the elastic fibers that make up the muscle are overextended and may tear, bleed and contract.A sprain is an injury to a ligament and other soft tissue around a joint. Ligaments are bands of fiber that connect the bones at a joint. They can be stretched or torn when a joint is twisted, "jammed" or overextended. With a sprain, slight bleeding may produce skin discoloration which resolves slowly.What you can do         The basic treatment for strains and sprains is a two-part process: RICE (rest, ice, compression, elevation) to treat the immediate injury and MSA (movement, strength, alternate activity) to help the injury heal and prevent further problems.Begin the RICE process immediately following the injury:Rest. Do not put weight on injured joint or muscle, and limit movement in the area of the injury. Use crutches, splints or a sling as needed.Ice. Apply ice pack for 10 to 15 minutes every hour for two hours, then leave ice off for two hours. Repeat this cycle for 48 hours or until swelling is gone. For protection, place a washcloth between bare skin and ice. Do not use heat as long as there is swelling.Compress. Wrap injured area in an elastic bandage for support and protection.Elevate. Place injured part on pillows while you apply ice and anytime you are seated or lying down. Raise injured area above the level of your heart whenever possible.Aspirin and ibuprofen may ease pain and inflammation. Acetaminophen (Tylenol) eases discomfort but does not decrease inflammation. Do not use other drugs to mask pain in order to continue using the injured part. NEVER give aspirin to children/teenagers. It can cause Reye's syndrome, a rare but often fatal condition.The MSA process can be started only if the initial swelling is gone:Movement. Begin gently moving the joint to resume full range of motion.Strength. After the swelling is gone and a full range of motion is reached, gradually begin to strengthen the injured part. Slow, gentle stretching during the healing process will make scar tissue flexible and prevent limited movement later.Alternate activities. Resume regular exercise through activities and sports that do not place a strain on the injured area. Go slowly and stop any activity that causes discomfort.Any increase in pain or return of swelling is a sign to stop MSA and resume RICE.PreventionUse correct form in all work and play activities.Adjust equipment and furniture to fit your needs.Go slowly when starting a new activity or sport.Use warm-up and cool-down exercises to help your body prepare and recover safely.Take frequent breaks when performing any continuous activity.Do not push beyond your strength or ability; advance your skill level gradually.*19\303\2*

Clinical ManifestationsPatients with acute cholangitis usually have a prior history of biliary tract disease, particularly cholelithiasis or choledochelithiasis. The onset of cholangitis is usually acute, with high fevers, rigors, and abdominal pain. The classic Charcot triad of fever, RUQ abdominal pain, and jaundice can be found in up to 70% of cases. Patients with acute obstructive suppurative cholangitis, in which there is pus in the biliary tree, may additionally present with altered mental status and hypotension (Reynold's pentad). These extra findings are typically due to the presence of gram-negative sepsis, particularly by Escherichia coli or Klebsiella pneumoniae. A pyogenic liver abscess is a rare complication on acute cholangitis.
DiagnosisMost patients with acute cholangitis have marked leukocytosis, hyperbilirubinemia, and elevated alkaline phosphatase levels, but serum transaminases are usually only modestly elevated. Up to one third of cases have hyperamylasemia caused by concomitant obstruction of the pancreatic duct.Ultrasonography is the preferred study to confirm the diagnosis because of its ability to identify dilated biliary ducts. Significant biliary ductal dilatation in a patient with the appropriate clinical picture confirms the diagnosis. Ultrasonographic examination can also evaluate the gallbladder size, the presence of stones, masses associated with the bile ducts, and liver parenchymal changes.Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate means of determining the cause and location of obstruction. This is the procedure of choice if common bile duct stones are present, since stone extraction and biliary stent placement can be performed, decompressing the biliary system. MRCP may also allow visualization oil the biliary tree but does not permit removal of the obstruction.An abdominal CT scan can demonstrate the presence and, potentially, the cause of biliary obstruction. Plain radiography and HIDA scans are less useful in confirming the diagnosis.*107/348/5*

Beauty therapiesThere are many beauty therapies available for acne, most of which have no scientific rationale. While there is definitely a place for blackhead and whitehead extraction by beauticians because this unblocks the oily glands, it does not remove pusy sores. Other treatments such as cold lasers, acne creams, facial scrubs and masks have no proven benefit.
Acne scarringHopefully, in the twenty-first century, people will no longer have to live with acne scarring. Prevention of scarring is most important, as the treatments available for acne scarring are not entirely satisfactory.With time many acne scars do improve without treatment. For more severe scarring there are several treatment options. Lumpy acne scars may be injected with cortisone to make them flatter. More commonly, however, acne scars are depressions in the skin which may be valley type or very sharp pits. Valley-type scars may be injected with collagen or silicone. This is generally done by dermatologists. Although collagen is very popular, it needs to be injected every one to two years. Allergies to collagen may also develop, although they are rare. Silicone, on the other hand, is permanent. It must, however, be injected very carefully in minute quantities; the correction is permanent so there is no room for error. Although silicone has received a lot of bad press recently, it has been used for over thirty years to improve facial deformities and causes few problems if used in expert hands.Pitted acne scars are best treated with dermabrasion or laser abrasion, which is done by dermatologists and plastic surgeons. During this procedure the skin is 'sandpapered' to make it smoother. Although dermabrasion is an effective procedure for acne scarring it does have limitations, in that it can never make the skin entirely perfect, especially if scarring is deep. Dermabrasion is not without risk and can produce scarring and changes in the skin's pigment. Chemical peeling is often advocated for acne scarring but is not as effective as dermabrasion.It is best to wait at least twelve months after acne clears before having any acne scarring treatment. Much of the scarring will resolve in this time, during which cover-up cosmetics can be applied.
Open poresOpen pores are often evident on the nose in people with oily skin. This is a hereditary condition which cannot be altered by any cream or cosmetic. Oily secretions may accumulate in open pores, causing blackheads, which can be removed by manual extraction or with the use of Retin-A cream.Although there are products whose manufacturers claim can open and close open pores, this is medically impossible. Regular use of Retin-A cream will, however, minimize the appearance of open pores. Oil-absorbing lotions such as Almay oil absorbing lotion or Nutrasorb will also make them appear less shiny and so less conspicuous. Likewise, facial powder absorbs oil, giving the skin a matt appearance and making open pores less obvious.
It is important to realize that acne is of considerable consequence and should never be lightly dismissed as 'just a stage'. The physical and psychological effects of chronic acne and acne scarring are often underestimated. Now that effective therapies are available treatment for acne should be viewed more positively.
*25/150/5*

Many people wait until they are financially secure before deciding to have a baby. I have found the financial security needed to afford the new arrival never comes. There is always something more to do and buy. However, all usually works out for the best.When you decide to start a new family there are many things that need to be considered. The most important issue that needs to be addressed is nutrition, for without a balanced diet that contains all the essential vitamins and nutrients, you may not enjoy a normal healthy pregnancy and this may place baby at risk.This may sound alarming, but the latest medical research has shown that if the mother's nutrition is inadequate, then the result could be birth defects, lower birth weight and below normal intelligence for the baby. This improvement in nutrition must start before conception, as the development of the new child begins at the moment of conception.Let's now discuss the changes that occur to the mother-to-be and the developing baby after conception.After the male sperm fertilizes the female egg, the egg (ovum) undergoes a change called 'cleavage' or 'cell division'. These divided cells are called blastomeres. This cell division continues to double until the embryo forms a solid mass about the size of a match head at about five weeks. At seven weeks the arms and legs have started to appear, not looking much like arms and legs but within a week they soon develop and the embryo starts looking like your new baby.From the time of conception to full term or birth is 280 days or 10 lunar months. A lunar month is the time it takes the moon to go through a complete phase of 4 weeks. The length of the pregnancy is calculated from the first day of the last menstrual period to birth. This will give the probable date of the birth. Your practitioner may arrange an ultrasound scan during the pregnancy that will help determine a more accurate date.*1/199/5*