Diseases & Conditions

Symptoms of a diabetes and what diet should be at a diabetes?

2009-04-16T05:51:00.000-07:00

With a diagnosis of a diabetes it is impossible to say good bye for this disease forever. It to not be treated and with it it is necessary to learn to live correctly – to observe necessary recommendations, to support the organism with special procedures.

Sometimes the diabetes proceeds imperceptibly and has not an effect. But nevertheless the certain symptoms are shown sooner or later. Or it reveal casually at inspection, what or other disease.

Besides that, a diabetes could be different, it depends on on the form of a diabetes as well as on a personal condition of every organism. The basic and most popular symptoms at a diabetes are:

1. Sensation of weakness or weariness.
2. Fast fatigue.
3. Dizziness.
4. Frequent urination.
5. Frequent feeling of thirst.
6. Infringement of sight, not clear sight.
7. Fast loss of weight.
8. Temperature drop of a body below an average mark.
9. Spasms of gastrocnemius muscles, numbness and tingling in finitenesses.
10. Slow treatment from infectious diseases and healing of wounds.

It should be also mentioned that symptoms at a diabetes of 1 type differ from symptoms at 2 type. At a diabetes of 1-st type following symptoms are possible: frequent urination, thirst, a nausea, vomiting, loss of weight, weakness, constant feeling of famine, irritation.

Characteristic symptom for children of 1 type sick of a diabetes - night incontinentia urine (it is necessary to pay attention if before it it was not observed).

At a diabetes of 2-th types are observed: an itch, drowsiness, skin infections, slow healing of wounds, numbness legs, loss of hair on legs, an inflammation of an extreme flesh. This type of disease begins more often after 40 years (at mature age), and it is connected with a wrong feed.

If there are similar symptoms it is better to hand over the analysis of blood and urine on the maintenance of sugar. The high level of sugar of blood and presence of sugar in urine as is one of symptoms of disease.

Special diet at a diabetes.

In official medicine it is accepted to differentiate a feed of patients strict diets. They are designated by numbers. A sick diabetes register a diet №9. Certainly, in any diet there are certain specific features, but nevertheless main principles should be observed. This diet is appointed with objective of normalization of a carbohydrate exchange, and the prevention of infringement of a fatty exchange. As to define endurance to carbohydrates, i.e. what quantity of carbohydrates of food is acquired.

Migraine

2009-04-16T05:46:00.000-07:00

Migraine is repeating attacks of a sharp headache, usually unilateral and pulsing which proceed from 4 to 72 hours. A migraine is rather widespread disease, is not connected with race, a place of residing or a climate.

Women are ill more often, than men, in the ratio 4:1. Attacks of a migraine appear at teenage and youthful age, in the course of time tend to disappear (men after 45 years, women close to menopause period). There are two basic types of a migraine:

1. The usual migraine also known as a migraine without aura
2. The classical migraine also known as a migraine with aura

In most cases the aura designates the symptoms causing frustration of sight. Other symptoms connected with aura, - frustration of hearing and other feelings, confusion, impellent and mental frustration. The stage of aura usually lasts from 4 to 60 minutes. (i.e. migraines with aura) suffer from a classical migraine approximately 15 % of all patients.

The reasons of a migraine

Symptoms of a migraine are caused by change of blood vessels of a brain, however the reason of occurence is unknown. Approximately 70 % of patients have family predisposition to a migraine. Also occurrence of a migraine is promoted by following factors: stress, a nervous and physical overstrain, food factors (cheese, chocolate, nuts, a fish), alcohol (more often beer and red wine, champagne), the hormonal reasons (perios, reception of contraceptives), sleep (lack or surplus), weather factors (change of weather, change of climatic conditions).

Symptoms of a migraine

In general the migraine is shown by the sharp, accrueing pulsing pain localized in one half of a skull. Other symptoms of a migraine:

* the Raised light sensitivity and to sounds
* Vomiting
* the Nausea
* Drowsiness
* the General weakness
* Infringement of impellent functions
* Infringements of sight (flashes, zigzags, spirals etc).

During migraines shoot the light and sounds around can be intolerably irritating, and movement can hurt. Attacks of a migraine begin suddenly, however in some cases of patients can feel weariness, depression or insuperable bent for sweet.
As the sharp headache can be a symptom of other diseases, it is necessary to address to the doctor if the pain does not weaken during 24 hours and is accompanied by rise in temperature or occurrence rigidity cervical muscles. Also it is necessary to address for medical assistance if the headache is accompanied by unusual symptoms.

Preventive maintenance of a migraine

Some factors can promote occurrence of a migraine, therefore they are recommended to be avoided. The following concern to such factors:

* Stress and depression
* Undereating or famine
* Smoking
* Foodstuff (cheese, chocolate, nuts, a fish, the Chinese meal and bananas)
* Lack or surplus of a dream
* the Drinks containing caffeine (coffee, tea and cola)
* Alcohol, especially red wine
* Reception of contraceptives
* Travel - flights and the frustration of biorhythms connected with them
* Change of a climate and habitual conditions
* Hormonal variations at women (during pregnancy, period or a climax)

Sometimes it's difficult to define the reasons causing a migraine - frequently it not one factor but their combination. However even the detected trigger can cause only some attacks of a migraine but not all of them. Also, the rist factors are all individual.

Diagnostics of a migraine

For diagnostics of a migraine it is enough to therapist to learn about symptoms and frequency of attacks. Also spend inspection and appoint some analyses.
Also the doctor can advise to keep a diary within 2-3 months to track the scheme of occurrence of attacks. If in a migraine the certain scheme is traced, it specifies action of the certain factors.

Treatment of a migraine

If you feel approach of a migraine, immediately stop all activities, lye down in a dark room where is no street noise, and take a tablet of paracetamol or aspirin. If these measures will appear inefficient, the doctor can appoint other medical products. This medicines are effective if to accept them right at the beginning of an attack, especially if the headache is accompanied by a nausea.
If migraines bother you time or two in a week, the doctor will appoint a medicine for preventive maintenance.
If the migraine arises under action of the certain factor, is better to avoid this factor in the future.

Neuralgia of a figurative nerve

2009-04-16T05:44:00.000-07:00

The neuralgia results from traumas, the intoxications caused by diseases of a liver, kidneys, malignant tumors, salts of heavy metals, bacterial toxins, alcohol, metabolic infringements at a diabetes, chronic processes in a gastroenteric path, etc. Can develop at a flu, a malaria, a tuberculosis to be the first clinical display of infectious-allergic process in nervous system. The certain role in occurrence plays Neuralgias hypoxic factor, for example at atherosclerotic defeat of vessels, other diseases of cardiovascular system, anemias. In some cases the reason of the Neuralgia to establish it is not possible.

The attack-like pain extends on a course of a nervous trunk or its branches. The pain can be sharp, shooting, tearing, to be accompanied by sensation of burning. There are attacks spontaneously or at movements, under influence of a touch, overcooling of an emotional overstrain. Localization hurt corresponds to a zone of a innervation the certain nerve, characteristic painful points, for example points the Point, Bekhterev often come to light.

Features of clinical displays depend on localization of process.
The neuralgia of a trigeminal nerve can be result of a trauma of the person, the transferred inflammation of bosoms of the nose, a sick teeth (pulpitises), even a wrong bite. An attack hurt at a neuralgia of a trigeminal nerve can arise at any moment: as reaction to hot or cold food, to loud sounds, too bright light, even during cleaning a teeth. The attack begins with occurrence of "harbingers" - an itch, sensation of a “creeping”, and is then shown in the form of sharp, "shooting", up to tears of a pain which lasts no more pairs of minutes. In attempt to wait an attack, the person fades on seat, questions answers tersely, hardly slightly opening a mouth.

Treatment of a neuralgia
To removal of an attack of a neuralgia apply or a complex analginum + amidopyrine or carbamazepine. By the way, in opinion of some doctors, strong irritation all of the same zones during an attack, can stop it.

The range of methods of treatment of a neuralgia is rather wide - from physiotherapy up to surgical measures (when do not help medicines). The good effect in treatment of a neuralgia gives application of acupuncture, pulse currents of a low pressure and low frequency, magnetic and electromagnetic fields, infra-red and ultra-violet radiation, ultrasound, electrophoresis medicinal substances.

Mammography

2009-04-16T05:40:00.000-07:00

Mammogaphy is a x-ray research of a mammary gland. Occurs from a word «mammo» — a mammary gland and «graphy» — record.

What for mammography is needed?

Mammography is one of the basic diagnostic procedures in diagnostics of diseases of a mammary gland, first of all, a cancer of a mammary gland, fibrocystic illnesses, fibroma and fibroadenomas.
The mammography can be used as at presence of complaints or presence of the suspicious symptoms defined by the doctor, and as a screening method. Screening is a method of early revealing of the malignant tumours, based on regular inspection of women. Screening is a mass method, in an ideal all women after the certain age should be exposed by mammography. Only thus it is possible to reveal in most cases tumours at an early stage. It in turn affects both volume of treatment and on life expectancy.

How the mammography helds?

A mammographer has small supports on which it is necessary to have a mammary gland. From above the mammary gland is pressed down by a special plate then the picture of a mammary gland is carried out. The picture is carried out, as a rule, in two projections precisely to define the location of pathological formation.
Mammography is a not painful research. At presence of pains in mammary glands at mammography there can be unpleasant sensations connected with a compression of mammary glands.

What quality of the mammography depends on?

Quality of a picture depends, first of all, on the equipment — a mammographer etc., and also from quality of a film. Quality of the conclusion depends on qualification of the expert.

Whether it is possible to pass the mammography "just in case"?

It is possible and is necessary. Carrying out mammography allows to reveal tumours of a mammary gland early. It refers to as screening. The mammography is recommended usually after 40 years, after 45–50 years annual mammography procedure is recommended.

Cystitis. Treatment of a cystitis

2009-04-16T05:37:00.000-07:00

What is the cystitis?

The cystitis is an inflammation of a mucous membrane of a bladder. According to, about 20 % of women transfer this or that form of a cystitis, and 10 % of women suffer a chronic cystitis.

Complaints at a cystitis:

* Pains an the bottom of a stomach, in suprapubic areas.
* the Speeded up desires to urinarion.
* Emission wet in the small portions.
* Burning in the field of external genitals.

The reasons of occurrence of a cystitis.

In 80 % of cases the cystitis causes family of intestinal bacteria which get in a bladder ascending by through a urethra. It is promoted by some reasons. One of the most significant – features of an anatomic structure of bodies of urinogenital system of the woman:

- Short (2-5 sm) and the wide urethra is a good conductor for microorganisms.
- In immediate proximity from a urethra there is a vagina and a direct gut densely occupied by microorganisms.
- microorganisms can get in a bladder with a current of blood, a lymph from the remote centers of a chronic inflammation.

Cystitises of the allergic nature, and also caused are known for toxic and not infectious components, but there are they much less often.

But one penetration of microorganisms into a bladder insufficiently that inflammatory process has begun. Decrease in immunity as consequence of overcooling, hypovitaminosis, overfatigue, tool interventions on a bladder (cannulation, for example), conducts to destruction of a blanket. Bacteria are attached directly to cells of a mucous membrane of a bladder and cause its inflammation.

Progress of an inflammation is assisted also with the stagnation of blood circulation arising in a wall of a bladder and in a small basin because of a sedentary way of life, carrying of close clothes.

Treatment of a cystitis.

After carrying out of inspection the doctor-urologist makes the program of treatment into which antibacterial and anti-inflammatory preparations enter, medicines normalizing microblood circulation in walls of a bladder, physiotherapeutic procedures.

Wrong, untimely treatment of a cystitis leads to chronic current of disease. Pains and unpleasant sensation thus become dull, or leave, but inflammatory process remains in the faded condition. In the further there are frequent aggravations which all give in to treatment more difficultly and more difficultly.

What is Postural Orthostatic Tachycardia Syndrome?

2009-03-31T04:45:00.000-07:00

This video made by one girl who has Postural Orthostatic Tachycardia Syndrome. That's perfectly describes this disease. Have a look.

Postural Orthostatic Tachycardia Syndrome is a form of Dysautonomia. It is a life altering condition that results in a variety of symptoms; the most common being low blood pressure (orthostatic intolerance) and a high heart rate.

To find out more, watch the video!

I did my best to include as much information as possible - there was so much I wanted to say that it ended up being over ten minutes which is why there are two parts! :) My next videos will be more about my life and how POTS affects me.

Picks disease

2009-03-31T04:36:00.000-07:00

Definition

Pick's disease is a rare and permanent form of dementia that is similar to Alzheimer's disease, except that it tends to affect only certain areas of the brain.

Alternative Names

Semantic dementia; Dementia - semantic; Frontotemporal dementia; Arnold Pick's disease

Causes

People with Pick's disease have abnormal substances (called Pick bodies and Pick cells) inside nerve cells in the damaged areas of the brain.

Pick bodies and Pick cells contain an abnormal form of a protein called tau. This protein is found in all nerve cells. But some people with Pick's disease have an abnormal amount or type of this protein.

The exact cause of the abnormal form of the protein is unknown. A gene for the disease has not yet been found. Most cases of Pick's disease are not passed down through families.

Pick's disease is rare. It is more common in women than men. It can occur in people as young as 20, but usually begins between ages 40 and 60. The average age at which it begins is 54.

Symptoms

The disease can get worse slowly. Tissues in the temporal and frontal lobes of the brain start to shrink over time. Symptoms such as behavior changes, speech difficulty, and impaired thinking occur slowly, but continue to get worse.

The early personality changes can help doctors tell Pick's disease apart from Alzheimers. Memory loss is often the main, and earliest, symptom of Alzheimer's.

People with Pick's disease tend to behave the wrong way in different social settings. The changes in behavior continue to get worse and are often one of the most disturbing symptoms of the disease. Some patients will have difficulty with language (trouble finding or understanding words or writing).

General symptoms are listed below.

Behavioral changes:

Can't keep a job
Compulsive behaviors
Inappropriate behavior
Inability to function or interact in social or personal situations
Problems with personal hygiene
Repetitive behavior
Withdrawal from social interaction

Emotional changes:

Abrupt mood changes
Decreased interest in daily living activities
Failure to recognize changes in behavior
Failure to show emotional warmth, concern, empathy, sympathy
Inappropriate mood
Not caring about events or environment

Language changes:

Can't speak (mutism)
Decreased ability to read or write
Difficulty finding a word
Difficulty speaking or understanding speech (aphasia)
Repeat anything spoken to them (echolalia)
Shrinking vocabulary
Weak, uncoordinated speech sounds

Neurological problems:

Increased muscle tone (rigidity)
Memory loss that gets worse
Movement/coordination difficulties (apraxia)
Weakness

Exams and Tests

The doctor will ask you about your medical history and symptoms.

Your health care provider might order tests to help rule out other causes of dementia, including dementia due to metabolic causes. These tests can include:

Assessment of the mind and behavior (neuropsychological assessment)
Brain MRI
Electroencephalogram (EEG)
Examination of the brain and nervous system (neurological exam)
Examination of the fluid around the central nervous system (cerebrospinal fluid) after a lumbar puncture
Head CT scan
Psychological studies
Tests of sensation, thinking and reasoning (cognitive function), and motor function

A brain biopsy is the only test that can confirm the diagnosis.

Treatment

There is no specific treatment for Pick's disease. Certain antidepressants may help manage mood swings related to Pick's disease, but further research is needed.

Sometimes patients with Pick's take the same medications used to treat other types of dementia, such as medications that decrease the breakdown of the chemical messenger, acetylcholine (anticholinesterase inhibitors), and memantine (Namenda).

In some cases, stopping or changing medications that worsen confusion or that are not essential can improve thinking and other cognitive functions. This may include medications such as:

Analgesics
Anticholinergics
Central nervous system depressants
Cimetidine
Lidocaine

It's important to treat any disorders that contribute to confusion. These may include:

Anemia
Decreased oxygen (hypoxia)
Heart failure
Infections
Nutritional disorders
Thyroid disorders
Psychiatric conditions such as depression

Treating any medical and psychiatric disorders often helps improve mental function.

Medications may be needed to control aggressive, dangerous, or agitated behaviors.

Some patients may need hearing-aids, glasses, cataract surgery, or other treatments.

Behavior modification can help some people control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (when it's safe to do so).

Formal psychotherapy treatment doesn't always work, because it can cause further confusion or disorientation.

Reality orientation, which reinforces environmental and other cues, may help reduce disorientation.

Depending on the symptoms and severity of the disease, the patient might need monitoring and help with personal hygiene and self-care. Eventually, there may be a need for 24-hour care and monitoring at home or in a special facility. Family counseling can help the person cope with the changes needed for home care.

Care may include:

Adult protective services
Community resources
Homemakers
Visiting nurses or aides
Volunteer services

People may need legal advice early in the course of the disorder. Advance directives, power of attorney, and other legal actions can make it easier to make ethical decisions regarding the care of the person with Pick's disease.

Support Groups

Some communities may have support groups (such as the Alzheimer's - support group, elder care - support group, or others).

Outlook (Prognosis)

The disorder quickly and steadily becomes worse. Patients become totally disabled early in the course of the disease.

Commonly, Pick's disease causes death within 2 - 10 years, usually from infection and sometimes from general failure of the body systems.

Possible Complications

Abuse by an over-stressed caregiver
Infection
Loss of ability to care for self or perform normal activities
Loss of ability to interact with others
Progressive loss of ability to function
Side effects of medications used to treat the disorder
Reduced life span

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of Pick's disease.

Call your health care provider or go to the emergency room if mental function gets worse (which may mean that another disorder has developed).

Prevention

There is no known prevention.

References

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, MO: Mosby; 2004.

Pierce JM. Pick's disease. J Neurol Neurosurg Psychiatry. 2003 Feb;74(2):169.

Grossman M. Frontotemporal dementia: a review. J Intl Neuropsychol Soc. 2002;8:566-583.

Grossman M. Progressive aphasic syndromes: clinical and theoretical advances. Curr Opin Neurol. 2002;15:1-5.

McKhann G, Albert M, Grossman M, Miller B, Dickson D, Trojanowski J. Clinical and pathological diagnosis of frontotemporal dementia. Arch Neurology. 2001;58:1803-1809.

Goetz CG. Goetz: Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders; 2007.

Infertility in Men

2009-03-31T04:20:00.000-07:00

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of male infertility.

Causes

In a 2001 study, the causes of infertility in men seeking to conceive were the following:

Vasectomy. In the study 56% of men were seeking a reversal of this procedure. Thirty years ago, this was a factor in only 5% of men seeking help for fertility.
Varicocele (14%). A network of veins carries blood away from the testicles and back up into the body. If these veins become enlarged, twisted, and swollen (similar to varicose veins in the leg), this condition is termed a varicocele. Varicoceles can impair testicular function and fertility.
Unknown infertility (8%).
Absence of sperm (6%). There are many biologic and environmental factors that can lead to low sperm count. For instance, abnormalities in production or obstruction of the tubes that carry sperm can reduce sperm levels. A condition called Sertoli cell-only syndrome is one in which the cells that produce sperm (the Sertoli cells) are absent. This can be a congenital problem that a man is born with or caused by infection, injury, medication, radiation, or genetics. In addition, other conditions may cause infertility in men.

Age

The effect of aging on male fertility is not clear. Some growing evidence suggests that it may be a factor (although not to the extent that it is in women). One earlier study suggested that sperm number and quality do not decline until beyond age 64, but a subsequent 2000 trial reported reductions in sperm count and quality between the second and fifth decade of life. Another study reported that fertilization rates during fertility treatments were over 60% for men under 39 but fell to slightly over half after age 40. Genetic defects in sperm have also been observed to increase with advancing age, although the implications for fertility are unclear. A 2002 study indicated that when men with genital infections were not considered, there was no difference in fertility rates between older and younger men.

Temporary and Lifestyle Causes of Low Sperm Count

Nearly any major physical or mental stress can temporarily reduce sperm count. Some common conditions that lower sperm count, temporarily in nearly all cases, include the following:

Emotional Stress. Stress may interfere with the hormone GnRH and reduce sperm counts.

Sexual Issues. In less than 1% of cases, impotence, premature ejaculation, or psychological or relationship problems contribute to male infertility, although these conditions are usually very treatable. Lubricants used with condoms, including spermicides, oils, and Vaseline, can affect fertility. Astroglide, Replens, or mineral oil may not be as harmful to sperm. However, oil-based lubricants can damage latex condoms and should be avoided.

Testicular Overheating. Overheating, such as from high fevers, saunas, and hot tubs, may temporarily lower sperm count. Persistent exposure to high temperatures during work may even impair fertility. One French study suggested that driving for only two hours a day can increase temperature in the scrotum and reduce sperm count. This study was small, however, and more research is needed. A number of trials have found no negative effects on fertility from wearing tight trousers, briefs, or athletic supports, even every day.

Substance Abuse. Cocaine or heavy marijuana use appears to temporarily reduce the number and quality of sperm by as much as 50%. Sperm actually have receptors for certain compounds in marijuana that may impair the sperms ability to swim and also inhibit their ability to penetrate the egg. Alcohol does not appear to affect fertility, unless it is so abused that it causes liver damage.

Smoking. Smoking impairs sperm motility, reduces sperm lifespan, and may cause genetic changes that affect the offspring. One 2002 trial found that men or women who smoke have lower success rates with assisted reproductive technologies. An earlier study reported that men who smoke also have lower sex drives and less frequent sex.

Malnutrition and Nutrient Deficiencies. Deficiencies in certain nutrients, such as vitamin E, vitamin C, selenium, zinc, and folate, may be particular risk factors for infertility

Obesity. Some studies, but not all, have found an association between obesity in men and infertility.

Bicycling. Bicycling has been linked to impotence in men and also may affect fertility. Pressure from the bike seat may damage blood vessels and nerves that are responsible for erections. Mountain biking, which involves riding on off-road terrain, exposes the perineum (the region between the scrotum and the anus) to more extreme shocks and vibrations and increases the risk for injuries to the scrotum. A study in Austria found that men who mountain bike are far more likely to have scrotal abnormalities, including calcium deposits, cysts, and twisted veins. Men who cycle can reduce such risks by the following:

Taking frequent rests while biking.
Wearing padded bike shorts.
Using a padded or specially contoured bike seat that is raised high enough and sits at the proper angle.

Genetic Factors

Problems in the genes that regulate male fertility and in the genetic material of sperm itself are important contributors to infertility problems in men. In fact, even in men with no known fertility problems, 19% of the sperm are genetically defective. Certain inherited medical conditions also contribute to male infertility. Defective genes themselves can be inherited, produced by environmental assaults (such radiation exposure), or both. Of some concern is the possibility that these mutations will be pass to offspring in men who undergo fertilization techniques that retrieve sperm and directly fertilize to the egg. (Under natural conditions, genetically abnormal sperm would be very unlikely to reach and fertilize the egg.)

Defective Genetic Material. Sperm carry half the genetic material necessary to make a human being. Infertile men have been reported to have a relatively high percentage of sperm with broken or damaged DNA (the molecular chain that makes up a gene).

Genetic Factors Specifically Affecting Sperm Production or Quality. Abnormalities in genes that specifically regulate sperm production and quality are major factors in male infertility. Some research suggests that about 10% of cases of male infertility may be due to problems, most likely genetic, in the acrosome. The acrosome is the enzyme-filled membrane cap on the sperm--its warhead--that is critical for piercing the egg. In one study, pregnancy was impaired if 7% or more of sperm had abnormalities in the acrosome.

Inherited Disorders that Affect Fertility. Certain inherited disorders can impair fertility. Examples include the following:

Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm). In fact, in men whose infertility is caused by an inborn missing vas deferens have a 60% chance that they carry the gene for cystic fibrosis (even if they don't have the disease itself).
Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the seminiferous tubules in the testicles during puberty, although most other male physical attributes are unimpaired.
Kartagener syndrome, a rare disorder that is associated with a reversed position of the major organs, also includes immotile cilia (hair-like cells in lungs and sinuses that have a structure similar to the tails of sperm). Sperm motility may then also be impaired by this condition.
Polycystic kidney disease, a relatively common genetic disorder that causes large cysts to form on the kidneys and other organs during adulthood, may cause infertility as the first symptom if cysts develop in the reproductive tract.

Environmental Assaults

Exposure to toxins, chemicals, or infections may reduce sperm count either by direct effects on testicular function or by altering hormone systems, although the extent of the impact and specific environmental assaults involved are often controversial. Some experts believe it is contributing to a general worldwide decline in male fertility.

Free Radicals (Oxidants). The primary suspects in the link between environmental assaults and infertility are free radicals, also called oxidants. These are unstable molecules, usually containing oxygen, that are released as a by-product of many natural chemical processes in the body. Infections, chemicals, and other environmental assaults can produce high levels of these particles. And, high levels can do harm, even affect the genetic material in cells. Sperm are particularly vulnerable to the damaging effects of this oxidation process. There have been reports that significant levels of oxidants occur in the semen of about 25% of infertile men. Additional investigation is under way.

Exposure to Estrogen-Like and Hormone-Disrupting Chemicals. European studies have increasingly reported a worsening in male reproductive health and an increase in testicular and prostate cancers. Many investigators strongly suspect environmental causes, particularly excessive chemicals that disrupt hormones, as a major cause for both these events. Estrogen-like chemicals found in pesticides and other chemicals are of particular concern. Overexposure to estrogen in male animals reduces the number of Sertoli cells (the cells necessary for the initial development of sperm). Some hormone-disrupting chemicals under investigation include the following:

Treatment of prostate cancer varies depending on the stage of the cancer (i.e., spread) and may include surgical removal, radiation, chemotherapy, hormonal manipulation or a combination of these treatments.

Bisphenol A is a widely used chemical found in plastic food containers and bottles that has provoked concern. It has potent estrogen-like effects in low dose. Use of the chemical in female rats has produced prostate abnormalities in their male offspring.
Phthalates, chemicals used to soften plastics, are under particular scrutiny for their ability to disrupt hormones. Specific phylates of special concern include dibutyl phthalate (DBP), which is found in many products, including cosmetics and clay products sold to children (Fimo, Sculpey). Animals exposed to phylates have significantly impaired sperm count and abnormalities in their reproductive structures, such as the testes. In addition, there is some concern that exposure in pregnant women may affect the offspring,
Organochlorines are compounds that combine chlorine and organic substances--usually petrochemicals. Many have estrogen-like effects, including those previously used to make plastics (PCBs) and pesticides (e.g., DDT and p,p-DDE). Some, such as dioxins and furans, are byproducts of many chemical processes. Fortunately, most of these chemicals have been banned, but they were heavily used in manufacturing before 1970 and are still widespread within the population. Studies have reported that when men had a history of moderate or high on-the-job exposure to pesticides containing organochlorines their fertility rates were lower than men without such exposures. Studies in 2002 found a strong correlation between high levels of polychlorinated biphenyls (PCBs) or p,p-DDE with reduced sperm quality and quantity. In one of the studies, even men with healthy sperm with high organochlorine levels had a lower sperm count than those with lower levels of these compounds.
Because of the connection between estrogen and infertility, there has been some concern that plant-based estrogens (phytoestrogens), such as the isoflavones found in soy and other foods, may impair sperm. One study of men who took isoflavone supplements for two months found no negative effects on their reproductive health.

Most evidence on the hormone of chemical estrogens has occurred in animals and birds. Tests of single chemicals containing estrogen have reported little danger for people. Some studies suggest, however, that exposure to more than one of these chemicals may be very harmful. At this time, there is no strong evidence supporting a serious harmful effect in people who have normal exposure to these chemicals. Major efforts are underway to determine the extent of any possible harm from these chemicals.

Hydrocarbons and Other Industrial Chemicals. In one 2000 study, workers in a rubber factory who were chronically exposed to hydrocarbons (ethylbenzene, benzene, toluene, and xylene) had lower than average sperm counts and sperm qualities. (In one 2001 study, men who smoked and worked in petrochemical plants had particularly poor sperm quality.) Still, not all major studies have confirmed the effects of these chemicals and evidence showing any significant effect on fertility is weak.

Exposure to Heavy Metals. Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect sperm quality. Trace amounts of these metals in semen seem to inhibit the function of enzymes contained in the acrosome, the membrane that covers the head of the sperm.

Radiation Treatments. X-rays and other forms of radiation affect any rapidly dividing cell, so cells that produce sperm are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to two years to resume normal sperm production and, in severe circumstances, may never recover.

Low Semen Levels

Men with fertility problems because of low semen levels when they ejaculate may have a structural abnormality in the tubes transporting the sperm. (A normal amount of semen is 2.5 to 5 mL, or about 1/2 to 1 teaspoon.)

Varicocele

A varicocele is an abnormally enlarged and twisted (varicose) vein in the spermatic cord that connects to the testicle. Varicoceles are found in 15% to 20% of all men and in 25% to 40% of infertile men, although it is not clear how or even if they affect fertility. They tend to occur more commonly (85 percent) on the left side. Some theories supporting their possible effect on infertility include the following:

Click the icon to see an image of a varicocele.

Varicoceles may partially obstruct the passages through which sperm pass.
Varicoceles may elevate temperature in the testes.
Varicoceles may produce higher levels of nitric oxide, a substance that has beneficial effects on blood flow and other functions but which might, in excess, injure sperm.
Varicoceles may block oxygen supply to the sperm.
Varicoceles have been associated with abnormalities in cellular material in the sperm. One study suggested that some men may have genetic defects that cause both varicoceles and impaired sperm, rather than the varicocele itself causing infertility.

Some reports indicate that only varicoceles that are large enough to be felt (termed palpable) may impact fertility. On the other hand, an eight-year study of men with and without varicoceles, however, found no differences in sperm quality or in the ability to conceive. Furthermore, the few well-conducted studies on repair of varicoceles suggest that the procedure does not improve pregnancy rates. Their effect on fertility remains unclear.

Testosterone Deficiencies and Hypogonadism.

Hypogonadism is the general name for a severe deficiency in gonadotropin-releasing hormone (GnRH), the primary hormone that signals the process leading to the release of testosterone and other important reproductive hormones. Low levels of testosterone from any cause may result in defective sperm production.

Hypogonadism is uncommon and is most often present at the time of birth, usually the result of rare genetic diseases affecting the pituitary gland that may include selective deficiencies of the hormones FSH and LH, Kallman syndrome, or panhypopituitarism, in which the pituitary gland fails to make almost all hormones. It can also develop later in life from brain or pituitary gland tumors or as a result of radiation treatments. Defects in the gene on the X chromosome that regulates receptors that bind to androgens--male hormones--may also prove to be very important causes of male infertility.

Click the icon to see an image of the pituitary gland.

Autoantibodies

Autoimmunity is a condition in which microbe-fighting agents of the immune system called antibodies attack specific cells in the body, mistaking them for foreign microinvaders. In the case of male infertility, these so-called autoantibodies (self antibodies) target the sperm. Antibodies bind to specific parts of the sperm, such as the head or tail and, depending on the site of attachment, cause various problems:

Sperm may stick together (agglutinate).
They may fail to interact with cervical mucous.
They may be unable to penetrate the egg.

Some experts believe that in most cases the presence of these antibodies will not prevent conception unless a large percentage of sperm are affected.

Vasectomy and Anti-Sperm Antibodies. Vasectomy, the primary sterility procedure in men, is the most common cause of sperm autoantibodies (also called anti-sperm antibodies). Experts believe their typical development is as follows:

Vasectomy works by severing the vas deferens, the tube that carries sperm from the testicles to the urethra (which leads out of the penis).
After vasectomy, sperm continue to be produced but, instead of being confined to the reproductive passages, they leak out into the body.
Here, the immune system may perceive them as foreign invaders and develop antibodies to attack them.

Such antibodies often persist, even if a man restores sperm flow by a successful reversal procedure (vasovasostomy). The persistence of anti-sperm antibodies may result in infertility.

Click the icon to see an illustrated series detailing vasectomy.

Other Causes of Autoantibodies. Antibodies to sperm can also appear in men without previous vasectomies and have been reported to be present in 10% of all men with fertility problems. They may be linked to genital infections or injury, although the cause is usually not known.

Retrograde Ejaculation

Retrograde ejaculation occurs when the muscles of the urethra do not pump properly during orgasm and sperm are forced backward into the bladder instead of forward out of the urethra. Sperm quality is often impaired.

Retrograde ejaculation can be the consequence of a number of conditions:

Surgery to the bladder neck (the lower part of the bladder) or prostate is the most common cause of retrograde ejaculation.
Diabetes.
Multiple sclerosis.
Back surgery
Spinal cord injury.
A temporary side effect of certain drugs, such as tranquilizers, certain antipsychotics, or hypertension medications.

Testicular Dysgenesis Syndrome and Other Physical or Structural Abnormalities

Any structural abnormalities that affect the testes, tubes, or other reproductive structures can have a profound effect on fertility.

Testicular Dysgenesis Syndrome. Testicular dysgenesis syndrome is a recently observed occurrence of three conditions--impaired sperm production and quality, testicular cancer, and genital tract abnormalities. All three of these conditions are increasing--not necessarily all three in one individual--but in the male population generally. Environmental factors that increase damage from oxidants are believed to be responsible.

The genital abnormalities identified with this syndrome are undescended testes and hypospadias, each of which is associated with infertility:

Undescended Testes (Cryptorchidism). In some cases, there is a failure of the testes to descend from the abdomen into the scrotum during fetal life. Cryptorchidism is associated with mild to severe impairment of sperm production. In one survey, 38% of men who as youngsters had two undescended testicles and 10% of men with one undescended testicle were infertile, compared with 5% of men who had normal testes. Even one undescended testicle may impair fertility. In cryptorchidism, the testes are exposed to the higher internal body heat, but this may not totally explain the damage in sperm production that can occur. (Note: Men who suffer from this condition should be aware that even if the testicle is surgically moved to the scrotum, their risk of testicular cancer is significantly increased, warranting careful self-exams and regular follow-up with a physician.)
Hypospadias. This is a birth defect in which the urinary opening is on the underside of the penis, can prevent sperm from reaching the cervix if not surgically corrected.

Click the icon to see an image of an undescended testicle.

Click the icon to see an image of hypospadius.

Blockage in the Tubes that Transport Sperm. Some men are born with a blockage in the epididymis or ejaculatory ducts or other problems that later affect fertility. One center reported that 2% of men seeking treatment had no vas deferens.

Anorchia. In the very rare condition known as anorchia, a man is born without any testes.

Syringomyelia. This is a disease of the spinal cord, results in no ejaculate at all (aspermia).

Cancer and Its Treatments

Birth rates among cancer survivors are only 40% to 85% of the expected rates. Certain cancers, particularly testicular cancer, impair sperm production, often severely. The major cancer treatments such as chemotherapy and radiation may impair sperm quality and quantity. The closer radiation treatments are to reproductive organs, the higher the risk for infertility. Fortunately, while men may fail to produce sperm for as long as five years after radiation therapy, sperm production may eventually recover in many. Chemotherapy with alkylating agents or other drugs that can harm reproductive function tends to affect fertility more severely in men than in women. New regimens are helping to improve fertility rates.

On an encouraging note, in spite of concerns that cancer treatments may affect sperm DNA, a 2002 study found no higher rate of genetic abnormalities in the sperm of cancer survivors compared to men without a cancer history. Adolescents and older men undergoing cancer treatments who may want to father children should consider banking and freezing their sperm for later use in assisted reproductive therapies.

Infections

There is some controversy over the effect of infections on infertility. Simply detecting the presence of an infection in infertile men does not necessarily mean that it has any relationship to the infertility itself. Some experts believe that the immune response to some infections may release inflammatory factors and oxidants, chemically unstable particles that can damage sperm. The exact impact of this process on sperm is unclear, however. Infections may alter the liquidity of semen and sperm motility, although these are likely to be temporary effects. Among the infections most implicated in infertility are the following:

Sexually Transmitted Diseases. Repeated Chlamydia trachomatis or gonorrhea infections are most often associated with male infertility. Such infections can cause scarring and block sperm passage. Human papillomaviruses, the cause of genital warts, may also impair sperm function.

Mycoplasma. Mycoplasma is an infectious organism that appears to fasten itself to sperm cells and render them less motile.

Mumps. When mumps develops after puberty, it damages the testicles in 25% of men afflicted with the disease. (Interferon, an anti-viral drug, may help prevent infertility in adult males with active mumps, but the drug is highly toxic and caution is essential.)

Glandular Infections in the Urinary Tract or Genitals. Glandular infections that may affect fertility include prostatitis (in the prostate gland), orchitis (in the testicle), semino-vesculitis (in the glands that produce semen), or urethritis (in the urethra), perhaps by altering sperm motility. Even after successful antibiotic treatment, infections in the testes may leave scar tissue that blocks the epididymis.

Malocclusion of teeth

2009-03-30T06:34:00.000-07:00

Definition

Malocclusion means the teeth are not aligned properly.

Alternative Names

Crowded teeth; Misaligned teeth; Crossbite; Overbite; Underbite; Open bite

Causes

Occlusion refers to the alignment of teeth and the way that the upper and lower teeth fit together (bite). Ideally, all upper teeth fit slightly over the lower teeth. The points of the molars fit the grooves of the opposite molar.

The upper teeth keep the cheeks and lips from being bitten and the lower teeth protect the tongue.

Malocclusion is most often hereditary, which means the condition is passed down through families. There may be a difference between the size of the upper and lower jaws or between jaw and tooth size, resulting in overcrowding of teeth or in abnormal bite patterns.

Variations in size or structure of either jaw may affect its shape, as can birth defects such as cleft lip and palate. Other causes of malocclusion include:

Childhood habits such as thumb sucking, tongue thrusting, pacifier use beyond age 3, and prolonged use of a bottle
Extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth
Ill-fitting dental fillings, crowns, appliances, retainers, or braces
Misalignment of jaw fractures after a severe injury
Tumors of the mouth and jaw

There are different categories of malocclusion.

Class 1 malocclusion is the most common. The bite is normal, but the upper teeth slightly overlap the lower teeth.
Class 2 malocclusion, called retrognathism or overbite, occurs when the upper jaw and teeth severely overlap the bottom jaw and teeth.
Class 3 malocclusion, called prognathism or underbite, occurs when the lower jaw protrudes or juts forward, causing the lower jaw and teeth to overlap the upper jaw and teeth.

Symptoms

Abnormal alignment of teeth
Abnormal appearance of the face
Difficulty or discomfort when biting or chewing
Speech difficulties (rare) including lisp
Mouth breathing (breathing through the mouth without closing the lips)

Exams and Tests

Most problems with teeth alignment are discovered bya dentist during a routine exam. The dentist may pull your cheek outward and ask you to bite down to check how well your back teeth come together. If there is any problem, the dentist will usually refer you to an orthodontist for diagnosis and treatment.

Dental x-rays, head or skull x-rays, or facial x-rays may be required. Plaster or plastic molds of the teeth are often needed.

Treatment

Very few people have perfect teeth alignment. However, most problems are so minor that they do not require treatment.

Malocclusion is the most common reason for referral to an orthodontist.

By treating moderate or severe malocclusion, the teeth are easier to clean and there is less risk of tooth decay and periodontal diseases (gingivitis or periodontitis). Treatment eliminates strain on the teeth, jaws, and muscles, which lessens the risk of breaking a tooth and may reduce symptoms of temporomandibular joint disorders.

The goal is to correct the positioning of the teeth. Braces or other appliances may be used. Metal bands are placed around some teeth, or metal, ceramic, or plastic bonds are attached to the surface of the teeth. Wires or springs apply force to the teeth.

One or more teeth may need to be removed if overcrowding is part of the problem. Rough or irregular teeth may be adjusted down, reshaped, and bonded or capped. Misshapen restorations and dental appliances should be repaired. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to stabilize the jaw bone, in a similar manner to the surgical stabilization of jaw fracture.

It is important to brush and floss your teeth every day and have regular visits to a general dentist. Plaque accumulates on braces and may permanently mark teeth or cause tooth decay if not properly cared for.

Retainers (used to stabilize the teeth) may be required for an indefinite time to maintain the new position of the teeth.