Showing posts with label health. Show all posts

Sunday 30 December 2012

dementia by type'

Brain scan 'can sort dementia by type'

Tell-tale shrinkage of the frontal and temporal lobes on an MRI scan

Scientists say they have found a way to distinguish between different types of dementia without the need for invasive tests, like a lumbar puncture.

US experts could accurately identify Alzheimer's disease and another type of dementia from structural brain patterns on medical scans, Neurology reports.

Currently, doctors can struggle to diagnose dementia, meaning the most appropriate treatment may be delayed.

More invasive tests can help, but are unpleasant for the patient.

“Start Quote

This could be used as a screening method and any borderline cases could follow up with the lumbar puncture or PET scan”

Lead researcher Dr Corey McMillan

Distinguishing features

Despite being two distinct diseases, Alzheimer's and frontotemporal dementia, share similar clinical features and symptoms and can be hard to tell apart without medical tests.

Both cause the person to be confused and forgetful and can affect their personality, emotions and behaviour.

Alzheimer's tends to attack the cerebral cortex - the layer of grey matter covering the brain - where as frontotemporal dementia, as the name suggests, tends to affect the temporal and frontal lobes of the brain, which can show up on brain scans, but these are not always diagnostic.

A lumbar puncture - a needle in the spine - may also be used to check protein levels in the brain, which tend to be higher in Alzheimer's than with frontotemporal dementia.

A team at the University of Pennsylvania set out to see if they could ultimately dispense of the lumbar puncture test altogether and instead predict brain protein levels using MRI brain scans alone.

They recruited 185 patients who had already been diagnosed with either Alzheimer's disease or frontotemporal dementia and had undergone a lumbar puncture test and MRI scanning.

Dementia

There are many causes of dementia, with Alzheimer's the most common
More than half a million people in the UK have Alzheimer's disease
Frontotemporal dementia tends to affects people who are younger - under 65 - and can affect a personality and behaviour
Other types of dementia include vascular dementia and dementia with Lewy bodies

The researchers scrutinised the brain scans to see if they could find any patterns that tallied with the protein level results from the lumbar puncture tests.

They found the density of gray matter on the MRI scans correlated with the protein results.

The MRI prediction method was 75% accurate at identifying the correct diagnosis.

Although this figure is some way off an ideal 100%, it could still be a useful screening tool, say the researchers.

Lead researcher Dr Corey McMillan said: "This could be used as a screening method and any borderline cases could follow up with the lumbar puncture or PET scan."

Dr Simon Ridley, Head of Research at Alzheimer's Research UK, said: "This small study suggests a potential new method for researchers to distinguish between two different types of dementia, and a next step will be to investigate its accuracy in much larger studies involving people without dementia.

"While this method is not currently intended for use in the doctor's surgery, it may prove to be a useful tool for scientists developing new treatments. The ability to accurately detect a disease is vital for recruiting the right people to clinical trials and for measuring how well a drug may be working.

"Ultimately, different causes of dementia will need different treatment approaches, so the ability to accurately distinguish these diseases from one another will be crucial."

The only drug currently licensed in England and Wales for treating frontotemporal dementia is rivastigmine.

There are four licensed treatments for Alzheimer's - donepezil, galantamine, rivastigmine and memantine.

Tuesday 11 September 2012

Carbon emissions linked to Europe's hay fever rise

By Richard BlackEnvironment correspondent, BBC News, Vienna

The pollen season is getting longer in Europe, partly influenced by climate change

Carbon dioxide emissions may be raising pollen counts in European cities, according to a continent-wide study.

Researchers from 13 EU nations analysed pollen levels for more than 20 species of tree and plant.

They found that many, including several that cause allergies such as hay fever, correlated with rising CO2 levels.

Presenting their study at the European Geosciences Union (EGU) annual meeting, scientists said city planners might need to review which trees they plant.

Hay fever and other allergies appear to be rising across Europe.

In the UK, GP diagnoses of allergic rhinitis, which includes hay fever, rose by a third between 2001 and 2005.

It has been suggested that higher temperatures might be causing plants to produce more pollen.

But by comparing pollen counts during relatively hotter and relatively cooler years, this latest study found temperature was not the cause.

Annette Menzel from the Technical University of Munich said other possible factors were eliminated as well.

"We thought the increase in the amount of pollen could be related to land use changes, but we don't observe this," she told BBC News.

"We tried to link it to temperature, but that's not possible.

"So the only effect that's left would be a CO2 effect; and we know from experiments in the real world and in climate chambers that CO2 does promote the amount of pollen [that trees produce]."

Urban conundrum

“Start Quote

The season of suffering for people with hay fever is getting more serious”

Annette MenzelTechnical University of Munich

Data in the study came from pollen monitoring stations in the 13 nations, supplemented by tree cover information from the UN Food and Agriculture Organization and weather data.

Not all the 25 species studied show the same trend - pollen counts from some have actually gone down.

But 60% of species have seen an increase in pollen production across the decades of the study period, including nine species known to produce allergenic pollen.

There were also differences between trends in different countries, with pollen counts falling in a few.

Perhaps the most intriguing finding was that pollen counts have generally increased with CO2 inside cities, but not outside.

The researchers suggest this could be down to the longer lifetime of ozone molecules outside urban areas.

Pollen causes inflammation of the air passages by stimulating the immune system

The gas is known to disrupt plant growth.

Although more research remains to be done, Professor Menzel's team suggests further rises in pollen counts probably lie ahead, given that CO2 concentrations are rising.

The increasing length of pollen seasons in Europe is linked to the introduction of plants and trees from other continents, in addition to any impact of CO2.

"In Germany, it is now only in November that we do not see allergenic pollen - so the season of suffering for people with hay fever is getting more serious," she said.

"On a local scale, planners should be more aware of what sort of problems may arise from the urban trees they're planting.

"Often they use birch trees, for example, because of their nice silver colour, not aware that they leave allergenic problems behind."

Many of the researchers on this project are involved in wider efforts to plot climate impacts on the timing of natural events such as plant flowering, egg laying and bird migration across Europe - the field of phenology.

The hay fever research presented at EGU will shortly be written up for formal scientific publication.

Tuesday 1 November 2011

“Sunbeds may be even more dangerous than previously feared

Friday, 14 October 2011

“Sunbeds may be even more dangerous than previously feared

“Sunbeds may be even more dangerous than previously feared,” the Daily Mail has today reported. The newspaper said UVA rays, the main type of ultraviolet light emitted by tanning devices, has been found to cause the type of DNA damage that can lead to cancer.

The news is based on laboratory research that compared the DNA damage caused by UVA rays to that from UVB rays, which are already known to cause skin cancer. While UVB has long been linked to burning and skin cancer, UVA has previously been considered to be relatively harmless. However, this research builds on other studies that have suggested that UVA is not harmless and, like UVB, can lead to changes in the cell that increase the risk of skin cancer.
By exposing different areas of volunteers’ skin to UVA and UVB and examining skin tissue samples, the experimental study found that both could cause similar types of DNA damage, but that UVA tended to affect cells deeper in the skin. However, UVB affected cells at the surface of the skin more.
This research emphasises the need to use an appropriate-strength sunscreen that protects against both UVA and UVB. These sunscreens may be labelled as offering “broad spectrum” protection, and rated according to a five-star system in the UK. Cancer Research UK recommends that people use sunscreen of at least SPF 15 and with at least four stars to get good balanced protection across the UV spectrum.

Where did the story come from?

The study was carried out by researchers from King’s College London. It was funded by The National Institute for Health Research, the UK Medical Research Council, British Skin Foundation and the British Association for Dermatology.
It was published in the peer-reviewed, Journal of Investigative Dermatology.
The Daily Telegraph and the Daily Mail both appropriately advised that people should consider UVA protection as well as UVB when choosing a sunscreen.

What kind of research was this?

This laboratory-based research looked at how UVA rays affected skin cells. Light from the sun contains two types of ultraviolet (UV) rays, UVA and UVB. UVB has a shorter wavelength and has generally been thought of as the major carcinogen in sunlight. However, the researchers say that the action of UVA needs further consideration as there are more UVA than UVB rays in sunlight. UVA is also the predominant wavelength generated by sunbeds, and has now been classified as a carcinogen.
UVB is known to causes chemical changes to our DNA. In some cases the body’s natural DNA repair mechanisms can repair the damaged DNA, but in skin cancers these chemical changes have not been fixed and lead to harmful mutations in the DNA sequence. In skin cancers caused by UVB, there is a characteristic pattern of DNA damage that the researchers term a “UVB signature”.
UVA is also known to cause mutations, but this was previously thought to be by an indirect mechanism (i.e. causing chemical changes to other molecules in the cell that may have a knock-on effect on the DNA). However, recent experiments on cells in a lab have shown that UVA may also cause a “UVB signature” in the DNA sequence.
As recent evidence suggests that UVA may cause mutations in a similar way to UVB, this has raised doubts over the belief that UVA may be “safer” than UVB. Given this uncertainty, the researchers devised a series of experiments to see what effect comparable doses of UVA and UVB had on skin cells.

What did the research involve?

The researchers recruited 12 volunteers with healthy skin. The participants had fair, white skin that either always burns and never tans, or usually burns and tans with difficulty.
The participants were exposed to each wavelength of UV on 1 cm2 areas of previously-exposed skin on their buttocks.
Twenty-four hours later, the researchers used three participants to find the minimum doses of UVA and UVB needed to produce just-detectable redness of the skin. The participants were then given doses of UVA and UVB, which were multiples of this minimum dose (half the minimum dose, 1.5 times and 3 times). The degree of skin redness was assessed using a red skin scale.
The researchers took punch biopsies, which involved using a small tube-like device to extract a 4mm plug of skin from the exposed site. They used the biopsies to look at chemical changes to the DNA. To see how well the body could repair and reverse the DNA damage, they performed another set of biopsies on the exposure sites 3, 6, 24 and 48 hours after the UV exposure and examined the changes seen.

What were the basic results?

The researchers found that the skin became redder with increasing doses of either UVA or UVB. However, when they applied increasing multiples of the minimum dose required to cause redness, UVB caused more redness than UVA.
When the researchers looked for DNA chemical changes in skin cells immediately after exposure, they found that UVB led to more of these changes in the top layer of skin, whereas UVA led to more changes in the deeper layers of skin. They also found that as doses increased beyond the minimum dose, UVB caused more detectable chemical changes to the DNA than UVA. Although both UVA and UVB produced one particular type of DNA change, UVB caused additional chemical changes that were not found in UVA-treated cells.
The researchers then attempted to see how well the cells could repair the DNA damage caused by UV exposure. They found that the rate at which the body could repair the DNA damage was similar for damage caused by UVA and UVB. They said that by 48 hours the majority of DNA changes caused by UVA had disappeared but that there was still some DNA damage with UVB. The researchers said that this was because a higher proportion of DNA had been damaged with the UVB dose.

How did the researchers interpret the results?

The researchers say that they had demonstrated for the first time that UVA can cause DNA changes similar to some of those caused by UVB, although UVB also causes additional chemical changes not seen with UVA exposure. They said that deeper layers of skin are particularly vulnerable to UVA-induced damage and that this has implications for public health policies, particularly the need for developing measures that protect against UV light at a broader range of wavelengths.

Conclusion

This research has shown that UVA can produce some similar damage to the DNA when the skin becomes red as UVB. The research also showed that these changes may increase the risk of developing skin cancer if not repaired by the body. Previously, it was thought that UVB caused burning and was the major carcinogenic component of sunlight, while UVA was considered to be relatively harmless apart from ageing the skin.
In recent times studies, including this one, have suggested that UVA may directly cause the type of DNA damage that can lead to skin cancer. This study emphasises the importance of choosing a sunscreen that protects against both UVA and UVB (often labelled as offering ‘broad spectrum’ protection).
The charity Cancer Research UK has highlighted that there is no international measurement of UVA production, although in the UK there is a five-star system to measure UVA protection (the higher number of stars indicates a more balanced protection against UVA). Sunscreens will also contain a (sun protection factor) SPF rating. Cancer Research UK recommends that people use a sunscreen of SPF 15 or higher, with at least four stars to provide good protection against UVA and UVB. The charity also says consumers should not use sunscreen that has been open for over 12 to 18 months, but should instead buy fresh sunscreen offering appropriate protection.
Newspapers covering this research have also correctly highlighted that sunbeds may have a particularly high UVA output. The Daily Mail includes a quote that the strength of these rays can be 10 to 15 times higher than the midday sun. People using sunbeds and tanning booths should be aware that there is currently no regulation to govern the type or strength of UV rays that sunbeds give out. Even brief use may carry some risk, particularly for people who have fair features, freckles, lots of moles or damaged areas of skin. Read Are sunbeds safe? for more information.

Links To The Headlines

Tanning salons more dangerous than previously thought. The Daily Telegraph, October 7 2011
New sunbed alert: UV rays penetrate far deep into the skin than previously thought. Daily Mail, October 7 2011

Links To Science

Tewari A, Sarkany RP and Young AR. UVA1 Induces Cyclobutane Pyrimidine Dimers but Not 6-4 Photoproducts in Human Skin In Vivo. Journal of Investigative Dermatology, October 6 2011

Thursday 27 October 2011

IVF linked to ovarian tumours

Fertility drugs are used to force the ovaries to produce eggs

IVF has been linked to an increased risk of ovarian tumours in later life, according to a preliminary study.

Women given fertility drugs to produce eggs had more than triple the risk of an ovarian tumour that may turn cancerous, say Dutch researchers.

But the absolute risks are very low, they add.

A cancer charity said numbers involved in the study, published in the journal Human Reproduction, were too small to draw firm conclusions.

The study tracked more than 25,000 women attending IVF clinics in The Netherlands in the 80s and 90s.

Follow-up investigations revealed more cases than expected of ovarian tumours in women who had gone through IVF, which involves stimulating the ovaries to make eggs.

The biggest increase was in a type of growth, known as a borderline ovarian tumour, which can sometimes turn into cancer. It is less aggressive than other types of ovarian tumour, but requires surgery.

“Start Quote

Women should be informed about this but the risk should not be overstated”

End Quote Prof Flora van Leeuwen Netherlands Cancer Institute, Amsterdam

It normally affects around one in 1,000 women in the general population, but was found in about 3.5 in 1,000 women who had gone through IVF, say the researchers.

A smaller increase in other types of ovarian tumour was also found. Overall, ovarian cancer rates were twice as high among women who had gone through fertility treatment, the experts said.

Prof Flora van Leeuwen, a co-author of the study, told the BBC: "The absolute risk of these tumours is very low. But there is an increased risk of a borderline malignant tumour that needs surgery.

"Women should be informed about this but the risk should not be overstated."

Another co-author, Prof Curt Burger added: "The main message is that women who have had IVF shouldn't be alarmed. The incidence of ovarian cancer was extremely low."

'Reassuring'

Further research is planned to confirm the finding in a larger number of patients, and to look at whether some women are more at risk.

At present, the numbers involved are small. There were 61 women with ovarian tumours in the IVF treatment group; 31 had borderline ovarian tumours and 30 had ovarian cancer.

Ovarian cancer

Ovarian cancer is the 5th most common cancer in women in the UK
Most cases are in women who are past the menopause
Risk factors include a family history of cancer, being infertile or having fertility treatment, and smoking
The symptoms of ovarian cancer can be very vague, particularly when the disease is in its early stages.
Early symptoms can include pain in the lower abdomen or side, and/or a bloated, full feeling in the abdomen
Source: Cancer Research UK

Commenting on the study, Prof Hani Gabra, of the Ovarian Cancer Action Research Centre at Imperial College London, said:

"Reassuringly, and in keeping with lots of previous research in this area, this study shows that the risks of invasive ovarian cancer are small in populations of patients receiving ovarian stimulation for IVF.

"Although this study shows that ovarian stimulation may increase the risk of much less aggressive borderline ovarian tumours, it underlines the fact that ovarian stimulation for IVF is not a major risk factor for invasive ovarian cancer."

Dr Claire Knight, senior health information officer at Cancer Research UK, said: "This interesting study suggests a possible link between ovarian stimulation for IVF and borderline ovarian tumours, but it certainly doesn't show that IVF causes invasive ovarian cancer.

"There were only a relatively small number of cases in this study, and the researchers didn't find that risk increased with the number of cycles a woman had, making conclusions hard to reach.

"Women can reduce their risk of ovarian cancer by being a non-smoker and keeping a healthy weight, and women who have taken the Pill or been pregnant are also at lower risk." Pill 'lowers ovarian cancer risk' Ovarian Cancer Action humrep.oxfordjournals.org

Tuesday 27 September 2011

Vending machines 'undermine' hospitals' good work'

Comments (87)

By Dr Rachel Thompson World Cancer Research Fund

Vending machines tend to dispense high-calorie food like chocolate

Scrubbing Up

Hospitals are, by definition, buildings that are dedicated to health.

But in this week's Scrubbing Up, Dr Rachel Thompson, deputy head of science at World Cancer Research Fund, says that good work is being undermined by the contents of hospital vending machines.

Whenever I visit hospitals, I am always struck by how the efforts of the dedicated healthcare professionals who work in them are being undermined by what is happening in the waiting areas.

All too often, these waiting areas have vending machines that are filled with high-calorie foods and drinks such as chocolate bars, crisps and sugary drinks.

But because these foods are a cause of obesity, they are part of the reason many of the people will have ended up in hospital in the first place.

There is strong scientific evidence that excess body fat is a risk factor for cancer, as well as other non-communicable diseases such as heart disease and diabetes.

And yet hospital vending machines are selling products that are a cause of obesity at the same time as the health professionals working there are trying to cope with its consequences.

That is why hospitals should put an end to vending machines that sell high calorie foods and drinks.

Little focus

It is true that on its own this would be unlikely to have a serious impact on obesity levels.

You would have to spend a lot of time in hospital waiting rooms for the contents of the vending machines to make much of a difference to your weight.

“Start Quote

There is no great mystery about what needs to happen”

End Quote

But rather, the fact that hospital vending machines are filled with these kinds of foods and drinks is a symptom of how little meaningful focus there is on the obesity crisis.

Across society, big changes are needed if we are to address obesity and the preventable cases of cancer and other diseases that result from it.

The changes that we need are supported by common sense.

If you prioritise the needs of motorised transport when you plan a town, it is to be expected that people won't walk or cycle enough.

If you allow the food and drinks industry to market unhealthy products to children, then don't be surprised when children pester their parents to buy those products.

But the fact that hospital vending machines are still stocked with high-calorie foods and drinks illustrates that we are not recognising the problem.

There is no great mystery about what needs to happen.

There is already a large evidence base for what works and doesn't work when it comes to policy changes. What we need to see is political will and a change to the mindset where we tolerate the things that promote obesity.

This would not only mean the end of the kind of culture where the sale of unhealthy foods and drinks in hospital waiting rooms is seen as acceptable.

It could also mean fewer people end up in those waiting rooms in the first place.

Your comments (87)

Friday 9 September 2011

'Opportunities missed' in Alina Sarag's TB death

Alina Sarag lived life to the full, her family said

Opportunities were missed to diagnose a 15-year-old girl who died of tuberculosis (TB), the BBC can reveal.

Alina Sarag, a pupil at Golden Hillock School in Sparkhill, Birmingham, died on 6 January.

A simple phlegm test which could have shown she had tuberculosis was never carried out at one West Midlands hospital, a clinical review of the case revealed.

A chest X-ray could also have indicated TB but the condition was not picked up.

The review, by Heart of Birmingham Teaching Primary Care Trust, concluded there must be a Birmingham-wide review of all standard procedures for TB after no-one considered the possibility in Alina's case, a high-risk patient.

Alina had been treated for TB and was seen at Birmingham Chest Clinic, in October 2009.

She was treated with antibiotics but the clinic failed to follow up her treatment.

After a visit to Pakistan in July 2010 she was sick upon her return.

Her mother, Farhat Mahmoode, said: "We took her to every hospital.

Treatment timetable

On 26 August 2010 Alina referred to Heartland Hospital but given all-clear
On 5 October referred to Birmingham Children's Hospital, but history of TB not picked up and hospital queried typhoid or an infection
A week later, transferred to Sandwell Hospital after going to City Hospital in Birmingham. She remains there for five days and TB is noted but sputum test not carried out
Chest X-ray carried out but deemed most likely to have picked up chest infection
Alina attended Birmingham Children's Hospital on 30 October where it is suggested that it was a psychological issue
On 14 December she saw a clinical psychologist but was in such extreme pain that the psychologist could not complete the assessment
Second appointment was arranged for 6 January, the day of her death

"If Heartlands Hospital didn't pick up something, maybe City Hospital.

"We took her to the Children's Hospital.

"We thought maybe another doctor would find out what was wrong, but we were failed at every turn."

After doctors at Heartland and City hospitals did not detect TB, Alina was admitted to Sandwell Hospital where she stayed for five days.

TB was picked up but no sputum test was carried out and a chest X-ray was thought to have found a chest infection.

She later saw a clinical psychologist at Birmingham Children's Hospital but was in such extreme pain that the psychologist could not complete the assessment.

A second appointment was arranged for 6 January, the day of her death.

The medical director of Sandwell and West Birmingham Hospitals, Donal O'Donahue, accepted there were mistakes with her care, but denied there was any need to change the systems.

'Clinicians devastated'

Mr O'Donahue said TB was very difficult to diagnose and when the reader of the chest X-ray decided it was unlikely to be TB, the phlegm test was cancelled.

He said not diagnosing TB from the X-ray was reasonable.

"All the clinicians involved in Alina's case were devastated that we had missed an opportunity to diagnose TB.

"Other than the need to bear TB in mind, there is nothing in our systems that we felt that we needed to improve on the basis of Alina's care."

The review decided the chest clinic should have followed up her treatment and it should have ordered X-rays to ensure her treatment had been successful.

Heart of England NHS Foundation Trust (HEFT), which runs the chest clinic, said it had put an action plan in place.

It said: "HEFT is the centre of excellence for infectious diseases in the West Midlands and saw and treated over 350 patients last year with TB.

"We have completed an internal investigation into the care provided to Alina Sarag by Birmingham Chest Clinic and an action plan has been developed with our clinicians."

The review team has recommended training to increase awareness about TB for all Birmingham GPs and other clinicians.

Sunday 4 September 2011

Takeaway dishes high in illegal colourings, says study

The meals can contain high levels of salt, fat and artificial colourings, the study suggests

Two of the nation's favourite Indian and Chinese takeaway dishes can contain illegally high levels of certain colourings, a snapshot study suggests.

High levels of salt and saturated fat were also detected in chicken tikka masala and sweet and sour chicken meals at 223 takeaways in England and Wales.
And the Local Government Group study says that when nut-free chicken tikkas were ordered, 20% still contained nuts.
The Department of Health said labelling was key.
The analysis of 90 Indian takeaways was based on a portion of chicken tikka masala and pilau rice.
The Food Standards Agency has called for a voluntary ban on artificial colourings including sunset yellow (E110), allura red (E129), tartrazine (E102) and ponceau 4R (E124) because of their reported link to hyperactivity in some children.
When the sauces from 25 of the meals were tested for the colourings, five of the dishes were found to contain levels above the permitted maximum of 500mg/kg allowed under current food regulations.
The study also found that the Indian meals contained 116% of an individual's daily recommended saturated fat intake and 92% of their salt intake.
A similar analysis of sweet and sour chicken and fried rice from 133 Chinese takeaways discovered that the dish contained 119% of the recommended daily salt intake and 16 teaspoons of sugar, 75% of the recommended daily limit.
Eating too much salt is linked to high blood pressure, which can also increase the risk of developing heart disease.
Recommended dietary salt levels vary with age. Adults are recommended to have no more than 6g of salt per day in their diet, while toddlers should have no more than 2g.
Analysis of 11 sauces of the sweet and sour chicken meals found one contained illegally high levels of the colourings.
Nut danger
When buying some of the chicken tikka masala meals, it was stressed that the customer had a nut allergy.
Despite this, one in five of these takeaways contained peanuts or almonds without any warnings being provided. Just a small amount of nuts can be fatal for someone with a severe allergy.

“Start Quote

There are many ways to make takeaways more healthy such as using lower fat oils, natural colourings and reducing salt. ”

End Quote Paul Bettison Local Government Association

The Local Government Association said local authorities should work with "ethnic kitchens" to make sure false information was not provided when customers requested a meal which does not contain nuts.

On two occasions the meat found in sweet and sour chicken meals was actually turkey.
Pre-packaged meals sold in shops are required to carry details of artificial colourings.
A spokesman from the Department of Health said there are plans to give takeaway outlets guidelines on how to label their products.
"The government's Responsibility Deal includes actions that can be taken by restaurants and takeaways, for example by providing calorie information for food and drink.
"Whilst this work has to date focused on larger, chain restaurants, guidance for smaller businesses will be produced in due course. This will help maximise the opportunities for people to see, and use, calorie labelling."
Councillor Paul Bettison, chairman of the Local Government Regulation Board which carried out the study of takeaway meals, said that the high levels of fat, salt and sugar in them were "truly shocking and unnecessary".
"There's no excuse for illegal amounts of colouring and as for secretly using a cheaper type of meat, that's just shamefully ripping off customers. And including nuts when you've been told a person suffers from a nut allergy is unforgivable, it could potentially kill them.
"There are many ways to make takeaways more healthy such as using lower fat oils, natural colourings and reducing salt. These needn't compromise taste and promoting such a healthy approach often attracts customers who're keen to watch their waistline or their blood pressure."

Saturday 3 September 2011

In hydrocephalus, there is a buildup of fluid

Ventriculoperitoneal shunting

Shunt - ventriculoperitoneal; VP shunt; Shunt revision

Last reviewed: November 22, 2010.

Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus).

This article primarily discusses shunt placement in children.

Description

This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours.

The child's hair behind the ear is shaved off. A surgical cut in the shape of a horseshoe (U-shape) is made behind the ear. Another small surgical cut is made in the child's belly.

A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain.

Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter.

A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.

The valves in newer shunts can be programmed to drain more or less fluid from the brain.

Why the Procedure Is Performed

In hydrocephalus, there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This buildup of fluid causes higher than normal pressure on the brain. Too much pressure, or pressure that is present too long, will damage the brain tissue.

A shunt helps to drain the excess fluid and relieve the pressure in the brain. A shunt should be placed as soon as hydrocephalus is diagnosed.

Risks

Risks for any anesthesia are:

Reactions to medications

Problems breathing

Changes in blood pressure or breathing rate

Risks for any surgery are:

Bleeding

Infection

Possible risks of ventriculoperitoneal shunt placement are:

Blood clot or bleeding in the brain

Brain swelling

The shunt may stop working and fluid will begin to build up in the brain again.

The shunt may become infected.

Infection in the brain

Damage to brain tissue

Seizures

Before the Procedure

If the procedure is not an emergency (planned surgery):

Tell your doctor or nurse what drugs, supplements, vitamins, or herbs your child takes.

Give any drugs the doctor told you to give your child. It is okay if they take them with a small sip of water.

The doctor or nurse will tell you when to arrive at the hospital.

Ask your doctor or nurse about eating and drinking before the surgery. The general guidelines are:

Older children should not eat any food or drink any milk for 6 hours before surgery, but they can have clear fluids (juice or water) up until 4 hours before the operation.

Infants younger than 12 months can usually eat formula, cereal, or baby food until about 6 hours before surgery. They may have clear fluids up until 4 hours before the operation.

Your doctor may ask you to wash your child with a special soap on the morning of the surgery. Rinse well after using this soap.

After the Procedure

Your child will need to lie flat for 24 hours the first time a shunt placed. After that your child will be helped to sit up.

The usual stay in the hospital is 3 to 4 days.The doctor will check vital signs and neurological status often. Your child may get medication for pain. Intravenous fluids and antibiotics are given. The shunt will be checked to make sure it is working properly.

Outlook (Prognosis)

Shunt placement is usually successful in reducing pressure in the brain. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumor, meningitis, encephalitis, or hemorrhage, these conditions could affect the prognosis. The severity of hydrocephalus present before surgery will also affect the outcome.

Support groups for families of children with hydrocephalus or spina bifida are available in most areas.

The major complications to watch for are an infected shunt and a blocked shunt.

References

Etiological categories of neurological disease. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 28.

Kinsman SL, Johnston MV. Congential anomalies of the central nervous system. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 592.

Review Date: 11/22/2010.

Reviewed by: Kevin Sheth, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Disclaimer

Alisons Story

Pregnancy and spina bifida I wanted to write about my experience of having Jack and being pregnant. I have recently joined ASBAH's forum on Facebook and I realise how many other people with spina bifida are considering becoming a parent and thought it might be useful to share my experience.

I was 37 when, as a woman with spina bifida I became pregnant for the first time. Although it was a lovely surprise I have to admit it was also quite a shock having been told at the age of 20 I was infertile. Hence the pregnancy was unplanned as I had come to a point of acceptance years before that I wouldn't ever be a mum.

So there I was, standing in my bathroom in a state of disbelief staring at my pregnancy test as the word "pregnant" flashed up. I dropped the test stick in the sink and rushed in to my living room pacing the room. It was a mixture of elation and fear flooding through me all at once. Elation that once again the medical profession had got it wrong just like they told my mum I would probably never walk when I was two years old (I walked at 3 1/2). The realisation that I would in fact be a mum after so many years of believing I wouldn't. Then of course the fear. Fear for the baby as I hadn't been taking folic acid and fear for me. How would the pregnancy affect me and how could I physically cope with being a mum.

My pregnancy was full of professionals who although monitored me as a high risk "mum to be" appeared to have no specialist knowledge of spina bifida. Thank God for ASBAH and the medical advisers who I was really able to talk to and discuss and prepare myself for the way ahead.

My pregnancy wasn't easy. I went from walking without aids to being on crutches and barely able to dress myself at the end and other problems related to my disability worsened. Having said that I look back on the experience fondly and still remember the first time my unborn baby kicked me. It was Boxing Day and it was the best Christmas present I could ever have.

At 20 weeks pregnancy came a bit of a blow. My scan showed that my baby had talipes. They had been looking for spina bifida and had ruled it out up to then but since I too have talipes (clubfoot) and it can be associated with spina bifida I was told that they had to suspect that the baby could have some form of spina bifida even though they couldn't see it. Again I was fearful. Having a baby was going to be physically demanding enough for me but having a baby who also had physical problems to deal with seemed overwhelming. From then on I was scanned regularly until 30 weeks.

On 11th June 2008 I gave birth to my beautiful son Jack. He was born by emergency caesarean nearly 2 weeks overdue after I had been induced and he had gone into distress during labour. I have to say that one of the positive aspects of being a spina bifida mum in labour was that pain didn't scare me nor did medical intervention. The big disappointment was that my spina bifida meant that my caesarean had to be performed under general anaesthetic rather than a spinal anaesthetic so I wasn't awake to see him come into the world.

When I woke up I peered across the room to see my partner Michael holding this bundle in his arms. He brought him over to me and the midwife put him straight to my breast. It was love at first sight. I soon discovered why my labour hadn't progressed so well. He weighed in at 8 pound 14 oz and I'm only 4 ft 9 inches tall! My advice to other mums to be in my position is to push for a 36-week scan to estimate the baby’s size. I was offered one but was told it was optional and therefore didn’t have one as I’d had so many during my pregnancy. I think if I'd had one at that point they wouldn't have let me go overdue and the birth would have been a lot less traumatic for all of us whether it had been a planned Caesarean or a pre term vaginal delivery.

Jack started treatment for his clubfoot at 13 days old when he was put in plaster. His foot was gradually straightened using a series of weekly plasters, a small op and the boots and bars. He will have to wear them at night until he is 4 years old.

Jack doesn't have spina bifida. He was 10 weeks old before they finally ruled it out. I was relieved because even though I've achieved everything I have wanted to in life I'm glad he won't have to go through the operations and pain I had to put up with. And when he is 4 years old his foot will be completely corrected.

Caring for Jack through his treatment has been emotionally hard for me. Going to Great Ormond Street, albeit a fantastic hospital, bought back memories of my childhood that I would have rather left behind me. It's also been physically very challenging for me, as Jack is very tall and heavy for his age. My initial reservations about asking for help have subsided and I have managed to get some good support from occupational therapy in looking for equipment that will help me and strategies in helping me to get Jack be a bit more cooperative during change times so he doesn't fight and run away from me but gets rewarded for sitting still. I think though that asking for help has been the hardest aspect of being a new mum as I've fought all my life for maximum independence. You have to remember though that all new mums need help and not feel as though it's the disability getting the better of you.

A positive aspect of being a disabled mum is that I feel I am so much more used to assessing the risks that could be present for Jack. When you have a disability you have to plan ahead when you are going out and know your limitations. These become a way of life for a physically disabled person and they are excellent attributes to have as a mum. Also I've noticed how much of a shock it is to new able-bodied mums: having to think about ramps and access for buggies. Even though I walk independently I'm used to looking for lifts, handrails and ramps so a new pram didn't feel like a new obstacle; in fact it helped me get back on my feet by offering me something to hold on to... The best walking aid ever.... a pram with your new baby in it.

There are days when Jack is having tantrums that he makes me feel very physically inadequate. If he decides to run off and lie down on the ground in a temper there is nothing I can do to stop him. But I think every mum goes through these feelings so I try not to let it get to me. I know that all Jack really needs is love and affection. My disability is as insignificant to him as his foot problems are to me. They are just part of who we are and if anything add to the bond we have with each other.

Alison has spina bifida and is mum to Jack who is 2 years old.

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