Cephalic Vein

The candidate's comfort - patient's nightmare?

SUMMARY
Background is a necessary part of modern medicine, but the knowledge of men's close relationship to the nerves seemed to be inadequate.

Material and methods. We refer two patient stories that show the possible consequences of needle's projections of cephalic vein and radial artery.

Results. Both patients developed symptoms and clinical and neurophysiological findings suggestive of a lesion of radial nerve. One patient will most likely not develop a prolonged neuropathic pain, whereas in the second, the equivalent damage to the vagus radial lead to chronic and debilitating pain.

Interpretation. We discourage the distal part of the cephalic ("the candidate's comfort") as the first choice of cannulation and for training of inexperienced students. The vein should be reserved for patients where there is a lack alternative venous system and in acute situations where there is a need for rapid fluid infusion or blood transfusion.

The external branches of the vagus radiate and distal part of the cephalic vein and radial artery is anatomically close to each other. V. cephalic crosses the superficial branches of the radial nerve just proximal to carpo radial wrist while a stellate comes closer to the nerve branches. With precisely a few millimeters between blood vessels and nerve branch is the nerve fibers at particular risk of needlestick injury.

The superficial branches of the vagus radialis exposed to stab during the radial artery and its branches as the nerve crosses the cephalic vein.

Material and methods
We refer here from his own practice two patient stories that show potentially serious consequences of needle's projections of cephalic and A. radialis.

Patient 1
Before an elective surgery had a 45-year-old woman filed a needle in the cephalic just proximal to the left wrist ("the candidate's comfort"). During the introduction of the needle, she reported acute onset of pain radiating to the left middle finger. The next day she was tender in the left in-between finger and entered into and reduced extension force outcomes along the dorsal aspect of the port 2 and three finger. Press over the site triggered lancinating sensation over the radial side of hand. During a month disappeared from the ongoing, spontaneous pain, but sensibilities end ringer was still present.

Clinical neurological and neurophysiological examination revealed shock-like and lancinating pain by feathery pressure over the superficial branch of radial nerve. They found decreased sensation to light touch in a small area at the base of the left middle finger and a crown large area at the base of the left index finger. She had no tactile allodynia (pain with normally non-painful stimulus) but a Pressure hyperalgesia (increased pain on pressure) at the insertion site of the needle, as described above.

Patient 2
A 47-year-old man in connection with cardiac suffered severe pain during cannulation of the right radial a. In the first two weeks after the needles had no pain limited to the insertion site 5.5 cm proximal to wrist bending groove, then he developed severe pain along the radial side of forearm, and into the hand while the hand was swollen.

The clinical neurological examination five months after the injury, we found evidence of autonomic dysfunction and impaired sensibility, but no allodynia to light touch in the affected area radialis. He, however, had a local allodynia to light touch on the forearm and a hyperalgesia to pressure in a somewhat larger area.

After a year had been significantly reversed the swelling, but it could still vary in intensity. The hand appeared shiny and discolored (blue / red) and alternated between being warmer and colder than the left. The pain persisted with an intensity of 4-9 on a numeric scale from 0 - 10 (0 = no pain and 10 = maximum imaginable pain) and now includes all the fingers. Treatment with pregnable reduced pain intensity to 0-6 (average 4). The patient entered generally decreased power in the hand and loss of sensibility in the affected area radialis innervated.

Neurography
Neurography of the upper extremities was performed with a Dantec Counter Point, and with measurement of motor, distal latency, amplitude and conduction velocity of N. medianus and n ulnaris and measurement of sensory latency and conduction velocity of the same nerves. N. radialis' superficial branch was evaluated by measurement of sensory conduction velocity and response amplitude bilaterally.

It was with both patient's normal conditions in the motor and sensory fibers in n medianus and n ulnaris in the left upper limb, and in the radial nerve was the site like normal conditions for the sensory fibers.

Thin Fiber Function
Specific evaluation of small fiber function was performed using the thermal test and by measuring detection thresholds for heat, cold, heat pain and cold pain. The measurements were performed in innervation of radial nerve superficial branch bilaterally in spatium interosseus Primum.

For patient 1 showed thin fiber study normal and right side detection thresholds for hot and cold bilaterally, but slightly reduced sensitivity to be cold. The detection threshold for cold was of 29.9 ° C on the left side, compared with 30.9 ° C on the right side; heat pain threshold on the affected left side was 47.9 ° C, compared to 44.2 º C in the healthy hand. In addition, it was demonstrated kulde allodynia on the left side of the cold pain threshold 18.1 ° C, the normally below 10 º C on the right side.

For patient 2, there were greatly reduced sensitivity to both heat and cold on the right side compared to the left, with a heat detection threshold of 45.2 º C on the right, the normal 33.9 ° C on the left and cold detection threshold of 18.9 º C on the right side, compared to 30.8 ° C on the left side. Heat pain was abolished on the right, i.e. above 50 ° C, while it was normal on the left side (38.9 ° C). We found no kulde allodynia.

Interpretation of findings
For patient 1 interpreted the findings at the thermal test of involvement of the afferent fibers of small, predominantly of the afferent C-fibers are responsible for some heat pain, but perhaps also a slight affection of the afferent Aδ-fibers that are responsible for cold detection. It was also shown a hypersensitivity to cold, which could indicate an injury of some thin fibers, although the mechanisms of kulde allodynia not yet been fully clarified.

For patient 2 was the damage of thin fibers with a more pronounced involvement of both the hot and cold mediating pain mediating afferent C-fibers and the refrigerants to A-fibers. Despite normal findings on nerve conduction had on clinical grounds and based on a thermal test a lesion of the radial nerve. Pain picture, with simultaneous signs of autonomic dysfunction, led him to fulfill the criteria for complex regional pain syndrome type 2, formerly called causalgia.

Talk
They spoke of the patients were awake during the procedure, and insert reacted instantaneously with pain. Typically, local pain or radiating nerves throughout the supply area, there is the reason to recall that anesthetized patients will not be able to react.

Both patients developed symptoms and clinical and neurophysiological findings indicating damage of radial nerve. The clinical picture may give the appearance of damage to the thick, myelinised nerve fibers with reduced sensitivity to light touch. Affections of these cases were not of such as degree that it affected the results are nevrografi. There is also a reason to recall that nerve conduction is a rough survey, where only evaluates the function of the thick myelinated nerve fibers. Specific investigation (e.g. Thermal test) is required to detect damage to the thin nerve fibers.

Effects of nerve
Put in the nerve structures can lead to prolonged renal sensory function and severe pain conditions. As far as we know, there is no prevalence of nerve damage after cannulation of peripheral veins or arteries. A survey showed transient nerve injury in 1.7% of patients before surgery had a nerve plexus blockade. There is the reason to expect under reporting. The risk of injury has been shown to increase the injection of local anesthetic directly into the nerve. Nerve damage in general is a relatively common cause of peripheral neuropathic pain. Few studies have been published, but the incidence is 2.5 - 5.0% and up to 22.9%.

Patient 1 will most likely not develop chronic neuropathic pain. The spontaneous pain was in decrease a month after the injury, but she had persistent pressure-induced pain. The second example shows that similar damage of the radial nerve, triggered by kanye inserts, can give rise to chronic and debilitating pain.

It is thought that prolonged pain following a bite of a nerve due to damage of thin myelinated, nociceptive C-fibers. It is very rare that the nerve damage of pure thick fiber involvement causing pain. To confirm this hypothesis, one must examine the patients with and without pain after nerve injury. Very few such as studies have been performed, but in a study of patients with damage to the cranial nerves, the authors found no difference in the small fiber function on the affected side between patients with and without pain. Nevertheless, assume that the damage of nociceptive fibers is a prerequisite for the development of pain. Hyperexcitability of pain fibers (i.e., spontaneous combustion or spontaneous onset of action potentials) are believed to be the most common cause of pain after nerve injury.

The method that is used clinically for the detection of thin fiber's outcomes, has its limitations and will not be able to detect the failure and damage to the nerve fibers responsible for pain. This applies to both skin biopsies with detection of the density of thin fibers in the epidermis and the thermal test for the detection of renal function of the temperature mediating afferent nerve fibers. In anticipation of the new methods will still be needed for the detection of small fiber damage with the methods, we have been available. For the individual patient may be important to document nerve damage, especially where conventional nerve conduction is normal.

Cholesterol Function

Cholesterol, essential organic compound belonging to fats, lipids, and who have a so-called steroid skeleton ( steroid ) in its chemical structure.

Cholesterol is found in many parts of animal and human organism, including in most of the body cell membranes (membranes), both those that surround the cells and those found in these. Some places are cholesterol as such, but it is stored and transported predominantly in esterified form, which cholesteryl.

Formation and function
Most of the organism's cells produce cholesterol, so we do not rely on to get the drug supply. In cells synthesized cholesterol from acetyl coenzyme A in a process that has 20-30 enzymatic steps. Cholesterol is also supplied through food, in amounts that depend on diet composition.

Cholesterol has several functions in the organism, including important component of cell membranes. It further involved in the transport of blood fats, and it is a precursor in the formation of both steroid hormones (sex hormones and adrenal corticosteroids) that of bile acids and vitamin, D.

Cholesterol in the blood
Admissions, transport and storage of fats (lipids) takes place through a series of complicated processes, in which cholesterol in several places played an important role. Lipids, which are insoluble in aqueous solutions, such as blood plasma, blood must be transported together with other materials. This happens in so-called lipoproteins, which is a kind of small "package" with an inner portion, including contains cholesteryl and an outer sheath with both cholesterol and protein. It is in these lipoproteins, of which there are several types, most of the blood cholesterol present and measured.

Two of the most important blood-transporting lipoproteins is LDL (LowDensity Lipoprotein, the "bad" cholesterol) and HDL (HighDensity Lipoprotein, the "good" cholesterol). LDL and HDL together constitute the bulk of cholesterol in the blood. Cholesterol in the blood given as mmol / l, and normal values in adults can be 4-6. Previously, cholesterol in the blood indicated as mg / dl and corresponding normal asset value was 150-250.

Cholesterol, health and disease
Cholesterol turnover plays a role in several disease states. Much cholesterol excreted in bile and gall stones consist largely of cholesterol. In certain diseases, eg. diabetes and hypothyroidism , the amount of cholesterol in the blood may be increased as a result of the disease. There are also conditions of inherited, significantly elevated cholesterol levels in the blood.

Much attention is focused on the role cholesterol plays in the development of arteriosclerosis (hardening of the arteries), the compound found in the deposits that form in blood vessel's walls. Empirically, there is a correlation between cholesterol in the blood and the likelihood that it will develop symptomatic atherosclerosis, with eg. angina pectoris or myocardial infarction . The likelihood of such a disease is greater the higher the cholesterol level is, even though at high levels only is someone who develops the disease. Many factors other than cholesterol (eg. Smoking, high blood pressure) seems to be in when it comes to diseaseing risk.

Cholesterol levels in the blood is again from experience, depending on the diet containing cholesterol and fat in general, especially when saturated fat. A sustained high intake of saturated fat leads to increased cholesterol in the blood. Unsaturated fats do not have the same effect, and is therefore, beneficial in food. Saturated fats are found mostly in milk and milk products, margarine and hard in animal meat, while unsaturated fats found in vegetable oils and in fish and sea creatures. In particular, cholesterol-rich food sources are milk fat, egg yolks and offal.

With our Western dietary habits to cholesterol in the blood, which is low in infants, increasing to adulthood and be relatively high compared with that in populations with other dietetic habits. In southern Japan, where the diet contains little fat, so middle-aged men's average cholesterol levels 40% lower than in men of similar age in Oslo.

Measurement of cholesterol
The relationship between cholesterol levels and the likelihood of developing cardiovascular disease has made it plain with measure cholesterol in the blood of many adults. Assessments of the level and by what measures, if any, recommended is dependent on the person's age, as young people often are somewhat lower in level than the older. A common view is that it is good for total cholesterol in the blood of adults is less than five mmol / l located above this level, given often dietary advice, including in less intake of cholesterol-rich food sources of fat and in general, especially saturated fat. The higher your cholesterol level is, the more important it is to bet on the expensive side. At high values (6-7 mmol / l), and especially at very towering (above eight mmol / l), is often recommended as well as use of cholesterol-lowering drugs, as there are several. In assessing the level of cholesterol in blood is not only the total amount of important, but also the relationship between HDL and LDL. The larger share of total cholesterol posed by HDL, the better it is estimated that person's situation to be.

Cholesterol Function

Cholesterol Function

Cholesterol Definition

Cholesterol
Fatty substance that belongs to the sterols. Cholesterol is found in all cell types and used in the body, including the production of bile acids and steroid hormones. It is included as a component of cell membranes. The synthesis of cholesterol in the body is carefully regulated. Cells that supplied cholesterol, reduces its own synthesis. From the food supplied cholesterol from animal foods such as eggs, meat and offal, butter, milk and milk products. Nevertheless, the cholesterol from your diet is a relatively small part of the overall cholesterol turnover in the body. In the blood, cholesterol works with the proteins in the transport of fat the formation of lipoprotein is.

High blood cholesterol is an important risk factor for cardiovascular disease. Amount to particular type of fat in the diet is consequential for cholesterol in the blood. There is a strong correlation between the intake of hard fat (the sum of saturated fat and trans fat), serum cholesterol (LDL cholesterol) and incidence of myocardial infarction. A change of diet's fat intake, ie a reduction of saturated fat and an increase of unsaturated fats, lowers the amount of LDL cholesterol in the blood and reduces the risk of heart attack.

There are a number of drugs that lower a cholesterol level in blood (like statins).

Tonsils Bad Breath

Bad breath, the common term for a state with fetid breath.

Causes
Bad breath occurs as a symptom of many diseases. It can either be about local diseases of the oral cavity, pharynx, esophagus, stomach or upper and lower respiratory tract, or system diseases and poisoning.

In about 90% of cases the cause of the mouth it can be about poor oral hygiene, dental caries (cavities) and inflammation of the gums (gingivitis both acute and chronic periodontitis). The bad smell is due, mostly evaporation of sulfur compounds resulting from bacterial protein degradation. Of plaque and tongue back and dry mouth is important causes of bad breath. When food gets stuck between defective teeth and broken down by bacteria in the mouth, the exhaled a putrid odor, seeping blood from inflamed gum's often unpleasant odor. Patients rarely even notice the smell, but it may be accompanied by a bad taste in your mouth. When bad breath should always first consult your dentist. Some may even imagine that they have bad breath and no reason to avoid other people. In rare cases, large due to the dreadful spirit of a tumor in the mouth where there is dead tissue, and bacteria grow on the surface. The smell can also come from a chronic tonsillitis (tonsillitis) or from an inflammation of the nasal sinuses. Then pus drained out into the stomach compartment. At a special form of chronic nesekatarr, ozoena or stinknese, creating a sweet smelling discharge. Because the patient's sense of smell is lost at the same time, only the surroundinges that are disturbed by the stench.

Among the diseases of the lower respiratory tract that can cause bad breath to include bronchiectasis. The smell is caused when the rotting slime. By lung, abscess developed vevshenfall and suppuration a very penetrating odor.

Bad breath originating from the digestive tract, usually caused by expansion of the esophagus, where food particles can get caught and go to decay. A more rare cause is diseases where the food stagnates in the stomach while a lack of stomach acid also gives bacteria the ability to multiply in the stomach contents. Gastritis, dyspepsia and reflux of gastric contents back into the esophagus may be accompanied by halitosis, and the bacterium Helicobacter pylori plays a role in some people. Bowel disorder, eg. inflammatory bowel disease, accompanied occasionally by bad breath.

Halitosis can also be caused by bad-smelling substances that are brought around the body with the blood, is excreted in the lungs. The system disease is often very characteristic smell and was previously the important diagnostic aid to the doctor. Acetone odor indicates very serious complications of diabetes, and ammonia odors indicate kidney failure. When liver failure is a characteristic sweetish odor. Odor of bitter almonds may be the symptom of poisoning with hydrocyanic acid (potassium cyanide). Rare metabolic disorders (eg. trimethylaminuria) can cause halitosis. Diet (garlic, low carbohydrate content), alcohol and smoking affect the smell of exhaled.

Treatment
Treatment directed at the cause of bad breath. Usually, there will be about improving the cleaning of teeth, spaces between the teeth, tongue and any prostheses, and treatment of the gum disease dentists. Mouth Chicks with chlorhexidine may help, but can cause discoloration of the teeth and tongue, if dry mouth is recommended to drink more water, use sugar-free lozenges or artificial saliva.

Branchial Cyst Symptoms

Branchial Cyst, fluid-filled cavity that is residual after fetal life gill furrows. Most common in front of or below the upper part of the large sloping neck muscles (sternocleidomastoid muscle). Often appear in young adults in connection with the throat infection (tonsillitis). The treatment is surgical removal.

Acute Tonsillitis

What is Tonsillitis? is collective term for various inflammations of the tonsillar one. Tonsillitis can be acute or chronic.

Acute tonsillitis (tonsillitis acuta) occurs most commonly in children over two years and adolescents. This is due to the lymphatic tissue is begins to shrink after puberty.

CAUSES AND PREVALENCE
Inflammation may be caused by bacteria or viruses. The best-known throat inflammation is bacterial infection beta hemolytic streptococcus is group A, the physician can demonstrate by means of a rapid test.

A viral infection that usually also cause symptoms from the tonsils, is infectious mononucleosis , which attacks the lymphatic system in general. It is usually benign, but the recovery phase is longer than the bacterial tonsillitis.

SYMPTOMS
The symptoms of tonsillitis are fever and pain on swallowing. The pain often draws from the throat and up to both ears. The temperature is usually between 38 ° C and 40 ° C. Tonsils are swollen, red and yellow coating, and lymph nodes of the neck behind the jaw angle is almost always swollen and tender.

THE DIAGNOSIS
The diagnosis is made as a rule on the basis of medical history and inspection of the palate tonsils. The marked symptoms are common to do a rapid test in the pus from the tonsils to determine whether inflammation caused beta hemolytic streptococci.

TREATMENT AND COMPLICATIONS
If the throat inflammation caused by hemolytic streptococci, disease is the patient with penicillin for ten days. If the throat pain is expressed, the patient can take an analgesic drug, for example. paracetamol .

Complications of

acute tonsillitis are rare and include neck abscess (peritonsillar abscess), rheumatic fever and glomerulonephritis.

PROGNOSIS
If symptoms are moderate and there are signs of complications, the disease is often cured in a week's time.

Chronic tonsillitis
Chronic tonsillitis (tonsillitis Chronica) is most common in adolescents and young adults. The condition is characterized generally by frequent episodes of acute tonsillitis or longer periods of throat pain and moderate fever.

TREATMENT
One can treat chronic tonsillitis with a longer course of antibiotics. If treatment provides significant improvement, you can remove the tonsils surgically.

How to deal with Acne

As we all know, there are emotional effects caused by acne. More than red-light bumps on the face, there are the acne effects that cannot be cured several creams or emotional scars left by acne.

In good health, there is no expert dermatologist or doctor to give you the best answer to the problem of acne.

According to the fact of studies, acne is awfully common issue when you're in their teens. For teenagers there will be pain, acne, it is very difficult to deal with the social impacts of acne.

There are these marks of depression, self-pity and even shame. Being a parent of your teenager who has this difficulty could be one of the supreme help out. What may I do? You can do many things.

Be reminiscent of your child who acne is impermanent.

While the guardian, you must always there and encourage your child. Probably, it is so low, because the means people and criticisms of her or his grip. Tell him it will not last long and will be successfully overcome. Never stop explaining the meaning of progress, despite the negative reactions of others through their words are not important.

Take good care of the child to a dermatologist for acne.

Do not wait for their teenage acne problem to get worse before they see a dermatologist. The sooner the better, it can be very nice, but true and to realize the truth about this. You need to find a dermatologist who deserves your trust. Being a child, if you visit a dermatologist. Furthermore, help your child follow the instructions and guideline's dermatologist.

Guide your child to do well on acne, it is recommended.

There are some things or acts that may worsen acne. Make sure your child is coming up those who are not what they do and that would only cause negative effects. Explain cause and effect of acne problems and make sure t answer questions that your child has.

Decrease's confident has acne on her face.

Confidence falls when all those mocks and teases to arise. The fact that his son would be bitter. Be there to increase self-esteem, or the inside. Be generous with praise, but do not use them only flatter. Tell your child about how great is his talent. This would lift their morale.

Are you a father, and that can help you feel better your teen through poor judgment of the people with acne? It's just a phase dies in the end. Be there and support your child as if no one could.

Homemade masks against acne

Natural treatments for acne

Homemade masks for acne, and are tired of that acne take over your face and do not know how to control it, today we'll show you a natural home treatment consisting of a mask-based brewer's yeast (a few tablespoons) and the necessary water, all interests to mask your acne is to mix the ingredients mentioned above into a paste that is not very washed. Apply on the face and let it dry (15 - 20 minutes). You must rinse in warm water and cold. Take care your face after acne homemade mask with this quick and easy.

Note: For any natural homemade mask, it is always advisable to test anti-allergic in any body part preferably near the back of the ear or neck, if after a few minutes, the skin is red, or feel itchy , wash your face immediately and choose not to apply this mask.

Acne Cysts

Acne, hormone-induced inflammation of the sebaceous glands. Acne is a very common condition, especially during puberty and adolescence, but it can persist for years after that. Acne cannot be found in children before they reach puberty. The exception is children in the first months of life, which can get acne because sebaceous glands are more active then than later in childhood.

Acne Variants
There are several clinical variants of acne. Acne vulgaris is the most common form and consists of comedones and red nodules with or without pus formation in the skin. Pimples are usually limited to the face and upper chest and back, which is the area that has the largest oil production.

Komedonen is also common. This form of acne consists of numerous small comedones and inflammatory changes.

Acne Cystic and Acne fulminans  serious forms of acne, which generate large, deep and liquid with inflammatory changes in the face and / or on the chest and back. It can clear up a lot of pus (this polished is sterile). In addition, it can cause sores and scabs, which can lead to significant scarring when they heal.

Iron Deficient Anemia

Iron Deficiency Anemia is the most common cause of anemia that particularly affects women of childbearing age. Young women have a greater need for iron than men because of the additional loss through menstrual blood. It also requires pregnancy and lactation increased supply of iron. Children and youth in growth have large iron needs in relation to energy intake and may therefore be in a danger zone.

Researcher suggests that iron-deficiency anemia affect about. 5% of younger women, which was lower than for just a few decades ago. There are several reasons for this positive development, but the increased use of iron tablets has probably the greatest importance.

Iron-deficiency anemia is a far more serious problem in developing countries than in developed countries, both in terms of occurrence and extent. A general lack of food with low iron content leads to an anemia that can worsen chronic and worms.

Questions about how iron supply can best be increased in groups that may have too little iron supplied through the diet is highly debated. There is little disagreement that the most important measures must be to encourage an increased consumption of iron-rich foods, mainly cereals and wholemeal flour. In country Sweden, sifted flour added iron, while in some country was only goat cheese that is iron fortified. Iron tablets to those who really need extra supplements of iron, seems to be the best solution in addition to a balanced normal diet.

The diagnosis of iron deficiency is made by blood tests. Detection of base serum iron and despicable saturation of the transport protein, transferrin iron deficiency it meant. Another method is the indirect measurement of body iron stores by determining the level of ferritin in the blood. Ferritin consists of a spherical protein shell (apoferritin) that can bind iron, and thereby saves iron in the body. Some of the ferritin "leak" into the blood and the amount of ferritin in the blood correlates well with body iron stores. Values ​​below 10 mcg in the serum of women and 30 micrograms in the serum of men may be perceived as a sign of iron deficiency.

Megaloblastic Anaemia

Megaloblastic because the organism does not absorb enough vitamin B 12 or folic acid from the intestine. It might be in rare cases due to extremely low levels dietary habits or poor diet. The most familiar type of Megaloblastic is pernicious anemia is an autoimmune disease characterized by cell depletion in gastric cordially (atrophic gastritis). Which causes the stomach loses its ability to produce hydrochloric acid and secrete a particular protein - intrinsic factor - which is necessary for efficient absorption of vitamin B 12 at the end of the small intestine.

Beyond the general symptoms of anemia, patients may have nervous system symptoms (numbness in hands and feet), burning tongue (red and smooth) and time disturbances, which become permanent if the patient does not quickly get the right treatment. In the blood, we find a strong reduction of the number of red blood cells, and relatively sizeable number of very large red blood cells.

Diagnosis is made by combined studies of blood and bone marrow sample from the stomach and measurement of the vitamin content of the blood. Pernicious anemia usually occurs in adulthood. The disease led to earlier death within a few years (pernicious means devastating). Now, the disease can be treated effectively with an injection of vitamin B 12 approx. every three months.

What is anemia caused by

Anemia Causes
The average lifespan of the red blood cells is about 120 days. Every hour is nine billion worn-out red blood cells taken out of circulation and broken down. The organism usually forms the same number of new blood cells in bone marrow, where most of the production of blood cells takes place. A distinction is made between several main causes of anemia:

1. Bleeding Anemia
In a major bleeding occurs an acute shortage of blood. Blood loss must be replaced immediately, otherwise the patient into a life-threatening shock, supported by high blood pressure. The acute and major bleeding condition must immediately be treated with fluids, preferably directly into the bloodstream (blood transfusion). The organism can pretty quickly replace the plasma with tissue fluid that seeps into the blood vessels and may also quickly remedy the loss of white blood cells and plasma proteins. The organism can not increase its production of hemoglobin and red blood cells rapidly. In a liter of blood is the same number of red blood cells that the organism normally produces in a month. Therefore, the recovery time after a severe bleeding anemia demonstrated that slowly improves.

It is characteristic that in this phase can be detected increased numbers of immature red blood cells (reticulocytes). A similar but chronic bleeding-related anemia may be caused by seeping bleeding from internal organs (such as bleeding ulcers), strong, long lasting menstrual bleeding or hemorrhoids.

2. Anemia with impaired production of red blood cells.
Radiation injuries may be the cause of the anemia of this type and also to a number of disorders of the bone marrow, where the production of normal blood cells is reduced or stopped (leukemias and aplastic anemias).

3. Mangelanemier
This is the most common anemia. When a deficiency anemia is the organism loss of another material that is necessary for the production of blood cells. Hit hearing including iron deficiency anemia and megaloblastanemi.

4. Hemolytic anemias
Hemolytic anemia due to red blood cells are destroyed so fast that production is not keeping pace with consumption. Enhanced hemolysis (breakdown of blood cells) seen in hereditary structural defects in red blood cells, after insertion of artificial heart valves, as adverse reactions to the use of certain drugs and in autoimmune conditions. In almost one third of the cases detected no certain explanation. Some important types of anemia does not fit into this classification. On a number of chronic conditions (infections, inflammation, and cancer immunopatier) demonstrated mild to moderate anemia (Hb 12.9 g/100 ml), where the individual red cells can have a normal size and content of hemoglobin. The cause is often multifactorial (lack of iron and vitamin B 12 in particular due. Malabsorption, possibly complicated with increased hemolysis, decreased release of iron from the store, or reduced production of normal red blood cells due. Due to illness, etc.). There are also hereditary conditional errors in the production of hemoglobin.

5. Hereditary anemias contingent
There are forms of inherited anemia, "retreating" (recessive) and resulting from genetic errors in the blood pigment hemoglobin. One category of such anemias (thalassemia) are particularly frequent in Mediterranean countries, another (sickle cell anemia) in Africa.

In thalassemia, the production of hemoglobin defect, and by the severe form (thalassemia major), the patient must regularly receive blood transfusions or undergo a stem cell transplant . New technology has made it possible to determine whether the fetus has genes for thalassemia and other inherited defects in hemoglobin synthesis. Both parents of children with thalassemia in the severe form are carriers of a genetic defect of hemoglobin, but this is balanced by the fact that these people also have a normal gene for the production of hemoglobin. They feel very rarely sick even if they have moderate anemia (thalassemia minor). Average one-quarter of children to two facilities will be disease carriers unit from each parent.

Anemia Signs and Symptoms

Anemia, meaning that too few erythrocytes (red blood cells) circulating around the body. A good indirect measure of the number of erythrocytes is to measure the concentration of hemoglobin (Hb). Anemia is defined as a reduction of hemoglobin below the lower limit of the patient's age and gender. A man is anemic when the Hb falls below 13 g/100 ml, while a woman is anemic when the Hb falls below 12 g/100 ml. Actually, anemia either a diagnosis or disease. Anemia is a sign of disease. The doctor's task is to determine the cause of the patient is anemic. It may be simple, such as when the patient has a bleeding ulcer. Nevertheless, often the cause is far from obvious, and thorough investigations are required.

Symptoms / signs
Moderate anemia can present with the indisposed and decreased endurance. At a more severe anemia, the patient is pale and suffering from fatigue, sleepiness and sometimes headaches. The patient has a tendency to get dizzy (the black spots on the eyes) and to pass out. In severe cases, you get rapid pulse, palpitations, ringing in the ears and shortness of breath because the heart tries to remedy the lack of oxygen by pumping the oxygenated blood around faster.

Cause Acne

The cause of acne is a combination of several factors, including increased sebum production is the key. Increased sebum production due to an interaction between the sebaceous glands and the stimulation of androgens (male sex hormones). Hormones that can be converted to b, locally in the sebaceous glands are also found in women. The error is usually not that there are too many androgens, but that an estimated genetic system causes the sebaceous glands to respond particularly strongly to hormonal stimulation.

The first step in the development of acne is the formation of a horn narrowing or "stopper" in sebaceous gland opening, called a mikrokomedon. This leads to the retention of sebum and sebaceous gland. Blocked exit times (comedones) can be seen as black dots (blackheads) or as small bumps in the skin. The inflammation of the glands caused by normal penetrates into the sebaceous glands and breaks down the suet, and that the degradation products of this process come out of the tissue around the sebaceous gland. Degradation products activate the immune system. In this way there arises from an inflammation, possibly with formation of pus that can clear up the skin's surface.

In some cases, acne can be triggered or exacerbated, by the sun, called Mallorca acne or acne summer. Acne can also be triggered by greasy face creams (cosmetic acne), by contact with hydrocarbons (this can be an example. Look at the thighs of asphalt workers), or using certain medications such as cortisone (steroid acne) or anticonvulsants such as barbiturates or hydantoins. It is possible that excessive intake of milk may increase the tendency for acne. Otherwise, studies show that diet is important in acne. Acne is not caused by filth and is not contagious, either from person to person or from the skin site to skin a site. Stress and unhappiness seem to aggravate acne in some patients.

Acne Vulgaris

Acne Variants
There are several clinical variants of acne. Acne vulgaris is the most common form and consists of comedones and red nodules with or without pus formation in the skin. Pimples are usually limited to the face and upper chest and back, which is the area that has the largest oil production.

Blackheads are also common. This form of acne consists of numerous small comedones and inflammatory changes.

Acne conglobata and acne cystic serious forms of acne, which generate large, deep and liquid with inflammatory changes in the face and / or on the chest and back. It can clear up a lot of pus (this polished is sterile). In addition, it can cause sores and scabs, which can lead to significant scarring when they heal.