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Heart Attack

(Myocardial Infarction)

Heart attack

A heart attack (also known as a myocardial infarction) is the death of


heart muscle from the sudden blockage of a coronary artery by a blood
clot. Coronary arteries are blood vessels that supply the heart muscle
with blood and oxygen.

Blockage of a coronary artery deprives the heart muscle of blood and


oxygen,causing injury to the heart muscle. Injury to the heart muscle
causes chest pain and chest pressure sensation. If blood flow is not
restored to the heart muscle within 20 to 40 minutes, irreversible death
of the heart muscle will begin to occur.

Muscle continues to die for six to eight hours at which time the heart
attack usually is "complete." The dead heart muscle is eventually
replaced by scar tissue.Approximately one million Americans suffer a
heart attack each year. Four hundred thousand of them die as a result of
their heart attack.

Causes for heart attack

Atherosclerosis
Atherosclerosis is a gradual process by which plaques
(collections) of cholesterol are deposited in the walls of arteries.
Cholesterol plaques cause hardening of the arterial walls and
narrowing of the inner channel (lumen) of the artery. Arteries that are
narrowed by atherosclerosis cannot deliver enough blood to maintain
normal function of the parts of the body they supply.

For example, atherosclerosis of the arteries in the legs causes reduced


blood flow to the legs. Reduced blood flow to the legs can lead to pain
in the legs while walking or exercising, leg ulcers, or a delay in the
healing of wounds to the legs. Atherosclerosis of the arteries that
furnish blood to the brain can lead to vascular dementia (mental
deterioration due to gradual death of brain tissue over many years) or
stroke (sudden death of brain tissue).

In many people, atherosclerosis can remain silent (causing no


symptoms or health problems) for years or decades. Atherosclerosis

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can begin as early as the teenage years, but symptoms or health
problems usually do not arise until later in adulthood when the arterial
narrowing becomes severe.

Smoking cigarettes, high blood pressure, elevated cholesterol, and


diabetes mellitus can accelerate atherosclerosis and lead to the earlier
onset of symptoms and complications, particularly in those people who
have a family history of early atherosclerosis.

Coronary atherosclerosis (or coronary artery disease) refers to the


atherosclerosis that causes hardening and narrowing of the coronary
arteries.

Diseases caused by the reduced blood supply to the heart muscle from
coronary atherosclerosis are called coronary heart diseases (CHD).
Coronary heart diseases include heart attacks, sudden unexpected
death, chest pain (angina), abnormal heart rhythms, and heart failure
due to weakening of the heart muscle.

Atherosclerosis and angina pectoris


Angina pectoris (also referred to as angina) is chest pain or pressure
that occurs when the blood and oxygen supply to the heart muscle cannot keep
up with the needs of the muscle. When coronary arteries are narrowed by more
than 50 to 70 percent, the arteries may not be able to increase the supply of
blood to the heart muscle during exercise or other periods of high demand for
oxygen.

An insufficient supply of oxygen to the heart muscle causes angina. Angina that
occurs with exercise or exertion is called exertional angina. In some patients,
especially diabetics, the progressive decrease in blood flow to the heart may
occur without any pain or with just shortness of breath or unusually early fatigue.

Exertional angina usually feels like a pressure, heaviness, squeezing, or aching


across the chest. This pain may travel to the neck, jaw, arms, back, or even the
teeth, and may be accompanied by shortness of breath, nausea, or a cold sweat.
Exertional angina typically lasts from one to 15 minutes and is relieved by rest or
by taking nitroglycerin by placing a tablet under the tongue.

Both resting and nitroglycerin decrease the heart muscle's demand for oxygen,
thus relieving angina. Exertional angina may be the first warning sign of
advanced coronary artery disease. Chest pains that just last a few seconds
rarely are due to coronary artery disease.

Angina also can occur at rest. Angina at rest more commonly indicates
that a coronary artery has narrowed to such a critical degree that the

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heart is not receiving enough oxygen even at rest. Angina at rest
infrequently may be due to spasm of a coronary artery (a condition
called Prinzmetal's or variant angina). Unlike a heart attack, there is no
permanent muscle damage with either exertional or rest angina.

Atherosclerosis and heart attack

Occasionally the surface of a cholesterol plaque in a coronary artery


may rupture, and a blood clot forms on the surface of the plaque. The clot blocks
the flow of blood through the artery and results in a heart attack (see picture
below).

The cause of rupture that leads to the formation of a clot is largely unknown, but
contributing factors may include cigarette smoking or other nicotine exposure,
elevated LDL cholesterol, elevated levels of blood catecholamines (adrenaline),
high blood pressure, and other mechanical and biochemical forces.

Unlike exertional or rest angina, heart muscle dies during a heart attack and loss
of the muscle is permanent, unless blood flow can be promptly restored, usually
within one to six hours.

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While heart attacks can occur at any time, more heart attacks occur
between 4:00 A.M. and 10:00 A.M. because of the higher blood levels
of adrenaline released from the adrenal glands during the morning
hours. Increased adrenaline, as previously discussed, may contribute
to rupture of cholesterol plaques.

Approximately 50% of patients who develop heart attacks have


warning symptoms such as exertional angina or rest angina prior to
their heart

How is a heart attack diagnosed

When there is severe chest pain, suspicion that a heart attack is


occurring usually is high, and tests can be performed quickly that will
confirm the heart attack.

A problem arises, however, when the symptoms of a heart attack do


not include chest pain. A heart attack may not be suspected, and the
appropriate tests may not be performed. Therefore, the initial step in
diagnosing a heart attack is to be suspicious that one has occurred.

• Electrocardiogram.

An electrocardiogram (ECG) is a recording of the electrical


activity of the heart. Abnormalities in the electrical activity usually
occur with heart attacks and can identify the areas of heart muscle
that are deprived of oxygen and/or areas of muscle that have died.

In a patient with typical symptoms of heart attack (such as crushing


chest pain) and characteristic changes of heart attack on the ECG, a
secure diagnosis of heart attack can be made quickly in the emergency
room and treatment can be started immediately.

If a patient's symptoms are vague or atypical and if there are pre-


existing ECG abnormalities

Ffor example, from old heart attacks or abnormal electrical patterns


that make interpretation of the ECG difficult, the diagnosis of a heart
attack may be less secure. In these patients, the diagnosis can be
made only hours later through detection of elevated cardiac enzymes
in the blood.

Blood tests.

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Cardiac enzymes are proteins that are released into the blood by
dying heart muscles. These cardiac enzymes are creatine
phosphokinase (CPK), special sub-fractions of CPK (specifically, the MB
fraction of CPK), and troponin, and their levels can be measured in
blood.

These cardiac enzymes typically are elevated in the blood several


hours after the onset of a heart attack. A series of blood tests for the
enzymes performed over a 24-hour period are useful not only in
confirming the diagnosis of heart attack

The changes in their levels over time also correlates with the amount
of heart muscle that has died.

The most important factor in diagnosing

Rapid evaluation allows early treatment of potentially life-threatening


abnormal rhythms such as ventricular fibrillation and allows early
reperfusion (return of blood flow to the heart muscle) by procedures
that unclog the blocked coronary arteries. The more rapidly blood flow
is reestablished, the more heart muscle that is saved.

Large and active medical centers often have a "chest pain unit" where
patients suspected of having heart attacks are rapidly evaluated. heart
attack is diagnosed, prompt therapy is initiated.

What is new in heart attack

Greater public awareness about heart attacks and changes in lifestyle


have contributed to a dramatic reduction in the incidence of heart
attacks during the last four decades.

Improved anticoagulant drugs such as hirudin and hirulog, are being


tested and may complement current therapies. The role of the "super
aspirins" [abciximab (Reopro) and eptifibatide (Integrilin)] is currently
being investigated as well.

More effective versions of TPA are being developed. Increasingly,


paramedics can do ECGs in the field, diagnose a heart attack, and take
patients directly to hospitals that have the ability to do PTCA and
stenting.

This can save time and reduce damage to the heart. At present, the
accepted best treatment for a heart attack is identification promptly of
the diagnosis, and transport to a hospital that can perform prompt

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catheterization and PTCA or stenting within the first 90 minutes of the
cardiac event.

Research also has shown that inflammation may play a role in the
development of atherosclerosis, and this is an active area of current
investigation.

Treatment for heart attack

Thrombolytic (fibrinolytic or clot dissolving) therapy has been shown to


reduce death from heart attacks similarly in men and women;
however, the complication of strokes from the thrombolytic therapy
may be slightly higher in women than in men.

Emergency percutaneous transluminal coronary angioplasty (PTCA) or


coronary stenting for acute heart attack is as effective in women as in
men;

however women may have a slightly higher rate of procedure-related


complications in their blood vessels (such as bleeding or clotting at the
point of insertion of the PTCA catheter in the groin) and death.

This higher rate of complications has been attributed to women's older


age, smaller artery size, and greater severity of angina. The long-term
outcome of angioplasty or stenting however, is similar in men and
women, and should not be withheld due to gender.

The immediate mortality from coronary artery bypass graft surgery


(CABG) in women is higher than that for men. The higher immediate
mortality rate has been attributed to women's older age, smaller artery
size, and greater severity of angina

Prevention of Heart Attack:

Reasonable advice includes the following:

The cardiovascular benefits of regular exercise are a diminished


tendency of blood to form clots, an improved cholesterol profile, more
efficient use of oxygen by the muscles.

a larger volume of blood pumped with each heartbeat, and during


periods of exertion, greater dilation of the arteries, a lower heart rate
and lower blood pressure.

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Start slow and easy:For the first week or two, exercise at an easy
pace for no more than 10 to 20 minutes at a time.

Build up gradually – As a general rule, do not increase either the


intensity, frequency or duration of your exercise sessions by more than
10 percent each week.

Exercise often – It is safer to get modest amounts of exercise several


times a week than to try making up for days or weeks of inactivity with
a single, prolonged workout.

Do not overexert – Beginners should avoid pushing their heart rate


higher than 70 percent of its maximum. (Your maximum rate equals
roughly 220 minus your age).

Warm up – Begin every workout with a gentle warm-up to boost


circulation to the heart muscle. Jog in place, ride a stationary bicycle or
do calisthenic exercise for a few minutes. Then stretch to reduce the
risk of injury.

Cool down – Rapid muscle movement helps pump blood back to the
heart. If you stop exercising abruptly, the heart's blood supply may
drop abruptly.

Do not eat and run – During and after a meal, the body sends extra
blood to the digestive organs, leaving less blood for the heart and
muscles. Try to wait at least two hours after a heavy meal before
exercising.

Watch the weather – Blood vessels in the skin and the limbs
constrict when it is cold outside, making it more difficult for the heart
to pump blood throughout the body.

If you exercise outdoors in frigid weather, dress in warm layers and do


not push yourself too hard.

Working out in hot weather can also threaten the heart, since heavy
sweating decreases the total volume of blood, and in turn, the amount
flowing to the heart muscle.

Take pollution to heart - Exercising in polluted air increases blood


levels of carbon monoxide, which raises the risk of heart attack by
replacing oxygen in the blood.

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SWINE FLU(H1N1)

swine flu (novel H1N1 influenza A swine flu)

Swine flu (swine influenza) is a respiratory disease caused by viruses


(influenza viruses) that infect the respiratory tract of pigs and result in
nasal secretions, a barking-like cough, decreased appetite, and listless
behavior.

Swine flu produces most of the same symptoms in pigs as human flu
produces in people. Swine flu can last about one to two weeks in pigs
that survive. Swine influenza virus was first isolated from pigs in 1930
in the U.S. and has been recognized by pork producers and
veterinarians to cause infections in pigs worldwide.

0 In a number of instances, people have developed the swine flu


infection when they are closely associated with pigs (for example,
farmers, pork processors), and likewise, pig populations have
occasionally been infected with the human flu infection.

In most instances, the cross-species infections (swine virus to man;


human flu virus to pigs) have remained in local areas and have not
caused national or worldwide infections in either pigs or humans.
Unfortunately, this cross-species situation with influenza viruses has
had the potential to change.

Investigators think the 2009 swine flu strain, first seen in Mexico,
should be termed novel H1N1 flu since it is mainly found infecting
people and exhibits two main surface antigens, H1 (hemagglutinin type
1) and N1 (neuraminidase type1). Recent investigations show the eight
RNA strands from novel H1N1 flu have one strand derived from human
flu strains, two from avian (bird) strains, and five from swine strains.

History of swine flu (H1N1) in humans

In 1976, there was an outbreak of swine flu at Fort Dix. This virus is not
the same as the 2009 outbreak, but it was similar insofar as it was an
influenza A virus that had similarities to the swine flu virus. There was
one death at Fort Dix.

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The government decided to produce a vaccine against this virus, but
the vaccine was associated with neurological complications (Guillain-
Barré syndrome) and was discontinued.

Some individuals speculate that formalin, used to inactivate the virus,


may have played a role in the development of this complication in
1976. There is no evidence that anyone who obtained this vaccine
would be protected against the 2009 swine flu.

One of the reasons it takes a few months to develop a new vaccine is


to test the vaccine for safety to avoid the complications seen in the
1976 vaccine. New vaccines against any flu virus type are usually
made by growing virus particles in eggs.

A serious side effect (allergic reaction such as swelling of the airway)


to vaccines can occur in people who are allergic to eggs; these people
should not get flu vaccines. Individuals with active infections or
diseases of the nervous system are also not recommended to get flu
vaccines.

Why is swine flu (H1N1) now infecting humans

Many researchers now consider that two main series of events can
lead to swine flu (and also avian or bird flu) becoming a major cause
for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses


with a segmented genome; this means the viral RNA genetic code is
not a single strand of RNA but exists as eight different RNA segments
in the influenza viruses.

A human (or bird) influenza virus can infect a pig respiratory cell at
the same time as a swine influenza virus; some of the replicating RNA
strands from the human virus can get mistakenly enclosed inside the
enveloped swine influenza virus. For example, one cell could contain
eight swine flu and eight human flu RNA segments.

The total number of RNA types in one cell would be 16; four swine and
four human flu RNA segments could be incorporated into one particle,
making a viable eight RNA segmented flu virus from the 16 available
segment types.

Various combinations of RNA segments can result in a new subtype of


virus (known as antigenic shift) that may have the ability to
preferentially infect humans but still show characteristics unique to the
swine influenza virus.

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It is even possible to include RNA strands from birds, swine, and
human influenza viruses into one virus if a cell becomes infected with
all three types of influenza

For example, two bird flu, three swine flu, and three human flu RNA
segments to produce a viable eight-segment new type of flu viral
genome).

Formation of a new viral type is considered to be antigenic shift; small


changes in an individual RNA segment in flu viruses are termed
antigenic drift and result in minor changes in the virus. However, these
can accumulate over time to produce enough minor changes that
cumulatively change the virus' antigenic makeup over time (usually
years).

Second, pigs can play a unique role as an intermediary host to new flu
types because pig respiratory cells can be infected directly with bird,
human, and other mammalian flu viruses.

Consequently, pig respiratory cells are able to be infected with many


types of flu and can function as a "mixing pot" for flu RNA segments .

Bird flu viruses, which usually infect the gastrointestinal cells of many
bird species, are shed in bird feces. Pigs can pick these viruses up from
the environment and seem to be the major way that bird flu virus RNA
segments enter the mammalian flu virus population.

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Symptoms of swine flu (H1N1)

Symptoms of swine flu are similar to most influenza infections: fever


(100F or greater), cough, nasal secretions, fatigue, and headache, with
fatigue being reported in most infected individuals. Some patients also
get nausea, vomiting, and diarrhea.

In Mexico, many of the patients are young adults, which made some
investigators speculate that a strong immune response may cause
some collateral tissue damage.

Some patients develop severe respiratory symptoms and need


respiratory support (such as a ventilator to breathe for the patient).
Patients can get pneumonia (bacterial secondary infection) if the viral
infection persists, and some can develop seizures.

Death often occurs from secondary bacterial infection of the lungs;


appropriate antibiotics need to be used in these patients. The usual
mortality (death) rate for typical influenza A is about 0.1%, while the
1918 "Spanish flu" epidemic had an estimated mortality rate ranging
from 2%-20%.

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Swine flu in Mexico (as of April 2009) has had about 160 deaths and
about 2,500 confirmed cases, which would correspond to a mortality
rate of about 6%, but these initial data have been revised and the
mortality rate currently in Mexico is estimated to be much lower.

By June 2009, the virus had reached 74 different countries on every


continent except Antarctica, and by September 2009, the virus had
been reported in most countries in the world.

Fortunately, the mortality rate as of October 2009 has been low but
higher than for the conventional flu (average conventional flu mortality
rate is about 36,000 per year; projected novel H1N1 flu mortality rate
is 90,000 per year in the U.S. as determined by the president's
advisory committee).

swine flu (H1N1) diagnosed

Swine flu is presumptively diagnosed clinically by the patient's history


of association with people known to have the disease and their
symptoms listed above.

Usually, a quick test (for example, nasopharyngeal swab sample) is


done to see if the patient is infected with influenza A or B virus. Most of
the tests can distinguish between A and B types.

The test can be negative (no flu infection) or positive for type A and B.
If the test is positive for type B, the flu is not likely to be swine flu
(H1N1). If it is positive for type A, the person could have a conventional
flu strain or swine flu (H1N1).

However, the accuracy of these tests has been challenged, and the
U.S. Centers for Disease Control and Prevention (CDC) has not
completed their comparative studies of these tests.

A new test developed by the CDC and a commercial company


reportedly can detect H1N1 reliably in about one hour; as of October
2009, the test is only available to the military.

Swine flu (H1N1) is definitively diagnosed by identifying the particular


antigens associated with the virus type. In general, this test is done in
a specialized laboratory and is not done by many doctors' offices or
hospital laboratories. However, doctors' offices are able to send
specimens to specialized laboratories if necessary.

Because of the large number of novel H1N1 swine flu cases (as of
October 2009, the vast majority of flu cases [about 99%] are due to

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novel H1N1 flu viruses), the CDC recommends only hospitalized
patients' flu virus strains be sent to reference labs to be identified.

Treatment is available for swine flu (H1N1)

The best treatment for influenza infections in humans is prevention by


vaccination. Work by several laboratories has recently produced
vaccines. The first vaccine released in early October 2009 was a nasal
spray vaccine. It is approved for use in healthy individuals ages 2
through 49.

This vaccine consists of a live attenuated H1N1 virus and should not
be used in anyone who is pregnant or immunocompromised. The
injectable vaccine, made from killed H1N1, became available in the
second week of October. This vaccine is approved for use in ages 6
months to the elderly, including pregnant females.

Both of these vaccines have been approved by the CDC only after they
had conducted clinical trials to prove that the vaccines were safe and
effective.

Two antiviral agents have been reported to help prevent or reduce the
effects of swine flu. They are zanamivir (Relenza) and oseltamivir
(Tamiflu), both of which are also used to prevent or reduce influenza A
and B symptoms.

These drugs should not be used indiscriminately, because viral


resistance to them can and has occurred. Also, they are not
recommended if the flu symptoms already have been present for 48

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hours or more, although hospitalized patients may still be treated past
the 48-hour guideline.

Severe infections in some patients may require additional supportive


measures such as ventilation support and treatment of other infections
like pneumonia that can occur in patients with a severe flu infection.

The CDC has suggested in their interim guidelines that pregnant


females can be treated with the two antiviral agents.

Preventive measures for swine flu:

1. The first preventive measure is to avoid contact with the pigs


(swine)

2. Swine flu is communicable disease, so use the face masks to


protect from the swine flu antigens.

3. Cover your nose and mouth when coughing or sneezing,


using tissue when possible. Dispose this tissue by using only once

4. Avoid visiting the crowded places like theaters and prayer


halls. This can be the spreading ground for Swine flu

5. Maintain good hygiene. Wash your hands frequently with


soap and water to reduce the spread of virus. It would be better if
you use alcohol sanitizers or Dettol for washing hands.

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6. Take a special care of children because they easily get
infected with the Swine flu. It is okay if you don’t send them to
school for few days. Many schools have even announced holidays.

7. Avoid eating outside food because it may be contaminated


and may make you infected with the virus.

8. Don’t use the public urinals because many people spit there,
which could lead to the spreading of the disease.

Tuberculosis

Tuberculosis

Tuberculosis (TB) is an infectious disease caused by bacteria whose


scientific name is Mycobacterium tuberculosis. It was first isolated in
1882 by a German physician named Robert Koch who received the
Nobel prize for this discovery.

TB most commonly affects the lungs but also can involve almost any
organ of the body. Many years ago, this disease was referred to as
"consumption" because without effective treatment, these patients
often would waste away. Today, of course, tuberculosis usually can be
treated successfully with antibiotics.

There is also a group of organisms referred to as atypical tuberculosis.


These involve other types of bacteria that are in the Mycobacterium
family. Often, these organisms do not cause disease and are referred
to a "colonizers," because they simply live alongside other bacteria in
our bodies without causing damage.

At times, these bacteria can cause an infection that is sometimes


clinically like typical tuberculosis. When these atypical mycobacteria
cause infection, they are often very difficult to cure. Often, drug
therapy for these organisms must be administered for one and a half
to two years and requires multiple medication

How common is TB, and who gets it?

Over 8 million new cases of TB occur each year worldwide. In the


United States, it is estimated that 10-15 million people are infected
with the TB bacteria and 22,000 new cases of TB occur each year.

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Anyone can get TB, but certain people are at higher risk, including

• people who live with individuals who have an active TB infection,

• poor or homeless people,

• foreign-born people from countries that have a high prevalence


of TB,

• nursing home residents and prison inmates,

• alcoholics and intravenous drug users,

• people with diabetes, certain cancers, and HIV infection (the


AIDS virus), andhealth-care workers.

• There is no strong evidence for a genetically determined


(inherited) susceptibility for TB.

symptoms of tuberculosis

As previously mentioned, TB infection usually occurs initially in the


upper part (lobe) of the lungs. The body's immune system, however,
can stop the bacteria from continuing to reproduce.

Thus, the immune system can make the lung infection inactive
(dormant). On the other hand, if the body's immune system cannot
contain the TB bacteria, the bacteria will reproduce (become active or
reactivate) in the lungs and spread elsewhere in the body.

It may take many months from the time the infection initially gets into
the lungs until symptoms develop. The usual symptoms that occur with
an active TB infection are a generalized tiredness or weakness, weight
loss, fever, and night sweats.

If the infection in the lung worsens, then further symptoms can


include coughing, chest pain, coughing up of sputum (material from
the lungs) and/or blood, and shortness of breath. If the infection
spreads beyond the lungs, the symptoms will depend upon the organs
involved.

How does a doctor diagnose tuberculosis

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TB can be diagnosed in several different ways, including chest x-rays,
analysis of sputum, and skin tests. Sometimes, the chest x-rays can
reveal evidence of active tuberculosis pneumonia.

Other times, the x-rays may show scarring (fibrosis) or hardening


(calcification) in the lungs, suggesting that the TB is contained and
inactive. Examination of the sputum on a slide (smear) under the
microscope can show the presence of the tuberculosis-like bacteria.

Bacteria of the mycobacterium family, including atypical mycobacteria,


stain positive with special dyes and are referred to as acid-fast bacteria
(AFB). A sample of the sputum also is usually taken and grown
(cultured) in special incubators so that the tuberculosis bacteria can
subsequently be identified as tuberculosis or atypical tuberculosis.

Several types of skin tests are used to screen for TB infection. These
so-called tuberculin skin tests include the Tine test and the Mantoux
test, also known as the PPD (purified protein derivative) test. In each of
these tests, a small amount of purified extract from dead tuberculosis
bacteria is injected under the skin.

If a person is not infected with TB, then no reaction will occur at the
site of the injection (a negative skin test). If a person is infected with
tuberculosis.

however, a raised and reddened area will occur around the site of the
test injection. This reaction, a positive skin test, occurs about 48 to 72
hours after the injection.

If the infection with tuberculosis has occurred recently, however, the


skin test can be falsely negative.

The reason for a false negative test with a recent infection is that it
usually takes two to 10 weeks after the time of infection with
tuberculosis before the skin test becomes positive.

The skin test can also be falsely negative if a person's immune system
is weakened or deficient due to another illness such as AIDS or cancer,
or while taking medications that can suppress the immune response,
such as cortisone or anticancer drugs.

Remember, however, that the TB skin test cannot determine whether


the disease is active or not. This determination requires the chest x-
rays and/or sputum analysis (smear and culture) in the laboratory. The
organism can take up to six weeks to grow in culture in the
microbiology lab.

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A special test to diagnose TB called the PCR (polymerase chain
reaction) detects the genetic material of the bacteria. This test is
extremely sensitive (it detects minute amounts of the bacteria) and
specific (it detects only the TB bacteria)

Treatment for tuberculosis:

A person with a positive skin test, a normal chest x-ray, and no


symptoms most likely has only a few TB germs in an inactive state and
is not contagious. The antibiotic used for this purpose is called
isoniazid (INH). If taken for six to 12 months, it will prevent the TB from
becoming active in the future. In fact, if a person with a positive skin
test does not take INH, there is a 5%-10% lifelong risk that the TB will
become active.

Taking isoniazid can be inadvisable (contraindicated) during pregnancy


or for those suffering from alcoholism or liver disease. Also, isoniazid
can have side effects.

The side effects occur infrequently, but a rash can develop, and the
patient can feel tired or irritable. Liver damage from isoniazid is a rare
occurrence and typically reverses once the drug is stopped.

It is important therefore, for the doctor to monitor a patient's liver by


periodically ordering blood tests called "liver function tests" during the
course of INH therapy.

Another side effect of INH is a decreased sensation in the extremities


referred to as a peripheral neuropathy. This can be avoided by taking
vitamin B6 (pyridoxine), and this is often prescribed along with INH.

A person with a positive skin test along with an abnormal chest x-ray
and sputum evidencing TB bacteria has active TB and is contagious. As
already mentioned, active TB usually is accompanied by symptoms,
such as a cough, fever, weight loss, and fatigue.

Active TB is treated with a combination of medications along with


isoniazid. Rifampin (Rifadin), ethambutol (Myambutol), and
pyrazinamide are the drugs commonly used to treat active TB in
conjunction with isoniazid (INH). Four drugs are often taken for the first
two months of therapy to help kill any potentially resistant strains of
bacteria.

Then the number is usually reduced to two drugs for the remainder of
the treatment based on drug sensitivity testing that is usually available
by this time in the course.

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Streptomycin, a drug that is given by injection, may be used as well,
particularly when the disease is extensive and/or the patients do not
take their oral medications reliably (termed "poor compliance").
Successful treatment of TB is dependent largely on the compliance of
the patient.

Indeed, the failure of a patient to take the medications is the most


important cause of failure to cure the TB infection. In some locations,
the health department demands direct monitoring of patient
compliance with therapy.

Without treatment, however, tuberculosis can be a lethal infection.


Therefore, early diagnosis is important. Those individuals who have
been exposed to a person with TB, or suspect that they have been,
should be exami examined by a doctor for signs of TB and screened
with a TB skin test.

drug-resistant TB

Drug-resistant TB (TB that does not respond to drug treatment) has


become a very serious problem in recent years in certain populations.
For example, INH-resistant TB is seen among patients from Southeast
Asia.. However, the major reason for the development of resistance is
poorly managed TB care.

This can result from poor patient compliance, inappropriate dosing or


prescribing of medication, poorly formulated medications, and/or an
inadequate supply of medication. Multidrug-resistant tuberculosis
(MDR-TB) refers to organisms that are resistant to at least two of the
first-line drugs, INH and Rifampin.

More recently, extensively (extremely) drug resistant tuberculosis


(XDR-TB) has emerged. These bacteria are also resistant to three or
more of the second-line treatment drugs.

. Prevention of Tuberculosis

Preventive measures include strict standards for ventilation, air


filtration, and isolation methods in hospitals, medical and dental
offices, nursing homes, and prisons. If someone is believed to have
been in contact with another person who has TB, preventive antibiotic
treatment may have to be given. Infected persons need to be

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identified as soon as possible so that they can be isolated from others
and treated.

An antituberculosis vaccine, bacille Calmette-Guérin, or BCG vaccine,


was developed in France in 1908. Although there is conflicting
evidence as to its efficacy (it appears to be effective in 50% of those
vaccinated), it is given to over 80% of the world's children, mostly in
countries where TB is common; it is not generally given in the United
States. Federal health officials in the United States have stated (1999)
that a new vaccine is essential to TB prevention.

Systemic Lupus Erythematosus


(SLE or Lupus)

Lupus:

Lupus is an autoimmune disease characterized by acute and chronic


inflammation of various tissues of the body. Autoimmune diseases are
illnesses that occur when the body's tissues are attacked by its own
immune system. The immune system is a complex system within the
body that is designed to fight infectious agents, such as bacteria and
other foreign microbes.

One of the ways that the immune system fights infections is by


producing antibodies that bind to the microbes. Patients with lupus
produce abnormal antibodies in their blood that target tissues within
their own body rather than foreign infectious agents. Because the
antibodies and accompanying cells of inflammation can affect tissues
anywhere in the body, lupus has the potential to affect a variety of
areas

Types of lupus

. Sometimes lupus can cause disease of the skin, heart, lungs, kidneys,
joints, and/or nervous system. When only the skin is involved, the
condition is called lupus dermatitis or cutaneous lupus erythematosus.
A form of lupus dermatitis that can be isolated to the skin, without
internal disease, is called discoid lupus. When internal organs are
involved, the condition is referred to as systemic lupus erythematosus
(SLE).

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Both discoid and systemic lupus are more common in women than
men (about eight times more common). The disease can affect all ages
but most commonly begins from 20 to 45 years of age. Statistics
demonstrate that lupus is somewhat more frequent in African
Americans and people of Chinese and Japanese descent.

CAUSES OF LUPUS:

The precise reason for the abnormal autoimmunity that causes lupus is
not known. Inherited genes, viruses, ultraviolet light, and certain
medications may all play some role.

Genetic factors increase the tendency of developing autoimmune


diseases, and autoimmune diseases such as lupus, rheumatoid
arthritis, and autoimmune thyroid disorders are more common among
relatives of patients with lupus than the general population. Some
scientists believe that the immune system in lupus is more easily
stimulated by external factors like viruses or ultraviolet light.
Sometimes, symptoms of lupus can be precipitated or aggravated by
only a brief period of sun exposure.

It also is known that some women with SLE can experience worsening
of their symptoms prior to their menstrual periods. This phenomenon,
together with the female predominance of SLE, suggest that female
hormones play an important role in the expression of SLE. This
hormonal relationship is an active area of ongoing study by scientists.

More recently, research has demonstrated evidence that a key


enzyme's failure to dispose of dying cells may contribute the
development of SLE. The enzyme, DNase1, normally eliminates what is
called "garbage DNA" and other cellular debris by chopping them into
tiny fragments for easier disposal. Researchers turned off the DNase1
gene in mice. The mice appeared healthy at birth, but after six to eight
months, the majority of mice without DNase1 showed signs of SLE.
Thus, a genetic mutation in a gene that could disrupt the body's
cellular waste disposal may be involved in the initiation of SLE

symptoms and signs of lupus

Patients with SLE can develop different combinations of symptoms and


organ involvement. Common complaints and symptoms include
fatigue, low-grade fever, loss of appetite, muscle aches,
arthritis, ulcers of the mouth and nose, facial rash ("butterfly
rash"), unusual sensitivity to sunlight (photosensitivity),
inflammation of the lining that surrounds the lungs (pleuritis)

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and the heart (pericarditis), and poor circulation to the fingers
and toes with cold exposure (Raynaud's phenomenon).
Complications of organ involvement can lead to further
symptoms that depend on the organ affected and severity of the
disease.

Skin manifestations are frequent in lupus and can sometimes lead to


scarring. In discoid lupus, only the skin is typically involved. The skin
rash in discoid lupus often is found on the face and scalp. It usually is
red and may have raised borders. Discoid lupus rashes are usually
painless and do not itch, but scarring can cause permanent hair loss.
Over time, 5%-10% of patients with discoid lupus may develop SLE.

Over half of the patients with SLE develop a characteristic red, flat
facial rash over the bridge of their nose. Because of its shape, it is
frequently referred to as the "butterfly rash" of SLE. The rash is
painless and does not itch. The facial rash, along with inflammation in
other organs, can be precipitated or worsened by exposure to sunlight,
a condition called photosensitivity. This photosensitivity can be
accompanied by worsening of inflammation throughout the body,
called a "flare" of the disease.

Typically, this rash can heal without permanent scarring with


treatment.

Most patients with SLE will develop arthritis during the course of their
illness. Arthritis in SLE commonly involves swelling, pain, stiffness, and

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even deformity of the small joints of the hands, wrists, and feet.
Sometimes, the arthritis of SLE can mimic that of rheumatoid arthritis
(another autoimmune disease).

More serious organ involvement with inflammation occurs in the brain,


liver, and kidneys. White blood cells and blood-clotting factors also can
be characteristically decreased in SLE, known as leucopenia and
thrombocytopenia, respectively. Leucopenia can increase the risk of
infection and thrombocytopenia can increase the risk of bleeding.

Inflammation of muscles (myositis) can cause muscle pain and


weakness. This can lead to elevations of muscle enzyme levels in the
blood.

Inflammation of blood vessels (vasculitis) that supply oxygen to tissues


can cause isolated injury to a nerve, the skin, or an internal organ. The
blood vessels are composed of arteries that pass oxygen-rich blood to
the tissues of the body and veins that return oxygen-depleted blood
from the tissues to the lungs. Vasculitis is characterized by
inflammation with damage to the walls of various blood vessels. The
damage blocks the circulation of blood through the vessels and can
cause injury to the tissues that are supplied with oxygen by these
vessels.

Inflammation of the lining of the lungs (pleuritis) and of the heart


(pericarditis) can cause sharp chest pain. The chest pain is aggravated
by coughing, deep breathing, and certain changes in body position.
The heart muscle itself rarely can become inflamed (carditis). It has
also been shown that young women with SLE have a significantly
increased risk of heart attacks from coronary artery disease.

Kidney inflammation in SLE can cause leakage of protein into the urine,
fluid retention, high blood pressure, and even kidney failure. This can
lead to further fatigue and swelling of the legs and feet. With kidney
failure, machines are needed to cleanse the blood of accumulated
poisons in a process called dialysis.

Involvement of the brain can cause personality changes, thought


disorders (psychosis), seizures, and even coma. Damage to nerves can
cause numbness, tingling, and weakness of the involved body parts or
extremities. Brain involvement is referred to as lupus cerebritis.

Many patients with SLE experience hair loss (alopecia). Often, this
occurs simultaneously with an increase in the activity of their disease.
The hair loss can be patchy or diffuse and appear to be more like hair
thinning.

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Some patients with SLE have Raynaud's phenomenon. In these
patients, the blood supply to the fingers and/or toes becomes
compromised upon exposure to cold, causing blanching, whitish and/or
bluish discoloration, and pain and numbness in the exposed fingers
and toes.

How is lupus diagnosed

Since patients with SLE can have a wide variety of symptoms and
different combinations of organ involvement, no single test establishes
the diagnosis of systemic lupus. To help doctors improve the accuracy
of the diagnosis of SLE, 11 criteria were established by the American
Rheumatism Association. These 11 criteria are closely related to the
symptoms discussed above. Some patients suspected of having SLE
may never develop enough criteria for a definite diagnosis. Other
patients accumulate enough criteria only after months or years of
observation. When a person has four or more of these criteria, the
diagnosis of SLE is strongly suggested. Nevertheless, the diagnosis of
SLE may be made in some settings in patients with only a few of these
classical criteria, and treatment may sometimes be instituted at this
stage. Of these patients with minimal criteria, some may later develop
other criteria, but many never do.

The 11 criteria used for diagnosing systemic lupus erythematosus are

• malar (over the cheeks of the face) "butterfly" rash,

• discoid skin rash (patchy redness with hyperpigmentation and


hypopigmentation that can cause scarring),

• photosensitivity (skin rash in reaction to sunlight [ultraviolet


light] exposure),

• mucous membrane ulcers (spontaneous ulcers of the lining of


the mouth, nose, or throat),

• arthritis (two or more swollen, tender joints of the extremities),

• pleuritis or pericarditis (inflammation of the lining tissue around


the heart or lungs, usually associated with chest pain upon
breathing or changes of body position),

• kidney abnormalities (abnormal amounts of urine protein or


clumps of cellular elements called casts detectable with a
urinalysis),

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• brain irritation (manifested by seizures [convulsions] and/or
psychosis),

• blood-count abnormalities (low counts of white or red blood cells,


or platelets, on routine blood testing),

• immunologic disorder (abnormal immune tests include anti-DNA


or anti-Sm [Smith] antibodies, falsely positive blood test for
syphilis, anticardiolipin antibodies, lupus anticoagulant, or
positive LE prep test), and

• antinuclear antibody (positive ANA antibody testing [antinuclear


antibodies in the blood]).

In addition to the 11 criteria, other tests can be helpful in evaluating


patients with SLE to determine the severity of organ involvement.
These include routine testing of the blood to detect inflammation (for
example, tests called the sedimentation rate and C-reactive protein),
blood-chemistry testing, direct analysis of internal body fluids, and
tissue biopsies. Abnormalities in body fluids and tissue samples (kidney, skin,
and nerve biopsies) can further support the diagnosis of SLE. The appropriate testing procedures are
selected for the patient individually by the doctor

Treatment for systemic lupus

There is no permanent cure for SLE. The goal of treatment is to relieve


symptoms and protect organs by decreasing inflammation and/or the
level of autoimmune activity in the body. Many patients with mild
symptoms may need no treatment or only intermittent courses of
antiinflammatory medications. Those with more serious illness
involving damage to internal organ(s) may require high doses of
corticosteroids in combination with other medications that suppress
the body's immune system.

Patients with SLE need more rest during periods of active disease.
Researchers have reported that poor sleep quality was a significant
factor in developing fatigue in patients with SLE. These reports
emphasize the importance for patients and physicians to address sleep
quality and the effect of underlying depression, lack of exercise, and
self-care coping strategies on overall health. During these periods,
carefully prescribed exercise is still important to maintain muscle tone
and range of motion in the joints.

Nonsteroidal antiinflammatory drugs (NSAIDs) are helpful in reducing


inflammation and pain in muscles, joints, and other tissues. Examples
of NSAIDs include aspirin, ibuprofen (Motrin), naproxen (Naprosyn),

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and sulindac (Clinoril). Since the individual response to NSAIDs varies
among patients, it is common for a doctor to try different NSAIDs to
find the most effective one with the fewest side effects. The most
common side effects are stomach upset, abdominal pain, ulcers, and
even ulcer bleeding. NSAIDs are usually taken with food to reduce side
effects. Sometimes, medications that prevent ulcers while taking
NSAIDs, such as misoprostol (Cytotec), are given simultaneously.

Corticosteroids are more potent than NSAIDs in reducing inflammation


and restoring function when the disease is active. Corticosteroids are
particularly helpful when internal organs are affected. Corticosteroids
can be given by mouth, injected directly into the joints and other
tissues, or administered intravenously.

Unfortunately, corticosteroids have serious side effects when given in


high doses over prolonged periods, and the doctor will try to monitor
the activity of the disease in order to use the lowest doses that are
safe. Side effects of corticosteroids include weight gain, thinning of the
bones and skin, infection, diabetes, facial puffiness, cataracts, and
death (necrosis) of the tissues in large joints.

Hydroxychloroquine (Plaquenil) is an antimalarial medication found to


be particularly effective for SLE patients with fatigue, skin involvement,
and joint disease.

Consistently taking Plaquenil can prevent flare-ups of lupus. Side


effects are uncommon but include diarrhea, upset stomach, and eye-
pigment changes. Eye-pigment changes are rare but require
monitoring by an ophthalmologist (eye specialist) during treatment
with Plaquenil. Researchers have found that Plaquenil significantly
decreased the frequency of abnormal blood clots in patients with
systemic lupus. Moreover, the effect seemed independent of immune
suppression, implying that Plaquenil can directly act to prevent the
blood clots.

This fascinating study highlights an important reason for patients and


doctors to consider Plaquenil for long-term use, especially for those
SLE patients who are at some risk for blood clots in veins and arteries,
such as those with phospholipid antibodies (cardiolipin antibodies,
lupus anticoagulant, and false-positive venereal disease research
laboratory test). This means not only that Plaquenil reduces the chance
for re-flares of SLE, but it can also be beneficial in thinning the blood to
prevent abnormal excessive blood clotting. Plaquenil is commonly used
in combination with other treatments for lupus.

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For resistant skin disease, other antimalarial drugs, such as
chloroquine (Aralen) or quinacrine, are considered and can be used in
combination with hydroxychloroquine. Alternative medications for skin
disease include dapsone and retinoic acid (Retin-A). Retin-A is often
effective for an uncommon wart-like form of lupus skin disease. For
more severe skin disease, immunosuppressive medications are
considered as described below.

Medications that suppress immunity (immunosuppressive medications)


are also called cytotoxic drugs. Immunosuppressive medications are
used for treating patients with more severe manifestations of SLE, such
as damage to internal organ(s).

Examples of immunosuppressive medications include methotrexate


(Rheumatrex, Trexall), azathioprine (Imuran), cyclophosphamide
(Cytoxan), chlorambucil (Leukeran), and cyclosporine (Sandimmune).
All immunosuppressive medications can seriously depress blood-cell
counts and increase risks of infection and bleeding. Other side effects
are specific for each drug. For examples, Rheumatrex can cause liver
toxicity, while Sandimmune can impair kidney function.

In recent years, mycophenolate mofetil (Cellcept) has been used as an


effective medication for lupus, particularly when it is associated with
kidney disease.

Cellcept has been helpful in reversing active lupus kidney disease


(lupus renal disease) and in maintaining remission after it is
established. Its lower side-effect profile has advantage over traditional
immune-suppression medications.

In SLE patients with serious brain or kidney disease, plasmapheresis is


sometimes used to remove antibodies and other immune substances
from the blood to suppress immunity. Rarely, SLE patients can develop
seriously low platelet levels, thereby increasing the risk of excessive
and spontaneous bleeding.

Since the spleen is believed to be the major site of platelet destruction,


surgical removal of the spleen is sometimes performed to improve
platelet levels.

Other treatments have included plasmapheresis and the use of male


hormones. Plasmapheresis has also been used to remove proteins
(cryoglobulins) that can lead to vasculitis. End-stage kidney damage
from SLE requires dialysis and/or a kidney transplant.

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Most recent research is indicating benefits of rituximab (Rituxan) in
treating lupus. Rituximab is an intravenously infused antibody that
suppresses a particular white blood cell, the B cell, by decreasing their
number in the circulation.

B cells have been found to play a central role in lupus activity, and
when they are suppressed, the disease tends toward remission. This
may particularly helpful for patients with kidney disease

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CT SCAN:

What is CT Scanning of the Body?

CT scanning—sometimes called CAT scanning—is a noninvasive


medical test that helps physicians diagnose and treat medical
conditions.

29
CT scanning combines special x-ray equipment with sophisticated
computers to produce multiple images or pictures of the inside of the
body. These cross-sectional images of the area being studied can then
be examined on a computer monitor or printed.

CT scans of internal organs, bone, soft tissue and blood vessels provide
greater clarity and reveal more details than regular x-ray exams.

Using specialized equipment and expertise to create and interpret CT


scans of the body, radiologists can more easily diagnose problems
such as cancers, cardiovascular disease, infectious disease, trauma
and musculoskeletal disorders.

some common uses

CT imaging is:
 one of the best and fastest tools for studying the chest, abdomen
and pelvis because it provides detailed, cross-sectional views of
all types of tissue.
 often the preferred method for diagnosing many different
cancers, including lung, liver and pancreatic cancer, since the
image allows a physician to confirm the presence of a tumor and
measure its size, precise location and the extent of the tumor's
involvement with other nearby tissue.
 an examination that plays a significant role in the detection,
diagnosis and treatment of vascular diseases that can lead to
stroke, kidney failure or even death. CT is commonly used to
assess for pulmonary embolism (a blood clot in the lung vessels)
as well as for abdominal aortic aneurysms (AAA).
 invaluable in diagnosing and treating spinal problems and
injuries to the hands, feet and other skeletal structures because
it can clearly show even very small bones as well as surrounding
tissues such as muscle and blood vessels.

Physicians often use the CT examination to:


 quickly identify injuries to the lungs, heart and vessels, liver,
spleen, kidneys, bowel or other internal organs in cases of
trauma.

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 guide biopsies and other procedures such as abscess drainages
and minimally invasive tumor treatments.
 plan for and assess the results of surgery, such as organ
transplants or gastric bypass.
 stage, plan and properly administer radiation treatments for
tumors as well as monitor response to chemotherapy.
 measure bone mineral density for the detection of osteoporosis.

What does the equipment look like?

The CT scanner is typically a large, box like machine with a hole, or


short tunnel, in the center. You will lie on a narrow examination table
that slides into and out of this tunnel. Rotating around you, the x-ray
tube and electronic x-ray detectors are located opposite each other in
a ring, called a gantry. The computer workstation that processes the
imaging information is located in a separate room, where the
technologist operates the scanner and monitors your examination.

How does the procedure work?

In many ways CT scanning works very much like other x-ray


examinations. X-rays are a form of radiation—like light or radio waves
—that can be directed at the body. Different body parts absorb the x-
rays in varying degrees.

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CAT scan: liver

In a conventional x-ray exam, a small burst of radiation is aimed at and


passes through the body, recording an image on photographic film or a
special image recording plate. Bones appear white on the x-ray; soft
tissue shows up in shades of gray and air appears black.

With CT scanning, numerous x-ray beams and a set of electronic x-ray


detectors rotate around you, measuring the amount of radiation being
absorbed throughout your body. At the same time, the examination
table is moving through the scanner, so that the x-ray beam follows a
spiral path

A special computer program processes this large volume of data to


create two-dimensional cross-sectional images of your body, which are
then displayed on a monitor. This technique is called helical or spiral
CT.

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CT imaging is sometimes compared to looking into a loaf of bread by
cutting the loaf into thin slices. When the image slices are reassembled
by computer software, the result is a very detailed multidimensional
view of the body's interior.

Refinements in detector technology allow new CT scanners to obtain


multiple slices in a single rotation. These scanners, called "multislice
CT" or "multidetector CT," allow thinner slices to be obtained in a
shorter period of time, resulting in more detail and additional view
capabilities.

Modern CT scanners are so fast that they can scan through large
sections of the body in just a few seconds. Such speed is beneficial for
all patients but especially children, the elderly and critically ill.

For some CT exams, a contrast material is used to enhance visibility in


the area of the body being studied.

How is the CAT scan performed?

The technologist begins by positioning you on the CT examination


table, usually lying flat on your back or possibly on your side or on your
stomach. Straps and pillows may be used to help you maintain the
correct position and to hold still during the exam.

If contrast material is used, it will be swallowed, injected through an


intravenous line (IV) or administered by enema, depending on the type
of examination.

33
Next, the table will move quickly through the scanner to determine the
correct starting position for the scans. Then, the table will move slowly
through the machine as the actual CT scanning is performed.

You may be asked to hold your breath during the scanning. Any
motion, whether breathing or body movements, can lead to artifacts
on the images. This is similar to the blurring seen on a photograph
taken of a moving object.

When the examination is completed, you will be asked to wait until the
technologist verifies that the images are of high enough quality for
accurate interpretation.

CT scanning of the body is usually completed within 30 minutes.

What will I experience during and after the


procedure?

CT exams are generally painless, fast and easy. With helical CT, the
amount of time that the patient needs to lie still is reduced.

Though the scanning itself causes no pain, there may be some


discomfort from having to remain still for several minutes. If you have
a hard time staying still, are claustrophobic or have chronic pain, you
may find a CT exam to be stressful.

The technologist or nurse, under the direction of a physician, may


offer you a mild sedative to help you tolerate the CT scanning
procedure.

If an intravenous contrast material is used, you will feel a slight pin


prick when the needle is inserted into your vein. You may have a
warm, flushed sensation.

during the injection of the contrast materials and a metallic taste in


your mouth that lasts for a few minutes. Some patients may
experience a sensation like they have to urinate but this subsides
quickly.

If the contrast material is swallowed, you may find the taste mildly
unpleasant;

however, most patients can easily tolerate it. You can expect to
experience a sense of abdominal fullness and an increasing need to

34
expel the liquid if your contrast material is given by enema. In this
case, be patient, as the mild discomfort will not last long.

When you enter the CT scanner, special lights may be used to ensure
that you are properly positioned. With modern CT scanners, you will
hear only slight buzzing, clicking and whirring sounds as the CT
scanner revolves around you during the imaging process.

You will be alone in the exam room during the CT scan. However, the
technologist will be able to see, hear and speak with you at all times.

With pediatric patients, a parent may be allowed in the room but will
be required to wear a lead apron to prevent radiation exposure.

After a CT exam, you can return to your normal activities. If you


received contrast material, you may be given special instructions.

Who interprets the results and how do I get them

A physician, usually a radiologist with expertise in supervising and


interpreting radiology examinations, will analyze the images and send
a signed report to your primary care physician or the physician who
referred you for the exam, who will discuss the results with you.

USES OF CT SCAN:

CT scans are used to study areas of the body and the arms or legs.

Chest (thorax).

A CT scan of the chest can look for problems with the lungs, heart,
esophagus, the major blood vessel (aorta), or the tissues in the center of
the chest.

Some common chest problems a CT scan may find include infection, lung
cancer, a pulmonary embolism, and an aneurysm. It also can be used to
see if cancer has spread into the chest from another area of the body.

Abdomen.

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A CT scan of the abdomen can find cysts, abscesses, infection, tumors, an
aneurysm, enlarged lymph nodes, foreign objects, bleeding in the belly,
diverticulitis, inflammatory bowel disease, and appendicitis.

Urinary tract.

A CT scan of the kidneys, ureters, and bladder is called a CT KUB or CT


urogram. This type of scan can find kidney stones, bladder stones, or
blockage of the urinary tract. See a picture of a CT of diseased kidneys .
A special type of CT scan, called a CT intravenous pyelogram (IVP), uses
injected dye (contrast material) to look for kidney stones, blockage,
growths, infection, or other diseases of the urinary tract.

Liver

A CT scan can find liver tumors, bleeding from the liver, and liver
diseases. A CT scan of the liver can help determine the cause of jaundice.

Pancreas.

A CT scan can find a tumor in the pancreas or inflammation of the


pancreas (pancreatitis).

Gallbladder and bile ducts

A CT scan can be used to check for blockage of the bile ducts. Gallstones
occasionally show up on a CT scan. But other tests, such as ultrasound,
usually are used to find problems with the gallbladder and bile ducts.

Adrenal glands

A CT scan can find tumors or enlarged adrenal glands.

Spleen.

A CT scan can be used to check for an injury to the spleen or the size of
the spleen.

Pelvis

A CT scan can look for problems of organs in the pelvis. For a woman,
these include the uterus, ovaries, and fallopian tubes. For a man, the
pelvic organs include the prostate gland and the seminal vesicles.

Arm or leg

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A CT scan can look for problems of the arms or legs, including the
shoulder, elbow, wrist, hand, hip, knee, ankle, or foot.

Other uses for a CT scan

A CT scan may be used to make sure a procedure is done correctly. For


example, the doctor may use CT to guide a needle during a tissue
biopsy or to guide the proper placement of a needle to drain an
abscess.
For people with cancer, a CT scan can help determine how much the
cancer has spread. This is called staging the cancer.

Benefits vs Risks:

Benefits:
 CT scanning is painless, noninvasive and accurate.
 A major advantage of CT is its ability to image bone, soft tissue
and blood vessels all at the same time.
 Unlike conventional x-rays, CT scanning provides very detailed
images of many types of tissue as well as the lungs, bones, and
blood vessels.
 CT examinations are fast and simple; in emergency cases, they
can reveal internal injuries and bleeding quickly enough to help
save lives.
 CT has been shown to be a cost-effective imaging tool for a wide
range of clinical problems.
 CT is less sensitive to patient movement than MRI.
 CT can be performed if you have an implanted medical device of
any kind, unlike MRI.
 CT imaging provides real-time imaging, making it a good tool for
guiding minimally invasive procedures such as needle biopsies
and needle aspirations of many areas of the body, particularly
the lungs, abdomen, pelvis and bones.
 A diagnosis determined by CT scanning may eliminate the need
for exploratory surgery and surgical biopsy.
 No radiation remains in a patient's body after a CT examination.
 X-rays used in CT scans usually have no side effects.

37
Risks:
 There is always a slight chance of cancer from excessive
exposure to radiation. However, the benefit of an accurate
diagnosis far outweighs the risk.
 The effective radiation dose from this procedure ranges from
approximately two to 10 mSv, which is about the same as the
average person receives from background radiation in three to
five years. See the Safety page for more information about
radiation dose.
 Women should always inform their physician and x-ray or CT
technologist if there is any possibility that they are pregnant.
See the Safety page for more information about pregnancy and
x-rays.
 CT scanning is, in general, not recommended for pregnant
women unless medically necessary because of potential risk to
the baby.
 Nursing mothers should wait for 24 hours after contrast material
injection before resuming breast-feeding.
 The risk of serious allergic reaction to contrast materials that
contain iodine is extremely rare, and radiology departments are
well-equipped to deal with them.
 Because children are more sensitive to radiation, they should
have a CT study only if it is essential for making a diagnosis and
should not have repeated CT studies unless absolutely
necessary.

What are the limitations of CT Scanning of the Body

Soft-tissue details in areas such as the brain, internal pelvic organs, ?


knee or shoulder can be more readily and clearly seen with magnetic
resonance imaging (MRI). The exam is not generally indicated for
pregnant women.

A person who is very large may not fit into the opening of a
conventional CT scanner or may be over the weight limit for the
moving table.

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