29.09.09

Zhoubné nádory mozku edukace

Co potřebujete vědět o nádorech mozku   pdf
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Zhoubné nádory mozku -sdružení pacientů

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Alzheimer's Disease: Into the World's Most Common Form of Dementia

Source: Alzheimer's Disease: Into the World's Most Common Form of Dementia






TEXT = http://www.voanews.com/specialenglish/2009-09-14-voa2.cfm?renderforprint=1

MP3 = http://www.voanews.com/mediaassets/specialenglish/2009_09/audio/Mp3/se-sin-2553-alzheimers disease-15sept09_0.Mp3



VOICE ONE:

This is SCIENCE IN THE NEWS in VOA Special English. I'm Bob Doughty.


VOICE TWO:


And I'm Barbara Klein. Today we tell about Alzheimer's disease. More than a century after its discovery, Alzheimer's disease is still destroying people's brains. The cause remains unknown.



(MUSIC)

VOICE ONE:
September twenty-first is World Alzheimer's Day. The theme for the observance this year is "Diagnosing Dementia: See It Sooner." The goal is early identification of the disease so those affected get the treatment they need.


Around the world, there will be walks to raise money for medical research. Training courses and educational meetings also are planned.



In the United States, for example, more than twenty thousand teams are preparing for what organizers call memory walks. Singapore will hold public events in at least three languages: English, Malay and Mandarin. And, Barbados will mark World Alzheimer's Day with events like a religious service, a health fair and performances by musicians.



VOICE TWO:



An estimated thirty million people around the world have Alzheimer's disease. In the United States alone, more than five million people are said to suffer from this slowly increasing brain disorder.



Alzheimer's affects memory and personality -- those qualities that make a person an individual. There is no known cure. Victims slowly lose their abilities to deal with everyday life.



At first, they forget simple things, like where they put something or a person's name. As time passes, they forget more and more. They forget the names of their husbands, wives or children. Then they forget who they are.



Finally, they remember almost nothing. It is as if their brain dies before the other parts of the body. Victims of Alzheimer's do die from its effects or conditions linked to it. But death may not come for many years.



(MUSIC)

VOICE ONE:

Alzheimer's disease is the most common disability or mental sickness called dementia. Dementia is the loss of thinking ability that is severe enough to interfere with daily activities. It is not a disease itself. Instead, dementia is a group of signs of some conditions and diseases.


Some kinds of dementia can be cured or corrected. This is especially true if they result from drugs, infection, sight or hearing problems, head injury, and heart or lung problems. Other kinds of dementia can be corrected by changing levels of hormones or vitamins in the body. However, brain cells of Alzheimer's victims die and are not replaced.

Victims can become angry and violent as the ability to think and remember decreases. They sometimes shout and move with no purpose or goal. Media reports tell about older adults found walking in places far from their homes. They do not know where they are or where they came from. These people often are suffering from Alzheimer's disease.


VOICE TWO:
Alzheimer's generally develops differently in each person. Yet some early signs of the disease are common. The victims may not recognize changes in themselves. Others see the changes and struggle to hide them.


Probably the most common early sign is short-term memory loss. The victim cannot remember something that happened yesterday, for example. Also, victims of the disease have increasing difficulty learning and storing new information. Slowly, thinking becomes much more difficult. The victims cannot understand a joke, or cannot cook a meal, or perform simple work.


VOICE ONE:

Another sign of the disease is difficulty solving simple problems. Alzheimer's patients might not know what to do if food on a stove is burning. Also, people have trouble following directions or finding their way to places they have known all their lives.


Yet another sign is struggling to find the right words to express thoughts or understand what is being discussed. Finally, people with Alzheimer's seem to change. Quiet people may become noisy and aggressive. They may easily become angry and lose their ability to trust others.


VOICE TWO:

Alzheimer's disease normally affects people more than sixty-five years old. But rare cases have been discovered in people younger than fifty.


Alzheimer's is identified in only about two percent of people who are sixty-five. But the risk increases to about twenty percent by age eighty. By eighty five or ninety, half of all people are found to have some signs of the disease.


Alzheimer's affects people of all races equally. Yet women are more likely to develop the disease than men. This is partly because women generally live longer than men.

VOICE ONE:

There is no one, simple test to show if someone has Alzheimer's disease. Social workers and mental health experts sometimes test for memory and judgment. Patients may be asked to identify smells like smoke, natural gas or fruits. Some scientists say a weakened ability to identify smells may be involved. They believe it might show possible development of Alzheimer's.


Doctors who suspect a patient has Alzheimer's must test the person for many other physical problems first. Alzheimer's is considered if the tests fail to show the existence of other problems. The only way to be sure a person has Alzheimer's is to examine the victim's brain after death.

(MUSIC)

VOICE TWO:
People who care for Alzheimer's patients may become extremely tired physically and emotionally. Families often can get advice and emotional support from local groups. The Alzheimer's Disease Education and Referral Center and the Alzheimer's Association provide information and support.


Another group, Alzheimer's Disease International, lists ten symptoms of the disease on its Web site. The list shows the difference between these signs of normal aging and the possibility of developing Alzheimer's.

VOICE ONE:

Patients cannot fully recover from the disease. But many can be helped by medicine. That is especially true if the disease is found early.


America's Food and Drug Administration has approved several drugs to treat symptoms of the disease. The drugs are of two kinds. A doctor must order these medicines for patients. Most are called cholinesterase inhibitors.


VOICE TWO:

Cholinesterase inhibitors may work by protecting a chemical messenger needed for brain activities. They are meant to treat memory, thinking, language, judgment and other brain activity. They are used for mild to moderate cases of the disease.


The second kind of drug has a long name. It is represented by the drug memantine. This medicine seems to work by governing the activity of a chemical involved in information processing, storage and memory. It treats patients with moderate to severe Alzheimer's.


VOICE ONE:

The British writer Iris Murdoch died of Alzheimer's disease. She said it was a dark and terrible place.

The two thousand-seven film "Away From Her" tells what happens to one marriage when a partner suffers from the disease. Julie Christie was nominated for the Academy Award for Best Actress for playing the patient. Listen as she describes the pain of her mental condition.


JULIE CHRISTIE: "Half the time I wander around looking for something I can't remember what it is. Everything is gone."

VOICE TWO:


It has been more than a century since a German doctor, Alois Alzheimer, told about a dementia patient whose brain was studied after death. Her brain had sticky structures and nerve cells that appeared to be mixed together.

Later studies showed these nerves are made of a protein that changes so it sticks together in groups. The sticky structures were shown to be amyloid plaques.

Scientists are still not sure what causes Alzheimer's disease. The leading theory blames amyloid plaques. Still, a theory exists that amyloid plaques are an effect of the disease, not the cause.


VOICE ONE:


Work continues on possible genetic causes. This month, two teams of European researchers said they identified new genetic markers linked to Alzheimer's disease. The teams worked separately. Their findings were reported in the journal Nature Genetics.



The newly-found genetic markers may affect a person's risk of developing Alzheimer's. Until now, only four genes had been linked with the disease. They provided a better understanding of the disease process, but no immediate treatment.



Many more studies are being done to find the causes and treatment of Alzheimer's.



(MUSIC)





VOICE TWO:



This SCIENCE IN THE NEWS program was written by Jerilyn Watson. Our producer was Brianna Blake. I'm Barbara Klein.



VOICE ONE:



And this is Bob Doughty. Join us again next week for more news about science in Special English on the Voice of America.

23.09.09

Diseases Threaten Banana Crops in Africa




This is the VOA Special English Development Report.

Two separate diseases are destroying banana and plantain crops in Africa. They could threaten food security for millions of Africans who depend on bananas as an important part of their diet.



Banana bacterial wilt was first reported in Ethiopia in the late nineteen sixties. In two thousand one it was found in Uganda. Since then it has spread to neighboring countries including Kenya, Rwanda, Tanzania and the Democratic Republic of Congo.


The leaves of infected plants weaken and become yellow. They also leak a yellow liquid. The bananas ripen too quickly and begin to rot.

Farmers can unknowingly spread the infection with their cutting tools. Experts say by the time a farmer discovers that something is wrong, it is already too late. The crop must be destroyed.


Uganda is Africa's leading producer and consumer of bananas. The organization Biodiversity International reports losses of up to eighty percent in heavily affected areas of the country.

Farmers worry that a second disease could also spread to Uganda. Bunchy top disease causes all of the leaves to grow from the top of the banana plant. Infected plants produce small, abnormal fruit. Finally, they stop producing completely.


The International Institute for Tropical Agriculture says the disease is widely found in Gabon, Angola, Malawi, and the Democratic Republic of Congo.

The institute's Rachid Hanna says farmers must destroy infected plants, normally by burning them. Bunchy top disease can spread from plant to plant and is also spread by aphids. These small insects must be destroyed. Rachid Hanna advises farmers to use biological controls such as natural enemies of the aphids.

He says bunchy top disease and banana bacterial wilt can both affect entire plantations. Not only are farm incomes affected, but so are local food supplies. Experts say more than thirty million people could be at risk of shortages unless a solution is found.

Scientists from around the world met in Tanzania last month to discuss the situation. Rachid Hanna says strong measures must be taken now to prevent a crisis in the future.

RACHID HANNA: "What is necessary in this case is a collective effort, not only by the researchers and the people on the ground, but also the donor community, because controlling those two diseases can go a long way in improving people's food security and livelihoods in Sub-Saharan Africa."

And that's the VOA Special English Development Report, written by June Simms. I'm Steve Ember

Zdroj: http://www.voanews.com/specialenglish/2009-09-20-voa2.cfm

20.09.09

Patent českých vědců získal ocenění amerických lékařů

Patent českých vědců, mast na hojení ran Hemagel, získal ocenění prestižní asociace amerických lékařů. více















Základem masti je polymerní nosič, který dokáže vázat volné kyslíkové radikály v ráně. Právě volné kyslíkové radikály totiž výrazně brzdí proces hojení.

Cena:

  • 5g cca 140 Kč   
  • 30g     450 Kč

17.09.09

Paliativní léčba








Ondřej Sláma, Ladislav Kabelka, Jiří Vorlíček
Paliativní medicína pro praxi



Regulace rychlosti infuze

Počet kapek za minutu dle použitého setu
  • standartní set  20kapek =1ml
  • transfuzní set  15kapek =1ml
  • dětský inf.set  60 kapek =1ml
Výpočet:

Počet kapek za minutu = (Objem aplikovaného roztoku (ml)x počet kapek v ml) /doba trvání infuze

Hypodermoklýza - podkožní aplikace tekutin












Poznámky      

Ondřej Sláma , Podkožní aplikace léků a tekutin v paliativní léčbě

Praktické provedení
  1. Kanyla 18G nebo 22G do podkoží na přední straně hrudníku,
    na břiše, popř. na paži
  2. Jehlu s krátkou spojovací hadičkou fixujeme  náplastí.
  3. Subkutánní jehlu lze ponechat na jednom místě 5 – 7 dní
  4. Nejvyšší doporučená denní dávka tekutiny podaná s. c. je 3000 ml (tj. 1500 ml podaných
    paralelně dvěma s. c. vstupy).
  5. Rychlost podání je individuální. Obvykle začínáme rychlostí  50 ml/h a podle tolerance (tj. zda dochází k resorpci tekutiny z podkoží) můžeme rychlost zvýšit až na  150 ml/h.Někteří autoři popisují velmi dobrou toleranci i při aplikaci větších objemů, např. 500 ml FR ve dvouhodinové infuzi, opakovaně 2 – 3 x za den. Celkový objem tekutin se při hypodermoklýze obvykle pohybuje v rozmezí 500 – 2000 ml/24 h. Subkutánní infuzi lze s výhodou podat během nočního spánku (např. 1000 ml/8 h). Výpočet počtu kapek
  6. Roztoky vhodné k aplikaci NaCl (0,9 %), „poloviční“ FR (NaCl 0,45 %), kombinované

  7. roztoky NaCl a glukózy a 5 % roztok glukózy. V případě potřeby lze podávat také KCl podle potřeby a lokální tolerance maximálně v koncentraci 20 – 40 mmol/l
  8. Léky vhodné k apliaci: clodronat,morfin,diclofenac,dexametazon,haloperidol,metoklopramid,midazolam,tramadol

Odkazy:

11.09.09

Funční anatomie člověka





Autor: Ivan Dylevský a kol.


Ukázka ,obsah knihy zde 








Poznámky pro kliniku
______________________________________________




Cranium lebka
  • fossa cranii anterior -přední jáma lebeční (PJL) z hlediska šíření patolog.procesů je třeba vědět ,žepřední jáma leží nad oběma očnicemi,čichovými labyrinty,nosní dutinou a dutinou klínové kosti. Na povrch lebky se nejvyšší místo PJL promítá do roviny proložené nadočnicovými oblouky. Prední jáma přímo komunikuje s nosní dutinou. Neurologicky:Zlomeniny přední jámy lební – spodina přední jámy lební + strop orbity + paranazální dutiny-  hematom pod spojivkou a brýlový hematom očních víček, někdy vytéká likvor
  • fossa cranii media  střední lebeční jáma (SLJ)- nejhlubší místo SLJ leží na dně miskovitých prohlubní po stranách klínové kosti. Zevně lze dno SJL vymezit rovinou prloženou dolními okraji jařmových oblouků.  Zlomeniny střední jámy lební – nejzávažnější je zlomenina pyramidy-  hematom za uchem, někdy poškození zvukovodu, středního ucha a poškození hlavových nervů n. VII a VIII

     
  • fossa cranii posterior zadní lebeční jáma. Nejhluším místem je rovina proložená vrcholy procesus mastoidei. Od dutinek uvnitř proc. mastoidei odděluje prostor ZJL jen zcela tenká stěna esovitého žlábku
  • Orbita nejslabším místem orbity je vnitřní stěna,dno a střední pás stropu. Proti nárazu je nejodolnější zevní stěna. Tlak vycházející ze sinus maxillaris devastuje dno očnice a vytlačuje její obsah dopředu
    • žilní a mízní systém měkkých tkání obličeje (vedlejších nosních dutin!) je přes cévy orbity napojen na cirkulaci mozkových obalů a na cévní systém mozku. Tyto spoje mohou být cestami obousměrného šíření infekce
Svaly HK
  • m.deltoideus EM studie prokázaly,že abdukci HK do  90st.provádí především m.supraspinatus. Teprve po upažení nad horizontálu nastupuje m.deltoideus,který abdukční aktivitu přebírá. Paréza deltového svalu (inervace n.axillaris) se proto může objevit až po abdukci HK nad horizontální rovinu
Zevní nos:
  • philtrum
Tonzilla palatina


07.09.09

Kardiotoxicita antracyklinů

Medscape Oncology  (celý článek)


Current Concepts of Anthracycline Cardiotoxicity: Pathogenesis, Diagnosis and Prevention



Brad Pfeffer; Constantine Tziros; Richard J Katz,Published: 07/16/2009


poznámky


-









 
 
 
 













Obr. Návrh sledování  při léčbě antracykliny- čtyřnásobné snížení rizika vzniku   městnavého srdečního selhávání
 
 

Poznámky


  • snaha využití biomarkeru k odhadu toxicity ( troponin ) - včasné odhalení ohrožených osob, zatím ve výzkumu



  • Epirubicin, idarubicin,  mitoxantron - nížší kardiotoxicita , stejný efekt




  • liposomální formy - zkoumány liposomal. daunorubicin,liposomal doxorubicin a pegylovaný liposomal doxorubicin


  • pegylovaný liposom. doxorubicin - nížší karditoxicita - než doxorubicin


  
  • doxorubicinem (bakterie je obl. anerobní a může destruovat v hypoxických

  •  částech tumoru nádor samotný a pomoci vstupu l.doxorubicinu přímo do  nádoru)



  • kardioprotektiva dexrazoxan (CARDIOXAN)
  • *FDA indikace - in women with metastatic breast cancer.

 It is recommended for use in patients who received greater than 300 mg/m2 of doxorubicin     or  greater than 550 mg/m2 of epirubicin and who require further administration of these agents  for advanced, but anthracycline-sensitive, cancers.


  • nové možnosti v kardioprotekci
    •  ACE inhibitory - snížení remodelace LK a oxod. stresu, hledá se optimální doba nasazení inhibitorů
    • Antagonisté angiotensinu -vlastní antioxidační účinky
    • Karvediol

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