Cause

Epiglottitis is caused by a germ (Haemophilus influenzae) which causes inflammation and swelling of the epiglottis. The epiglottis normally sits at the top of the windpipe and prevents food and liquid entering the windpipe during swallowing. When it is inflamed and swollen, the epiglottis blocks air flow, causing breathing difficulty and marked distress.

Clinical features

The onset of epiglottitis is very rapid. Unlike croup, where the child has symptoms of a cold before he develops a barking cough and stridor, epiglottitis develops rapidly in a child who has previously been perfectly well. Within a few hours the child is often desperately sick. He looks toxic and unwell, pale, with saliva drooling from his open mouth. He will often have a soft snoring noise when he breathes, and will sit well forward, refusing to lie down because it causes him further respiratory distress. He is irritable and restless, feels hot, and it is difficult to console him.

No investigations are indicated. The diagnosis of epiglottitis is made on the basis of a very rapid onset of symptoms in a previously well child, and characteristic clinical signs. In fact, no investigations or procedures (such as taking blood, measuring temperature) etc. should be performed if epiglottitis is suspected because they may distress the child and precipitate obstruction of the windpipe.

Treatment

If epiglottitis is suspected, the child must be transferred immediately to a hospital which has an intensive care unit. There a breathing tube is usually inserted to help the child breathe, and antibiotics given intravenously.

When to see your doctor

Epiglottitis is a medical emergency, and if it is suspected then medical assessment must be obtained immediately. Do not delay — it is literally a matter of life and death.

Prevention

Epiglottitis is preventable by having your child vaccinated against Haemophilus influenzae. This is commonly called the Hib vaccine, and is now available in Australia. Make sure your child is fully immunised. This will prevent him from contracting this and other potentially fatal diseases.

*223\90\8*

Miscarriage is common. One in five pregnancies ends in miscarriage, and 75% of these occur within the first 10 weeks. Most miscarriages that occur in the early stages of pregnancy are a result of an abnormality in the foetus. Sometimes the miscarriage is due to a blighted ovum, that is, an egg that was not fertilised but caused a ‘phantom pregnancy’. Some fertilised eggs simply do not develop properly, and are rejected by the mother’s body.

Miscarriages during the later stages of pregnancy can be due to numerous factors, cental insufficiency (a placenta which stops functioning properly).

Having a miscarriage is not an experience that you need to go through alone, and talking over your feelings with others who have had similar experiences may help to ease the burden of guilt (unfounded) that you may be carrying. It may also give you the opportunity to air the sadness that you are bound to feel. This will help to rebuild your confidence, and make you feel more positive about trying again. Talk to your partner, who will also be feeling down. Share your concerns, feelings of guilt, fantasies with each other. Couples who have gone through repeated miscarriages, or who have had difficulty conceiving, may experience a sense of grief with the onset of each period, as if they have lost another ‘potential child’. This is a perfectly normal reaction, and you both need to mourn for this too, in order to achieve acceptance of the loss and to heal the ‘wounds’. Not discussing these feelings openly with each other can lead to a sense of resentment and anger which may interfere with sexuality too. This can lead to a vicious cycle of anxiety about sex, which is exactly what you don’t need if you are trying to conceive again.

*56\90\8*

ANSWER: Even though the rectum has connotations in our culture that make it seem dirty and corrupt, it is actually a very sensitive area. You know that, because you know how much it hurts you when he tries to enter you there. There is nothing unnatural about anal penetration. It is purely a matter of two things, preference and knowledge. The issue of preference can be addressed only by open communication. The issue of knowledge may help in this situation, because the facts may help you both to come up with a solution to your differences. The tissue in that area of the body is not only sensitive but can be damaged easily. Lubrication is important, so if you ever decide to do it, use a well-lubricated condom. Infection can be a problem, too, so make sure there is no cross-stimulation from the rectum to other areas of the body. Finally, it takes practice and cooperation to accomplish penetration of the anus. Practicing with slight insertion of the little finger and moving on to more and more penetration can help, and learning to relax the muscles in that area facilitates entry. Super marital sex rules indicate that the small-step approach can help here, with approximations of penetration aided by verbal fantasy of penetration. Surrendering or forcing only causes you both to relate such activity to the cultural orientation of “a pain in the ass.” An important super marital sex rule is that there should never be intentional mental or physical pain or coercion during any sexual interaction.

*247\97\8*

The bigger the tumour, the more of these relatively resistant cells it will contain. However, some of them are present even in tumours that are only a few millimetres across. The chances of curing growths which contain some poorly oxygenated cells and some cells which are not dividing can be improved by giving the radiation treatment in small doses spread over some weeks rather than giving the whole dose in one treatment session. As the cancer shrinks, cells which were not dividing start to divide and cells which were poorly oxygenated get more oxygen. Thus, as the weeks go by, these cells become much more sensitive to radiation treatment than they were to start with. Although the results are better when the treatment is spread out like this, bigger cancers still need a much higher total dose. Even with a higher dose, there is still a much smaller chance of curing the bigger cancers. Very big cancers simply cannot be cured with doses that are safe.

*262/40/1*

Sometimes, hospitalisation may be necessary but this may give the hysteric an opportunity to observe those with organic illness, and so the symptoms may become more definite and closer to real illness and further delay proper evaluation.

The underlying inadequate personality of the hysteric makes complete recovery difficult. The aim of treatment should be to restore the person as a functioning unit of society, rather than seeking to fully unravel all the hidden conflicts which have precipitated the illness or remove all the symptoms which have developed.

Too many medical opinions and examinations are only likely to reinforce the symptoms and to create further invalidism. Those treating hysteria should remain non-judgmental and should not react to attempts to manipulate them.

Those of us with an uncompromising view of life may deplore malingering and even hysteria and show this in our attitudes to those exhibiting such symptoms.

*452/71/1*

The symptoms that may result from anaemia are tiredness and shortness of breath. With iron deficiency anaemia there are other symptoms such as a sore red tongue and there may be a reduced amount of acid secreted by the stomach leading to digestive problems.

The diagnosis of iron deficiency anaemia is made by simple tests of the blood to determine the amount of haemoglobin and also by looking at the red blood cells under the microscope.

They will be less in number and they are also smaller and paler than normal.

The amount of iron in the blood may be measured and this reflects the amount of iron stored in the tissues.

Treatment is simple — iron tablets are given by mouth, usually in the form of the salt, ferrous sulphate which is cheap and effective.

Sometimes iron tablets may upset the bowel, causing diarrohoea or constipation. The iron will also stain the patient’s motion black and the patient needs to be warned about this.

*196/71/1*

Recent probes into the theory of retrograde menstruation reveal that a great percentage of women show an increased amount of blood in the pelvic cavity around menstruation and after ovulation. Blood has even been present in the dialysate (liquid drawn from the abdominal cavity) of women undergoing kidney dialysis while they had their periods. What this proves, again and again, is that retrograde menstruation it common.

Earlier experiments, specifically those performed in the 1950s, were more aggressive. One team—doctors R. B. Scott, R. W. TeLinde, and L. R. Wharton, Jr., of Chicago’s Northwestern Medical Centers-created pelvic endometriosis in rhesus monkeys by inducing retrograde menstruation in an extreme manner. Basically, what they did was cot into the monkey’s uterus, opening it so that menstrual blood spilled directly into the pelvic cavity instead of being washed out through the vagina. Six of the ten experimental monkeys developed endometriosis—some within two and a half months, whereas others had no signs of it for nearly three years. In 1958 a number of women voluntarily submitted to an experiment wherein doctors injected endometrial cells into a laparotomy incision. This experiment also produced endometriosis in most women,

Sampson’s theory has found a few detractors, but most doctors agree that the backward spraying of menstrual blood places endometrial tissue on vulnerable organs. Even Sampson postulated that in all probability there is “more than one” avenue available for the development and spread of this disease. One conclusion was that, he wrote, “the invasion and dissemination of endometrial tissue employ the same channels as the invasion of cancer.” This meant that fragments of endometrial tissue reached other parts of the body through channels such as the blood and lymph systems. The actual process of tissue transference from one organ to another by blood or lymph glands is known as metastasis.

*21\43\4*

Ultraviolet light seems to have a similar exfoliating effect on the skin and is therefore most beneficial in the treatment of this condition. It appears to be further helped by salt water, due no doubt to its drying action.

Oral antibiotics, particularly tetracycline, have a most dramatic and beneficial effect. Their action appears to be threefold. They reduce comedone formation, resulting in less blockages of sebaceous gland ducts. Furthermore they reduce the acidity of the sebum, which then results in less tissue breakdown when the glands rupture. They also decrease the amount of propionibacterium acnes. This results in less chemical or enzyme being released into the skin when the glands rupture. The overall result of this is much less inflammation. It can be seen, therefore, that the antibiotics are used not so much for their anti-bacterial effect as for a side effect that they appear to have on the oil glands. Very small doses of these antibiotics may be used, in fact much smaller doses than those required for the treatment of normal mild infections of the skin. Consequently they may be used for prolonged periods, except of course with pregnant women or children under the age of 12 years, or if side-effects appear.

*47\44\4*

• A low-fat diet has an automatically high percentage of carbohydrate.

• Carbohydrate is most simply classified as either sugar, starch or fibre.

• More complex classifications are currently being developed.

• A high-carbohydrate intake has not been linked to obesity in populations.

• A reduction in sugar consumption may be wise for some individuals.

• Client education should involve:

— assessment of dietary carbohydrate intake and its specific components; sugar, starch and fibre

— recommended food selection for increasing dietary fibre

— information on how to read food labels and ingredient lists

— explanation of nutritional claims about carbohydrate in food

Until recently, carbohydrates have drawn far less scientific attention than dietary fat. Now there is ample evidence to show that specific components of carbohydrate are beneficial for both health and body fat management. In percentage terms, carbohydrate will replace fat in the diet if a lower-fat eating plan is adopted.

*101\186\4*

It is thought that women with endometriosis have higher concentrations of prostaglandins in their peritoneal fluid and that these higher concentrations may contribute to infertility by hindering or preventing conception and implantation in a number of ways.

It is possible that prostaglandins interfere with the functioning of the ovaries and prevent the release of the ovum thereby preventing fertilisation.

Prostaglandins may affect the sperm as they move towards the ovum by slowing down their movement and thus reducing the number of healthy sperm that can reach the ovum in time for fertilisation.

Prostaglandins help the ovum move along the fallopian tube.

If the fertilised ovum is propelled too rapidly along the tube the ovum will reach the uterus too quickly. Therefore, when the fertilised ovum reaches the uterus it may not be mature enough to implant itself in the endometrium or the endometrium may not be ready to accept the fertilised ovum. If the fertilised ovum is propelled too slowly down the fallopian tube it may not reach the uterus in time to embed itself in the endometrium.

Prostaglandins may also affect the relaxation and contraction of the uterus. If they produce excessive contractions of the uterus they may prevent implantation of the fertilised ovum or they may cause it to be expelled soon after implantation.

*91\83\2*