Entering her second year as a widow, my dear friend Rachael was past the several stages of grief and closing that chapter of her life; not an easy task but necessary for anyone who has survival instincts. She began dating again and I couldnt have been happier for her. Sam was like a brother in a sense; a long time friend from our college days. At first it was dinner and theater tickets but soon developed into weekends at his Lake house.

Post menopausal, it didnt occur to Rachael to consider condoms. And in retrospect, she would not have asked Sam about his sexual activities there were things our generation didnt talk about. Therefore when her physician put her through a battery of tests because of her complaints regarding sudden weight loss and fatigue, she was shocked when she tested positive for HIV.

How does this happen at age 64, she wanted to know. But its a fact anyone can get HIVAIDS regardless of age from having unprotected sex, or sharing needles with an infected person. Latex condoms can help prevent, but not insure an infected person from transferring the virus to another. Because she did not know her partners drug andor sexual history, she was at risk!

Best friends since high school Rachael confided in me. We decided to do an in-depth study of patients 55 years and older with HIVAIDS. But we were immediately at a disadvantage because many, or should we say most, older people often mistake signs of this virus for the normal aging complaints — exactly as Rachael had and they are less likely to get tested. Besides, what patient in their senior years wants to discuss their sexual activity with a physician thats probably half their age? Not!

We soon realized the myths and misconceptions regarding all elderly citizens help put the barriers in the way of diagnosis and treatment of HIVAIDS. It is still assumed that old people live a life of celibacy and sobriety. Unfortunately, senior adults do not always conform to public images any more than teens do. Adding to this the doctors Dont ask, dont tell posture and were at an impasse.

Statistics do confirm that older women are becoming infected at a higher rate than older men. Without the fear of pregnancy, the post-menopausal woman who is uninformed of the dangers may become more sexually active with more partners. Even her biology increases her risk as the vaginal walls thin and lubrication decreases; thus, the membranes are more likely to tear during intercourse, providing access for the virus.

But whatever the reasons failure to communicate leads to failure of diagnosis in its early, most treatable stages. In many ways, HIV and old age converge and aggravate each other rather than conflict. For instance, memory loss may indicate AIDS-related dementia or Alzheimers disease. This distinction is important because dementia can be reversed; Alzheimers cannot.

As if the social isolation among senior citizens who have lost a spouse is not enough, it is multiplied many times over if their families realize they have HIVAIDS. Shamefully, this virus entered a society already having little respect for its seniors. Most adult children lack the patience, and precious few want the burden of caring for their parents in their final years.

While it is common knowledge that the face of AIDS is changing with the greater proportion being people of color, women, children and heterosexuals — what we never hear is that the face is also aging.

2006 Esther Smith

Ringworm of the groin is the disease caused by a fungus. The disease shows itself as a patch in the shape of a circle and itches. This itch is responsible for another name of this disease- Jock Itch. Let us find out about what are the treatments for Ringworm of the groin.

Ringworm of the groin- confirm the disease first

Self-medication without proper diagnosis can be a danger. Many skin diseases cause itching and only itching should not betaken as a symptom that you may be suffering from Ringworm of the groin. It may be psoriasis, or another dermatitis that may be causing the itch. First time, you suffer, please consult a doctor and get the diagnosis done. Once you are sure that it is ringworm, you can work on treatment.

Ringworm of the groin- treatment

Application of anti fungal medications is the first line of treatment. They may be powders or creams. If that does not cure the problem in two weeks, your doctor may prescribe anti fungal tablets to be taken orally. Keep the groin area clean and dry. Dont scratch yourself and touch other body parts after that. The ringworm may spread. Wear loose fitting clothes that breathe. Let the diseased part get lot of air. If you feel that by sitting in a wide legged position, you are getting air in the affected area, please do that in your privacy. Closing the legs together will increase humidity and warmth, which should be prevented.

This article is only for informative purposes. This article is not intended to be a medical advise and it is not a substitute for professional medical advice. Please consult your doctor for your medical concerns. Please follow any tip given in this article only after consulting your doctor. The author is not liable for any outcome or damage resulting from information obtained from this article.

It can be surprising to realize that an organ as high-powered and sophisticated as the brain also has a plumbing system. And, as the case with a house’s plumbing, the drainage side of the system can get gummed up. But the symptoms are different. When a home’s drainage backs up, well…I won’t go there. When the brain’s drainage system backs up, the brain’s owner can become confused, incontinent of urine and unsteady on his or her feet.

The plumbing system in question is that which produces and drains the cerebrospinal fluid CSF. Normal CSF looks the same as water from a faucet, but is created from the bloodstream in the choroid plexus tissue within three of the brain’s four inner chambers — the right and left “lateral” ventricles and the midline “fourth” ventricle, but not the interposed, midline “third” ventricle. The CSF percolates through passageways from one ventricle to another, finally emerging through openings at the base of the brain to bathe the outer surfaces of the brain and spinal cord before getting reabsorbed into the bloodstream again. This re-absorption occurs in special collection-nodes in the membranes surrounding the brain. The entire CSF volume of about 150 milliliters or five ounces about as much as a glass of wine is produced and reabsorbed four times a day, so the fluid is constantly turning over.

But blockages along the way can interfere with the normal flow of the CSF. For example, when the passageway between the third and fourth ventricles becomes narrowed or choked with sludge, the CSF backs into the lateral and third ventricles. Those ventricles react to the increased pressure by becoming physically dilated or enlarged. In this case, a CT or MRI scan could reveal the location of the blockage by showing expansion of the two lateral and the single third ventricles, but a normal-sized fourth ventricle. Another example of a blockage and its consequences is when the collection-nodes responsible for CSF re-absorption in the brain’s overlying membranes meninges become clogged. In this case, all four ventricles are upstream from the blockage, and all four of them expand. This, too, is visible on brain scans.

Both cases are examples of hydrocephalus, or water on the brain. The first case is one of “internal” or high-pressure hydrocephalus. The second is called “external” or normal-pressure hydrocephalus NPH. In NPH the pressure is inexplicably normal much of the time, but the term is somewhat misleading because prolonged recordings with pressure-monitors do show intermittent periods of increased pressure.

Hydrocephalus of one kind or another is especially prevalent at the two extremes of the life cycle — in the very young and the very old — but can occur at any age. In infancy, hydrocephalus can be caused by malformed brain-tissue. In contrast, adults with hydrocephalus were usually born with normal brain anatomy, but acquired a blockage due to a tumor, injury, bleed or infection. However, many cases of hydrocephalus in adults occur without a history of these preceding illnesses.

CT and MRI scans are sensitive tools in detecting hydrocephalus, particularly when it’s striking enough not be confused with ventricular enlargement due to gradual loss of surrounding brain tissue from aging. The main treatment of hydrocephalus is for a surgeon to insert a tube shunt into one of the swollen lateral ventricles and provide an alternative pathway for the backed-up CSF to drain. Once the shunt equipment is in place, a piece of hardware about the size of a large button sits outside the hole made in the skull but inside the skin of the scalp and redirects the excess CSF through another tube into either a jugular vein in the neck or into the abdominal cavity peritoneum. Thus, the patient can receive either a “VJ” shunt or a “VP” shunt, with the letters designating the locations of the two ends of the shunt.

The success or failure of shunting depends not just on the skill of the surgeon, but also on the selection of appropriate patients. Sometimes hydrocephalus turns up unexpectedly on a scan when doctors are looking for something else entirely. Although an unexpected finding like this should always cause the doctors to re-think the case, the point is that hydrocephalus doesn’t always cause problems. Sometimes the hydrocephalus has been there for years and the brain has adjusted to it in a way that produces no symptoms. This is an example of a case that should not be shunted, though it would still be appropriate to monitor the patient and his or her scans over subsequent months and years.

Who, then, should receive a shunt? The answer, in short, is people for whom the benefits of the operation exceed its risks. Identifying them, however, is the tough part. And the task is made even more difficult by the lack of randomized, controlled trials in which a group of patients receiving treatment is compared to an equivalent group of patients not receiving treatment. Although similar reasoning applies to adults thought to have internal high-pressure hydrocephalus, I’ll lay out the decision-tree as it applies to external normal-pressure hydrocephalus. Published observations imply that shunts are most likely to help NPH patients who have the following features
substantial enlargement of all four ventricles
a full “triad” of symptoms, including confusion, urinary incontinence and altered walking
poor walking as the first of the three symptoms
temporary improvement of symptoms after drainage of 50-60 milliliters 2 ounces of CSF by lumbar puncture spinal tap
The elderly patients most at risk for NPH are also at increased risk for other diseases, and the shunting operation doesn’t help symptoms produced by other causes. For example, confusion can be caused by Alzheimer’s disease and strokes. Urinary incontinence can be due to prostate disease in men and to sagging pelvic tissue in women. Walking can be disrupted by arthritis, fractured bones, low vision, inner-ear disease, Parkinson’s disease and many other unrelated processes.

So it’s important for the doctor to determine if other diseases might be to blame for the very symptoms that seem, at first glance, to be a result of NPH. Assuming that NPH still seems likely, the next round of decision-making concerns the possibility that an operation will cause harm. Even a patient whose brain scan and symptoms are classic for NPH can develop serious complications from the operation. A particularly feared complication is bleeding into the space outside the brain, called a subdural hematoma. Older patients are also more likely to have other medical conditions that could compromise the safety of an operation, like coronary artery disease or emphysema.

Cases in which expected benefits of the operation are much greater than risks, or in which the risks are much greater than the expected benefits, are easy to make decisions about. But many other cases are in the gray zone in which potential benefits and risks are more evenly matched and the chances of doing harm with an operation come close to canceling out the chances of doing good.

C 2006 by Gary Cordingley

At the age of 32 Sigmund Freud developed a new problem. Pricking and other unpleasant sensations had overtaken the skin on the outer side of his right thigh. Walking made his symptoms worse. The affected skin was exquisitely sensitive to touch and even the usual rubbing of his underclothes irritated the area.

Seven years later in 1895, when Freud wrote up his self-observations for a German medical journal, the abnormal sensations were still present, but had migrated. At first, the area of disturbance had been more noticeable near the top of the thigh, but gradually the abnormal sensations moved downward to a palm-sized area a hands breadth above the side of his knee.

When Freud squeezed a fold of skin in this area, it hurt more than it did in his left thigh. Although he could feel a pinprick as such, it also burned. Even so, individual spots within the zone of abnormal skin were insensitive to ordinarily painful maneuvers. He also noticed that temperature sense was impaired. Warm objects placed against the affected skin felt cooler than in unaffected areas. And although the original pricking sensations improved over time, his outer thigh had become generally less sensitive to usual stimulations.

Freuds physician, Josef Breuer, found that the affected skin was in the territory of the lateral femoral cutaneous nerve, a nerve that concerns itself with sensation only and has no muscular connections. Dr. Breuer concluded that Freuds symptoms were caused by damage to this nerve. Dr. Breuer also suspected that the nerve might be particularly vulnerable to injury in the groin near the front of the hip where it passes between strands of a ligament. As a result, he thought that wearing tight clothing might aggravate the condition.

Our understanding of this disorder has changed little in the 110 years since Freud wrote his report for Berlins Neurologisches Centralblatt, or in the 20 years since Francis Schiller, M.D., translated it into English for the American journal Neurology.

To set the record straight, Freud and Breuer were not the first to recognize this condition. Max Bernhardt of Germany first wrote about it in 1878 and in 1895 Vladimir Roth of Moscow named the condition meralgia paresthetica, a term still in use. This name is the sum of its three parts. Meros is Greek for thigh, algos is Greek for pain and paresthetica means unprovoked sensations. This entrapment neuropathy pinched nerve condition was one of the first to be recognized as such.

The lateral femoral cutaneous nerve is formed in the lower back from branches of the second and third lumbar spinal nerves which combine to form a single nerve on each side soon after emerging from the spinal column. The nerve passes through the interior of the pelvis and exits the pelvis near the outer border of the inguinal groin ligament before making a downward turn to run beneath the skin of the outer thigh.

The course of the nerve can vary from person to person and even from side to side in the same person. In about 25 of people the nerve splits into branches before reaching the inguinal ligament, and there can be up to 5 branches. This variability might make some people more vulnerable to nerve-injury than others.

Pressure within the pelvis, as from pregnancy, obesity and rarely tumors, can injure the portion of the nerve within the pelvis. And as Freud’s physician surmised, the nerve is particularly vulnerable to injury from external pressure at the inguinal ligament, as from corsets, wide belts and tight pants. However, a cause for meralgia paresthetica is not always found, as was apparently the case when Freud had it.

The nerve can also be injured during a wide variety of surgical procedures, including orthopedic, vascular, gynecological, abdominal, hernia and even stomach-stapling operations. In a recent series of spinal surgery cases in Taiwan, 60 out of 252 patients experienced meralgia paresthetica as a complication of the surgery. Fortunately, in all cases it resolved within two months.

Diagnosis of this condition is usually made from the history and the physical examination, with the key features being numbness and unpleasant sensations on the side of the thigh. Other conditions can mimic meralgia paresthetica, for example, a pinched spinal nerve in the lower back, or impairment in the nearby femoral nerve that also emerges from the pelvis at the inguinal ligament. Tests of muscle and nerve electricity–electromyography and nerve conduction studies–can help resolve ambiguous cases.

Treatment of meralgia paresthetica has not been studied by the gold-standard method of randomized, controlled trials involving a comparison group of untreated patients. So in choosing appropriate treatment all we have to go on are collections of cases published in medical journals. Because many cases turn out well without drastic treatments, conservative approaches are tried first. Weight loss, removal of tight garments, completion of pregnancy and simple watchful waiting can all be effective.

While awaiting a favorable outcome, symptoms can be managed with skin-patches containing a local anesthetic drug, anti-inflammatory medications, certain epilepsy and antidepressant drugs known to relieve nerve-pain, and local injections with steroids. Surgery to relieve the pinch is usually reserved as a last resort.

C 2005 by Gary Cordingley