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A bleeding-heart is any of several species of bird in the genus Gallicolumba of the pigeon family, native to the Philippines, characterized by a red patch on the plumage of the breast.
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Whipple's disease?
DefinitionWhipple's disease is a rare condition that prevents the small intestines from properly absorbing nutrients. This is called malabsorption.Alternative NamesIntestinal lipodystrophyCauses, incidence, and risk factorsWhipple's disease is caused by infection from bacteria called Tropheryma whippelii. The disorder mainly affects middle-aged white men.Whipple's disease is extremely rare. Risk factors are unknown.SymptomsSymptoms usually start slowly. Joint paint is the most common initial symptom. After that, often several years later, symptoms of gastrointestinal (GI) infection develop. Other symptoms may include:Abdominal painDiarrheaFeverGray to brown skin colorJoint painMemory lossMental changesWeight lossSigns and testsPossible signs:Enlarged lymph glandsFatty stoolsGastrointestinal (GI) bleedingHeart murmurSwelling in body tissues (edema)Tests to diagnose Whipple's disease may include:Complete blood count (CBC)Polymerase chain reaction (PCR) testing of the affected tissue for Tropheryma whippeliiSmall bowel biopsyUpper GI endoscopy (viewing the intestines with a flexible, lighted tube in a process called enteroscopy )This disease may also change the results of the following tests:Albumin levels in the bloodUnabsorbed fat in the stools (fecal fat)Intestinal absorption of a type of sugar (d-xylose absorption)TreatmentPeople with Whipple's disease need to take long-term antibiotics to cure any infections of the brain and central nervous system. An antibiotic called ceftriaxone is given through a vein (IV). It is followed by another antibiotic (such as trimethoprim-sulfamethoxazole) taken by mouth for up to 1 year.If symptoms come back during antibiotic use, the antibiotic treatment may be changed.Your health care provider should closely follow your progress, because signs of the disease can return after you finish therapy. Those who have nutritional deficiencies from malabsorption will also need to take dietary supplements.Expectations (prognosis)Without treatment, the condition is usually fatal. Treatment relieves symptoms and can cure the disease.ComplicationsBrain damageHeart valve damage (from endocarditis)Nutritional deficienciesSymptoms return (which may be because of drug resistance)Weight lossCalling your health care providerCall your health care provider if you have persistent joint pain, abdominal pain, or diarrhea.If you are being treated for Whipple's disease, call your health care provider if:Symptoms worsen or do not improveSymptoms reappearNew symptoms developReferencesWest SG. Systemic diseases in which arthritis is a feature. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 297.
CPR - adult?
DefinitionCPR is a lifesaving procedure that is performed when someone's breathing or heartbeat has stopped, as in cases of electric shock, drowning, or heart attack. CPR is a combination of:Rescue breathing, which provides oxygen to a person's lungs.Chest compressions, which keep the person's blood circulating.Permanent brain damage or death can occur within minutes if a person's blood flow stops. Therefore, you must continue these procedures until the person's heartbeat and breathing return, or trained medical help arrives.Alternative NamesCardiopulmonary resuscitation - adult; Rescue breathing and chest compressions - adult; Resuscitation - cardiopulmonary - adultConsiderationsCPR can be lifesaving, but it is best performed by those who have been trained in an accredited CPR course. The procedures described here are not a substitute for CPR training. (See www.americanheart.org for classes near you.)Time is very important when dealing with an unconscious person who is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 - 6 minutes later.When a bystander starts CPR before emergency support arrives, the person has a much greater chance of surviving. Nevertheless, when most emergency workers arrive at a cardiac arrest, they usually find no one giving CPR.Machines called automated external defibrillators (AEDs) can be found in many public places, and are available for home use. These machines have pads or paddles to place on the chest during a life-threatening emergency. They use computers to automatically check the heart rhythm and give a sudden shock if, and only if, that shock is needed to get the heart back into the right rhythm.When using an AED, follow the instructions exactly.CausesIn adults, major reasons that heartbeat and breathing stop include:Drug overdoseExcessive bleedingHeart disease (heart attack or abnormal heart rhythm)Infection in the bloodstream (sepsis)Injuries and accidentsSymptomsNo breathing or difficulty breathing (gasping)No pulseUnconsciousnessFirst AidThe following steps are based on instructions from the American Heart Association.Check for responsiveness. Shake or tap the person gently. See if the person moves or makes a noise. Shout, "Are you OK?"Call 911 if there is no response. Shout for help and send someone to call 911. If you are alone, call 911 and retrieve an AED (if available), even if you have to leave the person.Carefully place the person on their back. If there is a chance the person has a spinal injury, two people should move the person to prevent the head and neck from twisting.Open the airway. Lift up the chin with two fingers. At the same time, tilt the head by pushing down on the forehead with the other hand.Look, listen, and feel for breathing. Place your ear close to the person's mouth and nose. Watch for chest movement. Feel for breath on your cheek.If the person is not breathing or has trouble breathing:Cover their mouth tightly with your mouth.Pinch the nose closed.Keep the chin lifted and head tilted.Give two rescue breaths. Each breath should take about a second and make the chest rise.Perform chest compressions:Place the heel of one hand on the breastbone -- right between the nipples.Place the heel of your other hand on top of the first hand.Position your body directly over your hands.Give 30 chest compressions. These compressions should be FAST and hard. Press down about 2 inches into the chest. Each time, let the chest rise completely. Count the 30 compressions quickly: "1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30, off."Give the person 2 more breaths. The chest should rise.Continue CPR (30 chest compressions followed by 2 breaths, then repeat) until the person recovers or help arrives. If an AED for adults is available, use it as soon as possible.If the person starts breathing again, place them in the recovery position. Periodically re-check for breathing until help arrives.Do NotIf the person has normal breathing, coughing, or movement, DO NOT begin chest compressions. Doing so may cause the heart to stop beating.Unless you are a health professional, DO NOT check for a pulse. Only a health care professional is properly trained to check for a pulse.Call immediately for emergency medical assistance ifIf you have help, tell one person to call 911 while another person begins CPR.If you are alone, as soon as you determine that the person is unresponsive, call 911 immediately. Then begin CPR.PreventionTo avoid injuries and heart problems that can lead to cardiac arrest:Eliminate or reduce risk factors that contribute to heart disease, such as cigarette smoking, high cholesterol, high blood pressure, obesity, and stress.Get plenty of exercise.See your doctor regularly.Always use seat belts and drive safely.Avoid using illegal drugs.ReferencesEmergency Cardiovascular Care Committee, Subcommittees, and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005;112(24 Suppl):IV1-203.Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th Ed. St. Louis, MO: Mosby; 2002;64-82.
Carcinoid syndrome?
DefinitionCarcinoid syndrome is a group of symptoms associated with carcinoid tumors -- tumors of the small intestine, colon, appendix, and bronchial tubes in the lungs.Causes, incidence, and risk factorsCarcinoid syndrome is the pattern of symptoms sometimes seen in people with carcinoid tumors. These tumors are rare, and often slow growing.Carcinoid syndrome occurs only 10% of the time, usually after the tumor has spread to the liver or lung.These tumors release too much of the hormone serotonin, as well as several other chemicals that cause the blood vessels to open (dilate).More carcinoid tumors are being diagnosed today than in the past.SymptomsMost carcinoid tumors have no symptoms. They only produce the syndrome about 10% of the time.When symptoms do occur, they may include:Abdominal pain that comes and goesBright red flushing of the faceDiarrhea (may be explosive and severe)Heart palpitationsLow blood pressureWheezingSometimes symptoms are brought on by physical exertion, or eating or drinking things such as blue cheeses, chocolate, or red wine.Signs and testsMost of these tumors are found during abdominal surgery.A physical examination may show:Heart valve lesionsSigns of niacin-deficiency disease (pellagra)Tests may include:5-HIAA levels in urineBlood tests (including serotonin blood test)CT and MRI scanOctreoScan (to identify most carcinoids and other neuroendocrine tumors)TreatmentSurgery to remove the tumor is usually the first treatment. It can permanently cure the condition if the tumor is completely removed.If the tumor has spread to the liver, treatment involves destroying the local blood supply or giving chemotherapy directly into the liver.When the entire tumor cannot be removed, removing large portions of the tumor ("debulking") can help relieve the symptoms.Sandostatin (octreotide) injections are sometimes given to people with advanced carcinoid tumors that cannot be removed with surgery. This drug can block and reverse tumor growth. Interferon is often given with octreotide to help stop tumor growth.A serotonin antagonist may be prescribed to control diarrhea and poor absorption of nutrients from the intestines (malabsorption).One of several combinations of chemotherapy may be given through a vein (IV) or by mouth. If one combination does not work, another combination may be effective. About one-third of patients benefit from chemotherapy.Avoid alcohol, large meals, and foods high in tyramine (aged cheeses, avocado, many processed foods), because they may trigger symptoms.Some common medicines, like selective serotonin reuptake inhibitors (SSRIs, such as Paxil, Serzone, and Prozac) may make symptoms worse by increasing levels of serotonin. However, do not stop taking these medicines unless your doctor tells you to do so.Support GroupsLearn more about carcinoid syndrome and get support from:The Carcinoid Cancer FoundationThe Caring for Carcinoid FoundationExpectations (prognosis)The outlook in patients with carcinoid syndrome is different from the outlook in patients who have carcinoid tumors without the syndrome.In people with the syndrome, the tumor has usually spread to the liver, which lowers the survival rate. People with carcinoid syndrome are also more likely to have a separate cancer (second primary tumor) at the same time.The outlook is more favorable thanks to new treatment methods, such as Sandostatin.ComplicationsIncreased risk of falls and injury (from low blood pressure)Bowel obstruction (from tumor)Gastrointestinal bleedingRight-sided heart failureCalling your health care providerCall for an appointment with your health care provider if you have symptoms of carcinoid syndrome.PreventionTreating the tumor reduces the risk of carcinoid syndrome.ReferencesKulke MH. Clinical presentation and management of carcinoid tumors. Hematol Oncol Clin North Am. 2007;21:433-455.Robertson RG, Geiger WJ, Davis NB. Carcinoid tumors. Am Fam Physician. 2006;74:429-434.
