tag:blogger.com,1999:blog-38320021875269977472024-03-05T16:45:18.626-08:00Provides trusted health information regarding Cancer,Medicine and moreThe first step in a diagnosis of celeriac disease is a blood test, once diagnosed, a lifelong gluten-free diet is the only medicinejournalworld provides trusted health information regarding Cancer, Digestive Disease, Genomic Medicine, Neurological, Orthopedics, Respiratory, lungs, Urology, Kidneys, dental treatment, when your treatment starts, free tools, news and doctor-reviewed resources to encourage a healthy living for you and your loved ones.Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.comBlogger68125tag:blogger.com,1999:blog-3832002187526997747.post-38358641413106627522015-05-26T11:08:00.000-07:002024-01-18T21:21:39.898-08:00Substantial health disease found in China<div dir="ltr" style="text-align: left;" trbidi="on">
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<span face=""Arial",sans-serif" style="font-size: 13pt; line-height: 107%; mso-bidi-font-size: 14.0pt;">Tickborne illnesses - such as
Lyme disease, Tularemia and Rocky Mountain spotted fever - can be serious and
sometimes deadly. They are a major public health problem around the world. Now,
a new study reports the discovery in northern China of a tickborne illness in
humans that has never been seen before. <o:p></o:p></span></div>
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<i><span style="font-style: normal;">Some ticks carry pathogens like viruses and bacteria that enter the
bloodstream of the animals and people they bite.</span></i></span></div><div class="MsoNormal"><span face=""Arial",sans-serif" style="font-size: 13pt; line-height: 107%; mso-bidi-font-size: 14.0pt;"><i><span style="font-style: normal;"> </span></i><o:p></o:p></span></div>
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">Ticks
are small, blood-sucking arthropods, and like their cousins - mites, spiders
and scorpions - they have eight legs. There are many different species of tick,
with different ones biting and sucking the blood of different animals, and
sometimes this includes humans.<o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">Some
ticks carry pathogens like viruses and bacteria that enter the bloodstream of
the animals and people that they bite. There are many different tickborne
illnesses caused by a range of pathogens.</span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">The
Centers for Disease Control and Prevention (CDC) list at least 14 different
types of tickborne diseases known in the US.</span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">Tickborne
diseases usually cause fever, chills, aches, pains and rash. Symptoms range from
mild reactions that are treatable at home to severe infections requiring
hospitalization.<o:p></o:p></span><br />
<h2>
<b><span face=""Arial",sans-serif" style="color: red; line-height: 107%; mso-bidi-font-size: 14.0pt;">'Entirely new
species of bacteria'<o:p></o:p></span></b></h2>
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">The
new discovery, reported in </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">The Lancet Infectious Diseases</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">, is the work of a
team of researchers from China and the US. In their paper, they say it is
possible that the newly-discovered disease could be a "substantial"
threat to human and animal health in the region where the tick prevails.</span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">They
name the newly discovered pathogen - a bacterium - </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Anaplasma capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">,
after the fact it appears to be common in goats. "Capra" is the Latin
word for "goat."<o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">The
bacterium is related to other </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Anaplasma</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> bacteria, some of
which can also cause illness when transmitted from ticks to humans.</span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">However,
the researchers note they are not sure how widespread </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">A. capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">
and the tick that carries it might be and whether they bite other animals as
well as goats.</span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">Co-author
J. Stephen Dumler, a professor of pathology at the University of Maryland
School of Medicine in Baltimore and an expert with global experience of
tickborne diseases, says:<o:p></o:p></span><br />
<b><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">"This is an entirely new species of bacteria. This had
never been seen in humans before. We still have a lot to learn about this
species, but it may be that this bacteria is infecting humans over a wide area."</span></b></div><div dir="ltr" style="text-align: left;" trbidi="on"><b><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> </span></b><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">Prof.
Dumler himself discovered another </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Anaplasma</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> bacterium that
causes the disease human anaplasmosis 2 decades ago.</span><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">For
the study, he and his colleagues - including researchers from the Beijing
Institute of Microbiology and Epidemiology, the Mudanjiang Forestry Central
Hospital and Shanghai Jiaotong University, all in China - tested 477 patients
in northeast China who had been bitten by a tick over the period of a month in
the spring of 2014.</span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">They
found that 6% of the patients - 28 individuals - were infected by the new
species of bacteria - </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">A. capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">.</span><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">The
symptoms of infection by </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">A. capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> include fever, muscle aches, headache, tiredness
and dizziness. The patients recovered after treatment with antibiotics,
particularly doxycycline.<o:p></o:p></span><br />
<h2>
<i><b><span face=""Arial",sans-serif" style="color: red; font-style: normal; line-height: 107%; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic;">A. capra</span></b></i><b><span face=""Arial",sans-serif" style="color: red; line-height: 107%; mso-bidi-font-size: 14.0pt;"> probably transmitted by the taiga tick<o:p></o:p></span></b></h2>
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">Not
much is known about </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">A. capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">. It is not easy to diagnose - there is
no simple blood test.<o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">The
researchers say </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">A. capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> is probably transmitted by the taiga
tick - a close relative of the deer tick. The tick is widespread in Eastern
Europe and Asia - including Russia, China and Japan.<o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">If
the taiga tick spreads </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">A. capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> throughout this region, then human
infection may be common, says Prof. Dumler, who notes that more than a billion
people live in areas where the tick is prevalent. He and his colleagues
conclude:</span><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">"The
emergence of </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">A. capra</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> as a cause of human disease suggests
that individuals living in or traveling to endemic regions in northern China
should take precautions to reduce their risk of exposure to this novel
tickborne pathogen."<o:p></o:p></span><br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">The
Natural Science Foundation of China and the US National Institutes of Health
funded the study.<o:p></o:p></span><br />
<br />
<span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;">In
2013, </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Medical News Today</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 14.0pt;"> reported how researchers from Yale
University found a new infection caused by ticks that is extremely similar to
Lyme disease. They described how they found the unnamed disease for the first
time in humans - 18 people in southern New England and upstate New York - in
the </span><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">New </span></i><i><span face=""Arial",sans-serif" style="font-size: 13pt; font-style: normal; mso-bidi-font-size: 11.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">England Journal of Medicine</span></i><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 11.0pt;">.</span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span face=""Arial",sans-serif" style="font-size: 13pt; mso-bidi-font-size: 11.0pt;"> </span><span face=""Arial",sans-serif"><o:p></o:p></span><br />
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="35" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
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<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
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<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
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<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
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<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
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<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="21" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
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<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
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<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
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<div class="MsoNormal"><span style="font-family: arial;">
There are five types of psoriasis. The most common form,
plaque psoriasis, appears as raised, red patches covered with a silvery white
buildup of dead skin cells. Psoriasis can occur on any part of the body and is
associated with other serious health conditions, such as diabetes, heart
disease and depression.</span></div><div class="MsoNormal"><span style="font-family: arial;"> </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1;">
<b style="font-family: arial;"><span style="font-size: 24pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Symptoms and diagnosis</span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1;"><b style="font-family: arial;"><span style="font-size: 24pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"> </span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Psoriasis is an autoimmune disease that
causes raised, red, scaly patches to appear on the skin. It typically affects
the outside of the elbows, knees or scalp, though it can appear on any
location. Some people report that psoriasis is itchy, burns and stings.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">If you develop a rash that doesn't go
away with an over-the-counter medication, you should consider contacting your
doctor.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></div>
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<b style="font-family: arial;"><span style="font-size: 18pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Diagnosis</span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;"><b style="font-family: arial;"><span style="font-size: 18pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">About 95 percent of the time, your health
care provider can make a psoriasis diagnosis just by visual inspection. Your
doctor will consider where the raised, red, scales appear, if they have
well-defined edges and how the rash responds to medication when making a
diagnosis.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Psoriasis may seem similar to eczema,
but there are several differences:</span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Psoriasis plaques are
well-defined; eczema tends to be flatter with less well-defined edges.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Eczema typically occurs on
locations atypical for psoriasis, such as the front of elbows or behind
the knees. Psoriasis is most often found on the outside of knees and
elbows, the scalp, the lower back, the face, the palms and soles of feet.
It also can show up in other places, such as fingernails, toenails, the
genitals and inside the mouth.</span></li>
</ul>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">When biopsied, psoriasis skin looks
thicker and inflamed when compared to skin with eczema.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Your doctor also will want to learn
about your family history. About one-third of people with psoriasis have a
family member with the disease, according to dermatologist Dr. Paul Yamauchi
with the Dermatology and Skin Care Institute in Santa Monica, Calif.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial;"><br /></span></div>
<h1>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Types of Psoriasis</span></h1>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Psoriasis appears in a variety of forms with
distinct characteristics. Typically, an individual has only one type of
psoriasis at a time. Generally, one type of psoriasis will clear and another
form of psoriasis will appear in response to a trigger.</span><span style="font-family: arial;"><br /></span>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> </span><span style="font-family: arial;"><br /></span>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Plaque Psoriasis <i><span face=""Calibri",sans-serif" style="mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; text-decoration: none; text-underline: none;">(psoriasis
vulgaris)</span></i></span></h2>
<div class="separator" style="clear: both; text-align: center;">
</div>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Plaque psoriasis is the most common form of
the disease and appears as raised, red patches covered with a silvery white
buildup of dead skin cells or scale. These patches or plaques most often appear
on the scalp, knees, elbows and lower back. They are often itchy and painful,
and they can crack and bleed.</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Guttate</span><span style="font-family: arial;"></span></h2><h2><span style="font-family: arial;"><br /></span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Guttate [GUH-tate] psoriasis is a form of
psoriasis that often starts in childhood or young adulthood. This is the second
most common type of psoriasis, after plaque psoriasis. About 10 percent of
people who get psoriasis develop guttate psoriasis.</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Inverse</span><span style="font-family: arial;"></span></h2><h2><span style="font-family: arial;"><br /></span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Inverse psoriasis (also known as
intertriginous psoriasis) shows up as very red lesions in body folds. It may
appear smooth and shiny. Many people have another type of psoriasis elsewhere
on the body at the same time.</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Pustular</span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Pustular [PUHS-choo-lar] psoriasis in
characterized by white pustules (blisters of noninfectious pus) surrounded by
red skin. The pus consists of white blood cells. It is not an infection, nor is
it contagious.</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Erythrodermic</span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Erythrodermic [eh-REETH-ro-der-mik] psoriasis
is a particularly inflammatory form of psoriasis that often affects most of the
body surface. It may occur in association with von Zumbusch pustular psoriasis.
It is a rare type of psoriasis, occurring once or more during the lifetime of 3
percent of people who have psoriasis. It generally appears on people who have
unstable plaque psoriasis. This means the lesions are not clearly defined.
Widespread, fiery redness and exfoliation of the skin characterize this form.
Severe itching and pain often accompanies it.</span><span style="font-family: arial;"><br /></span>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial;"><br /></span></div>
<h1>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Psoriasis on Specific Locations</span></h1>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Psoriasis can show up anywhere—on the
eyelids, ears, mouth and lips, skin folds, hands and feet, and nails. The skin
at each of these sites is different and requires different treatments. In
addition, psoriasis can vary widely among individuals and in its response to
treatment. Light therapy or topical treatments are often used when psoriasis is
limited to a specific part of the body. However, doctors may prescribe oral or
injectable drugs if the psoriasis greatly affects a person's quality of life.
Effective treatments are available, no matter where your psoriasis is located.</span><span style="font-family: arial;"><br /></span>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Scalp</span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Scalp psoriasis can be very mild, with
slight, fine scaling. It can also be very severe with thick, crusted plaques
covering the entire scalp. Psoriasis can extend beyond the hairline onto the
forehead, the back of the neck and around the ears. Learn
about treating scalp psoriasis »</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Face</span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Facial psoriasis most often affects the
eyebrows, the skin between the nose and upper lip, the upper forehead and the
hairline. You might need a biopsy to confirm that it is psoriasis. Read
more about facial psoriasis »</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Hands,
Feet and Nails</span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">It is important to treat acute flares of
psoriasis on the hands and feet promptly and carefully. In some cases,
cracking, blisters and swelling accompany flares. Nail changes occur in up to
50 percent of people with psoriasis and at least 80 percent of people with
psoriatic arthritis. Learn more about how to treat psoriasis on hands,
feet & nails »</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Genital
Psoriasis</span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The most common type of psoriasis in the
genital region is inverse psoriasis. There are various regions of the genital
area that can be affected by psoriasis. More
information about genital psoriasis »</span><span style="font-family: arial;"><br /></span>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" size="2" width="100%" />
</div>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Skin
Folds</span></h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Inverse psoriasis can occur in skin folds
such as the armpits and under the breasts. This form of psoriasis is frequently
irritated by rubbing and sweating. Read
more about treating psoriasis in skin folds »</span><span style="font-family: arial;"><br /></span>
<h1>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Psoriasis Severity</span></h1>
<h2>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Psoriasis can be mild, moderate or severe</span></h2>
<div class="separator" style="clear: both; text-align: center;">
</div>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">People with psoriasis on less than three
percent of their body are considered to have a mild case. Those with three to
10 percent of the body affected by psoriasis are considered a moderate case.
More than 10 percent is considered severe. (The surface area of the hand equals
about one percent of the skin.)</span><span style="font-family: arial;"></span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span style="font-family: arial;"><br /></span>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">About four out of five people with psoriasis
have what is considered mild psoriasis, and about one out of five have moderate
to severe psoriasis. These categories are useful for selecting which treatments
may be most appropriate for each individual.</span><span style="font-family: arial;"><br /></span>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">However, the severity of psoriasis is also
measured by how psoriasis affects a person's quality of life. For example,
psoriasis can have a serious impact on one’s daily activities even if it
involves a small area, such as the palms of the hands or soles of the feet.</span><span style="font-family: arial;"><br /></span>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Generally, for those people who have mild
psoriasis—isolated patches on the knees, elbows, scalp and hands and feet—topical
treatments, including moisturizers, and over-the-counter and prescription
creams, ointments and shampoos are usually sufficient to control the plaques.</span><span style="font-family: arial;"><br /></span>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Many successful psoriasis alternative
therapies are also available and widely used with beneficial effects by
people with mild psoriasis. Find out as much as you can about all the options
available to you, and then learn what works best for your own mild psoriasis.</span><span style="font-family: arial;"><br /></span>
<span face=""Calibri",sans-serif" style="font-family: arial; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treating moderate to severe psoriasis usually
involves a combination of treatment strategies. Besides topical treatments,
your doctor may prescribe phototherapy
(also known as light therapy) and/or systemic
medications, including biologic
drugs. Phototherapy involves regularly exposing the skin to light, and
systemic medications are prescription drugs administered orally or by injection
that work throughout the body.</span><span style="font-family: arial;"></span></div><div dir="ltr" style="text-align: left;" trbidi="on"><span style="font-family: arial;"><br /></span>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1;">
<b style="font-family: arial;"><span style="font-size: 24pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Psoriasis Causes and Known Triggers</span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Scientists believe that at least 10
percent of the general population inherits one or more of the genes that create
a predisposition to psoriasis. However, only 2 percent to 3 percent of the
population develops the disease. Researchers believe that for a person to
develop psoriasis, the individual must have a combination of the genes that
cause psoriasis and be exposed to specific external factors known as
"triggers". Read more
about the science of psoriasis »</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Psoriasis triggers are not universal.
What may cause one person's psoriasis to become active, may not affect another.
<b>Established psoriasis triggers include</b>:</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<b style="font-family: arial;"><span style="font-size: 18pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Stress</span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Stress can cause psoriasis to flare for
the first time or aggravate existing psoriasis. Relaxation and stress
reduction may help prevent stress from impacting psoriasis.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<b style="font-family: arial;"><span style="font-size: 18pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Injury
to skin</span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Psoriasis can appear in areas of the
skin that have been injured or traumatized. This is called the Koebner
[KEB-ner] phenomenon. Vaccinations, sunburns and scratches can all trigger a
Koebner response. The Koebner response can be treated if it is caught early
enough.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<b style="font-family: arial;"><span style="font-size: 18pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Medications</span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Certain medications are associated with
triggering psoriasis, including:</span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: arial;"><b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Lithium</span></b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">: Used to treat manic depression
and other psychiatric disorders. Lithium aggravates psoriasis in about
half of those with psoriasis who take it.</span></span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: arial;"><b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Antimalarials</span></b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">: Plaquenil, Quinacrine,
chloroquine and hydroxychloroquine may cause a flare of psoriasis, usually
2 to 3 weeks after the drug is taken. Hydroxychloroquine has the lowest
incidence of side effects.</span></span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: arial;"><b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Inderal</span></b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">: This high blood pressure
medication worsens psoriasis in about 25 percent to 30 percent of patients
with psoriasis who take it. It is not known if all high blood pressure
(beta blocker) medications worsen psoriasis, but they may have that
potential.</span></span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: arial;"><b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Quinidine</span></b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">: This heart medication has been
reported to worsen some cases of psoriasis.</span></span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: arial;"><b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Indomethacin</span></b><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">: This is a nonsteroidal
anti-inflammatory drug used to treat arthritis. It has worsened some cases
of psoriasis. Other anti-inflammatories usually can be substituted.
Indomethacin's negative effects are usually minimal when it is taken
properly. Its side effects are usually outweighed by its benefits in
psoriatic arthritis.</span></span></li>
</ul>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<b style="font-family: arial;"><span style="font-size: 18pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Infection</span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Anything that can affect the immune
system can affect psoriasis. In particular, streptococcus infection (strep
throat) is associated with guttate psoriasis. Strep throat often is associated
with the first onset of guttate psoriasis in
children. You may experience a flare-up following an earache, bronchitis,
tonsillitis or a respiratory infection, too.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">It's not unusual for someone to have an
active psoriasis flare with no strep throat symptoms. Talk with your doctor
about getting a strep throat test if your psoriasis flares.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Learn
more about how psoriasis can affect your risk for infection »</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: arial; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Although scientifically unproven, some
people with psoriasis suspect that allergies, diet and weather trigger their
psoriasis. Strep infection is known to trigger guttate psoriasis.</span><span style="font-family: arial;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
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Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com1tag:blogger.com,1999:blog-3832002187526997747.post-24197395495415303802015-02-04T09:43:00.003-08:002015-02-04T09:43:49.990-08:00Conjunctivitis - Treatment<div dir="ltr" style="text-align: left;" trbidi="on">
<h2>
Treating conjunctivitis </h2>
<strong>The recommended treatment for conjunctivitis will
depend on whether it is caused by infection, an allergic reaction or an
irritant such as a stray eyelash.</strong><br />
Each treatment option is discussed in more detail below.<br />
<h3>
Infective conjunctivitis</h3>
Most cases of infective conjunctivitis do not require medical treatment and will clear up in one to two weeks.<br />
<h4>
Self-care</h4>
There are several ways that you can treat infective conjunctivitis at home. The following advice should help ease your symptoms:<br />
<ul>
<li><strong>Remove your contact lenses</strong>. If you wear contact
lenses, take them out until all the signs and symptoms of the infection
have gone. Avoid using contact lenses until 24 hours after you have
finished a course of treatment. Do not re-use the lenses after the
infection has passed as the old lens could be a potential source of
re-infection. </li>
<li><strong>Use lubricant eye drops</strong>. These are available
over the counter at pharmacies or they may be prescribed for you. They
may help ease any soreness and stickiness in your eyes. Always follow
the manufacturer’s instructions. </li>
<li><strong>Gently clean away sticky discharge</strong> from your eyelids and lashes using cotton wool soaked in water. </li>
<li><strong>Wash your hands regularly</strong>. This is particularly
important after you have touched your infected eyes and will stop the
infection spreading to other people. </li>
</ul>
<h4>
Antibiotics</h4>
<a href="http://www.nhs.uk/conditions/Antibiotics-penicillins/Pages/Introduction.aspx">Antibiotics</a> are
not usually prescribed for infective conjunctivitis as it usually
clears up by itself and there is a very low risk of complications for
untreated conjunctivitis.<br />
However, if the infection is particularly severe or it has lasted for
more than two weeks, you may be prescribed antibiotics. Some schools or
playgroups may insist that a child is treated with antibiotics before
they can return, although this is rarely necessary.<br />
The two main types of antibiotics that may be prescribed are:<br />
<ul>
<li>chloramphenicol </li>
<li>fusidic acid </li>
</ul>
<h4>
Chloramphenicol</h4>
<a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Bacterial%20eye%20infections&medicine=Chloramphenicol&preparation=Chloramphenicol%200.5%25%20eye%20drops%200.5ml%20unit%20dose%20preservative%20free">Chloramphenicol</a> is usually the first choice and comes in the form of eye drops. <br />
Make sure you follow your doctor's advice about how and when to use
the eye drops, or check the instructions that come with the medication
so you know how to use them properly.<br />
If eye drops are not suitable for you, you may be prescribed the antibiotic as an eye ointment instead.<br />
<h4>
Fusidic acid</h4>
<a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Eye%20infections&medicine=Fusidic%20Acid&preparation=Fusidic%20acid%201%%20modified-release%20eye%20drops">Fusidic acid</a> may
be prescribed if chloramphenicol is not suitable for you. It's often
better for children and elderly people as it doesn't need to be used as
often. It is also the preferred treatment for pregnant women.<br />
Like chloramphenicol, fusidic acid comes in the form of eye drops and
should be used as advised by your doctor or as described in the
instructions that come with the medication.<br />
<h4>
Side effects</h4>
Eye drops can briefly cause blurred vision. Avoid driving or operating machinery straight after using eye drops. <br />
Chloramphenicol and fusidic acid can also cause some other side
effects, such as a slight stinging or burning sensation in your eye.
This feeling should not last long.<br />
<h4>
Further treatment</h4>
If you still have symptoms after two weeks, it is very important to
go back to your GP. Also contact your GP immediately if you experience
any of the following symptoms:<br />
<ul>
<li>eye pain </li>
<li>sensitivity to light (photophobia) </li>
<li>loss of vision </li>
<li>intense redness in one or both of your eyes </li>
</ul>
Your GP may suggest that you are tested for sexually transmitted infections (STIs). Some STIs, such as <a href="http://www.nhs.uk/conditions/Chlamydia/Pages/Introduction.aspx">chlamydia</a>, can cause infective conjunctivitis. In this case, your symptoms may last for several months.<br />
<h3>
Allergic conjunctivitis</h3>
Your treatment will depend on which type of allergic conjunctivitis you have. <br />
The four main types of allergic conjunctivitis are:<br />
<ul>
<li><strong>seasonal conjunctivitis</strong>: typically caused by an allergy to pollen </li>
<li><strong>perennial conjunctivitis</strong>: usually caused by an allergy to dust mites or pets </li>
<li><strong>contact dermatoconjunctivitis</strong>: usually caused by an allergy to eye drops or cosmetics </li>
<li><strong>giant papillary conjunctivitis</strong>: usually caused by an allergy to contact lenses </li>
</ul>
Whatever the cause, you will find that some self-help methods can ease your symptoms.<br />
<h4>
Self-help</h4>
If you have allergic conjunctivitis, you can follow the guidelines below to treat your condition at home:<br />
<ul>
<li>Remove your contact lenses. If you wear contact lenses, take
them out until all the signs and symptoms of the conjunctivitis have
gone. </li>
<li>Do not rub your eyes, even though your eyes may be itchy. Rubbing them can make your symptoms worse. </li>
<li>Place a cool compress over your eyes. </li>
<li>Wetting a flannel with cool water and holding it over your eyes will help ease your symptoms. </li>
<li>Avoid exposure to the allergen, if possible. </li>
</ul>
<h4>
Seasonal and perennial allergic conjunctivitis</h4>
If you have seasonal or perennial conjunctivitis you may be prescribed the following medicines:<br />
<ul>
<li>antihistamines </li>
<li>mast cell stabilisers </li>
<li>corticosteroids </li>
</ul>
These are described in more detail below.<br />
<h4>
Antihistamines</h4>
If your allergic conjunctivitis requires rapid relief, your GP will probably prescribe a medicine known as an <a href="http://www.nhs.uk/conditions/Antihistamines/Pages/Introduction.aspx">antihistamine</a>.<br />
Antihistamines work by blocking the action of the chemical histamine,
which the body releases when it thinks it is under attack from an
allergen. This prevents the symptoms of the allergic reaction from
occurring.<br />
<h4>
Antihistamine eye drops</h4>
You may be prescribed antihistamine eye drops, such as:<br />
<ul>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Conjunctivitis&medicine=Azelastine%20hydrochloride&preparation=Azelastine%200.05%25%20eye%20drops">azelastine</a> (not suitable for children under four years of age) </li>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Conjunctivitis&medicine=Emedastine%20difumarate&preparation=Emedastine%200.05%25%20eye%20drops">emedastine</a> (not suitable for children under three years of age) </li>
<li><a href="http://www.nhs.uk/medicine-guides/pages/medicineoverview.aspx?condition=allergic+conditions&medicine=ketotifen&preparation=ketotifen+1mg%2f5ml+oral+solution+sugar+free">ketotifen</a> (not suitable for children under three years of age) </li>
<li>antazoline with xylometazoline (<a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?medicine=Otrivine%20Antistin">Otrivine-Antistin</a>, not suitable for children under 12 years of age) </li>
</ul>
Antazoline with xylometazoline (Otrivine-Antistin) is also available
over the counter from pharmacies without prescription. Always follow the
manufacturer’s instructions.<br />
If you are pregnant or breastfeeding, some antihistamine eye drops may not be suitable. Speak to your GP for advice. <br />
<h4>
Oral antihistamines</h4>
You may be prescribed an antihistamine such as:<br />
<ul>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?medicine=Cetirizine%20tablets">cetirizine</a> </li>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Allergic%20conditions&medicine=Fexofenadine%20hydrochloride&preparation=Fexofenadine%20180mg%20tablets">fexofenadine</a> </li>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Allergic%20conditions&medicine=Loratadine&preparation=Loratadine%2010mg%20tablets">loratadine</a> </li>
</ul>
You will usually only have to take an antihistamine once a day.<br />
If possible, oral antihistamines should not be taken if you are pregnant or breastfeeding. Speak to your GP for advice. <br />
Although new antihistamines should not make you drowsy, they may
still have a sedating effect. This is more likely if you take high doses
or drink alcohol while you are taking antihistamines.<br />
<h4>
Mast cell stabilisers</h4>
Mast cell stabilisers are an alternative type of medicine. Unlike
antihistamines, they will not provide rapid relief from your symptoms,
but they are more effective at controlling your symptoms over a longer
period of time.<br />
It may take several weeks to feel the effects so you may also be prescribed an antihistamine to take at the same time.<br />
Mast cell stabilisers that are commonly prescribed in the form of eye drops include:<br />
<ul>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Conjunctivitis&medicine=Lodoxamide%20trometamol&preparation=Lodoxamide%200.1%25%20eye%20drops">lodoxamide</a> </li>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Conjunctivitis&medicine=Nedocromil&preparation=Nedocromil%202%25%20eye%20drops">nedocromil sodium</a> </li>
<li><a href="http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Conjunctivitis&medicine=Sodium%20Cromoglicate&preparation=Sodium%20cromoglicate%202%25%20eye%20drops">sodium cromoglicate</a> </li>
</ul>
<h4>
Corticosteroids</h4>
If your symptoms of allergic conjunctivitis are particularly severe,
you may be prescribed a short course of topical corticosteroids (a
cream, gel or ointment). However, these are not usually prescribed
unless absolutely necessary.<br />
<br />
<h4>
Giant papillary conjunctivitis</h4>
As giant papillary conjunctivitis is usually caused by contact
lenses, the symptoms often clear up after you stop wearing them. The
spots that form on the inside of your upper eyelid may last slightly
longer.<br />
If you develop giant papillary conjunctivitis as a result of recent
eye surgery, you will be immediately referred to an ophthalmologist.
This is to ensure that your eyes can be carefully monitored and the most
effective treatment given.<br />
<h3>
Irritant conjunctivitis</h3>
Most cases of irritant conjunctivitis do not require any treatment as
the condition should clear up once the irritant is removed from the
eye.<br />
An exception to this is if your eyes were exposed to harmful
substances such as bleach or acid. This is usually regarded as medical
emergency and you will need to be admitted to hospital so your eyes can
be washed out with saline solution.</div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-15429432826112650912015-02-04T08:42:00.002-08:002015-02-04T08:42:40.892-08:00Psoriasis Treatments<div dir="ltr" style="text-align: left;" trbidi="on">
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<br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treating your psoriasis is critical to good
disease management and overall health. Work with your doctor to find a
treatment—or treatments—that reduce or eliminate your symptoms. What works for
one person with psoriasis might not work for another. So it's important to know
the different treatment options and keep trying until you find the right
regimen for you.</span><br />
<h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Moderate to Severe Psoriasis and Psoriatic
Arthritis: Biologic Drugs</span></h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Biologic drugs, or "biologics," are
given by injection or intravenous (IV) infusion. A biologic is a protein-based
drug <a href="http://www.psoriasis.org/publications/psoriasis-advance/2003/july-august/the-making-of-biologics"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">derived
from living cells cultured in a laboratory</span></a>. While biologics have
been used to treat disease for more than 100 years, modern-day techniques have
made biologics much more widely available as treatments in the last decade.</span><br />
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
Biologics
are different from traditional systemic drugs that impact the entire immune
system. Biologics, instead, target specific parts of the immune system. The
biologics used to treat psoriatic disease block the action of a specific type
of immune cell called a T cell, or block proteins in the immune system, such as
tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A, or interleukins 12
and 23. These cells and proteins all play a major role in developing psoriasis
and psoriatic arthritis.</div>
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Biosimilar substitution</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The National Psoriasis Foundation Medical
Board has issued a statement on biosimilar substitution. <a href="http://www.psoriasis.org/about-psoriasis/treatments/statement-on-biosimilars"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Read
the statement »</span></a></span><br />
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Tumor necrosis factor-alpha (TNF-alpha)
blockers</span></h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><a href="http://www.psoriasis.org/about-psoriasis/treatments/biologics/resources#cimzia"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Cimzia
(certolizumab pegol)</span></a>, <a href="http://www.psoriasis.org/about-psoriasis/treatments/biologics/resources#enbrel"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Enbrel
(etanercept)</span></a>, <a href="http://www.psoriasis.org/about-psoriasis/treatments/biologics/resources"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Humira
(adalimumab)</span></a>, <a href="http://www.psoriasis.org/about-psoriasis/treatments/biologics/resources#remicade"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Remicade
(infliximab)</span></a> and <a href="http://www.psoriasis.org/about-psoriasis/treatments/biologics/resources#simponi"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Simponi
(golimumab)</span></a> are drugs that block TNF-alpha. TNF-alpha is a cytokine,
or a protein, that prompts the body to create inflammation. In psoriasis and psoriatic
arthritis, there is excess production of TNF-alpha in the skin or joints. That
leads to the rapid growth of skin cells and/or damage to joint tissue. Blocking
TNF-alpha production helps stop the inflammatory cycle of psoriatic disease.</span><br />
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Interleukin 12/23</span></h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Stelara (ustekinumab) works by selectively
targeting the proteins, or cytokines, interleukin-12 (IL-12) and interleukin 23
(IL-23). Interleukins-12/23 are associated with psoriatic inflammation.</span><br />
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Interleukin 17-A</span></h2>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
Cosentyx
(secukinumab) binds to and inhibits a cytokine, or protein, called
interleukin-17A (IL-17A), which is involved in inflammatory and immune
responses. There are elevated levels of IL-17A in psoriatic plaques. By
inhibiting cytokines that trigger inflammation, Cosentyx interrupts the inflammatory
cycle of psoriasis. This can lead to improvement in symptoms for many people
who take it.</div>
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">How are they used?</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The biologics are taken by injection or by IV
infusion. Cimzia, Cosentyx, Enbrel, Humira and Simponi are injected in the
legs, abdomen or arms, typically by the individual with psoriatic disease or a
family member. Stelara is administered as a subcutaneous injection by a health
care provider. Remicade is given through IV infusion in a doctor’s office or
infusion center. Biologics are prescribed for individuals with moderate to
severe cases of plaque psoriasis and psoriatic arthritis. They are a viable
option for those who have not responded to or have experienced harmful side
effects from other treatments. Studies show that TNF-alpha blockers help reduce
the progression of joint damage in psoriatic arthritis.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Do not take biologics if:</span></h3>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">Your
immune system is significantly compromised;</li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">You have
an active infection.</li>
</ul>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Screening for tuberculosis (TB) or other
infectious diseases is required before starting treatment with Cosentyx,
Enbrel, Humira, Remicade, Simponi and Stelara.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">What are the risks?</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Anyone considering taking a biologic drug
should talk with his or her doctor about the short- and long-term side effects
and risks. It is important to weigh the risks against the benefits of using the
drugs.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Biologics can increase the risk of infection.
Individuals who develop any sign of an infection such as a fever, cough or
flu-like symptoms or have any cuts or open sores should contact their doctor
right away.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The impact of biologics on developing fetuses
or nursing infants is not known. Biologics should only be prescribed to <a href="http://www.psoriasis.org/pregnant"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">pregnant or nursing
women</span></a> if there is a clear medical need.</span><br />
<strong><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Common side effects for biologics
include:</span></strong><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span><br />
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">Respiratory
infections</li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">Flu-like
symptoms</li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">Injection
site reactions</li>
</ul>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">These side effects are generally mild and in
most cases do not cause individuals to stop taking the medication.</span><br />
<strong><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Rare side effects for biologics
include:</span></strong><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span><br />
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">Serious
nervous system disorders, such as multiple sclerosis, seizures, or
inflammation of the nerves of the eyes;</li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">Blood
disorders;</li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;">Certain
types of cancer.</li>
</ul>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Call your doctor if you are experiencing any
side effects with biologic drugs. For specific side effect information,
download the <a href="http://www.psoriasis.org/about-psoriasis/treatments/biologics/resources"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">individual
product fact sheet</span></a>.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Using biologics with other psoriasis
treatments</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">All the current biologics can be used with
other treatments such as phototherapy or topicals, though using phototherapy
along with Remicade may increase skin cancer risk.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Cimzia, Enbrel, Humira and Remicade are shown
to be safe and effective when taken with methotrexate. Talk to your doctor
about whether using any other treatments with a biologic is right for you.</span><br />
<div class="MsoNormal">
<span style="color: #ff8200; font-size: 24.0pt; line-height: 107%; mso-bidi-font-family: Arial;">Traditional Systemic Medications</span></div>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Systemic medications are prescription drugs
that work throughout the body. They are usually used for individuals with
moderate to severe psoriasis and psoriatic arthritis. Systemic medications are
also used in those who are not responsive or are unable to take <a href="http://www.psoriasis.org/about-psoriasis/treatments/topicals">topical
medications</a> or <a href="http://www.psoriasis.org/about-psoriasis/treatments/phototherapy">UV
light therapy</a>.<br />
<br />
Systemic psoriasis drugs are taken by mouth in liquid or pill form or given by
injection. Systemics have been used for more than 10 years.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><a href="http://services.psoriasis.org/apps/ctr/redirect.php?url=http://www.psoriasis.org/NetCommunity/Document.Doc%3fid=161&domain=psoriasis.org&lntype=image&id=1137&pid=432">Download
the Systemic Medications Booklet (pdf) »</a></span><br />
<h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Phototherapy</span></h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Phototherapy or light therapy, involves
exposing the skin to ultraviolet light on a regular basis and under medical
supervision. Treatments are done in a doctor's office or psoriasis clinic or at
home with phototherapy unit. The key to success with light therapy is
consistency.<br />
National Psoriasis Foundation does not support the use of indoor tanning beds
as a substitute for phototherapy performed with a prescription and under a
doctor's supervision. Indoor tanning raises the risk of melanoma by 59 percent,
according to the American Academy of Dermatology and the World Health
Organization, and does not provide the type of light that most effectively
treats psoriasis. Read more on the Psoriasis Foundation <a href="http://www.psoriasis.org/about-psoriasis/treatments/statement-on-tanning-beds"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">position
on indoor tanning beds »</span></a></span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><a href="http://www.psoriasis.org/health-care-providers/physicians-directory"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Find
a provider who offers phototherapy in our Health Care Provider Directory »</span></a></span><br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" id="uvb" size="2" width="100%" />
</div>
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Ultraviolet light B (UVB)</span></h2>
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">UVB phototherapy</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Present in natural sunlight, ultraviolet B
(UVB) is an effective treatment for psoriasis. UVB penetrates the skin and
slows the growth of affected skin cells. Treatment involves exposing the skin
to an artificial UVB light source for a set length of time on a regular
schedule. This treatment is administered in a medical setting or at home.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">There are two types of UVB treatment, broad
band and narrow band. The major difference between them is that narrow band UVB
light bulbs release a smaller range of ultraviolet light. Narrow-band UVB is
similar to broad-band UVB in many ways. Several studies indicate that
narrow-band UVB clears psoriasis faster and produces longer remissions than broad-band
UVB. It also may be effective with fewer treatments per week than broad-band
UVB.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">During UVB treatment, your psoriasis may
worsen temporarily before improving. The skin may redden and itch from exposure
to the UVB light. To avoid further irritation, the amount of UVB administered
may need to be reduced. Occasionally, temporary flares occur with low-level
doses of UVB. These reactions tend to resolve with continued treatment.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">UVB can be combined with other topical and/or
systemic agents to enhance efficacy, but some of these may increase
photosensitivity and burning, or shorten remission. Combining UVB with systemic
therapies may increase efficacy dramatically and allow for lower doses of the
systemic medication to be used.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Home UVB phototherapy</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treating psoriasis with a UVB light unit at
home is an economical and convenient choice for many people. Like phototherapy
in a clinic, it requires a consistent treatment schedule. Individuals are
treated initially at a medical facility and then begin using a light unit at
home.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">It is critical when doing phototherapy at
home to follow a doctor's instructions and continue with regular check-ups.
Home phototherapy is a medical treatment that requires monitoring by a health
care professional.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">All phototherapy treatments, including
purchase of equipment for home use, require a prescription. Some insurance
companies will cover the cost of <a href="http://www.psoriasis.org/about-psoriasis/treatments/phototherapy/uvb/home-equipment"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">home
UVB equipment</span></a>. Vendors of home phototherapy equipment often will
assist you in working with your insurance company to purchase a unit.</span><br />
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" id="sunlight" size="2" width="100%" />
</div>
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Sunlight</span></h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Although both UVB and ultraviolet light A
(UVA) are found in sunlight, UVB works best for psoriasis. UVB from the sun
works the same way as UVB in phototherapy treatments.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Short, multiple exposures to sunlight are
recommended. Start with five to 10 minutes of noontime sun daily. Gradually
increase exposure time by 30 seconds if the skin tolerates it. To get the most
from the sun, all affected areas should receive equal and adequate exposure.
Remember to wear sunscreen on areas of your skin unaffected by psoriasis.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Avoid overexposure and sunburn. It can take
several weeks to see improvement. Have your doctor check you regularly for sun
damage.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Some topical medications can increase the
risk of sunburn. These include <a href="http://www.psoriasis.org/about-psoriasis/treatments/topicals/non-steroid#tazorec"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">tazarotene</span></a>,
<a href="http://www.psoriasis.org/about-psoriasis/treatments/topicals/over-the-counter"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">coal
tar</span></a>, Elidel (pimecrolimus) and Protopic (tacrolimus). Individuals
using these products should talk with a doctor before going in the sun.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">People who are using PUVA or other forms of
light therapy should limit or avoid exposure to natural sunlight unless
directed by a doctor.</span><br />
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" id="puva" size="2" width="100%" />
</div>
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Psoralen + UVA (PUVA)</span></h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Like UVB, ultraviolet light A (UVA) is
present in sunlight. Unlike UVB, UVA is relatively ineffective unless used with
a light-sensitizing medication psoralen, which is administered topically or
orally. This process, called PUVA, slows down excessive skin cell growth and
can clear psoriasis symptoms for varying periods of time. Stable <a href="http://www.psoriasis.org/about-psoriasis/types"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">plaque psoriasis</span></a>,
<a href="http://www.psoriasis.org/about-psoriasis/types"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">guttate
psoriasis</span></a>, and psoriasis of the <a href="http://www.psoriasis.org/about-psoriasis/specific-locations/hands-feet-nails"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">palms
and soles</span></a> are most responsive to PUVA treatment.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The most common short-term side effects of
PUVA are nausea, itching and redness of the skin. Drinking milk or ginger ale,
taking ginger supplements or eating while taking oral psoralen may prevent
nausea. Antihistamines, baths with colloidal oatmeal products or application of
<a href="http://www.psoriasis.org/about-psoriasis/treatments/topicals/over-the-counter"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">topical
products</span></a> with capsaicin may help relieve itching. Swelling of the
legs from standing during PUVA treatment may be relieved by wearing support
hose.</span><br />
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" id="laser" size="2" width="100%" />
</div>
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Laser Treatments</span></h2>
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Excimer laser</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The excimer laser—recently approved by the
Food and Drug Administration (FDA) for treating chronic, localized psoriasis plaques—emits
a high-intensity beam of ultraviolet light B (UVB).</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The excimer laser can target select areas of
the skin affected by mild to moderate psoriasis, and research indicates it is a
particularly effective treatment for scalp psoriasis. Researchers at the
University of Utah, for example, reported in <em><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The Journal
of Drugs in Dermatology</span></em> that in a small series of patients, laser
treatment, combined with a topical steroid, cleared scalp psoriasis that
resisted other treatment.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Individual response to the treatment varies.
It can take an average of four to 10 sessions to see results, depending on the
particular case of psoriasis. It is recommended that patients receive two
treatments per week, with a minimum of 48 hours between treatments.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">There is not yet enough long-term data to
indicate how long the improvement will last following a course of laser
therapy.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Pulsed dye laser</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Like the excimer laser, the pulsed dye laser
is approved for treating chronic, localized plaques. Using a dye and different
wavelength of light than the excimer laser or other <a href="http://www.psoriasis.org/about-psoriasis/treatments/phototherapy"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">UVB-based
treatments</span></a>, pulsed dye lasers destroy the tiny blood vessels that
contribute to the formation of psoriasis lesions.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treatment consists of 15- to 30-minute
sessions every three weeks. For patients who respond, it normally takes about
four to six sessions to clear the target lesion.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The most common side effect is bruising after
treatment, for up to 10 days. There is a small risk of scarring.</span><br />
<div align="center" class="MsoNormal" style="text-align: center;">
<hr align="center" id="tanning" size="2" width="100%" />
</div>
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Tanning beds</span></h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Some people visit tanning salons as an
alternative to natural sunlight. Tanning beds in commercial salons emit mostly
UVA light, not UVB. The beneficial effect for psoriasis is attributed primarily
to UVB light. National Psoriasis Foundation does not support the use of indoor
tanning beds as a substitute for phototherapy performed with a prescription and
under a doctor's supervision. Read more on the Psoriasis Foundation <a href="http://www.psoriasis.org/about-psoriasis/treatments/statement-on-tanning-beds"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">position
on indoor tanning beds »</span></a></span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The <a href="http://www.aad.org/" target="_blank"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">American Academy of Dermatology</span></a>,
the <a href="http://www.fda.gov/" target="_blank"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Food and Drug Administration</span></a>
(FDA) and the <a href="http://www.cdc.gov/" target="_blank"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Centers
for Disease Control and Prevention</span></a> all discourage the use of tanning
beds and sun lamps. Indoor tanning raises the risk of melanoma by 59 percent,
according to the American Academy of Dermatology and the World Health
Organization. In May 2014, the FDA reclassified sunlamps (which are used in
tanning beds and booths) from Class I (low risk) to Class II (moderate risk)
products. The FDA can exert more regulatory control over Class II products,
according to a press release on the FDA website.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The ultraviolet radiation from these devices
can damage the skin, cause premature aging and increase the risk of skin
cancer.</span><br />
<h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">New Oral Treatments</span></h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">New oral treatment options have emerged with
a sophisticated approach to treating psoriatic disease. These so-called
"small-molecule" treatments can be delivered effectively by mouth.
Unlike earlier pills used for psoriasis and psoriatic arthritis, these new oral
treatments selectively target molecules inside immune cells. By adjusting the
complicated processes of inflammation within the cell, these treatments correct
the overactive immune response that causes inflammation in people with
psoriasis and psoriatic arthritis,, leading to improvement in redness and
scaliness as well as joint tenderness and swelling.</span><br />
<h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Otezla</span></h2>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The newest available oral treatment for
psoriasis and psoriatic arthritis is Otezla (apremilast). Otezla treats
psoriatic arthritis by regulating inflammation within the cell. It inhibits an
enzyme known as phosphodiesterase 4, or PDE4. PDE4 controls much of the
inflammatory action within cells, which can affect the level of inflammation
associated with psoriatic disease.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">By helping to control inflammation in this
way, Otezla improves joint tenderness and swelling in people with active
psoriatic arthritis, and can improve symptoms of redness and scaliness in
people with psoriasis.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">How is it used?</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Otezla is available as a 30-milligram (mg)
tablet. The first five days is a start period, where the dosage will gradually
increase over five days until the recommended dose of 30 milligrams twice daily
is reached. Otezla is designed to be taken continuously to maintain
improvement.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">What are the risks?</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">In clinical trials, 10 to 12 percent of
people taking Otezla reported unexplained weight loss of 5 to 10 percent during
their trial period. It is recommended that people taking Otezla have their
weight monitored regularly.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">In clinical trials, approximately 6.1 percent
of the people taking Otezla for psoriasis discontinued treatment due to an
adverse reaction.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Common side effects</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">In clinical trials, the most common side
effects were diarrhea, nausea and headache, which occurred in the first two
weeks and tended to lessen with continued treatment.</span><br />
<h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Using Otezla with other treatments</span></h3>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Otezla can be used with other treatments such
as phototherapy or topicals. It has been shown to be safe and effective when
taken with methotrexate. Talk to your doctor about whether using any other
treatments with Otezla is right for you.</span><br />
<h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Topical Treatments</span></h1>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Topical treatments—medications applied to the
skin—are usually the first line of defense in treating psoriasis. Topicals slow
down or normalize excessive cell reproduction and reduce psoriasis
inflammation.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">There are several effective topical
treatments for psoriasis. While many can be purchased over the counter (OTC),
others are available by prescription only.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Corticosteroids, or just
"steroids," are the most frequently used treatment for psoriasis.
They are referred to as anti-inflammatory agents, because they reduce the
swelling and redness of lesions. Anthralin, synthetic vitamin D3, and vitamin A
are also used in prescription topical treatments to control psoriasis lesions.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">OTC topicals come in many different forms.
Two active ingredients, salicylic acid and coal tar, are approved by the FDA
for the treatment of psoriasis. There are other products that contain
substances such as aloe vera, jojoba, zinc pyrithione and capsaicin, which are
used to moisturize, soothe, remove scale or relieve itching.</span><br />
<div class="MsoNormal">
<br /></div>
<br />
<div class="clear" id="headerImg">
<span style="color: #ff8200; font-family: 'Archivo Narrow', Arial, Helvetica, sans-serif; font-size: 2em; font-style: normal; font-variant: normal; line-height: normal;">Complementary and Alternative Therapies</span></div>
Many patients today with chronic conditions, including psoriasis and
psoriatic arthritis, have an interest in complementary and alternative
therapies—these focus more on preventative care and pain management.<br />
Surveys for the National Center for Complementary and Alternative
Medicine (NCCAM) and National Center for Health Statistics (part of the
Center for Disease Control and Prevention) show <a href="http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm" rel="nofollow" target="_blank">more than a third of Americans (36 percent) use complementary and alternative therapies</a>.
These therapies include diet, herbs and supplements, mind/body
therapies such as aromatherapy, yoga and meditation, physical therapies,
exercise and the ancient arts of acupuncture and tai chi.<br />
Much of the evidence supporting complementary and alternative
therapies for psoriasis and psoriatic arthritis is anecdotal.
Increasingly, researchers have studied complementary and alternative
therapies particularly in looking at drug interactions, dietary outcomes
and safety. Most complementary and alternative therapies are safe.
However, some can interfere with your treatments prescribed by your
doctor.<br />
Always talk to your doctor or consult with a licensed health care
professional before adding any complementary and alternative treatments
to your treatment plan for psoriasis and psoriatic arthritis.<br />
<h3>
Find a Naturopathic Physician</h3>
Need help sorting through alternative treatments? Naturopathic
physicians use diet, exercise, lifestyle changes and natural therapies
to promote wellness in their patients’ lives and help with disease
management or minimize side effects from other therapies. <a href="http://www.naturopathic.org/AF_MemberDirectory.asp?version=2" rel="nofollow" target="_blank">Locate a licensed naturopathic doctor near you »</a><br />
<hr />
<h2 class="hub-image-cat-header">
<img alt="Diet and Nutrition" class="image_left hub-image-cat" height="90" src="http://www.psoriasis.org/images/cam/diet-thumb.jpg" title="Diet and Nutrition" width="125" /><span><a href="http://www.psoriasis.org/about-psoriasis/treatments/alternative/diet-supplements">Diet and Nutrition</a></span></h2>
Many people with psoriasis have no doubt suspected what they eat
affects their condition. Some find eliminating certain foods can help
their psoriasis to clear. Learn more about certain foods that can help
relieve symptoms. <a href="http://www.psoriasis.org/about-psoriasis/treatments/alternative/diet-supplements">View more about diet and nutrition »</a><br />
<hr />
<h2 class="hub-image-cat-header">
<img alt="Herbal Remedies" class="image_left hub-image-cat" height="110" src="http://www.psoriasis.org/images/cam/herbal-thumb.jpg" title="Herbal Remedies" width="125" /><span><a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/herbal-remedies">Herbal Remedies</a></span></h2>
Many herbal remedies have become mainstream in recent years. Don't mistake the terms "herbal" or "natural" or safe. <a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/herbal-remedies">Read more about herbal remedies »</a><br />
<hr />
<h2 class="hub-image-cat-header">
<img alt="Mind/Body Therapies" class="image_left hub-image-cat" height="117" src="http://www.psoriasis.org/images/cam/mind-thumb.jpg" title="Mind/Body Therapies" width="125" /><span><a href="http://www.psoriasis.org/about-psoriasis/treatments/alternative/mind-body">Mind/Body Therapies</a></span></h2>
Mind-body techniques can help reduce your stress levels. <a href="http://www.psoriasis.org/about-psoriasis/treatments/alternative/mind-body">Learn about mind/body therapies »</a><br />
<hr />
<h2 class="hub-image-cat-header">
<img alt="Alternative Therapies" class="image_left hub-image-cat" height="93" src="http://www.psoriasis.org/images/cam/alternative-thumb.jpg" title="Alternative Therapies" width="125" /><span><a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/alternative-therapies">Alternative Therapies</a></span></h2>
Some psoriasis patients report hands-on alternative therapies can
help relieve their psoriasis and psoriatic arthritis symptoms. <a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/alternative-therapies">More about alternative therapies »</a><br />
<hr />
<h2 class="hub-image-cat-header">
<img alt="Exercise" class="image_left hub-image-cat" height="150" src="http://www.psoriasis.org/images/cam/exercise-thumb.jpg" title="Exercise" width="125" /><span><a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/exercise">Exercise</a></span></h2>
Physical activity is important for your overall health and especially
so if you have psoriasis or psoriatic arthritis. Exercise can help you
maintain a healthy weight and lower your risk of heart disease and type 2
diabetes. Your risk for heart disease and type 2 diabetes is increased
when you have psoriasis. <a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/exercise">Read more »</a><br />
<hr />
<h2 class="hub-image-cat-header">
<img alt="Yoga and Tai Chi" class="image_left hub-image-cat" height="127" src="http://www.psoriasis.org/images/cam/yoga-thumb.jpg" title="Yoga and Tai Chi" width="125" /><span><a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/yoga-and-tai-chi">Yoga and Tai Chi</a></span></h2>
Yoga combines controlled breathing, stretching and strengthening
exercises, and meditation to help control stress and improve blood flow
to areas affected by psoriasis. Like yoga, Tai Chi is an ancient Chinese
art that can be effective in treating arthritis. <a href="http://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/yoga-and-tai-chi">Learn more »</a><br />
</div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-15255596359220762792015-01-09T05:00:00.003-08:002015-01-09T05:00:58.006-08:00Dialysis: Deciding to StopThere may come a time when you feel you want to discontinue dialysis
treatment. You may feel that dialysis is no longer maintaining or
improving your quality of life. If this occurs, it is important to know
that you have the right to make the decision to stop dialysis. However,
before making this decision, it is important that you discuss it
carefully with your loved ones and treatment team.<br />
<h2>
Can I really stop dialysis treatment if I want to?</h2>
Yes,
dialysis patients are allowed to make decisions about stopping dialysis
treatment. You are encouraged to discuss your reasons for wanting to
stop treatment with your doctor, other members of your health care team
and your loved ones before making a final decision.<br />
<h2>
If I ask to stop dialysis, how will the health care team at my unit respond?</h2>
The
members of your health care team will want to have a clear
understanding of why you made this decision (worsening health, specific
treatment problems, depression) to determine if any improvements might
be made that could affect your decision. Your doctor, social worker and
nurse may all speak to you and encourage you to talk openly about your
feelings.<br />
<h2>
How do I discuss my decision with my family and friends?</h2>
Many
people find it difficult to talk to loved ones about stopping
treatment, and they worry about how others will feel and react. Although
you may find it hard at first, the best approach is to discuss your
feelings openly with your loved ones. You may wish to have members of
your health care team (like the doctor, primary care nurse or social
worker) present when you speak with them.<br />
<h2>
Can any changes be made in my treatment that might improve my quality of life?</h2>
Maybe.
If you are thinking about stopping dialysis because of specific
treatment or other medical problems, your doctor might be able to make
some changes that would improve your situation.<br />
<h2>
Will I be asked to speak to a mental health professional?</h2>
You
might. If your health care team is concerned that you want to stop
dialysis for solely emotional reasons or because you are suffering
depression, you may be asked to speak with a psychiatrist, social worker
or other counseling professional. Depression may be treated
successfully with counseling, medicine or a combination of both. The
team may also want you to speak with a mental health professional to
make sure you understand the full impact of what stopping dialysis will
mean.<br />
<h2>
Is stopping dialysis considered suicide?</h2>
Many
religions teach that individuals have the right to stop treatment,
including dialysis, if they feel it is not helping and is burdensome.
You may wish to speak with your religious adviser if you have concerns
about this.<br />
<h2>
How long will I live if I choose to stop dialysis?</h2>
This
varies from person to person. People who stop dialysis may live
anywhere from one week to several weeks, depending on the amount of
kidney function they have left and their overall medical condition.<br />
<h2>
What should I expect after stopping dialysis?</h2>
Death
from kidney failure is usually painless. However, if you do feel any
discomfort, pain medicine may be prescribed for you. Without your
dialysis treatment, toxic wastes and fluid will build up in your body,
making you feel more tired. The fluid build-up can make it more
difficult for you to breathe, but your doctor can prescribe diuretics or
a treatment called ultrafiltration to remove fluid and make breathing
easier for you. The doctor may also recommend that you limit your intake
of salt and fluids to reduce fluid weight gain.<br />
<h2>
What type of food and drink could I have?</h2>
Typically,
there is no reason for you to continue to follow your renal diet at
this time. Your doctor and dietitian can answer other specific questions
you may have about diet.<br />
<h2>
Will my renal health care team continue to help me?</h2>
Absolutely.
Your team should remain available to you and your loved ones. Your
doctor and primary nurse can advise you about the type of care you might
need, and your social worker can help you arrange for care as well as
provide emotional support to you and your loved ones.<br />
<h2>
Can I get hospice care?</h2>
Usually.
If you choose to stop dialysis, you are considered to be in a terminal
state and you are eligible for hospice care. The type of hospice care
available may be either a home hospice program or a hospice facility.
Your social worker can help you and your loved ones in making
arrangements for hospice care.<br />
<h2>
Do I have a choice of where I die?</h2>
Your
wishes about where you want to die will be honored as much as possible.
Many people choose to die at home, where they feel more comfortable in
familiar surroundings. If you choose this option, your social worker can
assist you and your family in making any special arrangements for your
care at home. A nursing home may be another option for some patients. A
hospital admission is not always available, depending on the nature of
your insurance coverage and your overall medical condition. Your health
care team can help you decide if hospitalization is an option for you if
you wish.<br />
<h2>
If I choose to die at home, can I get a home health care worker to help my loved ones?</h2>
The
types of services covered at home will depend on your insurance. If you
are in a home hospice program, a home health aide may be available to
assist. If your insurance does not cover a home health aide and you and
your loved ones wish to pay privately for these services, you can do so.
Your social worker can usually assist in arranging these services.<br />
<h2>
Will I still be covered by Medicare and/or my private medical insurance if I stop treatment?</h2>
Your
Medicare coverage will not end, even if you decide to stop dialysis. It
is important that you and your family speak with your doctor about the
type of care you will need. Once this is decided, you can check on
whether your insurance will cover this care.<br />
<h2>
If I change my mind, can I go back on dialysis? Will I feel sicker if I do?</h2>
You
may go back on dialysis if you change your mind. If you have missed
several treatments, you may have some discomfort when you first start
dialysis again. You should discuss the possibility of returning to
dialysis with your doctor.<br />
<h2>
Can I name someone to make decisions for me if I am not able to act on my own behalf?</h2>
You
can name someone (such as a spouse, adult child or close friend) to
make medical decisions for you, such as stopping dialysis, in case you
are no longer able to make these decisions for yourself. This is done by
filling out a form called a health care proxy or a durable health care
power of attorney. The person you name to make medical decisions for you
is called a surrogate. It is important to make sure the person is
willing to act on your behalf and that he or she knows your short- and
long-term goals, values and what treatments you would or would not want
to have if you were not able to speak for yourself. It is helpful if you
complete a form called a treatment-specific living will, which will
give your surrogate clear directions about your wishes regarding
stopping dialysis and/or other medical treatments.<br />
The role and
responsibilities of the surrogate, as well as the types of decisions the
surrogate may make, may vary from state to state, depending on the law
of that state. Generally, the surrogate must follow your wishes. For
more information about naming a surrogate and about the laws in your
state, you may speak with an attorney or the social worker at your unit.
To obtain copies of the forms used in your state, you may contact your
local or state bar association or contact Choice in Dying, 1035 30th
Street NW, Washington, DC 20007, (800) 989-WILL.<br />
<h2>
What should I do if I decide to stop dialysis treatment?</h2>
If you decide to stop dialysis treatment, you or your surrogate may want to make sure the following items are in order:<br />
<ul>
<li>Your will.</li>
<li>Signed
advance directive (living will, durable health care power of attorney
or health care proxy) complying with your state law.</li>
<li>A durable
power of attorney, complying with your state law, naming someone to act
on your behalf on all matters other than medical (e.g., legal,
financial, banking and business matters). Your power of attorney must be
a "durable" one in order to stay in effect even if you become unable to
make your own decisions or if you die.</li>
<li>An inventory, including
the location of your bank, brokerage and other financial accounts, stock
and bond holdings, real estate and business records, medical and other
insurance policies, pension plans and other legal papers.</li>
<li>Names,
addresses and telephone numbers of your attorney, accountant, family
members and other loved ones, friends and business associates who should
be notified of your death or who may have information that will be
helpful in dealing with estate affairs.</li>
<li>A statement about your
preference for funeral/memorial services, burial or cremation
instructions and decisions about organ and tissue donation.</li>
<li>Written or video- or audio-taped message to family members and other loved ones, business associates and friends.</li>
</ul>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-16437476621345444712015-01-09T04:54:00.003-08:002015-01-09T04:54:49.134-08:00Treatment Methods for Kidney Failure: HemodialysisHemodialysis is the most common method used to treat advanced and
permanent kidney failure. Since the 1960s, when hemodialysis first
became a practical treatment for kidney failure, we've learned much
about how to make hemodialysis treatments more effective and minimize
side effects. In recent years, more compact and simpler dialysis
machines have made home dialysis increasingly attractive. But even with
better procedures and equipment, hemodialysis is still a complicated and
inconvenient therapy that requires
a coordinated effort from your whole health care team, including
your nephrologist, dialysis nurse, dialysis technician, dietitian, and
social worker. The most important members of your health care team are
you and your family. By learning about your treatment, you can work with
your health care team to give yourself the best possible results, and
you can lead a full, active life.<br />
<br />
<h3 id="fail">
When Your Kidneys Fail</h3>
Healthy kidneys clean your blood by removing excess fluid,
minerals, and wastes. They also make hormones that keep your bones
strong and your blood healthy. When your kidneys fail, harmful wastes
build up in your body, your blood pressure may rise, and your body may
retain excess fluid and not make enough red blood cells. When this
happens, you need treatment to replace the work of your failed kidneys.<br />
<br />
<h3 id="how">
How Hemodialysis Works</h3>
In hemodialysis, your blood is allowed to flow, a few ounces at
a time, through a special filter that removes wastes and extra fluids.
The clean blood is then returned to your body. Removing the harmful
wastes and extra salt and fluids helps control your blood pressure and
keep the proper balance of chemicals like potassium and sodium in your
body.<br />
One of the biggest adjustments you must make when you start
hemodialysis treatments is following a strict schedule. Most patients go
to a clinic—a dialysis center—three times a week for 3 to 5 or more
hours each visit. For example, you may be on a Monday-Wednesday-Friday
schedule or a Tuesday-Thursday-Saturday schedule. You may be asked to
choose a morning, afternoon, or evening shift, depending on availability
and capacity at the dialysis unit. Your dialysis center will explain
your options for scheduling regular treatments.<br />
Researchers are exploring whether shorter daily sessions, or
longer sessions performed overnight while the patient sleeps, are more
effective in removing wastes. Newer dialysis machines make these
alternatives more practical with home dialysis. But the Federal
Government has not yet established a policy to pay
for more than three hemodialysis sessions a week.<br />
<img alt="Illustration of a dialyzer." border="1" height="241" src="http://kidney.niddk.nih.gov/KUDiseases/pubs/hemodialysis/images/dialysis.gif" width="320" /><br />
<span class="caption">Hemodialysis.</span><br />
Several centers around the country teach people how to perform
their own hemodialysis treatments at home. A family member or friend who
will be your helper must also take the training, which usually takes at
least 4 to 6 weeks. Home dialysis gives you more flexibility in your
dialysis schedule. With home hemodialysis, the time for each session and
the number of sessions per week may vary, but you must maintain
a regular schedule by giving yourself dialysis treatments as often
as you would receive them in a dialysis unit.<br />
<br />
<h3 id="changes">
Adjusting to Changes</h3>
Even in the best situations, adjusting to the effects of kidney
failure and the time you spend on dialysis can be difficult. Aside from
the "lost time," you may have less energy. You may need to make changes
in your work or home life, giving up some activities and
responsibilities. Keeping the same
schedule you kept when your kidneys were working can be very
difficult now that your kidneys have failed. Accepting this new reality
can be very hard on you and your family. A counselor or social worker
can answer your questions and help you cope.<br />
Many patients feel depressed when starting dialysis, or after
several months of treatment. If you feel depressed, you should talk with
your social worker, nurse, or doctor because this is a common problem
that can often be treated effectively.<br />
<br />
<h3 id="ready">
Getting Your Vascular Access Ready</h3>
<span class="caption" style="float: right;"><img alt="Arm with an arteriovenous fistula." border="1" height="309" src="http://kidney.niddk.nih.gov/KUDiseases/pubs/hemodialysis/images/fistula.gif" width="180" /><br />Arteriovenous fistula.</span>
One important step before starting hemodialysis is preparing a
vascular access, a site on your body from which your blood is removed
and returned. A vascular access should be prepared weeks or months
before you start dialysis. It will allow easier and more efficient
removal and replacement of your blood with fewer complications. For more
information about the different kinds of vascular accesses and how to
care for them, see the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) fact sheet
<a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/vascularaccess/index.aspx">Vascular Access for Hemodialysis</a>.<br />
<br />
<h3 id="equip">
Equipment and Procedures</h3>
When you first visit a hemodialysis center, it may seem like a
complicated mix of machines and people. But once you learn how the
procedure works and become familiar with the equipment, you'll be more
comfortable.<br />
<img alt="Illustration of a looped graft." border="1" height="164" src="http://kidney.niddk.nih.gov/KUDiseases/pubs/hemodialysis/images/graft.gif" width="300" /><br /><span class="caption">Graft.</span><br />
<h4>
Dialysis Machine</h4>
The dialysis machine is about the size of a dishwasher. This machine has three main jobs:<br />
<ul>
<li>pump blood and watch flow for safety</li>
<li>clean wastes from blood</li>
<li>watch your blood pressure and the rate of fluid removal from your body</li>
</ul>
<h4>
Dialyzer</h4>
<span class="caption" style="float: right;"><img alt="Illustration of a hollow fiber dialyzer." border="1" height="260" src="http://kidney.niddk.nih.gov/KUDiseases/pubs/hemodialysis/images/fiber_dialyzer.gif" width="196" /><br />
Structure of a typical hollow fiber dialyzer.</span>
The dialyzer is a large canister containing thousands of small
fibers through which your blood is passed. Dialysis solution, the
cleansing fluid, is pumped around these fibers. The fibers allow wastes
and extra fluids to pass from your blood into the solution, which
carries them away. The dialyzer is sometimes called an artificial
kidney.<br />
<ul>
<li><strong>Reuse.</strong> Your dialysis center may use
the same dialyzer more than once for your treatments. Reuse is
considered safe as long as the dialyzer is cleaned before each use. The
dialyzer is tested each time to make sure it's still working, and it
should never be used for anyone but you. Before each session, you should
be sure that the dialyzer is labeled with your name and check to see
that
it has been cleaned, disinfected, and tested.</li>
</ul>
<h4>
Dialysis Solution</h4>
Dialysis solution, also known as dialysate, is the fluid in the
dialyzer that helps remove wastes and extra fluid from your blood. It
contains chemicals that make it act like a sponge. Your doctor will give
you a specific dialysis solution for your treatments. This formula can
be adjusted based on how well
you handle the treatments and on your blood tests.<br />
<h4>
Needles</h4>
Many people find the needle sticks to be one of the hardest
parts of hemodialysis treatments. Most people, however, report getting
used to them after a few sessions. If you find the needle insertion
painful, an anesthetic cream or spray can be applied to the skin. The
cream or spray will numb your
skin briefly so you won't feel the needle.<br />
Most dialysis centers use two needles—one to carry blood to the
dialyzer and one to return the cleaned blood to your body. Some
specialized needles are designed with two openings for two-way flow of
blood, but these needles are less efficient and require longer sessions.
Needles for high-flux or high-efficiency dialysis need to be a little
larger than those used with regular dialyzers.<br />
<img alt="Illustration of an arm with arterial and venous needles." border="1" height="171" src="http://kidney.niddk.nih.gov/KUDiseases/pubs/hemodialysis/images/needles.gif" width="350" /><br />
<span class="caption">Arterial and venous needles.</span><br />
Some people prefer to insert their own needles. You'll need
training on inserting needles properly to prevent infection and protect
your vascular access. You may also learn a "ladder"
strategy for needle placement in which you "climb" up the entire
length of the access session by session so that you don't weaken an area
with a grouping of needle sticks. A different approach is the
"buttonhole" strategy in which you use a limited number of sites but
insert the needle back into the same hole made by the previous needle
stick. Whether you insert your own needles or not, you should know these
techniques to better care for your access.<br />
<br />
<h3 id="tests">
Tests to See How Well Your Dialysis Is Working</h3>
About once a month, your dialysis care team will test your
blood by using one of two formulas—URR or Kt/V—to see whether your
treatments are removing enough wastes. Both tests look at one specific
waste product, called blood urea nitrogen (BUN), as an indicator for the
overall level of waste products in your system. For more information
about these measurements, see the NIDDK fact sheet <a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/hemodialysisdose/index.aspx">Hemodialysis Dose and Adequacy</a>.<br />
<br />
<h3 id="related">
Conditions Related to Kidney Failure and Their Treatments</h3>
Your kidneys do much more than remove wastes and extra fluid.
They also make hormones and balance chemicals in your system. When your
kidneys stop working, you may have problems with anemia and conditions
that affect your bones, nerves, and skin. Some of the more common
conditions caused by kidney failure are extreme tiredness, bone
problems, joint problems, itching, and "restless legs." Restless legs
will keep you awake as you feel them twitching and jumping.<br />
<h4>
Anemia and Erythropoietin (EPO)</h4>
Anemia is a condition in which the volume of red blood cells is
low. Red blood cells carry oxygen to cells throughout the body. Without
oxygen, cells can't use the energy from food, so someone with anemia
may tire easily and look pale. Anemia can also contribute to heart
problems.<br />
Anemia is common in people with kidney disease because the
kidneys produce the hormone erythropoietin, or EPO, which stimulates the
bone marrow to produce red blood cells. Diseased kidneys often don't
make enough EPO, and so the bone marrow makes fewer red blood cells. EPO
is available commercially and is commonly given to patients on
dialysis.<br />
For more information about the causes of and treatments for anemia in kidney failure, see the NIDDK fact sheet <a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/anemia/index.aspx">Anemia in Kidney Disease and Dialysis</a>.<br />
<h4>
Renal Osteodystrophy</h4>
The term "renal" describes things related to the kidneys. Renal
osteodystrophy, or bone disease of kidney failure, affects 90 percent
of dialysis patients. It causes bones to become thin and weak or formed
incorrectly and affects both children and adults. Symptoms can be seen
in growing children with kidney disease even before they start dialysis.
Older patients and women who have gone through menopause are at greater
risk for this disease.<br />
For more information about the causes of this bone disease and its treatment in dialysis patients, see the NIDDK fact sheet <a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/CKD_Mineral_Bone/index.aspx">Renal Osteodystrophy</a>.<br />
<h4>
Itching (Pruritus)</h4>
Many people treated with hemodialysis complain of itchy skin,
which is often worse during or just after treatment. Itching is common
even in people who don't have kidney disease; in kidney failure,
however, itching can be made worse by wastes in the bloodstream that
current dialyzer membranes can't remove from the blood.<br />
The problem can also be related to high levels of parathyroid
hormone (PTH). Some people have found dramatic relief after having their
parathyroid glands removed. The four parathyroid glands sit on the
outer surface of the thyroid gland, which is located on the windpipe in
the base of your neck, just above the collarbone. The parathyroid glands
help control the levels of calcium and phosphorus in the blood.<br />
But a cure for itching that works for everyone has not been
found. Phosphate binders seem to help some people; these medications act
like sponges to soak up, or bind, phosphorus while it is in the
stomach. Others find relief after exposure to ultraviolet light. Still
others improve with EPO shots. A few
antihistamines (Benadryl, Atarax, Vistaril) have been found to
help; also, capsaicin cream applied to the skin may relieve itching by
deadening nerve impulses. In any case, taking care of dry skin is
important. Applying creams with lanolin or camphor may help.<br />
<h4>
Sleep Disorders</h4>
Patients on dialysis often have insomnia, and some people have a
specific problem called the sleep apnea syndrome, which is often
signaled by snoring and breaks in snoring. Episodes of apnea are
actually breaks in breathing during sleep. Over time, these sleep
disturbances can lead to "day-night reversal" (insomnia at night,
sleepiness during the day), headache, depression, and decreased
alertness. The apnea may be related to the effects of advanced kidney
failure on the control of breathing. Treatments that work with people
who have sleep apnea, whether they have kidney failure or not, include
losing weight, changing sleeping position, and wearing a mask that
gently pumps air continuously into the nose (nasal continuous positive
airway pressure, or CPAP).<br />
Many people on dialysis have trouble sleeping at night because
of aching, uncomfortable, jittery, or "restless" legs. You may feel a
strong impulse to kick or thrash your legs. Kicking may occur during
sleep and disturb a bed partner throughout the night. The causes of
restless legs may include
nerve damage or chemical imbalances.<br />
Moderate exercise during the day may help, but exercising a few
hours before bedtime can make it worse. People with restless leg
syndrome should reduce or avoid caffeine, alcohol, and tobacco; some
people also find relief with massages or warm baths. A class of drugs
called benzodiazepines, often used to treat insomnia or anxiety, may
help as well. These prescription drugs include Klonopin, Librium,
Valium, and
Halcion. A newer and sometimes more effective therapy is levodopa
(Sinemet), a drug used to treat Parkinson's disease.<br />
Sleep disorders may seem unimportant, but they can impair your
quality of life. Don't hesitate to raise these problems with your nurse,
doctor, or social worker.<br />
<h4>
Amyloidosis</h4>
Dialysis-related amyloidosis (DRA) is common in people who have
been on dialysis for more than 5 years. DRA develops when proteins in
the blood deposit on joints and tendons, causing pain, stiffness, and
fluid in the joints, as is the case with arthritis. Working kidneys
filter out these proteins, but dialysis filters are not as effective.
For more information, see the NIDDK fact sheet <a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/amyloidosis/index.aspx">Amyloidosis and Kidney Disease</a>.<br />
<br />
<h3 id="diet">
How Diet Can Help</h3>
Eating the right foods can help improve your dialysis and your
health. Your clinic has a dietitian to help you plan meals. Follow the
dietitian's advice closely to get the most from your hemodialysis
treatments. Here are a few general guidelines.<br />
<ul>
<li><strong>Fluids.</strong> Your dietitian will help you
determine how much fluid to drink each day. Extra fluid can raise your
blood pressure, make your heart work harder, and increase the stress of
dialysis treatments. Remember that many foods—such as soup, ice cream,
and fruits—contain plenty of water. Ask your dietitian for tips on
controlling your thirst.</li>
<li><strong>Potassium.</strong> The mineral potassium is
found in many foods, especially fruits and vegetables. Potassium affects
how steadily your heart beats, so eating foods with too much of it can
be very dangerous to your heart. To control potassium levels in your
blood, avoid foods like oranges, bananas, tomatoes, potatoes, and dried
fruits. You can remove some of the potassium from potatoes and other
vegetables by peeling and soaking them in a large container of water for
several hours, then cooking
them in fresh water.<br />
<img alt="Potatoes soaking in water." border="1" height="117" src="http://kidney.niddk.nih.gov/KUDiseases/pubs/hemodialysis/images/potatoes.gif" width="288" /><br />
<span class="caption">You can remove some potassium from potatoes by soaking them in water.</span></li>
<li><strong>Phosphorus.</strong> The mineral phosphorus can
weaken your bones and make your skin itch if you consume too much.
Control of phosphorus may be even more important than calcium itself in
preventing bone disease and related complications. Foods like milk and
cheese, dried beans, peas, colas, nuts, and peanut butter are high in
phosphorus and should be avoided. You'll probably need to take a
phosphate binder with your food to control the phosphorus in your blood
between dialysis sessions.</li>
<li><strong>Salt (sodium chloride).</strong> Most canned
foods and frozen dinners contain high amounts of sodium. Too much of it
makes you thirsty, and when you drink more fluid, your heart has to work
harder to pump the fluid through your body. Over time, this can cause
high blood pressure and congestive heart failure. Try to eat fresh foods
that are naturally low in sodium, and look for products labeled "low
sodium."</li>
<li><strong>Protein.</strong> Before you were on dialysis,
your doctor may have told you to follow a low-protein diet to preserve
kidney function. But now you have different nutritional priorities. Most
people on dialysis are encouraged to eat as much high-quality protein
as they can. Protein helps you keep muscle and repair tissue, but
protein breaks down into urea (blood urea nitrogen, or BUN) in your
body. Some sources of protein, called high-quality proteins,
produce less waste than others. High-quality
proteins come from meat, fish, poultry, and eggs. Getting most of
your protein from these sources can
reduce the amount of urea in your blood.</li>
<li><strong>Calories.</strong> Calories provide your body
with energy. Some people on dialysis need to gain weight. You may need
to find ways to add calories to your diet. Vegetable oils—like olive,
canola, and safflower oils—are good sources of calories and do not
contribute to problems controlling your cholesterol. Hard candy, sugar,
honey, jam, and jelly also provide calories and energy. If you have
diabetes, however, be very careful about eating sweets. A dietitian's
guidance is especially important for people with diabetes.</li>
<li><strong>Supplements.</strong> Vitamins and minerals may
be missing from your diet because you have to avoid so many foods.
Dialysis also removes some vitamins from your body. Your doctor may
prescribe a vitamin and mineral supplement designed specifically for
people with kidney failure. Take your prescribed supplement after
treatment on the days you have hemodialysis. <strong>Never take vitamins that you can buy off the store shelf, since they may contain vitamins or minerals that are harmful to you.</strong></li>
</ul>
You can also ask your dietitian for recipes and titles of
cookbooks for patients with kidney disease. Following the restrictions
of a diet for kidney disease might be hard at first, but with a little
creativity, you can make tasty and satisfying meals. For more
information, see the NIDDK booklet <a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/eatright/index.aspx">Eat Right to Feel Right on Hemodialysis</a>.<br />
<br />
<h3 id="finance">
Financial Issues</h3>
Treatment for kidney failure is expensive, but Federal health
insurance plans pay much of the cost, usually up to 80 percent. Often,
private insurance or State programs pay the rest. Your social worker can
help you locate resources for financial assistance. For more
information, see the NIDDK fact sheet <a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/financialhelp/index.aspx">Financial Help for Treatment of Kidney Failure</a>.<br />
<br />
<h3 id="hope">
Hope through Research</h3>
The NIDDK, through its Division of Kidney, Urologic, and
Hematologic Diseases, supports several programs and studies devoted to
improving treatment for patients with progressive kidney disease and
permanent kidney failure, including patients on hemodialysis.<br />
<ul>
<li><strong>The End-Stage Renal Disease Program</strong>
promotes research to reduce medical problems from bone, blood, nervous
system, metabolic, gastrointestinal, cardiovascular, and endocrine
abnormalities in kidney failure and to improve the effectiveness of
dialysis and transplantation. The research focuses on evaluating
different hemodialysis schedules and on finding the most useful
information for measuring dialysis adequacy. The program also seeks to
increase kidney graft and patient survival and to maximize quality of
life.</li>
<li><strong>The HEMO Study,</strong> completed in 2002,
tested the theory that a higher dialysis dose and/or high-flux membranes
would reduce patient mortality (death) and morbidity (medical
problems). Doctors at 15 medical centers recruited more than 1,800
hemodialysis patients and randomly assigned them to high or standard
dialysis doses and high- or low-flux filters. The study found no
increase in the health or survival of patients who had a higher dialysis
dose, who dialyzed with high-flux filters, or who did both.</li>
<li><strong>The U.S. Renal Data System (USRDS)</strong>
collects, analyzes, and distributes information about the use of
dialysis and transplantation to treat kidney failure in the United
States. The USRDS is funded directly by the NIDDK in conjunction with
the Centers for Medicare & Medicaid Services. The USRDS publishes an
<a href="http://www.usrds.org/adr.aspx">Annual Data Report</a> <a href="http://www.niddk.nih.gov/Pages/disclaimers.aspx"><img alt="leaving site icon" border="0" height="10" src="http://kidney.niddk.nih.gov/images/exit_small.gif" width="10" /></a>,
which identifies the total population of people being treated for
kidney failure; reports on incidence, prevalence, death rates, and
trends over time; and develops data on the effects of various treatment
approaches. The report also helps identify problems and opportunities
for more focused special studies of renal research issues.</li>
<li><strong>The Hemodialysis Vascular Access Clinical Trials Consortium</strong>
is conducting a series of multicenter, clinical trials of drug
therapies to reduce the failure and complication rate of arteriovenous
(AV) grafts and fistulas in hemodialysis. These studies are randomized
and placebo ontrolled, which means the studies meet the highest
standard for scientific accuracy. AV grafts and fistulas prepare the
arteries and veins for regular dialysis. See the NIDDK fact sheet <a href="http://kidney.niddk.nih.gov/KUDiseases/pubs/vascularaccess/index.aspx">Vascular Access for Hemodialysis</a> for more information. Recently developed drugs to prevent blood clots may be evaluated in these large clinical trials.</li>
</ul>
<br />
<h3 id="resources">
Resources</h3>
<h4>
Organizations That Can Help</h4>
<strong>American Association of Kidney Patients</strong><br />
3505 East Frontage Road<br />
Suite 315<br />
Tampa, FL 33607<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18007492257" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–749–2257</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Email: <a href="mailto:info@aakp.org">info@aakp.org</a><br />
Internet: <a href="http://www.aakp.org/">www.aakp.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<strong>American Kidney Fund</strong><br />
6110 Executive Boulevard<br />
Suite 1010<br />
Rockville, MD 20852<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18006388299" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–638–8299</span><span class="skype_c2c_free_text_span"></span></span></span></span> or <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+13018813052" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">301–881–3052</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Email: <a href="mailto:helpline@kidneyfund.org">helpline@kidneyfund.org</a><br />
Internet: <a href="http://www.kidneyfund.org/">www.kidneyfund.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<strong>Life Options Rehabilitation Program</strong><br />
c/o Medical Education Institute, Inc.<br />
414 D'Onofrio Drive<br />
Suite 200<br />
Madison, WI 53719<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18004687777" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–468–7777</span><span class="skype_c2c_free_text_span"></span></span></span></span> or <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+16082322333" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">608–232–2333</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Email: <a href="mailto:lifeoptions@MEIresearch.org">lifeoptions@MEIresearch.org</a><br />
Internet: <a href="http://www.lifeoptions.org/">www.lifeoptions.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<span style="margin-left: 3.7em;"><a href="http://www.kidneyschool.org/">www.kidneyschool.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a></span><br />
<strong>National Kidney Foundation, Inc.</strong><br />
30 East 33rd Street<br />
New York, NY 10016<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18006229010" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–622–9010</span><span class="skype_c2c_free_text_span"></span></span></span></span> or <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+12128892210" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">212–889–2210</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Internet: <a href="http://www.kidney.org/">www.kidney.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<h4>
Additional Reading</h4>
If you would like to learn more about kidney failure and its treatment, you may be interested in reading<br />
<strong><em>AAKP Patient Plan</em></strong><br />
A series of booklets and newsletters that cover the different
phases of learning about kidney failure, choosing a treatment, and
adjusting to changes.<br />
American Association of Kidney Patients<br />
3505 East Frontage Road<br />
Suite 315<br />
Tampa, FL 33607<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18007492257" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–749–2257</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Email: <a href="mailto:info@aakp.org">info@aakp.org</a><br />
Internet: <a href="http://www.aakp.org/">www.aakp.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<strong><em>Getting the Most From Your Treatment</em> series</strong><br />
A series of brochures based on the National Kidney Foundation's
Dialysis Outcomes Quality Initiative (NKF-DOQI). Titles include <em>What
You Need to Know About Peritoneal Dialysis, What You Need to Know
Before Starting Dialysis, and What You Need to Know About Anemia</em>.<br />
Additional patient education brochures include information on diet, work, and exercise.<br />
National Kidney Foundation, Inc.<br />
30 East 33rd Street<br />
New York, NY 10016<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18006229010" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–622–9010</span><span class="skype_c2c_free_text_span"></span></span></span></span> or <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+12128892210" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">212–889–2210</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Internet: <a href="http://www.kidney.org/">www.kidney.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<strong><em>Medicare Coverage of Kidney Dialysis and Kidney Transplant Services</em></strong><br />
Publication Number CMS-10128<br />
U.S. Department of Health and Human Services<br />
Centers for Medicare & Medicaid Services<br />
7500 Security Boulevard<br />
Baltimore, MD 21244–1850<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18006334227" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–MEDICARE</span><span class="skype_c2c_free_text_span"></span></span></span></span> (<span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18006334227" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–633–4227</span><span class="skype_c2c_free_text_span"></span></span></span></span>)<br />
TDD: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18774862048" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–877–486–2048</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Internet: <a href="http://www.medicare.gov/publications/pubs/pdf/10128.pdf">www.medicare.gov/publications/pubs/pdf/10128.pdf</a> PDF Version (717 KB)<a href="http://kidney.niddk.nih.gov/accessibility.aspx">*</a><br />
<h4>
Newsletters and Magazines</h4>
<strong><em>Family Focus Newsletter</em></strong> (published quarterly)<br />
National Kidney Foundation, Inc.<br />
30 East 33rd Street<br />
New York, NY 10016<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18006229010" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–622–9010</span><span class="skype_c2c_free_text_span"></span></span></span></span> or <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+12128892210" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">212–889–2210</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Internet: <a href="http://www.kidney.org/">www.kidney.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<strong><em>For Patients Only</em></strong> (published six times a year)<br />
ATTN: Subscription Department<br />
18 East 41st Street<br />
20th Floor<br />
New York, NY 10017–6222<br />
<strong><em>Renalife</em></strong> (published quarterly)<br />
American Association of Kidney Patients<br />
3505 East Frontage Road<br />
Suite 315<br />
Tampa, FL 33607<br />
Phone: <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+18007492257" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1–800–749–2257</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
Email: <a href="mailto:info@aakp.org">info@aakp.org</a><br />
Internet: <a href="http://www.aakp.org/">www.aakp.org</a> <a href="http://kidney.niddk.nih.gov/disclaimers.aspx"><img alt="click to view disclaimer page" src="http://kidney.niddk.nih.gov/images/exit_small.gif" /></a><br />
<div style="background-color: #f7f7f7; border: 1px solid black; padding: 1em; width: 600px;">
The U.S. Government does not endorse or favor any specific commercial product or company. Trade,
proprietary, or company names appearing in this document are used only because they are considered
necessary in the context of the information provided. If a product is not mentioned, the omission does not
mean or imply that the product is unsatisfactory.</div>
<br />
<h3 id="acknowledgments">
Acknowledgments</h3>
The NIDDK thanks these dedicated health professionals for their careful review of the original version of this publication.<br />
<blockquote>
Richard A. Sherman, M.D.<br />
Robert Wood Johnson Medical School</blockquote>
<blockquote>
Richard D. Swartz, M.D.<br />
University of Michigan Health System</blockquote>
<blockquote>
Charlie Thomas, A.C.S.W., C.I.S.W.<br />
Samaritan Transplant Services, Phoenix, AZ</blockquote>
The individuals listed here facilitated field testing for this publication. The NIDDK thanks them for their contribution.<br />
<blockquote>
Kim Bayer, M.A., R.D., L.D.<br />
BMA Dialysis<br />
Bethesda, MD</blockquote>
<blockquote>
Cora Benedicto, R.N.<br />
Clinic Director<br />
Gambro Health Care<br />
N Street Clinic<br />
Washington, DC</blockquote>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-76313925988899253002015-01-09T04:36:00.001-08:002015-01-09T04:36:04.743-08:00What happens if someone stops dialysis?For many people with kidney failure, dialysis or a kidney transplant
enables them to live longer and enjoy their quality of life. However,
this may not be the case for everyone and each person has the right to
choose how — or even if — they want to receive treatment for chronic kidney disease. Without life-sustaining dialysis or a kidney transplant, once a person with kidney disease reaches Stage 5 (end stage renal disease (ESRD)), toxins build up in the body and death usually comes within a few weeks.<br />
The decision to stop treatment should be an informed and voluntary
choice. Experts recommend that patients talk with their physicians and
perhaps a social worker or therapist to fully understand their choices
and know what to expect. It’s important to rule out depression or other
issues that may affect how the patient feels about life-sustaining
treatment. Ideally, the physician-patient relationship encourages shared
decision-making. With shared decision-making, the doctor fully informs
the patient about treatment options, including stopping (or not
starting) dialysis and planning for end-of-life care.<br />
With advance planning, patients who have made the decision to stop
treatment can spend their last days how and where they choose — with
loved ones or alone at home, in hospice or in the hospital. The patient
can also get help with how to tell loved ones about their decision.<br />
<h4>
Talking to family members about stopping dialysis</h4>
Frequently, visitors to the DaVita.com discussion forum who have a
family member that wishes to stop treatment will ask, “What will happen
once dialysis is stopped?” It is natural for loved ones to be concerned,
because without lifesaving treatment death will occur, usually within a
few weeks. However, it is the patient’s right to make this decision and
sometimes, knowing that death can be pain-free and peaceful for the
person with end stage renal disease (ESRD), helps ease family members’ fears.<br />
There are many reasons why someone with ESRD may not want to continue
or start dialysis. Some people feel they’ve lived a full life and don’t
want to bother with additional surgery and treatments. For dialysis, a
person will need an access placement and hemodialysis three times a week, or peritoneal dialysis
every day. Some people who are already on dialysis may feel that the
treatment is no longer maintaining or improving their health because
they are unable to live independently or enjoy a certain quality of
life.<br />
Studies have shown that people most likely to withdraw from dialysis
are older and living in nursing homes. They often have health problems
in addition to kidney disease, and suffer more severe pain. They usually
have physical limitations that restrict normal daily activities.<br />
If a loved one decides to stop dialysis, it’s important that family
members try to understand and respect that decision. The patient’s
treatment team should be available to make sure the patient and family
members understand the effects of the decision.<br />
<h4>
Preparing for stopping dialysis — Advance Directives and Hospice</h4>
While talking about death and dying can be difficult, most families
find it is a relief to have a plan in place for when the time does come.
Planning for care and respecting the wishes of the patient make
end-of-life decisions easier. An Advance Directive can help family
members know what the patient wants regarding end-of-life care so the
family doesn’t have to make those decisions for the patient. An Advance
Directive is a legal document that spells out a person’s wishes
regarding future crisis care. All adults should have an Advanced
Directive. Having an Advance Directive lets everyone know what to do if
you become unable to communicate those wishes.<br />
There are two basic kinds of Advance Directives: living wills and
health care proxies (durable power of attorney for health care
decisions). You’ll want to make sure everyone involved with your care
has a copy of your Advance Directive. State laws determine how people
can direct their care. An attorney can determine the legally appropriate
form for your state. If you have questions about an Advance Directive,
please talk with your physician or an attorney.<br />
Patients who stop dialysis receive what’s called palliative care.
Palliative care, also called comfort care, focuses on helping patients
stay as comfortable as possible during the time remaining. When someone
has made the decision to stop dialysis, hospice can be referred by their
physician. Hospice, a form of palliative care, provides pain relief and
symptom control and can take place in the patient’s home, at a hospice
facility or in the hospital. Hospice is a service that can be of help to
end stage renal disease patients and their family members; however, it
is used by less than half of those who withdraw from dialysis. For more
information on hospice, talk to your physician.<br />
<h4>
What to expect once dialysis is stopped</h4>
Without dialysis, toxins build up in the blood, causing a condition
called uremia. The patient will receive whatever medicines are necessary
to manage symptoms of uremia and other medical conditions. Depending on
how quickly the toxins build up, death usually follows anywhere from a
few days to several weeks.<br />
As the toxins build up, a person may experience certain physical and
emotional changes. The body has a normal, natural way to prepare itself
to stop. Understanding what’s happening can help the patient’s friends
and family members prepare to help their loved one. In the final days,
the body starts to shut down. In most instances, the shut-down is an
orderly series of physical changes which may include:<br />
<ul type="disc">
<li>Loss of appetite and fluid overload</li>
<li>Sleeping most of the day </li>
<li>Restlessness</li>
<li>Visions of people who don’t exist</li>
<li>Disorientation, confusion and failure to recognize familiar faces</li>
<li>Changes in breathing (Normal breathing patterns may become shallow,
irregular, fast or extremely slow. There may be periods of breathing
that sound like panting. Exhaling may create a moan-like sound. This is
not distress, but the sound of air passing over the vocal cords. Changed
breathing patterns indicate decreased circulation in the internal
organs and buildup of waste products. Elevating the head and/or turning
onto the side may increase comfort.)</li>
<li>Congestion (If saliva and mucus collect in the back of the throat,
you may hear a gurgling sound. While the sound can be distressing to
hear, it’s a normal response to a fluid imbalance and the inability to
cough up normal secretions. It may help to raise the head. Turning the
head to the side allows gravity to drain the congestion.)</li>
<li>Changes in color and skin temperature</li>
</ul>
Patients who choose to stop or not start dialysis are not required to
eat or take in fluids. In most cases, a patient is allowed to eat or
drink if they want to, but forcing fluids or nutrition is not
recommended.<br />
Medicines can be given for pain, anxiety, agitation or congestion.
However, other medicines are often stopped when a person decides to quit
dialysis treatments, since treating the chronic medical conditions is
no longer a priority.<br />
As the body’s systems shut down, a person slips into unconsciousness and the heart stops beating.<br />
Most people who pass away from kidney failure have what family
members and caregivers describe as a “good death.” A study reported that
patients who discontinued dialysis described a good death as pain-free,
peaceful and brief. The patients’ families echoed this sentiment,
adding a good death included having loved ones present at the end.<br />
<h4>
Treasure the time you have</h4>
When the dialysis patient and their loved ones are prepared for the
final days, the time remaining can be spent in companionship,
reminiscing, laughing and crying. Many people never have the opportunity
for closure, many kidney failure patients and their loved ones say they
are grateful for the opportunity to express affection and say goodbye. <sup> </sup><br />
<h5>
External links</h5>
<ul type="disc">
<li><a href="http://www.guidelines.gov/summary/summary.aspx?doc_id=2195&nbr=001421&string=dialysis">Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis</a> – National Guideline Clearinghouse</li>
<li><a href="http://ndt.oxfordjournals.org/cgi/content/full/ndt;18/5/869?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=which+patients+choose+to+stop+dialysis&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT">Which patients choose to stop dialysis?</a> – Oxford Journals Nephrology Dialysis Transportation</li>
<li><a href="http://jasn.asnjournals.org/cgi/content/abstract/3/9/1631">Death by withdrawal from dialysis: a 20-year clinical experience</a> – JAMA Journal of the American Society of Nephrology</li>
</ul>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-68576971742295544692015-01-09T04:18:00.001-08:002015-01-09T04:18:54.735-08:00KIDNEY DIALYSIS AND TRAVEL<b>If well enough, with careful planning, a holiday can boost your
confidence and well being. However, when you live with any chronic
disease, there are major road blocks to negotiate before you can travel
sensibly.
</b><br />
<ul>
<li>Ensure you have funds for costs for health emergency treatment and medicine. Dialysis can be expensive! <br />
</li>
<li>Do not organise dialysis without talking with your health team about how travel may affect your health. </li>
</ul>
<strong>Home dialysis on the road</strong><br />
Quick reference guide to help planning - <a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=DeEO3Ho%2bqUk%3d&tabid=811&mid=1886">Home dialysis on the road></a><br />
<br />
<strong>Booking travel dialysis arrangements in Australia </strong><br />
With increasing demand, lack of spare dialysis chairs is a problem
(capacity). Dialysis sessions should always be booked well in advance
and confirmed before travel. You must be prepared to be flexible. <br />
<strong>Private temporary dialysis in Australia</strong><br />
Capacity is a problem even in private units. If available, a dialysis
session is approx cost: $450 to $650 per treatment (Sth Australia),
eastern states $800 to $900 per treatment, depending on location.
Strict minimum 1 month notice.<br />
<strong>Medically required medication</strong><br />
<a href="http://www.health.gov.au/internet/main/publishing.nsf/content/general-guidance-for-travellers-bringing-medicines-to-and-from-australia">Many countries, including Australia</a> only allow <em>medically required</em> <em>medication to cover you for a maximum of 3 months at maximum dose</em>.
Ensure your doctor updates your treatment letter with current health
and medication list for Customs. Your dialysis unit will also give you
an introduction letter - <a href="http://www.humanservices.gov.au/customer/services/medicare/travelling-overseas-with-pbs-medicine?utm_id=9">Travel overseas with PBS medication</a><br />
<strong><br />
TIPS FOR AUSSIES OVERSEAS - TRAVEL WITH KIDNEY DISEASE<br />
</strong><br />
<hr />
<div dir="ltr" style="margin-right: 0px;">
<strong>Obtaining haemodialysis in other countries is possible </strong>-
standards of care may differ to Australian standards. Some global
holiday dialysis groups specialise in this service and offer quality
service guaranteed - but charge for the service. Ask what is covered
in the fees and get a firm quote.<br />
</div>
<div dir="ltr" style="margin-right: 0px;">
<strong>Travel on Peritoneal Dialysis (PD) is simpler</strong>
- with careful planning dialysis supplies can be delivered to a
destination, if arranged in advance. Ask your health team if they can
arrange contacts for back-up medical care, essential in case of ill
health. <small><a href="http://findarticles.com/p/articles/mi_m0ICF/is_5_31/ai_n17207525/?tag=content;col1">Peritoneal Dialysis Travel 'Tool Box'</a> Nephrology Nursing Journal. Bobbie Knotek, Laurie Biel USA</small></div>
<div dir="ltr" style="margin-right: 0px;">
<strong>Travel when waiting for a kidney transplant </strong>
- consult your doctor and Transplant Coordinator to decide if you will
be able to return in time if a kidney becomes available. You are
unlikely to receive travel insurance whilst on the transplant waiting
list, or for some time post transplant. Your health must be confirmed
as stable. </div>
<div dir="ltr">
<strong>Travel anywhere, when you have a chronic disease</strong>
- when making hotel reservations - remember to request ground floor
room or handicapped-accessible room, if stairs or walking distances
are a problem. </div>
<strong>When making travel or flight bookings - contact a <a href="http://www.qantas.com.au/travel/airlines/mobility-assistance/global/en">Disability or Special Assistance Co-ordinator</a></strong>
- if booking via a travel agent advise special needs - specific diet,
accessible rooms and assistance to change planes. If you need
assistance boarding a plane or train, inform staff when you check in.
An agent can also advise the best method for safe transport of
dialysis supplies to foreign countries. <br />
<a href="http://www.kidney.org.au/ForPatients/DUGDialysisUnitGuide/tabid/607/Default.aspx"><img align="right" alt="" border="0" height="78" src="http://www.kidney.org.au/Portals/0/assets/Images/DUG%20Cover%20mini.jpg" width="87" /></a><br />
<strong>Aussies with kidney disease wanting to travel</strong><br />
<a href="http://www.kidney.org.au/ForPatients/DUGDialysisUnitGuide/tabid/607/Default.aspx" target="_blank">Australian Dialysis Unit Guide (DUG)</a> Find a particular Dialysis Unit in Australia<br />
<a href="http://bigdandme.wordpress.com/category/holiday-dialysis/">BigDandMe - Holiday Dialysis Blog</a> Tales from an Aussie and his Holiday Dialysis adventures<br />
<a href="http://www.dialysisescapeline.com/" target="_blank">Dialysis Escape Line: Australia</a> PD & haemo dialysis nurses on all cruises <br />
- call <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61882270181" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">08 8227 0181</span><span class="skype_c2c_free_text_span"></span></span></span></span> or Wayne Cooper <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61448588880" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">0448 588 880</span><span class="skype_c2c_free_text_span"></span></span></span></span><a href="http://www.dialysisabroad.com.au/"><br />
Dalysis Abroad</a> International escorted tours on dialysis - <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61883626657" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">08 8362 6657</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
<a href="http://fmc-au.com/patients-and-caregivers/holiday-dialysis">NephroCare Australia - Fresenius</a> Travel and dialysis <a href="http://fmc-au.com/health-care-professionals/clinic-finder">Fresenius - Dialysis Clinic Finder</a><br />
<a href="http://www.renalinfo.com/listAllCountries.html" target="_blank"> RenalInfo</a> Support and Resources (Baxter) <a href="http://www.renalinfo.com/" target="_blank">all countries including Australia</a><br />
<a href="http://www.traveldoctor.com.au/Content/Travel-Packs-Kits"> </a> <strong><br />
Australian Dialysis Units who may offer travel on dialysis places</strong><br />
<table align="" border="1" cellpadding="1" cellspacing="1" style="height: 472px; width: 690px;" summary="">
<tbody>
<tr>
<td bgcolor="#ccccff"><strong>State</strong></td>
<td bgcolor="#ccccff"><small>Booking ahead essential - no guarantee space is available - click links in red below<br />
Session fees apply for private units listed<br />
</small></td>
</tr>
<tr>
<td><strong>New South<br />
Wales</strong><br />
</td>
<td>
<div dir="ltr" style="margin-right: 0px;">
<a href="http://www.enable.health.nsw.gov.au/home/afhh">EnableNSW - The Away From Home Haemodialysis Program></a><br />
Eligible haemodialysis patients access dialysis services at
no cost when traveling away from home - education, work, holidays.
Subject to availability & funding. Eligible patients may access up
to 3 sessions per year at participating private renal unit (N/A
Tasmania) away from usual place of residence. <strong>For NSW residents only!</strong><br />
<br />
<a href="http://users.hunterlink.net.au/%7Embbjan/hdn.html">Newcastle: Wansey Dialysis Centre - John Hunter Hospital NSW></a> <br />
Call Team Leader, High Dependency <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61249439635" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">02 4943 9635</span><span class="skype_c2c_free_text_span"></span></span></span></span> or send written request to: <br />
Wansey Dialysis Centre, 1A Dudley Road Charlestown NSW 2290<br />
<br />
</div>
</td>
</tr>
<tr>
<td><strong>Northern<br />
Territory</strong></td>
<td><a href="http://www.health.nt.gov.au/Renal_Services/Work_for_Us/Alice_Springs_Unit/index.aspx">Alice Springs Renal Unit></a> (public) staff try to keep shift for travelers - advance notice essential<br />
Visit MacDonnell Ranges or Standley Chasm - call Dialysis Unit on <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61889516750" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">08 8951 6750</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
<br />
<a href="http://www.fmc-au.com/alice-springs-renal-unit">Alice Springs - Dialysis Unit></a> (private - dialysis fees apply) Fresenius Medical Care<br />
<br />
</td>
</tr>
<tr>
<td><strong>Queensland</strong> <br />
</td>
<td><a href="http://www.health.qld.gov.au/townsville/hospital_tour/renal.asp" target="_blank">Townsville Renal Unit></a> private/public units have capacity problems but worth trying - call <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61744332650" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">07 4433 2650</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
<br />
<a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=6l%2bL7bPHzG0%3d&tabid=608&mid=474">Caloundra Private Renal Unit></a> (dialysis fees apply) read brochure then call <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61754920215" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">07 5492 0215</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
<br />
</td>
</tr>
<tr>
<td><strong>Tasmania </strong><br />
</td>
<td>
<a href="http://www.dhhs.tas.gov.au/service_information/information/northern_tasmanian_renal_services">Launceston Community Health Centre Renal Unit></a><br />
Call <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61363365132" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">03 6336 5132</span><span class="skype_c2c_free_text_span"></span></span></span></span> - dialysis sessions North/ North West Tasmania residents - advance notice essential<br />
<br />
<br />
</td>
</tr>
<tr>
<td><strong>Victoria</strong></td>
<td align="left" valign="top">
<div dir="ltr" style="margin-right: 0px;">
<strong>Dialysis & Transplant Association of Victoria</strong> D.A.T.A. <a href="http://www.datavic.org/index.html" style="color: red; text-decoration: none;">datavic.org/index.html</a><br />
Members may access low cost holiday homes to enable family holidays with dialysis<br />
<br />
<strong>Kyabram & District Health Services </strong><br />
Provide holiday dialysis: *Tues *Thurs *Sat (morning) call Natalie Sheehan <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61358570217" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">03 5857 0217</span><span class="skype_c2c_free_text_span"></span></span></span></span><br />
<br />
<strong>Lorne Satellite Dialysis Unit - Satellite unit of Geelong Hospital (Barwon Health)</strong><br />
M-W-F am sessions, Christmas to February, dialysis unit open
2 morning sessions (M-Sat) but no renal physician on site. Enquiries
<a href="mailto:reception@swarh.vic.gov.au">reception@swarh.vic.gov.au</a> or call <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61352894300" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">03 5289 4300</span><span class="skype_c2c_free_text_span"></span></span></span></span> - see <a href="http://www.kidney.org.au//LinkClick.aspx?fileticket=dqcK4QYzX8E%3d&tabid=608&mid=474">travel brochure></a></div>
</td>
</tr>
</tbody>
</table>
<br />
<a href="mailto:subscribe@kidney.org.au"><img align="right" alt="" border="0" height="133" src="http://www.kidney.org.au/Portals/0/assets/Images/Subscribe%20to%20Kidney%20Community%20News.jpg" width="133" /></a><br />
<strong>SUBSCRIBE for your e-copy of Kidney Community News</strong><br />
We would all love to hear about your path with kidney disease,
particularly any travel on dialysis adventures you may have enjoyed, or
post transplant. <br />
<br />
Email Cassandra Bradshaw, the Editor of <a href="http://www.kidney.org.au/KidneyDisease/KidneyNews/tabid/736/Default.aspx">Kidney Community News</a> at <a href="mailto:cassandra.bradshaw@kidney.org.au">cassandra.bradshaw@kidney.org.au</a> with suggestions for articles. <br />
<br />
Call <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+611800454363" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1800 454 363</span><span class="skype_c2c_free_text_span"></span></span></span></span> - our staff will help you to subscribe.<br />
<br />
<br />
<strong>KIDNEY HEALTH AUSTRALIA - DIALYSIS AND TRAVEL PROGRAMS </strong><br />
<hr />
<a href="http://www.kidney.org.au/ForPatients/BIGREDKIDNEYBUS/tabid/839/Default.aspx"><img align="right" alt="" border="0" height="80" src="http://www.kidney.org.au/Portals/0/assets/Images/BIG_RED_KIDNEY_BUS.jpg" width="106" /></a><strong>Big Red Kidney Mobile Dialysis Bus - bookings now open!</strong><br />
Holiday dialysis at Victorian holiday spots for up to 6 weeks at a time,
parked at local caravan parks (see current session detail below).
Dialysis patients need holiday accommodation, but can book to dialyse
on our Big Red Kidney Bus, to enjoy a real holiday with family and
friends. We need your help to develop the project nationally. Find out
more about this program at: <a href="http://www.kidney.org.au/ForPatients/BIGREDKIDNEYBUS/tabid/839/Default.aspx">Big Red Kidney Bus></a><br />
<br />
<ul>
<li><strong>The Grampians: 23 March to 26 April 2015 </strong> <a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=Q3bFRP7sg4U%3d&tabid=839&mid=2016">Vacancies at 9 January 2015></a><br />
Big4 Grampians Parkgate Resort, 2372 Grampians Road, Halls Gap<br />
If you wish to book a cabin - <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+611800810781" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1800 810 781</span><span class="skype_c2c_free_text_span"></span></span></span></span> (freecall) or <a href="mailto:stay@parkgateresort.com.au">stay@parkgateresort.com.au</a><em><em><br />
Big Red Kidney Bus Offer:</em> stay 7 nights-pay 5 or stay 5 nights-pay 4</em><br />
</li>
</ul>
<ul>
<li> <strong>Anglesea: 9 February to 14 March 2015 </strong><a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=d2bFA%2f6iHn8%3d&tabid=839&mid=2016">Vacancies at 9 January 2015></a><br />
Big4 Anglesea Holiday Park, 45 Murray Street, Anglesea <br />
Book a cabin - <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+611800631640" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1800 631 640</span><span class="skype_c2c_free_text_span"></span></span></span></span> (freecall) or <a href="mailto:info@big4anglesea.com.au">info@big4anglesea.com.au</a><br />
</li>
</ul>
<span class="Normal LabelEditOverClassML" id="dnn_ctr1931_HtmlModule_lblContent">
<em></em><br />
</span>
<ul>
<li><strong>Phillip Island: 5 January to 1 February 2015</strong><em> Bookings closed</em><br />
Big4 Phillip Island Caravan Park, 24 Old Bridge Drive, Newhaven<br />
Book a cabin - <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61359567227" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">03 5956 7227</span><span class="skype_c2c_free_text_span"></span></span></span></span> (freecall) or <a href="mailto:info@phillipislandcpk.com.au">info@phillipislandcpk.com</a></li>
</ul>
<br />
<img align="right" alt="" border="0" height="78" src="http://www.kidney.org.au/Portals/0/assets/Images/Kidney%20Kamper%20Van%20prototype.jpg" width="223" /><strong>Travel Freedom on Dialysis - Campervan Program</strong><br />
Exciting initiative to provide respite or holiday dialysis options for
Aussies living with kidney disease. Each Kidney Campervan fitted with
dialysis machines (see prototype) initially available in Queensland.
Future plans are to expand program nationally. <a href="http://www.kidney.org.au/Portals/0/assets/documents/Marketing/Release%20-%20Gold%20Coast%20Adventurer.pdf">See media></a>
<div style="margin: 0cm 0cm 0pt;">
<a href="http://www.kidney.org.au/Portals/0/assets/documents/Marketing/Release%20-%20Gold%20Coast%20Adventurer.pdf"><br />
</a></div>
<div style="margin: 0cm 0cm 0pt;">
<small>The Wade family made a generous startup $50,000 donation to <a href="http://www.kidney.org.au/Youcanhelp/Donations/TravelFreedomonDialysisCampervanProgram/tabid/870/Default.aspx">dialysis campervan program</a>. Every dollar raised helps put a fleet on the road. To raise more funds <a href="http://www.vintageadventurer.com.au/">the Vintage Adventurer</a>
drives his 1930 Model ‘A’ Ford to remote locations - the intrepid
team recently drove across America from East to West on Route 66. For
more visit <a href="http://www.everydayhero.com.au/event/vintageadventurer">Vintage Adventure><br />
</a></small></div>
<br />
<strong><br />
TRAVEL HEALTH INSURANCE WHEN YOU HAVE KIDNEY DISEASE</strong><br />
<hr />
<img align="right" alt="" height="135" src="http://www.kidney.org.au/Portals/0/assets/Images/Home%20Dialysis.jpg" width="167" />
When you have any chronic disease be realistic about the likelihood
of buying travel insurance for a pre-existing condition. Aussies
should consider locations in Australia as better options to long
distance travel overseas. Don’t book travel until travel health
insurance cover is secure and ensure you budget for any emergency. <br />
<br />
<strong>Will you qualify for travel health insurance?</strong> If you
had private health insurance cover when you developed a chronic health
condition, you may get travel cover from your health insurance company.
If you had a complex path to kidney failure, are experiencing
dialysis issues, or have multiple health conditions, you may not find a
travel insurer. <br />
<br />
<strong>Consider basic travel insurance to cover emergencies. </strong>Pay
for travel with a credit card which offers some level of travel
insurance, or consider general travel insurance via a union, bank or
even Superannuation. Ask questions about travel insurance especially
with multiple pre-existing health conditions. Most travel cover will
exclude existing chronic conditions. Some level of travel insurance is
strongly advised. We recommend you use an insurance broker to find
travel insurance to save time. <br />
<br />
<em><small>As a guide: travel insurance MAY be granted if you have
kidney disease, have had a transplant at least six months old; there
must never have been a rejection or infection and your overall health
must be stable. Travel insurance will NOT usually cover anyone on a
transplant waiting list or with a complex health history. </small></em> <small><br />
<br />
</small><strong>Travel insurance agencies who are known to offer cover to people post transplant </strong><br />
An applicant is assessed on individual health - if it does not meet the criteria you are likely to be refused. <br />
<blockquote>
*<a data-mce-href="http://auspost.com.au/travel-id/travel-insurance.html" href="http://auspost.com.au/travel-id/travel-insurance.html">Australia Post Travel Insurance</a> (extra premium) *<a data-mce-href="http://www.allianz.com.au/travel-insurance" href="http://www.allianz.com.au/travel-insurance">Allianz Australia -Travel Insurance</a> *<a data-mce-href="http://www.covermore.com.au/1/home.aspx" href="http://www.covermore.com.au/1/home.aspx">Cover-More Travel Scene</a> *<a data-mce-href="http://www.chartisinsurance.com/contact-us_920_210125.html" href="http://www.chartisinsurance.com/contact-us_920_210125.html">Chartis Travel</a> *<a data-mce-href="http://www.columbusdirect.com.au/" href="http://www.columbusdirect.com.au/">Columbus Direct</a> *<a data-mce-href="http://www.travelscene.net.au/site/" href="http://www.travelscene.net.au/site/">Travel Scene Insurance</a> *<a data-mce-href="http://www.worldcare.com.au/" href="http://www.worldcare.com.au/" target="_blank" title="Worldcare Travel Insurance Australia">Worldcare Travel Insurance Australia</a> or compare travel cover and conditions at <a href="http://www.comparethemarket.com.au/">www.comparethemarket.com.au</a> <br />
<small> Useful reading: <a href="http://www.smartraveller.gov.au/getting_help_overseas.html">Getting help when traveling overseas</a> * <a href="http://www.smartraveller.gov.au/travel_insurance.html">Importance of travel Insurance</a></small> </blockquote>
<div dir="ltr">
<strong>Important contact information for Aussie travelers overseas</strong></div>
<div dir="ltr">
<a href="http://www.dfat.gov.au/consular/advice/index.html">Australian Department of Foreign Affairs & Trade</a> Australians traveling overseas may access a 24-hour Consular Emergency Centre - Consular advice for emergencies: call <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+611300555135" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1300 555 135</span><span class="skype_c2c_free_text_span"></span></span></span></span> within Australia or <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+61262613305" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">+61 2 6261 3305</span><span class="skype_c2c_free_text_span"></span></span></span></span> from outside Australia<small>. Important: Australians traveling should register with <a href="http://www.smartraveller.gov.au/" target="_blank">Smart Traveller</a> <span style="font-family: Arial;">to receive</span> up to date travel advice and receive consular assistance quickly - especially if you have a chronic health problem.</small></div>
<a href="http://www.phio.org.au/about-phio/about-phio.aspx">Private Health Insurance - Ombudsman</a> <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+611800640695" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1800 640 695</span><span class="skype_c2c_free_text_span"></span></span></span></span> <br />
<a href="http://www.privatehealth.gov.au/">Private Health</a> (Australian Government site) compare health insurance policies <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+611300737299" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1300 737 299</span><span class="skype_c2c_free_text_span"></span></span></span></span> <br />
<a href="http://www.tmvc.com.au/">Travel Doctor</a> Australian Traveler's Medical & Vaccination Centre <a href="http://www.traveldoctor.com.au/Content/Travel-Packs-Kits">Travel Kits Medical</a><br />
<strong><br />
INTERNATIONAL TRAVEL ON DIALYSIS AND POST TRANSPLANT </strong><br />
<hr />
Be aware delays can be expected if a bed in a public hospital isn’t
available - a global problem. Even if eligible for free treatment, you
may prefer to have control over treatment using travel health cover.<br />
<strong>Reciprocal Health Care Agreements </strong>(RHCA)<br />
Countries signatories: <em>New Zealand, United Kingdom, Republic of Ireland, Sweden, Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway. </em>More detail on <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries#a8">individual country benefits here></a><br />
<br />
RHCA are not designed to replace private travel health insurance
for overseas travel as not all treatment is covered. Each agreement is
different and varies in benefits, duration and eligibility for <em>medically necessary treatment</em> - a complex area of travel health cover, especially if you have multiple chronic health conditions and there are limits. <br />
<br />
<ul>
<li><a href="http://www.humanservices.gov.au/customer/services/medicare/reciprocal-health-care-agreements">Australians overseas</a>: may receive help with the cost of <em>essential medical treatment</em></li>
<li>Visitors to Australia: residents of RHCA countries listed above can get <em>essential medical treatments</em></li>
</ul>
<small>Exceptions where no cover is available are: pre-arranged or
elective treatment not immediately necessary, ambulance cover and
paramedical services, dental care, medical evacuation to a home
country, funerals, treatment in private hospital, or as a private
patient in a public hospital.</small><br />
An Australian RHCA may cover <em>medically necessary treatment</em> <em>INCLUDING dialysis for eligible visitors from</em>: <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries">Netherlands</a> - <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries">New Zealand</a> - <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries">United Kingdom</a> but there are limits.<br />
To receive <em>medically necessary treatment </em>for any ill-health or injury whilst visiting an RHCA country, you must provide local health authorities with:<br />
<ul>
<li>Australian passport or other passport which shows you are a permanent Australian resident </li>
<li>valid Medicare card - check expiry date to ensure you are covered until you return to Australia </li>
<li>if known treatment is expected, advise the relevant medical
staff that you wish to be treated under an RHCA with Australia, to
establish dialysis capacity. Be aware co-payments apply - there are
limits.</li>
</ul>
<strong>Important contact information</strong><br />
<br />
<blockquote>
<blockquote>
</blockquote>
<strong><a href="http://www.humanservices.gov.au/customer/services/medicare/reciprocal-health-care-agreements">Reciprocal Health Care Agreements</a> </strong><br />
Travel with PBS Medicine <span class="skype_c2c_container notranslate" data-isfreecall="false" data-ismobile="false" data-isrtl="false" data-numbertocall="+611800500147" dir="ltr" id="skype_c2c_container" tabindex="-1"><span class="skype_c2c_highlighting_inactive_common" dir="ltr"><span class="skype_c2c_textarea_span" id="non_free_num_ui"><img class="skype_c2c_logo_img" height="0" src="resource://skype_ff_extension-at-jetpack/skype_ff_extension/data/call_skype_logo.png" width="0" /><span class="skype_c2c_text_span">1800 500 147</span><span class="skype_c2c_free_text_span"></span></span></span></span> - Department of Human Services 132 290<br />
Medicare: <a href="https://www.blogger.com/null">Australians traveling overseas</a> and <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/health-care-for-visitors-to-australia">Visitors to Australia</a> <a href="http://www.hica.com.au/content/reciprocal-health-care-agreement-1"><br />
Health Insurance Consultants</a> - independent review of RHCA<br />
<strong>Medicare 132 011 - or to locate a Medicare office </strong><br />
TTY 1800 552 152 for hearing/speech impaired - 131 450 interpreting service <br />
<blockquote>
</blockquote>
</blockquote>
<br />
<strong>VISITORS TO AUSTRALIA - ON DIALYSIS OR POST TRANSPLANT</strong><br />
<hr />
Eligible RHCA country residents visiting Australia are entitled to<em> medically necessary treatment </em>for
ill-health or injury whilst in Australia, but this does not include
treatment considered ongoing, elective or in a private hospital. <a href="http://www.medicareaustralia.gov.au/public/migrants/visitors/uk.jsp">Visitors to Australia - can expect these entitlements for treatment under RHCA></a><br />
<ul dir="ltr">
<li>free treatment as a public in-patient or outpatient in a public hospital </li>
<li>subsidised medicine under Pharmaceutical Benefits Scheme (PBS) </li>
<li>Medicare benefits to cover some out-of-hospital medical
treatment provided by doctors through surgeries and community health
centres - be aware that a co<span style="font-family: Arial;">-payment usually applies.</span></li>
</ul>
<strong>RHCA eligible visitors to Australia may be entitled to use dialysis services in Australia as a public patient</strong><br />
<span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span class="Normal"><span style="color: #343434; font-family: Arial;">
<div dir="ltr">
<span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;">
The number of dialysis treatments available depends on availability of
resources of a treating hospital. Australia has agreed to provide RHCA
visitors with free dialysis for the lesser of: either a maximum
period of 4 weeks (covering all service sites) OR a maximum 12
sessions, within a 12 month period from date of first treatment.</span></span>However, it is important to note these points:</div>
</span></span></span></span><span style="color: #343434; font-family: Arial;">
<ul>
<li><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;">Dialysis in Medicare funded dialysis units (public) for eligible patients is based on clinical need.</span></span></span></span></span></span></li>
<li>The ability of the Australian health system to fund eligible
overseas patients must not interfere with the physical, clinical
and/or financial capacity of any Area Health Service to meet
clinical priorities for Australian residents.</li>
<li><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;">In
reality, travelers needing dialysis may have difficulty in finding
spare capacity in public Australian Dialysis Units. Dialysis is limited
to one RHCA patient at each site, subject to staffing and
resources - each state may impose their own limits on free
treatments offered.</span></span></span></span></span></span></li>
</ul>
<span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;">
<div dir="ltr">
<strong>Dialysis is NOT covered under these RHCA agreements</strong> <strong>- emergency treatment only</strong></div>
<blockquote dir="ltr" style="margin-right: 0px;">
<div dir="ltr" style="margin-right: 0px;">
<em>Visitors from <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries#a8">New Zealand</a> and <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries">Republic of Ireland</a></em>
should present their passport to Australian hospital clerical staff
to be eligible for cover under Medicare. Access to public health care
in Australia for visitors under an RHCA is restricted to a person
ordinarily resident in the Republic of Ireland and temporarily in
Australia. Such visitors will not be issued with Medicare cards. </div>
<div dir="ltr" style="margin-right: 0px;">
<em>Visitors from <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries">Finland - Norway<span style="color: #343434;"><span style="font-family: Arial;"> </span></span>- Sweden</a> </em>must
take your passport and travel visa to a Medicare office to be
registered and given a Medicare number. This card and number must be
presented to hospital clerical staff to prove Medicare eligibility.
Registration may be done during or after your hospital stay. If you do
not register you may be liable for the costs of treatment. </div>
<div dir="ltr" style="margin-right: 0px;">
<em>Visitors from <a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries">Belgium - Slovenia - Netherlands</a></em> present your current European Health Card and passport. <br />
<br />
<em><a href="http://www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/participating-rhca-countries">Residents of Malta and Italy</a></em><span style="font-family: Arial;"> -</span> only covered for six months from date of arriva<span style="font-family: Arial;">l and must provide passport.</span> </div>
</blockquote>
<span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span class="Normal"><span style="color: #343434; font-family: Arial;">
<div dir="ltr">
<strong>Considering skilled work in Australia? </strong>You and your family must be healthy - strict health criteria!<br />
<strong></strong> <a href="http://www.immi.gov.au/media/fact-sheets/">Overseas Skilled Workers: health requirements: Australian Immigration</a> Refer to Fact Sheet 22<br />
<a href="http://www.immi.gov.au/media/publications/translated/#a">Translated resources - Australian Immigration Department</a></div>
</span></span></span></span></span></span></span></span></span><br />
<strong>TRAVEL HEALTH AND KIDNEY DISEASE</strong><br />
<hr />
When on holiday your health care team must be able to contact you,
especially if on the transplant waiting list. Give your health team a
detailed travel itinerary with contact details and remember to advise
dialysis unit staff of any changes you make to your travel itinerary
or plans. Be aware, blood tests are compulsory for most units anywhere
in the world - allow time to have the tests done and receive results.
Check if vaccines are needed in countries where you travel - some
vaccines are not recommended for dialysis patients - note: transplant
patients need to be especially careful when having vaccines.<br />
<ul>
<li>Keep an up to date treatment letter from your doctor with you
at all times (copy in checked luggage) summarising your health, recent
lab results and medication prescribed and why. You may need to
provide this letter to Customs - also essential if you need to consult a
doctor away from home. Keep scanned e-copies in an email (Yahoo,
Hotmail) for access in emergencies. Your doctor can provide a copy in
an emergency, but not ideal if you need urgent treatment or medication.<br />
<br />
</li>
<li>Check that medications you need are not considered illegal in
countries you may travel to, especially pain killers or opiates.
Erythropoietin is banned for sports persons - so ensure if you need
this drug, it is noted in your treatment letter - otherwise you may be
fined, face lengthy delays in Customs, or worse! <small><a href="http://www.wada-ama.org/en/" style="color: red; text-decoration: none;" target="_blank"><br />
Prohibited list; Therapeutic use exemptions</a> World Anti-Doping Agency<br />
<br />
</small></li>
<li>Travel with at least a 3 day reserve of supplies - to cover you
for flight delays, unexpected scheduling or shipment delays. Bags can
also go astray - they may arrive on the next flight, but to be safe
always pack medications in a carry-on bag, never in checked luggage. <br />
<br />
</li>
<li>Planes don't have fridges for personal use - if you have a drug
which must be kept cool, ask your pharmacist how to pack it for
travel. Check if your hotel offers a room fridge as some countries do
not - they may suggest options. Consider packing medications in a
thermo-bag with re-usable freezer packs or use a wide-necked thermos
chilled in advance. Make sure you allow time for transfers and delays
when calculating the total length of your travel to avoid times when
medication may be unrefrigerated. <br />
<br />
</li>
<li>Ensure you arrange a clean space in advance to do exchanges and
store supplies. Carry two universal power connectors, one in personal
bag and one in checked luggage, in case one is lost in transit. <br />
<br />
</li>
<li>If you bring syringes, you must bring the drug you inject, like
insulin etc (some countries including Australia require a special
license for certain drugs). There is no limit to how many unused empty
syringes you can travel with, but you must display a professionally
printed label on the associated medication which clearly identifies it.
On your return trip ensure you declare any drugs you were given or
prescribed. A treatment letter listing medication may be requested by
Customs when returning home. <br />
<br />
</li>
<li>If you travel by plane or train, make arrangements for special
meals (e.g. low-salt, low-fat, diabetic). If diabetic, carry glucose
tablets and snacks such as low-potassium juice to treat low blood
sugar. Travel with lunch or nutrition supplement, in case of delays.
Managing diabetes can be simpler by having a travel pack of insulin,
syringes and blood glucose monitoring unit in your hand luggage. <br />
<br />
</li>
<li>Pack an emergency supply of bandages, pain killers, insect-bite
ointment and anti-diarrhoea pills. Ask your health team for names of
over-the-counter drugs you could use if needed. Avoid over-exposure
to sun - take a high-factor sunscreen and use it - sun protection is
very important for transplant patients.<br />
<br />
</li>
<li>Watch what you eat and drink. Talk to your dietitian about foods
to avoid overseas. Don't risk drinking local water, use bottled water
only, including water for brushing teeth. Avoid salads and ice cubes
unless prepared yourself using bottled water. Avoid any foods from
street vendors, especially ice cream.</li>
</ul>
<br />
<strong>INTERNATIONAL TRAVEL LOCATIONS - OFFERING DIALYSIS</strong><br />
<hr />
<em>Be aware that the quality, standards & charges may vary greatly in cities overseas</em><br />
<em> </em><br />
<a href="http://www.nephrocareasia.com/" target="_blank"> </a> <img align="right" alt="" border="0" height="80" src="http://www.kidney.org.au/Portals/0/assets/Images/IFKF%20Globe.jpg" width="107" /> <a href="http://www.nephrocareasia.com/" target="_blank">Asia Pacific Nephrocare - Global Dialysis Clinic Finder</a><br />
<a href="http://www.dialysisabroad.com.au/"> Dalysis Abroad</a> Australian escorted tours with quality dialysis - Japan, Bali & Italy<br />
<a href="http://www.dialysisatsea.com/">Dialysis at Sea </a><a href="http://www.dialysisatsea.com/">- USA</a>
Cruise with medical and dialysis needs managed by trained medical
professionals on board - USA, Alaska, Hawaii, Mexico, Canada, Bermuda<br />
<a href="http://www.diaverum.com.au/all-destinations-uk" target="_blank">Diaverum Holiday Dialysis - many global locations</a><br />
<a href="http://www.eurodial.org/international/index.html" target="_blank">Eurodial</a> Global dialysis group - guarantee sessions with reputable private dialysis centres<br />
<a href="http://www.eneph.com/" target="_blank">eNeph</a> Clinicfinder for list of global Dialysis Units.<br />
<a href="http://www.dialysisfreedom.co.uk/">Dialysis Freedom</a>run in conjunction with <a href="http://www.britishkidney-pa.co.uk/">British Kidney Patients Association</a> See list of all UK dialysis units<br />
<a href="http://www.nephrocare.com.au/temp-312528671.php">Fresenius Medical Care: Travel & Dialysis Internatiional</a> Locate holiday dialysis unit - global<br />
<a href="http://www.hditravel.com/en/15.htm">Fresenius Holiday Dialysis - global</a> Private dialysis unit finder<br />
<a href="http://www.globaldialysis.com/" target="_blank">Global Dialysis</a> Resource for travel on dialysis patients <br />
<a href="http://www.hditravel.com/"> Holiday Dialysis International</a> - dialysis cruises <a href="http://www.hditravel.com/cps/rde/xchg/SID-8E118039-1004A8BA/fme-hdi_en/hs.xsl/366.htm">online booking/query form</a> <br />
<a href="http://www.dialysis-travel.com/">Holiday Dialysis - Dr Berger</a> UK and European dialysis travel eligible for subsidised dialysis at these centres. For quote for treatment/availability <a href="mailto:info@dialysis-travel.com">info@dialysis-travel.com</a><br />
<a href="http://www.ifkf.org/members/inventory-of-resources.html" target="_blank">International Federation of Kidney Foundations - Member Inventory</a> Global members give valuable information on local availability of dialysis, quality of care and relevant charges <br />
<a href="http://www.nxtbook.com/nxtbooks/wiley/dt_201107/">The List: Dialysis & Transplantation</a> Global guide to travel and dialysis - extensive resource<br />
<a href="http://www.kidney.org.uk/help/holidays/index">National Kidney Foundation UK</a> Dialysis Centres worldwide and support information <br />
<br />
<strong><br />
INTERNATIONAL DIALYSIS PROVIDERS FOR TRAVEL ON DIALYSIS</strong><br />
<hr />
<img align="right" alt="" height="111" src="http://www.kidney.org.au/Portals/0/assets/Images/BIMC%20HOSPITAL%20Dialysis%20Centre%20%283%29.jpg" width="179" /><strong>BALI - INDONESIA Nusa Dua</strong><br />
<a href="http://www.bimcbali.com/dialysis-centre">BIMC Hospital Dialysis Unit</a> Upgrades to facilities ensure high Australian standards - 4 star Hotel nearby. Contact unit well before travel - <a href="http://www.bimcbali.com/wp-content/uploads/2012/09/e-DIALYSIS-BROCHURE.pdf">e-brochure</a>
US$249 per session. PD support - Australian staff speak: English,
German, French, Japanese & Indonesian (9-5, 6 days no Sunday)
<div dir="ltr" style="margin-right: 0px;">
<small>Jo Skala - Haemodialysis Coordinator</small> - <small>Call +62 361 300 0911 <br />
</small><small><a href="mailto:jo@bimcbali.com">jo@bimcbali.com</a> * <a href="mailto:dialysiscentre@bimcbali.com">dialysiscentre@bimcbali.com</a> or <a href="mailto:nusadua@bimcbali.com">nusadua@bimcbali.com</a> </small></div>
<div dir="ltr" style="margin-right: 0px;">
<strong>CANADA</strong><br />
<a href="http://www.travelingdialysisrvassociation.com/">Traveling Dialysis RV Associates - water purification system</a> No training given - patient must be trained with this type of unit.</div>
<a href="http://www.travelingdialysisrvassociation.com/"> </a><blockquote>
<span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><span style="color: #343434; font-family: Arial;"><a href="http://www.travelingdialysisrvassociation.com/"> </a>
<div dir="ltr" style="margin-right: 0px;">
<strong>CANARY ISLANDS </strong><br />
<a href="http://www.dialysecanarias.com/index-en.html">Club Haemodialysis</a> Fresenius Private Travel <a href="mailto:info@dialysecanarias.com">info@dialysecanarias.com</a><br />
Bulgaria, Croatia, Czech Republic, Egypt, Greece-Crete, Hungary, Italy, Poland, Spain, Tunisia, Turkey <a href="http://www.dialysis-travel.com/holiday-dialysis-clinics.html">Holiday Dialysis: by Dr Berger</a> for extensive travel service for dialysis patients<br />
Cyprus <a class="oBoxLink" href="http://www.treatmentabroad.net/dialysis-treatment/cyprus-health-board-dialysis/" title="Dialysis treatment in Cyprus: Cyprus Health Service Promotion Board">Dialysis via Cyprus Health Service Promotion Board</a> - <a href="http://www.cyprodial.com.cy/" target="_blank">Cyprus Holiday Dialysis Unit</a><br />
Greece and other countries Treatment Abroad: Dialysis holidays<a class="oBoxLink" href="http://www.treatmentabroad.net/dialysis-treatment/" title="T&T Executive: Renal dialysis treatment and holidays in Greece"><br />
Greece - Rhodes</a><a class="oBoxLink" href="http://www.treatmentabroad.net/dialysis-treatment/" title="T&T Executive: Renal dialysis treatment and holidays in Greece"> </a><a href="http://www.helionephro.com/">Helionephro Dialysis</a> (approx 250 euros a treatment) <a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=7B6Q8Yojolc%3d&tabid=608&mid=1758">Helionephro Sun Dialysis Unit</a> <br />
<a class="oBoxLink" href="http://www.treatmentabroad.net/dialysis-treatment/" title="T&T Executive: Renal dialysis treatment and holidays in Greece"> </a><a href="http://www.privatehealth.co.uk/hospitaltreatment/find-a-treatment/dialysis-treatment/dialysis-treatment-abroad/">Apollo Bramwell Hospital</a> holiday dialysis - get quote and confirm booking before travel.</div>
</span></span></span></blockquote>
<div dir="ltr" style="margin-right: 0px;">
<strong>NEW ZEALAND</strong><a href="http://www.kidneys.co.nz/Dialysis/Holiday-Dialysis/"><br />
Kidney Health New Zealand</a> access to holiday Dialysis Units <a href="http://www.wellingtonkidneysociety.org.nz/"><br />
Wellington Region Kidney Society's Taupo Holiday Home</a> (minimum charges apply) <a href="http://www.kidneysociety.co.nz/what-we-do/information/holidays-and-travel.html"><br />
Kidney Society of Auckland - Holidays and Travel</a> </div>
<blockquote>
<div dir="ltr" style="margin-right: 0px;">
<strong>PACIFIC REGION</strong></div>
<div dir="ltr" style="margin-right: 0px;">
<strong>Fiji Islands:</strong>
Colonial War Memorial Hospital in Suva (east coast - 200 km from west
coast holiday spots) Session approx $500 Fiji. Call +679 310 0020 or <a href="mailto:fijidialysiscentre@gmail.com">fijidialysiscentre@gmail.com</a></div>
<strong>Western Samoa:</strong> +679 310 0020 Motootua Hospital in Apia
- very important to check with staff on status of current dialysis
care, access to care by qualified doctors during dialysis and
availability.<br />
</blockquote>
<strong>UNITED ARAB EMIRATES </strong>- Dubai <br />
<a href="http://zulekhahospitals.com/inner.php?pageId=684&Division_Id=1">Zulekha Hospital - Holiday Dialysis</a> Most countries (inc Australia) are offered <a href="http://zulekhahospitals.com/inner.php?pageId=467&Division_Id=1">free Travel Visas</a> <br />
<blockquote>
<strong>UNITED KINGDOM</strong><br />
<a href="http://www.dialysisfreedom.co.uk/"> Dialysis Freedom - dialysis holiday specialists</a> <br />
<a href="http://www.dialysisholidays.co.uk/"> Dialysis Holidays UK </a><br />
<a href="http://www.privatehealth.co.uk/hospitaltreatment/find-a-treatment/dialysis-treatment/"> Private Dialysis UK</a> Find a holiday/ private dialysis clinic - get quote for anticipated treatment <br />
<a href="http://www.renal.org/whatwedo/InformationResources/RenalUnits.aspx"> Renal Assocation of UK - Lists over 70 main Dialysis Units</a> Sort by map or postcode<br />
<a href="http://www.scottish-holiday-dialysis.com/"> Haemodialysis in Edinburgh Scotland</a> <br />
</blockquote>
<div dir="ltr" style="margin-right: 0px;">
<strong>UNITED STATES OF AMERICA</strong><br />
<a href="http://nephron.com/usacgi.html" target="_blank">Dialysis Units in the USA</a> <br />
<a href="http://www.dialysisfinder.com/travellinks.cfm" target="_blank">Dialysisfinder.com Travel links</a> Book your dialysis sessions early <br />
<a href="http://www.kidney.org.uk/holidays/index.html" target="_blank">NKF (USA) Holiday Pages</a><br />
<a href="http://www.davita.com/services/travel-support/travel-tips-and-articles">Traveling on dialysis advice</a> DaVita USA - hints for travel on dialysis and more<br />
<a href="http://www.wheredialysis.com/" target="_blank">WhereDialysis.com</a> Find dialysis facilities in the USA</div>
</span></span></span>Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-46570389683393141752015-01-09T04:12:00.000-08:002015-01-09T04:12:01.699-08:00WHAT IS KIDNEY CANCER?<br />
<span class="Normal">Kidney cancer
is a type of cancer that occurs in the cells of the kidney. Cancer is
caused by the rapid abnormal overgrowth of cells within the kidney. Our
bodies are always making new cells: so we can grow, to replace worn-out
cells, or heal damaged cells after injury. </span><br />
<span class="Normal">This process is controlled by certain genes and
all cancers are caused by changes to these genes. Changes to our genes
usually happen during our lifetime, although a small number of people
inherit such a change from a parent. <br />
</span><br /><span class="Normal"><img align="right" alt="" border="0" height="334" src="http://www.kidney.org.au/Portals/0/assets/Images/Kidney%20Cancer%20Stage%201.png" width="324" />
As with all cancers, kidney cancers begin small and grow larger over
time. Kidney cancers usually grow as a single mass but more than one
tumour may occur in one or both kidneys. These lumps can be benign (not
cancerous) or malignant (cancerous). Benign lumps do not spread to other
parts of the body. <br />
<br />
When it first develops a malignant tumour is confined to its original
site. If cancer is treated in its early stages, the potential for cure
of the cancer can be very good. If these cells are not treated, they may
spread into surrounding tissue and to other parts of the body. When
these cells reach a new site they may continue to grow</span><br />
<span class="Normal"><span class="Normal" id="dnn_ctr1840_HtmlModule_lblContent"></span></span><br />
<div align="left">
<strong>Incidence of Kidney Cancer<br />
</strong><span style="color: #343434; font-family: Arial;">In Australia, kidney cancer
is one of the ten most common cancer diagnoses. It is estimated that
3,000 people received a diagnosis of kidney cancer in 2012. </span></div>
<div align="left">
<span style="color: #343434; font-family: Arial;">Between 1991 and 2009 the incidence of kidney cancer has increased by approximately 30%. </span><span style="color: #343434; font-family: Arial;">The
increase in diagnosed kidney cancer may be due to the aging of the
population, better diagnostic methods, or increased rate of coincidental
diagnosis during scans for other reasons.</span></div>
<span style="color: #343434; font-family: Arial;">Kidney cancer is mostly a disease seen in adults aged over 55, and is rare in children.</span><br />
<br />
Australians have a 1 in 69 risk of developing kidney cancer before the
age of 85 (1 in 49 for males and 1 in 110 for females). Males are
currently twice as likely to develop kidney cancer as females. Kidney
cancer is mostly a disease seen in adults aged over 55, and is rare in
children. <br />
<strong>Survival <em> <br />
</em></strong>Worldwide, over 100,000 people die of kidney cancer each
year. Kidney cancer caused 927 deaths in Australia in 2009 (575 men, 352
women), accounting for 2% of all cancer deaths, and for 0.6% of all
causes deaths.<br />
Survival from kidney cancer has increased greatly over time. The
5-year relative survival from 47% in the period 1982-1987 to 72% in
2006-2010. The 5-year survival rate is similar for males and females
overall, although females aged 50–59 (5-year survival of 83%) had a
slight survival advantage over males of the same age (76%). <br />
Improved outcomes are due largely to increases in the detection and
survival of early-stage renal cell carcinoma, the most common form of
kidney cancer.<br />
<small><strong>Health Professionals - register to receive our <a href="http://kidneycancer.org.au/support-resources/health-professionals/">Kidney Cancer Newsletter 2014></a></strong></small><br />
<br />
<strong>Different types of kidney cancer<em> <br />
</em></strong>Around 85% of kidney cancers are renal cell carcinomas.
These cancers begin to grow in the lining of one or both kidneys.
Without treatment, this type of cancer can spread to other parts of your
body. <br />
<br />
Other (less common) types of kidney cancer include<em>:</em> <br />
<ul>
<li>Transitional cell carcinoma – starts in the join between the
kidney and its ureter (the tube that drains urine from the kidney into
the bladder) </li>
<li>Renal sarcoma – a rare type of kidney cancer. </li>
<li>Wilm’s tumour – a rare type of kidney cancer that affects children. </li>
</ul>
<small>
</small><strong></strong><strong><br />
</strong><strong><small>SOURCES OF DATA</small></strong><br />
<br />
<ul>
<li> <small><a href="http://www.aihw.gov.au/cancer/ncsch/index.cfm">Australian Cancer Incidence and Mortality Book (2010)</a> AIHW Canberra & Australasian Association of Cancer Registries </small></li>
<li><small><a href="http://www.aihw.gov.au/publication-detail/?id=60129542358"> Cancer in Australia: an overview 2012</a> Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW </small></li>
<li><small> AIHW 2012 <a href="http://www.aihw.gov.au/publication-detail/?id=60129542358">Cancer in Australia: in brief 2012</a> Cancer series no. 73. Cat. no. CAN 69. Canberra: AIHW. </small></li>
<li><small> Australian Institute of Health and Welfare <a href="http://www.aihw.gov.au/publication-detail/?id=10737422720">Cancer survival and prevalence in Australia: period estimates from 1982 to 2010</a> 2012. Cancer Series no. 69 Cat. no. CAN 65. Canberra: AIHW </small></li>
</ul>
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Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-43107301985022936232015-01-09T04:01:00.004-08:002015-01-09T04:01:57.817-08:00RISK FACTORS & SYMPTOMS OF KIDNEY DISEASE? <span class="Normal" id="dnn_ctr1898_HtmlModule_lblContent"></span><br />
If you
understand and know the risk factors for CKD and ask your GP for a
regular kidney health check, you can help detect chronic kidney disease
early and improve long term outcomes.<br />
<strong>You are <em>at increased risk</em> of chronic kidney disease if you:</strong> <br />
<ul>
<li> adult Australians are at an increased risk of CKD if they:
<ul>
<li>have diabetes </li>
<li>have high blood pressure </li>
<li>have established heart problems (heart failure or heart attack) and/or have had a stroke </li>
<li>have a family history of kidney disease </li>
<li>are obese (Body Mass Index (BMI) - more than or equal to 30) </li>
<li>are a smoker </li>
<li>are 60 years or older </li>
<li>are of Aboriginal or Torres Strait Islander origin </li>
</ul>
</li>
</ul>
<small><strong></strong></small><br />
<hr />
<small><br />
<img alt="" height="52" src="http://www.kidney.org.au/Portals/0/assets/Images/NWS_horiz_graphic.jpg" width="300" /></small>
<strong>WHAT ARE THE SYMPTOMS OF KIDNEY DISEASE?</strong><br />
There are no warning signs for CKD and individuals can lose up to 90%
of their kidney function before they feel any symptoms - and by then
it's too late.<br />
The symptoms of reduced kidney function may include:<br />
<ul>
<li>high blood pressure </li>
<li>changes in the amount and number of times urine is passed, e.g. at night </li>
<li><strong><img align="right" alt="" height="163" src="http://www.kidney.org.au/Portals/0/assets/Images/Kidney%20blood%20flow%20diagram.jpg" width="175" /></strong>changes in the appearance of urine </li>
<li>blood in the urine </li>
<li>puffiness e.g. legs and ankles </li>
<li>pain in the kidney area </li>
<li>tiredness </li>
<li>loss of appetite </li>
<li>difficulty sleeping </li>
<li>headaches </li>
<li>lack of concentration </li>
<li>itching </li>
<li>shortness of breath </li>
<li>nausea and vomiting </li>
<li>bad breath and a metallic taste in the mouth </li>
</ul>
These symptoms may worsen gradually as kidney function declines.
However, the symptoms are very general and may be caused by other
illness. If you are you are <em>at increased risk</em> of kidney disease, as explained above, or are experiencing many of these symptoms, ask your doctor for a kidney health check. See some real life stories of personal journeys with kidney failure.<br />
<br />
<strong>WHAT ARE THE STAGES OF KIDNEY FAILURE - WHAT DO THEY MEAN?</strong><br />
These images represent different stages used by doctors to determine the severity of chronic kidney disease:<br />
<img alt="" height="122" src="http://www.kidney.org.au/Portals/0/assets/Images/Stages%20of%20Kidney%20Disease.png" width="680" /><br />
<small>This image taken from <a href="http://www.kidney.org.au/HealthProfessionals/IndigenousResources/tabid/770/Default.aspx">Kidney Stories - for Indigenous Australians</a> - presented with graphics made available by <a href="http://www.health.nt.gov.au/Renal_Services/index.aspx">NT Renal Services</a></small><br />
<strong>Early stages of kidney failure - <em>small amount of kidney damage, although GFR may be normal</em></strong><br />
<ul>
<li>Often there are no symptoms in the early stages of kidney disease, blood tests can be normal. </li>
<li>There may be scarring and blockages that change blood flow to parts of the kidney so they don't work as well as they should. </li>
<li>There is an increased risk of heart disease. You doctor can help you reduce your risk of heart disease. </li>
</ul>
<strong>Middle stages of kidney failure - <em>sometimes discovered because level of waste product in the blood rises</em></strong><br />
<ul>
<li>Some people begin to feel unwell and notice an increase in urine frequency. </li>
<li>Blood pressure can rise as the kidneys slow down. High blood
pressure further increases the risk of heart disease, heart attack and
stroke. </li>
<li>Early signs of bone disease may be present. </li>
<li>Anaemia may appear, caused when there are not enough red blood
cells in the blood to carry oxygen around the body. Symptoms include
weakness, fatigue and a shortness of breath. </li>
</ul>
<strong>Later stages of kidney failure</strong><br />
<ul>
<li>High blood pressure almost always occurs. </li>
<li>You may start to notice changes in the amount of urine you pass. </li>
<li>Lack of energy, increased tiredness and reduced appetite are common symptoms. </li>
<li>You may need to make dietary changes, including limiting the use
of salt or reducing the amount of potassium or phosphorus in your diet.
</li>
</ul>
<strong>End-Stage Kidney Disease (ESKD)</strong><br />
<ul>
<li>The kidneys are only functioning at 10-15 per cent of their
capacity and are unable to properly filter waste products, remove extra
water from the body and help maintain the blood's chemical balance. </li>
<li>This is the time to consider commencing dialysis or having a kidney transplant. </li>
</ul>
Adjusting to kidney failure is more difficult for some people than
others, even with time to prepare for it. When there is no time to
prepare, the sudden impact makes dealing with kidney failure much
harder.<br />
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-86964355905996414242015-01-09T03:57:00.000-08:002015-01-09T03:57:39.351-08:00How our kidneys workThe role of the kidneys is often underrated when we think about our
health. In fact, the kidneys play an important role in the daily
workings of our body. They are so important to health that nature gave
us two kidneys to cover the possibility that one might be lost to an
injury. They are so important that with no kidney function death occurs
within a few days.<br />
<br />
We can live quite well with only one kidney and some people live a
healthy life even though born with one missing. But while bones can
break, muscles can waste away and the brain can sleep without risk to
life, if both of your kidneys fail, as happens in end stage kidney
failure, the body dies without life saving dialysis.<br />
<br />
<strong><img align="right" alt="" border="0" height="205" hspace="5" src="http://www.kidney.org.au/Portals/0/assets/Images/Kidneys%20and%20urinary%20system%20small.jpg" vspace="5" width="137" />How do our kidneys work?</strong> <br />
The kidneys play a major role in maintaining your general health and
wellbeing. Think of them as an extremely sophisticated, environmentally
friendly, waste disposal system which sorts non‐recyclable waste from
recyclable waste, 24 hours a day, seven days a week, while also cleaning
your blood.<br />
<br />
Most people are born with two kidneys, each one about the size of an
adult fist, are bean-shaped and weigh around 150 grams each. <a href="http://en.wikipedia.org/wiki/Kidney">The kidneys are located at both sides of your backbone</a>
just under the rib cage or above the small of your back. They are
protected from injury by a large padding of fat, your lower ribs and
several muscles. <br />
<br />
In each kidney, blood is filtered through millions of mini‐filters
called ‘nephrons’. The excess fluid and unwanted chemicals from this
filtering process become urine and are passed from the kidneys to your
bladder.<br />
<br />
<strong>What do your kidneys do?</strong> <br />
Our kidneys are small biological marvels with a fascinating design.
Every hour your blood supply circulates through the kidneys about 12
times. Each day your kidneys process around 200 litres of blood, with
around 1 to 2 litres of waste leaving the body as urine.<br />
The kidneys also play a role in the production and regulation of several important hormones and enzymes, which help to:<br />
<br />
<ul>
<li>Control blood pressure</li>
<li>Make red blood cells</li>
<li>Maintain strong and healthy bones</li>
</ul>
All this makes the kidneys a vital player in your body’s mechanism and your overall health.<br />
<strong>Anatomy of the kidneys</strong><br />
We have about a million hairpin-like glomeruli at birth, but lose about
100,000 of these every decade of life. Droplets of filtered blood pass
through a number of tubules (tiny tubes) into the medulla, a central
collecting region. The glomeruli and tubules together make up nephrons,
long and extremely fine tubes which, if connected, would run for 80
kilometres (50 miles).<br />
Cleaned blood returns to the body by the renal vein. Waste and extra
water removed by the kidney passes through a tube called the ureter to
the bladder, where it is stored as urine or wee. When the bladder is
full, urine passes out of the body through another tube called the
urethra.<br />
The process of removing waste and extra water in simple terms is: <br />
<ul>
<li>food and drink enters the stomach and are broken down into nutrients </li>
<li>solid waste products are removed and nutrients enter the bloodstream. </li>
<li>nutrients are used by the body for energy, growth, repair and maintenance of body functions. </li>
<li>this process creates waste which is removed by the kidneys. </li>
<li>extra nutrients not immediately needed by the body are also removed by the kidneys. </li>
<li>waste products and extra water move from the kidneys to the bladder, then leave the body as urine </li>
</ul>
<strong>Our kidneys are designed to last a life-time, they do an amazing job! It is important to care for them.</strong><br />
<small>We recommend these kidney education tools below for a visual introduction to the kidney.<strong> </strong>Click on diagrams to view animations * <a href="http://www.kidney.org.au/flash/kidney_animation/kidneys.html#intro">How our kidneys work</a> * <a href="http://www.kidney.org.au/flash/dialysis_animation/dial.html">How dialysis works</a> to replace the work of healthy kidneys,<br />
</small><br />
<small> </small><br />
<table align="" border="1" cellpadding="1" cellspacing="1" style="width: 650px;" summary="">
</table>
<small> </small><small>
<table align="" border="0" cellpadding="2" cellspacing="2" style="height: 300px; width: 700px;" summary="">
<tbody>
<tr>
<td align="center"><a href="http://www.kidney.org.au/flash/kidney_animation/kidneys.html#intro"><img alt="How Kidneys Work" border="0" height="300" src="http://www.kidney.org.au/assets/images/kidney_still1.gif" width="214" /></a></td>
<td align="center"><small><small><a href="http://www.kidney.org.au/flash/dialysis_animation/dial.html"><img alt="How Dialysis Works" border="0" height="300" src="http://www.kidney.org.au/assets/images/kidney_still2.gif" width="281" /></a></small></small></td>
</tr>
<tr>
<td align="center"><span class="Normal">Click diagram go to animation</span><br />
<span class="Normal"><a href="http://www.kidney.org.au/flash/kidney_animation/kidneys.html#intro">How a healthy kidney works> </a> </span><small><small><br />
</small></small></td>
<td align="center"><span class="Normal">Click diagram go to animation<br />
<a href="http://www.kidney.org.au/flash/dialysis_animation/dial.html">Structure of the kidneys and bladder></a></span></td>
</tr>
</tbody>
</table>
</small>
<small>Kidney Health Australia acknowledges <a href="http://www.davita.com/">DaVita</a> for allowing use of these images their excellent teaching resource on our website.</small><br />
<strong>How can I look after my kidneys?<br />
</strong>There are many risk factors that can contribute to kidney
disease, and it’s important to be aware of these risks and take the
right steps to prevent kidney damage.<strong><img align="right" alt="" height="82" src="http://www.kidney.org.au/Portals/0/assets/Images/Stop%20smoking.jpg" width="82" /></strong><br />
<strong>Stop Smoking<br />
</strong>If you don’t smoke, don’t start. If you do, quit! This is the
simplest, most important lifestyle habit to change to reduce the risk of
kidney disease. People who smoke are three times more likely to have
reduced kidney function, and have a four to five times greater risk of
heart attack and stroke. Tips to help you quit:<br />
<br />
<ul>
<li>Get the appropriate help. <a href="http://www.quit.org.au/article.asp?ContentID=6615">Order a free QUIT pack - call QUIT Hotline 137 848</a> or contact your local community services directory or health centre for a referral to a smoking cessation program.</li>
<li>Surround yourself with people who are non‐smokers.</li>
<li>Talk to your general practitioner. Research shows that spending
as little time as three to five minutes talking with your health
practitioner can increase your quit rate.</li>
<li>Find healthy alternatives to smoking, such as meditation and yoga.</li>
</ul>
<strong>What can I do to keep my kidneys healthy?</strong><br />
Key recommendations to staying healthy and maintaining kidneys health are:<br />
<br />
<ul>
<li>Keep your blood pressure below 130/90 and maintain healthy levels of cholesterol</li>
<li>If you have diabetes make sure you actively treat your blood
glucose levels - normal levels are 4-6 mmol/L before meals and 4-8
mmol/L two-hours after meals.</li>
<li>It’s important to have your cholesterol levels checked regularly - recommended level is no higher than 5.5 mmol/litres.</li>
<li>Lead a healthy lifestyle and maintain healthy weight, be active for more than 30 minutes most days.</li>
<li>Eat a balanced healthy diet low in saturated fats<strong>.</strong></li>
</ul>
<strong><small><strong><a href="http://www.kidney.org.au/ForPatients/HealthFactSheets/tabid/609/Default.aspx"><img align="right" alt="" height="231" src="http://www.kidney.org.au/Portals/0/assets/Images/Nutrition%20information.png" width="233" /></a></strong></small>Healthy Eating </strong><br />
The food you eat plays a huge role in the health and well being of your
body. As well as providing the body with a variety of nutrients, food
choices can also help in weight reduction and weight control. Tips to
help you do this are:<br />
<br />
<ul>
<li>eat healthy foods - with as many fresh ingredients as possible.<br />
</li>
<li>don't over eat - always leave a meal feeling like you could eat a little bit more.<br />
</li>
<li>eat breakfast - a good breakfast activates your metabolism first thing in the morning.<br />
</li>
<li>avoid fad diets - they are hard to maintain over a long period and can create or worsen ill health.<br />
</li>
<li>check nutrition panels on all parceled foods you buy - choose
only foods that list a low percentage of sugar and salt and are low in
saturated fats - find out about food ingredients.</li>
</ul>
<strong>To satisfy thirst - drink water instead!</strong><br />
<strong><img align="right" alt="" height="101" src="http://www.kidney.org.au/Portals/0/assets/Images/Drink%20water%20instead%20web%20small.jpg" width="150" /></strong>Drink
plenty of fluids and listen to your thirst. Water is the recommended
choice, it is also calorie-free, inexpensive and readily available.
Sugar drinks have lots of calories, while caffeine and alcohol are both
diuretics and can leave the body dehydrated.<br />
<br />
Research also states that one drink containing sugar each day, has been
shown in females to be associated with an 80 % increase in the risk of
acquiring diabetes. Choose to drink water instead!<br />
Note: Bottled mineral water contains salt which can lead to fluid
retention and even increased blood pressure in susceptible people. Check
the label and choose low sodium varieties (less than 30mg sodium per
100ml).<br />
<br />
<strong>Losing weight can reduce how hard your kidneys need to work</strong><br />
Weight loss can also lead to a decrease in the amount of protein lost
via urine. High levels of protein in the urine can make your kidney
function worse. Obesity may also cause some people with existing forms
of some kidney disease to lose their kidney function more rapidly.<br />
<br />
There is also evidence to suggest excess weight is also associated with
an increased risk of kidney cancer. If you are overweight, you have an
increased risk of developing diabetes and high blood pressure - both are
major risk factors for kidney disease. Losing as little as 5 kilograms
reduces blood pressure in most people who are 10% above a healthy
weight.<br />
<br />
<strong>Do at least 30 minutes of physical activity most days of the week</strong><br />
Stay fit. The key is to start slowly and gradually increase time and
intensity of activities. Physical activity leads to increased strength,
stamina and energy. You can break down any activity into 3 x 10 minute
bursts, which can be increased as fitness improves.<strong><br />
</strong><br />
<blockquote>
<strong>STOP exercising without delay, tell your health care team, or go to hospital if you: </strong><br />
- have chest pain or pressure<img align="right" alt="" height="73" src="http://www.kidney.org.au/Portals/0/assets/Images/STOP.bmp" width="73" /><br />
- feel dizzy or light headed<br />
- have an irregular or fast heart beat that persists when the activity is completed<br />
- have excessive shortness of breath<br />
</blockquote>
<strong>Limit alcohol intake</strong><br />
Excessive alcohol intake can lead to heart disease and high blood
pressure, increasing the risk of kidney disease. Tips to cut down on
your alcohol intake:<strong><br />
</strong>
<ul>
<li>Limit alcohol to less than two standard drinks per day.</li>
<li>Ask for ice with your drinks – when the ice melts it will dilute alcohol.</li>
<li>Alternate your drinks by having a glass of water in between each alcoholic drink.</li>
<li>If you want to feel like you’re partaking in a drinking session, fake it – drink your water from a wine glass.</li>
</ul>
<strong>Enjoy Life</strong><br />
Good health and wellbeing mean<strong>s t</strong>hat we are healthy
from all dimensions of our lives – physically, mentally, socially and
spiritually. Tips for an enjoyable life:<br />
<ul>
<li>Have less stress in your life.</li>
<li>Do the things you love.</li>
<li>Spend more time with people you enjoy being</li>
<li>with – those who challenge you to be more… not less.</li>
<li>Balance the load.</li>
</ul>
<small><small> </small></small><br />
<strong> </strong><strong>KidneyEd TV</strong><br />
Our collection of YouTube videos, grouped into playlists, enable you to
learn more about the kidneys, urinary system and related topics. View
reviewed kidney health education videos at KidneyHealthAus - on YouTube. <br />
<div align="left">
<span class="Normal"></span></div>
<em><strong>Without any kidney function our body dies. Some kidney function is essential for life!</strong></em><br />
<hr size="2" width="100%" />
<br />
<span><span><span><span><span><span><img align="right" alt="The Kidney" height="137" src="http://www.kidney.org.au/assets/images/clip_image002%20-%20The%20Kidney" width="117" /></span></span></span></span></span></span><strong>WHAT CAN GO WRONG WITH THE KIDNEYS?</strong>
<span><span><span><span><span><span>Most kidney diseases attack the
nephrons. Sometimes kidney failure can happen quickly, caused for
example by a sudden loss of large amounts of blood or an accident. A
sudden drop in kidney function is called Acute Kidney Failure and is
often short lived, but can occasionally lead to lasting kidney damage. <br />
</span></span></span></span></span></span><br />
<span><span><span><span><span><span>More often kidney function
worsens over a number of years. This is actually good news, because if
kidney disease is found early, medication, dietary and lifestyle changes
can increase the life of your kidneys and keep you feeling your best
for as long as possible. </span></span></span></span></span></span><br />
<span class="Normal"><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>Kidney disease progression can also be slowed with medicines which help to protect your kidneys. </span></span></span></span></span></span><span><span><span><span><span><span>Your GP can prescribe these medicines for you. Talk to your local pharmacist when you have your prescription filled. </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span>Take the test at Check My Kidneys to find out if you are at increased risk of kidney disease.</span><br />
<strong>What does Chronic Kidney Disease mean?</strong><br />
If you lose over one third of your kidney function for over 3 months, it is called Chronic Kidney Disease or CKD. <br />
<br />
Sometimes kidney disease leads to kidney failure, which requires
dialysis or a kidney transplant to keep you alive. Early detection and
treatment can help prevent kidney failure and the need for dialysis or
transplant treatment.<br />
If you are diagnosed with CKD, this means that your kidneys have been
damaged and are not working as well as they should normally. Kidney
disease is called a ‘silent disease’ as there are often no warnings. <br />
<ul>
<li>It is not uncommon for people to lose up to 90% of their kidney function before getting any symptoms. </li>
<li>People can live a near normal life with as little as 20 percent of their total kidney function. </li>
<li>When symptoms do occur the initial signs may be general, such as feeling tired or generalised itching. </li>
<li>As kidney disease progresses, symptoms can include changes in
the urine (reduced volume, discolouration, blood or pus), nausea and
vomiting and appetite loss. </li>
<li>Other symptoms include swollen or numb hands and feet (because
of water retention), weakness and lethargy, darkened skin and muscle
cramps. </li>
<li>About 50 people a day die of a kidney related disease.</li>
</ul>
<strong><img align="right" alt="" height="282" hspace="5" src="http://www.kidney.org.au/Portals/0/assets/Images/The%20body%20and%20our%20kidneys%20Web.jpg" vspace="5" width="166" /></strong><br />
<strong>How do you know if you have CKD? <br />
</strong>In most cases CKD does not cause any symptoms and is detected
because a test has shown an abnormality. It may be a urine test for
blood or protein; an X-ray or scan of the kidneys; or a blood test to
measure kidney function. Most cases are discovered by your GP as part of
normal care.<br />
<strong>How common is CKD?</strong> <br />
1 in 9 Australians over age 25 years have at least one clinical sign of
existing CKD, such as reduced kidney function or evidence of kidney
damage. It is less common in young adults. <br />
<br />
In the older person it is more common due to the natural aging of the
kidneys. A number of diseases can damage the kidneys such as diabetes,
hypertension (high blood pressure) and some inherited conditions. Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-33925605652300343102015-01-09T03:51:00.000-08:002015-01-09T03:51:05.599-08:00KIDNEY DISEASE - WHAT ARE MY TREATMENT OPTIONS?Sometimes kidney diseases lead to kidney failure which requires
dialysis or a kidney transplant to keep you alive when the kidneys have
stopped working. Dialysis removes waste products from the blood when the
kidneys fail.
<br />
<strong>Kidney failure occurs in two ways:</strong><br />
<blockquote>
<strong><em>Acute Kidney Failure </em></strong><br />
Sudden drop in kidney function, often short-lived, but can occasionally lead to lasting kidney damage. <br />
<br />
<strong><em>Chronic Kidney Disease</em> </strong><br />
More often kidney function worsens over a number of years. <br />
</blockquote>
Good news: if <a href="http://www.kidney.org.au/KidneyDisease/tabid/578/Default.aspx">kidney disease</a>
is found early, medication, dietary and lifestyle changes can increase
the life of your kidneys and keep you feeling good for as long as
possible. <br />
<br />
When you have been diagnosed with <a href="http://www.kidney.org.au/ForPatients/HealthFactSheets/tabid/609/Default.aspx">Chronic Kidney Disease (CKD)</a> you
have lost over one-third of your kidney function. This loss of
function has persisted for over three months. It is long-term permanent
damage to the kidneys. <br />
<br />
Signs and symptoms usually start when the kidneys are working below 40%.
Once they are working below 10%, dialysis or a transplant is needed to
stay alive. <blockquote dir="ltr" style="margin-right: 0px;">
</blockquote>
<div dir="ltr" style="margin-right: 0px;">
<strong>Living With Reduced Kidney Function</strong> <br />
Many factors affect the progress of kidney failure - these are not
completely understood. If you have kidney disease it is important to
follow your health team's advice to slow down its progress. <a href="http://www.kidney.org.au/ForPatients/LivingwithKidneyFailure/ReducedKidneyFunction/tabid/830/Default.aspx">Refer to our LWRKF handbook</a> to help your kidneys stay stronger, for longer and perhaps delay the need for dialysis.<br />
<br />
Appropriate management of Chronic Kidney Disease can help to prevent or
delay the progression of the illness to its end stages, when dialysis or
transplantation is required to sustain life. Effective management of
CKD can also help to control symptoms or side effects, such as high
blood pressure, loss of appetite, nausea, tiredness and swelling of the
hands, face and feet.<br />
<br />
Management of CKD should be done in conjunction with your general
practitioner, kidney specialist (if applicable) and allied health team.
Management of CKD often involves addressing factors related to
nutrition, fitness, medication and mind/spirit. It can also impact on
sexuality. <br />
<br />
<strong>Treatment is a Choice <a href="http://www.renalresource.com/multicult.php"><strong></strong></a><br />
</strong>Learning about kidney failure treatments is an important part
of deciding which treatment choice is best for you. Hospitals offer
education sessions that give you and your family time to ask questions
and talk to others. Some people feel they have to start or continue any
treatment offered to them. <br />
<br />
<strong>Decisions about your body are your responsibility <br />
</strong>Your health team can provide the best guidance but you’re the
one in control. It is important to get to know your health team and
build a strong relationship. Open communication about your physical and
emotional health, as well as lifestyle needs, can help you get the most
out of your treatment. </div>
<div style="margin-right: 0px;">
<strong><strong><strong></strong></strong>Treatment options for Kidney Failure</strong></div>
<ul>
<li>
<div style="margin-right: 0px;">
<strong>Dialysis -</strong> removes waste and extra fluid from the blood</div>
</li>
</ul>
<ul>
<li>
<div style="margin-right: 0px;">
<strong>Transplantation</strong> - If you start dialysis you will also be assessed for your suitability for <a href="http://www.kidney.org.au/ForPatients/Treatmentoptions/Transplantation/tabid/815/Default.aspx">transplantation</a>. Health issues may prevent this option. </div>
</li>
</ul>
<ul>
<li>
<div style="margin-right: 0px;">
<strong>Conservative or Supportive Care</strong>
- If you decide that dialysis or transplant is not for you, then your
health-care team will support you to stay as healthy as possible without
dialysis. Your life-span however will be limited. </div>
</li>
</ul>
<hr />
<strong>TREATMENT - DIALYSIS</strong><br />
<strong>What does dialysis do? </strong><br />
Dialysis helps to maintain your body’s balance by removing waste and
extra fluid from the blood, keeping the blood’s chemical balance at a
safe level and assisting with blood pressure control. Dialysis is a
useful and important treatment.<br />
<ul>
<li><a href="http://www.kidney.org.au//LinkClick.aspx?fileticket=DRU6YQQIzbU%3d&tabid=609&mid=882"><strong>Haemodialysis</strong> </a><br />
Uses a machine acting as an artificial kidney cleans the blood. Requires good <a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=tZ3Bg2s6Bn0%3d&tabid=609&mid=882">access to your bloodstream</a>,
which may be an issue if you have diabetes. If you have heart problems,
changes in blood pressure and waste levels associated with
haemodialysis can cause problems. <br />
</li>
<li><strong><a href="http://www.kidney.org.au/ForPatients/HealthFactSheets/tabid/609/Default.aspx">Peritoneal Dialysis</a></strong> <br />
Allows the blood to be cleaned inside the body and is usually done
at home. PD may not be possible if you’ve had major abdominal surgery
causing scarring. It may also be difficult to obtain the right amount of
dialysis with PD if you are tall and muscular, or overweight. </li>
</ul>
<strong>WHERE CAN I DO MY DIALYSIS<br />
- WHAT ARE MY OPTIONS?</strong><br />
You can choose one of two locations to have your dialysis - <em>Home-based Dialysis or <a href="http://www.kidney.org.au/ForPatients/Treatmentoptions/UnitbasedDialysis/tabid/813/Default.aspx">Unit-based Dialysis</a></em>.<br />
<strong>Home Dialysis</strong><br />
If you choose to dialyse at home you are trained to manage your own dialysis. There are two forms of Home Dialysis.<br />
<ul>
<li><strong>Home Haemodialysis</strong><br />
Special plumbing is installed in your house and the quality of the
water supply is tested. If needed, a friend, carer or partner can be
trained to assist. You can choose to dialyse day or night. Go to our new
dedicated <a href="http://www.homedialysis.org.au/">Home Dialysis website</a> for more information. <br />
<br />
</li>
<li><strong>Home Peritoneal Dialysis</strong> <br />
Peritoneal Dialysis (PD) occurs inside your body using the
peritoneal membrane as a filter. This membrane is located in your
abdomen (belly). During PD the membrane is used to filter waste products
and extra fluid from your blood. A special peritoneal catheter is used
to transfer dialysis fluid into and out of the peritoneal cavity. </li>
</ul>
<strong>Unit-based Dialysis</strong><br />
<ul>
<li><a href="http://www.kidney.org.au//LinkClick.aspx?fileticket=DRU6YQQIzbU%3d&tabid=609&mid=882" id="dnn_ctr882_Document_grdDocuments_ctl04_ctlTitle" target="_blank">Haemodialysis</a> Is
offered as a hospital treatment when some dialysis patients attend a
special dialysis or satellite unit to dialyse for several hours, usually
three times a week. Some hospitals offer <a href="http://www.nocturnaldialysis.org/geelong_experience.htm">nocturnal dialysis</a> sessions, which is dialysing while you sleep. </li>
</ul>
<small><br /></small>
<hr />
<strong><br />
WHICH TREATMENT SHOULD I CHOOSE?</strong><br />
The choice of treatment is influenced by many factors including: <br />
<ul>
<li>personal preference </li>
<li>your health and medical suitability </li>
<li>your lifestyle </li>
<li>availability of resources </li>
<li>where you live </li>
<li>finances e.g. travel costs </li>
</ul>
<strong><em></em><strong><em></em></strong></strong>Medical
issues can influence the choice of dialysis. Most people can do both
types of dialysis and those with reasonable health may be suitable for
transplantation. Your kidney doctor or specialist nurse will advise if
you are not medically suited for a particular type of treatment.<br />
<small>
<br />
<br />
</small><hr />
<strong><br />
TREATMENT - TRANSPLANTATION</strong><br />
Transplantation is also a form of treatment for kidney failure but it
is not a cure. If you start dialysis you will also be assessed for your
suitability for transplantation. Health issues may prevent this option.<br />
Kidney
transplants are very successful. Over 94% of transplants are working
one year later. The average wait for a deceased donor kidney is about 4
years. <br />
<br />
Staying fit and as healthy as possible helps you remain suitable for a
transplant and aids your recovery. It is a good idea to have regular
health and dental checks as well as maintaining your: <br />
<ul>
<li>recommended fluid and dietary restrictions
<ul>
<li><a href="http://www.kidneypatientguide.org.uk/fluidAnim.php">excellent animation on how fluid balance in the body works</a> (UK KidneyPatientGuide)</li>
</ul>
</li>
<li>ideal body weight for your age and size - people who are overweight are at increased risk of problems during surgery </li>
<li>dialysis schedule </li>
<li>regular fitness or exercise plan </li>
</ul>
<small><a href="http://www.kidney.org.au/ForPatients/Treatmentoptions/Transplantation/tabid/815/Default.aspx"></a></small><br />
<hr />
<strong><br />
CONSERVATIVE OR SUPPORTIVE CARE</strong><br />
Some people choose no active treatment, known as <a href="http://www.kidney.org.au/ForPatients/Treatmentoptions/ConservativeCare/tabid/807/Default.aspx">conservative or supportive care</a>.
It is also sometimes referred to as palliative care. Without transplant
or dialysis to replace kidney function, progression to end of life will
occur. If you decide that dialysis or transplant is not for you, then
your health-care team will support you to stay as healthy as possible
without dialysis. <br />
If you choose conservative care a doctor still manages your
medications and general health, but this will limit your life-span. You
will continue to see your health care team and maybe a palliative care
team as well. The palliative care team supports you and your family to
live as independently and comfortably as you can in the face of serious
illness.<br />
<small><hr />
</small>
<strong><br />
THE FUTURE - STEM CELL TREATMENT?</strong><br />
<strong>Stem Cell Treatment from Dr Sharon Ricardo of the <a href="http://www.stemcellcentre.edu.au/">Australian Stem Cell Centre></a></strong><br />
<br />
Dr Ricardo's advice is:<br />
"currently the only proven treatments offered involving stem cells are
for the treatment of some blood and auto immune diseases. Treatments
involve either bone marrow or cord blood, such as a bone marrow
transplant for leukaemia. Other stem cell based therapies are still in
research phase or in clinical trials. Clinical trials are essential to
ensure treatment is proven, safe and effective, before widespread use in
patients. Many treatments offered by overseas organisations do not
appear to have undergone any clinical trial process and therefore we
cannot know if they are safe or if they even work." <br />
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-6729960318988665252015-01-09T03:43:00.000-08:002015-01-09T03:43:14.002-08:00WHAT IS KIDNEY DISEASE? Kidney disease occurs when the nephrons inside your kidneys, which
act as blood filters are damaged. This leads to the build up of waste
and fluids inside the body.<br />
<strong>Why are your kidneys so important?</strong><br />
Kidneys are the silent partner to good health! We can live quite well
with only one kidney and indeed, some people live a healthy life even
though born with one missing. <br />
Our kidneys are amazing, they play a major role in maintaining your
general health and wellbeing but are not usually thought of as essential
to a healthy life. But while bones can break, muscles can waste away
and the brain can sleep without risk to life, if both kidneys fail, as
happens in end stage kidney failure, bone, muscle or brain can not
carry on. <br />
<strong>What can go wrong with your kidneys?<br />
</strong>Kidney disease is called a silent disease as there are often no
warning signs. More often kidney function worsens over a number of
years. <br />
<br />
This is good news because if kidney disease is found early, medication,
dietary and lifestyle changes can increase the life of your kidneys and
keep you feeling your best for as long as possible. <br />
<br /><ul>
<li>You can lose up to 90 per cent of kidney function without
realising it, by which time it is almost impossible to prevent further
serious problems.<br />
</li>
<li>People can live a near normal life with as little as 20 percent of their total kidney function.<br />
</li>
<li>When symptoms do occur the initial signs may be general, such as feeling tired or generalised itching.<br />
</li>
<li>As kidney disease progresses, the symptoms can include changes
in the urine (reduced volume, discolouration, blood or pus), nausea and
vomiting, and appetite loss.<br />
</li>
<li>Other symptoms include swollen or numb hands and feet (because
of water retention), weakness and lethargy, darkened skin and muscle
cramps. </li>
</ul>
<strong>Acute Kidney Failure</strong>
is sometimes kidney failure which can happen quickly, caused for
example by a sudden loss of large amounts of blood, infection, or an
accident. A sudden drop in kidney function is often short lived but can
occasionally lead to lasting kidney damage. <br />
<strong>Chronic Kidney Disease (CKD)</strong>
is responsible for substantial burden of illness and premature
mortality. If you lose over 1/3 of your kidney function for over 3
months, it is called Chronic Kidney Disease (CKD). Sometimes kidney
disease leads to kidney failure, which requires dialysis or a kidney
transplant to keep you alive. As kidney function decreases, waste begins
to build-up in the blood.<br />
<strong>How can I avoid kidney disease?</strong><br />
You can reduce your risk of kidney disease especially if you are at <em>increased risk</em>:<br />
<ul>
<li>become a non-smoker </li>
<li>ensure your blood glucose is well controlled if you have diabetes </li>
<li>control your blood pressure </li>
<li>stay fit, exercise regularly and maintain a healthy weight by eating a healthy diet </li>
<li>avoid high salt foods and reduce salt intake wherever you can </li>
<li>drink water - instead of sugary drinks </li>
<li>drink alcohol moderately <small>(no more than 2 standard glasses a day for men -1 standard glass for women)</small></li>
</ul>
<strong>WHAT ARE THE STAGES OF CHRONIC KIDNEY DISEASE?</strong>
<br />
Test results or clinical values can be grouped to show how well your
kidneys are working. These groupings are only a guide and results may be
outside these ranges. Kidney function may naturally fall as we age.
Other factors can also lower kidney function normally.<br />
Kidney function can be classified into stages, depending on your
eGFR. Your doctor uses these stages as a guide for deciding which
treatment is best for you. Treatment also depends on the cause of your
kidney damage. Controlling diabetes and high blood pressure can help to
slow or prevent further kidney damage. It also reduces the risk of other
health problems, such as heart attacks and strokes. <br />
<blockquote dir="ltr" style="margin-right: 0px;">
</blockquote>
<div dir="ltr" style="margin-right: 0px;">
<strong>Stage 1: </strong>A normal GFR greater than or equal to 90 mL/min/1.73m<sup>2 </sup><br />
<strong>Stage 2:</strong> Slightly decreased GFR between 60‐89 mL/min/1.73m<sup>2</sup><br />
<br />
If your kidney function is at stage 1 or 2, you only have CKD if you
have albuminuria, haematuria, a pathological abnormality or a structural
abnormality.<br />
<br />
<strong>Stage 3a: </strong>Mild‐moderate decrease in GFR between 45‐59 mL/min/1.73m<sup>2 </sup><br />
<strong>Stage 3b: </strong>Moderate‐severe decrease in GFR between 30‐44 mL/min/1.73m<sup>2 </sup><br />
<br />
<strong>Stage 4:</strong> Severe decrease in GFR between 15-29 mL/min/1.73m<sup>2</sup><br />
<strong>Stage 5: </strong>Kidney failure as GFR decreases to less than 15 mL/min/1.73m<sup>2</sup> or dialysis is started </div>
<blockquote dir="ltr" style="margin-right: 0px;">
</blockquote>
<div dir="ltr">
Your eGFR and albuminuria results are combined to provide
an overall picture of how well your kidneys are working. Your doctor
uses this information to decide which treatment is best for you.
Treatment also depends on the cause of your kidney damage. Controlling
diabetes and high blood pressure can help to slow or prevent further
kidney damage. It also reduces the risk of other health problems, such
as heart attacks and strokes.</div>
<span class="Normal">
<div dir="ltr">
<img alt="" height="118" src="http://www.kidney.org.au/Portals/0/assets/Images/Stages%20of%20Kidney%20Disease.png" width="660" /></div>
<small>Image from <a href="http://www.kidney.org.au/HealthProfessionals/IndigenousResources/tabid/770/Default.aspx">Kidney Stories - for Indigenous Australians</a> - graphics made available by <a href="http://www.health.nt.gov.au/Renal_Services/index.aspx">NT Renal Services</a><br />
</small></span><span class="Normal">
<strong></strong><span class="Normal"> </span><br />
<div dir="ltr">
<img align="right" alt="" border="0" height="205" hspace="5" src="http://www.kidney.org.au/Portals/0/assets/Images/Kidneys%20and%20urinary%20system%20small.jpg" vspace="5" width="124" /></div>
</span><strong>COMMON KIDNEY RELATES TESTS AND PROCEDURES</strong>
People with kidney disease undergo a large range of medical tests and
procedures. Medical tests are an important part of making an action
plan to meet your health care needs. They are needed to confirm a
diagnosis, plan treatment or check progress. Some of the most commonly
used tests for people with kidney disease are outlined here. Also see <a href="http://www.kidney.org.au/KidneyDisease/KidneyGlossary/tabid/679/Default.aspx">Kidney Glossary</a> to find out meanings of terms used in tests.<br />
<strong>Tests for kidney function and damage</strong><br />
<strong>Blood tests</strong><br />
<ul>
<li><strong>Estimated Glomerular Filtration Rate (eGFR)</strong>:
the best measure of your kidney function. It shows how well your kidneys
are cleaning the blood. Your GFR is usually estimated (eGFR) from the
results of the creatinine blood test. </li>
</ul>
<blockquote dir="ltr" style="margin-right: 0px;">
<ul>
<li>eGFR is reported in millilitres per minute per 1.73m<sup>2</sup> (mL/min/1.73m<sup>2</sup>)</li>
<li>A GFR of 100 mL/min/1.73m<sup>2</sup> is in the normal range so it is useful to say that 100 mL/min/1.73m<sup>2</sup> is about equal to ‘100% kidney function’ </li>
<li>A GFR of 50 mL/min/1.73m<sup>2</sup> could be called ‘50% kidney function’</li>
</ul>
</blockquote>
<ul dir="ltr">
<li><strong>Creatinine:</strong> a waste product made by the
muscles. It is usually removed from the blood by the kidneys and passes
out in the urine. When the kidneys aren’t working well, creatinine stays
in the blood. Creatinine varies with age, gender and body weight so is
not an accurate way of measuring overall kidney function. When on
dialysis creatinine levels are always high.<br />
</li>
<li><strong>Urea</strong> - a waste product, which is made as the body breaks down protein. High urea levels suggest decreased kidney function. </li>
</ul>
<div dir="ltr">
<strong>Urine tests</strong></div>
<ul dir="ltr">
<li><strong>Albumin Creatinine Ratio:</strong> used to measure the
amount of albumin (a kind of protein) that leaks into your urine when
your kidneys are damaged. A small or ‘micro’ amount of albumin in the
urine is called microalbuminuria, and a larger ‘macro’ amount is called
macroalbuminuria <br />
</li>
<li><strong>Urinalysis</strong>: an examination of a urine sample to
detect medical conditions like kidney and liver disease, diabetes and
urinary tract infections. This can be a visual examination for colour
and clearness. For example, blood in the urine (haematuria) may make
urine red or an infection can make it cloudy. A chemically treated strip
or dipstick is used to test for pH, sugar (glucose), blood, bacteria or
waste products. A urine sample can be sent to a laboratory for an
examination under a microscope or to grow a culture if an infection is
suspected. </li>
</ul>
<div dir="ltr">
<strong>Blood tests for diabetes</strong></div>
<ul dir="ltr">
<li><strong>Glucose:</strong> blood glucose monitoring is a
measurement of glucose (sugar) in the blood. Values can vary depending
on physical activity, meals and insulin administration. Your glucose
level is raised in diabetes. </li>
<li><strong>Glycosylated haemoglobin (HbA1c):</strong> test that
measures the amount of glycosylated haemoglobin in the blood.
Glycosylated haemoglobin is a molecule in red blood cells that attaches
to glucose (blood sugar). There are higher levels of glycosylated
haemoglobin if you have more sugar in your blood. </li>
</ul>
<div dir="ltr">
<strong>Tests for heart health</strong></div>
<ul dir="ltr">
<li><strong>Blood pressure:</strong> the pressure of the blood
against the walls of the arteries as the heart pumps the blood around
your body. Blood pressure is recorded as two numbers, for example 140/90
mmHg. The larger number indicates the pressure in the arteries as the
heart squeezes out blood during each beat. This is called the systolic
blood pressure. The lower number indicates the pressure as the heart
relaxes before the next beat. This is called the diastolic blood
pressure. </li>
</ul>
<div dir="ltr">
<strong>Blood tests - Cholesterol</strong></div>
<ul dir="ltr">
<li><strong>Cholesterol:</strong> a naturally-occurring, waxy
substance made by the body. It is an essential building block of cell
membranes, hormones and vitamin D. Too much cholesterol in the blood can
cause clogging of the arteries and lead to heart disease. </li>
<li><strong>Low-density lipoprotein (LDL) cholesterol:</strong> known as the “bad” cholesterol. The higher the amount of LDL cholesterol, the higher the risk of heart disease. </li>
<li><strong>High-density lipoprotein (HDL) cholesterol</strong>: known as the “good” cholesterol. The higher the amount of HDL cholesterol, the lower the risk of heart disease. </li>
<li><strong>Triglycerides</strong>: the most common type of fat
stored in your body. A high level of triglycerides in your blood can
increase your risk of heart disease. </li>
</ul>
<div dir="ltr">
<strong>Blood tests for vitamin and mineral levels</strong></div>
<ul dir="ltr">
<li><strong>Potassium (K+):</strong> a mineral found in many foods.
If your kidneys are healthy, they remove extra potassium from the
blood. If your kidneys are damaged, the potassium level can rise and
affect your heart. A low or high potassium level can cause an irregular
heartbeat. </li>
<li><strong>Sodium (salt, Na+):</strong> a substance which together with chloride makes up common salt. High levels of sodium may indicate dehydration. </li>
<li><strong>Calcium (Ca):</strong> needed for healthy bones and
teeth. Most of the cells in the body need calcium to work properly.
Raised calcium levels may cause headaches, nausea, sore eyes, aching
teeth, itchy skin, mood changes and confusion. </li>
<li><strong>Phosphate (PO4):</strong> a mineral, which together with
calcium keeps your bones strong and healthy. Too much phosphate causes
itching and pain in the joints, such as the knees, elbows and ankles.
When the kidneys are not functioning properly, high levels of phosphate
accumulate in the blood </li>
<li><strong>Vitamin D</strong>: a vitamin that is made in your skin
after you have been in the sun. The kidneys change Vitamin D so that
your body can use it. </li>
</ul>
<div dir="ltr">
<strong>Tests for anaemia</strong></div>
<ul dir="ltr">
<li><strong>Haemoglobin (Hb):</strong> the oxygen-carrying part of red blood cells that gives them their red colour and transports oxygen around the body. </li>
<li><strong>Haematocrit (Hct)</strong>: a measure of the percentage of blood made up of red blood cells. </li>
<li><strong>Transferrin saturation (TSAT):</strong> indicates the
proportion of the iron-transporting protein transferring and helps to
determine if the body is transporting or binding iron in the right way. </li>
<li><strong>Ferritin</strong>: a protein that stores iron in your body. </li>
</ul>
<div dir="ltr">
<strong>Tests for hormones</strong></div>
<ul dir="ltr">
<li>
<div>
<strong>Parathyroid hormone (PTH):</strong> helps control
calcium, phosphorus, and vitamin D levels within the blood and bone.
Kidney failure can cause the parathyroid glands to produce too much PTH.
</div>
</li>
</ul>
<div dir="ltr">
<strong>Imaging tests</strong> </div>
<ul>
<li><strong>X‐rays:</strong> uses very short energy beams to produce an image of body parts such as bones and organs. </li>
<li><strong>Ultrasound:</strong> Examination of the kidneys, prostate or bladder using sound waves to outline the structure of organs. </li>
<li><strong>Computerised Tomography (CT) Scan or Magnetic Resonance Imaging (MRI)</strong>:
these tests use multiple small X-ray beams, or radio-frequency
wavelengths and a strong magnetic field to provide clear and detailed
pictures of internal organs and tissues. You may be asked to swallow a
liquid containing a positive contrast material or ‘dye’, which allows
the radiologist to see the kidneys more clearly. </li>
<li><strong>Kidney biopsy:</strong> a procedure where a needle is
passed through your skin into the kidney and a small piece of kidney
tissue is removed for examination under a microscope. Local anaesthetic
is used and it is a relatively painless procedure. </li>
<li><strong>Fistulagram:</strong> used to check fistula function. Dye is injected into your fistula to allow its structure to show up on an x‐ray. </li>
<li><strong>Cystoscopy:</strong> this test uses a thin, flexible,
tube-like telescope called a cystoscope to view the inside of the
bladder and some parts of the kidney. </li>
<li><strong>Intravenous Pyelogram (IVP</strong>): series of x‐rays
of the abdomen taken after dye has been injected into a vein in the arm.
The dye is then viewed on the x-ray pictures as it passes through the
kidneys </li>
</ul>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-85369925240127801512014-12-24T12:28:00.001-08:002014-12-24T12:28:13.369-08:00Your Mind on Chemo<span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div class="post-header"><br />
</div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<br />
<br />
Mentioning chemobrain to a group of cancer survivors is the equivalent of yelling "FIRE" in a crowded theater. <br /><br />
Yesterday it was impossible to miss the collective shouting<br />
when the Radiological Society of North America (RSNA) announced the <br />
results of a small study demonstrating the physiological process behind <br />
the symptoms that plague so many of us.<br /><br />
Now there is a scientific explanation behind that freaky <br />
and disabling symptoms that make up the word "chemobrain." While <br />
sometimes used derisively, sometimes jokingly, sometimes teasingly, <br />
there is now no getting around the fact that administering chemotherapy <br />
causes significant and demonstrable changes in brain metabolism.<br /><br />
Makes sense, you think.<br /><br />
And it does. But common sense isn't science; and even those<br />
medical professionals who listened sympathetically to their patients <br />
had little to offer in return. Part of the answer came in the way the <br />
scientists approached the problem.<br /><br />
Instead of studying chemotherapy's effect on the brain's <br />
appearance, Rachael A Lagos, D.O., and colleagues at the West Virginia <br />
Univeristy School of Medicine instead looked at its effect on brain <b>function </b>through an analysis of PET/CT brain imaging results utilizing special software.<br /><br />
<br /><br />
</span><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><img border="0" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6DGJnc2_FlxdaL25ZSgv6LBdVLcMTPFvKaskrQlVJ7OFIXgIYNTKvVw-3ZTmmFoVhfqbHvi2xmaQzuUutdWXViPIzUgbuVwgtJDmqVrxZrtaUGTVKy82nISbrnwdp3Z7q0N8drMyHtuPO/s320/safe_image.php.jpeg" width="320" /> </span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
What a difference that made. The proof was in the scans where <b>"statistically significant decreases in regional brain metabolism" </b>were noted. Those changes were seen in areas associated with contentration and memory.<br /><br />
Long story short: your brain has as much difficulty processing chemotherapy drugs as the rest of your body does.<br /><br />
<br /><br />
By now you all know that <a href="https://www.facebook.com/robertbazell" target="_blank">Robert Bazell</a>, heath/science correspondent and author of <a href="http://www.randomhouse.com/book/9960/her-2-by-robert-bazell" target="_blank">The Making of Herceptin</a> covered the story for <a href="https://www.facebook.com/nbcnightlynews?fref=ts" target="_blank">NBC Nightly News</a> and a crew came to talk with me yesterday morning about my chemobrain experience. <br /><br />
My experience may have been different from yours. Mine may<br />
have lasted longer. You may have had sypmtoms that disappeared <br />
overnight. I don't know how much of the cognitive problems I <br />
encountered can be attributed to chemo or simply the totality of <br />
treatment -- radiation, multiple surgeries, and tamoxifen, the ultimate<br />
in brain scrambling medications. But I don't need a study or PET/scan <br />
of my brain to say that definitively about Tamoxifen. After seeing this<br />
short and doable demonstration from a radiation resident (the RSNA <br />
study was a poster session, mind you) from just ONE aspect of cancer <br />
treatment is more than enough for me.<br /><br />
<br /><br />
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<tr><td style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCacAocJkPZDXLisd_j-z6-yJQCpdSLkf19kkavnQVhK49UMsMu4adYnpOzDjYUNukBJh_5BtEdlJM3HpvqD-Fn2oQeSXEoHbwYQqovXXvcrtfuzOjR83mH2gGFqggKOavbLbFJcFesCZD/s1600/2012-11-27+10.02.51.jpg" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCacAocJkPZDXLisd_j-z6-yJQCpdSLkf19kkavnQVhK49UMsMu4adYnpOzDjYUNukBJh_5BtEdlJM3HpvqD-Fn2oQeSXEoHbwYQqovXXvcrtfuzOjR83mH2gGFqggKOavbLbFJcFesCZD/s320/2012-11-27+10.02.51.jpg" width="320" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;">Exercise works for easing chemobrain. Truly does.</span></td></tr>
</tbody></table><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<b>Now where we need to go is to continue the discussion on working through the disability.</b><br />
That's why the crew filmed the additional segments that they did. <br />
Those weren't random. Both cycling and quilting were activities I took<br />
up AFTER treatment to help cope. There is no doubt that physical <br />
exercise, intense aerobic activity, is one of the best possible things <br />
you can do to cope with chemobrain, fatigue, and regain strength and <br />
vitality. Taking up quilting involved learning a compelte new set of <br />
tasks, and yes, not seriously injuring myself or anyone else when using a<br />
rotary cutter. A third way to help anyone suffering cognitive <br />
impairment would be assistance with organizational skills. Anyone who <br />
knows me and looks at my waning organizational skills can attest to <br />
that. A good text on ADD probably woundn't hurt either. Stress <br />
management is also key. <br /><br />
<br /><br />
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<tr><td style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHiI-KWP8mUoDtTsY7hVlssa7wBgLgQlqAiF2JFPMFjhSt8hyIzXueLs7YFlPxaDWa3xhpxcKyXnnG64HZGaaFk9hLBAPc80JuG6lP_Z-b-6cJvfQTwqyXVkkqZ5CxDQ7qhq6yX525s3gA/s1600/2012-11-27+09.27.10.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHiI-KWP8mUoDtTsY7hVlssa7wBgLgQlqAiF2JFPMFjhSt8hyIzXueLs7YFlPxaDWa3xhpxcKyXnnG64HZGaaFk9hLBAPc80JuG6lP_Z-b-6cJvfQTwqyXVkkqZ5CxDQ7qhq6yX525s3gA/s640/2012-11-27+09.27.10.jpg" width="640" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;">Quilting is <br />
something I took up after cancer treatment....it's soemthing creative <br />
and stress managment all in one. Here I'm using English paper piecing of<br />
3/4" hexagons. There's no way to machine piece them accurately.</span></td></tr>
</tbody></table><span style="font-family: Arial,Helvetica,sans-serif;"><br />
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<tr><td style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjR3cmW8JxeKpH0wrpW1jvup9xwNA9V1L7qp1fCWFb8xylSUTpDx1lShRtlS35_WM_xInSv33ZRUywTbcb3XdDflqVYGVD-jKrVMPOB91yVA6duSuPRUCc0-tWyzdtSV2f2qHJoxXStp-l/s1600/2012-11-27+09.07.37.jpg" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjR3cmW8JxeKpH0wrpW1jvup9xwNA9V1L7qp1fCWFb8xylSUTpDx1lShRtlS35_WM_xInSv33ZRUywTbcb3XdDflqVYGVD-jKrVMPOB91yVA6duSuPRUCc0-tWyzdtSV2f2qHJoxXStp-l/s320/2012-11-27+09.07.37.jpg" width="320" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;">With Debbie Strauss of NBC News.<br /><br /></span></td></tr>
</tbody></table><span style="font-family: Arial,Helvetica,sans-serif;"><br />
When I watched both the broadcast and web footage last <br />
night I was reminded that for many of us, the cancer itself wasn't a <br />
problem but recovering from treatment <b>WAS. </b> While we were talking<br />
I told correspondent Debbie Strauss that during those difficult months I<br />
remember staring at a blank piece of paper trying to write a simple <br />
paragraph. <br /><br />
A paragraph. Something I used to do in my sleep. Something I<br />
could do upside down or inside out. No, writing a paragraph has never <br />
been the same. But never has the sense of accomplishment carried such a<br />
sweet ring, either. And that will always be enough.<br /><br />
<br /><br />
<br /><br />
More where this came from:<br /><br />
<a href="http://video.msnbc.msn.com/nightly-news/49986490#49986490" target="_blank">Reserarchers Find Evidence of Chemobrain</a><br /><br />
<a href="http://video.msnbc.msn.com/nightly-news/49986490#49986490" target="_blank">Healing from ChemoBrain Gradual</a><br /><br />
<br /><br />
BoingBoing: <a href="http://boingboing.net/2012/11/28/new-evidence-of-chemo-brain.html" target="_blank">Chemobrain....Isn't All in Your Head</a><br /><br />
<br /><br />
Great blog on chemobrain <a href="http://chemo-brain.blogspot.com/2012/11/you-can-thrive-can-you-help.html" target="_blank">AnneMarie Ciccarella</a> and this recommendation: <a href="http://www.idelledavidson.com/" target="_blank">Your Brain After Chemo</a>, by journalist Idelle Davidson.</span>Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-53638374541139822112014-12-24T12:25:00.001-08:002014-12-24T12:25:38.826-08:00Women with Cancer: Is Metastatic Breast Cancer on the Rise in Young W...<h3 class="post-title entry-title" itemprop="name"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
Is Metastatic Breast Cancer on the Rise in Young Women? <br />
</span></h3><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div class="post-header"><br />
</div><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">Something long noted in breast cancer circles was study coming out today in the <i>Journal of the American Medical Association</i> that<br />
found a very small, but statistically significant, increase in the <br />
number of young women between the ages of 25 to 39 who are diagnosed <br />
with metastatic breast cancer. </span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">The change <br />
noted comes down to an absolute increase of 1.37 women per 100,000 women<br />
over 34 years, or approximately 2 percent per year. The same increase <br />
was not noted in older women and was consistent across all ethnic and <br />
socioeconomic groups. One surprise is that there was a more pronounced <br />
increased in women with hormone sensitive breast cancer, rather than ER-<br />
cancer. </span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">Why this is <br />
happening is yet to be determined and was not the purpose of the study. <br />
We are left with more questions than answers. </span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">Studies are often complicated, and this one, a retrospective, observational analysis of <i>three</i> different<br />
sets of incidence and survvial rates from the US Surveillance, <br />
Epidemiology and End Results (SEER) program at the National Cancer <br />
Institute from l976 through 2009 - even more so. The collection of SEER <br />
data began in l973, yet the study years ran from 1976 - 2009. Even the <br />
largest data set used, SEER 18, only comprises 28 percent of the US <br />
population. SEER 9, by comparison, only includes 9.5% of the <br />
population, and the third set, SEER 13, 15 percent. </span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">Study author <br />
Rebecca Johnson, MD, Seattle Children's Hospital and University of <br />
Washington, wrote in the study that, "Whatever the causes - and likely <br />
there are more than 1 - the evidence we observed for the increasing <br />
incidence of advanced breast cancer in young women will require <br />
corroboration and may be best confirmed by data from other countries. <br />
If verified, the increase is particularly concerning, because young age<br />
itself is an independent prognostic factor for breast cancer."</span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">Vast <br />
improvements in diagnostic imaging between 1976 and now, staging <br />
work-ups and other factors come into play. "The changes noted may be <br />
multifactorial," said Jennifer Litton, MD, of The University of Texas MD<br />
Anderson Cancer Center, "with changes in rates of incidence and younger<br />
women having more aggressive underlying biologies coupled with <br />
potentially other genetic factors. What is much more clinically <br />
important than this would be changes in overall survival."</span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<br />
<br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">Breast cancer <br />
advocates concur. "These numbers do not change it for anyone who dies of<br />
this disease today," said Joy Simha, co-founder of the Young Survival <br />
Coalition. "We need to focus on finding the cause of breast cancer so we<br />
can make change happen."</span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="background-color: white; color: #333333; font-size: 13px; line-height: 17px;"><br /></span></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;">Another aspect<br />
confirms what was discussed in last night's #BCSM discussion. "What the<br />
study enforces to me is the need for all young women to be aware of <br />
changes and to be proactive about their health," said Deanna Attai, MD, <br />
breast surgeon and #BCSM comoderator. "Doctors need to be educated that<br />
there's no such things as "too young for breast cancer." No such <br />
thing."</span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">For women with<br />
breast cancer today? Nothing changes. If you're in treatment today? <br />
Nothing changes. But if you're watching the larger picture of cancer <br />
incidence in the United States in a population that already suffers <br />
unduly from a breast cancer diagnosis? Heads up. This is a signal we <br />
need to heed. </span></div><div style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"># # #</span></div></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span><div style="margin: 0px;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span><br />
<div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">3/3/2013: <br />
Comments from Ann Partdridge, MD: breast medical oncologist from the <br />
Dana Farber Cancer Institute in Boston and medical advisor to the Young <br />
Survival Coalition: </span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 1.1em; line-height: 1.8em;"><br /></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span><br />
<div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 1.1em; line-height: 1.8em;">It<br />
is not clear from the study "whether the overall rate of breast cancer <br />
in young women is actually increasing," said Ann Partridge, MD, a <br />
medical oncologist from the Dana-Farber Cancer Institute and Harvard <br />
Medical School in Boston, Massachusetts. In other words, the study does <br />
not indicate whether the increase in advanced disease means that there <br />
is an overall increase in disease in young women.</span></span></div></div><div style="font-size: 1.1em; line-height: 1.8em; margin-bottom: 15px; margin-top: 5px; overflow: visible; padding: 0px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">That is <br />
important because other studies using SEER data have indicated that the <br />
rate of overall disease is stable in young women, said Dr. Partridge.</span></div><div style="font-size: 1.1em; line-height: 1.8em; margin-bottom: 15px; margin-top: 5px; overflow: visible; padding: 0px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">She pointed <br />
out that Dr. Johnson and colleagues found that the rates of localized <br />
and regional disease held steady in young women. Therefore, because they<br />
found an increase in advanced disease, there<em>should</em> be an overall increase in young women, she said.</span></div><div style="font-size: 1.1em; line-height: 1.8em; margin-bottom: 15px; margin-top: 5px; overflow: visible; padding: 0px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">However, the <br />
researchers "did not show/discuss data on overall rates of breast cancer<br />
in young women," Dr. Partridge wrote in an email. This omission, <br />
combined with the fact that the study findings might be in conflict with<br />
findings from other studies using SEER data, "leads me to wonder about <br />
the article," she said.</span></div><div style="font-size: 1.1em; line-height: 1.8em; margin-bottom: 15px; margin-top: 5px; overflow: visible; padding: 0px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">Check out the rest of the <a href="http://www.medscape.com/viewarticle/779917">article</a> and others: </span></div><div style="font-size: 1.1em; line-height: 1.8em; margin-bottom: 15px; margin-top: 5px; overflow: visible; padding: 0px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">From Liz Szabo, USA Today: <a href="http://www.freep.com/usatoday/article/1949157?odyssey=mod%7Cnewswell%7Ctext%7CFRONTPAGE%7Cp" target="_blank">"Deadly Breast Cancers are Rising in Young Women"</a></span></div><div style="font-size: 1.1em; line-height: 1.8em; margin-bottom: 15px; margin-top: 5px; overflow: visible; padding: 0px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">From the NYTimes: <a href="http://www.nytimes.com/2013/02/27/health/advanced-breast-cancer-may-be-rising-among-young-women-study-finds.html" target="_blank"> "Study Finds More Breast Cancer at Young Age"</a></span></div></div><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<br />
</span><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">From NPR: <a href="http://www.npr.org/blogs/health/2013/02/27/172969262/younger-women-have-rising-rate-of-advanced-breast-cancer-study-says" target="_blank"> "Younger Women Have Rising Rate of Advanced Breast Cancer Study Says" </a></span></div>Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com2tag:blogger.com,1999:blog-3832002187526997747.post-57453346154755454462014-12-24T12:23:00.001-08:002014-12-24T12:23:08.220-08:00Survivorship Guidelines. For real.<h3 class="post-title entry-title" itemprop="name">Survivorship Guidelines. For real. <br />
</h3><div class="post-header"><br />
</div><div dir="ltr" style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifuManwn6-n4OaovD2vlglFQ-_XW_R2HgTKEkRvbYWXxbGmxgg82dblOIonnCksud8URpkGp_Xpwcw8BwnReYYRcMHHHaOj6422WEZRE_5C6BDMN726b8K85XyI6eHL26HIvRvKHKjol6f/s320/59993_150804764959471_6428032_n.jpg" width="320" /> </div><div class="separator" style="clear: both; text-align: center;"> </div><span style="font-family: Arial, Helvetica, sans-serif;">Late last week the National Comprehensive Cancer Network (<a href="http://www.nccn.org/about/default.asp">NCCN</a>), a nonprofit alliance of 21 comprehensive cancer centers, announced its <i>first ever</i> set </span><span style="font-family: Arial, Helvetica, sans-serif;">of clinical practice guidelines for survivorship care.</span><br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> There are <br />
some 13.7 million cancer survivors in the United States alone. Of those,<br />
2.9 million are breast cancer survivors. All of us have found our way <br />
through those first difficult months and years following diagnosis. <br />
Treatment itself was one thing. Trying to adjust to life after cancer <br />
was another.</span><br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> But by any measure the guidelines are good news for any man or woman in treatment now. </span><span style="font-family: Arial, Helvetica, sans-serif;">The 100-page report covers eight distinct areas:</span><br /><br />
<ul style="text-align: left;"><li><span style="font-family: Arial, Helvetica, sans-serif;">anxiety and depression</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">cognitive function</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">exercise </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">fatigue</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">immunizations and infections</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">pain</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">sexual function </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">sleep disorders. </span></li>
</ul><span style="font-family: Arial, Helvetica, sans-serif;"> <br />
Standards for evidence-based survivorship care are only being developed<br />
now. The first conference on survivorship science as an entity in and <br />
of itself did not take place until 2003. In 2004, the CDC and Livestrong<br />
published "A National Cancer Action Plan for Cancer Survivorship," <br />
which included the simple, yet powerful recommendation to establish an </span><span style="font-family: Arial, Helvetica, sans-serif;">infrastructure<br />
for a comprehensive database on cancer survivorship. I don't know if <br />
that has transpired. While that sounds smart to me, making smart things<br />
happen is not one of the hallmarks of our framented health care system.<b style="font-style: italic;"> </b> </span><br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Then as most of you know, in 2005 the Institute of Medicine published its landmark consensus report <i><a href="http://www.iom.edu/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition.aspx">Lost in Transition</a>, </i>which made the case for survivorship care. Six years later </span><span style="font-family: Arial, Helvetica, sans-serif;">Livestrong<br />
held a collaborative symposium of stakeholders, health care <br />
professionals and advocates to begin a consenus building project to <br />
articulate the "essential" elements in surivorship care. </span><br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> A <br />
later IOM report, "From Cancer Care for the Whole Patient: Meeting <br />
Psychosocial Health Needs," recommended that psychosocial screening be <br />
part of quality cancer care. This is well covered in NCCN guidlines but<br />
why other concepts from </span><i style="font-family: Arial, Helvetica, sans-serif;">Lost in Transition</i><span style="font-family: Arial, Helvetica, sans-serif;"> and </span><i style="font-family: Arial, Helvetica, sans-serif;">Elements</i><span style="font-family: Arial, Helvetica, sans-serif;"><br />
didn't become part of NCCN's report aren't clear, even though both <br />
reports are mentioned. NCCN surivorship care guidlines, for example, <br />
don't even support the need for a survivorhip care plan or treatment <br />
summary. While we all understand that there's no economic incentive in <br />
place for this let's get serious. A one page print out is not rocket <br />
science. Both "Lost" and "Elements" stress the need for education - of <br />
providers and patients - and coordination of care. NCCN's guidelines <br />
don't venture that far.</span><br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><span style="font-family: Arial, Helvetica, sans-serif;"> NCCN's <a href="http://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf">guidelines</a> are<br />
directed at professionals. How this material will make its way from the<br />
nation's 21 comprehensive cancer centers to the community setting, <br />
where the majority of women are seen, is not explained. Color me <br />
skeptical but I see a packet of information stacked on an oncologist's <br />
already stacked desk. Neither were there <i><b>any outside patient advocates </b></i>or<br />
organizations on the committees as listed in the report. This makes no <br />
sense to me. You'd think that patient advocacy networks would be tapped <br />
for their assistance and guidance in moving this material to where it <br />
needs to be. </span><i style="font-family: Arial, Helvetica, sans-serif;">Let patients know and let them help. </i><span style="font-family: Arial, Helvetica, sans-serif;">No one is more invested in assuring the provision of good survivorship care than we are</span><i style="font-family: Arial, Helvetica, sans-serif;">. </i><br /><br />
<div><div><span style="font-family: Arial, Helvetica, sans-serif;"> A few other take-aways to the report:</span></div><div><ul style="text-align: left;"><li><span style="font-family: Arial, Helvetica, sans-serif;">at least <br />
50% of (all) survivors suffer from some late effect of cancer treatment.<br />
The most common problems seen are pain, depression and fatigue.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">anxiety and<br />
depression affect up to 29 percent of all survivors; and some 19% meet <br />
the diagnostic criteria for post-traumatic stress syndrome.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">the <br />
increasing trend toward more treatment, combined chemo, radiation, <br />
hormone therapy and surgery can result in more late effects. One example<br />
was the study from last week on increased of heart disease for women <br />
receiving radiation therapy.</span></li>
</ul><div><span style="font-family: Arial, Helvetica, sans-serif;"> <br />
Believe me, I am far from done with this topic. Sometimes It seems the <br />
more we do to treat - not cure - cancer - the more potential for <br />
problems there are down the road. We can't go back and undo treatment <br />
we selected, decisions we made when faced with a difficult, confounding <br />
disease. I do believe we can do a better job with survivorship though, <br />
and these guidelines are one place to start.</span><br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> I <br />
hope you'll take a look at the report. You will need to establish an <br />
account but you can access the material by registering with your email <br />
address </span><a href="https://subscriptions.nccn.org/profile.aspx" style="font-family: Arial, Helvetica, sans-serif;">here:</a><br /><br />
<br /><br />
<div style="text-align: center;"># # #<br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<div style="text-align: left;"><span style="font-family: Arial, Helvetica, sans-serif;">Interesting <br />
note: I just saw a news release from NCCN announcing that two <br />
additional cancer centers have been added to their network. They are UC<br />
San Diego Moores Cancer Ceneter and University of Colorado Cancer <br />
Center.</span></div></div></div></div></div></div>Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-52825067925193457342014-12-24T12:21:00.001-08:002014-12-24T12:21:20.321-08:00Women with Cancer: Cancer: Round Two<a href="http://womenwcancer.blogspot.com/2013/04/cancer-round-two.html?spref=bl">Women with Cancer: Cancer: Round Two</a>: This is how things change. On Tuesday, April 9 we celebrate DH's (darling husband's) birthday with an extravagant dinner with f...Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-35553437932064042562014-12-24T12:17:00.001-08:002014-12-24T12:17:35.361-08:00Cancer and My Marriage<h3 class="post-title entry-title" itemprop="name" style="text-align: left;"></h3><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div class="post-header" style="text-align: left;"><br />
</div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<br />
<br />
<br />
</span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="font-size: 14px; margin-bottom: 12px; text-align: left;"></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0px;"><i>Note: Ask any survivor about <br />
side-effects or working with an oncologist and you’ll receive a <br />
notebook’s worth of helpful information. Ditto for managing cancer on <br />
the job or with children. But ask them about their relationship and <br />
you’re apt to hear variations on this theme, “He never blinked,” or “He <br />
really showed me how strong a man he truly is.” In other words, you’re <br />
not apt to hear what it’s truly like for some women. While we celebrate <br />
relationships where love’s better nature rules, it’s also time to <br />
honestly share the kind of stress cancer and its associated treatment <br />
brings to many two-income families where jobs, children, carpools and <br />
chemotherapy all need to be balanced in the course of a day. I was asked<br />
by a woman whom I admire to publish this essay here. It is my honor to <br />
do so.</i></span></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;"></span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;"><i><span style="letter-spacing: 0px;"> </span><span style="letter-spacing: 0px;">--- Jody Schoger</span></i></span></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;"><br />
</span><br />
</span></div><div style="color: #37628d; font-size: 14px; margin-bottom: 12px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"><br /><br />
</span></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<br />
<span style="letter-spacing: 0.0px;">I never thought I would write an anonymous blog post.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">Nonetheless, here I am, writing <br />
about cancer’s impact on my marriage after my late-night Google searches<br />
only yielded stories of marital triumph, replete with images of the <br />
devoted spouse proffering a tender kiss on his partner’s bald head. My <br />
hope is that the next despondent, lonely cancer patient might feel a <br />
little less crazy reading my story</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">I love my husband and do not want to be disloyal to him. I will remain strategically vague on some details and alter others to</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">shield<br />
my family’s privacy. We have had the kind of marriage people say they <br />
can bet on. Single friends confess that they hope to find a partnership <br />
like ours. Obviously, things are always messier on the inside, but we <br />
undoubtedly share a strong love for and commitment to one another.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">When I was diagnosed we’d been <br />
married with children for more than a decade. Like every couple we had <br />
our strengths and weaknesses. We were strong in the communication <br />
department, which allowed us to navigate the transitions of parenthood, <br />
moves and job changes.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">Even with these strengths at our <br />
disposal, nothing challenged our relationship like my cancer diagnosis. I<br />
was in treatment for almost a year, with follow-up drugs and surgeries <br />
that impacted my quality of life for a prolonged long period of time, <br />
far longer than either one of us expected. I had chemo, a mastectomy and<br />
radiation which was then followed by a</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">series of reconstructive surgeries. All the while, I held down a job, tried to help raise my children and hold things together.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">Our marital glue was communication,<br />
adventure, and sex. Chemobrain wiped out my ability to communicate, <br />
especially about emotional issues. Strong emotions made me queasy,</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">leading<br />
me to shut down even more. Also, my forgetfulness was a constant source<br />
of frustration to my husband, who came to treat me like one of the <br />
children, nagging and cajoling me.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;"></span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br />
<span style="letter-spacing: 0.0px;">The painful truth was that he <br />
wasn’t totally off-base in doing this. He had to keep the household <br />
together, and I was falling apart. As for adventure, it is hard to be <br />
spontaneous when you are immunocompromised,</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">nauseated and unprepared for the</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">undertow of fatigue that can</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">pull<br />
you in and wipe you out. And of course, our sex life was horribly <br />
disrupted. Given the length of our relationship and the presence of <br />
children, we were surprisingly regular in our sexual activity. Chemo <br />
brought on chemical menopause; the mastectomy took away a critical <br />
erogenous zone and left me with profound loss of body confidence. <br />
Radiation, for me, was painful and a complete energy drain. All this <br />
together is the opposite of sexy.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">I have read accounts of the <br />
sympathetic, supportive husbands who wait patiently for a partner to <br />
heal. My husband was like this probably two-thirds of the time. But he <br />
is only human. All the things I couldn’t do he did ... from driving <br />
carpools, cleaning the house, doing laundry, communicating with <br />
teachers, mediating sibling spats, and tween-age drama</span><span style="color: #37628d; letter-spacing: 0.0px;">.</span><span style="letter-spacing: 0.0px;"> He was holding down his own job, and could only</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">watch</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">as the little energy I had energy my went to my work. By the time I arrived home I was</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">completely spent and totally unavailable emotionally </span><span style="color: #37628d; letter-spacing: 0.0px;">or </span><span style="letter-spacing: 0.0px;">sexually.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">Plus my bitterness at the length of treatment grew </span><span style="color: #37628d; letter-spacing: 0.0px;">a</span><span style="letter-spacing: 0.0px;">s the months dragged </span><span style="color: #263e0f; letter-spacing: 0.0px;">on. </span><span style="letter-spacing: 0.0px;">If it had been a month or two,</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">I<br />
think we could have endured it and come out relatively unscathed. But <br />
this has gone on for years. Not only was this ordeal loosening our glue,<br />
but</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">the<br />
friction points of marriage – the ways we see things so differently –– <br />
began to push us further apart. Because of my limited energy and <br />
concentration, we couldn’t have one of our major realignment <br />
conversations that used to bring us back to a place of mutual <br />
understanding and respect about our differences. Add to this mix the <br />
financial strain of decreased income and increased expenses. A chunk of <br />
my income comes from freelance work, which was now off the table because<br />
of my illness. Even though we have good insurance, I was stunned at how<br />
quickly medication co-pays and deductibles added up to big numbers. <br />
Money</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">is the source of conflict even in stable situations and we began to argue about purchases that never were an issue before.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">Eventually we hit several crisis points. There were the periodic pity parties my husband had about his utter deprivation,</span><span style="color: #37628d; letter-spacing: 0.0px;"> </span><span style="letter-spacing: 0.0px;">emotionally,<br />
physically and sexually. It was a stretch for me to comfort him, since <br />
he was basically right. Guys really don’t reach out to other men when <br />
they are vulnerable. Where I am sure my girlfriends would have rallied <br />
to my side had our roles been reversed, he was left basically alone. <br />
None of our extended family members live near us. There wasn’t a <br />
grandparent, an aunt or even a cousin to give him a break for any length<br />
of time. </span><span style="letter-spacing: 0px;">Nor did it help our<br />
bond that he was petrified at the idea of actually losing me. At his <br />
lowest moments, he would vacillate between his frustration with my <br />
helplessness and the terror of my possible death.</span><span style="color: #37628d; letter-spacing: 0px;"> </span><span style="letter-spacing: 0px;">He<br />
told me through tears one day, "I can't stand that the one person I <br />
want to talk about all this with is you, and you are really not really <br />
able to talk."</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0px;">Another crisis came after my <br />
treatment was over and I started to regain my cognitive and physical <br />
energy. It would no longer do for him to treat me like his other child. <br />
But it takes more than a simply saying, “Mom’s back in business.” The <br />
children had learned that Dad was the Real Parent in the house, an idea <br />
reinforced by the ways he would second-guess my authority as a mother. <br />
It was difficult to stand up to this. How do you stake a claim to your <br />
authority when you are not the same in memory, strength, or energy? I <br />
confronted him about this. To his great credit, he has worked with me to<br />
rebalance our parenting team, with the understanding that I am still <br />
not </span><span style="color: #37628d; letter-spacing: 0px;">100 </span><span style="letter-spacing: 0px;">percent. Regaining authentic balance in our partnership remains an ongoing challenge.</span><span style="letter-spacing: 0.0px;"></span></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">Our sex life is on the mend but is <br />
still a source of strife. I have not figured out how to feel comfortable<br />
naked, with all the scars riddling my torso and the false breast that <br />
feels numb and dead. My energy remains unreliable. At night, once the <br />
dishes are washed and the children tucked in, I often want to crawl in <br />
the bed to sleep. We are trying to be more deliberate about carving out <br />
time for ourselves and our relationship, but it is so hard. So, so hard.</span></span><br /><span style="font-family: Arial,Helvetica,sans-serif;"><br />
</span></div><div style="min-height: 17px; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="letter-spacing: 0.0px;"></span><br /></span></div><div style="text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;"><br />
<span style="letter-spacing: 0.0px;">There is a lot of talk in the <br />
cancer world about survivorship plans for patients. What I really need <br />
is a survivorship plan for my marriage. In my support group, I see a lot<br />
of people getting divorced after the crisis of treatment subsides. <br />
These wounds cut deep, touching our greatest insecurities. Luckily, I do<br />
know a handful of survivors whose marriages did recover. I just wish I <br />
had more of a roadmap for how to steer my marriage toward success and <br />
away from the potential disaster.</span></span></div>Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-86824200782107703762014-12-24T12:11:00.005-08:002014-12-24T12:11:49.774-08:00Gynecological Tumours<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Arial,Helvetica,sans-serif;">Cervix uteri and corpus uteri were among the first sites to be classified by
the TNM system. The "League of Nations" stages for carcinoma of the
cervix have been used with minor modifications for over 50 years, and, because
these are accepted by the Fédération Internationale de Gynécologie
et d'Obstétrique (FIGO), the TNM categories have been defined to correspond
to the FIGO stages. Some amendments have been made in collaboration with FIGO,
and the classifications now published have the approval of the FIGO, UICC, and
the national TNM committees including the AJCC.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><span style="font-family: Arial,Helvetica,sans-serif;">Each site is described under the following headings: </span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"> Rules for classification with the procedures for assessing T, N, and M
categories; additional methods may be used when they enhance the accuracy
of appraisal before treatment</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"> Anatomical subsites where appropriate</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"> Definition of the regional lymph nodes</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"> TNM Clinical classification</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"> pTNM Pathological classification</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"> Stage grouping</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"> Summary</span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">2. Distant Metastasis</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The categories M1 and pM1 may be further specified according to the following
notation: <br />
<br />
</span><div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Pulmonary</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">PUL</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Bone marrow</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">MAR</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Osseous</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">OSS</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Pleura</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">PLE</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Hepatic</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">HEP</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Peritoneum</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">PER</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Brain</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">BRA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Adrenals</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">ADR</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Lymph nodes</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">LYM</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Skin</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">SKI</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Others</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">OTH</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
</h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">3. Histopathological Grading</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The definitions of the G categories apply to all classified tumours except
gestational trophoblastic tumours. These are:<br />
<br />
<b>GX.</b> Grade of differentiation cannot be assessed<br />
<b>G1.</b> Well differentiated<br />
<b>G2.</b> Moderately differentiated<br />
<b>G3.</b> Poorly differentiated or undifferentiated<br />
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">4. R Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><span style="font-family: Arial,Helvetica,sans-serif;">The absence or presence of residual tumour after treatment is
described by the symbol R. The definitions of the R classification
are:</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">
<b>RX.</b> Presence of residual tumour cannot be assessed<br />
<b>R0.</b> No residual tumour<br />
<b>R1.</b> Microscopic residual tumour<br />
<b>R2.</b> Macroscopic residual tumour</span></div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-41057510247038851242014-12-24T12:10:00.001-08:002014-12-24T12:10:45.912-08:00Gestational Trophoblastic Tumours<div dir="ltr" style="text-align: left;" trbidi="on">
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">1. Rules for Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The following classification for gestational trophoblastic tumours
is based on that of FIGO adopted in 1992 and updated in 2001
(Gestational trophoblastic tumours. Ngan HYS, Odicino F,
Maisonneuve P, Beller U, Benedet JL, Heintz APM, Pecorelli S,
Sideri M, Creasman WT. J Epidemiol Biostatist 2001;6:175-184). The
definitions of T and M categories correspond to the FIGO stages.
Both systems are included for comparison. In contrast to other
sites, an N (regional lymph node) classification does not apply to
these tumours. A prognostic scoring index, which is based on
factors other than the anatomic extent of the disease, is used to
assign cases to high risk and low risk categories, and these
categories are used in stage grouping.<br />
<br />The classification applies to choriocarcinoma (9100/3), invasive hydatidiform
mole (9100/1), and placental site trophoblastic tumour (9104/1). Placental site
tumours should be reported separately. Histological confirmation is not required
if the human chorionic gonadotropin (hCG) level is abnormally elevated. History
of prior chemotherapy for this disease should be noted.<br />
<br />The following are the procedures for assessing T and M categories:<br />
<br />
<b>T categories.</b> Physical examination, imaging including urography and cystoscopy<br />
<b>M categories.</b> Physical examination and imaging<br />
<b>Risk categories.</b> Age, type of antecedent pregnancy, interval from index pregnancy,
pretreatment hCG, diameter of largest tumour, site of metastasis, number of
metastases, and antecedent treatment are integrated to provide a prognostic
score that divides cases into low and high risk categories.<br />
<br />
<b>2.1. Primary Tumour</b><br />
<br />
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="center" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TM Categories</span></th>
<th align="center" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">FIGO Stages<sup><span> <b>*</b></span></sup></span></th>
<th align="center" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></th>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">TX</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Primary tumour cannot be assessed</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T0</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">No evidence of primary tumour</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour confined to uterus</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour extends to other genital structures: vagina, ovary, broad ligament, fallopian tube by metastasis or direct extension</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1a</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Metastasis to lung(s)</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1b</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IV</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Other distant metastasis</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
<span><b><sup>*</sup>Note:</b> Stages I to IV are subdivided into A and B according to the prognostic score.</span><br />
<br />
<b>2.2. M - Distant Metastasis</b><br />
<br />
<b>MX.</b> Metastasis cannot be assessed<br />
<b>M0.</b> No distant metastasis<br />
<b>M1.</b> Distant metastasis<br />
<b>M1a.</b> Metastasis to lung(s)<br />
<b>M1b.</b> Other distant metastasis
<br />
<span><b>Note:</b> Genital metastasis (vagina, ovary, broad ligament, fallopian tube)
is classified T2. Any involvement of non-genital structures, whether by direct
invasion or metastasis is described using the M classification.</span><br />
<br />
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">3. pTM Pathological Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The pT and pM categories correspond to the T and M categories.<br />
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">4. Prognostic Score</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">Prognostic Factor</span></th>
<th align="center" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">0</span></th>
<th align="center" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">1</span></th>
<th align="center" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">2</span></th>
<th align="center" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">4</span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Age</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><40</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">≥40</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Antecedent pregnancy</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">H. mole</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Abortion</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Term pregnancy</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Months from index pregnancy</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><4</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">4-<7</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">7-12</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">>12</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Pretreatment serum hCG (IU/ml)</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><10<sup>3</sup></span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">10<sup>3</sup>-<10<sup>4</sup></span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">10<sup>4</sup>-<10<sup>5</sup></span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">≥10<sup>5</sup></span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Largest tumour size including uterus</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><3 cm</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">3-<5 cm</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">≥5 cm</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Sites of metastasis</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Lung</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Spleen, kidney</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Gastrointes-tinal tract</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Liver, brain</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Number of metastasis</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">1-4</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">5-8</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">>8</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Previous failed chemotherapy</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Single drug</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Two or more drugs</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">5. Stage Grouping</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Risk Category</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Unknown</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Low</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">High</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Unknown</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Low</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">High</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Unknown</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Low</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">High</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IV</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Unknown</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Low</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">High</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">6. Summary</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TM and risk</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">Gestational Trophoblastic Tumours</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">Stage</span></th>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Confined to uterus</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Other genital structures</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1a</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Metastasis to lung(s)</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1b</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Other distant metastasis</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IV</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Low risk</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Prognostic score 7 or less</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IA-IVA</span></td>
</tr>
<tr>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">High risk</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Prognostic score 8 or more</span></td>
<td align="center" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IB-IVB</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /><em></em></span></div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-26239839851528810312014-12-24T12:09:00.001-08:002014-12-24T12:09:17.539-08:00Gynecological Tumours Fallopian Tube <div dir="ltr" style="text-align: left;" trbidi="on">
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">Introduction</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The following classification for carcinoma of the fallopian tube
is based on that of FIGO adopted in 1992. The definitions of the
T, N, and M categories correspond to the FIGO stages. Both systems
are included for comparison.
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">1. Rules for Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The classification applies only to carcinoma. There should be histological
confirmation of the disease.<br />
<br />The following are the procedures for assessing T, N, and M categories:<br />
<br />
<b>T categories.</b> examination, imaging, laparoscopy, and/or surgical exploration<br />
<b>N categories.</b> Physical examination, imaging, laparoscopy, and/or surgical exploration<br />
<b>M categories.</b> Physical examination, imaging, laparoscopy, and/or surgical exploration<br />
<br />
The FIGO stages are based on surgical staging. (TNM stages are based on clinical
and/or pathological staging.)
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">2. Regional Lymph Nodes</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The regional lymph nodes are the hypogastric (obturator), common
iliac, external iliac, lateral sacral, para-aortic, and inguinal
nodes.
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">3. TNM Clinical Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
<b>3.1. T - Primary Tumour</b><br />
</span><div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TNM Categories</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">FIGO Stages</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">TX</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Primary tumour cannot be assessed</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">No evidence of primary tumour</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Carcinoma in situ (preinvasive carcinoma)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour confined to fallopian tube(s)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour limited to one tube, without penetrating the serosal surface</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour limited to both tubes, without penetrating the serosal surface</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour
limited to one or both tube(s) with extension onto or through the tubal
serosa, or with malignant cells in ascites or peritoneal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour involves one or both fallopian tube(s) with pelvic extension</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Extension and/or metastasis to uterus and/or ovaries</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Extension to other pelvic structures</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Pelvic extension (2a or 2b) with malignant cells in ascites or peritoneal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour involves one or both fallopian tube(s) with peritoneal implants outside the pelvis and/or positive regional lymph nodes</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Microscopic peritoneal metastasis outside the pelvis</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Macroscopic peritoneal metastasis outside the pelvis 2 cm or less in greatest dimension</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3c and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Peritoneal metastasis more than 2 cm in greatest dimension and/or positive regional lymph nodes</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IV</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Distant metastasis (excludes peritoneal metastasis)</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span><b>Note:</b> Liver capsule metastasis is T3/stage III,
liver parenchymal metastasis, M1/ stage IV. Pleural effusion must have
positive cytology for M1/stage IV.</span></span>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>3.2. N - Regional Lymph Nodes</b></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>NX.</b> Regional lymph nodes cannot be assessed</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>N0.</b> No regional lymph node metastasis</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>N1.</b> Regional lymph node metastasis</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>3.3. M - Distant Metastasis</b></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>MX.</b> Distant metastasis cannot be assessed</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>M0.</b> No distant metastasis</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>M1.</b> Distant metastasis</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">4. pTNM Pathological Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The pT, pN, and pM categories correspond to the T, N, and M categories.<br />
<br />
<b>pN0.</b> Histological examination of a pelvic lymphadenectomy specimen
will ordinarily include 10 or more lymph nodes. If the examined
lymph nodes are negative, but the number ordinarily examined is
not met, classify as pN0.
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">5. G Histopathological Grading</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
<b>GX.</b> Grade of differentiation cannot be assessed <br />
<b>G1.</b> Well differentiated <br />
<b>G2.</b> Moderately differentiated <br />
<b>G3.</b> Poorly differentiated <br />
<b>G4.</b> Undifferentiated
<br />
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">6. Stage Grouping</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage 0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" rowspan="2" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IV</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
<br />
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">7. Summary</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TNM</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">Fallopian Tube</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">FIGO</span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Limited to tube(s)</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> One tube; serosa intact</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Both tubes; serosa intact</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Serosa involved; malignant cells in ascites or peritoneal washings</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Pelvic extension</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Uterus and/or ovaries</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Other pelvic structures</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Malignant cells in ascites or peritoneal washings</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Peritoneal metastasis outside the pelvis and/or regional lymph node metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Microscopic peritoneal metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Macroscopic peritoneal metastasis ≤2 cm</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3c and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Peritoneal metastasis >2 cm and/or regional lymph node metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Distant metastasis (excludes peritoneal metastasis)</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IV</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
<span style="font-family: Arial,Helvetica,sans-serif;"><em></em></span></div>
</div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-80292897593255574132014-12-24T12:08:00.000-08:002014-12-24T12:08:01.879-08:00Gynecological Tumours Ovary<div dir="ltr" style="text-align: left;" trbidi="on">
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">1. Rules for Classification</span></h3>
<span style="font-family: Verdana,sans-serif;">
The classification applies to malignant surface epithelial-stromal
tumours including those of borderline malignancy or of low
malignant potential (WHO histological classification, 2nd edition,
Scully 1999) corresponding to "common epithelial tumours" of the
earlier terminology. Non-epithelial ovarian cancers may also be
classified using this scheme. There should be histological
confirmation of the disease and division of cases by histological
type.
</span><span style="font-family: Verdana,sans-serif;">
The following are the procedures for assessing T, N, and M categories:</span>
<span style="font-family: Verdana,sans-serif;"><br /></span>
<span style="font-family: Verdana,sans-serif;"><b>T categories.</b> Physical examination, imaging, laparoscopy, and/or
surgical exploration </span>
<span style="font-family: Verdana,sans-serif;"><b>N categories.</b> Physical examination, imaging,
laparoscopy, and/or surgical exploration </span>
<span style="font-family: Verdana,sans-serif;"><b>M categories.</b> Physical
examination, imaging, laparoscopy, and/or surgical exploration The
FIGO stages are based on surgical staging. (TNM stages are based
on clinical and/or pathological classification.)</span>
<span style="font-family: Verdana,sans-serif;"><br />
The definitions of the T, N, and M categories correspond to the FIGO stages.
Both systems are included for comparison.</span>
<br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">2. Regional Lymph Nodes</span></h3>
<span style="font-family: Verdana,sans-serif;">
The regional lymph nodes are the hypogastric (obturator), common iliac,
external iliac, lateral sacral, para-aortic, and inguinal nodes.<br />
<br />
</span><h3 align="center">
<span style="font-family: Verdana,sans-serif;">3. TNM Clinical Classification</span></h3>
<span style="font-family: Verdana,sans-serif;">
<b>3.1. T - Primary Tumour</b><br />
</span><div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">TNM Categories</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">FIGO Stages</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;"><br /></span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">TX</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Primary tumour cannot be assessed</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">No evidence of primary tumour</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">I</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tumour limited to the ovaries</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Tumour
limited to one ovary; capsule intact, no tumour on ovarian surface; no
malignant cells in ascites or perito-neal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Tumour limited to both ovaries; capsule intact, no tumour on ovarian surface; no malignant cells in ascites or perito-neal
washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T1c</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IC</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Tumour
limited to one or both ovaries with any of the following: capsule
ruptured, tumour on ovarian surface, malignant cells
in ascites or peritoneal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">II</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tumour involves one or both ovaries with pelvic extension</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Extension and/or implants on uterus and/or tube(s); no malignant cells in ascites or peritoneal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Extension to other pelvic tissues; no malignant cells in ascites or peritoneal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T2c</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIC</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Pelvic extension (2a or 2b) with malignant cells in ascites or peritoneal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">III</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tumour involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or regional
lymph node metastasis</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Microscopic peritoneal metastasis beyond pelvis</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIIC</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension and/or regional lymph node metastasis</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">IV</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Distant metastasis (excludes peritoneal metastasis)</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Verdana,sans-serif;">
<small><b>Note:</b> Liver capsule metastasis is T3/stage III, liver
parenchymal metastasis M1/stage IV. Pleural effusion must have positive
cytology for M1/stage IV.</small>
</span>
<span style="font-family: Verdana,sans-serif;"><b>3.2. N - Regional Lymph Nodes</b></span>
<span style="font-family: Verdana,sans-serif;"><br /></span>
<span style="font-family: Verdana,sans-serif;"><b>NX.</b> Regional lymph nodes cannot be assessed</span>
<span style="font-family: Verdana,sans-serif;"><b>N0.</b> No regional lymph node metastasis</span>
<span style="font-family: Verdana,sans-serif;"><b>N1.</b> Regional lymph node metastasis</span>
<span style="font-family: Verdana,sans-serif;"><br /></span>
<span style="font-family: Verdana,sans-serif;"><b>3.3. M - Distant Metastasis</b></span>
<span style="font-family: Verdana,sans-serif;"><br /></span>
<span style="font-family: Verdana,sans-serif;"><b>MX.</b> Distant metastasis cannot be assessed</span>
<span style="font-family: Verdana,sans-serif;"><b>M0.</b> No distant metastasis</span>
<span style="font-family: Verdana,sans-serif;"><b>M1.</b> Distant metastasis</span>
<span style="font-family: Verdana,sans-serif;"><br /></span>
<br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">4. pTNM Pathological Classification</span></h3>
<span style="font-family: Verdana,sans-serif;">
The pT, pN, and pM categories correspond to the T, N, and M categories.<br />
<br />
<b>pN0.</b> Histological examination of a pelvic lymphadenectomy specimen will
ordinarily include 10 or more lymph nodes. If the lymph nodes are negative, but
the number ordinarily examined is not met, classify as pN0.<br />
<br />
</span><h3 align="center">
<span style="font-family: Verdana,sans-serif;">5. G Histopathological Grading</span></h3>
<span style="font-family: Verdana,sans-serif;">
See definitions on .
</span>
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">6. Stage Grouping</span></h3>
<span style="font-family: Verdana,sans-serif;">
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IC</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1c</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IIA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IIB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IIC</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2c</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" rowspan="3" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IIIC</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3c</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IV</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M1</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Verdana,sans-serif;">
<br /><br />
</span><h3 align="center">
<span style="font-family: Verdana,sans-serif;">7. Summary</span></h3>
<span style="font-family: Verdana,sans-serif;">
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">TNM</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">Ovary</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">FIGO</span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Limited to the ovaries</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">I</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> One ovary, capsule intact</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Both ovaries, capsule intact</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T1c</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Capsule ruptured, tumour on surface, malignant cells in ascites or peritoneal washings</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Pelvic extension</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">II</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Uterus, tube(s)</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Other pelvic tissues</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T2c</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Malignant cells in ascites or peritoneal washings</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Peritoneal metastasis beyond pelvis and/or regional lymph node metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">III</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Microscopic peritoneal metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Macroscopic peritoneal metastasis ≤2 cm</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> Peritoneal metastasis >2 cm and/or regional lymph node metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"> IIIC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Distant metastasis (excludes peritoneal metastasis)</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">IV</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
<span style="font-family: Verdana,sans-serif;"><em></em></span></div>
</div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-57109746007675170832014-12-24T12:06:00.000-08:002014-12-24T12:06:02.816-08:00Gynecological Tumours Corpus Uteri <div dir="ltr" style="text-align: left;" trbidi="on">
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">1. Rules for Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;"><br />The definitions of the T, N, and M categories correspond to the FIGO stages.
Both systems are included for comparison.<br />
<br />The classification applies to carcinomas and malignant mixed mesodermal tumours.
There should be histological verification with subdivision by histological type
and grading of the carcinomas. The diagnosis should be based on examination
of specimens taken by endometrial biopsy.<br />
<br />The following are the procedures for assessing T, N, and M categories:<br />
<br /><b>T categories.</b> Physical examination and imaging including urography and cystoscopy<br />
<b>N categories.</b> Physical examination and imaging including urography<br />
<b>M categories.</b> Physical examination and imaging.<br />
<br />
The FIGO stages are based on surgical staging. (TNM stages are based on clinical
and/or pathological classification.)
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">2. Anatomical Subsites</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><span style="font-family: Arial,Helvetica,sans-serif;">1. Isthmus uteri (C54.0)<br />
2. Fundus uteri (C54.3)</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">3. Regional Lymph Nodes</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The regional lymph nodes are the pelvic (hypogastric [obturator, internal iliac],
common and external iliac, parametrial, and sacral) and the para-aortic nodes.<br />
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">4. TNM Clinical Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
<b>4.1. T - Primary Tumour</b><br />
<br />
</span><div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TNM Categories</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">FIGO Stages</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">TX</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Primary tumour cannot be assessed</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">No evidence of primary tumour</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Carcinoma in situ (preinvasive carcinoma)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour confined to corpus uteri</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour limited to endometrium</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour invades less than one half of myometrium</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour invades one half or more of myometrium</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour invades cervix but does not extend beyond uterus</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Endocervical glandular involvement only</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Cervical stromal invasion</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Local and/or regional spread as specified in T3a, b, N1, and FIGO IIIA, B, C below</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour involves serosa and/or adnexa (direct extension or metastasis) and/or cancer cells in ascites or peritoneal washings</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Vaginal involvement (direct extension or metastasis)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Metastasis to pelvic and/or para-aortic lymph nodes</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour invades bladder <b>mucosa</b> and/or bowel <b>mucosa</b></span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Note:</b> The presence of bullous edema is not sufficient evidence to classify a tumour as T4. The lesion should be confirmed by biopsy.</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Distant metastasis (<b>excluding</b> metastasis to vagina, pelvic serosa, or adnexa)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Note:</b> FIGO (2001) recommends that Stage I patients given primary radiation therapy can be clinically classified as follows:<br />Stage I: Tumour confined to corpus uteri<br />Stage IA: Length of uterine cavity 8 cm or less<br />Stage IB: Length of uterine cavity more than 8 cm</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
<br />
<b>4.2. N - Regional Lymph Nodes</b><br />
<br />
<b>NX.</b> Regional lymph nodes cannot be assessed<br />
<b>N0.</b> No regional lymph node metastasis<br />
<b>N1.</b> Regional lymph node metastasis<br />
<br />
<b>4.3. M - Distant Metastasis</b><br />
<br />
<b>MX.</b> Distant metastasis cannot be assessed<br />
<b>M0.</b> No distant metastasis<br />
<b>M1.</b> Distant metastasis
<br />
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">5. pTNM Pathological Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><span style="font-family: Arial,Helvetica,sans-serif;">The pT, pN, and pM categories correspond to the T, N, and M
categories.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><span style="font-family: Arial,Helvetica,sans-serif;">pN0. Histological examination of a pelvic lymphadenectomy specimen
will ordinarily include 10 or more lymph nodes. If the lymph nodes
are negative, but the number ordinarily examined is not met,
classify as pN0.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">6. G Histopathological Grading</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><span style="font-family: Arial,Helvetica,sans-serif;">For histopathological grading see: Creasman WT, Odicino F,
Maisoneuve P, Beller U, Benedet JL, Heintz APM, Ngan HYS, Sideri
M, Pecorelli S. FIGO Annual Report on the results of treatment in
gynaecological cancer. Vol. 24. Carcinoma of the corpus uteri. J
Epidemiol Biostat 2001;6:45-86.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">7. Stage Grouping </span>
</h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage 0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIC</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1, T2, T3</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IVA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IVB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">8. Summary</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center">
<table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TNM</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">Corpus Uteri</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">FIGO</span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">In situ</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Confined to corpus</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour limited to endometrium</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Less than half of myometrium</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1c</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> One half or more of myometrium</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Invades cervix</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Endocervical glandular only</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Cervical stroma</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3 and/or N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Local or regional as specified below</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Serosa/adnexa/positive peritoneal cytology</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Vaginal involvement</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Regional lymph node metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIC</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Mucosa of bladder/bowel</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Distant metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVB</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
<em></em></span></div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-11404998660887518142014-12-24T12:04:00.000-08:002015-05-11T09:56:47.472-07:00Gynecological Tumours Cervix Uteri <div dir="ltr" style="text-align: left;" trbidi="on">
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">1. Rules for Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The classification applies only to carcinomas. There should be
histological confirmation of the disease.<br />
<br />
The following are the procedures for assessing T, N, and M
categories:<br />
<br />
<b>T categories.</b> Physical examination, cystoscopy,* and imaging
including urography<br />
<b>N categories.</b> Physical examination and imaging
including urography<br />
<b>M categories.</b> Physical examination and imaging<br />
<br />
The FIGO stages are based on clinical staging. This includes
histological examination of a cone or amputation of the cervix.
(TNM stages are based on clinical and/or pathological
classification.)<br />
<br />
The definitions of the T and M categories correspond to the FIGO
stages. Both systems are included for comparison.
</span><br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">2. Anatomical Subsites</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
1. Endocervix (C53.0)<br />
2. Exocervix (C53.1)
</span><br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">3. Regional Lymph Nodes</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><span style="font-family: Arial,Helvetica,sans-serif;">The regional lymph nodes are the paracervical, parametrial,
hypogastric (internal iliac, obturator), common and external iliac,
presacral, and lateral sacral nodes.
</span><br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">4. TNM Clinical Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
<b>4.1.T - Primary Tumour</b><br />
<br />
</span><br />
<div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center"><table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TNM Categories</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">FIGO Stages</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">TX</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Primary tumour cannot be assessed</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">No evidence of primary tumour</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Carcinoma in situ (preinvasive carcinoma)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Cervical carcinoma confined to uterus (extension to corpus should be disregarded)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Invasive
carcinoma diagnosed only by microscopy. All macroscopically visible
lesions-even with superficial invasion-are T1b/Stage
IB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Stromal invasion no greater than 3.0 mm in depth and 7.0 mm or less in horizontal spread</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Stromal invasion more than 3.0 mm and not more than 5.0 mm with a horizontal spread 7.0 mm or less<br /><b>Note:</b>
The depth of invasion should not be more than 5 mm taken from the base
of the epithelium, either surface or glandular, from
which it originates. The depth of invasion
is defined as the measurement of the tumour from the epithelial-stromal
junction
of the adjacent most superficial
epithelial papilla to the deepest point of invasion.<br />Vascular space involvement, venous or lymphatic, does not affect classification.</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Clinically visible lesion confined to cervix or microscopic lesion greater than T1a2/IA2</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Clinically visible lesion 4.0 cm or less in greatest dimension</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Clinically visible lesion more than 4 cm in greatest dimension</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour invades beyond uterus but not to pelvic wall or to lower third of vagina</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Without parametrial invasion</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> With parametrial invasion</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tumour extends to pelvic wall, involves lower third of vagina, or causes hydronephrosis or non-functioning kidney</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour involves lower third of vagina, no extension to pelvic wall</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour extends to pelvic wall or causes hydronephrosis or non-functioning kidney</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IVA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Tumour invades <i>mucosa</i> of bladder or rectum or extends beyond true pelvis<br /><b>Note:</b> The presence of bullous oedema is not sufficient to classify a tumour as T4. The lesion should be confirmed by biopsy.</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Distant metastasis</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /><br />
<b>4.2. N - Regional Lymph Nodes</b><br />
<br />
<b>NX.</b> Regional lymph nodes cannot be assessed<br />
<b>N0.</b> No regional lymph node metastasis<br />
<b>N1.</b> Regional lymph node metastasis<br />
<br />
<b>4.3. M - Distant Metastasis</b><br />
<br />
<b>MX.</b> Distant metastasis cannot be assessed <br />
<b>M0.</b> No distant metastasis <br />
<b>M1.</b> Distant metastasis </span><br />
<br />
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<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial",sans-serif;">If you need
Information about Insurance, Please <a href="http://worldinsuranceinfo.com/">follow
links</a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/accident-sickness-and-unemployment-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Accident, sickness, and
unemployment insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/auto-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Auto insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/burial-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Burial insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/car-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Car insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/gap-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gap insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/health-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Health insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/liability-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Liability insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/life-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Life insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/other-types-of-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Other types of Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/pet-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pet Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/property-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Property insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/travel-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Travel Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/visitor-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Visitor Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
</ul>
</span><br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">5. pTNM Pathological Classification</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
The pT, pN, and pM categories correspond to the T, N, and M categories.<br />
<br />
<b>pN0.</b> Histological examination of a pelvic lymphadenectomy specimen
will ordinarily include 10 or more lymph nodes. If the lymph nodes
are negative, but the number ordinarily examined is not met,
classify as pN0.<br />
</span><br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">6. G Histopathological Grading</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
<b>GX.</b> Grade of differentiation cannot be assessed <br />
<b>G1.</b> Well differentiated <br />
<b>G2.</b> Moderately differentiated <br />
<b>G3.</b> Poorly differentiated <br />
<b>G4.</b> Undifferentiated
</span><br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">7. Stage Grouping</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center"><table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage 0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IA1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1a1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IA2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1a2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IB1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1b1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IB2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1b2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" rowspan="2" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IIIB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1, T2, T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IVA</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Stage IVB</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<h3 align="center">
<span style="font-family: Arial,Helvetica,sans-serif;">8. Summary</span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span>
<div align="center">
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center"><table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">TNM</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">Cervix Uteri</span></th>
<th align="left" valign="bottom"><span style="font-family: Arial,Helvetica,sans-serif;">FIGO</span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">In situ</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Confined to uterus</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">I</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Diagnosed only by microscopy</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Depth ≤3 mm, horizontal spread ≤7 mm</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA1</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1a2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Depth >3-5 mm, horizontal spread ≤7 mm</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IA2</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Clinically visible or microscopic lesion, greater than T1a2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> ≤4 cm</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB1</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T1b2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> >4 cm</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IB2</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Beyond uterus but not pelvic wall or lower third vagina</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">II</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> No parametrium</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T2b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Parametrium</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T3</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Lower third vagina/pelvic wall/hydronephrosis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">III</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3a</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Lower third vagina</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> T3b</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> Pelvic wall/hydronephrosis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;"> IIIB</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Mucosa of bladder/rectum; beyond true pelvis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">N1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Regional</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">-</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">Distant metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Arial,Helvetica,sans-serif;">IVB</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
<i></i></span></div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0tag:blogger.com,1999:blog-3832002187526997747.post-21521951072606172762014-12-24T12:02:00.001-08:002015-05-11T09:55:20.595-07:00Gynecological Tumours Vagina <div dir="ltr" style="text-align: left;" trbidi="on">
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">1. Rules for Classification</span></h3>
<span style="font-family: Verdana,sans-serif;">
The classification applies to primary carcinomas only. Tumours present
in the vagina as secondary growths from either genital or extragenital
sites are excluded. A tumour that has extended to the portio and reached
the external os (orifice of uterus) is classified as carcinoma of the
cervix. A tumour involving the vulva is classified as carcinoma of the
vulva. There should be histological confirmation of the disease.<br />
<br />
The following are the procedures for assessing T, N, and M categories:<br />
<br />
<b>T categories.</b> Physical examination, endoscopy, and imaging<br />
<b>N categories.</b> Physical examination and imaging<br />
<b>M categories.</b> Physical examination and imaging<br />
<br />
The FIGO stages are based on surgical staging. (TNM stages are based on clinical and/or pathological classification.)<br />
<br />
The definitions of the T and M categories correspond to the FIGO stages. Both systems are included for comparison.<br />
<br />
</span><br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">2. Regional Lymph Nodes</span></h3>
<span style="font-family: Verdana,sans-serif;">
Upper two-thirds of vagina: the pelvic nodes including obturator,
internal iliac (hypogastric), external iliac, and pelvic nodes, NOS.<br />
<br />
Lower third of vagina: the inguinal and femoral nodes.<br />
<br />
</span><br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">3. TNM Clinical Classification</span></h3>
<span style="font-family: Verdana,sans-serif;">
<b>3.1. T - Primary Tumour</b>
</span>
<br />
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center"><table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">TNM Categories</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">FIGO Stages</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;"><br /></span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">TX</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Primary tumour cannot be assessed</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;"><br /></span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">No evidence of primary tumour</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Carcinoma in situ (preinvasive carcinoma)</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">I</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tumour confined to vagina</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">II</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tumour invades paravaginal tissues but does not extend to pelvic wall</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">III</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tumour extends to pelvic wall</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">IVA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tumour invades <i>mucosa</i> of bladder or rectum, and/or extends beyond the true pelvis<br /><b>Note:</b> The presence of bullous oedema is not sufficient evidence to classify a tumour as T4.</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">IVB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Distant metastasis</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Verdana,sans-serif;">
<br />
<b>3.2. - Regional Lymph Nodes</b><br />
<br />
<b>NX.</b> Regional lymph nodes cannot be assessed<br />
<b>N0.</b> No regional lymph node metastasis<br />
<b>N1.</b> Regional lymph node metastasis<br />
<br />
<b>3.3. - Distant Metastasis</b><br />
<br />
<b>MX.</b> Distant metastasis cannot be assessed<br />
<b>M0.</b> No distant metastasis<br />
<b>M1.</b> Distant metastasis<br />
<br />
</span><br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">4. pTNM Pathological Classification</span></h3>
<span style="font-family: Verdana,sans-serif;">
The pT, pN, and pM categories correspond to the T, N, and M categories.<br />
<br />
<b>pN0.</b> Histological examination of an inguinal lymphadenectomy
specimen will ordinarily include 6 or more lymph nodes; a pelvic
lymphadenectomy specimen will ordinarily include 10 or more lymph
nodes. If the lymph nodes are negative, but the number ordinarily
examined is not met, classify as pN0.<br />
<br />
</span><br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">5. G Histopathological Grading</span></h3>
<span style="font-family: Verdana,sans-serif;">
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<div class="MsoNormal">
<span style="font-family: "Arial",sans-serif;">If you need
Information about Insurance, Please <a href="http://worldinsuranceinfo.com/">follow
links</a></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/accident-sickness-and-unemployment-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Accident, sickness, and
unemployment insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/auto-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Auto insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/burial-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Burial insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/car-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Car insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/gap-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gap insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/health-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Health insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/liability-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Liability insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/life-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Life insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/other-types-of-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Other types of Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/pet-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pet Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/property-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Property insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/travel-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Travel Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 5.0pt; mso-bidi-font-size: 11.0pt;"><a href="http://worldinsuranceinfo.com/category/visitor-insurance/"><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Visitor Insurance</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 9.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span></li>
</ul>
<br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">6. Stage Grouping</span></h3>
<span style="font-family: Verdana,sans-serif;">
</span><br />
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center"><table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage 0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Tis</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage I</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage II</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" rowspan="3" valign="top"><span style="font-family: Verdana,sans-serif;">Stage III</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N0</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1. T2. T3</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IVA</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M0</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Stage IVB</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Any T</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Any N</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M1</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Verdana,sans-serif;">
</span><br />
<h3 align="center">
<span style="font-family: Verdana,sans-serif;">7. Summary</span></h3>
<span style="font-family: Verdana,sans-serif;">
</span><br />
<div align="center">
<table style="width: 80%px;">
<tbody>
<tr>
<td align="center"><table bgcolor="#CCFFFF" border="" cellpadding="3" cellspacing="0">
<tbody>
<tr>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">TNM</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">Vagina</span></th>
<th align="left" valign="bottom"><span style="font-family: Verdana,sans-serif;">FIGO</span></th>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Vaginal wall</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">I</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T2</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Paravaginal tissue</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">II</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T3</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Extends to pelvic wall</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">III</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">T4</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Mucosa of bladder/rectum, beyond pelvis</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">IVA</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">N1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Regional</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">-</span></td>
</tr>
<tr>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">M1</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">Distant metastasis</span></td>
<td align="left" valign="top"><span style="font-family: Verdana,sans-serif;">IVB</span></td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: Verdana,sans-serif;">
<i></i></span></div>
Khondoker Hafizur Rahmanhttp://www.blogger.com/profile/07509718864527787617noreply@blogger.com0