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Wednesday 30 March 2016

Basal-cell carcinoma

Basal-cell carcinoma Treatment 


Basal cell carcinoma (also known as basal cell carcinoma or basal cell cancer) is malignancy of the most common skin, and one of the most common cancers in the United States. Although basal cell carcinoma has a low metastatic potential, this tumor can cause significant destruction and disfigurement by invading surrounding tissues


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In the United States, approximately 3 out of 10 Caucasians develop a basal cell carcinoma in her lifetime. This tumor accounts for about 70% of non-melanoma skin cancers. In 80 percent of all cases, the basal cell carcinoma affects the skin of the head and neck. It also seems that there is an increase in the incidence of basal cell cancer stem in recent years


basal cell carcinoma can be divided into three groups, based on growth patterns.


superficial basal cell carcinoma, formerly known basal cell carcinoma in situ, is characterized by proliferation of neoplastic surface basal cells. This tumor is usually sensitive to chemotherapy issue, such as Aldara (imiquimod), or fluorouracil.

infiltrative basal cell carcinoma, which also includes morfea and micronodular basal cell cancer is more difficult to treat with conservative methods, given its tendency to penetrate into the deeper layers of the skin.


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Nodular basal cell carcinoma includes most of the remaining categories of basal cell cancer. It is not unusual to find heterogeneous morphological characteristics within the same tumor.

Absent periods

In many cases, absence of periods are not a cause for concern. However, sometimes an underlying medical condition may be responsible for that will have to be investigated and treated.


Some girls are not going to start their periods by the expected age, and there are several reasons why periods can stop naturally at certain times.


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For example, your periods will stop during pregnancy, during breastfeeding, or after menopause. Some types of contraceptives can also make you temporarily stop having periods.


underlying medical conditions


The medical name for the periods of absence is amenorrhea. The absence of periods can sometimes be a sign of an underlying medical condition, such as:

Polycystic ovary syndrome (PCOS) - a condition where the ovaries do not release an egg regularly (ovulate)

hypothalamic amenorrhea - where part of the brain that regulates the menstrual cycle stops working properly; this is thought to be caused by excessive exercise, excessive weight loss or stress

hyperprolactinemia - when a person has abnormally high levels of a hormone called prolactin in the blood

POF - where the ovaries stop functioning properly in women who have not yet reached the age of natural menopause (usually from age 50)


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When to seek medical advice

You should consult your doctor if you are concerned about any problems with your periods so they can try to find the cause.

Depending on what your doctor thinks may be the cause of your absent periods, you may be referred to a specialist for further investigation and necessary treatment.

More information about the diagnosis of absent periods.

Who is affected?

It is relatively common to stop having periods after being with them. This is known as secondary amenorrhea, and is estimated to affect 1 in 25 women at some point in their lives.

It is more common in adolescent girls and young women, especially in certain groups, such as professional athletes, dancers and gymnasts.

Do not start their periods by the expected age (primary amenorrhea) is much less common. It is estimated to affect 1 in 300 girls.

Treatment periods of absence


Treatment for the absence of periods depend on the cause. For example, the syndrome often can control the use of hormonal treatments, while women with hypothalamic amenorrhea often start having regular periods if cut in exercise and achieve a healthy weight.

In some cases, doctors may recommend waiting to see if their return periods or start your own.

Sometimes it is not possible for periods to be restored with treatment. This is usually the case of the absence of periods caused by premature ovarian failure.

appendix cancer Treatment

Appendicular appendix cancer or cancers are rare malignant tumors of the vermiform appendix.


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Gastrointestinal stromal tumors are rare tumors with malignant potential. Primary lymphomas can occur in the appendix. Breast cancer, colon cancer and tumors of the genital tract of women can metastasize in Appendix

Treatment


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The treatment for tumors varies. Carcinoid small (<2 cm) without features of malignancy can be treated by appendectomy if complete removal is possible. Other carcinomas and adenocarcinomas may require colectomy right. Note: The term "carcinoid" is outdated: These tumors are now more accurately called "neuroendocrine tumors." For more information, see "appendix neuroendocrine tumors."

pseudomyxoma peritoneal treatment includes cytoreductive surgery involving the removal of a visible tumor and affected vital organs within the abdomen and pelvis. The peritoneal cavity with heated chemotherapy is infused known as HIPEC in an attempt to eradicate residual disease. Surgery may or may not be preceded or followed by intravenous chemotherapy or HIPEC

localized disease


localized disease

localized (carcinoma-in-situ) and the precursor condition, anal intraepithelial neoplasia (AIN or anal dysplasia) disease may be minimally invasive ablation methods such as infrared photocoagulation.


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Previously, anal cancer was treated with surgery, and early-stage disease (ie, localized cancer of the anus without metastasis to the inguinal lymph nodes), surgery is often curative. The difficulty with surgery has been the need to eliminate internal and external anal sphincter, with concomitant fecal incontinence. For this reason, many patients with anal cancer have required permanent colostomy.


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The gold standard current therapy is chemotherapy and radiation treatment to reduce the need for debilitating surgery. This approach "combined modality" has led to increased preservation of an intact anal sphincter, and therefore a better quality of life after definitive treatment. The survival and cure rates are excellent, and many patients are left with a functional sphincter. Some patients have fecal incontinence after combined chemotherapy and radiotherapy. Biopsies to document regression after being advised chemotherapy and radiation sickness, but are not as frequent longer. Current chemotherapy is continuous infusion of 5-FU for four days with mitomycin bolus administered with radiation. 5-FU and cisplatin are recommended for metastatic anal cancer


Anal cancer is cancer (malignant tumor) that arises from the anus, the distal opening of the gastrointestinal tract. It is a separate entity from the more common colorectal cancer

Anal cancer is typically a squamous cell carcinoma arising annals near the squamocolumnar, often union related to infection by human papillomavirus (HPV). You can keratinizing (Basaloid) or nonkeratinizing (cloacogenic). Other types of anal cancer are adenocarcinoma, lymphoma, sarcoma or melanoma. From the data collected 2004-2010, the survival rate five years relative in the United States is 65.5%, although individual rates can vary depending on the stage of cancer at diagnosis and response to the tills

HIV/AIDS

HIV/AIDS Treatment 


HIV and acquired immunodeficiency syndrome (HIV / AIDS) is a spectrum of diseases caused by infection with HIV (HIV). After initial infection, a person may not notice any symptoms or may experience a brief period of influenza illness.Typically, this is followed by a prolonged period without symptoms.As infection progresses, more interferes with the immune system, increasing the risk common infections such as tuberculosis and other opportunistic infections and tumors that rarely affects people who work late systems.These immune symptoms of infection are known as AIDS.This stage often also associated with weight loss .

HIV is spread primarily through unprotected sex (including anal and oral sex), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, childbirth or breastfeeding. Some body fluids, such as saliva and tears, do not transmit HIV. Prevention methods include safe sex, needle exchange programs, treatment of infected persons, and male circumcision. A baby disease can often be prevented by giving both mother and child medication.There antiretroviral no cure or vaccine; However, antiretroviral treatment can slow the course of the disease and can lead to an almost normal life expectancy.Treatment is recommended as soon as the diagnosis is made. Without treatment, the average survival time after infection is 11 years.

In 2014 some 36.9 million people were living with HIV and the result was 1.2 million deaths. Most of those infected live in sub-Saharan Africa. Between its discovery and 2014 AIDS has caused an estimated 39 million deaths worldwide. HIV / AIDS is considered a pandemic, an outbreak of a disease that is present in a large area and is spreading actively. HIV is thought to have originated in West Africa Central during the late 19th or early 20th century AIDS was first identified by the Centers for Disease Control and Prevention (CDC) in 1981 and its cause infection HIV-was identified in the early part of the decade.

HIV / AIDS has had a major impact on society, both as a disease and as a source of discrimination. The disease also has great economic impacts.There are many misconceptions about HIV / AIDS, such as the belief that can be transmitted by casual non-sexual contact. The disease has become the subject of many controversies involving religion including the decision of the Catholic Church does not support the use of condoms as prevention.It has attracted medical attention and international politics, as well as large-scale financing since it was identified in the 1980s

The second most frequent mode of transmission of HIV through blood and blood products. transmission via blood can be through sharing needles during intravenous drug use, pricked with a needle, transfusion of contaminated blood or blood products or medical injections with unsterilized equipment. The risk of sharing a needle during injection drug use is between 0.63 and 2.4% for each event, with an average of 0.8% .The risk of contracting HIV from a needle stick from a HIV-infected person is estimated at 0.3% (about 1 in 333) for each act and risk after exposure of mucous membranes to infected blood as 0.09% (about 1 in 1000) per act. In the United States injecting drug users make up 12% of all new HIV cases in 2009, and in some areas more than 80% of people who inject drugs are HIV positive.

HIV is transmitted in approximately 93% of blood transfusions using infected blood. In developed countries, the risk of contracting HIV from a blood transfusion is extremely low (less than one half million), which takes place a better selection of donors and HIV screening; For example, in the UK the risk is reported at one and five million in the United States was one of 1.5 million in 2008 in low-income countries, only half the transfusions you can properly screened (from 2008), and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% Although the global infections is rare due to the detection, it is possible to get HIV from organ and tissue transplantation.

unsafe medical injections play an important role in the spread of HIV in sub-Saharan Africa. In 2007, between 12 and 17% of infections in this region is attributed to the use of medical syringe. The World Health Organization estimates that the risk of transmission as a result of a medical injection in Africa at 1.2% .Significant risks are also associated with invasive procedures, assisted delivery, and dental care in this area of the world.

People give or receive tattoos, piercings, and scarification are theoretically the risk of infection, but there are no confirmed cases they have been documented. It is not possible for mosquitoes or other insects transmit HIV.

HIV is the cause of the spectrum of the disease known as HIV / AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4 + T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4 + T cells.

HIV is a member of the genus Lentivirus, part of the Retroviridae.Lentiviruses family share many morphological and biological characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-term illnesses with a long incubation period. Lentiviruses are transmitted as positive-sense single-stranded, enveloped RNA viruses. Upon entry into the target cell, the viral RNA genome is converted (reverse transcription) in double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome into the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrates into cellular DNA encoded by a virus integrase and host cofactors. Once integrated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system. Alternatively, the virus can be transcribed, the production of new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle again.

HIV now cases of transmission between T CD4 + cells by two parallel paths are known: the free propagation cells and spread from cell to cell, that is, hybrid mechanisms diffusion is used In diffusion cell free particles virus outbreak of infection. T cells enter the blood / extracellular fluid and then infect other T cell after a chance encounter. [81] HIV may also spread by direct transmission from one cell to another by a process of spreading from cell to cell. [82] [83] hybrid mechanisms spread of HIV contributes to the continuous replication of virus with antiretroviral therapies.

They have characterized two types of HIV: HIV-1 and HIV-2. HIV-1 is the virus that was originally discovered (and initially also referred to as LAV or HTLV-III). It is more virulent, more infectious, [85] and is the cause of most HIV infections in the world. The lower infectivity of HIV-2 compared to HIV-1 implies that fewer of those exposed to HIV-2 were infected by exposure. Because of its relatively low capacity transmission, HIV-2 is largely confined to West Africa.


pathophysiology


Main article: Pathophysiology of HIV / AIDS

File: HIV and AIDS explained in a simple way.webm

HIV / AIDS explained in a simple manner

After the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. This response is accompanied by a marked decrease in the number of circulating CD4 + T cells. Viremia acute almost invariably associated with is the activation of CD8 + T cells that kill cells infected by HIV, and subsequently with antibody production, or seroconversion. The response of CD8 + T cells is thought to be important in controlling virus levels, which peak and then decreases as the CD4 + T cells recover. A good response of CD8 + T cells has been linked to progression of disease slower and prognosis, although not eliminate the virus.

Ultimately, HIV causes AIDS by depleting CD4 + T cells. This weakens the immune system and allows opportunistic infections. T cells are essential for immune response and without them, the body can not fight infections or kill cancer cells. The mechanism of cell depletion CD4 + T difference in the acute and chronic phases. During the acute phase, HIV induced cell-lysis and death of cells infected by cytotoxic T cells accounts for the depletion of CD4 + T cells, despite apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in the number of CD4 + T cells.

Although symptoms characteristic immunodeficiency AIDS do not appear for years after a person is infected, most of the loss of CD4 + T cells occurs during the first few weeks of infection, especially in the intestinal mucosa, which houses most lymphocytes are found in the body. The reason for the preferential loss of T cells of mucosal CD4 + is most T cells of mucosal CD4 + expressing CCR5 protein that HIV uses as a co-receptor for accessing cells while only a small fraction of CD4 + T cells in the bloodstream do so. A specific genetic change that alters the CCR5 protein when present on both chromosomes very effectively prevents HIV-1

HIV seeks out and destroys CCR5 cells expressing CD4 + T during acute infection. A vigorous immune response eventually controls infection and clinically latent phase starts. CD4 + T cells in mucosal tissues remain HIV replication affected.Continuous particularly causes a state of persistent along phase.Immune chronic immune activation generalized activation, reflected in the increased activation status of immune cells and the release of pro-inflammatory cytokines, the results of the activity of several HIV gene products and the immune response to HIV continuous replication. It is also linked to the breakdown of immune surveillance system gastrointestinal mucosal barrier caused by the depletion of CD4 + T cells lining during the acute phase of the disease.

Adrenocortical carcinoma

Adrenocortical carcinoma

Adrenocortical carcinoma

This carcinoma, adrenal cortex also (ACC) and cancer of the adrenal cortex, is an aggressive cancer originating in the cortex (steroid hormone-producing tissue) of the adrenal gland. This carcinoma is a rare tumor, with an incidence of 1-2 per million inhabitants annually.Adrenocortical carcinoma has a bimodal age distribution, with cases clustering in children under 5 years and adults 30-40 years old. adrenocortical carcinoma is notable for the many hormonal syndromes that can occur in patients with steroid hormone-producing tumors ( "functional"), including Cushing's syndrome, Conn syndrome, virilization, and feminization. This often carcinoma has invaded nearby tissues or organs distant metastases at diagnosis, and the overall survival rate at 5 years is only 20-35%. Steroids line producing angiotensin-II-sensitive widely used cell H295R was originally isolated from a tumor diagnosed as adrenocortical carcinoma.


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Treatment





This carcinoma may present differently in children and adults. Most tumors in children are functional, and virilization is by far the most common symptom, followed by the syndrome and Cushing early puberty.Among adults who have hormonal syndromes, Cushing's syndrome alone is the most common, followed by mixing Cushing and virilization (glucocorticoid and androgen overproduction). Feminization syndrome Conn (excess mineralocorticoid) occur in less than 10% of cases. Rarely, hypersecretion of pheochromocytoma-like catecholamines has been reported in cancer of the adrenal cortex. The nonfunctioning tumors (about 40%, authorities vary) usually present with abdominal or flank pain, varicocele and renal vein thrombosis or may be asymptomatic and detected incidentally.


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All patients with suspected adrenocortical carcinoma should be evaluated carefully for signs and symptoms of hormonal syndromes. For Cushing's syndrome (excess glucocorticoid) these include weight gain, loss of muscle mass, purple lines on the abdomen, fat "buffalo hump" in the neck, a "moon" face, and thinning , fragile skin. Virilismo (androgen excess) is more evident in women, and can cause excess facial and body hair, acne, enlargement of the clitoris, deepened voice, thickening of facial features, cessation of menstruation. Conn (mineralocorticoid excess) syndrome is marked by high blood pressure that can result in headache and hypokalemia (serum potassium low, which in turn can cause muscle weakness, confusion, palpitations) and renin activity plasma low and high serum aldosterone. Feminization (excess estrogen) is most easily seen in men, including breast enlargement, decreased libido and impotence.

Tuesday 29 March 2016

Acute myeloid leukemia (AML)


Acute myeloid leukemia (AML)


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also known as acute myelogenous leukemia or acute nonlymphocytic leukemia (ANLL), is a cancer of the myeloid line of blood cells, characterized by rapid growth of white blood cells abnormal that they accumulate in the bone marrow and interfere with the production of normal blood cells. AML is the most common acute leukemia affecting adults, and its incidence increases with age. Although AML is a relatively rare disease, accounting for about 1.2% of cancer deaths in the United States, its incidence is expected to increase as the population ages.


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The symptoms of AML are caused by the replacement of normal bone marrow with leukemic cells, causing a decline in red blood cells, platelets and normal white cells. These symptoms include fatigue, shortness of breath, easy bruising and bleeding, and increased risk of infection. Several risk factors and chromosomal abnormalities have been identified, but the specific cause is unclear. As an acute leukemia, AML progresses rapidly and is typically fatal within weeks or months if left untreated.


AML has several subtypes; treatment and prognosis varies among subtypes. LMA is cured in 35-40% of people under 60 years of age and 5-15% over 60 years old. Older people who are not able to withstand intensive chemotherapy have a median survival of 5-10 months.



AML is treated initially with chemotherapy aimed at inducing a remission; Patients may receive additional chemotherapy or hematopoietic stem cells. Recent research on the genetics of AML has resulted in the availability of tests that can predict which drug or drugs may work best for a particular patient, and the time the patient is likely to survive. Treatment and prognosis of AML differ from those of chronic myelogenous leukemia (CML) in part because cell differentiation is not the same; AML involves a higher percentage of undifferentiated and differentiated cells, including more blasts (myeloblasts, Monoblasts and megakaryoblasts).

The first clue to the diagnosis of AML is typically an abnormal result on a complete blood count. While an excess of abnormal white blood cells (leukocytosis) is a common finding, and leukemic blasts are sometimes seen, AML can also present with decreases isolated on platelets, red blood cells, or even with a low white blood cell count (leukopenia) .  While a presumptive diagnosis of AML can be done by examining peripheral blood smear when there are circulating leukemic blasts, a definitive diagnosis usually requires a bone marrow aspiration and biopsy appropriate.

Marrow or blood is examined under a light microscope and flow cytometry to diagnose the presence of leukemia, to differentiate AML from other types of leukemia (acute lymphoblastic leukemia, for example - ALL), and to classify subtype of disease. A sample of bone marrow or blood is typically also tested for chromosomal abnormalities by routine cytogenetics or fluorescent in situ hybridization. Genetic studies can also be performed to look for specific mutations in genes such as FLT3, nucleophosmin, and KIT, which may influence the outcome of the disease.




staining of blood smear and bone marrow are useful in distinguishing AML all, and subclassification of AML. The combination of myeloperoxidase or Sudan black dye and stain provide nonspecific esterase desired information in most cases. The reactions of myeloperoxidase or Sudan black are more useful to determine the identity of AML and ALL distinguish. Nonspecific esterase stain is used to identify a monocyte component in AML and to distinguish a poorly differentiated monoblastic leukemia ALL.

The diagnosis and classification of AML can be challenging, and should be done by a hematologist or qualified hematopathologist. In simple cases, the presence of certain morphological characteristics (eg Auer rods) or flow cytometry results can distinguish specific AML other leukemias; however, in the absence of such features, diagnosis may be more difficult


The two most commonly used classification schemes for AML are the oldest French-American-British system (FAB) system and the newer World Health Organization (WHO). According to WHO criteria widely used, the diagnosis of AML is established by demonstrating involvement of more than 20% of the blood and / or bone marrow by leukemic myeloblasts, except in the three best ways prognosis of AML with abnormalities recurrent genetic, inv  yt in which the presence of the genetic abnormality diagnostic is independently percent explosion. The French-American-British (FAB) is a little stricter, requiring a percentage of blasts of at least 30% in the bone marrow (BM) or peripheral blood (PB) for the diagnosis of AML.  AML must be carefully differentiated from "pre-leukemic" conditions such as myelodysplastic syndromes or myeloproliferative, which are treated differently.
Because acute promyelocytic leukemia (APL) has the highest curability and requires a unique form of treatment, it is important to quickly establish or exclude the diagnosis of this subtype of leukemia. Fluorescent in situ hybridization performed on blood or bone marrow is often used for this purpose as it easily identifies the chromosomal translocation [t (15; 17) (q22; q12)] that characterizes APL. There is also a need for molecularly detect the presence of protein / RARA fusion PML, which is an oncogene product that translocation.

World Health Organization


The WHO classification of acute myeloid leukemia attempts to be more clinically useful and to produce more meaningful information than the FAB criteria prognosis. Each of the WHO categories contains numerous descriptive subcategories of interest to the hematopathologist and oncologist


signs of leukemia ,chronic lymphocytic leukemia ,  acute lymphocytic leukemia