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  • Benign Prostate Hyperplasia
  • Organ Transplantation
  • Invasive Fungal Infections
  • Chemotherapy Induced Nausea
  • Overactive Bladder
  • Hypertensive Crisis

What is the prostate gland?

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).

Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function. A urologist is a specialist in diseases of the urinary system, including diagnosing and treating problems of the prostate gland.

How does the doctor detect prostate enlargement?

A doctor usually can detect an enlarged prostate by rectal exam. The doctor also may examine the urethra, prostate, and bladder using a cytoscope, an instrument that is inserted through the penis.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hyperplasia and abbreviated as BPH.

When does benign prostatic hyperplasia start?

BPH generally begins in a man's 30s, evolves slowly, and most commonly only causes symptoms after 50.

What happens in BPH? What are symptoms of BPH?

In BPH, the prostate gland grows in size. It may compress the urethra which courses through the center of the prostate. This can impede the flow of urine from the bladder through the urethra to the outside. It can cause urine to back up in the bladder (retention) leading to the need to urinate frequently during the day and night. Other common symptoms include a slow flow of urine, the need to urinate urgently and difficulty starting the urinary stream. More serious problems include urinary tract infections and complete blockage of the urethra, which may be a medical emergency and can lead injury to the kidneys.

How common is BPH? Are there any risk factors?

BPH is extremely common. Half of all men over 50 develop symptoms of BPH, but only 10% need medical or surgical intervention.

Is BPH a type of cancer?

No! BPH is completely benign. It is not a precursor (a forerunner) to prostate cancer.

Is BPH always treated?

No. Treatment of BPH is usually reserved for men with significant symptoms. Watchful waiting with medical monitoring once a year is appropriate for most men with BPH.

How is BPH treated?

There are several different ways to treat BPH:

  •     Watchful waiting is often chosen by men who are not bothered by symptoms of BPH. They have no treatment but get regular checkups and wait to see whether or not the condition gets worse.
  •     Medical treatment of BPH is usually reserved for men who have significant symptoms. The available drugs include
    •         alpha blockers relax the smooth muscles of the prostate, and the bladder neck, which helps to relieve urinary obstruction caused by an enlarged prostate in BPH. Side effects can include headaches, fatigue, or lightheadedness. Commonly used alpha blockers in BPH include tamsulosin (Harnal), alfuzosin (Uroxatral), and older medications such as terazosin (Hytrin) or doxazosin (Cardura). These drugs generally will lead to improvement in symptoms within several weeks and have no effect on prostate size; and
    •         5-alpha reductase inhibitors block the conversion of the male hormone testosterone into its active form in the prostate (DHT). The prostate enlargement in BPH is directly dependent on DHT, so these drugs lead to an approximate 25% reduction in prostate size over six to 12 months. For this reason, improvement in urinary symptoms most commonly takes this long to occur. Examples of 5-alpha reductase inhibitors include Finasteride (Proscar) and dutasteride (Avodart). Side effects of finasteride may include declining interest in sex, problems getting an erection, and problems with ejaculation.
  •     Surgery or office procedures may also be used to treat BPH, most commonly in men who have not responded satisfactorily to medication or those who have more severe problems, such as a complete inability to urinate.
    •         Transurethral resection of the prostate (TURP) has been used for the longest period of time. After the patient is given anesthesia, the doctor inserts a special instrument into the urethra through the penis. With the instrument, the doctor then shaves away part of the inner prostate to relieve the outflow of urine from the bladder.
    •         Laser procedures: A number of laser procedures are available, some of which can be performed in the doctor's office with minimal anesthesia. These procedures also involve the removal of obstructing prostate tissue. They are generally associated with less bleeding and quicker recovery than TURP but may not be as effective over the long term in some men.
    •         Microwave therapy: This procedure is generally performed in the office and involves the use of microwave energy delivered to the prostate to kill some of the cells leading eventually to shrinkage of the prostate.

Men should carefully weigh the risks and benefits of each of these options. Prostate surgery has traditionally been seen as offering the most benefits for BPH but unfortunately carries the most risks.

For more information you may go to: http://www.medicinenet.com/benign_prostatic_hyperplasia/article.htm


What is an organ transplant?

An organ transplant replaces a failing organ with a healthy organ. A doctor will remove an organ from another person and place it in your body. This may be done when your organ has stopped working or stopped working well because of disease or injury.

Not all organs can be transplanted. Organs most often transplanted include:

  •     The kidney, because of diabetes, polycystic kidney disease, lupus, or other problems.
  •     The liver, because of cirrhosis, which has many causes.
  •     The heart , because of coronary artery disease, cardiomyopathy, heart failure, and other heart problems.
  •     The pancreas, because of diabetes.
  •     The lung , because of cystic fibrosis, COPD (Chronic Obstruction Pulmonary Disease), and other problems.
  •     The small intestine, because of short bowel syndrome caused by necrotizing enterocolitis, Crohn's disease, and other problems.

More than one organ can be transplanted at one time. For example, a heart and lung transplant is possible.

everyone is a good candidate for an organ transplant. Your doctor or a transplant center will do tests to see if you are. You probably are not a good candidate if you have an infection, heart disease that is not under control, a drug or alcohol problem, or another serious health problem.

How successful is an organ transplant?

Organ transplants have been done in the United States since the 1950s. The procedure is always improving, and transplants are more successful today than ever before. Organ transplant success depends on:

  •     Which organ is transplanted.
  •     How many organs are transplanted. For example, you could have a heart transplant or a heart and lung transplant.
  •     The disease that has caused your organ to fail.

How do you prepare for an organ transplant?

First, you'll need to have blood and tissue tests done that will be used to match you with a donor. This is because your immune system may see the new organ as foreign and reject it. The more matches you have with the donor, the more likely your body will accept the donor organ.

You'll need to take care of your health. Continue to take your medicines as prescribed and get regular blood tests. Follow your doctor’s directions for eating and exercising. You also may want to talk with a psychiatrist, psychologist, or licensed mental health counselor about your transplant.

To learn more about what happens, talk to someone who has had a transplant. Your transplant center or doctor can give you the name of someone who is willing to share his or her experience with you.

You may have to wait days, months, or years for your transplant. Be patient, and ask your doctor what you can do while you're waiting.

What can you expect afterward?

After a transplant, many people say they feel better than they have in years. What you can and can't do will depend on the type of transplant you had, other health problems you have, and how your body reacts to the new organ.

You will have to take daily antirejection medicines for the rest of your life to prevent your immune system from rejecting the new organ. You will need less of these medicines as time goes by.

Because these antirejection medicines weaken the immune system, you may have to stay away from large crowds for a while and stay away from people who have infections. Be sure you talk to your doctor before you take any nonprescription medicines, such as cold remedies. These medicines may cause problems with your antirejection medicines.

You will also have regular checkups and blood tests to see how well your new organ is working.

Depression is common after an organ transplant. If you think you may be depressed, get help. The earlier depression is treated, the more quickly you will feel better.

You may need to make some lifestyle changes to keep your new organ healthy and strong. This can include eating healthy foods, getting regular exercise, and getting enough sleep. Your doctor can help you plan any needed changes. Keeping in touch with your doctor, taking your medicines, going to your doctor appointments, and making lifestyle changes are all important.

Who can be an organ donor?

Most people can be organ donors. Many people choose to donate an organ upon their death. But a person can donate certain organs while he or she is still living. These people are called "living donors." To be a living donor, you must be in good health and be physically fit, free from long-term diseases such as diabetes or high blood pressure, free from mental health problems, and between the ages of 18 and 60.

Source: WebMD

More transplantation info please visit: www.transplantexperience.com


Invasive Fungal Infections (IFI)

Invasive fungal infections caused by yeast and mold are a growing problem in health care. From 1980 through 1997, invasive mycoses increased from the 10th most common cause of death from infectious diseases to the 7th most common.[1] The major factors responsible for this increase in fungal infections have been advances in medicine, which have enabled or prolonged the survival of susceptible patients, including those undergoing solid organ and bone marrow transplantation, improved therapeutic outcomes for critically ill patients, and the HIV epidemic.

Candida species are the predominant pathogens associated with nosocomial fungal infections, particularly in the intensive care unit (ICU).[2] This is further complicated by the emergence of non-Candida albicans species, such as Candida glabrata. A recent study describing the annual incidence of primary Candida bloodstream infections among ICU patients noted that there was a significant increase in the rate of bloodstream infections due to C. glabrata and a decrease in C. albicans-related infections.[3] This trend is alarming, given that C. glabrata has variable susceptibility to the commonly used antifungal agent fluconazole, which has been a drug of choice for the treatment of Candida infections since its introduction in the early 1990s. A recent review of global trends in species distribution and in vitro susceptibility among 6082 bloodstream isolates of Candida species collected from 250 medical centers in 32 nations over a 10-year period (1992-2001) found that fluconazole resistance among C. glabrata isolates was greatest in the United States and varied by U.S. Census region.[4] The potential for triazole cross-resistance may limit the clinical utility of second-generation triazoles, such as voriconazole, against this pathogen.[5] Although fungal infections caused by invasive aspergillosis are not as common as those caused by Candida species, their impact on immunosuppressed patients is on the rise. A retrospective cohort study of 5589 patients who underwent hematopoietic stem cell transplantation (HSCT) over a 15-year period at a large cancer center found that the incidence of invasive aspergillosis had at least tripled among both allograft and autograft recipients.[6] Every antifungal agent used to treat invasive aspergillosis has issues that limit its use. Amphotericin B deoxycholate, the conventional formulation of amphotericin B that has been the mainstay of treatment since the late 1950s, is notorious for infusion-related adverse effects and nephrotoxicity. While lipid-based amphotericin B formulations have helped to reduce these adverse effects, their acquisition cost may present a problem for some institutions. The secondgeneration triazole antifungal, voriconazole, is highly effective against invasive aspergillosis, but the potential for drug-drug interactions is of concern. Therefore, the introduction of a novel antifungal class, the echinocandins, provides clinicians with another treatment option for these pathogens.

Originally the echinocandins were named pneumocandins because of their in vitro activity against Pneumocystis jiroveci (formerly P. carinii) and Candida species.[7] The first of these compounds to undergo preclinical evaluation was cilofungin; however, further development was not pursued because of toxicity associated with the i.v. polyethylene glycol formulation vehicle. Caspofungin (Cancidas, Merck & Co.), introduced in 2001, was the first echinocandin to receive marketing approval from the Food and Drug Administration (FDA), followed by micafungin (Mycamine, Astellas Pharma) in March 2005. A third echinocandin, anidulafungin (Eraxis, Pfizer), was approved by FDA in February 2006.

Source: http://www.medscape.com/viewarticle/545478

Chemotherapy Induced Nausea & Vomiting

Nausea and vomiting are common side effects of chemotherapy treatment for cancer. But in most cases, these side effects can be controlled with preventive medications and other measures. If you're considering chemotherapy, you and your doctor can take steps to prevent or decrease nausea and vomiting associated with chemotherapy. This can help make you more comfortable during your cancer treatment.

Who's at risk of nausea and vomiting during and after chemotherapy?

Whether you'll experience nausea and vomiting as a result of chemotherapy depends on what chemotherapy drugs you receive, whether you receive other cancer treatments — such as radiation — during your chemotherapy treatment, and whether you've experienced nausea and vomiting in the past.

Chemotherapy drugs that cause nausea and vomiting

Certain chemotherapy drugs are more likely than are others to cause nausea and vomiting. Some medications associated with significant risk of these side effects include:

  •     Altretamine
  •     Busulfan
  •     Carmustine
  •     Cisplatin
  •     Cyclophosphamide
  •     Dacarbazine
  •     Doxorubicin
  •     Epirubicin
  •     Estramustine
  •     Etoposide
  •     Ifosfamide
  •     Lomustine
  •     Mechlorethamine
  •     Procarbazine
  •     Streptozocin
  •     Temozolomide

If you'll be receiving one of these chemotherapy drugs, preventive measures are available to help you avoid these side effects.

Whether a drug will cause nausea and vomiting also depends on the amount you receive. Some drugs may be less likely to cause side effects at lower dosages. Ask your doctor whether your treatment plan is likely to cause nausea and vomiting.

Personal factors that may increase your risk

Not everyone reacts to chemotherapy in the same way. Certain factors may make you more vulnerable to treatment-related nausea and vomiting. You may be more vulnerable if one or more of the following apply to you:

  •     You're a woman.
  •     You're younger than 50.
  •     You've experienced nausea and vomiting with previous treatments, or you have a history of motion sickness.
  •     You have a high level of anxiety.
  •     You experienced morning sickness during pregnancy.
  •     You are prone to vomiting when you're sick.
  •     You have a history of drinking little or no alcohol.

In addition, if you expect that your treatment will cause nausea and vomiting, there's a chance that it will. You can become so convinced that nausea and vomiting will occur that it does occur. This might happen if you think, like many people do, that all cancer treatments cause these side effects, which isn't true. Your doctor can tell you specifically whether the treatment you'll receive is likely to cause nausea and vomiting.

How do doctors prevent nausea and vomiting?

Most people undergoing chemotherapy receive anti-nausea (anti-emetic) medications to prevent nausea and vomiting. These drugs, given alone or in combination, can be taken in pill form or administered through a vein in your arm. Your doctor advises which to use based on the treatment you're receiving.

Anti-nausea medications are typically given before treatment begins and on a scheduled basis for several hours or days after treatment. You may receive additional medications if you develop nausea and vomiting after chemotherapy.

Your doctor determines which anti-nausea medications to use based on your specific situation, for example, what type of chemotherapy drugs you're receiving. Drugs used to prevent nausea and vomiting include:

  •     Aprepitant
  •     Dexamethasone
  •     Dolasetron
  •     Dronabinol
  •     Droperidol
  •     Granisetron
  •     Haloperidol
  •     Methylprednisolone
  •     Metoclopramide
  •     Nabilone
  •     Ondansetron
  •     Palonosetron
  •     Prochlorperazine
  •     Ramosetron

Drugs used to treat anxiety associated with chemotherapy nausea include:

  •     Alprazolam
  •     Lorazepam
  •     Midazolam

Doctors take this proactive approach to prevent nausea and vomiting because these side effects can be difficult to control once they begin. Nausea and vomiting can make you feel miserable, add to your fatigue and distress, and make you reluctant to stick to your treatment schedule. If you're unsure about taking anti-nausea medication when you aren't feeling nauseated, talk to your doctor about the risks and benefits of these drugs.

What additional measures can you take to prevent nausea and vomiting?

You can take steps to reduce your risk of nausea and vomiting. For example:

  •     Eat small meals.
  •     Eat what appeals to you.
  •     Drink lots of fluids.
  •     Avoid unpleasant smells.
  •     Make yourself comfortable.
  •     Use relaxation techniques.

These self-care measures may help you prevent nausea and vomiting, but they can't take the place of anti-nausea medications. If you begin to feel nauseated despite the medications, call your doctor. Treatments may include additional medications, though your individual treatment will depend on what's causing your signs and symptoms.

Source: Mayo Clinic

Overactive bladder

Overactive bladder is a problem with bladder storage function that causes a sudden urge to urinate. The urge may be difficult to suppress, and overactive bladder can lead to the involuntary loss of urine (incontinence).

If you have overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that after a brief evaluation to determine the cause of overactive bladder, you can receive treatments that may greatly reduce or eliminate the symptoms of overactive bladder and help you manage their effect on your daily life.

Source: http://www.mayoclinic.com/health/overactive-bladder/DS00827

Signs and symptoms of overactive bladder may mean you:

  •     Feel a strong, sudden urge to urinate
  •     Experience urge incontinence, the involuntary loss of urine immediately following an urgent need to urinate
  •     Urinate frequently, usually eight or more times in 24 hours
  •     Awaken two or more times in the night to urinate (nocturia)
  •     Although you may be able to get to the toilet in time when you sense an urge to urinate, frequent and nighttime urination, as well as the need to suddenly "drop everything," can disrupt your life.

When to see a doctor

Many people never talk to their doctors about their overactive bladder symptoms. Although it can sometimes be difficult to discuss such a normally private matter with your doctor, it's important that you do, especially if you experience urge incontinence or if other symptoms of overactive bladder disrupt your work schedule, social interactions and everyday activities.

Sometimes, people assume that an overactive bladder or urinary incontinence is just a normal part of aging, and simply deal with the condition by wearing absorbent undergarments or pads. But, symptoms of urgency and incontinence aren't an inevitable part of getting older, and treatments are available that might help you. Additionally, it's important to talk to your doctor because an overactive bladder and urge incontinence may occur as a result of a serious underlying problem, such as a cancerous tumor.

Source: http://www.mayoclinic.com/health/overactive-bladder/DS00827/DSECTION=symptoms

For more information you may visit: http://www.mayoclinic.com/health/overactive-bladder/DS00827/DSECTION=causes

What is Hypertensive Crisis?


Hypertensive crises can present as hypertensive urgency or as a hypertensive emergency. These two conditions occur when blood pressure becomes very high, possibly causing organ damage.
Hypertensive Urgency is a situation where the blood pressure is severely elevated [180 or higher for your systolic pressure (top number) or 110 or higher for your diastolic pressure (bottom number)], but there is no associated organ damage. Those experiencing hypertensive urgency may or may not experience one or more of these symptoms:

  •     Severe headache
  •     Shortness of breath
  •     Nosebleeds
  •     Severe anxiety

Treatment of hypertensive urgency generally requires readjustment and/or additional dosing of oral medications, but most often does not necessitate hospitalization for rapid blood pressure reduction. A blood pressure reading of 180/110 or greater requires immediate evaluation, because early evaluation of organ function and blood pressure elevations at these levels is critical to determine the appropriate management.
Hypertensive Emergency exists when blood pressure reaches levels that are damaging organs. Hypertensive emergencies generally occur at blood pressure levels exceeding 180 systolic OR 120 diastolic, but can occur at even lower levels in patients whose blood pressure had not been previously high.

The consequences of uncontrolled blood pressure in this range can be severe and include:

  •     Stroke
  •     Loss of consciousness
  •     Memory loss
  •     Heart attack
  •     Damage to the eyes and kidneys
  •     Loss of kidney function
  •     Aortic dissection
  •     Angina (unstable chest pain)
  •     Pulmonary edema (fluid backup in the lungs)
  •     Eclampsia


What are the symptoms of Hypertensive Emergency?

Symptoms of a hypertensive emergency include:

  •     Headache or blurred vision
  •     Increasing confusion or level of consciousness
  •     Seizure
  •     Increasing chest pain
  •     Increasing shortness of breath
  •     Swelling or edema (fluid buildup in the tissues)


What's the Treatment for Hypertensive Emergency and Associated Organ Damage?

In a hypertensive emergency, the first goal is to bring down the blood pressure as quickly as possible with intravenous (IV) blood pressure medications to prevent further organ damage. Whatever organ damage that has occurred is treated with therapies specific to the organ that is damaged.

Source: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp