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Benign Prostatic Hypertrophy
The prostate gland is located in the midline at the junction of the urinary bladder and urinary passage in the penis. It is present only in men and is about 20 gms in weight at 20 yrs of age, but increases in size to about 50 gms by the age of 80 yrs.
It surrounds the urinary passage on all sides just below the bladder and this part of the urinary passage is called prostatic urethra. The prostate gland is a chemical factory. It produces secretions which act as lubricants, produces chemicals which can increase or decrease blood pressure. It also produces a substance called prostacyclin which reduces blood clotting by stopping platelets from adhering to each other.
As the prostate enlarges over the age, in about 20% of men, it can produce symptoms or obstruction. The incidence of obstruction rises with advancing age. The symptoms of prostatic enlargement are often referred as LUTS (men) or lower urinary tract symptoms.
Urgency or inability to hold urine for adequately long time
Precipitancy or voiding rapidly at times soiling undergarments
Frequency or repeatedly passing urine more often
Hesitancy or difficulty in starting urination
Feeling of incomplete evacuation of urine
Incontinence or passing urine at times in clothes
Nocturia frequent getting up at night to pass urine
Later on a person may develop retention or a full bladder, urge to pass urine but the inability to do so.
The symptoms do not always progress and may even improve spontaneously in many. In some cases, if the passage of urine is obstructed, the bladder wall becomes thick and pressure generated for passing urine may damage the kidneys leading to renal failure.
Investigations for prostate disease.
The symptoms are investigated by
Rectal examination to look for prostate cancer.
Ultrasound examination of bladder, prostate, amount of retained urine after voiding, nodules in the prostate etc
Uroflowmetry or the time and volume study as urine is passed. Normally a person should pass urine at a rate of > 20 ml/sec.
Urine routine examination.
Prostate surface antigen Or PSA which increases with kidney size but is an important marker of cancer of the prostate.
Treatment is both by drugs (in early cases) and by surgery in advanced cases. The drugs used are Alfa blockers which decrease the resistance to urine flow in prostate and finasteride (inhibits enzyme converting testosterone to DHT a more active form). Finasteride, dutasteride and similar drugs reduce prostate size over months.
Surgical treatment consists of the removal of partial or total of the prostate gland. It can also be done via laser (TURP) and more refined means.
For patients suffering from type II /adult onset diabetes :In type II diabetes, diagnosis is often late (after the disease has already been present for some time). In early days T2DM (short for the adult type of diabetes) are often without symptoms. Hence the delay in diagnosis. This means complications will be seen early after diagnosis. Foot Care :
Foot disease in diabetes may lead to difficulty in walking, pain and may lead to infections. If neglected amputation may be required.
Inspect feet with a mirror before going to sleep every night.
Use well fitting shoewear.
Do not walk bare feet even in the house.
Socks should be clean and correct size.
In case of deformities of feet, special shoes can be worn. Eye Care :
It is nowadays the commonest cause of blindness throughout the world. Continue Reading ~ Second Medical Opinion / Advice
Nephrotic Syndrome Kidneys receive approximately 1 liter of blood every minute. Of this, about 100 ml gets filtered in the kidney. This contains, small molecules and few large molecules. This is due to the intricate cellular structure that prevents proteins from getting filtered into the urinary space. A derangement of this filter results in passage of heavy amounts of proteins in urine. This condition is called HeavyProteinuria or Nephrotic syndrome or Nephrosis. Definition:
In the urine, the protein excretion is > 3.5 gm/day or in children, it is >50mg/kg of body weight. In most cases, the serum albumin is <3gm/dl (normal>4), and passage of lipids in the urine. The lipids in the blood increase and swelling of face and feet also occur. Causes of Nephrotic Syndrome:
In children, most cases are due to Minimal Change Disease, FSGS, MPGN etc. In adults, most cases are due to primary illness while upto 30% may be due to secondary illness. Clinical Features:
Apart from Edema, ther…
Asthma or Bronchial Asthma is a common disease. About 75 % cases start in childhood before 10 years of age. A large no of patients stop having symptoms at the time of puberty and some may again have the disease in the later years. It is uncommon after 50 years of age. It can be troublesome, disabling and if not treated properly may be dangerous.
The disease results from heightened reactivity of the airways in response to irritants, allergens, fumes and at times exercise. It is typically intermittent and a person feels well when there is no ongoing attack of asthma. Symptoms:
Symptoms of asthma are shortness of breath, difficulty in breathing, cough and whistling sounds during breathing. These symptoms may also be seen in a no of heart, lung or infective conditions. Hence the diagnosis is usually made by experienced doctors after a few episodes have occurred!
The important markers of the disease are rapid reversibility of the signs and symptoms with appropriate treatment or spontaneousl…