Subarachnoid hemorrhage – a silent killer!

Subarachnoid hemorrhage (SA) is a devastating clinical phenomenon mostly commenced at the middle age (30 to 40 year). It is acknowledged that cerebral artery aneurism (dilated vessel) is a fatal procedure on this issue to initiate bleeding inside the brain from ruptured artery. Until now, the cause is unknown – demonstrating that high blood pressure, diabetes are responsible for this disease procedure; however, some studies suggest that SA is not related with these diseases. Genetic disorder can be mentioned on this issue. Closed head injury is also another precipitating cause of cerebral artery aneurism. The worst is this, the dilatation of artery has no clinical feature that after vessel-rupture, the patient feels mild headache. Now, it is obligatory to abstain from this disease procedure – imaging screening should be an ideal method. In another, from the middle decade of life, regular monitoring of blood pressure relating with imaging scanning method might be suggested, when any predisposing symptom is noticed. CT scan of head is one option.

The art of loss!

I put the title – ‘The art of loss’ to evaluate pathogenesis and investigation of central nervous system diseases. Recently one international symposium organized by Tohoku University (my host university) of Japan elucidated the imaging diagnostic procedure of central nervous system disease (neurodegeneration) with the title mentioned above. It is acknowledged that nerve cell (neuron) degeneration of central nervous system (brain) is started usually from the middle age (at the age 50 y). Dementia (memory loss) is the devastating symptom of neurodegenration. There are some investigation procedures when symptoms are pronounced – CSF assessment (spinal fluid) and imaging (MRI scan) are useful for this evaluation. Recently PET imaging (positron emission tomography) – a nuclear medicine technique has been applied to evaluate nerve cell degeneration (neurodegeneration). Thanks to this nuclear medicine imaging method. In future, this method (PET scan) might have clinical application in evaluating in dementia like (memory loss) diseases.

Imaging perspective of intestinal function!

‘Bowel dysfunction’ is a common problem relating with abnormal intestinal motility especially among female subjects – leading to gastrointestinal disorder. This bowel dysfunction consists of abnormal bowel symptoms – constipation and/or loose stool. It is argued that stress is a predisposing factor to initiate this ‘bowel dysfunction’ – might be associated with imbalance between sympathetic and parasympathetic nervous system function (autonomic nervous system). It is also suggested that improper ‘life-style’ such as abnormal food habit should also be a delicate factor. However, assessment of intestinal function (physiology and anatomy) can be a good predictor to set up appropriate medical management on abnormal ‘bowel dysfunction’. Radiological approach such as barium-swallow X-ray and/or ultrasound examination are important investigation procedures on this issue.

Herb and drug interaction!

Nowadays, the herbal medicine is becoming popular. It is acknowledged that some herbs can reduce cardiovascular symptoms-such as ginger and/or garlic have potential importance to health benefits. It is argued that these herbs (ginger and garlic) may have vital role in reducing high blood pressure and/or hypertriglyceraedemia. When the individual suffers from cardiovascular disorder, take cardiovascular drugs according to prescription. Recently some studies suggest that herbs (garlic or ginger) have adverse reactions, when they are administered with cardiovascular drugs-may induce the blood thinner than usual. Bleeding disorder is a critical phenomenon in this issue. So, it is suggested to omit the herb (ginger or garlic) combined with cardiovascular drug, to prevent from further adverse reactions.

Breast cancer and perspective!

Breast cancer is the most common malignancy among women. There are certain factors such as hormonal, environmental those initiate in developing breast cancer. Arsenic is one of the important causes of major types of breast cancer in case of environmental issue. Recently, it is reported that alcohol consumption is linked with developing breast cancer among women. Though mechanism is not clear enough, however, it is involved with genetic mutation. One cancer epidemiological survey suggested that more than one million women around the world are diagnosed with breast cancer every year and out of them 410,000 lost their lives. Now, regarding investigation procedure, ‘mammography’ is the valuable and useful diagnostic method of breast cancer mass detection. Until now, this ‘mammographic examination’ is established as only ‘screening procedure’ of breast cancer. There would be new nuclear medicine technique for future trend. Clinical examination is also mandatory in this regard. It is shown that breast cancer mass is mostly diagnosed in the later stage of malignancy. So, this is also suggested to perform ‘self examination’ to prevent fatality. Self examination and yearly screening are necessary steps.

Does swine flu (H1N1) always show the clinical features?

Swine flu (H1N1) infection has clinical features like seasonal flu in it’s early stage. However, patients show the devastating symptoms at the progressive stage of viral pathogenesis inside the body. The neurological symptoms are shocking in the advanced stage. Recently, it is shown that some H1N1 patients have negative symptoms, revealing no clinical features all around it’s pathogenesis period. One report from Japanese high school students’ survey suggest that 20% of students and teachers infected with swine flu displayed no symptoms. Then, antibody testing confirmed the positive for H1N1 for those symptomless students. It is known that H1N1 flu possesses rapid replication capacity inside the body after primary pathogenesis; however, rapid multiplication might be one reason to show symptoms among some patients and/or it might be due to person to person physiological variations. The obvious mechanism is yet to be studied. Therefore, ‘clinical screening’ might be a good option for symptomless patients.

Do we overlook ‘white coat hypertension’?

Sometime, to determine ‘clinical hypertension’ is a troublesome task for the physicians. It is said that atleast several consecutive measures should be taken to determine ‘clinical hypertension’ at both office and home. Home monitoring of blood pressure is differed from office monitoring, should be problematic one and to determine the final interpretation. Therefore, it is important to consider about ‘white coat hypertension’, revealing a rise in blood pressure at physician’s office or clinic. There should be certain mechanism; however, it is known that anxiety is responsible for the rise in blood pressure in the office, demonstrating ‘white coat hypertension’. Now, the question is to determine the fundamental measurement procedure to establish blood pressure measure among normal subjects and patients. It is known, the morbidity is higher among sustained hypertensive patients than white coat hypertensive patients; however, there is higher morbidity among the white coat hypertensive patients than clinically normotensive patients. So, it is necessary to consider this ‘white coat hypertension’ among normal population. Therefore, this suggests, home-monitoring of blood pressure is suitable to determine ‘clinical hypertension’ after considering different predisposing factors.