Anorexia nervosa

Introduction

The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when the patient is obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as “fat,” and commonly expresses dissatisfaction with a particular aspect of her physical appearance.
Although the term anorexia suggests that the patient’s weight loss is associated with a loss of appetite, this is rare. Anorexia nervosa and bulimia nervosa can occur simultaneously. With anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self-induced vomiting, or abuse of laxatives or diuretics.

Incidence
Anorexia occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising.
Although the prognosis varies, it improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15%—the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide.

Causes
No one knows what causes anorexia nervosa. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life.

Signs and symptoms
The patient’s history usually reveals a 25% or greater weight loss for no organic reason, coupled with a morbid dread of being fat and a compulsion to be thin. Such a patient tends to be angry and ritualistic. 

She may report amenorrhea, infertility, loss of libido, fatigue, sleep alterations, intolerance to cold, and constipation.

Hypotension and bradycardia may be present. 

Introduction to Hydrocephalus

An excessive accumulation of cerebrospinal fluid (CSF) within the ventricular spaces of the brain, hydrocephalus occurs most commonly in neonates. It can also occur in adults as a result of injury or disease. In infants, hydrocephalus enlarges the head, and in both infants and adults, the resulting compression can damage brain tissue.
With early detection and surgical intervention, the prognosis improves but remains guarded. Even after surgery, such complications as developmental delay, impaired motor function, and vision loss can persist. Without surgery, the prognosis is poor: Mortality may result from increased intracranial pressure (ICP) in people of all ages; infants may also die prematurely of infection and malnutrition.

Causes
Hydrocephalus may result from an obstruction in CSF flow (noncommunicating hydrocephalus) or from faulty absorption of CSF (communicating hydrocephalus).

Noncommunicating hydrocephalus
In noncommunicating hydrocephalus, the obstruction occurs most commonly between the third and fourth ventricles, at the aqueduct of Sylvius, but it can also occur at the outlets of the fourth ventricle (foramina of Luschka and Magendie) or, rarely, at the foramen of Monro.
This obstruction may result from faulty fetal development, infection (syphilis, granulomatous diseases, meningitis), a tumor, a cerebral aneurysm, or a blood clot (after intracranial hemorrhage).

Communicating hydrocephalus
In communicating hydrocephalus, faulty absorption of CSF may result from surgery to repair a myelomeningocele, adhesions between meninges at the base of the brain, or meningeal hemorrhage. Rarely, a tumor in the choroid plexus causes overproduction of CSF, producing hydrocephalus.

Lung Abscess - A Brief Discussion

A lung abscess is an infection accompanied by pus accumulation and tissue destruction. The abscess may be putrid (due to anaerobic bacteria) or non putrid (due to anaerobes or aerobes), and it commonly has a well-defined border. The availability of effective antibiotics has made lung abscesses much less common than they were in the past.

Causes
A lung abscess is a manifestation of necrotizing pneumonia, commonly the result of aspiration of oropharyngeal contents. Poor oral hygiene with dental or gingival (gum) disease is strongly associated with a putrid lung abscess. Septic pulmonary emboli commonly produce cavitary lesions. Infected cystic lung lesions and cavitating bronchial carcinoma must be distinguished from lung abscesses.

Signs and symptoms
Signs and symptoms of lung abscess include a cough that may produce bloody, purulent, or foul-smelling sputum; pleuritic chest pain; dyspnea; excessive sweating; chills; fever; headache; malaise; diaphoresis; and weight loss.

Brief Summary of Cerebral Palsy

The most common cause of crippling in children, cerebral palsy is an umbrella term for a group of neuromuscular disorders resulting from prenatal, perinatal, or postnatal central nervous system (CNS) damage. Although nonprogressive, these disorders may become more obvious as an affected infant ages.

Types:
Three major types of cerebral palsy occur—

1. spastic, 
2. athetoid, and 
3. ataxic

—sometimes in mixed forms. Motor impairment may be minimal (sometimes apparent only during physical activities such as running) or severely disabling. Associated defects—such as seizures, speech disorders, and mental retardation—are common.
The prognosis varies. With mild impairment, proper treatment may make a near-normal life possible.

Cerebral palsy is most common in premature infants (anoxia plays the greatest role in contributing to cerebral palsy) and in those who are small for their gestational age. Cerebral palsy is common in whites and is slightly more common in males than in females.

Uterine cancer

Cancer of the endometrium, or uterine cancer, is the most common gynecologic cancer. It usually affects postmenopausal women between ages 50 and 60; it’s uncommon between ages 30 and 40 and extremely rare before age 30. Most premenopausal women who develop uterine cancer have a history of anovulatory menstrual cycles or another hormonal imbalance.

Incidence
Uterine cancer has an incidence of 1% to 2% in the United States.

Causes
Uterine cancer seems linked to several predisposing factors:

• low fertility index and anovulation
• abnormal uterine bleeding
• obesity, hypertension, or diabetes
• familial tendency
• history of atypical endometrial hyperplasia
• estrogen therapy (still controversial).

Pathology

Generally, uterine cancer is an adenocarcinoma that metastasizes late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and the brain, through the blood or the lymphatic system. Lymph node involvement can also occur. Less common uterine tumors include adenoacanthoma, endometrial stromal sarcoma, lymphosarcoma, mixed mesodermal tumors (including carcinosar- coma), and leiomyosarcoma.