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Stridor is an inspiratory noise (heard when the child is breathing in) which has been described as sounding like the bark of a seal. It generally indicates some obstruction or narrowing of the windpipe (trachea). The most common cause is croup, which is relatively common in young toddlers, and which is caused by a viral infection. However, stridor is occasionally caused by a condition called epiglottitis, which is due to a germ and which is serious and potentially life threatening (and for which immunisation is now available). It may also be caused by an inhaled foreign body.

Croup

Croup is very common in young children. It is usually associated with a cold (and is therefore more common in winter), and for the most part is not a serious condition. However, the obstruction to the breathing tube is occasionally severe enough to cause breathing difficulties, and the child needs urgent medical attention and sometimes observation and treatment in hospital.

Cause

The stridor or croup that is heard when the child breathes in is caused by swelling of the breathing tube just below the vocal cords. This is caused by one of the viruses that are responsible for the common cold.

Clinical features

The child usually has symptoms of a cold before the onset of croup, including a runny nose, sore throat, fever, and irritability. He then develops a harsh, barking cough, sometimes a hoarse voice, and then noisy breathing. The noise is heard when he breathes in (in contrast to asthma, in which the wheeze occurs as the child breathes out).

The stridor and the cough are usually worse at night and when the child is distressed. In the majority of children, the symptoms improve over a few days and then disappear. In a small number of children the croup is more severe and the child has difficulty with breathing. Sometimes there will be drawing in of the child’s breastbone and the muscles between the ribs, as well as flaring of the nostrils. He may appear restless and have trouble feeding and drinking, and will not want to lie down. Severe croup requires emergency medical attention.

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This is a situation in which a newborn’s red blood cells are destroyed because the mother’s and the baby’s blood groups are incompatible. During pregnancy and mainly during delivery some red blood cells from the foetus cross the placenta and enter the mother’s bloodstream. If the mother is Rhesus negative and the foetus is Rhesus positive, the mother will produce antibodies (immunity) which recognise the foetal red blood cells as foreign. During a first pregnancy there is little chance that this will become a problem. However, in a subsequent pregnancy the mother’s immune response is more vigorous and her antibodies cross the placenta and attack the foetus red blood cells. This can lead to problems of anaemia and oedema (fluid overload) while the baby is still in the womb, and to severe jaundice of the baby after birth (due to the release of a substance called bilirubin from the damaged red blood cells).

To prevent problems resulting from Rheus incompatibility, Rheus negative mothers are given a substance called anti-D immediately after delivery. This destroys any Rhesus positive cells from the foetus which are present in the mother’s bloodstream, preventing the mother from mounting an immune response. Because antibodies do not develop a subsequent pregnancy is problem free.

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“Why can’t we come together? We have tried every trick in the book. We never climax together.”

ANSWER: Nobody ever comes together if by that you mean simultaneous pelvic muscle contraction. If it does happen, it is rare and an accident, mere chance and luck. The effort to accomplish this mutual reflex would be like trying to sneeze together. You might be able to do it, but you would wait a long time, and even if you did it, you would wonder why. Trying to have pelvic contractions together only gets in the way of enjoying psychasms together, which is much more satisfying because they are much longer and easier to share. Remember that orgasmic contractions last less than fifteen seconds. It makes little sense to spend most of the sexual encounter to synchronize your fifteen seconds. A super marital sex rule is that where you are going together is much more important than trying to end together. It’s too bad the-word “climax” was ever used. A better word might be to ‘ ‘preamble” together, to start instead of end. You might try using a less motion-oriented vocabulary of “come,” “get,” and “do” in favor of the more experiential terms of “share,” “feel,” and “be.”

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I have already said that any cell can be killed by radiation, provided the dose is high enough. So, what is it that prevents us from using radiation to cure all people with cancer?

The first problem is that radiation (with a few exceptions which I will mention later) is, like surgery, a local form of treatment. Only known cancer deposits, or areas that are very likely to be involved, are treated. This means that any undetected groups of cancer cells lying outside the irradiated area escape treatment. The treatment then cannot cure the patient, not because it fails to kill the treated cells, but because some cells are not treated at all. It is exactly the same sort of problem as we have with surgery that is aimed at cure. Careful assessment reduces the chance of some cancer escaping untreated. However, as you know, there are no tests that are capable of picking up very tiny groups of cancer cells. This means that even the most careful search for secondaries followed by a course of treatment which kills every cancer cell in the treated area cannot be guaranteed to produce a complete and permanent cure.

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The sufferer attempts to manipulate his circumstances and those around him to his own advantage. Suicide attempts may be made and are usually arranged so as not to be successful.

These patients become attached to, and dependent on, their doctors. They may improve a little to encourage him, then relapse or develop new symptoms if he appears less interested or too casual.

Hysteria may occur with, and complicate, real physical or other emotional illnesses. This may be seen with accident cases which are subject to compensation, either from injury at work or on the road.

Some cases of shell shock in wartime were due to hysteria. The soldier may develop marked tremors or withdraw into a passive state, take to bed and require to be fed and washed, and may even lose control of the bladder and bowels.

Improvement occurs when he is removed from the active theatre of war and the symptoms recur if he is to be posted back to active duty.

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When we speak of a person being anaemic, we mean he is pale and the pallor is thought to be due to a lack of blood. Oxygen is carried from the lungs to the tissues attached to the red blood cells. These erythrocytes contain a substance, haemoglobin, which has a high affinity for oxygen.

This haemoglobin, which is a complex chemical, contains iron as an essential part of its make-up.

The red blood cells are made in the bone marrow. There are about five million red blood cells to every cubic millimetre of blood and the average man has about 11 pints of blood in his system.

The red cells have a life of about 120 days and when they are aged, they are broken down by the liver and the spleen. The iron in the haemoglobin is then transferred to the body’s store and can be used again.

A shortage of the element iron will lead to problems with the red blood cells — they will contain less haemoglobin and they will be less in number.

This is the condition known as iron deficiency anaemia.

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How did I get endometriosis?” women want to know. “Why me?” “Why is one woman susceptible to the disease and not another?” doctors ask.

Endometriosis is not a disease with a single cause. Clinicians have long been attempting to find the key to the onset of endometriosis. Is it associated with a virus, a weakness in the immune system, a hereditary predisposition, or is it related to personality—especially in regard to coping with stress or numerous other environmental variables?

Further probing brings up other questions of why one woman will fall victim to endometriosis and not another: Is the susceptibility traceable to a balance, or imbalance, of some combination of factors? Can you accidentally give yourself endometriosis as the result of a fall or any other accident? How implicated are birth control pills or even intrauterine influences from before you were born?

Ingenious laboratory experiments and dedicated scientific observations over the last decade have added to a vast body of knowledge about the disease. We have solved a few intriguing riddles about this condition, although we are still puzzling through the many possible theories. Of them, a number have been scientifically validated; others are myths—or misinformation—but they tend to hold a certain power for believers.

There could be no better time than now to find the Cause and cure of endometriosis. Women understand their bodies and arc more informed partners in their health care. This is an extraordinary time in women’s lives. Contemporary pressures and biological nuances—such as high-pressure life-styles and the problems of delaying childbirth, in combination with abnormal menstrual bleeding—have significantly added to the number of victims of endometriosis. Overwork, worry, fatigue, and stress-related illnesses common to working women also contribute to the onset of the disease.

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Eczema frequently becomes infected, and in such cases oral antibiotics may be very useful. In general it is better to treat infection with oral antibiotics than with antibiotic creams. More potent cortisone-based creams are of course sometimes necessary, but they should be reserved for sparing and infrequent use on the more severely affected areas of the skin. This is because of

their well-known local and internal side-effects, which will be discussed elsewhere.

It is still unknown what the place of diet is in the management of these children. Some workers have found that breastfeeding for as long as possible may delay the onset of atopic eczema in some so predisposed children. This work has as yet not been confirmed. Some children improve when goats’ milk or soya-based milk is substituted for cows milk. This is usually only of benefit to children that show other evidence of milk-protein allergy, and rarely has any prolonged benefit for children with eczema alone. Occasionally the parents will notice that the ingestion of one or two specific foods is followed by severe itching, and it seems sensible for them then to avoid these foods. However the withdrawal of potentially essential nutrients, in the hope that a cure for eczema might be found, it ill advised.

The hospitalization of those cases of severe generalized eczema which do not respond to normal treatment is often extremely beneficial. This enables one to remove the child from a potential area of stress, and allows more adequate reassessment and the introduction of a controlled, supervised treatment programme. In particular it is very useful to be able to bandage the child adequately, so that the skin which has been scratched has an opportunity to heal and regain its normal function. This can only be done by skilled nursing staff, who can then train the parents to follow this regimen at home if necessary. In hospital surroundings ‘messy’ creams and potions (which are often very useful) may be used without the parents becoming too upset about the appearance of their child’s bed linen. In hospital surroundings it is also much easier to reintroduce a normal diet for children who have been unnecessarily restricted in this regard. It is common experience for parents who may never have seen their child’s skin normal and clear to be astounded, after one week’s hospitalization, at the sight of their child with normal skin, astounded at how the skin ‘really looks’. Of course once the skin is back to normal it is much easier to keep it that way, and the parents should now have the confidence and skills required to do so.

What future or prognosis do these children have? It is often stated, quite correctly I believe, that children usually ‘grow out of eczema. This is because their oil and sweat glands mature and begin to function normally. Consequently their skin becomes less dry, less easily overheated and irritable; consequently the attacks of eczema become less and less frequent. More specifically however, the prognosis is related to whether the genetic pie-disposition is present in one or both parents. Statistically, many children have cleared by the age of 2 years, and at least 50 per cent are clear by the age of 6. Of the remaining 60 per cent, 30 per cent will clear by the age of 12, and a further 10 per cent by the age of 15.

This, however, does leave some 10 per cent of individuals who still get eczema over the age of 15. The older child or adult with persistent eczema may have it localized to just the hands, the creases, or some other less important area. This group must avoid contact with sufferers of active cold sores, and should not receive smallpox vaccinations as complications of a severe kind may result. They would be best advised to avoid those occupations which involve contact with irritant chemicals, including; oils, degreasing agents, and various hairdressing solutions. Other than this, it is important that affected children lead a normal life.

It must be stressed that children with eczema require continuing support and careful explanation of how they can learn to live within their skin’s capabilities; they need reassurance that their life can be made more comfortable, and that no permanent disfigurement will result. Worrying, especially about such things as these, will lower the individual’s threshold to skin irritation, and lead to more scratching and aggravation of the eczema.

Although the family must give a child with eczema special attention, it is important that the child not be allowed to ‘rule the roost’; rather firmness, with love, should be employed by the parents. When the child is older he must become an active participant in life rather than a passive recipient of treatment.

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