Monday, December 13, 2010

Interstisial Sistitis (Diagnosa yang mungkin bagi permasalahan perkemihan yang tak kunjung sembuh)


Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate, a frequent need to urinate, or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation. They may sometimes experience pain during vaginal intercourse.


People who have interstitial cystitis may have the following symptoms:

  • An urgent need to urinate, both in the daytime and during the night (yet you may pass only very small amounts of urine each time)
  • Pressure, pain and tenderness around the bladder, pelvis and perineum (the area between the anus and vagina or the anus and the scrotum). This pain and pressure may increase as the bladder fills and decrease as it empties in urination.
  • A bladder that won't hold as much urine as it used to
  • Pain during sexual intercourse
  • In men, discomfort or pain in the penis or scrotum

For many women, the symptoms get worse before their menstrual period. Stress may also make the symptoms worse, but it doesn't cause them.


The therapy for interstitial cystitis (IC) begins with extensive patient education regarding the chronic nature of the disease and realistic assessments of the condition, prognosis, and potential responses to therapy. Ongoing reassurance and physical and emotional support are important as the diagnostic evaluation progresses and therapies are applied. Only rarely will patients with interstitial cystitis have an immediate, complete, and durable response to any particular therapy. They must be counseled at length regarding the lack of universally effective therapies. Often, referral to one of the local interstitial cystitis support groups, especially a local chapter of the Interstitial Cystitis Association, can be helpful in providing a continuing network of support for the patient.

Ideally, in clinical practice, the treatment of interstitial cystitis should be initiated with the least invasive, least expensive, and most reversible therapy. In general, this consists of a program of dietary and fluid management, time and stress management, and behavioral modification. Thereafter, treatments are applied in a progressively more invasive step-wise fashion until some degree of symptomatic relief is obtained.

Interventions might include various pharmacological agents (eg, pentosan polysulfate sodium [Elmiron], antihistamines, tricyclic antidepressants, analgesics, anti-inflammatory agents), intravesical therapy (ie, medications intermittently instilled directly into the bladder via a catheter), electrical stimulation, and complementary therapies such as acupuncture and hypnosis.

Managing the pain component can be difficult in patients with interstitial cystitis. The etiology of the pain remains unclear, but various authors have postulated the etiology to be mediated centrally, peripherally, or locally via a neurogenic or inflammatory mechanism. Some patients require long-term pain medications, while others rely on these only during periods of symptomatic flares. Anti-inflammatory agents, acetaminophen, gabapentin (Neurontin), tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and various other agents are used. Most clinicians tend to avoid the extensive use of narcotics in patients with interstitial cystitis. When the pain component becomes unresponsive to nonnarcotic agents, referral to a chronic pain management facility may be helpful.

Transcutaneous electrical nerve stimulation (TENS) units, electrical stimulation (intravaginal), acupuncture, and intrathecal and intraspinal infusions have all been used. Topical anesthetics such as lidocaine have been applied directly to the bladder intravesically and have yielded some success.

Friday, September 17, 2010


Human genetics describes the study of inheritance as it occurs in human beings. Human genetics encompasses a variety of overlapping fields including: classical genetics, cytogenetics, molecular genetics, biochemical genetics, genomics, population genetics, developmental genetics, clinical genetics, and genetic counseling. Genes can be the common factor of the qualities of most human-inherited traits. Study of human genetics can be useful as it can answer questions about human nature, understand the diseases and development of effective disease treatment, and understand genetics of human life. This article describes only basic features of human genetics; for the genetics of disorders please see: Medical genetics.

For women, genetic screening offers the hope of better understanding the likelihood that they'll develop breast cancer. But reality doesn't match that dream, at least not yet. Scientists at the U.S. National Cancer Institute (NCI) today report that DNA doesn't predict breast cancer risk much better than a questionnaire. The small improvement does not yet justify the cost of introducing the technique into the clinic, they say.

In recent years, several gene mutations have been discovered that increase a woman's risk of breast cancer. Best known are mutations in two tumor-suppressor genes called BRCA1 (breast cancer susceptibility gene 1) and BRCA2, which are thought to be present in 0.3% of the U.K. population. A harmful mutation in either gene increases a woman's lifetime risk from 12% to about 60%. Eighteen other genes have been discovered that more subtly influence a woman's risk of breast cancer.

In theory, testing for these genes could allow women to make more informed choices about how often to undergo routine mammograms, for example, or, more radically, whether to take anticancer drugs like tamoxifen prophylactically. These decisions are currently made by patients, in consultation with clinicians, based on a predicted risk of cancer provided by the so-called Gail model. This model calculates a risk based on the answers to seven questions, including the age at which a woman began menstruating, the age at which she had her first child, and the number of relatives with breast cancer.

To find out how well genetic screening measured up to the question-based Gail model, a team of cancer epidemiologists at NCI pooled data from five of the studies originally used to isolate the breast cancer genetic risk factors. Four were cohort studies in which a healthy population was genetically screened at the outset and followed for 15 years to see who developed breast cancer and who did not.

In the new work, published today in The New England Journal of Medicine (NEJM), the researchers identified from those studies 5590 women who went on to develop breast cancer and 5998 who did not. Then they retrospectively calculated a prediction of cancer risk based on each woman's data for the 10 genetic risk factors known at the outset of the study. They next asked a simple question: What is the probability that a woman selected at random from the group that did go on to develop cancer would have a higher risk prediction than a randomly selected woman who did not? For a completely useless model, the answer would be 50%; for a perfect model, the answer would be 100%.

The answer for the genetic screening was 59.7%, whereas the answer for the question-based Gail model was 58%. By combining the two, the researchers were able to produce a model with a predictive power of 61.8%. But that combination didn't impact the prediction of risk, also called the score, very much for most individual patients. “There were very, very few cases in which the new score was hugely different from the old score,” says cancer epidemiologist Patricia Hartge of the National Cancer Institute in Bethesda, Maryland, a study co-author. She and her colleagues conclude that, given the cost involved, genetic screening is not worthwhile in a clinical context.

Nevertheless, Hartge remains optimistic about the future. She points out that the common genetic variants they tested were discovered less than 3 years ago. "Isn't it fascinating that we get the same ability to predict from these that we got from 40 years of painstaking research on the other risk factors?" Discoveries of more mutations, including the eight found since this study began, should improve the reliability of genetic tests, she says.

Cancer epidemiologist Paul Pharoah of the University of Cambridge in the United Kingdom, who published a similar analysis 2 years ago in NEJM based on just seven genetic risk factors, agrees that genetic tests don't add a whole lot to the Gail model. But he questions the new paper's assessment that screening has to be expensive: "The cost of one of these genetic tests in reality is trivial," Pharoah says. So genetic tests could be a cost-effective way to decide whom to screen further, he says.

Like millions of Americans, Thomas Robinson wanted to investigate the roots of his family tree before the point at which his ancestors emigrated to the USA. “I did paper-based genealogy research on my family and could not get very far, especially on my father's side since I had never met my paternal grandfather and knew little about him,” said Robinson, a professor of accounting at the University of Miami, FL, USA. “I also read quite a bit on the origins of man and how DNA testing was used to trace migration patterns.” Robinson, who also studied biology at university, thus sent a cheque with a cheek scraping to Oxford Ancestors (UK), one of many companies that use molecular genetics to unravel family histories. In early 2003, he received his results: a signature from his Y chromosome and detailed information on his mitochondrial DNA. The latter indicated that his family might have originated on what is now the Spanish/French coast, whereas the Y-line information was not specific.clip_image001

But the story did not end there. In March 2006, a representative from Oxford Ancestors called Robinson to tell him that he was apparently descended from Genghis Khan, the thirteenth-century Mongol emperor. Robinson's Y-signature matched seven out of nine markers in Khan's signature, which are found in unusually high numbers—about 8%—of men living in a wide swathe of Asia from the Pacific Ocean to the Caspian Sea (Zerjal et al, 2003). “It was exciting to hear and nice to put a ‘name' to an ancestor,” said Robinson, a rather unlikely-looking member of the Mongol horde. The story was picked up in newspapers around the world, and the Mongolian ambassador to the USA promised to hold a reception in Washington, DC, to toast the new-found descendant of the Great Khan.

However, at the suggestion of a filmmaker who had contacted him about a documentary on Mongolia, Robinson pursued more detailed testing. Family Tree DNA (Houston, TX, USA) concluded that he and Genghis Kahn shared no common ancestry within the past 30,000–40,000 years, let alone the past 800 years. Robinson was booted out of the yurt. The Mongolian ambassador never followed through with the reception and the newspapers ran retractions. It was “a bit disappointing”, Robinson admitted, “but I learned quite a bit more [about DNA and Genghis] in the process.”

“The Y-STR [short tandem repeats] data from Oxford Ancestors and Family Tree DNA matched perfectly, but the interpretation differed,” said Chris Tyler-Smith from the Sanger Institute (Cambridge, UK), who is one of the authors of the study on Khan's signature. “In particular, Family Tree DNA typed some additional Y-SNPs [single nucleotide polymorphisms] that showed that the two lineages were not as closely related as appeared from the Y-STRs.”

Although this particular case is unusual, Robinson is just one of many who rely on molecular biology to find their ancestors. Companies such as Oxford Ancestors, Family Tree DNA and DNAPrint Genomics (Sarasota, FL, USA) have attracted more than 300,000 customers in the past six years. Most cases address more modest objectives, such as confirming relationships between people with similar surnames or investigating family stories about a Native American ancestor. Jill Servian Whitehead, a 55-year-old social researcher from London, UK, is such a customer. Through traditional paper-based searches, she found that her Jewish ancestry could be traced back to eighteenth-century Poland and Lithuania.

Most cases address more modest objectives, such as confirming relationships between people with similar surnames or investigating family stories about a Native American ancestor

As she had a longstanding interest in genealogy, history and biology, Whitehead had her DNA tested by Family Tree DNA. Her results showed that she had a relatively rare haplotype, and she used the company's online database to find matches to people with shared Jewish roots from the Baltics. At the same time, Whitehead was contacted by Mike Moseley through the Jewish Genealogical Society of Great Britain, who was searching for people named Servian. Testing confirmed that the two, who had previously never met, shared common great-grandparents. “Even without paper trails, genetic testing has enabled us to find fairly close relations going back over the last 300 years or so. This has been very exciting and enriching,” Whitehead said.

However, as the Robinson case highlights, customers should take their results with a pinch of salt. Scott Woodward, a molecular genetics researcher and President of the Sorenson Molecular Genealogy Foundation (Salt Lake City, UT, USA), a non-profit organization that collects DNA samples to build up database-integrated family trees, worries that overselling can backfire. “The public is getting the impression that DNA is the answer to everything. That's not necessarily so. I think we have to be careful about emphasizing what the realities are, what you really can do with DNA,” he said.

As a commercial service, genealogical DNA testing holds the same promises and pitfalls as any business, but the potential drawbacks for customers are not normally dramatic. “As far as mixing science and capitalism goes as in fee-for-services testing, it is a ‘let the buyer beware' marketplace,” said Peter Underhill, a senior research scientist at Stanford University (CA, USA). “How much responsibility a company has in educating a potential client prior to sample submission and credit card number is a value judgment matter. Also mistakes do occur, during either the actual data collection or its interpretation. Fortunately errors in paternal ancestry assignment are not life-threatening, as would be the case in blood typing prior to transfusion, for instance.”

“[A]s usual, there are those who simply want to make money out of it, those for whom it is part of serious science, and those who are extremely desperate to look for their famous ancestors and who will do anything to reach their target,” commented Peter de Knijff, a geneticist at Leiden University, the Netherlands, who was involved in a highly publicized study showing that a male from the bloodline of US President Thomas Jefferson fathered a child with his slave Sally Hemings (Foster et al, 1998). There is “a lot of total rubbish on many of the Y-STR project sites [online], but it seems that those involved are perfectly happy with what they do,” de Knijff said. “People are entitled to have their dreams, and if they are willing to pay for that, well, fine with me.”

Not surprisingly, the commercial use of genetic tools in genealogy initially was rather off-putting for both genealogists and molecular biologists. Megan Smolenyak, a genealogist who conducts studies for the US military to identify remains of soldiers from the Vietnam and Korean wars, said many traditional genealogists are reluctant to leave the archives and take a dip in the genetic pool. “It's very much the same sort of life-cycle that we went through when the Internet came along,” she said. “[S]ome of the pros were saying, ‘Oh, this is cheating. This is just people looking to take shortcuts.'” But things changed, she said, as genealogists realized that the genetic tools were complementary to methods such as digging out paper records that can be used to prove or disprove family links.

Bryan Sykes, a professor of human genetics at Oxford University and founder of Oxford Ancestors, said some of his colleagues have indeed looked down on his commercial enterprise. “There are always some academics who believe it is entirely wrong to almost corrupt pure academic investigation by turning these into commercial services.” Sykes, whose own research involved genotyping Ötzi the Iceman and the Romanovs, said, “The only way to open up a field to the general public […] is by offering a proper commercial service. It can't and shouldn't be done in research laboratories because they are there to do other things.”

For Woodward and the Sorenson Molecular Genealogy Foundation, it is also a matter of people partaking in research that they supported in the first place. “To find disease genes, we used pedigrees to identify people in those families who've had a particular disease. It was through genealogy and family trees that we were able to identify those pieces of DNA,” he said. “And then we just sort of turned it around and brought some of those tools back to the people who would now be able to use them to find their families.”

Fortunately errors in paternal ancestry assignment are not life-threatening, as would be the case in blood typing prior to transfusion, for instance.

Underhill also sees another positive aspect. “On the one hand, such enterprises open the door for the public to get a better understanding of science, genetics, human evolution and the important fact of the African ancestry of our species, as well as the very high degree of genetic similarity between people of the world,” he said. “On the other hand, these activities potentially reinforce a culture of personality [spotlighting famous people] […] as well as potentially trivializing science. I don't think it is a bad thing if neighbours at a weekend BBQ stand around and discuss what haplogroups they belong to, as long as such activities do not cause the public to mistrust or view the underlying science of deciphering human evolution and human history as trivial and shallow.”

Spencer Wells, a senior explorer with the US National Geographic Society (Washington, DC) and leader of its Genographic Project, believes that commercial genealogists can contribute knowledge, just as amateur astronomers and ornithologists have made important contributions to their respective fields. “It's probably similar to the astronomy community thinking that somebody standing out in their backyard with their telescope looking at the sky isn't going to find anything,” Wells said. “In come cases, amateur astronomers actually do discover things. They discover comets, nebulae and so on. I think there is something to be gained from tapping into the interest in genealogy.”

This is what the Genographic Project aims to do. Launched by Wells, the US National Geographic Society, IBM (Armonk, NY, USA) and the Waitt Family Foundation (La Jolla, CA, USA), it is an anthropological rather than a genealogical exploration. It hopes to collect DNA samples from 100,000 indigenous people, along with a minimum of 100,000 public participants who pay US$99 to get a glimpse of their ancestry while helping to fund both the research and a payback project for the indigenous groups. During the first 15 months of the five-year project, 160,000 people signed on, far more than had been anticipated. “I think it is part of people's general interest […], particularly people who live in countries with large immigrant populations like the United States, where everybody, unless you're a Native American, came from somewhere else relatively recently,” Wells said. “They have the desire to connect to the old country. There is a tremendous interest in genealogy. And this application of a new tool tells us a little more about our ancestry.”

…genealogists realized that the genetic tools were complementary to methods such as digging out paper records that can be used to prove or disprove family links

However, not everyone is as pleased with the project. Debra Harry, a Paiute Indian, and Executive Director of the Indigenous Peoples Council on Biocolonialism (Pyramid Lake, NV, USA), and Le'a Malia Kanehe, a Native Hawaiian attorney for the group, noted that the study consent form states that the research “may contradict an oral, written, or other tradition held by you or by members of your group” and criticized that research could undermine these beliefs (Harry & Kanehe, 2006). “The discounting of indigenous historical knowledge goes beyond just a difference of opinion. A claim that challenges the ‘indigenousness' or ‘aboriginality' of certain indigenous peoples could pose serious political threats,” they wrote.

“The Genographic Project is an anthropological and historical research initiative, and some indigenous people might find value in that very same knowledge gained by the project scientists,” Wells commented. “In addition, the Genographic Project has established the Genographic Legacy Fund […] to provide tangible benefits to indigenous communities in support of their aspirations to promote and protect their cultures.” He added, “ultimately, the Genographic Project has the potential to highlight human unity and connectedness while celebrating cultural diversity.”

However, Edwin Black, author of War Against the Weak: Eugenics and America's Campaign to Create a Master Race, warned that the data could be abused, for example, to discriminate against indigenous people. He also worries that the Genographic Project and others could sell their databases to governments, which could then use the information to persecute minorities. Wells dismissed Black's worries. “Technologies are powerful and they can be misused. People do find reasons to discriminate that have nothing to do with genetics.” He also discounted Black's concerns about the Genographic Project database being sold. “Our database, once we publish the data, will be in the public domain. For that reason alone, I don't think anybody would be willing to spend any money on it because it's going to be freely available,” Wells said. “We are simply testing genetic markers that tell us about ancestry. We're not doing anything that is medically or clinically relevant. […] It's only information about deep ancestry with no information tying it to a particular person.”

The same worries apply to commercial companies. For example, at Family Tree DNA, consumers can consent to having their DNA stored for future testing. “We offer storage and allow people to have the DNA destroyed if they wish,” said Bennett Greenspan, the company's founder. “To date, we've had 70,000 test takers and only two people have asked that their DNA be tossed out, so we accommodate both sides.” He added that the company's database is not for sale and that samples are bar-coded to protect their consumers' identity.

Nevertheless, concerns remain. Howard Sachs, an 80-year-old federal judge from Kansas City, MO, USA, who used Oxford Ancestors and Family Tree DNA to trace his Jewish roots, worries that genetic information could be abused by people with racist agendas. “This would have been a great tool for the Nazis,” he said. Sykes agrees, “Some companies do so-called ethnicity testing. They will use any range of autosomal markers [to determine] the percentage of [ethnicity],” and declare whether an individual is 25% Native American or 10% Asian, for example.

The question then is whether any interested group could use molecular genealogy to discriminate against other people. Matt Thomas, a senior scientist at DNAPrint Genomics, which performs autosomal testing for genealogical purposes, said that this is possible, but his company opposes testing to determine “racial purity” and he is unaware of it being done. “It has been our policy as a company and as individuals who work for the company to resist that kind of use of the technology,” he commented, but conceded that DNAPrint Genomics would not be able to exclude clients by questioning their motives. Ultimately, the idea of a genetically pure race has no biological basis, as it implies that people once existed in racially pure groupings. “They never did,” Sykes said. “We're just a temporary state of a huge swirling cloud of genes coming from all over the place.”

…commercial genealogists can contribute knowledge, just as amateur astronomers and ornithologists have made important contributions to their respective fields

The increasing fascination with ancestry—not only in the USA but also worldwide—suggests that genealogical DNA testing is here to stay. But as the Robinson case so aptly illustrated, “interpretation of the results can be difficult, and surprising conclusions need to be checked particularly carefully,” said Tyler-Smith. By and large, the results will prove very useful to the studies of anthropology and ancestry, for both scientists and society. More nefarious uses will be subject to the principles of the individual. As Thomas pointed out, “The results and the sample belong to our customers. Whatever they do with it is their business.”


  • Foster EA, Jobling MA, Taylor PG, Donnelly P, de Knijff P, Mieremet R, Zerjal T, Tyler-Smith C (1998. ) Jefferson fathered slave's last child. Nature 396: 27–28 [PubMed]
  • Harry D, Kanehe LM (2006. ) Genetic research: collecting blood to preserve culture? Cultural Survival Quarterly, 6 Jan.
  • Zerjal T et al. (2003. ) The genetic legacy of the Mongol

Wednesday, May 19, 2010

Great Quotes

  • What the word IMPOSSIBLE says I M Possible. So every thing which seems impossible is itself says that is possible.
  • In life LOVE is never planned nor does it happen for a reason.But when LOVE is real,It becomes ur PLAN for life and ur reason for.
  • Mistakes are painful when they happen,But years later a collection of mistakes called Experience Which leads us to success.
  • What is trust ?? Trust is a feeling that a one year child has , when you throw him in air and catch again , and he enjoys it.
  • When GOD drops needles and pins along ur path in LIFE, dont stay away,, instead pick them up and collect them..they were designed to be STRONG!
  • Dont think how many moments in your life, just think how much life is there in a moment.
  • Treat everyone with politeness,Even those who are rude to U.....Not because they are not nice,But bcoz u are nice.
  • Success is like tip of the tail !!!If cat runs to catch the tail.It has to keep running forever.But if it walks in its own style.Tail follows!!Live life with ur own rules.
  • GOD is always playing CHESS with each one of us. He makes Moves in our LIFE & then sits back to see how we react to the CHALLENGES ... So make the best move before CHECKMATE.
  • Life gives answer in 3 ways... It says Yes & gives u what u want, it says no and gives u something better, it says wait and gives u the Best!
  • Each moment of ur life is a picture which u had never seen before. And which ull never see again so enjoy & live life & make each moment beautiful.
  • GODISNOWHERE this can be read as GOD IS NO WHERE or as GOD IS NOW HERE everything depends on how do u see anything. so think positive
  • A negative thinker see a difficulty in every opportunity,A positive thinker see an opportunity in every difficulty,wish u an optimistic life.
  • Love urself ,Flirt with ur understanding,Romance with dreams,Get engaged with simplicity,Marry genuiness,Divorce the ego...Thats Good Life.
  • Enjoy Your Life Today Because Yesterday Has Gone and Tomorrow May Never Come. By Baber Ali
  • It takes years to build trust but few seconds to destroy it. By Mukhoji
  • Don`t hurt anyone! It only takes few seconds to hurt people you love and it takes years to heal. By Mukhoji
  • Don't be special to become special, Be ordinary to become special.
  • Shoot for the moon if you will miss,you will be still high. By Amooo
  • Remember the way of least resistence rarely leads to success.By Amooo
  • The fragrance of flowers spreads only in the direction of the wind. But the goodness of a person spreads in all directions".By neha kaushik
  • SMILE!Simply Makes Isolated Life Easy.By Mukhoji
  • When the creature create the human same , his structure , blood , Mind , kind thinking for others . Then only our politicians divide us only for their own benefits , governments , to get the power . We think all human beings are same then why we are separate from other nations . By Nayyar
  • Show mercy towards those who are on earth so that the one who is in heaven will show mercy to you 


    Friday, April 30, 2010


  for Health and Medical Information


    Medical Author: Benjamin C. Wedro, MD, FAAEM
    Medical Editor: Jay W. Marks, MD

    What is a headache?

    Headache is defined as pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.

    How are headaches classified?

    Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache. Because so many people suffer from headaches, and because treatment is sometimes difficult, the new classification system allows health care practitioners to understand a specific diagnosis more completely to provide better and more effective treatment regimens.

    There are three major categories of headaches:

    1. primary headaches,
    2. secondary headaches, and
    3. cranial neuralgias, facial pain, and other headaches

    What are primary headaches?

    Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.

    Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. Tension headaches are more common among women than men.

    Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. An estimated 6% of men and up to 18% of women will experience a migraine headache.

    Cluster headaches are a rare type of primary headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years of age, although headaches may begin in childhood.

    Primary headaches affect quality of life. Some people have occasional headaches that resolve quickly, while others are debilitated. Tension, migraine, and cluster headaches are not life-threatening.

    What are secondary headaches?

    Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis.

    What are cranial neuralgias, facial pain, and other headaches?

    Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes a group of headaches that occur because the nerves in the head and upper neck become inflamed and are the source of the head pain. Facial pain and a variety of other causes for headache are included in this category.

    What causes tension headaches?

    While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where muscles that assist the jaw to move are located, and the forehead.

    There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. Physical stress that may cause tension headaches include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.

    What are the symptoms of tension headaches?

    The symptoms of tension headache are:

    • A pain that begins in the back of the head and upper neck as a band-like tightness or pressure.
    • Described as a band of pressure encircling the head with the most intense pain over the eyebrows.
    • The pain is usually mild (not disabling) and bilateral (affecting both sides of the head).
    • Not associated with an aura (see below) and are not associated with nausea, vomiting, or sensitivity to light and sound.
    • Usually occur sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.
    • Most people are able to function despite their tension headaches.

    How are tension headaches diagnosed?

    The key to making the diagnosis of any headache is the history given by the patient. The health care practitioner will ask the appropriate questions to understand when the headache began, learn about the quality, quantity, and duration of the pain, and ask about any associated symptoms. The history of tension headache will include pain that is mild to moderate, located on both sides of the head, described as a tightness that is not throbbing, and not made worse with activity. There will be no associated symptoms like nausea, vomiting, or light sensitivity.

    The physical examination is important in tension headaches because it has to be normal to make the diagnosis. The only exception is that there may be some tenderness of the scalp or neck muscles. If the health care practitioner finds an abnormality, then the diagnosis of tension headache would not be considered.

    How are tension headaches treated?

    Tension headaches are painful, and often patients are upset that the diagnosis is "only" a tension headache. Though it is not life-threatening, a tension headache can affect daily life activities.

    Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people:

    If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Massage, biofeedback, and stress management can all be used as adjuncts to help with headache control.

    It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It is always wise to ask your health care practitioner or pharmacist if you have questions about OTC medications and their use. This is especially important with OTC pain medications, because patients use them so frequently.

    It is important to read the ingredient listing of OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third ingredient may have the potential for drug interaction or contraindication with medications the patient is currently taking. For example:

    • Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients.
    • In night time preparations, diphenhydramine (Benadryl) may be added. This may cause drowsiness and driving or using heavy machinery may not be appropriate when taking the medication.

    Other examples were caution should be used include the following:

    • Aspirin should not be used in children and teenagers because of the risk of Reye's Syndrome, a disease where coma, brain damage, and death can occur with a viral like illness and aspirin use.
    • Aspirin and ibuprofen are irritating to the stomach and may cause bleeding. They should be used with caution in patients who have peptic ulcer disease or who take blood thinners like warfarin (Coumadin) and clopidogrel bisulfate (Plavix).
    • Acetaminophen, if used in large amounts, can cause liver damage or failure. It should be used with caution in patients who drink significant amounts of alcohol or who have liver disease.
    • One cause of chronic tension headaches is overuse of medications for pain. When pain medications are used for a prolonged time, headaches can recur as the effects of the medication wear off. Thus, the headache is a symptom of medication withdrawal (rebound headache).

    What causes cluster headaches?

    The cause of cluster headaches is uncertain. It may be that certain parts of the brain begin to malfunction for an unknown reason. The hypothalamus, an area located at the base of the brain is responsible for the body's biologic clock and may be the part of the brain that is the source for the headaches. When brain scans are performed on patients who are in the midst of a cluster headache, there is abnormal activity in the hypothalamus.

    Cluster headaches also:

    • tend to run in families and this suggests that there may be a genetic role.
    • may be triggered by changes in sleep patterns.
    • may be triggered by medications (for example, nitroglycerin, used for heart disease) .

    If the patient is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate) can precipitate the headache.

    What are the symptoms of cluster headaches?

    Cluster headaches are headaches that come in groups (clusters) lasting weeks or months, separated by pain-free periods of months or years.

    • During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily.
    • Each episode of pain lasts from 30 minutes to an hour and a half.
    • Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.
    • The pain typically is excruciating and located around or behind one eye.
    • Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery.
    • The nose on the affected side may become congested and runny.

    Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in males than females.

    How are cluster headaches diagnosed?

    The diagnosis of cluster headache is made by the patient history of symptoms. The description of the pain and it's clock-like recurrence is usually enough to make the diagnosis.

    If examined in the midst of an attack, the patient is usually in a pain crisis and may have the eye and nose watering as described above. If the patient presents when the pain is not present, the physical examination is normal and the diagnosis again depends upon the patient history.

    How are cluster headaches treated?

    Cluster headaches may be very difficult to treat, and it make take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled , and additional headaches need to be prevented.

    Initial treatment options may include the following:

    • inhalation of high concentrations of oxygen (though this will not work if the headache is well established);
    • injection of tryptan medications, for example, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are commonly used for migraine treatments as well;
    • injection of lidocaine, a local anesthetic, into the nostril;
    • dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict;
    • caffeine

    Preventative cluster headache treatment options may include the following:

    Can cluster headaches be prevented?

    Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted.

    Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache.

    What diseases cause secondary headaches?

    Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time diagnostic tests are being considered. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential, if damage is to be limited.

    The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (this is not a complete list):

    Head and neck trauma

    Blood vessel problems in the head and neck

    Non-blood vessel problems of the brain

    • Brain tumors, either primary, originating in the brain or metastatic from a cancer that began in another organ
    • Idiopathic intracranial hypertension, once named pseudotumor cerebri, where there is too much cerebrospinal fluid pressure within the spinal canal.

    Medications and drugs (including withdrawal from those drugs)


    • Meningitis
    • Encephalitis
    • Systemic infections (for example, pneumonia or influenza)

    Changes in the body's environment

    Problems with the eyes, ears, nose throat, teeth and neck

    Psychiatric disorders

    How are secondary headaches diagnosed?

    If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.

    However, some patients present in crisis with a decreased level of consciousness or unstable vital signs. In these situations, the health care practitioner may decide to treat a specific cause without waiting for tests to confirm the diagnosis.

    For example, in patients with headache, fever, stiff neck, and confusion that suggest meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis.

    What are the exams and tests for secondary headaches?

    The patient history and physical examination provide the best means for determining the cause of secondary headaches. Therefore, it is extremely important that patients with severe headaches seek medical care and give their health care practitioner an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing headaches include:

    • blood tests,
    • computerized tomography (CT Scan),
    • magnetic resonance imaging (MRI) scans of the head, and
    • lumbar puncture.

    Specific tests will depend upon what potential issues the health care practitioner and patient want to address.

    Blood tests

    Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Blood tests can also assess electrolyte disturbances, and a variety of organ functions like liver, kidney, and thyroid.

    Computerized tomography of the head

    Computerized tomography is able to detect bleeding, swelling, and tumor. It can also show evidence of previous stroke. With intravenous contrast injection, it can also be used to look at the arteries of the brain.

    Magnetic resonance imaging (MRI) of the head

    MRI is able to better look at the anatomy of the brain, meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals.

    Lumbar puncture

    Cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid can reveal infection (such as meningitis due to bacteria, a virus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor in the brain.

    When should patients with headache seek medical care?

    A patient should seek medical care if their headache is:

    • The "worst headache of your life"
    • Different than your usual headaches
    • Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity
    • Associated with persistent nausea and vomiting
    • Associated with fever or stiff neck
    • Associated with seizures
    • Associated with recent head trauma or a fall
    • Associated with changes in vision, speech, or behavior
    • Associated with weakness or change in sensation
    • Not responding to treatment and is getting worse
    • Requires more than the recommended dose of over-the-counter medications for pain
    • Disabling and interfering with work and quality of life

    Headache At A Glance
    • The head is one of the most common sites of pain in the body.
    • The most common types of headache can be classified as 1) primary, 2) secondary, and 3) cranial neuralgias, facial pain, and other headaches.
    • The most common types of primary headaches are 1) tension, 2) migraine, and 3) cluster.
    • Tension headaches are the most common type of primary headache and usually are treated with over-the-counter medications for pain
    • Secondary headaches are a symptom of an injury or an underlying illness.
    • Patients should seek medical care for new onset headaches, fever, stiff neck, change in behavior, vomiting, weakness or change in sensation.

    References: International Headache Society, "The Classification,"

    Previous contributing author and editor: Dennis Lee, MD and Harley I. Kornblum, MD, PhD

    Last Editorial Review: 9/30/2008

    © 2010 MedicineNet, Inc. All rights reserved.
    MedicineNet does not provide medical advice, diagnosis or treatment. See additional information

    Monday, March 29, 2010



    Saturday, March 27, 2010


    Psikiatri 3
    1. Dokter/Dokter Gigi yang telah dinyatakan diterima dan diangkat sebagai PTT Pusat periode April 2010,
    diwajibkan untuk :
    a. Melapor ke Dinas Kesehatan Propinsi Lulusan pada tanggal 25 s/d 29 Maret 2010 dengan
    menggunakan lembar konfirmasi keberangkatan (download dari lembar
    konfirmasi yang telah diisi dapat di fax atau diserahkan langsung ke Dinas Kesehatan propinsi.
    Terlampir nomor telp dan fax Dinas Kesehatan seluruh Indonesia yang dapat dihubungi.
    Contoh :
    - Lulusan dari FK dan FKG di Propinsi DKI Jakarta melapor ke Dinkes Propinsi DKI Jakarta
    - Lulusan dari FK dan FKG di Propinsi Jawa Tengah melapor ke Dinkes Propinsi Jawa Tengah
    - Lulusan dari FK dan FKG di Propinsi NAD melapor ke Dinkes Propinsi NAD
    - Lulusan dari FK dan FKG di Propinsi Sumatera Utara melapor ke Dinkes Propinsi Sumut.
    - Lulusan dari FK dan FKG di Propinsi Riau melapor ke Dinkes Prop Riau
    - Lulusan dari FK dan FKG di Propinsi Lampung melapor ke Dinkes Prop Lampung
    - Lulusan dari FK dan FKG di Propinsi Kalimantan Selatan melapor ke Dinkes Prop Kalsel
    - Lulusan dari FK dan FKG di Propinsi Papua melapor ke Dinkes Propinsi Papua
    b. Bagi yang telah berada di Propinsi Penugasan, melapor ke Dinas Kesehatan Propinsi setempat serta
    menghubungi Dinas Kesehatan Propinsi Lulusan untuk diketahui.
    - Dokter PTT Lulusan FK Unair dan penempatan Jambi. Saat ini sudah berada di Propinsi Jambi
    maka segera melapor ke Dinas Kesehatan Propinsi Jambi dan mengirimkan fax lembar konfirmasi
    keberangkatan ke Dinas Kesehatan Propinsi Jawa Timur untuk diketahui.
    - Dokter PTT Lulusan FK UNSRI dan penempatan di Majene – Sulawesi Selatan. Saat ini sudah
    berada di Propinsi Sulawesi Selatan maka segera melapor ke Dinas Kesehatan Propinsi Sulsel dan
    mengirimkan fax lembar konfirmasi keberangkatan ke Dinas Kesehatan Propinsi Sumatera Selatan
    untuk diketahui.
    c. Bagi Dokter/Dokter Gigi PTT lulusan FK/FKG di luar DKI Jakarta namun saat ini berada di DKI
    Jakarta diharap segera melapor ke Dinas Kesehatan Propinsi DKI Jakarta untuk konfirmasi
    keberangkatan dari DKI Jakarta serta menghubungi Dinas Kesehatan Propinsi Lulusan untuk
    Dokter PTT Lulusan FK USU penempatan Papua Barat dan saat ini berada di Jakarta, agar melapor
    ke Dinas Kesehatan Propinsi DKI Jakarta untuk diberangkatkan dari Jakarta ke Propinsi Penugasan.
    Lebih lanjut juga melapor ke Dinas Kesehatan Propinsi Sumatera Utara bahwa keberangkatan
    melalui Dinas Kesehatan Propinsi DKI Jakarta.
    d. Untuk memperlancar proses pembayaran gaji, masing-masing dokter/dokter gigi PTT diwajibkan
    memiliki rekening giro di PT Pos yang dapat dibuat di Propinsi manapun (tidak harus di Prop
    Contoh : Dokter PTT penempatan Papua Barat dapat membuka rekening giro PT Pos pada PT
    Pos di Jakarta
    2. Pemberangkatan ke Propinsi Penugasan :
    a. Pembekalan :
    - Dilaksanakan pada Propinsi lulusan berkaitan dengan pengaturan pemberangkatan dan
    persiapan tiket keberangkatan, maka bagi dr/drg PTT periode April 2010 wajib hadir untuk
    mengikuti pembekalan pada tanggal 1 April 2010 mengingat pada tanggal 1 April 2010 sudah
    terhitung bertugas dan akan dibuatkan SPMT Propinsi penugasan.
    - Bagi dr/drg PTT yang sudah berada di Propinsi penugasan wajib hadir pada tanggal
    1 April 2010 untuk diberikan pembekalan mengingat pada tanggal 1 April 2010 sudah terhitung
    bertugas dan akan dibuatkan SPMT Propinsi tmt 1 April 2010. Selanjutnya pada tanggal 5 April
    2010 wajib hadir di Dinas Kesehatan Propinsi untuk menerima SK pengangkatan, SPMT dan
    SK penempatan bersama-sama dengan dr/drg PTT dari Propinsi lulusan lainnya sesuai
    jadwal yang telah ditetapkan oleh masing-masing Dinas Kesehatan Propinsi penugasan.
    b. Pemberangkatan dilaksanakan secara serentak di bawah Koordinasi Dinas Kesehatan Propinsi
    Lulusan pada tanggal 5 April 2010.
    3. Pemberangkatan ke Kabupaten Penugasan :
    Dijadwalkan tanggal 6 April 2010 sudah diberangkatkan ke Kabupaten Penugasan agar pengusulan gaji
    disegerakan secara kolektif dan tidak terjadi keterlambatan.
    4. Biaya perjalanan dibayarkan dengan ketentuan sbb:
    a. Biaya perjalanan dokter/dokter gigi PTT dibayarkan oleh Depkes sampai ke Propinsi Penugasan dan
    biaya perjalanan ke Kabupaten dibayarkan oleh Daerah melalui APBD setempat.
    b. Biaya perjalanan dihitung dari Propinsi lulusan ke Propinsi penugasan
    c. Bagi dokter/dokter gigi PTT yang berdomisili sama dengan Propinsi Penugasan, tidak diberikan biaya
    lintas propinsi (Bukti domisili berdasarkan KTP pada saat pendaftaran)
    d. Untuk penugasan 6 (enam) bulan, biaya perjalanan ke Propinsi penugasan diberikan hanya untuk
    dokter/dokter gigi PTT yang bersangkutan (tidak dengan keluarga)
    e. Untuk penugasan 1 (satu) tahun, biaya perjalanan ke Propinsi penugasan diberikan beserta
    suami/isteri yang bertugas di luar Propinsi tujuan dan maksimal 2 (dua) anak
    f. Bagi Dokter/Dokter Gigi PTT yang sudah berada di Propinsi Penugasan dan termasuk kriteria yang
    mendapat biaya perjalanan, dapat mengajukan klaim melalui Propinsi Penugasan untuk diteruskan
    ke Pusat dengan melampirkan bukti perjalanan sesuai ketentuan.
    5. Persyaratan administrasi untuk keberangkatan antara lain :
    a. Mengisi lembar konfirmasi keberangkatan
    b. Melampirkan : 1. Foto copy rekening giro PT. Pos (rangkap 3)
    2. Bagi suami/isteri/anak yang menyertai keberangkatan melampirkan juga :
    a. Asli surat keterangan kerja suami/isteri
    b. Foto copy surat nikah
    c. Foto copy surat keterangan kelahiran anak
    (lampiran tsb diserahkan kepada Dinkes Prop tempat pemberangkatan)
    6. Dokter/Dokter Gigi PTT yang telah diangkat dan telah ditempatkan sesuai dengan peminatan dan
    alokasi kebutuhan daerah yang ada, apabila mengundurkan diri / tidak melaksanakan tugas / tidak
    berangkat, akan dikenakan sanksi :
    a. Jika belum menerima biaya (perjalanan, uang harian, pengepakan dan penginapan), dikenakan
    sanksi tidak diperbolehkan mendaftar PTT Pusat pada periode berikutnya.
    b. Jika sudah menerima biaya (perjalanan, uang harian, pengepakan dan penginapan), maka
    dikenakan sanksi pengembalian biaya yang sudah diterima sebesar 6 (enam) kali lipat, yang akan
    disetorkan ke Kas Negara dan tidak diperbolehkan mendaftar PTT Pusat pada periode berikutnya.
    7. Informasi lebih lanjut dapat menghubungi Hotline PTT nomor 085880901818 dan 081510800303.


    Jakarta, 23 Maret 2010
    Kepala Biro Kepegawaian
    dr. H. Abdul Rival, M.Kes
    NIP. 19520312 198103 1 004


    - Dinas Kesehatan Propinsi lulusan adalah Dinas Kesehatan dimana Saudara lulus dari FK/FKG
    Contoh : lulusan FK-UKI maka lapor ke Dinas Kesehatan DKI Jakarta
    lulusan FK-USU maka lapor ke Dinas Kesehatan Sumatera Utara
    - Dinas Kesehatan Propinsi penugasan adalah Dinas Kesehatan dimana Saudara diangkat sebagai dokter
    /dokter gigi PTT

    Sunday, February 28, 2010

    Mirror – Mirror Who’s the most Beautiful in The World?

    At some point, the mirror betrays you. It shakes your sense of youth with vivid signs of aging – little wrinkles around the eyes or lips, age spots, maybe some sagging skin. There used to be few options for turning back the clock without going under the knife. But today, you can soften the signs of aging with a wide range of non-surgical procedures for the face. Learn how these techniques work – and see before-and-after photos.

    Botox Basics
    If forehead creases are bringing you down, Botox and Dysport injections can provide a temporary fix. Botox is the purified toxin of botulism bacteria. In tiny doses, this toxin relaxes the clenched facial muscles that cause crow’s feet, frown lines, and the like. The injections take only a few minutes and cause minimal discomfort.

    Botox: Before and After
    Botox injections usually take three to seven days to reach their full effect. The result is smoother skin in the treated area. As the muscles slowly regain the ability to contract, lines and wrinkles reappear. To maintain the desired effect, injections must be repeated every four to six months.

    Chemical Peel Basics
    Chemical peels use an acid solution to exofliate the outer layers of skin. The solution often contains a combination of glycolic acid, lactic acid, salicylic acid, or trichloro acetic acid (TCA). Application can take as little as 15 minutes and may cause some stinging and irritation. Over the next few days, the upper layers of skin will peel, revealing newer, younger and smoother looking skin.

    Chemical Peel: Before and After
    A series of treatments can reduce age spots, fine lines around the mouth and eyes, acne scars, and wrinkles caused by sun damage or aging. Mild peels, like the one shown here, have more subtle results. The application may be repeated every few weeks until the desired effect is reached. Deeper peels initially cause swelling and crusting but ultimately have more dramatic results. Moderate to deep peels may be repeated in six to twelve months.

    Microdermabrasion Basics
    You may have heard of dermabrasion, a procedure that sands away the top layer of skin. It's an effective way to treat severe sun damage, but it causes bleeding and requires a week of recovery time. Microdermabrasion is a non-surgical alternative. Often called a “power peel,” it blasts the skin with tiny crystals that exfoliate the outer layer. This can reduce fine lines, brown spots, and mild acne scars -- usually with no recovery time.

    Microdermabrasion: After
    As the outer layer of skin is exfoliated, the powdery dead skin cells are suctioned from the face (shown on left). Immediately following microdermabrasion, the newly revealed skin looks pink and feels tight, like a sunburn (shown on right). The irritation usually subsides in about 24 hours leaving subtle improvements in tone and texture. It can take up to 10 sessions, several weeks apart, before the differences are clearly visible.

    Thermage Basics
    For saggy, crepe-like skin, thermage can come to the rescue. This device uses radio frequency energy to heat the skin. The heat stimulates the body’s production of collagen, tightening the skin. Thermage can be painful, but one treatment is usually enough for good results.

    Thermage: Before and After – Eyelids
    Droopy eyelids respond particularly well to Thermage. The results won’t appear until four to six months after the procedure, but the difference can be dramatic.

    Nonablative Laser (Fraxel) Basics
    Nonablative lasers, such as Fraxel, penetrate beneath the surface of the skin without damaging the outer layer. This stimulates collagen production, reduces fine lines, and improves skin tone and firmness. The procedure can be painful, so a topical anesthetic is applied. Because nonablative lasers do not damage surface skin, there is no recovery time.

    Nonablative Laser: Before and After
    Nonablative laser therapy is a good option for people hoping to improve both skin tone and texture without taking time off from work. Each session may cause mild redness, which improves quickly. For the best results, plan on four to six treatments with several weeks in between.

    Nonablative Laser for Melasma
    Non-ablative lasers are especially effective in treating melasma, the splotchy brown patches that often develop during pregnancy. This image shows a striking difference in the cheek area after four treatments with a Fraxel laser.

    Diode Laser Basics
    People with severe acne are experiencing dramatic results from another laser procedure. Diode lasers can destroy the oil-producing glands that feed acne. Like Fraxel, diode lasers penetrate below the surface without damaging the skin’s outer layer. The main side effect is short-term redness and inflammation, but patients usually do not require a recovery period.

    Diode Laser: Before and After
    Diode laser therapy may require several sessions to maximize results. In this image, acne has improved significantly six months after a series of five diode laser treatments.

    Intense Pulse Light (IPL)
    Like lasers, IPL goes below the surface to a deeper layer of skin called the dermis. Short pulses of light are administered to heat and destroy targeted cells and stimulate rejuvenation. Unlike a laser, IPL delivers a broad spectrum of light which can treat a variety of skin imperfections at the same time and causes only moderate sensation.

    IPL: Before and After
    IPL can reduce the redness associated with Rosacea or lighten dark circles under the eyes caused by clusters of blood vessels showing through the skin. Several sessions of IPL vaporize the blood vessels, leaving the surface skin undamaged. IPL can also remove unwanted pigmentation (like melasma and age spots) by destroying pigmented cells.  IPL also stimulates collagen production, which can reduce fine lines and wrinkles.

    Cosmetic Filler Basics
    Cosmetic fillers are substances that help smooth facial wrinkles and folds by bulking up the tissue underneath. The fillers are injected directly into problem areas in hopes of reducing wrinkle lines and facial creases. Collagen, a natural firming fiber, is the oldest and best-known cosmetic filler. Newer alternatives include hyaluronic acid, calcium hydroxyapatite, and ordinary fat harvested from your own thigh or belly.

    Cosmetic Filler: Before and After
    The results of hyaluronic acid injection, shown here on the right, can last nine months or longer. The results of collagen injections vary but may need to be repeated every three to six months. The effects of injecting a wrinkle with fat cells are often permanent. Another filler that yields permanent results is polymethyl methacrylate or PMMA. PMMA has long been used by surgeons in bone cement for joint replacement, but is now approved for cosmetic procedures.

    Cosmetic Filler: Beyond Wrinkles
    Today’s cosmetic fillers have become sophisticated enough to treat problems beyond fine lines and wrinkles. Here, a middle-aged woman’s “sunken cheek” is plumped up with a filler made from human tissue.

    Cosmetic Filler for Dark Circles: Before & After
    Fillers can also mask tired-looking “bags” and dark circles under the eyes. By filling in the hollow area around the eye socket, this strategy reduces shadows, puffiness, and sunken eye appearance.

    Cosmetic Filler for Lips: Before and After
    Many of the same cosmetic fillers used to treat wrinkles and dark circles can also plump up the lips. Collagen and hyaluronic acid injections have a temporary effect. Injecting the lips with fat cells sometimes achieves permanent results.

    Making the Decision
    Non-surgical cosmetic procedures are not without risks. There’s the possibility of an allergic reaction to topical anesthetics or injectable fillers. Chemical peels and microdermabrasion can result in scarring or uneven skin color. But these procedures are generally considered less risky than cosmetic surgery. To assess your personal risks and benefits, talk to your dermatologist.

    Friday, February 26, 2010

    Sleep and you ( Secrets of sleep )


    If you're confiding in a friend about sleep problems, the conversation might turn to topics like not getting enough rest or tossing and turning at night. But what about things your body does during sleep - like drooling, snoring, bedwetting, or passing gas - that you might be embarrassed to talk about by the light of day?

    For example, take Kindra Hall, vice president of sales at a network marketing firm in Phoenix. She admits that drooling excessively while sleeping is a major source of embarrassment, especially when she's been caught in the act. Soaked bed pillows and stained throw pillows are constant reminders of her humiliating habit.

    "I'm very conscious about saliva control," Hall tells WebMD via email, "but as soon as my eyes are closed and I enter dreamland, all bets are off."

    You might not even be aware of your sleeping habits -- until your bed partner clues you in. Sometimes, these behaviors are a part of the natural sleep process. Other times, what you might consider a nuisance -- like snoring -- could be a sign of an underlying sleep problem.

    "It's important for people to realize what is a normal phenomenon versus something that needs further evaluation," says William Kohler, MD, medical director of Florida Sleep Institute in Spring Hill, Fla.

    Here is the lowdown on your nighttime habits - why they happen and when they could be a sign of something more serious.

    Habit #1: Snoring

    An estimated 37 million American adults snore on a regular basis, according to the National Sleep Foundation.

    Snoring is caused by airway narrowing and tissue vibrations in the nasal passages and throat. Snoring can be associated with colds and allergies, but can also be a sign of a more serious problem, like obstructive sleep apnea.

    "It's not really the loudness [that's concerning], it's whether the obstruction that's causing snoring is also causing respiratory impairment at night," Kohler says.

    The verdict: Snoring is a common problem, but if you suspect that it's disrupting your sleep, you should get a medical evaluation.

    Habit #2: Drooling

    Drooling in your sleep can be a normal phenomenon or it can occur in medical conditions that increase salivation, Kohler says. If you drool regularly, you may want to find out if you are at risk for a blocked airway at night or sleep apnea. The verdict: Drooling can be normal, but it can also be associated with other medical conditions.


    Habit #3: Sleepwalking

    "The odd things that happen in the night that get people's attention tend to be things that are scary or potentially dangerous, like complicated episodes of sleepwalking," says Helene Emsellem, MD, medical director of the Center for Sleep & Wake Disorders in Chevy Chase, Md.

    "We should be paralyzed while we're in the dream phase of sleep. If there's a failure of the normal paralysis that protects us from acting out our dreams, then we can potentially be dangerous and inadvertently hurt ourselves or a bed partner," Emsellem says.

    In extreme cases, someone might go into the kitchen, turn on the stove, and forget to turn it off without any memory of the incident.

    The verdict: If you're acting out complex behaviors during sleep, it's time to see a doctor to figure out what's going on.

    Habit #4: Talking in Your Sleep

    Talking in your sleep, whether it sounds like a conversation or just mumbling, is usually harmless by itself. But screaming and yelling with intense fear are associated with night terrors, which are more common in children than adults. They occur during REM sleep, so you will not remember it in the morning. The verdict: Don't lose sleep over talking in your sleep.

    Habit #5: Bedwetting

    Bedwetting is embarrassing and distressing, but a once-in-a-blue-moon episode is not particularly concerning, especially if you're dreaming about going to the bathroom, Emsellem says.

    However, repeated bedwetting could indicate a problem, such as nocturnal seizures. Bowel movements during sleep are unusual, Emsellem says, so one instance should merit a visit to the doctor.

    The verdict: You can write off one bedwetting episode, but you should see a doctor if you have repeat performances.

    Habit #6: Nocturnal Orgasms

    Nocturnal orgasms, sometimes referred to as wet dreams, can occur on a regular basis for men and women, typically during REM sleep. That's a normal phenomenon that occurs throughout our life, Kohler says. The Verdict: Completely natural.

    Habit #7: Flatulence

    Passing gas can occur during sleep, but most people aren't aware of it. "It depends a lot on the GI tract and what you're eating," Kohler says. "There's nothing pathologic, but it can be embarrassing if your partner tells you about it." The verdict: Examine your diet if you're gassing up the entire room.

    Habit #8: Twitching

    When you're nodding off, you may experience a release phenomenon known as a hypnic jerk. Your body may twitch, or you may experience a visual or audio component like seeing flashing lights or hearing a popping sound. The verdict: Hypnic jerks are generally benign.


    By Jennifer Soong
    WebMD Feature

    Reviewed by Louise Chang, MD