11/15/15

dust diseases

The Dust diseases - Lung disorders caused by dust particles inhaled and absorbed into the lung tissues. There, they may cause fibrosis (formation of scar tissue) and progressive lung damage.

The main symptoms are a cough and breathing difficulty. It may take at least ten years of exposure to dusts containing coal, silica, talc, or asbestos before serious lung damage develops (see pneumoconiosis). Hypersensitivity to moulds on hay or grain may lead to allergic alveolitis.

Preventive measures, such as the installation of dust extraction machinery, have reduced the incidence of dust diseases, and replacements have been found for especially hazardous substances such as asbestos.
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Duroziez's disease

The Duroziez's disease - A congenital (present at birth) form of mitral stenosis (a narrowing of the opening of the mitral valve, which is situated on the left side of the heart).
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Dupuytren's contracture

The Dupuytren's contracture - A disorder of the hand in which one or more fingers become fixed in a bent position. In about half of the cases, both hands are affected. In most cases there is no apparent cause, but the disease may be, in part, inherited. Men over the age of 40 are most often affected.

The tissues just under the skin in the fingers or palm become thickened and shortened, which causes difficulty in straightening the fingers. Surgery can correct deformity of the fingers, but in some cases the condition recurs.
Dupuytren's contracture
Dupuytren's contracture
A band of tissue in the hand thickens and contracts, gradually pulling the fingers into a permanently bent position.
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duplex kidney

The duplex kidney - Two fused kidneys on one side of the body. Another structural abnormality of the kidney is duplex renal pelvis, in which a single kidney has two renal pelvises (urine-collecting chambers).

A third possibility is duplex ureter, in which there are two ureters leading from one kidney. The ureters may open into the bladder, or, in females, one may open into the vagina. These malformations arise during formation in the embryo. Surgical correction may be necessary to prevent complications such as infections.
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duodenum

LOCATION OF THE DUODENUM
The duodenum - The first part of the small intestine. The duodenum begins at the duodenal cap, just beyond the pylorus (the muscular valve at the lower end of the stomach). It extends to the ligament of Treitz, which marks the boundary with the second part of the small intestine (the jejunum). (See Location of the duodenum, opposite page.)

The duodenum is about 25 cm long and C-shaped; it forms a loop around the head of the pancreas. Ducts from the pancreas, liver, and gallbladder feed into it through a small opening. Digestive enzymes in the pancreatic secretions and chemicals in the bile are released into the duodenum through this opening.

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duodenitis

The duodenitis - Inflammation of the duodenum (the first part of the small intestine), producing vague gastrointestinal symptoms. It is diagnosed by oesophagogastroduodenoscopy (see gastroscopy): examination of the walls of the upper digestive tract with a flexible viewing instrument. The treatment for duodenitis is similar to that for a duodenal ulcer (see peptic ulcer).
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duodenal ulcer

The duodenal ulcer - A raw area in the wall of the duodenum (the first part of the small intestine) due to erosion of its inner surface lining. Duodenal and gastric (stomach) ulcers are types of peptic ulcer, and have similar causes, symptoms, and treatment.
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dumping syndrome

The dumping syndrome - Symptoms that include sweating, fainting, and palpitations due to the rapid passage of food from the stomach into the intestine. Dumping syndrome (also known as rapid gastric emptying) is uncommon but mainly affects people who have had a gastrectomy (surgical removal of the stomach).

Symptoms may occur within about 30 minutes of eating (early dumping) or after 90–120 minutes (late dumping). Some very anxious people may experience the symptoms of dumping even though their stomach is intact.

CAUSES
Gastric surgery interferes with the normal mechanism for emptying food from the stomach (see digestion). If a meal containing a high level of carbohydrates is “dumped” too quickly from the stomach, the upper intestine may swell. This, together with excessive amounts of certain hormones released into the bloodstream, causes the symptoms of early dumping. As sugars are absorbed from the intestine, they rapidly increase the blood glucose level, causing excess insulin hormone release. This may, in turn, later lower the blood glucose level below normal, causing the symptoms of late dumping.

PREVENTION
A person who has had a gastrectomy can prevent symptoms by eating frequent, small, dry meals that contain no refined carbohydrates. Symptoms may also be prevented by lying down for a rest after a large meal. Adding guar gum to food is also sometimes effective.

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Duke’s classification

The Duke’s classification - A staging system for carcinomas (cancerous tumours arising from cells in an organ’s surface layer or lining membrane) in the lower gastrointestinal tract.

Carcinomas of the colon (the main part of the large intestine) or rectum (the muscular tube that connects the large intestine to the anus) are classified according to this system.

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ductal carcinoma

The ductal carcinoma - Any carcinoma (a cancerous tumour arising from cells in an organ’s surface layer or its lining membrane) of a duct (a tube or tube-like passage leading from a gland).

Examples of ducts that are most frequently affected by carcinomas are the pancreatic duct (see pancreas) and the milk ducts in the female breast. Ductal carcinomas of the breast that have not yet spread into the breast tissue can usually be cured by surgery.

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Dubin Johnson syndrome

The Dubin Johnson syndrome - An inherited disorder that is caused by an autosomal recessive genetic trait (see genetic disorders). Dubin–Johnson syndrome is characterized by long-standing, mild jaundice (yellowing of the skin and the whites of the eyes), which may not become apparent until puberty or adulthood.

There is an abnormality in the transportation of bilirubin (the main pigment found in bile) from the liver to the biliary system, which causes the bilirubin to accumulate in the liver.

No specific treatment is available. Affected people are advised to avoid drinking alcohol, and to avoid taking a range of medications that are processed by the liver, for example oral contraceptives. Genetic counselling may be offered to prospective parents who have a family history of Dubin–Johnson syndrome.
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DTaP/IPV/Hib

The DTaP/IPV/Hib - A combined vaccine, introduced in 2004, that provides immunity against diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, and Hib. In this vaccine (and in the dTaP/IPV vaccine), the polio and pertussis parts have been altered to minimize the risk of adverse effects.

HOW IT IS DONE
The injection is given in three doses to infants at two, three, and four months of age, so that they are protected as soon as possible. (Meningitis C vaccination is given at the same time.) The childhood immunization schedule also includes a preschool booster (see dTaP/IPV), and a further diphtheria, tetanus, and polio booster before leaving school. (See Typical childhood immunization schedule,)

PROTECTION
The vaccine provides a very high level of immunity to diphtheria, tetanus, pertussis, polio, and Hib infections.

POSSIBLE ADVERSE EFFECTS
DTaP/IPV/Hib is less likely to cause reactions than the older vaccines. Any side effects are usually mild and tend to occur within 12–24 hours.They include a slightly raised temperature, irritability and fretfulness, and a small lump, redness, and swelling at the injection site. Severe side effects are very rare. The vaccine should not be given to children who have reacted severely to a preceding dose or to the old DTP vaccine, or to children who could have a severe reaction to neomycin, streptomycin, or polymyxin B (see polymyxins), which may exist in the vaccine in trace amounts.

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dTaP/IPV

The dTaP/IPV - A combined vaccine, introduced in 2004, that provides immunity against diphtheria (in a low dose), tetanus, pertussis (whooping cough), and poliomyelitis. It is given to children aged three to five years as part of the childhood immunization programme. (See Typical childhood immunization schedule,)
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DSM-IV

The DSM-IV - The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It classifies psychiatric illnesses and is widely used in other countries.
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dry socket

The dry socket - Infection at the site of a recent tooth extraction, causing pain, bad breath, and an unpleasant taste in the mouth. Dry socket occurs when a blood clot fails to form in the tooth socket after a difficult extraction, such as removal of a wisdom tooth (see impaction, dental).

The clot itself may become infected, or infection may already have been present before extraction. The inflamed socket appears dry, and exposed bone is often visible.

The socket is irrigated to remove debris and may then be coated with an anti-inflammatory paste. The infection usually clears up within a few days.
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dry ice

The dry ice - Frozen carbon dioxide. Carbon dioxide changes from a gas to a solid when cooled, without passing through a liquid phase. Dry ice may be applied to the skin in cryosurgery, a freezing technique that is used, for example, to treat warts.
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drusen

The drusen - Abnormal yellowish deposits that build up in the retina (the light-sensitive layer at the back of the eye), which can lead to a disturbance of central vision. Drusen may be a sign of age-related macular degeneration.
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drug psychosis

The drug psychosis - A mental condition in which a person loses contact with reality during or following use of certain drugs (see drug abuse). Drug psychosis may be produced by drugs such as amphetamines, cocaine, LSD (lysergic acid diethylamide) and cannabis. The condition may also be caused by prescribed drugs, particularly by high doses of corticosteroid drugs.

Other possible effects associated with drug psychosis include abnormal behaviour, hallucinations, delusions, and extreme emotion, such as excitement or a dazed, unresponsive state. Treatment involves withdrawal from the drug and the use of antipsychotic drugs to relieve symptoms.
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Drug poisoning

The Drug poisoning - The harmful effects on the body that occur as a result of an excessive dose of a particular drug.

INCIDENCE AND CAUSES
Accidental poisoning most commonly occurs in young children. Child-resistant drug containers have helped to reduce this risk. In adults, drug poisoning usually occurs in elderly or confused people who are unsure about their treatment and dosage requirements. Accidental poisoning may also occur in drug abuse. Deliberate self-poisoning may be a cry for help (see suicide; suicide, attempted). Drugs that are most commonly taken in overdose include benzodiazepine drugs and antidepressant drugs.

TREATMENT:
Anyone who has taken a drug overdose, and any child who has swallowed tablets belonging to someone else, needs immediate medical attention. It is important to identify the drugs that have been taken. Treatment in hospital may involve washing out the stomach by passing water through a tube introduced into the mouth (see lavage, gastric). Charcoal may be given by mouth to reduce the absorption of the drug from the intestine into the bloodstream. To eliminate the drug, urine production may be increased by an intravenous infusion. Antidotes are available only for a few specific drugs. Such antidotes include naloxone (for morphine) and methionine (for paracetamol).

COMPLICATIONS
Drug poisoning may cause drowsiness, breathing difficulty, irregular heartbeat, and, rarely, cardiac arrest, fits, and kidney and liver damage. Antiarrhythmic drugs can be given to treat heartbeat irregularity. Fits are treated with anticonvulsant drugs. Blood tests to monitor liver function and careful monitoring of urine
output are carried out if the drug is known to damage the liver or kidneys.
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drug overdose

The drug overdose - The taking of an excessive amount of a drug, which may cause toxic effects (see drug poisoning).

METHODS OF DRUG ADMINISTRATION
By mouth - Drugs are digested and absorbed from the intestine in the same way as nutrients. How quickly the tablet or liquid works depends on how rapidly it is absorbed. This, in turn, depends on such factors as the drug’s composition, how quickly the drug dissolves and the effect of digestive juices on it. Some drugs are inactivated as soon as they reach the liver and never enter the circulation.

By injection - Drugs given by injection have a very rapid effect and are given if digestive juices would destroy a drug.

Topical - These drugs have a local effect on the parts of the body that are exposed to them as well as a systemic (generalized) effect if some of the drug is absorbed into the bloodstream from the site of application.
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Drug induced disease

The drug-induced disease - Any disorder resulting from the use of a drug. Examples include drug-induced lupus erythematosus, haemolytic anaemia (see anaemia, haemolytic), and parkinsonism.

Factors that may increase the risk of drug-induced disease are age, sex, individual sensitivity, underlying disease (especially of the kidneys or liver), and the combination of drugs a patient is taking. Adverse effects associated with the use of medications may lead to hospitalization, disability, or even death. (See also side effect.)
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Drug eruption

The Drug eruption - An adverse, allergic reaction (see allergy) that is provoked by the ingestion or topical application of a particular drug. A drug eruption is usually manifested as a rash on the surface of the skin.

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Drug dependence

The Drug dependence - The compulsion to continue taking a drug, either to prevent the ill effects that occur when it is not taken, or to produce the desired effects of taking it.

TYPES
Drug dependence can be psychological or physical, or more commonly both. A person is psychologically dependent if he or she experiences craving or distress when the drug is withdrawn. In physical drug dependence, the body has adapted to the drug, causing the symptoms and signs of withdrawal syndrome when the drug is stopped. These symptoms are relieved if the drug is taken again.

CAUSE
Dependence develops as a result of regular or excessive drug use, and it develops most frequently with drugs that alter mood or behaviour.

SYMPTOMS AND SIGNS
Drug dependence may cause physical problems, for example lung and heart disease from smoking and liver disease from excessive alcohol consumption. Mental problems, such as anxiety and depression, are common during drug withdrawal. Dependence may also be linked with drug tolerance, in which increasing doses of the substance are needed to produce the same effect.

COMPLICATIONS
Complications such as hepatitis or AIDS are a particular risk for people who abuse drugs by injection. Death may occur as a result of taking a contaminated drug, or be due to accidental overdose from taking a purer, more potent preparation than usual.

TREATMENT AND OUTLOOK
Controlled withdrawal programmes are available in special centres and hospitals, which usually offer gradual, supervised reductions in dose. Alternative, less harmful drugs may be given, as well as treatment for any withdrawal symptoms. Social service agencies and support groups may provide follow-up care. The success of treatment depends on the motivation of the affected person. Problems often recur if people return to the circumstances that originally gave rise to the drug abuse.
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Drug abuse

The drug abuse - Use of a drug for a purpose other than that for which it is normally prescribed or recommended. Commonly abused drugs include stimulant drugs, such as cocaine and amphetamine drugs; central nervous system depressants, such as alcohol and barbiturate drugs; hallucinogenic drugs, such as LSD; and narcotics (see opioid drugs), such as heroin. Some drugs are abused in order to improve performance in sports (see sports, drugs and; steroids, anabolic).

Problems resulting from drug abuse may arise from the adverse effects of the drug, accidents that occur during intoxication, or from the habit-forming potential of many drugs, which may lead to drug dependence.
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Drug

The Drug - A chemical substance that alters the function of one or more body organs or the process of a disease. Drugs include prescribed medicines, over-the-counter remedies, and various substances (such
as alcohol, tobacco, and drugs of abuse) that are used for nonmedical purposes.

CLASSIFICATION AND LICENSING
Drugs normally have a chemical name, an officially approved generic name (see generic drug), and often a brand name. Drugs for medical use are either licensed for prescription by a doctor only or can be bought over the counter at a chemist’s or supermarket. Most drugs are artificially produced to ensure a pure preparation with a predictable potency (strength). Some drugs are genetically engineered. A drug is classified according to its chemical make-up, or the disorder it treats, or according to its specific effect on the body. All new drugs are tested for their efficiency and safety. In the UK, drugs are licensed by the Medicines and Healthcare products Regulatory Agency (MHRA). A licence may be withdrawn if toxic effects are reported or if the drug causes serious illness.

USES
Drugs can be used to relieve physical or mental symptoms, to replace a natural substance that is deficient, or to stop the excessive production of a hormone or other chemical by the body. Some drugs are given to destroy foreign organisms, such as bacteria or fungi. Others, which are known as vaccines, are given to stimulate the body’s immune system to form antibodies.

METHODS OF ADMINISTRATION
Drugs are given by mouth or injection, or are applied directly or indirectly to the affected site via transdermal, nasal, and other direct routes (for example, to the lungs through an inhaler). Drugs that are injected take effect more rapidly than those taken by mouth because they enter the bloodstream directly, without passing
first through the digestive system. There are different routes for injection. The fastest is intravenous; intramuscular is also fast because muscles have a good blood supply; subcutaneous injection is the slowest method, but is easier for self-administration of drugs.

ELIMINATION
Unabsorbed drugs are broken down in the liver. Those taken orally are excreted in faeces; those that have entered the bloodstream are eliminated in urine.

ADVERSE EFFECTS
Most drugs can produce adverse effects. These effects may wear off as the body adapts to the drug. Adverse effects are more likely if there is a change in the absorption, breakdown, or elimination of a drug (caused, for example, by liver disease). Unexpected reactions sometimes occur due to a genetic disorder, an allergic reaction, or the formation of antibodies that damage body tissues. Some drugs interact with food, alcohol, or other drugs. Many drugs can cross the placenta; some affect the growth and development of the fetus if taken by a pregnant woman. Most drugs can pass into the breast milk of a nursing mother, and some have adverse effects on the baby.
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Drowsiness

Types of drowning

The Drowsiness - A state of consciousness between full wakefulness and sleep or unconsciousness. Drowsiness is medically significant if a person fails to awaken after being shaken, pinched, and shouted at, or wakes but relapses into drowsiness.

Abnormal drowsiness must be treated as a medical emergency. It may be the result of a head injury, high fever, meningitis (inflammation of the membranes surrounding the brain and spinal cord), uraemia (excess urea in the blood due to kidney failure), or liver failure. Alcohol or drugs may also produce this effect. In a person with diabetes mellitus, drowsiness may be a result of hypoglycaemia (low blood sugar levels) or of hyperglycaemia (high blood sugar levels).

Types of drowning
In four-fifths of deaths due to drowning, the victim has inhaled liquid into his or her lungs. In the other fifth, no liquid is present in the lungs; this condition is called dry drowning. In both cases, death is by suffocation.
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Drowning, dry

The Drowning, dry - A form of drowning in which no fluid enters into the lungs. Some fatal drowning cases are “dry”. Victims of dry drowning have a particularly strong laryngeal reflex, which diverts water into the stomach instead of the lungs, but at the same time impairs breathing. As with cases of “wet” drowning, death occurs by suffocation.
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Drowning

The Drowning - Death caused by suffocation and hypoxia (a lack of oxygen) associated with immersion in a fluid. Most often, the person inhales liquid into the lungs; but sometimes no liquid enters the lungs, a condition called dry drowning (see drowning, dry). People who are resuscitated after prolonged immersion are said to be victims of “near drowning”.

MECHANISM OF DROWNING
Initially, automatic contraction of a muscle at the entrance to the windpipe, a mechanism known as the laryngeal reflex, prevents water from entering the lungs; instead, the water enters the oesophagus and stomach. However, the laryngeal reflex impairs breathing and can quickly lead to hypoxia and to loss of consciousness. If the person is buoyant at this point and floats face-up, his or her chances of survival are reasonable because the laryngeal reflex begins to relax and normal breathing may then resume.

FIRST AID AND TREATMENT
An ambulance should be called and the person’s condition assessed. If he or she is not breathing and/or the pulse is absent, resuscitative measures should be started (see artificial respiration; cardiopulmonary resuscitation) and continued until medical help arrives.

Victims can sometimes be resuscitated despite a long period immersed in very cold water (which reduces the body’s oxygen needs). In all cases of successful resuscitation, the person should be sent to hospital, because life-threatening symptoms may develop some hours after rescue if water has passed from the lungs into the blood.
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Dropsy

The Dropsy - An outmoded term for generalized oedema (fluid accumulation in body tissues). It is not a disease in itself, but a sign of disease, especially of congestive heart failure or kidney disease.
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Dropped beat

The Dropped beat - A type of cardiac arrhythmia (see arrhythmia, cardiac) characterized by the absence of a single ventricular contraction. The next heartbeat often comes slightly early, and is more forceful than usual; this beat is often the one that is noticed, rather than the dropped one.

Dropped beat is very common and may be caused by alcohol, caffeine, and some medications. Single, infrequent dropped beats are very unlikely to be due to heart disease.
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Drop attack

The Drop attack - A brief disturbance that affects the nervous system, causing a person to fall to the ground without warning. Unlike in fainting, the person may not lose consciousness, but injuries can occur from the fall. Elderly women make up the group most commonly affected.

CAUSES:
The causes are not fully understood, but they may be a form of transient ischaemic attack (TIA) in which there is a fall in blood flow to nerve centres in the brainstem. Elderly men may have a drop attack while passing urine or while standing, possibly due to low blood pressure or an abrupt alteration in heart rhythm. Akinetic seizures (a rare form of epilepsy) are also sometimes described as drop attacks; the sufferer falls to the ground but does not have muscular spasms.

TREATMENT:
There is no treatment for drop attacks in elderly people. Akinetic seizures usually respond to anticonvulsant drugs.
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Health and driving

The Health and driving - Safe driving depends in part on the health of the vehicle’s driver. Any state or medical disorder that affects a driver’s physical condition, or impairs mental faculties such as judgment, alertness, or speed of reaction, increases the risk of injury to the driver and also to other road users and pedestrians.

One of the most obvious hazards is being under the influence of alcohol. There are strict laws regarding the maximum blood alcohol level allowed, because alcohol is known to impair judgment and to slow reaction times. Illicit drugs (see drug abuse) have a similarly harmful effect. Some prescribed drugs can also affect ability to drive; for example, some antihistamines (used to treat disorders such as hay fever) can cause drowsiness. The combination of drugs and alcohol is more potent than either used alone. Other states that can be hazardous include fatigue and any type of stress reaction such as anger and anxiety. Driving when tired is one of the most common causes of road accidents.

Impaired vision obviously affects a person’s fitness to drive. Various other health problems should be disclosed to the driver’s vehicle licensing authority, and in some cases may preclude driving for a period of time. Drivers who have diabetes mellitus must inform their vehicle licensing authority as well as their insurance company if they begin insulin therapy. Careful monitoring of blood sugar levels is of vital importance, because abnormally high or low levels may impair the person’s judgment or cause loss of consciousness. People who have had a stroke, or who have had a pacemaker fitted, may also be subject to driving restrictions. Stricter regulations are in place for certain groups of drivers, for example people with epilepsy.

Regardless of the medical condition, it is extremely important that the patient contacts the vehicle licensing authority for advice on fitness to drive if there is the least cause for concern.
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Dribbling

The Dribbling - Involuntary leakage of urine from the bladder (see incontinence, urinary) or of saliva from the mouth (drooling). Dribbling of saliva is normal in infants. In adults, it may be due to poorly fitting dentures; alternatively, it may be the result of facial paralysis, dementia, or another disorder of the nervous system, most commonly Parkinson’s disease. Dribbling of saliva may also be caused by an obstruction in the mouth that interferes with swallowing.
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Dressler's syndrome

The Dressler's syndrome - An uncommon disorder, also known as postinfarction syndrome, that may occur following a myocardial infarction (heart attack) or heart surgery.

Dressler’s syndrome is characterized by fever, chest pain, pericarditis (inflammation of the membrane lining the heart), and pleurisy (inflammation of the membrane around the lungs). Treatment is with aspirin or, in severe cases, with corticosteroid drugs.
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dressings

The dressings - Protective coverings for wounds that are used to absorb blood or other body secretions, prevent contamination, or retain moisture. Pressure dressings are applied to stem bleeding or to reduce swelling at the site of injury.

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Dreaming

The Dreaming - Mental activity that takes place during sleep. Dreaming is thought to occur only during periods of REM (rapid eye movement) sleep, which last for about 20 minutes and occur four to five times a night. Compared to other phases, the REM phase of sleep is active.

Blood flow and brain temperature increase, and there are sudden changes in heart rate and blood pressure. Dreams usually closely mirror the day’s preoccupations. Dreaming can be seen as a process in which the mental impressions, feelings, and ideas are sorted out. People roused during REM sleep report especially vivid dreams.

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Dream analysis

The Dream analysis - The interpretation of a person’s dreams as part of psychoanalysis or psychotherapy. First developed by Sigmund Freud, it is based on the idea that repressed feelings and thoughts are revealed, in a disguised way, in dreams.
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drain, surgical

The Drain, surgical - An appliance that is inserted into a body cavity or a wound in order to release air or permit drainage of fluid. Drains range from simple soft rubber tubes that pass from a body cavity into a dressing to wide-bore tubes that connect to a collection bag or bottle. Suction drains are thin tubes containing many small holes to help collect fluid or air, which is then drawn into a vacuum bottle.
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drainage angle

The drainage angle - The gap between the outer edge of the iris (the coloured ring of muscle in the eye) and the cornea (the transparent covering of the eyeball). This structure, and the network of tissue behind it (the trabecular network), allows excess aqueous humour to drain from the front chamber of the eye. Blockage of the drainage angle causes acute glaucoma.
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doxycycline

The doxycycline - A tetracycline drug used in the treatment of chronic prostatitis, pelvic inflammatory disease, acne, and chest infection in chronic bronchitis. It is also used to prevent and treat malaria. Taking the drug with food reduces possible side effects.
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doxorubicin

The doxorubicin - An anticancer drug given by injection, often with other anticancer drugs. It is used in the treatment of a variety of cancers, including lung cancer.
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doxazosin

The doxazosin - An antihypertensive drug taken to reduce high blood pressure (see hypertension). Possible side effects include dizziness, headache, and nausea.
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