Medical Transplantation, transfer of a living tissue or organ to an injured or ill person to restore health or reduce disability. Over the past 45 years, surgeons have made great strides in their ability to implant organs in people who are seriously ill. At least 21 different organs—such as hearts, livers, and kidneys—and tissues—such as corneas and bone marrow—can now be successfully transplanted into patients who can then expect to survive for years or even decades.
Each year, more than 20,000 internal organs are successfully implanted into patients in the United States and more than 1,600 organ transplants are performed in Canada. Improved surgical techniques are partly responsible for the success of organ transplants, but a more important factor is the development of drugs that can suppress the body’s rejection of the implanted organ without also leaving the patient highly susceptible to infections.
But this success also created a major problem: as the demand for organs grew, it soon outstripped the supply of donated organs. As of April 2001, more than 76,000 Americans were on a waiting list for organs or tissues and as of December 2000, more than 3,540 Canadians were also on a waiting list.
Each year in the United States, more than 4,000 die before a donated organ can be found. In order to match the scarce supply of donated organs with critically ill patients, in 1984 the United States Congress passed the National Organ Transplant Act to regulate the transplant business. The United Network for Organ Sharing (UNOS) serves as the umbrella organization for organ procurement and transplantation centers around the nation.
When a physician determines that a patient requires a transplant, the patient’s medical information is sent to the closest transplant center. At the transplant center, candidates are evaluated and ranked according to medical criteria. The patient’s medical records are then sent to UNOS for inclusion on its computerized waiting list.
When a donated organ becomes available, it is offered to patients on a waiting list in the donor’s local area. A match is made if laboratory tests show that the recipient is compatible with the available organ, reducing the risk that the organ will be rejected, and if the patient is healthy enough and available to undergo major surgery immediately. If the highest-ranked patient on the list does not meet these criteria, the organ is offered to the next patient on the list. If no one locally can use the organ, it is offered regionally. If it cannot be used regionally, in rare cases the organ is offered to the highest-ranking patient elsewhere in the United States.
In some cases, this system of organ allocation means that people living in certain areas of the country who require a transplant receive a donor organ faster than people living in other areas of the country. To make organ allocation more equitable, in early 2000 the U.S. Department of Health and Human Services (HHS) proposed legislation that called for enhanced government oversight of organ allocation policies. If enacted, the legislation would establish guidelines ensuring that a donated organ or tissue is offered to the patient in most need, no matter where the patient lives.
Most transplanted organs are from people who have died recently, particularly people involved in accidents injuring the head. Once all brain activity stops in a patient, the person is considered legally dead. When the brain dies, the rest of the body is kept alive temporarily until organs can be removed. Someone from either the hospital staff or a local organ procurement organization asks the victim’s family for permission to harvest the organs. To save time and increase the supply of organs, many states encourage people to sign and carry donor cards that indicate their willingness to donate their organs in the event of an accidental death. This information can also be displayed on the driver’s license in many states.
Some organs and tissues can be donated from living donors. For example, millions of people each year donate blood. After donating about 500 ml (about 1 pt) of blood, the donor’s body quickly grows new blood cells to replace the donated ones. The donor suffers no ill effects of donating blood. Other organs that can come from living donors include the kidney and the liver.
Saturday, November 29, 2008
Transplant Rejection
For medical transplantation to be successful, physicians must elude the combative efforts of the body’s complex immune system, which fights to protect the body from infections of all sorts.
Central to the functioning of the immune system is its ability to distinguish between invading or foreign matter, which should be attacked, and matter that is a normal part of the body, which should not be attacked.
This recognition system uses specific markers called histocompatibility antigens that are on the surface of all cells in an individual’s body. The immune system attacks anything that lacks these histocompatibility antigens or has antigens different from those found in the rest of the body, such as those found on invading viruses, bacteria, or other microorganisms.
This recognition system causes the immune system to attack transplanted tissues that have different antigens because it has no way to distinguish between harmful and beneficial foreign matter.
There are over 200 different histocompatibility antigens, with each individual having a specific set of them. The odds that two unrelated people will have the same set of histocompatibility antigens are about one in 30,000.
Transplant surgeons attempt to match histocompatibility antigens of the donor and the recipient as closely as possible in order to minimize rejection. In most cases, the match will not be exact, and the recipients must take drugs to suppress the immune response.
The first drugs that were used were azathioprine and prednisone. But these drugs suppress the entire immune system, leaving the recipient vulnerable to infections and certain cancers. They also have toxic side effects.
A major breakthrough in immune suppression was the development of cyclosporine, a natural product derived from a fungus found in soil. Cyclosporine suppresses the part of the immune system involved in organ rejection with less severe impact on other parts of the immune system.
A few years later, the drug tacrolimus (FK-506) was found to be even more effective for kidney, liver, heart, and lung transplants. However, patients who take these two drugs still face some increased risk of infection and cancer, and the drugs can cause kidney damage. Doctors often use a combination of immune-suppressing drugs to limit these side effects.
Central to the functioning of the immune system is its ability to distinguish between invading or foreign matter, which should be attacked, and matter that is a normal part of the body, which should not be attacked.
This recognition system uses specific markers called histocompatibility antigens that are on the surface of all cells in an individual’s body. The immune system attacks anything that lacks these histocompatibility antigens or has antigens different from those found in the rest of the body, such as those found on invading viruses, bacteria, or other microorganisms.
This recognition system causes the immune system to attack transplanted tissues that have different antigens because it has no way to distinguish between harmful and beneficial foreign matter.
There are over 200 different histocompatibility antigens, with each individual having a specific set of them. The odds that two unrelated people will have the same set of histocompatibility antigens are about one in 30,000.
Transplant surgeons attempt to match histocompatibility antigens of the donor and the recipient as closely as possible in order to minimize rejection. In most cases, the match will not be exact, and the recipients must take drugs to suppress the immune response.
The first drugs that were used were azathioprine and prednisone. But these drugs suppress the entire immune system, leaving the recipient vulnerable to infections and certain cancers. They also have toxic side effects.
A major breakthrough in immune suppression was the development of cyclosporine, a natural product derived from a fungus found in soil. Cyclosporine suppresses the part of the immune system involved in organ rejection with less severe impact on other parts of the immune system.
A few years later, the drug tacrolimus (FK-506) was found to be even more effective for kidney, liver, heart, and lung transplants. However, patients who take these two drugs still face some increased risk of infection and cancer, and the drugs can cause kidney damage. Doctors often use a combination of immune-suppressing drugs to limit these side effects.
Types of Transplants
Kidneys
Kidneys are the most common organs to be transplanted. Kidneys remove waste products from the blood stream. If they fail, often as a result of diabetes mellitus or cancer, a person can die from the buildup of these toxic materials.
The waste products can be removed artificially through a process called kidney dialysis, but the patient must be hooked up to the dialysis machine two to three times each week for as long as 12 hours at a time.
Kidney transplants free the recipient from dependence on dialysis. If the kidney is rejected, the patient must go back on dialysis or receive another transplant.
The first successful transplant of any organ was performed in 1954, when American surgeon Joseph Murray successfully transplanted a kidney donated from the recipient’s twin brother.
In the United States, some 13,290 kidney transplants were performed in 2000, of which 5,227 came from living donors. The one-year survival rate for kidney transplant patients is about 95 percent. Some kidney transplant patients have survived more than 25 years.
Because people have two kidneys but need only one, a living relative often serves as a donor, retaining one kidney for his or her own use. About one-third of transplanted kidneys come from living relatives and about two-thirds are from someone who recently died.
Many patients whose kidney failure was caused by diabetes mellitus receive a pancreas transplant at the same time. The pancreas normally secretes insulin, a substance that helps the body use and store sugars. In some diabetics, the body’s immune system destroys insulin-secreting cells in the pancreas.
In many cases, the disease can be controlled with shots of insulin. However, if the diabetic requires a kidney transplant, the surgeon will often transplant a pancreas at the same time. In 2000, there were 436 pancreas transplants and 914 simultaneous kidney and pancreas transplants performed in the United States. The one-year survival rate for pancreas transplant patients is about 95 percent.
Heart Transplant
Heart transplants are perhaps the most dramatic of all organ transplants because without a functioning heart, a patient cannot survive more than a few minutes. The heart is also more sensitive to a lack of blood than other organs, and can be preserved for only a few hours without damage.
The first successful heart transplant was conducted in December 1967 by South African surgeon Christiaan Barnard. It was not until cyclosporine was approved for clinical use in the United States in 1983 that heart transplants gained widespread use. Most patients are able to resume a normal life about six months after surgery, and about 84 percent of them survive the first year. In 2000, about 2,200 patients received heart transplants, and 48 received heart-lung transplants, in the United States.
Liver failure caused by cirrhosis, cancer, or hepatitis can be fatal. The liver is the only internal organ with the capacity to regenerate. This capacity provides the surgeon additional flexibility in treating liver damage. For instance, if the damage is not very severe, a temporary transplant can take over the liver’s function while the patient’s own liver recovers. It is also possible to remove part of a liver from a living donor and transplant it. After the surgery both the donor’s liver and the transplanted portion will grow to full size. In 2000, about 4,900 livers were transplanted. The one-year survival rate is about 84 percent.
Lungs Transplant
Lung transplants are used to replace a single diseased lung, and sometimes both lungs. In some cases lung disease has damaged the heart, and these cases may benefit from a combined heart-lung transplantation. Successful lung transplants are hampered by the difficulty in preserving a lung from a person who has recently died so that it is still viable by the time a proper recipient is found. In 2000, 956 lungs were transplanted in the United States. The one-year survival rate for lung transplants is about 74 percent.
Other organ transplant surgeries are being developed and some are still in the experimental stage. In 2000, 79 small intestines were transplanted in the United States to replace organs damaged by disease. Reliable survival data for intestine transplant patients are not yet available because the procedure is still experimental.
Tissue Transplant
The most common tissue transplant is blood transfusion, commonly used to replace blood lost by a person in an accident or during surgery. Other tissues commonly transplanted include bone marrow, corneas, skin, bone, cartilage, tendons, and blood vessels.
Bone marrow is the living tissue found in the center of many large bones of the body. Special cells in the bone marrow, called stem cells, are the source of both red blood cells, the primary component of blood, and white blood cells, the workhorses of the immune system. Certain blood diseases, including leukemia and sickle-cell anemia, are the result of the stem cells in the bone marrow producing faulty blood cells.
In some cases, these diseases can be treated by destroying all of the patient’s bone marrow and replacing it with new donor bone marrow that does not produce the faulty blood cells. Bone marrow transplants are also used in fighting breast and other cancers because intensive radiation or chemotherapy used to cure the cancer also kills the patient’s bone marrow, which must then be replaced with a transplant.
Bone marrow transplants require a closer matching of donor and recipient than is the case with other types of transplants. If the match is not good enough, the recipient’s body may reject the bone marrow or the white blood cells generated by the donor marrow can attack the recipient’s body, a phenomenon known as graft-versus-host disease.
About 30 percent of patients who require a bone marrow transplant have a close family member who is suitably matched. The rest must find a suitable donor. In the United States, the federal government has established the National Marrow Donor Program registry, which currently lists more than 4 million potential donors.
More than 1,500 bone marrow transplants occur every year in the United States from marrow donated from unrelated people. The success rate of a transplant depends on the disease being treated. Transplants to treat sickle-cell anemia have a 90 percent success rate, but success rates are only in the 30 to 60 percent range for other diseases.
Cornea Transplant
The cornea is the transparent front covering of the eye and is necessary for vision. Cornea transplants replace corneas that have become cloudy, swollen, or painful, usually as a long-term complication from cataract surgery.
Corneas can also become scarred after an injury or require replacement because of birth defects. Cornea transplants are very successful, with a success rate of more than 90 percent if the cornea is placed on the eye in such a manner that blood vessels do not come into contact with it. Without blood vessels, the body cannot send immune cells to attack the cornea.
About 33,000 cornea transplants are performed every year. Eye surgeons can also transplant scleral tissue, the fibrous tissue that forms the white of the eye. Sclera transplants are used to treat glaucoma patients and those requiring reconstructive eye surgery.
Skin was the first tissue transplanted, and researchers used skin transplants in the late 1950s and early 1960s to decipher the immune system response to transplants. Most skin transplants are so-called autografts, in which skin is taken from one site on the recipient’s body and grafted onto an injured site, thus avoiding the problems with rejection.
However, in cases where the amount of skin needed is greater than the recipient can provide, such as in burn victims with extensive burns, skin from donors is used.
Donated skin is useful, even if not properly matched, since it provides temporary protection from infection while new skin grows. By the time the graft is rejected, new skin is present.
Other Organ and Tissue Sources
Other Organ and Tissue sources
In addition to organs donated from humans, researchers are exploring the use of partially or wholly artificial organs manufactured in the laboratory. The use of organs from other species of mammals, a technique called xenotransplantation, is also being researched.
Artificial Organs and Tissues
One way to get around the shortage of donors is to use wholly or partially artificial organs made of plastic, metal, and other synthetic materials. A kidney dialysis machine, for example, is an artificial organ, even if it is too large to implant in the body.
In 1982 American physician William DeVries implanted a crude artificial heart into the chest of dentist Barney Clark. But Clark survived for only 112 days and the heart itself, powered by an air pump that required its own cart, proved impractical.
Although subsequent researchers have built smaller, more efficient hearts, none of these devices have proved successful. Instead, emphasis has shifted to the use of left-ventricular assist devices (LVADs), which are implanted beside a patient’s heart to help it pump blood. LVADs keep patients alive until a donor heart is available.
Many artificial devices work to restore the operation of malfunctioning organs without replacing the whole organ. Examples include artificial heart valves and pacemakers to help the heart function properly, and cochlear implants to restore hearing.
Other researchers are working to build replacement organs and tissues from human cells, a technique known as tissue engineering. The Food and Drug Administration (FDA) has approved two types of artificial skin made by growing a relatively small number of human skin cells on an artificial surface in the laboratory.
The cells multiply and grow into a useful skin covering that can be used to cover larger areas than are possible with a simple autograft. Researchers hope to develop other types of artificial organs as well, such as artificial pancreases in which insulin-secreting pancreatic cells are enclosed in a porous membrane that enables nutrients, but not immune cells, to reach the cells while insulin diffuses out.
Some scientists hope to use embryonic stem cells, which are found in very early stage human embryos and are capable of developing into almost any type of cell in the body, to overcome the shortage of donor organs. If researchers learn how to make embryonic stem cells develop into specific tissues, the cells could be used to produce new organs or to repair organs, such as the heart, that cannot regenerate.
In addition to organs donated from humans, researchers are exploring the use of partially or wholly artificial organs manufactured in the laboratory. The use of organs from other species of mammals, a technique called xenotransplantation, is also being researched.
Artificial Organs and Tissues
One way to get around the shortage of donors is to use wholly or partially artificial organs made of plastic, metal, and other synthetic materials. A kidney dialysis machine, for example, is an artificial organ, even if it is too large to implant in the body.
In 1982 American physician William DeVries implanted a crude artificial heart into the chest of dentist Barney Clark. But Clark survived for only 112 days and the heart itself, powered by an air pump that required its own cart, proved impractical.
Although subsequent researchers have built smaller, more efficient hearts, none of these devices have proved successful. Instead, emphasis has shifted to the use of left-ventricular assist devices (LVADs), which are implanted beside a patient’s heart to help it pump blood. LVADs keep patients alive until a donor heart is available.
Many artificial devices work to restore the operation of malfunctioning organs without replacing the whole organ. Examples include artificial heart valves and pacemakers to help the heart function properly, and cochlear implants to restore hearing.
Other researchers are working to build replacement organs and tissues from human cells, a technique known as tissue engineering. The Food and Drug Administration (FDA) has approved two types of artificial skin made by growing a relatively small number of human skin cells on an artificial surface in the laboratory.
The cells multiply and grow into a useful skin covering that can be used to cover larger areas than are possible with a simple autograft. Researchers hope to develop other types of artificial organs as well, such as artificial pancreases in which insulin-secreting pancreatic cells are enclosed in a porous membrane that enables nutrients, but not immune cells, to reach the cells while insulin diffuses out.
Some scientists hope to use embryonic stem cells, which are found in very early stage human embryos and are capable of developing into almost any type of cell in the body, to overcome the shortage of donor organs. If researchers learn how to make embryonic stem cells develop into specific tissues, the cells could be used to produce new organs or to repair organs, such as the heart, that cannot regenerate.
The First Baboon Organ Transplant
Xenotransplants
The shortage of donors has led some surgeons to consider using animals as donors. Chimpanzee kidneys were successfully transplanted in 1963, with one recipient living for nine months after the surgery. Although the kidneys were not rejected, they proved too small to keep the recipient alive. Efforts to transplant chimpanzee and baboon hearts into humans in the 1960s and 1970s also failed because the hearts were too small.
The first successful baboon organ transplant occurred in 1984, when a baboon’s heart was transplanted into a two-week-old premature baby whose heart was congenitally malformed. The baby survived for 20 days before her body rejected the organ. Because of problems with the small size of chimpanzee and baboon organs, doctors are now turning to other species as potential organ donors.
One animal receiving a lot of attention from the medical community is the pig. Pigs have organs that are the right size for human use, they have large litters, and they mature quickly so there is a ready supply of donating animals. Human bodies do not reject some pig tissues, such as heart valves. Surgeons in the United States transplant about 60,000 pig heart valves into humans annually. However, other transplanted pig organs undergo a phenomenon called hyperacute rejection.
The recipient’s immune system recognizes that the blood vessels in the transplanted organ are foreign and shuts off blood flow to the new organ within hours or even minutes, causing the transplanted organ to blacken and die. Recently, scientists have used genetic engineering techniques to breed pigs whose blood vessels contain the marker antigens found in human blood vessels.
Livers from these pigs have been successfully connected to the bloodstream of several patients to clear toxic wastes while the patients’ own livers recovered. Fetal pig brain cells have also been used to treat Parkinson disease, and research is underway on using other organs from these pigs.
One of the big drawbacks of xenotransplants is the fear that unknown, possibly deadly viruses could be transferred from animals to humans. Once the animal viruses get into humans, they might spread to other humans. In 1997, scientists showed that pig viruses could infect humans with unpredictable results. The unresolved questions surrounding xenotransplantation mean that future research must be done cautiously.
The shortage of donors has led some surgeons to consider using animals as donors. Chimpanzee kidneys were successfully transplanted in 1963, with one recipient living for nine months after the surgery. Although the kidneys were not rejected, they proved too small to keep the recipient alive. Efforts to transplant chimpanzee and baboon hearts into humans in the 1960s and 1970s also failed because the hearts were too small.
The first successful baboon organ transplant occurred in 1984, when a baboon’s heart was transplanted into a two-week-old premature baby whose heart was congenitally malformed. The baby survived for 20 days before her body rejected the organ. Because of problems with the small size of chimpanzee and baboon organs, doctors are now turning to other species as potential organ donors.
One animal receiving a lot of attention from the medical community is the pig. Pigs have organs that are the right size for human use, they have large litters, and they mature quickly so there is a ready supply of donating animals. Human bodies do not reject some pig tissues, such as heart valves. Surgeons in the United States transplant about 60,000 pig heart valves into humans annually. However, other transplanted pig organs undergo a phenomenon called hyperacute rejection.
The recipient’s immune system recognizes that the blood vessels in the transplanted organ are foreign and shuts off blood flow to the new organ within hours or even minutes, causing the transplanted organ to blacken and die. Recently, scientists have used genetic engineering techniques to breed pigs whose blood vessels contain the marker antigens found in human blood vessels.
Livers from these pigs have been successfully connected to the bloodstream of several patients to clear toxic wastes while the patients’ own livers recovered. Fetal pig brain cells have also been used to treat Parkinson disease, and research is underway on using other organs from these pigs.
One of the big drawbacks of xenotransplants is the fear that unknown, possibly deadly viruses could be transferred from animals to humans. Once the animal viruses get into humans, they might spread to other humans. In 1997, scientists showed that pig viruses could infect humans with unpredictable results. The unresolved questions surrounding xenotransplantation mean that future research must be done cautiously.
Ethical Issues Haunt The Transplant Field
ETHICAL ISSUES
A number of ethical issues haunt the transplant field. With few exceptions, donated organs go to the patient who is nearest death, even though a healthier patient might benefit more by living longer after the transplant. People who need a second, third, or fourth transplant because their prior transplants failed usually gain top priority, even though they are not likely to do as well as patients who have not already had a transplant.
Some critics object to giving organs to patients whose organ failure was the result of their own actions, such as cirrhosis of the liver resulting from alcohol abuse.
Money is also a major issue. Access to transplantation is impossible without access to good primary medical care and good insurance, both of which are largely unavailable to the poor. To be placed on the waiting list, patients must show they can pay for the transplant.
In 2000 a kidney transplant cost about $111,000 and a liver transplant as much as $250,000 in the first year after the surgery. Many insurance companies do not cover such costs, particularly for the new procedures, such as lung, pancreas, or multiple organ transplants, which are still considered experimental.
Although organs cannot be bought and sold legally in the United States, there is evidence that a black market in organs exists in China and other countries. Persistent allegations have been made of people traveling to China and paying for organ transplants. Human rights groups have reported evidence that the bodies of executed prisoners are the source for most of the organs transplanted in China.
In the United States, where organ donation is voluntary, ethical questions arise over the nature of the consent and the use of incentives. Intensive donor solicitations in recent years have not made much of a dent in the shortages of organs.
Even though many people sign organ donor cards, their families are often reluctant to grant permission at the moment of crisis. Some ethicists debate whether family members should have the right to refuse donation if the deceased signed an organ donor card.
Presumed consent laws, in which everyone would be considered willing donors unless they have specifically said they were unwilling, have been tried in Europe and South America, and on a limited basis in Pennsylvania and Maryland. Some experts have suggested financial incentives, such as cash rebates, estate tax discounts, or payment for burial expenses.
Others have suggested broadening the criteria used to determine death beyond the lack of all brain activity. This would permit a surgeon to use organs from anencephalic children, who are born without a brain, and from people in a persistent vegetative state.
The implantation of tissues from aborted fetuses into the brain has proved a possible treatment for both Parkinson and Huntington’s disease, but the treatment has raised its own set of ethical questions.
The foremost is the question of abortion itself. The possibility of using embryonic stem cells to create replacement organs has faced opposition for similar reasons.
Some researchers believe that this issue can be surmounted by growing cells in the laboratory or by genetically engineering a patient’s own skin cells. Fetal pig cells have also been used as a treatment for Parkinson and Huntington’s disease, but that raises other ethical issues regarding the treatment of animals.
A number of ethical issues haunt the transplant field. With few exceptions, donated organs go to the patient who is nearest death, even though a healthier patient might benefit more by living longer after the transplant. People who need a second, third, or fourth transplant because their prior transplants failed usually gain top priority, even though they are not likely to do as well as patients who have not already had a transplant.
Some critics object to giving organs to patients whose organ failure was the result of their own actions, such as cirrhosis of the liver resulting from alcohol abuse.
Money is also a major issue. Access to transplantation is impossible without access to good primary medical care and good insurance, both of which are largely unavailable to the poor. To be placed on the waiting list, patients must show they can pay for the transplant.
In 2000 a kidney transplant cost about $111,000 and a liver transplant as much as $250,000 in the first year after the surgery. Many insurance companies do not cover such costs, particularly for the new procedures, such as lung, pancreas, or multiple organ transplants, which are still considered experimental.
Although organs cannot be bought and sold legally in the United States, there is evidence that a black market in organs exists in China and other countries. Persistent allegations have been made of people traveling to China and paying for organ transplants. Human rights groups have reported evidence that the bodies of executed prisoners are the source for most of the organs transplanted in China.
In the United States, where organ donation is voluntary, ethical questions arise over the nature of the consent and the use of incentives. Intensive donor solicitations in recent years have not made much of a dent in the shortages of organs.
Even though many people sign organ donor cards, their families are often reluctant to grant permission at the moment of crisis. Some ethicists debate whether family members should have the right to refuse donation if the deceased signed an organ donor card.
Presumed consent laws, in which everyone would be considered willing donors unless they have specifically said they were unwilling, have been tried in Europe and South America, and on a limited basis in Pennsylvania and Maryland. Some experts have suggested financial incentives, such as cash rebates, estate tax discounts, or payment for burial expenses.
Others have suggested broadening the criteria used to determine death beyond the lack of all brain activity. This would permit a surgeon to use organs from anencephalic children, who are born without a brain, and from people in a persistent vegetative state.
The implantation of tissues from aborted fetuses into the brain has proved a possible treatment for both Parkinson and Huntington’s disease, but the treatment has raised its own set of ethical questions.
The foremost is the question of abortion itself. The possibility of using embryonic stem cells to create replacement organs has faced opposition for similar reasons.
Some researchers believe that this issue can be surmounted by growing cells in the laboratory or by genetically engineering a patient’s own skin cells. Fetal pig cells have also been used as a treatment for Parkinson and Huntington’s disease, but that raises other ethical issues regarding the treatment of animals.
Friday, November 28, 2008
First Reliable Report of Transplant Surgery
HISTORY
The first reliable report of a transplant surgery is from 1823 when German surgeon Carl Bunger performed plastic surgery on a woman’s nose, grafting skin from her thigh. By 1863, French physiologist Paul Bert had demonstrated that tissues transplanted from one person to another are rejected. Forty years later, German biologist Carl O. Jensen found that this rejection was carried out by the immune system.
During the early 20th century, researchers such as the French surgeon Alexis Carrel and American physiologist Charles Guthrie developed the surgical techniques needed for performing transplants, but rejection remained a problem. In 1958 French immunologist Jean-Baptiste-Gabriel-Joachim Dausset discovered the histocompatibility system for tissue matching.
Minimizing histocompatibility differences, along with the development of the first immunosuppressive drugs azathioprine and prednisone, made transplants possible in the 1950s. Nonetheless, they remained relatively rare until Swiss biochemist Jean Borel discovered the remarkable immunosuppression properties of cyclosporine in 1972.
Cyclosporine revolutionized the field when it was marketed in 1983, making transplants more common.
Thomas H. Maugh II
The first reliable report of a transplant surgery is from 1823 when German surgeon Carl Bunger performed plastic surgery on a woman’s nose, grafting skin from her thigh. By 1863, French physiologist Paul Bert had demonstrated that tissues transplanted from one person to another are rejected. Forty years later, German biologist Carl O. Jensen found that this rejection was carried out by the immune system.
During the early 20th century, researchers such as the French surgeon Alexis Carrel and American physiologist Charles Guthrie developed the surgical techniques needed for performing transplants, but rejection remained a problem. In 1958 French immunologist Jean-Baptiste-Gabriel-Joachim Dausset discovered the histocompatibility system for tissue matching.
Minimizing histocompatibility differences, along with the development of the first immunosuppressive drugs azathioprine and prednisone, made transplants possible in the 1950s. Nonetheless, they remained relatively rare until Swiss biochemist Jean Borel discovered the remarkable immunosuppression properties of cyclosporine in 1972.
Cyclosporine revolutionized the field when it was marketed in 1983, making transplants more common.
Thomas H. Maugh II
Thursday, November 27, 2008
National Institute of Diabetes and Digestive and Kidney Diseases
National Institute of Diabetes and Digestive and Kidney Diseases
Founded in 1950, the National Institute of Diabetes and Digestive and Kidney Diseases funds and coordinates research involving metabolic disorders such as diabetes, digestive diseases, and kidney dysfunction.
It also leads federal research on nutrition and supports more than 20 centers around the United States dedicated to nutrition, digestive diseases, and obesity.
Known Physician.
Bright, Richard (1789–1858)
British physician, who described many conditions and linked edema (accumulation of fluid in the body) to kidney disease. Bright's disease, an acute inflammation of the kidneys (Nephritis), is named for him.
Bright was born in Bristol, England, and studied medicine at Edinburgh University in Scotland. He was on the staff of Guy's Hospital in London, England, from 1820.
Bright initiated the use of biochemical studies by working with chemists to demonstrate that urea is retained in the body during kidney failure.
He also correlated symptoms in patients with the pathological changes he later found in postmortem examinations of the same people.
In this way he found that the presence of the protein albumin in the urine and edema are associated with pathological changes in the kidneys.
Founded in 1950, the National Institute of Diabetes and Digestive and Kidney Diseases funds and coordinates research involving metabolic disorders such as diabetes, digestive diseases, and kidney dysfunction.
It also leads federal research on nutrition and supports more than 20 centers around the United States dedicated to nutrition, digestive diseases, and obesity.
Known Physician.
Bright, Richard (1789–1858)
British physician, who described many conditions and linked edema (accumulation of fluid in the body) to kidney disease. Bright's disease, an acute inflammation of the kidneys (Nephritis), is named for him.
Bright was born in Bristol, England, and studied medicine at Edinburgh University in Scotland. He was on the staff of Guy's Hospital in London, England, from 1820.
Bright initiated the use of biochemical studies by working with chemists to demonstrate that urea is retained in the body during kidney failure.
He also correlated symptoms in patients with the pathological changes he later found in postmortem examinations of the same people.
In this way he found that the presence of the protein albumin in the urine and edema are associated with pathological changes in the kidneys.
Tuesday, November 25, 2008
Everybody knows that some organs in the human body are necessary for survival;
you need;
your brain
your heart
your lungs
your kidneys
KIDNEYS
the kidneys are every bit as important as the heart.
You need at least one kidney to live!
Kidneys normally come in pairs.
If you've ever seen a kidney bean, then you have a pretty good idea what the kidneys look like.
Each kidney is about 5 inches (about 13 centimeters) long and about 3 inches (about 8 centimeters) wide — about the size of a computer mouse.
To locate your kidneys, put your hands on your hips, then slide your hands up until you can feel your ribs.
Now if you put your thumbs on your back, you will know where your kidneys are.
You can't feel them, but they are there.
One of the main jobs of the kidneys is to filter the waste out of the blood.
How does the waste get in your blood? Well, your blood delivers nutrients to your body.
Chemical reactions occur in the cells of your body to break down the nutrients.
Some of the waste is the result of these chemical reactions.
Some is just stuff your body doesn't need because it already has enough.
The waste has to go somewhere; this is where the kidneys come in.
First, blood is carried into the kidneys by the renal artery (anything in the body related to the kidneys is called "renal").
The average person has 1 to 1½ gallons of blood circulating through his or her body.
The kidneys filter that blood as many as 400 times a day! More than 1 million tiny filters inside the kidneys remove the waste.
These filters, called nephrons (say: neh-fronz), are so small you can see them only with a high-powered microscope.
The waste that is collected combines with water (which is also filtered out of the kidneys) to make urine (pee).
As each kidney makes urine, the urine slides down a long tube called the ureter (say: yu-ree-ter) and collects in the bladder, a storage sac that holds the urine.
When the bladder is about halfway full, your body tells you to go to the bathroom.
When you pee, the urine goes from the bladder down another tube called the urethra (say: yu-ree-thruh) and out of your body.
The kidneys, the bladder, and their tubes are called the urinary system.
you need;
your brain
your heart
your lungs
your kidneys
KIDNEYS
the kidneys are every bit as important as the heart.
You need at least one kidney to live!
Kidneys normally come in pairs.
If you've ever seen a kidney bean, then you have a pretty good idea what the kidneys look like.
Each kidney is about 5 inches (about 13 centimeters) long and about 3 inches (about 8 centimeters) wide — about the size of a computer mouse.
To locate your kidneys, put your hands on your hips, then slide your hands up until you can feel your ribs.
Now if you put your thumbs on your back, you will know where your kidneys are.
You can't feel them, but they are there.
One of the main jobs of the kidneys is to filter the waste out of the blood.
How does the waste get in your blood? Well, your blood delivers nutrients to your body.
Chemical reactions occur in the cells of your body to break down the nutrients.
Some of the waste is the result of these chemical reactions.
Some is just stuff your body doesn't need because it already has enough.
The waste has to go somewhere; this is where the kidneys come in.
First, blood is carried into the kidneys by the renal artery (anything in the body related to the kidneys is called "renal").
The average person has 1 to 1½ gallons of blood circulating through his or her body.
The kidneys filter that blood as many as 400 times a day! More than 1 million tiny filters inside the kidneys remove the waste.
These filters, called nephrons (say: neh-fronz), are so small you can see them only with a high-powered microscope.
The waste that is collected combines with water (which is also filtered out of the kidneys) to make urine (pee).
As each kidney makes urine, the urine slides down a long tube called the ureter (say: yu-ree-ter) and collects in the bladder, a storage sac that holds the urine.
When the bladder is about halfway full, your body tells you to go to the bathroom.
When you pee, the urine goes from the bladder down another tube called the urethra (say: yu-ree-thruh) and out of your body.
The kidneys, the bladder, and their tubes are called the urinary system.
Here's a list of all of the parts of the urinary system:
- the kidneys: filters that take the waste out of the blood and make urine
- the ureters: tubes that carry the urine to the bladder
- the bladder: a bag that collects the urine
- the urethra: a tube that carries the urine out of the body
Keeping a Balance
The kidneys also balance the volume of fluids and minerals in the body.
This balance in the body is called homeostasis (say: hoh-mee-oh-stay-sus).
If you put all of the water that you take in on one side of a scale and all of the water your body gets rid of on the other side of a scale, the sides of the scale would balance.
Your body gets water when you drink it or other liquids.
You also get water from some foods, like fruits and vegetables.
Water leaves your body in several ways.
It comes out of your skin when you sweat, out of your mouth when you breathe, and out of your urethra in urine when you go to the bathroom.
There is also water in your bowel movements (poop).
When you feel thirsty, your brain is telling you to get more fluids to keep your body as balanced as possible.
If you don't have enough fluids in your body, the brain communicates with the kidneys by sending out a hormone that tells the kidneys to hold on to some fluids.
When you drink more, this hormone level goes down, and the kidneys will let go of more fluids.
You might notice that sometimes your urine is darker in color than other times.
Remember, urine is made up of water plus the waste that is filtered out of the blood.
If you don't take in a lot of fluids or if you're exercising and sweating a lot, your urine has less water in it and it appears darker.
If you're drinking lots of fluids, the extra fluid comes out in your urine, and it will be lighter.
What Else Do Kidneys Do?
Kidneys are always busy. Besides filtering the blood and balancing fluids every second during the day, the kidneys constantly react to hormones that the brain sends them. Kidneys even make some of their own hormones.
For example;
the kidneys produce a hormone that tells the body to make red blood cells.
Now you know what the kidneys do and how important they are.
Monday, November 24, 2008
Saturday, November 22, 2008
Safety for the recipients must ensure
Human organ trafficking in the Philippines is due to a lack of information, very few people know the Good and bad effects of removing one kidney and transfer to another human being, due to a lack of health information and attention most likely in the urban places where some families didn't have jobs, money to buy foods to eat, desperately had no choices. Selling the parts of their body like kidneys is an easy money for them to get through even without physicians authorization, not knowing the effects.
Good Samaritan" or "altruistic" donation is giving a donation to someone not well-known to the donor. Some people choose to do this out of a need to donate. Some donate to the next person on the list; others use some method of choosing a recipient based on criteria important to them.
Web sites are being developed that facilitate such donation. It has been featured in recent television journalism that over half of the members of the Jesus Christians, an Australian religious group, have donated kidneys in such a fashion.
Safety....
In November 2007, the CDC reported the first-ever case of HIV and Hepatitis C being simultaneously transferred through an organ transplant.
The donor was a 38-year-old male, considered "high-risk" by donation organizations, and his organs transmitted HIV and Hepatitis C to four organ recipients, none of whom had been told he was "high-risk."
Experts say that the reason the diseases didn't show up on screening tests is probably because they were contracted within three weeks before the donor's death, so antibodies wouldn't have existed in high enough numbers to detect.
The crisis has caused many to call for more sensitive screening tests, which could pick up antibodies sooner. Currently, the screens cannot pick up on the small number of antibodies produced in HIV infections within the last 90 days or Hepatitis C infections within the last 18-21 days before a donation is made.
NAT (nucleic acid testing) is now being done by many organ procurement organizations and is able to detect antibodies for HIV and Hepatitis C within seven to ten days of exposure to the virus.
Good Samaritan" or "altruistic" donation is giving a donation to someone not well-known to the donor. Some people choose to do this out of a need to donate. Some donate to the next person on the list; others use some method of choosing a recipient based on criteria important to them.
Web sites are being developed that facilitate such donation. It has been featured in recent television journalism that over half of the members of the Jesus Christians, an Australian religious group, have donated kidneys in such a fashion.
Safety....
In November 2007, the CDC reported the first-ever case of HIV and Hepatitis C being simultaneously transferred through an organ transplant.
The donor was a 38-year-old male, considered "high-risk" by donation organizations, and his organs transmitted HIV and Hepatitis C to four organ recipients, none of whom had been told he was "high-risk."
Experts say that the reason the diseases didn't show up on screening tests is probably because they were contracted within three weeks before the donor's death, so antibodies wouldn't have existed in high enough numbers to detect.
The crisis has caused many to call for more sensitive screening tests, which could pick up antibodies sooner. Currently, the screens cannot pick up on the small number of antibodies produced in HIV infections within the last 90 days or Hepatitis C infections within the last 18-21 days before a donation is made.
NAT (nucleic acid testing) is now being done by many organ procurement organizations and is able to detect antibodies for HIV and Hepatitis C within seven to ten days of exposure to the virus.
Organ Transplant Laws
Both developing and developed countries have forged various policies to try to increase the safety and availability of organ transplants to their citizens.
Brazil, Italy, Poland and Spain have ruled all adults potential donors with the “opting out” policy, unless they attain cards specifying not to be.
Iran is the only country in the world where it is lawful for one citizen to sell an organ to another for transplantation.
However, whilst potential recipients in developing countries may mirror their more developed counterparts in desperation, potential donors in developing countries do not.
The Indian government has had difficulty tracking the flourishing organ black market in their country and have yet to officially condemn it.
Other countries victimized by illegal organ trade have implemented legislative reactions.
Moldova has made international adoption illegal in fear of organ traffickers.
China has made selling of organs illegal as of July 2006 and claims that all prisoner organ donors have filed consent.
However, doctors in other countries, such as the United Kingdom, have accused China of abusing its high capital punishment rate.
Despite these efforts, illegal organ trafficking continues to thrive and can be attributed to corruption in healthcare systems, which has been traced as high up as the doctors themselves in China, Ukraine, and India, and the blind eye economically strained governments and health care programs must sometimes turn to organ trafficking.
Some organs are also shipped to Uganda and the Netherlands. This was a main product in the triangular trade in 1934.
Starting on May 1, 2007, doctors involved in commercial trade of organs will face fines and suspensions in China. Only a few certified hospitals will be allowed to perform organ transplants in order to curb illegal transplants. Harvesting organs without donor's consent was also deemed a crime.
On June 27, 2008, Indonesian, Sulaiman Damanik, 26, pleaded guilty in Singapore court for sale of his kidney to CK Tang's executive chair, Mr Tang Wee Sung, 55, for 150 million rupiah (S$ 22,200).
The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of
In an article appearing in the Econ Journal Watch, April 2004.
Brazil, Italy, Poland and Spain have ruled all adults potential donors with the “opting out” policy, unless they attain cards specifying not to be.
Iran is the only country in the world where it is lawful for one citizen to sell an organ to another for transplantation.
However, whilst potential recipients in developing countries may mirror their more developed counterparts in desperation, potential donors in developing countries do not.
The Indian government has had difficulty tracking the flourishing organ black market in their country and have yet to officially condemn it.
Other countries victimized by illegal organ trade have implemented legislative reactions.
Moldova has made international adoption illegal in fear of organ traffickers.
China has made selling of organs illegal as of July 2006 and claims that all prisoner organ donors have filed consent.
However, doctors in other countries, such as the United Kingdom, have accused China of abusing its high capital punishment rate.
Despite these efforts, illegal organ trafficking continues to thrive and can be attributed to corruption in healthcare systems, which has been traced as high up as the doctors themselves in China, Ukraine, and India, and the blind eye economically strained governments and health care programs must sometimes turn to organ trafficking.
Some organs are also shipped to Uganda and the Netherlands. This was a main product in the triangular trade in 1934.
Starting on May 1, 2007, doctors involved in commercial trade of organs will face fines and suspensions in China. Only a few certified hospitals will be allowed to perform organ transplants in order to curb illegal transplants. Harvesting organs without donor's consent was also deemed a crime.
On June 27, 2008, Indonesian, Sulaiman Damanik, 26, pleaded guilty in Singapore court for sale of his kidney to CK Tang's executive chair, Mr Tang Wee Sung, 55, for 150 million rupiah (S$ 22,200).
The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of
- "poor and socially disadvantaged donors who are unable to make informed choices and suffer potential medical risks."
Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient's adopted son, and was paid 186 million rupiah (20,200 US). Upon sentence, both would suffer each, 12 months in jail or 10,000 Singapore dollars (7,300 US) fine.
In an article appearing in the Econ Journal Watch, April 2004.
- Economist Alex Tabarrok examined the impact of direct consent laws on transplant organ availability. Tabarrok found that social pressures resisting the use of transplant organs decreased over time as the opportunity of individual decisions increased. Tabarrok concluded his study suggesting that gradual elimination of organ donation restrictions and move to a free market in organ sales will increase supply of organs and encourage broader social acceptance of organ donation as a practice.
Tuesday, November 18, 2008
Kidney Failure
Kidney stone(renal calculi)
Parathyroid Gland
Unless accessory tissue is formed or hormone injections are given, parathormone deficiency results in death. Overactivity of the parathyroid glands, occurring in cases of parathyroid tumors or hyperplasia of the normal glands, results in decreased blood phosphorus and increased blood calcium; the calcium in the bloodstream is withdrawn from the bones, which become soft as a result. Crystallization of excess calcium excreted in the urine in hyperparathyroidism may cause formation of kidney stones. The calcium may be carried to and deposited in the soft tissues of the body by the bloodstream; calcium deposition may also cause dysfunction of various organs, particularly the kidneys.
1.) Constipation
Constipation that develops suddenly in people who have previously had normal bowel function may be a symptom of a serious disorder, such as excessive production of thyroid hormones or kidney failure. Disturbing changes in bowel habits should be reported to a physician.
2.) Kidney Dialysis
Also known as hemodialysis, medical treatment used to remove waste materials from the blood of patients lacking renal function. Blood from an artery is pumped through a dialyzer, or artificial kidney, where it flows past a semipermeable membrane. Dialysis fluid passing on the other side of the membrane removes unwanted elements in the blood by diffusion. The blood is then returned to the body through a vein.
3.) Lymphoma
The symptoms of lymphoma vary greatly from person to person, but most frequently the first symptom is a painless swelling of a lymph node in the neck, under an arm, or in the groin. Other symptoms of lymphoma can include shortness of breath; a dry, persistent cough; and pain from masses of tumor cells in various parts of the body, such as the chest or abdomen. Organs, such as the kidneys or liver, may stop functioning properly if lymphoma cells grow into tumors there. Some patients also develop fever, night sweats, or weight loss.
4.) Uremia
Uremia, presence in the bloodstream of too many chemical wastes such as urea, a nitrogen-rich waste product attributable to extra protein in the diet. As chemical wastes build up in the body they produce a toxic effect, possibly resulting in drowsiness, irritability, nausea, vomiting, breathlessness, headaches, and muscle cramps. In extreme cases, uremia may cause convulsions, coma, or death.
The kidneys normally filter chemical wastes from the blood and send them to the urinary system for elimination from the body.
Uremia most commonly develops when the kidneys fail to function properly. In some cases, however, uremia occurs when blood flow to the kidneys is reduced due to severe bleeding, serious burns, or heart attack, or when more wastes are formed in the bloodstream as a result of traumatic injuries or large surgical incisions than can be removed by the kidneys. A kidney stone, a tumor in the urinary tract, or a severely enlarged prostate in males may also cause uremia.
Victims of uremia due to kidney failure undergo kidney dialysis, a medical procedure that removes wastes from the blood. Transplantation of kidneys from healthy donors to uremic patients has also proven effective in some cases.
Parathyroid Gland
Unless accessory tissue is formed or hormone injections are given, parathormone deficiency results in death. Overactivity of the parathyroid glands, occurring in cases of parathyroid tumors or hyperplasia of the normal glands, results in decreased blood phosphorus and increased blood calcium; the calcium in the bloodstream is withdrawn from the bones, which become soft as a result. Crystallization of excess calcium excreted in the urine in hyperparathyroidism may cause formation of kidney stones. The calcium may be carried to and deposited in the soft tissues of the body by the bloodstream; calcium deposition may also cause dysfunction of various organs, particularly the kidneys.
1.) Constipation
Constipation that develops suddenly in people who have previously had normal bowel function may be a symptom of a serious disorder, such as excessive production of thyroid hormones or kidney failure. Disturbing changes in bowel habits should be reported to a physician.
2.) Kidney Dialysis
Also known as hemodialysis, medical treatment used to remove waste materials from the blood of patients lacking renal function. Blood from an artery is pumped through a dialyzer, or artificial kidney, where it flows past a semipermeable membrane. Dialysis fluid passing on the other side of the membrane removes unwanted elements in the blood by diffusion. The blood is then returned to the body through a vein.
3.) Lymphoma
The symptoms of lymphoma vary greatly from person to person, but most frequently the first symptom is a painless swelling of a lymph node in the neck, under an arm, or in the groin. Other symptoms of lymphoma can include shortness of breath; a dry, persistent cough; and pain from masses of tumor cells in various parts of the body, such as the chest or abdomen. Organs, such as the kidneys or liver, may stop functioning properly if lymphoma cells grow into tumors there. Some patients also develop fever, night sweats, or weight loss.
4.) Uremia
Uremia, presence in the bloodstream of too many chemical wastes such as urea, a nitrogen-rich waste product attributable to extra protein in the diet. As chemical wastes build up in the body they produce a toxic effect, possibly resulting in drowsiness, irritability, nausea, vomiting, breathlessness, headaches, and muscle cramps. In extreme cases, uremia may cause convulsions, coma, or death.
The kidneys normally filter chemical wastes from the blood and send them to the urinary system for elimination from the body.
Uremia most commonly develops when the kidneys fail to function properly. In some cases, however, uremia occurs when blood flow to the kidneys is reduced due to severe bleeding, serious burns, or heart attack, or when more wastes are formed in the bloodstream as a result of traumatic injuries or large surgical incisions than can be removed by the kidneys. A kidney stone, a tumor in the urinary tract, or a severely enlarged prostate in males may also cause uremia.
Victims of uremia due to kidney failure undergo kidney dialysis, a medical procedure that removes wastes from the blood. Transplantation of kidneys from healthy donors to uremic patients has also proven effective in some cases.
Kidney Disease and Treatment
Kidney
Kidneys are paired organs, each sharing equally the work of removing wastes and excess water from the blood. Remarkably, a single kidney can do the job of both if one kidney is lost through injury or disease. It sometimes occurs, although rarely, that a person is born with only one kidney. Such people are able to lead normal lives.
Canser
Bacterial infections, most frequently caused by the common intestinal bacterium Escherichia coli, can occur in any part of the urinary system. Antibiotics usually conquer the infection, although recurrent and chronic infections are not uncommon. The incidence of kidney and bladder cancer has risen markedly in the last 30 years. These cancers have been linked to various causative agents, primarily cigarette smoking, abuse of analgesics, obesity, and certain industrial chemicals. Treatment typically includes removal of cancerous tissue, followed by radiation therapy.
1.) Cystitis
In medicine, inflammation of the urinary bladder, usually from bacterial infection originating in the urethra, vagina, or, in more complicated cases, the kidneys. Cystitis may also be caused by irritation from crystalline deposits in the urine or from any condition or urologic abnormality that interferes with normal bladder function. Symptoms include painful or difficult urination, urinary urgency, and, in some cases, cloudy or bloody urine. Treatment is primarily with antibiotics.
2.) Diagnosis and treatment of disease and disorder
Urologists treat common disorders of the urinary system, including urinary tract infections; enuresis, the involuntary discharge of urine; cystitis, the inflammation of the bladder; tumors of the bladder; and mineral deposits in the kidney, commonly known as kidney stones. Urologists also specialize in disorders of the male reproductive system, such as enlargement of the prostate gland, and reproductive problems such as infertility and impotence.
3.) Gouty nephrophaty
Repeated attacks may result in the development of a condition known as chronic tophaceous gout. In this condition crystals of uric acid lodge as white, chalky material in soft body tissues and in and about the joints, where they may cause bursitis and destruction of bone. Large and deforming deposits may, after many years, settle in the outer margins of the ears, a characteristic feature of the disease. Chronic gout may also cause kidney damage by the formation of uric acid stones, a condition called urate, or gouty, nephropathy.
4.) Hermorrhagic fever
Hantaviruses, any of several members of the virus family Bunyaviridae that infect vertebrates (animals with backbones, including humans). Unlike most members of this family, which are carried by mosquitoes, ticks, or flies, hantaviruses are carried by specific rodent hosts and are transmitted directly from host to host by virus-laden saliva, urine, and feces. Humans are infected through exposure to the dried excretions from infected rodents. Hantaviruses cause two different human diseases: hemorrhagic fever with renal syndrome, in which damage to the kidneys is common, and acute respiratory distress syndrome, in which damage to the lungs is common.
Kidneys and the regulation of blood pressure
The kidneys play a major role in the regulation of blood pressure. Kidneys secrete the hormone renin, which causes arteries to contract, thereby raising blood pressure. The kidneys also control the fluid volume of blood, either by retaining salt or excreting salt into urine. When kidneys retain salt in the bloodstream, the salt attracts water, increasing the fluid volume of blood. As a higher volume of blood passes through arteries, it increases blood pressure.
Monday, November 17, 2008
END-STAGE OF KIDNEY FAILURE
Descriptions
Chronic renal failure is a progressive deterioration of kidney function over a long period of time. It can be caused by diseases such as hypertension, diabetes, lupus erythematosus, acquired immunodeficiency syndrome (AIDS), and a form of cancer called myeloma. If diagnosed early the degenerative process can be slowed, but not reversed, by interventions that can range from simply restricting fluid intake and protein consumption (proteins are the main source of waste products) to taking drugs to address the underlying disease that is damaging the kidneys. Some patients may go on to develop end-stage renal failure, a life-threatening condition that requires long-term dialysis or a kidney transplant.
Treatment
Kidney Dialysis, also known as hemodialysis, medical treatment used to remove waste materials from the blood of patients lacking renal function. Blood from an artery is pumped through a dialyzer, or artificial kidney, where it flows past a semipermeable membrane. Dialysis fluid passing on the other side of the membrane removes unwanted elements in the blood by diffusion. The blood is then returned to the body through a vein.
Transplantation
Kidneys are the most common organs to be transplanted. Kidneys remove waste products from the blood stream. If they fail, often as a result of diabetes mellitus or cancer, a person can die from the buildup of these toxic materials. The waste products can be removed artificially through a process called kidney dialysis, but the patient must be hooked up to the dialysis machine two to three times each week for as long as 12 hours at a time. Kidney transplants free the recipient from dependence on dialysis. If the kidney is rejected, the patient must go back on dialysis or receive another transplant. The first successful transplant of any organ was performed in 1954, when American surgeon Joseph Murray successfully transplanted a kidney donated from the recipient’s twin brother.
Chronic renal failure is a progressive deterioration of kidney function over a long period of time. It can be caused by diseases such as hypertension, diabetes, lupus erythematosus, acquired immunodeficiency syndrome (AIDS), and a form of cancer called myeloma. If diagnosed early the degenerative process can be slowed, but not reversed, by interventions that can range from simply restricting fluid intake and protein consumption (proteins are the main source of waste products) to taking drugs to address the underlying disease that is damaging the kidneys. Some patients may go on to develop end-stage renal failure, a life-threatening condition that requires long-term dialysis or a kidney transplant.
Treatment
Kidney Dialysis, also known as hemodialysis, medical treatment used to remove waste materials from the blood of patients lacking renal function. Blood from an artery is pumped through a dialyzer, or artificial kidney, where it flows past a semipermeable membrane. Dialysis fluid passing on the other side of the membrane removes unwanted elements in the blood by diffusion. The blood is then returned to the body through a vein.
Transplantation
Kidneys are the most common organs to be transplanted. Kidneys remove waste products from the blood stream. If they fail, often as a result of diabetes mellitus or cancer, a person can die from the buildup of these toxic materials. The waste products can be removed artificially through a process called kidney dialysis, but the patient must be hooked up to the dialysis machine two to three times each week for as long as 12 hours at a time. Kidney transplants free the recipient from dependence on dialysis. If the kidney is rejected, the patient must go back on dialysis or receive another transplant. The first successful transplant of any organ was performed in 1954, when American surgeon Joseph Murray successfully transplanted a kidney donated from the recipient’s twin brother.
UROLOGY
Urology, surgical specialty concerned with diseases of the urinary system and male reproductive system. Urologists study, diagnose, and treat disorders of the ureters, bladder, urethra, and kidney, and conditions affecting the male reproductive system, especially the prostate gland.
Urologists treat common disorders of the urinary system, including urinary tract infections; enuresis, the involuntary discharge of urine; cystitis, the inflammation of the bladder; tumors of the bladder; and mineral deposits in the kidney, commonly known as kidney stones. Urologists also specialize in disorders of the male reproductive system, such as enlargement of the prostate gland, and reproductive problems such as infertility and impotence.
Urologists use a variety of surgical techniques, diagnostic tools, and treatment therapies. One of the tests urologists use most frequently to diagnose disease is urinalysis, the chemical analysis of a patient's urine. Ultrasound, a procedure that uses inaudible sound waves to generate computerized images of internal organs, enables urologists to see irregularities in the bladder and other organs. Urologists treat small kidney stones nonsurgically with lithotripsy, a procedure in which doctors direct sound waves at stones in the bladder to disintegrate them. Two other important tools are the catheter, a long, tubular device for draining an obstructed bladder, and the cystoscope, a narrow, illuminated probe used to examine the bladder and ureters. Urologists also perform surgical procedures, such as prostatectomy—that is, the partial or complete removal of an enlarged or cancerous prostate gland—and operations to remove large kidney stones.
Those interested in a career in urology must obtain a medical degree and complete a two-year training program in general surgery, followed by at least three years of urological training. Finally, candidates must pass a written and an oral examination.
Urologists treat common disorders of the urinary system, including urinary tract infections; enuresis, the involuntary discharge of urine; cystitis, the inflammation of the bladder; tumors of the bladder; and mineral deposits in the kidney, commonly known as kidney stones. Urologists also specialize in disorders of the male reproductive system, such as enlargement of the prostate gland, and reproductive problems such as infertility and impotence.
Urologists use a variety of surgical techniques, diagnostic tools, and treatment therapies. One of the tests urologists use most frequently to diagnose disease is urinalysis, the chemical analysis of a patient's urine. Ultrasound, a procedure that uses inaudible sound waves to generate computerized images of internal organs, enables urologists to see irregularities in the bladder and other organs. Urologists treat small kidney stones nonsurgically with lithotripsy, a procedure in which doctors direct sound waves at stones in the bladder to disintegrate them. Two other important tools are the catheter, a long, tubular device for draining an obstructed bladder, and the cystoscope, a narrow, illuminated probe used to examine the bladder and ureters. Urologists also perform surgical procedures, such as prostatectomy—that is, the partial or complete removal of an enlarged or cancerous prostate gland—and operations to remove large kidney stones.
Those interested in a career in urology must obtain a medical degree and complete a two-year training program in general surgery, followed by at least three years of urological training. Finally, candidates must pass a written and an oral examination.
Friday, November 14, 2008
NEPHRITIS
Nephritis
General term for inflammatory diseases of the kidney. Although many types of nephritis exist, the most common form is glomerulonephritis, or Bright's disease. In the U.S., nephritis ranks high among the diseases that are a direct cause of death. Patients with acute nephritis generally recover, particularly children. A small percentage of cases result in chronic nephritis, which tends to be a progressive disease that gradually destroys the kidney.
Patients with acute nephritis often have a history of a streptococcal infection such as strep throat a few weeks before the onset of nephritis. The disease is characterized by fatigue, appetite loss, facial puffiness, abdominal or flank pain, and scanty, smoky, dark urine.
Chronic nephritis usually presents no symptoms, but the urine will be found to contain albumin and, on microscopic examination, red blood cells. When there is an advanced destruction of kidney tissue with grossly impaired kidney function, patients may develop high blood pressure and die of kidney or heart failure.
In recent years, techniques such as dialysis have been successful in removing poisons that accumulate in the blood of patients with kidney failure. Improvement in kidney transplantation techniques has given hope to patients in the last stage of nephritis.
General term for inflammatory diseases of the kidney. Although many types of nephritis exist, the most common form is glomerulonephritis, or Bright's disease. In the U.S., nephritis ranks high among the diseases that are a direct cause of death. Patients with acute nephritis generally recover, particularly children. A small percentage of cases result in chronic nephritis, which tends to be a progressive disease that gradually destroys the kidney.
Patients with acute nephritis often have a history of a streptococcal infection such as strep throat a few weeks before the onset of nephritis. The disease is characterized by fatigue, appetite loss, facial puffiness, abdominal or flank pain, and scanty, smoky, dark urine.
Chronic nephritis usually presents no symptoms, but the urine will be found to contain albumin and, on microscopic examination, red blood cells. When there is an advanced destruction of kidney tissue with grossly impaired kidney function, patients may develop high blood pressure and die of kidney or heart failure.
In recent years, techniques such as dialysis have been successful in removing poisons that accumulate in the blood of patients with kidney failure. Improvement in kidney transplantation techniques has given hope to patients in the last stage of nephritis.
KIDNEY INFECTION *
Treatment by preventing bacterial cell division
Loracarbef
Antibiotic drug used in the treatment of illnesses including bronchitis, pneumonia, upper respiratory tract infection, skin infection, urinary tract infection, and kidney infection—all of which are caused by specific bacteria. Loracarbef prevents the cell division and growth of bacteria by interfering with the formation of bacterial cell walls.
This drug is available by prescription in tablets and a dissolvable powder. The typical adult dosage is 200 to 400 mg every 12 hours for seven days. A reduced dosage based on body weight is prescribed for infants and children under the age of 12. The drug begins to take effect in about one hour.
Loracarbef should be taken at least one hour prior to eating or two hours after eating. Its use should continue for the full seven-day course to prevent reinfection. It should not be taken by persons with a known allergy to loracarbef or to cephalosporin-class antibiotics. It should be used with caution, at a reduced dosage, by persons with impaired kidney function, a history of colitis, penicillin allergies, and persons taking potent diuretics to increase the volume of urine excreted. This drug has not been proven safe for pregnant or breast-feeding women or for children under six months of age.
The most common side effects of loracarbef are diarrhea, abdominal pain, and skin rashes. Less common side effects are colitis, nausea and vomiting, loss of appetite, headache, sleepiness, nervousness, insomnia, and dizziness. Use of loracarbef with potent diuretics increases the risk of kidney disease. Use with probenecid, an antigout drug, increases the levels of loracarbef in the bloodstream.
Treatment by interfering with bacterial metabolism
Nitrofurantoin
antibiotic drug used to treat bacterial infections of the bladder and kidneys. Nitrofurantoin kills susceptible strains of Escherichia coli, Staphylococcus aureus, Enterobacter, and Klebsiella bacteria by breaking down cell walls and interfering with the bacteria’s metabolism.This drug is available by prescription only. It is taken orally in 25-mg, 50-mg, and 100-mg tablets and as a liquid suspension of 25 mg per 5-ml spoonful. The typical adult dosage for treatment of infections ranges from 50 to 100 mg every six hours, day and night. For prevention of recurrent infections, the usual adult dosage is 50 to 100 mg taken at bedtime. Dosages for children and infants over one month old are determined on the basis of age and weight and given on a similar schedule. The drug begins to take effect within 20 to 30 minutes.To prevent stomach irritation and increase the effectiveness of nitrofurantoin, it should be taken with a meal or a glass of water or milk. The liquid should be shaken well before measuring, and the dose may be diluted in water, milk, fruit juice, or baby formula. Although nitrofurantoin may cause the symptoms of a urinary tract infection to disappear within a few days, it should be taken for the length of time prescribed. If dizziness or drowsiness occurs, driving and other risk-related activities should be avoided. Nitrofurantoin should not be used by pregnant women, especially in the third trimester; by breast-feeding women; persons with impaired kidney function; or infants less than one month old. It should be used with extreme caution by persons with anemia, diabetes, electrolyte imbalances, vitamin-B deficiency, or any debilitating disease.Nitrofurantoin is a potentially toxic drug with many side effects. Stomach irritation is the most common. Nitrofurantoin may also cause abdominal or stomach pain, diarrhea, loss of appetite, nausea, or vomiting. A normal but harmless side effect is a change in the color of urine for the duration of treatment. Occasionally this drug may have serious, adverse effects on the lungs or liver. The elderly have an increased chance of experiencing side effects.This drug may interact adversely with other drugs including acetazolamide, anticholinergic medications, magnesium trisilicate, nalidixic acid, oral antacids, probenecid, sodium bicarbonate, and sulfinpyrazone.
Loracarbef
Antibiotic drug used in the treatment of illnesses including bronchitis, pneumonia, upper respiratory tract infection, skin infection, urinary tract infection, and kidney infection—all of which are caused by specific bacteria. Loracarbef prevents the cell division and growth of bacteria by interfering with the formation of bacterial cell walls.
This drug is available by prescription in tablets and a dissolvable powder. The typical adult dosage is 200 to 400 mg every 12 hours for seven days. A reduced dosage based on body weight is prescribed for infants and children under the age of 12. The drug begins to take effect in about one hour.
Loracarbef should be taken at least one hour prior to eating or two hours after eating. Its use should continue for the full seven-day course to prevent reinfection. It should not be taken by persons with a known allergy to loracarbef or to cephalosporin-class antibiotics. It should be used with caution, at a reduced dosage, by persons with impaired kidney function, a history of colitis, penicillin allergies, and persons taking potent diuretics to increase the volume of urine excreted. This drug has not been proven safe for pregnant or breast-feeding women or for children under six months of age.
The most common side effects of loracarbef are diarrhea, abdominal pain, and skin rashes. Less common side effects are colitis, nausea and vomiting, loss of appetite, headache, sleepiness, nervousness, insomnia, and dizziness. Use of loracarbef with potent diuretics increases the risk of kidney disease. Use with probenecid, an antigout drug, increases the levels of loracarbef in the bloodstream.
Treatment by interfering with bacterial metabolism
Nitrofurantoin
antibiotic drug used to treat bacterial infections of the bladder and kidneys. Nitrofurantoin kills susceptible strains of Escherichia coli, Staphylococcus aureus, Enterobacter, and Klebsiella bacteria by breaking down cell walls and interfering with the bacteria’s metabolism.This drug is available by prescription only. It is taken orally in 25-mg, 50-mg, and 100-mg tablets and as a liquid suspension of 25 mg per 5-ml spoonful. The typical adult dosage for treatment of infections ranges from 50 to 100 mg every six hours, day and night. For prevention of recurrent infections, the usual adult dosage is 50 to 100 mg taken at bedtime. Dosages for children and infants over one month old are determined on the basis of age and weight and given on a similar schedule. The drug begins to take effect within 20 to 30 minutes.To prevent stomach irritation and increase the effectiveness of nitrofurantoin, it should be taken with a meal or a glass of water or milk. The liquid should be shaken well before measuring, and the dose may be diluted in water, milk, fruit juice, or baby formula. Although nitrofurantoin may cause the symptoms of a urinary tract infection to disappear within a few days, it should be taken for the length of time prescribed. If dizziness or drowsiness occurs, driving and other risk-related activities should be avoided. Nitrofurantoin should not be used by pregnant women, especially in the third trimester; by breast-feeding women; persons with impaired kidney function; or infants less than one month old. It should be used with extreme caution by persons with anemia, diabetes, electrolyte imbalances, vitamin-B deficiency, or any debilitating disease.Nitrofurantoin is a potentially toxic drug with many side effects. Stomach irritation is the most common. Nitrofurantoin may also cause abdominal or stomach pain, diarrhea, loss of appetite, nausea, or vomiting. A normal but harmless side effect is a change in the color of urine for the duration of treatment. Occasionally this drug may have serious, adverse effects on the lungs or liver. The elderly have an increased chance of experiencing side effects.This drug may interact adversely with other drugs including acetazolamide, anticholinergic medications, magnesium trisilicate, nalidixic acid, oral antacids, probenecid, sodium bicarbonate, and sulfinpyrazone.
FEW LIST OF NOTABLE RECIPIENTS
Kidney Transplant
This list of notable organ transplant donors and recipients includes people who were the first to undergo certain organ transplant procedures or were people who made significant contributions to their chosen field and who have either donated or received an organ transplant at some point in their lives, as confirmed by public information.
Fashion critic and member of Entertainment Tonight. In November 2004 he announced that he was suffering from polycystic kidney disease and would require a kidney transplant. He underwent transplant surgery on January 14, 2005, after his friend Abby Finer donated one of her kidneys. Later, the kidney became infected by a virus, and in June 2005 he underwent a second operation to have the new kidney removed. On August 17, he announced that his body was free of the viral infection and that he was ready to find a new transplant. He then received a second kidney transplant, which was donated by his mother.Gary Coleman
- Actor who played Arnold on Diff'rent Strokes. Received two separate kidney transplants, one in 1973 and another in 1984.
Lucy Davis
- Actress best known for playing the character Dawn Tinsley in the BBC comedy, The Office. Kidney received in 1997, which was donated by her mother.
Sean Elliot
- NBA basketball star. The kidney was donated by his brother. Elliott made history by returning to play in the NBA following his surgery.
Jennifer Harman
- Poker player; only woman to win two open events in the World Series of Poker. Had two separate kidney transplants.
Jonah Lomu
- New Zealand All Blacks rugby union player. The kidney was donated by Wellington radio presenter Grant Kereama. Lomu came back to professional rugby in 2005, though not with his past success.
Alonzo Mourning
- NBA basketball star. Like Elliott, Mourning returned to play in the NBA following his surgery, and is currently playing.
George Lopez
- Actor-Comedian and star of The George Lopez Show. Kidney transplant from his wife, Ann Lopez in April 2005
Ron Spring
- Former NFL player. Kidney donated by former Dallas Cowboys teammate Everson Walls.
Billy Preston
- An American soul musician from Houston, Texas, raised mostly in Los Angeles, California.
Kerry Packer
- His long-serving helicopter pilot, Nick Ross, donated one of his own kidneys to Packer for transplantation.
Ken Howard
- Tony-winning actor who is best known for his role in the television show The White Shadow as basketball coach and former Chicago Bulls player, Ken Reeves.
Charles Perkins
- Australian soccer player, Aboriginal activist and government minister.
Monday, November 10, 2008
KIDNEYS (human organ)
The government on the other hand should promote or assist the foundation created by most talented and with a sincere dedication to give help to people in need of health attentions, doctors or individuals. One example is Philippine Society of Nephrologies., a newly form organization. Dra. Perez once I've heard in a government radio station explaining some of the the issue of kidney trafficking which for me as simple ordinary citizens was surprise, some people in the urban places sold their organ kidney even lower than the amount compared to other countries just to survived, yet many kidney doctors know that persons with only one (1) kidney can live normally, explanation about the side-effect if there is, the terms and condition is also needed. Promoting the amount of organ kidney, help packages for the donors, accident victims, compensation of lost wages, preventive medication after such transplantation success, can at least, lessened, maybe, eliminates kidneys human organ trafficking. The percentage get by the sales agent lessened too cause people already have the knowledge about the issue. Most important is, let the people knows in a good or right or simple explanation so people can easily understand the matters.
This example is from the United Network of Organ Sharing (UNOS), the USA umbrella organization for transplant centers. Up-to-date data can be obtained from the UNOS website.
- Survival Statistics- Depend greatly on the age of donor, age of recipient, skill of the transplant center, compliance of the recipient, whether the organ came from a living or cadaveric donor and overall health of the recipient. Median survival rates can be quite misleading, especially for the relatively small sample that is available for these organs. Survival rates improve almost yearly, due to improved techniques and medications.
Friday, November 7, 2008
HUMAN KIDNEY TRAFFICKING (exploitation)
What is the primary causes of Human organ Trafficking?
There are few consideration we must think first why this is happening.
Exploitation of human kidney trafficking donors in the Philippines is due to a poorer condition of a family. Many are forced themselves to make a decision they think is right, and the only solution to get money to buy their needs just to survive.
Trade in organs, if properly and effectively regulated, to ensure that the seller is fully informed of all the consequences of donation, and may present a help package for the donor.
Compensation for donors also increases the risk of introducing diseased organs to recipients because these donors often yield from poorer populations unable to receive health care regularly and organ dealers may evade disease screening processes. The majority of such deals include one major payment and no follow up care for the donor.
One of the driving forces for illegal organ trafficking and “transplantation tourism” is the price differences for organs and transplant surgeries in different areas of the world.
According to the New England Journal of Medicine.
Manila a kidney can be purchase for $1000- $2000 or more.
There are few consideration we must think first why this is happening.
Exploitation of human kidney trafficking donors in the Philippines is due to a poorer condition of a family. Many are forced themselves to make a decision they think is right, and the only solution to get money to buy their needs just to survive.
Trade in organs, if properly and effectively regulated, to ensure that the seller is fully informed of all the consequences of donation, and may present a help package for the donor.
Compensation for donors also increases the risk of introducing diseased organs to recipients because these donors often yield from poorer populations unable to receive health care regularly and organ dealers may evade disease screening processes. The majority of such deals include one major payment and no follow up care for the donor.
One of the driving forces for illegal organ trafficking and “transplantation tourism” is the price differences for organs and transplant surgeries in different areas of the world.
According to the New England Journal of Medicine.
Manila a kidney can be purchase for $1000- $2000 or more.
- Latin America a kidney can be purchase for $10,000. or more.
- South Africa a kidney can be purchase for $20,000. more.
China, transplant operation approximatly:
- Kidney transplant: $70,000
- Lliver transplant: $160,000
- Heart transplant: $120,000
China does 10,000 transplants a year, with sources claiming up to 90% of organs are taken from executed prisoners. Close relative donations represent only 2% of transplants
Although these prices are still unattainable to the poor, compared to the fees of the United States.
Transplant may demand:
- kidney transplant : $100,000,
- Liver transplant: $250,000
- Heart transplant: $860,000
Both the source and method of obtaining the organ to transplant are major ethical issues to consider as well as the notion of distributive justice.
Wednesday, November 5, 2008
KIDNEY TRANSPLANT PATIENTS
The Family of the donor patients is one of the important issue. This is also a way to build a success to a kidney Transplantation. Proper explanation to them (family) may lead to a quick approval, most likely a patients of a vehicular accident while patients are still alive.
The one-year survival rate for kidney transplant patients is about 95 percent.Some kidney transplant patients have survived more than 25 years. Because people have two kidneys but need only one. About one-third of transplanted kidneys come from living relatives and about two-thirds are from someone who recently died.
Many patients whose kidney failure was cause by diabetes mellitus receive a pancreas normally secretes insulin, a substance that helps the body use and store sugars. In some diabetic, the body's immune system destroys insulin-secreting cells in the pancreas. In many cases, the disease can be controlled with shots of insulin. However, if the diabetic requires a kidney transplant, the surgeon will often transplant a pancreas at the same time.
Kidneys are the most common organs to be transplanted. Kidneys remove waste products from the blood stream. If they fail, often as a result of diabetes mellitus or cancer, a person can die from the buildup of this toxic materials.
The waste products can be removed artificially through a process called kidney dialysis, but the patients must be hooked up to the dialysis machine two to three times each week for as long as 12 hours at a time.
Kidney transplant free the recipients from dependence on dialysis. If the kidney is rejected, the patient must go back on dialysis or receive another transplant.
Tuesday, November 4, 2008
PUS CELLS IN THE URINE
Pus cells in the urine results usually from an infection of the urinary tract. They occur in connection with abscesses, tuberculosis, or stones of the kidney. More frequently they are associated with inflammation of the bladder or with an enlargement of the prostate, but most frequently they are seen in connection with gonorrhea.
Pus cells do not indicates Bright's Disease. however, where the pus occurs in large quantities albumin also may be present.
If pus cells in your urine are reported it is suggested that you void your urine into two separate glasses, and send to a laboratory a portion of the urine voided last into the second glass. It is advisable to have a second sample examined in this way because if pus is found in the urine voided in this manner it usually indicates that the pus does not arise from an old gonorrhea but is caused by some condition in the bladder or kidneys.
If considerable pus occurs persistently in the urine a competent physician should be consulted to ascertain the exact cause. While the pus may indicate nothing of great importance you cannot be certain until the correct diagnosis is made.
Pus cells do not indicates Bright's Disease. however, where the pus occurs in large quantities albumin also may be present.
If pus cells in your urine are reported it is suggested that you void your urine into two separate glasses, and send to a laboratory a portion of the urine voided last into the second glass. It is advisable to have a second sample examined in this way because if pus is found in the urine voided in this manner it usually indicates that the pus does not arise from an old gonorrhea but is caused by some condition in the bladder or kidneys.
If considerable pus occurs persistently in the urine a competent physician should be consulted to ascertain the exact cause. While the pus may indicate nothing of great importance you cannot be certain until the correct diagnosis is made.
Saturday, November 1, 2008
RENAL COLIC or GRAVEL
Renal colic is associated with the formation of stones in the kidney. chemically, this stones consist of usually of uric acids. A study of persons giving a history of renal colic shows that before the age of forty the death rate is normal, but after this age here is the tendency to excessive mortality from apoplexy, heart disease, arteriosclerosis , and kidney disease. this is particularly true where there is associated, as there often is, some degree of overweight. It is advisable for persons who have passed gravel, or who have had attacks of renal colic.
To eat meats very sparingly once a day is more than sufficient to supply the elements that meats contribute to the body chemistry. It is particularly desirable to avoid such meats as liver, kidneys, brains, and sweetbreads. Boiled meats are probably no more harmful than the white meats.
Fruits are very beneficial especially the citrus fruits.
Constipation is harmful and must be avoided. usually it can be overcome by proper regulation of the diet.
Overweight particularly past the age of forty, should be guarded against. the suggestions under the heading of Height and Weight will be of value in keeping down the tendency to obesity.
Alcohol appears to be harmful particularly the heavy sweet wines or heavy brews of beer or ale and whisky, especially the cocktail before meals, unduly stimulates the appetite and encourages overeating.
Water drinking is beneficial provided it is not done excessively, three or four pints a day are usually sufficient. It is usually good practice to drink a glassful of water before breakfast and again before retiring at night.
Alkaline mineral waters may be used instead of plain water, but most of the virtue is in the water rather than in the salts in the mineral waters.
A pinch of good baking soda 9about as much as can be heaped upon a dime) in a glass of hot water before breakfast will probably do as much good as the average mineral water, the baking soda being alkaline helps somewhat in rendering the urine less acid and favoring the solution of uric in the urine. a yearly chemical and microscopic examination should be made of the urine. finally, dissipation, excitement, too much business responsibility , nervous and emotional strain, such as anger, unquestionably are harmful
To eat meats very sparingly once a day is more than sufficient to supply the elements that meats contribute to the body chemistry. It is particularly desirable to avoid such meats as liver, kidneys, brains, and sweetbreads. Boiled meats are probably no more harmful than the white meats.
Fruits are very beneficial especially the citrus fruits.
Constipation is harmful and must be avoided. usually it can be overcome by proper regulation of the diet.
Overweight particularly past the age of forty, should be guarded against. the suggestions under the heading of Height and Weight will be of value in keeping down the tendency to obesity.
Alcohol appears to be harmful particularly the heavy sweet wines or heavy brews of beer or ale and whisky, especially the cocktail before meals, unduly stimulates the appetite and encourages overeating.
Water drinking is beneficial provided it is not done excessively, three or four pints a day are usually sufficient. It is usually good practice to drink a glassful of water before breakfast and again before retiring at night.
Alkaline mineral waters may be used instead of plain water, but most of the virtue is in the water rather than in the salts in the mineral waters.
A pinch of good baking soda 9about as much as can be heaped upon a dime) in a glass of hot water before breakfast will probably do as much good as the average mineral water, the baking soda being alkaline helps somewhat in rendering the urine less acid and favoring the solution of uric in the urine. a yearly chemical and microscopic examination should be made of the urine. finally, dissipation, excitement, too much business responsibility , nervous and emotional strain, such as anger, unquestionably are harmful
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