Nowadays tonsillectomy is performed far less frequently. In fact, only a minority of children have their tonsils removed. There is little medical evidence that the removal of tonsils makes very much difference to the general health of the vast majority of children. In particular, it does not reduce the frequency of colds or sore throats that are a normal part of childhood.

These are the commonly accepted reasons for performing a tonsillectomy on a child:

1. Repeated attacks of tonsillitis — three to five attacks per year over at least 2 years. The doctor will also take into account the severity of the attacks, the response to treatment, the effect it has on the child’s general health and lifestyle, including his absences from school.

2. Obstruction of the child’s airway or breathing passages. The child may have apnoea (forgets to breathe), may snore at night, may have difficulty swallowing, may not gain weight satisfactorily, or may fall asleep during the day. Airway obstruction is relatively rare in children.

3. Other causes such as an abscess in the tonsils (quinsy), or chronic tonsillitis (persistent infection which does not clear up despite repeated courses of treatment, and which is more common in adolescents and adults than children).

Sometimes the doctor may recommend that the child’s adenoids be removed (adenoidectomy) because they are enlarged. Like the tonsils, the adenoids are a collection of lymphoid tissue at the back of the throat, which are part of the body’s defence against infection. If they become chronically enlarged, they may contribute to a number of problems, including middle ear disease (glue ear), deafness, and obstruction of the breathing passages. The latter may cause the child to snore at night, breathing with his mouth open because his nose is blocked.

An adenoidectomy is most commonly performed in a child who has frequent ear infections and resultant hearing loss. It is often done in conjunction with another procedure, such as the insertion of tubes in the ears (grommets) or tonsillectomy.

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If the birth has been difficult because your pelvis is small and the baby is big, his collarbone (clavicle) may break on one side. This injury is also more common with breech deliveries. Because babies’ bones are malleable, the fracture heals well without treatment, occasionally leaving a small lump. Gentle handling until the break heals will reduce pain and discomfort. More rarely, fractures of the long bones of the arm or leg (humerus and femur) are seen. This kind of break will require splinting until it heals. Skull fractures are also rare, but need to be watched carefully, although they generally heal without complications.

Bruising

Your baby may come out looking like he’s been in a fight! His face or head may be swollen and bruised. If this is a mirror injury, it requires no treatment and will resolve itself. If there is marked swelling due to significant bruising, then a skull X-ray may be performed to rule out a fracture, and the baby’s blood may be checked to make sure there have been no complications from bleeding. In the majority of cases the results of these tests are normal, and the bruising is due to the pressure on the face and head during the baby’s passage through the birth canal. If forceps are used, they may leave visible marks on each side of the face and head. These usually disappear after a few days and are not a cause for concern.

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cottage] than at home? We’re the same people.”

ANSWER: That’s exactly the point. You are the same couple, so the trick is to look at how you relate and what you do up north compared to what you do at home. Most likely you have more time, less pressure, and you make sex a priority away from home. You should know, however, that this is very good news, because vacations are also times when couples fight, draw further apart, and exaggerate their problems. The fact that time away becomes time together reflects a strong relationship just waiting to get some of the same attention and priority at home. One more thing. Different places for sex seem to be invigorating, and you don’t have to go all the way up north for that. Try going downstairs at home, even out to the garage.

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On the whole, healthy tissues can take more radiation than tissues that are scarred, infected or otherwise diseased. As a rule, the tissues of older people can take less radiation than those of younger people, because they tend to have less ability to heal, a poorer blood supply and so on. Tissues that have previously been exposed to the average safe dose of radiation can never safely be re-treated, not even many years later, because the effects of radiation are permanent. Some chemotherapy drugs increase the sensitivity of some normal tissues to radiation. A dose of radiation that is normally safe can produce some serious reactions in people having these particular drugs. Thus there are many factors which can make a usually effective and safe dose of radiation unsafe for some individuals. These should all be considered by your radiotherapist when treatment is planned.

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It appears to be as common as headache but it is a symptom which many people find difficult to describe and, when the term is used, different people often mean different things.

For some it may be anorexia or loss of appetite. It may be nausea or even vomiting. Others regard it as abdominal discomfort. There may be regurgitation of food or acid into the mouth.

“Water-brash” is a symptom where bitter acid fluid from the stomach is regurgitated up into the mouth.

Heartburn usually means a pain behind the breastbone.

The indigestion may be associated with flatulence or be used to describe this condition where there is an excess of wind in the stomach which is either brought up or passed onwards and passed as flatus.

Just as there are different conditions which mean indigestion, so there are many causes of this symptom.

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To be scientifically correct, the term “antibiotic” should be reserved for those drugs obtained from a living organism, such as a fungus or mould.

Those other drugs which act in the same way but which are synthesised in the laboratory, are usually spoken of as chemotherapeutic drugs.

These agents kill or inhibit the growth of bacteria, and there are few bacterial diseases which don’t respond to them.

However, those infectious diseases which are due to viruses are not influenced by antibiotics, except for a few caused by the larger viruses and a few organisms which appear to be halfway between viruses and bacteria.

The sulphonamide drugs were the first of these new tools of medicine. Their action was first reported by the Bayer company in Germany in 1935.

Although the sulphonamides are active against a wide range of bacteria, their main use now is in urinary tract infections. A new generation of doctors has grown up with so many other antibiotics available that the sulphonamides are rarely thought of when prescribing treatment.

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The immune system has an awesome task, employing a force of “agents1* co keep it operating at its peak. These agents fight disease and remember the type of invading microorganism so they can prevent reinfection. The system’s guard consists of interferon, complex fighter cells that attack bacteria and viruses by destroying their ability to reproduce in the human body. Interferon responds first in fighting infection, slowing down the potency of invaders so the body can summon other defenses. Laboratory studies reveal that only four hours after infection the body begins its charge with interferon.

The suppport system has varied responsibility, but it operates as a strategic team. Phagocytes engulf and consume invaders, or antigens, and can prevent disease from spreading. Antibodies recognize intruding bodies, clamp on to them, and destroy them. T cell lymphocytes, which are derived from the thymus gland, and B cell lymphocytes, derived from bone marrow, also work in tandem. T cells will control and regulate antibodies; B cells perform the important function of binding with antigens (the enemies) to render them harmless.

When bodily tissue is invaded, substances are released into the blood that marshal white blood cells of a different nature: neutrophils and macrophages. Neutrophils can consume about twenty-five invaders, and macrophages can “cat” four times that amount before expiring from the toxins they’ve ingested. Macrophages also clean up blood and keep it healthier by consuming diseased or ineffective red blood cells. (In terms, of endometriosis, macrophage count, for example, has been found to be double the normal amount in the cul-de-sacs of women with the disease.) Memory cells function after disease is fought of C recognizing invaders and acting quickly to prevent reinfection.

Individual immune systems, like any army—no matter how sweeping—on suffer losses or serious setbacks in defense efforts through stress, alcohol consumption, smoking (cigarettes or marijuana), drugs (recreational or medicinal), and even diets that arc high in fat, sugar, and. recent srtidie have found, deity products. An extreme form of immune system devastation is AIDS (acquired immune deficiency syndrome). Traced to a virus that begins a chain of destruction among these infection-fighting cells, victims of AIDS don’t die from AIDS itself, but from diseases the body’s immune system is powerless to fight-Doctors have long speculated that there may be an altered cellular immune response among women who develop endometriosis. This alteration, they propose, might explain why the implants adhere and grow. Among the many studies done in chit field. Investigators sought to explore an Immune system deficiency that may occur along with another factor, (or example, excessive menstrual flow or malfunction of the fallopian tubes. Answers to many of these studies were inconclusive. It was found that there might be an immune system breakdown or physiological problems in a victim of endometriosis, or an immune system deficiency and another factor. Therefore, conditions explaining the cause of the disease might exist as mutually exclusive factors or they might in fact be interconnected, la other words, there is, so far, no conclusive answer.

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A more common and important variant, which occurs in women, is acne cosmetica. This appears to be precipitated by the prolonged use of cosmetics, especially those containing lanolin or petrolatum. In particular, various cleansing creams and moisturizers may contain chemicals which can aggravate acne. They do not so much obstruct the ducts physically, but rather appear to induce comedones chemically. The treatment is simple, entailing avoidance of cosmetics until the inflammation settles down.

There is a fairly characteristic acne-like dermatitis of the lower face which occurs mainly in young women. The pimples are small and not usually pustular. Frequently the condition is treated as a dermatitis, with steroid creams, which initially may improve the appearance but actually prolong the course of the problem. Women with this complaint are frequently found to be taking the contraceptive pill, which is thought (by some) to be the causative factor. The trouble may occur several years after commencing to take the Pill, and can occur with any brand although statistically the mini-type Pills are more frequently implicated. As with other types of acne, treatment with tetracyclines along with cessation of the use of steroid creams cures the problem. (The taking of the Pill can usually be continued after treatment,)

Acne can be a devastating disease coming as it often does at a time when young people wish to be looking their best, and identifying with the beautiful idols of their peer group. Many parents are heard to tell their children that they will ‘grow out of it’, that ‘it will clear when you turn 22′ or ‘when you marry’; finally, if it has not improved, as predicted it would, by the time that ‘ you have children*, the sufferers will often angrily seek active treatment.

Fortunately most cases clear up with little or no help. However the severity of the disorder will depend on a person’s hormone balance and the receptivity of the oil glands. About adolescence, many hormonal and emotional changes are under way. We all possess endocrine glands (such as the adrenals, ovaries, testicles and thyroid) which secrete hormones into the blood stream. These are chemicals that regulate the function of other endocrine glands as well as the blood vessels, oil glands, hair follicles and so forth. There is a dose link between the endocrine and nervous systems which is controlled by a gland attached to the base of the brain called the pituitary. As a result of this link, emotional situations will affect a person’s hormones and vice versa. Consequently as a result of, for example, premenstrual or examination stress, the skin tends to become oilier and ‘break out’. Similarly, male hormones cause the oil glands to enlarge and produce more oil, while in susceptible males, they will cause baldness.

This interaction between a person’s emotions and hormones is essential to the understanding and subsequent treatment of patients with acne. Many individuals have their social, emotional and even professional lives ruined because they do not have ‘a clear skin’. Consequently it is most important that such people should be able to seek sympathetic counselling and appropriate care. The condition may not seem too bad to an observer but if it upsets an individual’s self-esteem or body image, treatment is essential.

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Dietary fibre meets a somewhat different fate. Most fibre resists the digestive enzymes of the intestine and passes through to the large bowel. Here, some of it is metabolised by bacteria that produce the specific enzymes necessary for breakdown. This process is known as ‘colonic fermentation’. The end products include the gases carbon dioxide, methane and hydrogen along with volatile fatty acids called short chain fatty acids (SCFAs). The SCFAs are absorbed from the large bowel, enter the bloodstream and are transported to the liver. The degree of fermentation in the large bowel depends on the type of fibre and varies between individuals. This explains why some people produce a lot of gas and others produce very little following consumption of fibre-rich foods. Soluble fibres are entirely digested by bacteria and produce most of the SCFAs. Insoluble fibres are digested to only a small degree and the amount depends on the time spent in the large bowel before excretion.

The term resistant starch is a relatively new addition to the fibre scene. This is used to describe polysaccharides which are resistant to normal enzymatic digestion. This means that a portion of the starch eaten in foods will pass through the stomach and small intestine to the large bowel where it is fermented in a similar way to fibre. For this reason most nutritionists currently regard resistant starch as a component of dietary fibre. Resistant starch can occur naturally, such as in raw potato or bananas, be formed in partly milled grains and seeds, or can form following heating and cooling of cooked potatoes, bread and cornflakes. The approximate resistant starch content of specific foods. Food manufacturers have been able to incorporate resistant starch into white bread and other foods without affecting the sensory qualities of texture and flavour. This is a major advantage as consumers can eat foods that are higher in this fibre-like substance, but not radically different from more accepted forms.

This new dimension in carbohydrate physiology has stimulated another broad classification of carbohydrates. Nutritional scientists now use the terms ‘available’ (sugars and most starches) and ‘unavailable’ (resistant starch and fibre) when referring to the nutritional implications of carbohydrates.

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Establishing infertility

Usually the first thing is to try to conceive for a year without using contraception. A Melbourne IVF specialist says that approximately 10% to 15% of couples will not conceive in that time. ‘At that stage we feel that it is time to start investigations and try to pinpoint any problem’, he said.

The first step is to get a referral to a gynaecologist. Most women with endometriosis will already be under a specialist who may also manage their infertility investigation but they may be referred to an infertility specialist.

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