Renal transplantation is the treatment of choice for a minority of patients with end-stage renal disease (ESRD). Most adult patients with ESRD are never referred for evaluation for transplantation, and have a 70% 5-year mortality on dialysis. Marked improvements in early graft survival and long-term graft function have made kidney transplantation a more cost-effective alternative to dialysis. In the United States, over 375,000 kidney transplants have been performed, and in 2012, 191,400 patients were alive and with a functioning transplanted kidney; currently, more than 101,000 patients are waiting for kidney transplants.[1, 2] Before the advent of immunosuppression, renal transplantation was limited to identical twins and was not applicable to the vast majority of patients with ESRD. The introduction of combined azathioprine-steroid therapy in 1963 produced encouraging results and became the mainstay of immunosuppression. Although this therapy improved the results of transplantation, acute rejection and complications associated with steroid therapy persisted. The introduction of cyclosporine in 1983 significantly improved the outcomes of all solid-organ transplants by reducing the risk of rejection. Further innovations, including anti–T cell antibodies (both monoclonal and polyclonal preparations), as well as other maintenance immunosuppressants (eg, tacrolimus, mycophenolate, sirolimus), have made a significant impact on both patient and graft survival. Currently, 1-year patient and graft survival rates exceed 90% in most transplant centers. For patient education information, see Kidney Transplant and the Mayo Clinic's kidney transplant information Web page.

What is polycystic kidney disease? Polycystic kidney disease (also called PKD) causes numerous cysts to grow in the kidneys. These cysts are filled with fluid. If too many cysts grow or if they get too big, the kidneys can become damaged. PKD cysts can slowly replace much of the kidneys, reducing kidney function and leading to kidney failure. How common is PKD? In the United States about 600,000 people have PKD. It is the fourth leading cause of kidney failure. It is found in all races and occurs equally in men and women. It causes about 5% of all kidney failure. What other organs besides the kidney are affected by PKD? PKD can affect other organs besides the kidney. People with PKD may have cysts in their liver, pancreas, spleen, ovaries, and large bowel. Cysts in these organs usually do not cause serious problems, but can in some people. PKD can also affect the brain or heart. If PKD affects the brain, it can cause an aneurysm. An aneurysm is a bulging blood vessel that can burst, resulting in a stroke or even death. If PKD affects the heart, the valves can become floppy, resulting in a heart murmur in some patients. What are the clues that someone has PKD? Most people do not develop symptoms until they are 30 to 40 years old. The first noticeable signs and symptoms may include: Back or side pain An increase in the size of the abdomen Blood in the urine Frequent bladder or kidney infections High blood pressure High blood pressure is the most common sign of PKD. Occasionally, patients may develop headaches related to high blood pressure or their doctors may detect high blood pressure during a routine physical exam. Because high blood pressure can cause kidney damage, it is very important to treat it. In fact, treatment of high blood pressure can help slow or even prevent kidney failure. Fluttering or pounding in the chest About 25% of PKD patients have a so-called floppy valve in the heart, and may experience a fluttering or pounding in the chest as well as chest pain. These symptoms almost always disappear on their own but may be the first hint that someone has PKD. How is PKD diagnosed? Ultrasound is the most reliable, inexpensive and non-invasive way to diagnose PKD. If someone at risk for PKD is older than 40 years and has a normal ultrasound of the kidneys, he or she probably does not have PKD. Occasionally, a CT scan (computed tomography scan) and MRI (magnetic resonance imaging) may detect smaller cysts that cannot be found by an ultrasound. MRI is used to measure and monitor volume and growth of kidneys and cysts. In some situations, genetic testing might also be done. This involves a blood test that checks for abnormal genes that cause the disease. Genetic testing is not recommended for everyone. The test is costly, and it also fails to detect PKD in about 15% of people who have it. However, genetic testing can be useful when a person: has an uncertain diagnosis based on imaging tests has a family history of PKD and wants to donate a kidney is younger than 30-years old with a family history of PKD and a negative ultrasound, and is planning to start a family

New CPR Guidelines For Adults

Constipation is a common problem. It means either going to the toilet less often than usual to empty the bowels, or passing hard or painful stools (faeces). Constipation may be caused by not eating enough fibre, or not drinking enough fluids. It can also be a side-effect of certain medicines, or related to an underlying medical condition. In many cases, the cause is not clear. Laxatives are a group of medicines that can treat constipation. Ideally, laxatives should only be used for short periods of time until symptoms ease. Note: there is a separate leaflet on constipation in children. What is constipation? Constipation is common. If you are constipated it causes one or more of the following: Stools (faeces) become hard and difficult or painful to pass. The time between toilet trips increases compared with your usual pattern. (Note: there is a large range of normal bowel habit. Some people normally go to the toilet to pass stools 2-3 times per day. For others, 2-3 times per week is normal. It is a change from your usual pattern that may mean that you are constipated.) Sometimes, crampy pains occur in the lower part of your tummy (abdomen) You may also feel bloated and feel sick if you have severe constipation. What are the causes of constipation? Known causes include the following: Not eating enough fibre (roughage) is a common cause. The average person in the UK eats about 12 g of fibre each day. But, 18 g per day is recommended by the British Nutrition Foundation. Fibre is the part of plant food that is not digested. It remains in your gut. It adds bulk to the stools (faeces) and helps your bowels to work well. Foods high in fibre include fruit, vegetables, cereals and wholemeal bread. Not drinking much may make constipation worse. Stools are usually soft and easily passed if you eat enough fibre and drink enough fluid. However, some people need more fibre and/or fluid than others in order to avoid constipation. Some special slimming diets are low in fibre and may cause constipation. Some medicines can cause constipation as a side-effect. Examples are painkillers (particularly those with codeine, such as co-codamol, or very strong painkillers, such as morphine), some antacids, some antidepressants (including amitriptyline) and iron tablets; however, there are many others. See the list of possible side-effects on the leaflet that comes with any medicine that you may be taking. Tell a doctor if you suspect a medicine is making you constipated. A change of medication may be possible. Various medical conditions can cause constipation. For example, an underactive thyroid gland, irritable bowel syndrome, some gut disorders and conditions that cause poor mobility, particularly in the elderly. Pregnancy. About 1 in 5 pregnant women will become constipated. It is due to the hormonal changes of pregnancy that slow down the gut movements. In later pregnancy, it can simply be due to the baby taking up a lot of room in the tummy and the bowels being pushed to one side.

Aortic valve replacement is a procedure in which a patient's failing aortic valve is replaced with an artificial heart valve. The aortic valve can be affected by a range of diseases; the valve can either become leaky (aortic insufficiency / regurgitation) or partially blocked (aortic stenosis).

The difference between bronchitis and pneumonia is that bronchitis causes an inflammation of the air passages while pneumonia causes fluid in the lungs due to an infection. The common cold however, allows people to remain active and presents itself with a clear runny nose, cough, and a low-grade or no fever.

Factitious disorder is the term used to describe a pattern of behavior centered on the exaggeration or outright falsifications of one’s own health problems or the health problems of others. Some people with this disorder fake or exaggerate physical problems; others fake or exaggerate psychological problems or a combination of physical and psychological problems. Factitious disorder differs from a pattern of falsified or exaggerated behavior called malingering. While malingerers make their claims out of a motivation for personal gain, people with factitious disorder have no such motivation.

The Urinary System is a group of organs in the body concerned with filtering out excess fluid and other substances from the bloodstream. The substances are filtered out from the body in the form of urine. Urine is a liquid produced by the kidneys, collected in the bladder and excreted through the urethra.

Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply. Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body — most commonly, your eyes. There is no cure for ankylosing spondylitis, but treatments can lessen your symptoms and possibly slow progression of the disease.

Keep tabs on your blood pressure. If it's too high, your risk of a heart attack and heart disease goes up. Stress management, a healthy diet, and regular exercise can help you manage your blood pressure. Your doctor may also prescribe medications to lower your levels.

Maybe you're just really eager to get pregnant, or maybe you hope that your baby will be born at a certain time of year. Here are five ways to boost your chances of conceiving quickly – along with tips for a healthy pregnancy and guidelines on when to be concerned about a fertility problem. Tip #1: See your healthcare provider You can lay the groundwork for a healthy pregnancy even before you get pregnant. You're more likely to have a successful pregnancy when your body is up to the task. Schedule a preconception checkup with a doctor or midwife to find out whether you're in your best baby-making shape – and to learn what changes may help. You may not be able to get an appointment right away or resolve any health issues immediately, but taking these steps as soon as possible can help you conceive more easily in the long run. Tip #2: Plan for a healthy pregnancy When you're trying to conceive, eat nutritious foods, maintain a healthy weight, get regular exercise, and try to kick any bad habits (like drinking, smoking, or using drugs). Limit your caffeine intake to less than 200 milligrams a day (about 12 ounces of coffee). Any more than that may contribute to fertility problems. At your preconception appointment, discuss any medications you're taking and find out if they'll be safe to use during pregnancy. You can dramatically reduce the risk of certain birth defects if you begin taking folic acid at least one month before you start trying to conceive. Find out what else you can do ahead of time to give your baby a healthy start. Tip #3: Figure out when you ovulate The biggest secret to getting pregnant quickly is knowing when you ovulate (release an egg from your ovary). You ovulate only once each menstrual cycle, and there are just a few days during that time when it's possible to conceive. Knowing when you ovulate means that you and your partner can time intercourse to have the best chance of getting pregnant that cycle. You can use a few different methods to figure out when you ovulate. Our article on predicting ovulation walks you through them. This ovulation calculator also does the math for you by determining when you're most likely to be fertile. (If you have irregular periods, pinpointing ovulation could be difficult. Ask your provider for advice.) Tip #4: Have sex at the right time Once you know the timeframe your egg is likely to be released from your ovary, you can plan to have sex during your most fertile days, which is usually about three days before ovulation through the day you ovulate. You have a range of days for baby-making sex because sperm can survive for three to six days in your body. (Your egg survives for only about a day.) That means if you have sex on Monday, sperm can survive in your fallopian tubes until Thursday – or even as late as Sunday. If you're not sure when your fertile period will be, just have sex every other day. This means you'll have healthy sperm in your fallopian tubes whenever your egg gets released. (If you want to have sex more often than every other day, that's fine. It won't improve your chances any more, but it won't hurt, either.) Another tip: If you and your partner are waiting to have sex until your most fertile time, make sure you haven't gone through too long of a dry spell beforehand. Your partner should ejaculate at least once in the days just before your most fertile period. Otherwise there could be a buildup of dead sperm in his semen. (Ed. note: Vaginal lubricants including saliva, olive oil, and most water-based lubricants can slow down sperm. Ask your provider to recommend one that's safe to use when trying to conceive. Canola oil can be a good alternative.) Tip #5: Give sperm a boost Sperm have the best shot of fertilizing an egg when they're healthy, strong, and plentiful. Your partner can do several things to help: Cut back on alcohol. Studies show that drinking daily can lower testosterone levels and sperm counts, increasing the number of abnormal sperm. Skip tobacco and recreational drugs. These can cause poor sperm function. Try to maintain a healthy weight. Obesity can lower sperm count and slow down sperm. Get enough of certain key nutrients – like zinc, folic acid, calcium, and vitamins C and D – that help create strong and plentiful sperm. Don't use hot tubs and saunas or take hot baths because heat kills sperm. (Testicles function best at 94 to 96 degrees Fahrenheit, a couple of degrees cooler than normal body temperature.) The sooner your partner can make these changes, the better: Sperm take a while to mature, so any improvements now will yield better sperm specimens about three months from now. How long to try before getting help If you're going to get pregnant naturally, it's very likely to happen within the first six months. About 8 out of 10 couples have conceived by then. After that, how long you should keep trying before you seek help from a fertility specialist depends in large part on your age. Fertility declines as you get older, so if you're age 40 or older, get help from an expert right away. If you're 35 to 40, talk to a specialist after you've tried for six months with no luck. And if you're younger than 35, it's probably fine to keep trying for a year before seeking assistance. Of course, if you know of a reason you or your partner are more likely to have a fertility problem, make an appointment right away. There's no reason to wait in that case.

Aspirin, or acetylsalicylic acid (ASA) is a salicylate drug, and is generally used as an analgesic (something that relieves pain without producing anesthesia or loss of consciousness) for minor aches and pains, to reduce fever (an antipyretic), and also as an anti-inflammatory drug.

Osteoporosis is a disease in which bones become brittle and fragile due to low bone mass and bone tissue loss. It's the most common type of bone disease, according to the National Institutes of Health (NIH), and increases your risk of fractures, particularly of the hips, spine, and wrists. Prevalence In the United States, nearly 54 million people ages 50 and older were living with osteoporosis or osteopenia (low bone mass ) in 2010, according to a 2014 article in the Journal of Bone and Mineral Research. More specifically, 10.2 million adults had osteoporosis, and 43.4 million adults had osteopenia, which puts a person at high risk for osteoporosis.

The heart is the body's engine room, responsible for pumping life-sustaining blood via a 60,000-mile-long (97,000-kilometer-long) network of vessels. The organ works ceaselessly, beating 100,000 times a day, 40 million times a year—in total clocking up three billion heartbeats over an average lifetime. It keeps the body freshly supplied with oxygen and nutrients, while clearing away harmful waste matter.

Cancer starts when cells in a part of the body begins to grow out of control and can spread to other areas of the body. There are many kinds of cancer. Cells in nearly any part of the body can become cancer. To learn more about how cancers start and spread, see What Is Cancer? Leukemias are cancers that start in cells that would normally develop into different types of blood cells. Here we will talk about acute myeloid leukemia (AML). Acute myeloid leukemia (AML) has many other names, including acute myelocytic leukemia, acute myelogenous leukemia, acute granulocytic leukemia, and acute non-lymphocytic leukemia. “Acute” means that this leukemia can progress quickly if not treated, and would probably be fatal in a few months. “Myeloid” refers to the type of cell this leukemia starts from. Most cases of AML develop from cells that would turn into white blood cells (other than lymphocytes), but some cases of AML develop in other types of blood-forming cells. The different types of AML are listed in “ How is acute myeloid leukemia classified?” AML starts in the bone marrow (the soft inner part of certain bones, where new blood cells are made), but in most cases it quickly moves into the blood. It can sometimes spread to other parts of the body including the lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testicles. Other types of cancer can start in these organs and then spread to the bone marrow. But these cancers that start elsewhere and then spread to the bone marrow are not leukemias. Normal bone marrow, blood, and lymphoid tissue To understand the different types of leukemia, it helps to know about the blood and lymph systems.

A stress fracture typically feels like an aching or burning localized pain somewhere along a bone. Usually, it will hurt to press on it, and the pain will get progressively worse as you run on it, eventually hurting while walking or even when you're not putting any weight on it at all.

How to examine a patient's wrist if you suspect a scaphoid fracture: by Cape Town Emergency Medicine

Tonsillectomy (ton-sih-LEK-tuh-me) is the surgical removal of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. A tonsillectomy was once a common procedure to treat infection and inflammation of the tonsils (tonsillitis). Today, a tonsillectomy is usually performed for sleep-disordered breathing but may still be a treatment when tonsillitis occurs frequently or doesn't respond to other treatments. A tonsillectomy may also be necessary to treat breathing and other problems related to enlarged tonsils and to treat rare diseases of the tonsils.

Each year, thousands of babies in the U.S. are born addicted to opiates. And the problem is getting worse.

Norepinephrine is synthesized from dopamine by dopamine β-hydroxylase.[7] It is released from the adrenal medulla into the blood as a hormone, and is also a neurotransmitter in the central nervous system and sympathetic nervous system where it is released from noradrenergic neurons.