When a person has idiopathic thrombocytopenic purpura, or ITP, the body for some reason produces antibodies which attack the platelets that allow the blood to clot. Thus, the symptoms of ITP are excessive bruising and bleeding. ITP is a relatively unusual medical condition that can occur in people without HIV infection, but it is far more common in those with the infection. Most people are unaware of this condition; it is usually discovered with routine laboratory testing. Several forms of treatment are considered effective. Whether ITP means that HIV infection is progressing is unclear. Many studies have shown that people with HIV-related ITP do not go on to get AIDS any faster than people with HIV infection who do not have ITP. Other studies have shown that people with HIV-related ITP develop AIDS more quickly than people who have HIV infection but do not have ITP.
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The optimal approach to analysis of seizures is to both see and record their onset and their spread. Such an approach is mandatory in situations in which surgery is being considered. When surgery is even an option, it is critical to know the exact area of the brain involved in the origin of the seizures. Video-EEG monitoring allows recording of the EEG from multiple areas of the brain and also simultaneous video recording of the seizures.Video-EEG monitoring can also be useful when there is a question about what the spells really are. The ability to see a spell that is said to be a seizure and to record the EEG at the same time is the definitive way to differentiate seizures from pseudo-seizures.Two examples will illustrate: Sasha was a fifteen-year-old with a severe behavior disorder and seizures. Despite several years of intensive outpatient psychotherapy, he was once again thrown out of school. His family was exasperated. It was clear to both his neurologist and psychiatrist that he used his seizures to manipulate his environment. He was taken off medication and these peculiar episodes, which did not sound like seizures, did not increase in frequency. The family was taught to ignore them and Sasha seemed able to control them. But their persistence and his abnormal EEG remained of concern to his psychiatrist.The only resolution to his problem was to send him to a residential institution where he could be taught better behavioral control. Since the psychiatrist at the institution was uncomfortable dealing with a child with seizures, we brought him into the monitoring unit to see whether all of his spells were pseudo-seizures.Much to our surprise, while most of his episodes were, indeed, pseudo-seizures, at night he had genuine tonic-clonic seizures. Placing him back on medication eliminated these true seizures and allowed the psychiatrist at the institution to concentrate on his behavioral problems.Simon’s seizures began when he was two. They would start in his left foot and spread up the left side. At times, he would have a weakness in the left leg that was thought to be post-ictal paralysis, but at other times the leg was quite normal. Despite intensive attempts with medication, seizures continued to occur several times each day. The EEG showed a focus near the motor strip on the right, and we faced the choice of operating to remove the focus (with the probability of causing paralysis at least of the leg) or of allowing him to continue to have seizures. We decided to wait. After several years, video-EEG monitoring allowed us to see the start of several seizures. The seizures actually began anteriorally in the frontal lobe and then spread into the motor strip. They began in an area that could possibly be removed without damaging his motor ability. Simon was, therefore, put on the list for evaluation with the grid electrodes placed on the surface of his brain and eventually had successful surgery—without experiencing paralysis.Intensive monitoring allows us to make decisions we were never able to make before. It gives us the opportunity to separate true seizures definitively from pseudo-seizures and more successfully to identify children as prospects for surgery.*87\208\8*
In 2000, an estimated 36,100 new cases of uterine cancel were diagnosed in the United States. Most uterine cancers develop in the body of the uterus, usually in the endometrium (lining). The rest develop in the cervix, located at the base of the uterus. The overall incidence of early-stage uterine cancer – that is, cervical cancer – has increased slightly in recent years in women under the age of 50. In contrast, invasive, later-stage forms of the disease appear to be decreasing. Much of this apparent trend may be due to more effective regular screenings of younger women using the Pap test, a procedure in which cells taken from the cervical region are examined for abnormal cellular activity. Although these tests are very effective for detecting early-stage cervical cancer, they are less effective for detecting cancers of the uterine lining and are not effective at all for detecting cancers of the fallopian tubes or ovaries.Risk factors for cervical cancer include early age of first intercourse, multiple sex partners, cigarette smoking, and certain sexually transmitted diseases, such as the herpes virus and the human papillomavirus. For endometrial cancer, a history of infertility, failure to ovulate, obesity, and treatment with tamoxifen or unopposed estrogen therapy appear to be major risk factors.Early warning signs of uterine cancer include bleeding outside the normal menstrual period or after menopause or persistent unusual vaginal discharge. These symptoms should be checked by a physician immediately.*28/277/5*