Skin Cancer

Do you have any spot dark in your skin? Please pay attention to evaluate and to look that the spot dark in your skin is massive growth , before anything happen to you because many people they don't know if the spot dark in their skin is early of skin cancer which called MELANOMA.

What is skin cancer?
Skin cancer is a malignant growth on the skin which can have many causes. Skin cancer generally develops in the epidermis, the outermost layer of skin, so a tumor is usually clearly visible. This makes most skin cancers detectable in the early stages.
Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, MELANOMA, is more dangerous but less common.

What Is Melanoma?
Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin). Melanocytes are found throughout the lower part of the epidermis. They make melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment, causing the skin to tan, or darken.
Risk factors for melanoma include the following:

• Unusual moles.
  
• Exposure to natural sunlight.
  
• Exposure to artificial ultraviolet light (tanning booth).
  
• Family or personal history of melanoma.
  
• Being white and older than 20 years.
  
• Red or blond hair.
  
• White or light-colored skin and freckles.
  
• Blue eyes.

The following stages are used for melanoma:
Stage 0
In stage 0, melanoma is found only in the epidermis (outer layer of the skin). Stage 0 is also called melanoma in situ.

Stage I
Stage I is divided into stages IA and IB.

• Stage IA: In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration. The tumor is in the epidermis and upper layer of the dermis.
  
• Stage IB: In stage IB, the tumor is either:
  o not more than 1 millimeter thick, with ulceration, and may have spread into the dermis or the tissues below the skin; or
  o 1 to 2 millimeters thick, with no ulceration.
  

Stage II
Stage II is divided into stages IIA, IIB, and IIC.

• Stage IIA: In stage IIA, the tumor is either:
  o 1 to 2 millimeters thick, with ulceration; or
  o 2 to 4 millimeters thick, with no ulceration.


• Stage IIB: In stage IIB, the tumor is either:
  o 2 to 4 millimeters thick, with ulceration; or
  o more than 4 millimeters thick, with no ulceration.


• Stage IIC: In stage IIC, the tumor is more than 4 millimeters thick, with ulceration.

Stage III
In stage III, the tumor may be any thickness, with or without ulceration, and:

• has spread to 1 or more lymph nodes; or
  
• has spread into the nearby lymph system but not into nearby lymph nodes; or
  
• has spread to lymph nodes that are matted (not moveable); or
  
• satellite tumors (additional tumor growths within 2 centimeters of the original tumor) are present and nearby lymph nodes are involved.

Stage IV
In stage IV, the tumor may be any thickness, with or without ulceration, may have spread to 1 or more nearby lymph nodes, and has spread to other places in the body.

How to reduce from Skin Cancer?
The following steps have been recommended by the American Academy of Dermatology and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer.

• Minimize your exposure to the sun at midday and between the hours of 10:00AM and 3:00PM.
  
• Apply sunscreen with at least a SPF (Sun Protection Factor)-15 or higher, to all areas of the body which are exposed to the sun. Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
  
• Wear clothing that covers your body and shades your face. (Hats should provide shade for both the face and back of the neck.)
  
• Avoid exposure to UV radiation from sunlamps or tanning parlors. Protect your children. Keep them from excessive sun exposure when the sun is strongest (10:00AM and 3:00PM), and apply sunscreen liberally and frequently to children 6 months of age and older. Do not use sunscreen on children under 6 months of age. Parents with children under 6 months of age should severely limit their children's sun exposure.

Four types of standard treatment are used:

1. Surgery
   

Surgery to remove the tumor is the primary treatment of all stages of melanoma. The doctor may remove the tumor using the following operations:


• Local excision: Taking out the melanoma and some of the normal tissue around it.
  
• Wide local excision with or without removal of lymph nodes.
  
• Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer.
  
• Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.

Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.

Even if the doctor removes all the melanoma that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to increase the chances of a cure, is called adjuvant therapy.


2. Chemotherapy
   

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

In treating melanoma, anticancer drugs may be given as a hyperthermic isolated limb perfusion. This technique sends anticancer drugs directly to the arm or leg in which the cancer is located. The flow of blood to and from the limb is temporarily stopped with a tourniquet, and a warm solution containing anticancer drugs is put directly into the blood of the limb. This allows the patient to receive a high dose of drugs in the area where the cancer occurred.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.


3. Radiation therapy
   

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.


4. Biologic therapy
   

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

New types of treatment are being tested in clinical trials. These include the following:


5. Chemoimmunotherapy
   

Chemoimmunotherapy is the use of anticancer drugs combined with biologic therapy to boost the immune system to kill cancer cells.

Keep your skin away from Skin Cancer, do the right way, how to avoid skin cancer.
Sources:
www.maui.net
www.nlm.nih.gov
en.wikipedia.org
http://www.cancer.gov

Blood Tranfusion

What Is Blood Transfusion?
Blood Transfusion is a process of transferring blood or blood-based products from person to other person according to Blood grouping matching(A, B, AB, or O)and each type have 2 Rhesus (REE-sus) or "Rh" types should be matching too. The Rh types are positive and negative. All blood, even O negative blood, can have antibodies (AN-ti-bah-dees).

When you need Blood Transfusion?
Blood transfusions can be life-saving in some situations and will be given who anybody want to do surgery procedure or getting massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease. People suffering from hemophilia or sickle-cell disease may require frequent blood transfusions.

Does Blood Transfusion safe?
If the blood transfusion given to other person precede by screened it will be save to the patients live, but if it's not screened it will be transfer many disease to the recipient through transfusion transmitted infections (TTIs) such as HIV, Hepatitis B, Hepatitis C and Syphilis from blood donated. Therefore donated blood should be tested for other infections such as Chagas Disease and Malaria. Blood is also tested to identify the blood group and for the presence of irregular red cell antibodies before transfusion. This is to make sure the patient who will receive compatible blood in order to avoid serious haemolytic transfusion reactions.

Transfusion Procedure

1. Ensure each pack is label with A,B,O and rhesus (D) group and the individual component number also record on the blood product document.
   
2. Check the patient identity on the blood product document againts the patient
   wrist bend.
   
3. Prior administration, record details, on the blood component infusion in the patient note, including date, time of issue, product pact number, ordering medical officer, given by, checked by, time started.
   
4. Infuse all blood component through giving set whit an integral filter to trap large aggregates. Microaggregate filter are not routinely require.
   
5. Never add any drug to a blood component infusion.
   
6. Do not use giving set which previously contained dextrose or gelatin.
   
7. Red cell concentrates may be diluted with 0.9% saline using a Y giving set to improve flow rates. Never add any other solution.

Complication of Blood Transfusion
Rapid infusion of blood products may lead to hypothermia. Blood product are normaly store 2-6 celcius deggre. Use blood warmers routinely for rapid transfusion. Never warm a blood product by putting a pack into hot water, on radiator, or any other heat source.
Occasionally complications caused by blood transfusions as a below:

• Fluid overload - this common side effect can be lessened by slowly introducing the donated blood.
  
• Allergic reaction - the most common complication. The recipient’s immune system treats the donated blood products as a threat. Symptoms include itching, dizziness, headache and difficulties in breathing.
  
• Haemolytic reaction - occurs if the recipient is given the wrong type of blood. The transfused red blood cells are killed off. Symptoms include a feeling of pressure in the chest, back pain and difficulties in breathing. Haemolytic reaction can sometimes be life threatening.
  
• Graft versus host disease - where the donated white blood cells destroy the recipient’s cells. The symptoms include low blood pressure and fever. It is also life threatening.

Transfusion Reaction
Monitor the patient especially closely the firsts 5-10 times of the infusion of the each unit of blood to detect early clinical evidence of acute reactions. Treat allergic reaction include itching, urticaria, bronchospasm, and fever.
If a transfusion reaction is suspected:

• Stop the transfusion.
  
• Keep the IV line open with 0,9% saline.
  
• Double check the blood unit label with the patient's wrist identity band and other identifiers.
  
• Send the unit of blood product and giving set to the blood bank.
  
• Take 40 mL of blood. Send it as follows:
  
5 mL anticoagulated and 5 mL clotted blood to blood bank.
10 mL for u&E.
10 mL for coagulation screening.
10 mL for blood culture.

• Contact the blood bank directly by phone for further advice and if further transfusion is required

New Drug for Advanced Kidney Cancer

The U.S. Food and Drug Administration (FDA) may,30,2007 approved Torisel (the generic name is temsirolimus) for the treatment of a certain type of advanced kidney cancer known as renal cell carcinoma. Torisel was approved based on a study that showed use of the drug prolonged survival of patients with renal cell carcinoma. The drug is an enzyme inhibitor, a protein that regulates cell production, cell growth and cell survival.

"We have made significant advances in the battle against kidney cancer,” said Steven Galson, M.D., M.P.H., director of the FDA’s Center for Drug Evaluation and Research. "Torisel is the third drug approved for this indication in the past 18 months, and one that shows an increased time in survival for some patients."
The approval of Torisel follows the December 2005 approval of Nexavar (sorafenib), which was based on a delay in progression of disease. In January 2006, Sutent (sunitinib) received accelerated approval based on durable response rate, or tumor size reduction, and was later demonstrated to delay tumor progression.

The safety and effectiveness of Torisel were shown in a clinical trial of 626 patients divided into three groups. One group received Torisel alone, another received a comparison drug called Interferon alfa, and a third received a combination of Torisel and interferon.

The group of patients who received Torisel alone showed a significant improvement in overall survival. The median overall survival was 10.9 months for patients on Torisel alone versus 7.3 months for those treated with the interferon alone. Progression-free survival (when the disease does not get worse) increased from 3.1 months on the interferon alone arm to 5.5 months on the Torisel alone arm. The combination of Torisel and interferon did not result in a significant increase in overall survival when compared with interferon alone.

The most common adverse reactions, occurring in at least 30 percent of Torisel-treated patients, were rash, fatigue, mouth sores, nausea, edema, and loss of appetite. The most common laboratory abnormalities were high blood sugar, elevated blood lipids and triglycerides, elevated liver and kidney blood tests, and low red cell, white cell, and platelet counts.

Renal cell carcinoma, diagnosed in about 51,000 people annually in the United States, accounts for about 85 percent of all U.S. adult kidney cancer.

Torisel is manufactured by Philadelphia-based Wyeth Pharmaceuticals, Inc
Important Safety from used Torisel
Source

Cardiopulmonary Resuscitation (CPR)

What Is CPR (Cardiopulmonary Resuscitation)

CPR is combination of rescue breathing(to get oxygen to the lungs) and chest compressions (to keep blood circulating) delivered to victims to save of patient life when a person experiences cardiac arrest, whether due to heart failure in adults and the elderly or an injury such as near drowning,suffocation, poisoning, smoke inhalation, electrocution or severe trauma in the child and newborn.

Cardiac arrest is often caused by an abnormal heart rhythm called ventricular fibrillation (VF). When VF develops, the heart quivers and doesn't pump blood. The victim in VF cardiac arrest needs CPR and delivery of a shock to the heart, called defibrillation. Defibrillation eliminates the abnormal VF heart rhythm and allows the normal rhythm to resume. Defibrillation is not effective for all forms of cardiac arrest but it is effective to treat VF, the most common cause of sudden cardiac arrest.

CPR may not save to the victim even when performed properly, but if started 4 minutes of cardiac arrest and defibrillation is provided whitin 10 minutes, a person have 40% chance of survival. Here the CPR time line described you have to do CPR , if you are doing CPR starting 0-4 minutes you can save from brain damage, 4-6 minutes brain damage possible happen, 6-10 minutes brain damage probable and over 10 minutes probable brain death, so choose the right time when you are perform CPR.

To make learning CPR is easier , you have to remember the sequence letters A-B-C as explained the following:

1. A : Airway
2. B : Breathing
3. C : Circulation

When CPR to be Perform?

CPR is most successful when administered as quickly as possible, but you must first determine if it's necessary. It should only be performed when a person isn't breathing or circulating blood adequately.

How to perform CPR?

You should not try CPR unless you have had training - if it is done incorrectly, it could harm someone and will killing victim try to looking some help or you can calling victim, you have to be skill full, and to keep your skill up, you should repeat the training every two years. You can call 9-1-1 in USA, UK 9-9-9 or you can call any Emergency Care in your own country, or you can contact local Ambulance number if you have it.

If yo can do CPR, Remember the ABCs
Airway, Breathing and Circulation — to remember the steps explained below.

AIRWAY: Clear the airway

1. Put the person on his or her back on a firm surface.
   
2. Kneel next to the person's neck and shoulders.
   
3. Open the person's airway using the head tilt-chin lift. Put your palm on the person's forehead and gently push down. Then with the other hand, gently lift the chin forward to open the airway.
   
4. Check for normal breathing, taking no more than 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Do not consider gasping to be normal breathing. If the person isn't breathing normally or you aren't sure, begin mouth-to-mouth breathing.

BREATHING: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

1. With the airway open (using the head tilt-chin lift), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.
   
2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head tilt-chin lift and then give the second breath.
   
3. Begin chest compressions — go to "CIRCULATION" below.

CIRCULATION: Restore blood circulation

1. Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
   
2. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 1 1/2 to 2 inches. Push hard and push fast — give two compressions per second, or about 100 compressions per minute.
   
3. After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn’t rise, repeat the head tilt-chin lift and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions.
   
4. If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, open the kit and follow the prompts. If you're not trained to use an AED, a 911 operator may be able to guide you in its use. Trained staff at many public places are also able to provide and use an AED. Use pediatric pads, if available, for children ages 1 to 8. If pediatric pads aren't available, use adult pads. Do not use an AED for infants younger than age 1. If an AED isn't available, go to Number 5 below.
   
5. Continue CPR until there are signs of movement or until emergency medical personnel take over.

sources
1.www.mayoclinic.com
2.www.learncpr.org
3.www.americanheart.org