Garcia Montes said “it is an accumulation of protein-rich fluid called lymph in the interstitial space from overload or damage the drainage system and is characterized by chronic and progressive edema of the affected limb, and its most common form of appearance is associated with neoplastic disease and causes major disruption resulting aesthetic and functional problems of pain.

This expert said that although there is no cure, it may prevent the onset of secondary lymphedema and can be treated when it is already well established to reduce disability and occurrence of complications and keep it stable over time.

He also stressed that “the most common cause of lymphedema is mastectomy lymphedema, which accounts for 70 percent of the total, but nuance is not yet the most difficult cases to diagnose. “The lower limb lymphedema is often overlooked and misdiagnosed, which causes patients who suffer from it takes an average of 13 years to receive a proper diagnosis, and attending a specialist in advanced stages of the disease when complications occur partner, “he said.

As for the main causes of lymphedema noted that are congenital anomalies of the lymphatic system (which is known as primary lymphedema), cancer and its treatment – secondary lymphedema – a chronic venous disease of lower limb (edema lymphoma venous) or certain surgical procedures in the lower limbs.

He indicated that “the most frequent complications of lymphedema include infection (erysipelas, lymphangitis) and dermal complications as skin fibrosis, hyperkeratosis, elephantiasis, lymphatic fistulas with Chyle and, less commonly, lymphatic ulcers.

Among the recommendations for these patients, the expert stressed wash skin daily with pH neutral soap and dry thoroughly, using moisturizer to prevent dryness, avoid punctures or wounds on the affected arm, enable the use of preventive systems such as the use a thimble, gloves, mittens or oven; extreme caution in the manicure and shaving, trying to keep the nails straight, and without biting cuticles, or avoid direct heat sources in the affected limb

In addition, advise to use cotton clothing, avoid loading arm weights with affection and eliminate the use of bags, avoid cluttering it encourages lymphedema; not to overuse in sports, try to avoid the warm weather countries, to avoid compression of jewelry and not take the tension in the affected arm.
Source: Azprensa

What is Digestion?

Digestion is defined as a set of mechanical processes (chewing, mixing of food and intestinal motility or peristalsis), chemical (enzymatic hydrolysis) and physical (emulsification of fats by bile salts), by which substances are extracted nutritious food and degrade to smaller particles, can be absorbed easily.

At the mouth, ingested food is crushed and mixed with saliva, then passed to the stomach, where it acquired a consistency softer by the joint action of mechanical contractions of the body and gastric juice. In the stomach, proteins are extracted from food and undergo partial hydrolysis.

The peristaltic wave form that has the digestive tract, allows the movement of the bolus along the small intestine where digestion occurs true. The secretions of the intestine, pancreatic juice and bile play a fundamental role because, in addition to liquefy foods contain digestive enzymes responsible for degrading proteins, fats and carbohydrates in the diet into smaller particle size: amino acids , fatty acids and simple sugars, respectively. Besides releasing the vitamins, minerals and water from food.

Finally, all small molecules cross the walls of the small intestine (absorption) and through blood, reach the various organs and tissues to perform specific life functions.

How are the feces and defecation how it happens?

The food remains have not been absorbed continue their transit through the intestine, where they acquire a solid or pasty consistency. Thus, stool form, consisting of waste animal foods (dairy and meat fibers), plants, bacteria and colon cells that are derived from the intestinal mucosa. The food takes about 6-8 hours after ingestion to reach the colon, where food residues can remain in 18-72 hours.

The volume of the stool depends on the content of dietary fiber. It is well known that the fibers, their ability to absorb water, cause increased fecal volume, which in turn stretches the walls of the large intestine thus facilitating intestinal peristalsis into the rectum. When the stool reaches the rectal ampulla, it issues a warning that can be reflected defecation.

If the colonic content moves too slowly, or does not (for lack of fiber, for example) is drained because it is absorbed more water. This causes hard stools, scanty and difficult to pass (constipation). By contrast, people who eat the recommended amounts of dietary fiber in fruit, vegetables, legumes, breads and cereals, have softer stools, larger and easier to expel.

The content of nutrients in the diet also contributes to the increase in fecal mass in the following increasing order: protein, fat, digestible carbohydrates and indigestible carbohydrates. In Western countries, the stool weight varied from 45-250 grams, but about half the population excretes less than 100 grams per day.

Many people think that periodontal disease is an adult problem. However, studies indicate that gingivitis (the first stage of periodontal disease) is nearly universal in children and adolescents. Advanced forms of periodontal disease are rarer in children than in adults, but can occur.

To ensure healthy teeth as an adult, you must establish good oral habits as a child. Parents can encourage good oral health habits at home. For example, parents may reward children with visits from the tooth fairy or the Tooth Fairy not only when they drop a tooth, but when the child passes the dental examination.

Types of periodontal diseases in children

Chronic gingivitis is common in children. It usually causes the gums to swell, turn red and bleed easily. Gingivitis can be prevented and treated well by following a regular routine of brushing, flossing and professional dental care. However, if it is not treated, can progress over time towards a more serious forms of periodontal disease.

Aggressive periodontitis can affect healthy. Localized aggressive periodontitis is found in adolescents and young adults and mainly affects the first molars and incisors (front). It is characterized by severe loss of alveolar bone, and ironically, patients are very little dental plaque or calculus.

Generalized aggressive periodontitis may begin more or less at puberty and may involve the entire mouth. It is characterized by inflammation of the gums and large accumulations of plaque and tartar. Over time can cause teeth to become loose.

Periodontitis associated with systemic diseases occurs in children and adolescents and adults. Conditions that make children more susceptible to periodontal disease include:

* Type 1 Diabetes

* Down Syndrome

* Papillon-Lefevre syndrome

For example, a study of 263 Type 1 diabetics between 11 and 18 years of age, 10% had periodontitis evident.

The anxieties, difficulty concentrating, overreacting to minor problems, easy irritability, forgetfulness and mood swings are typical psychological problems. Studies indicate that many cases of depression relate more to the circumstances of menopause it self. Other events, such as care for elderly relatives, retirement, divorce or widowhood, children growing and leaving the house occur around the time of menopause. Also, some problems may be caused indirectly due to the disruption of sleep. To address emotional symptoms you should exercise regularly. This will help maintain your hormonal balance and preserving bone strength. Talking with other women, who are going through menopause, can help with emotional symptoms. Women approaching menopause often complain of memory loss and inability to concentrate.

Menopause is the period that ends a woman’s reproductive phase. Menopause begins at the end of menstruation. Over time, the ovaries gradually lose the ability to produce estrogen and progesterone, hormones that regulate the menstrual cycle. As estrogen production decreases, ovulation and menstruation occur very often, and eventually stop. Menstruation can be stopped early due to illness or a hysterectomy. In these cases we speak of induced menopause. In Europe and North America, menopause usually happens when a woman is around 51-52 years old. Menopause can happen but sometimes as early as 40. The age and menopausal symptoms also have a strong genetic influence. As a rule of thumb, women who began menstruation early is more likely to experience menopause earlier.

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Following a diet free of gluten (wheat flour) in two weeks there is an improvement of symptoms in most cases. If no improvement may be that the diet is not suitable or because complications occur lymphoma. In asymptomatic individuals the diet is made also because the disease tends to worsen if nothing is done and because the incidence of lymphomas and adenocarcinomas increases seem to match these tumors increased with the degree of intestinal inflammation. Therefore it is not clear that individuals with positive serology but no intestinal inflammation should take this diet.

Parallel to diarrhea diseases chronic intolerance to gluten. Not always associated with the intestinal disorder.

• Hyperkinetic Syndrome
• Epilepsies
• Disturbances of attention
• Intestinal lymphoma
• Intestinal Adenocarcinomas
• Dermatitis herpetiformis
• Schizophrenia

Diagnosis is made by measuring specific antibodies in the blood, a biopsy of the intestine and symptoms. Duodenal biopsy is often, but will be more sensitive to the jejunum.

Are three different models that vary according to clinical presentation:

Villous epithelial infiltration with lymphocytes, with normal villi and crypts. This model was found in 40% of individuals with Dermatitis Herpetiformis and a small portion of patients with bowel involvement and affected relatives are asymptomatic. Elongation of the crypts and flattening and inflammatory cells in the lamina propria. This model is classically in individuals with celiac disease with intestinal symptoms in asymptomatic affected relatives, and individuals with dermatitis herpetiformis. In most of these individuals, treatment with a gluten-free diet results in improvement of the villi and crypts architecture that becomes normal or nearly normal.

Complete flattening of the mucosa with absence of villi and crypts very small. It is found in more severely affected patients. It is often refractory to gluten-free diet, and the injury is not reversible. Are patients requiring intravenous nutrition supplements. Property and repeated biopsy to avoid false positives of intestinal infections, with lesions caused by lactose. We must also bear in mind that patients in remission or with intermittent symptoms may have normal biopsy and the results of the analysis but remain very sensitive to any prolamin.

Mechanisms involved in gluten intolerance:

• Lack of digestive enzymes (intestinal glutaminase)
• Production of anti-prolamin antibodies, or fragments of it.
• Increased intestinal permeability to macromolecules and protein antigens.
• Increased production of mediators (histamine, serotonin, kinins, prostaglandins, and interleukins).
• The first-degree relatives have a predisposition to be found on chromosome 6 and is the most common marker associated with HLA DQw2.

The first attempt of classification of vasculitis returns to Zeek who in 1952 proposed to identify multiple entities according to their clinical and pathological (102): hypersensitivity vasculitis, allergic granulomatous vasculitis Churg-Strauss (SCS), the classic PAN and Horton’s disease. Since this classification has been refined by others but the main framework set forth therein remain valid. Fauci described then a “group of polyarteritis nodosa” including the PAN, the SCS and forms overlap (103). This classification had the advantage of being pragmatic and useful for the clinician but further work has to distinguish the microscopic polyangéite (MPA) as a distinct systemic vasculitis of PAN (299,95,104). This recognition has not been taken into account in the classification established in 1990 by the American College of Rheumatology (ACR) (105) (Table 1). Indeed, the PAN and MPA have long been not distinguished because of their resemblance clinical (general manifestations, neurological, gastro-intestinal .).

Nevertheless, these two diseases are distinct. According to the nomenclature proposed at Chapel Hill, PAN preferentially affects the vessels of medium caliber and MPA the small vessels, ie arterioles, capillaries and venules (104). Glomerulonephritis and pulmonary capillaritis observed in the MPA, while the PAN, renal disease is vascular and lung is spared. It is so easy to differentiate the NAP of the MPA in patients with vasculitis with severe renal impairment and / or lung. For cons, the majority of patients, particularly those with vasculitis respects the kidney and lung, the distinction is sometimes impossible even applying the Chapel Hill nomenclature or classification criteria of the ACR PAN (106). Furthermore, impairment of small vessels is possible during the NAP (107) and conversely a violation of vessels of medium size is possible during the MPA (105).