child care

 WHAT TO DO WHEN YOUR KIDS CRY ?

Crying is a physiological process in the life of a baby.All normal babies cry to communicate with others.Sine they can't express their feelings in words crying is the only way for communication. If any uncomfortable feeling comes they simply cry.Normally babies cry in situations like hunger,wetting,too heat or cold,tight cloaths,pain ect. Some kids need the presence of somebody otherwise will cry simply.Crying without any cause is habitual in some babies. Eventhough crying is considered as normal it may worry the family members.Since the reasons for crying ranges from simple causes to serious causes it should not be ignored and hence exact cause has to be identified and managed accordingly.

The following are some points which should be considered while dealing with a crying baby.

• 1, It is dangerous to shake the baby vigorously.
• 2,Tight cloaths can cause irritation hence it should be removed.
• 3,If the room is hot put the fan and open the windows.
• 4,If the nappy is wet remove it and after cleaning the parts make it dry with a soft towel.
• 5,Pat her back or stroke her head slowly and let her here your soothing sound.
• 6,Give breast milk and make her quiet.
• 7,If the climate is cold cover her in soft towel.
• 8,Rock her gently in your arms and walk slowly in the room.
• 9,Take a music making doll and let her listen.
• 10,Try a pacifier or help her for thumb sucking.
• 11,If no response change her position.
• 12,Walk outdors with her.
• 13,Put her on the cradle and rock gently.
• 14,If no response ask somebody to carry the baby.

Even after all these steps the baby goes on crying see for the following signs.( Probable cause is given after every sign)

• 1,Press her abdomen gently,she may twist or resist you:---Colic
• 2,Pull her ear gently she may become worse or push your hands away:---Earache.
• 3,Feel her temperature with the back of your hands:--Fever due to any infection.
• 4,Examine the skin from head to foot:--Eruptive disease,nappy rash,measles,vesicles,allergy ect.
• 5,See the nose for any discharge:--Coryza.
• 6,Move the head gently to feel any neck stiffness:--Meningitis,head injury ect.
• 7,Keep your ear near her chest to hear any rattling sound:--Increased mucus in wind pipes.       (pneumonia,bronchiolitis,asthamatic bronchitis ect)
• 8,Examine the anal orifice:--Anal erosion,rectal polyp,crawling of worms.
• 9,Examine the genitalia:--Any discharge or erosion.
• 10,In male baby see the testicles which may be swollen or tender:--Orchitis,torsion of testes.
• 11,also notice the body movements and see for any  onvulsions,rigors,vomiting,cough,laboured breathing ect.

If you see the above signs or any other abnormal signs consult your doctor for proper treatement.

 

Vitamins And Your Health

          These days, we all know that taking vitamins is an easy way to start pursuing a healthy and disease free way of life.  In the past, vitamins were used with diets, although they weren’t near as sophisticated as they are today.  The vitamins of today are far more sophisticated and geared towards certain aspects of your body and your health.
Even though some people may not realize it, food doesn’t give you all of the vitamins and nutrients your body needs.  Although you may be following a healthy diet, you won’t receive everything your body needs to carry out daily functions.  You can buy high quality food if you wish, although it isn’t the preferred way to fix this type of situation.  No matter what you choose to eat, you still won’t get the vitamins and nutrients you need.
          If you have any type of restrictions with your diet, it can be even more difficult to get the vitamins and nutrients you need.  Those who suffer from food allergies especially, find it even harder to get the right amount of vitamins.  Even if you have a small appetite, you can be at a major disadvantage to getting everything your body needs.  Smaller appetites get full a lot quicker, making it harder to eat the foods you need on a daily basis.
          No matter how you look at it, you won’t get everything your body needs from food.  To get the vitamins, minerals, and nutrients you need, you’ll need to use supplements and vitamins.  Vitamin supplements are the easiest way to give your body what it needs.  You can use vitamins and supplements in your normal diet, although you’ll need to choose them accordingly with what you need and what your diet consists of.
         Even though there are many vitamins that you can benefit from, one of the most important is B12, which can raise your energy levels and help with your immune system.  Some other vitamins you’ll need to include in your normal diet are vitamin A, C, D, and E.  These vitamins are very important to your body, as they help with many different functions.  Vitamins C and E are among the most important, as they help with your skin, hair growth, and the way your body functions.
        To ensure that your body remains at it’s best, you should make sure that you get the right amount of vitamins with your diet.  You can find vitamin supplements locally or on the Internet, with hundreds to choose from.  You should also include selenium and colostrum in your daily diet as well, as these two vitamins will help you with your health.  If you take the right vitamins with your diet - you’ll find that your health and energy will always will remain at their top levels of performance.

Mineral Vitamin Supplements

         The majority of mineral vitamin supplements are made from chemicals rather than natural substances. However, there is a steady growth in the demand for natural mineral vitamin supplements. This is due to the amount of debate that there is as to whether chemical mineral vitamins can be more harmful than beneficial in the long term.
             The fact is that chemical mineral vitamin supplements are not as easily absorbed as normal food particles are. The mineral vitamin industry is constantly striving to create products that are more easily processed by the body and therefore more beneficial.
           Every now and then the industry comes up with a new 'more bio-available' form of a vitamin or mineral. To overcome this, a large number of mineral vitamins have been developed that combine other elements with the vitamins and minerals to enable them to be more easily absorbed by the body. Iron is commonly combined to form iron gluconate which enable the mineral vitamin supplement to be more absorbable.
           The amount of a nutrient in a mineral vitamin supplement needs to be far greater than it would be in a more natural form for the body to be able to absorb the amount that is required. This can obviously lead to problem where a toxic level of the particular nutrient is being consumed by the large doses of the mineral vitamin supplement that are needed. It is therefore extremely important that a person does not simply take vast quantities of all of the mineral vitamin supplements that are advertised on television and should seek advice from a health professional. It is also worth being aware of the developments in the mineral vitamin supplement industry as there are constantly new and better combinations being developed.
             One method that mineral vitamin manufacturers have developed to help aid absorption is through culturing the raw materials with yeast cells. This form of mineral vitamins are known as ‘food state’ and are up to four times easier for the body to absorb the required nutrients as the yeast is completely digested.
          Of course, the need for mineral vitamin supplements depends on the diet that a person has. There is no doubt that it is far more preferable for a person to obtain the nutrients that they require from their food rather than by taking mineral vitamin supplements wherever possible. During certain periods it may be necessary for a person to take mineral vitamin supplements on a temporary basis but their long term use is not recommended for a number of the supplements that are available.

Getting Into Law School

         Once the season for college applications start, you would hardly have the time for yourself amidst all the forms that you need to fill out. Getting into law school is no easy feat. If you decide that you really want to take up law in college, prepare yourself for the time-consuming tasks ahead.

  

How to Get Into Law School

         LSAT stands for Law School Admission Test. This should be your main priority since you cannot get into law school if you fail this test. Register ahead of the deadline. More students apply for law school each year, which would mean more competition.
 

         Maintain your Grade Point Average or GPA to have better chances of getting into law school. Visit the official web sites of your prospective law schools. Make a list of their deadline for application, the requirements and all other pertinent details for your application to be processed.

The Ivey Guide to Law School Admissions: Straight Advice on Essays, Resumes, Interviews, and More   

         It is a requirement for most law schools to subscribe to the LSDA’s. This stands for Law School Data Assembly Service.  This is a service that compiles your student profile and sends it to the schools that you have chosen. The LSDA’s also sends them an update about your scores on tests, as well as your letters of recommendation.

        After securing your LSAT admission ticket, take the exam. Compile all of your paper works, application and acknowledgement forms, test results and letter of recommendations. After taking your tests, the LSDA should do the brunt of your work for you. Give them a couple of weeks to process your letters and record your scores to be sent to the law schools that you have chosen.

         Do not forget to pay all the required fees. Regularly check the official web sites for the status of your application. Then, you can wait and hope for the interviews to come next. Finally, you should apply to more than enough law schools to increase your chances of getting into law school and do not hesitate to retake the LSAT’s  if you need to.

 

 

 

 

Tea you can have it hot or cold

                   You can have it hot or cold, black or green, herbal or lemon; yes what we are talking about is tea. Tea is the most popular beverage worldwide. The discovery of tea was done in 2700bc by a Chinese emperor, also a scientist, Shen Nung. In the Indian and Japanese legend tea was supposedly discovered by a Buddhist missionary monk Daruma. Shen Nung had discovered tea when some leaves from the garden fell into his pot of boiling water resulting in a refreshing drink where as it is believed Daruma on being disappointed of himself for not being able to complete his nine year meditation had cut off his eyelids and thrown it on the ground from which originated the tea plant.  It was the monkeys who were first trained to pick tea leaves.

                     Tea slowly gained popularity among the French and the Dutch, but due to its high cost remained a drink for the wealthy. With the passage of time and the increasing popularity different processes of brewing, preparing and drinking tea was evolved. Marquise de seven was the first to have mentioned the addition of milk to tea giving the drink a new dimension.

                    Tea was first taken to Europe by the Dutch in the 1600bc. In the 1700bc tea was first sold in a fashionable coffee house by Thomas.  John Dorniman was the first to sell tea in nett weighed packets. The first European to write about tea was father Jasper De Cruz, in the year 1560, who tasted the drink at a missionary. The duchess of Bedford originated the custom of afternoon tea but the credit turning it into a pastime should be given to Queen Victoria.

                   Tea was originally grown in china and exported to Europe and other parts of the world. china emerged as the trader of tea . Due to the steep rise in demand and also to keep a check on the balance of trade the Europeans started looking for other places where tea could be grown .this search gave birth to the tea fields of India . Later Europe imported tea from India followed by Ceylon.

                  The history of tea also enhances our general knowledge.   When we move back in time, we learn that the practice of tipping was developed in the tea gardens of England where a small wooden locked box labeled tips (to insure prompt service) was kept for its customers. Customers came and went by, years and centuries passed by, only to take to new heights the refreshing drink called Tea.

Products and Programs that Can Help Lose Weight

 Lose Weight

               Many available weight loss products and programs offer quick solutions to weight problems. It is a fact that it is a very hard task to achieve the desired weight. Before you get into a weight loss program, it is important that you check the cost of the whole session. Most of these programs offer high cost registration fees and may pressure you to buy pills and special supplements that will help you to have a physically fit body.

                Over 50 million of Americans are engaged in weight loss programs, but only 5 percent sustain the weight they have worked off. Many people think that losing weight is easy; they may encounter the struggles of working out and dieting in the course of their weight loss programs. Many are still finding the most effective way to get rid of the excess weight in their body not realizing the fact that there is no such thing as a quick solution to get rid of the excess weight in a short time.

               One solution that is seen by experts to be the answer to weight problems is the change of the lifestyle of a person. Eating healthier foods and having an active lifestyle only proves that it is the most effective way to lose weight.

              Products that are sold over the counter to help you in your weight problems and even weight loss programs that enables you to have a regular exercise everyday can cost more money. If you want to engage in these kinds of programs, it is important that you must first get the enough information on how good the products or programs are that made others look good and achieve a physically ft body.

           Although weight loss products and programs have the capability to help you lose the unwanted weight, it is important that you must select the program that can truly guide and help you in your quest for a physically fit body. To have a healthy diet could be the most recommendable thing that one must do to help the overall health aspects.   

About Aromatherapy

What is Aromatherapy?

                  Aromatherapy is the science of using fragrant essential oils from trees and plants, natural herbs to enhance a person’s health and his beauty. The field of aromatherapy is becoming famous because people are looking for a better solution to new days emerging diseases as an alternate to existing system of medicine in allopathic, ayurvedic etc. It is science and art of using herbs and essential oils from trees and plants to make use of their medicinal value. Aromatherapy is a practical, safe and inexpensive means of better health. In this method by which essential oils taken from natural aromatic plants, and herbs is taken in crushed form used to enhance the health of a person and also for the emotional well being of person.

Where the concept did came from?

              Early Egyptians used this herbs and essential oils to purify their body for life after death in pharaohs. French Chemist Rene Maurice is credited with the origin of the term Aromatherapy. The story of the term Aromatherapy begins with him. It was accidentally this term came into existence. The story of the beginning of this term Aromatherapy is explained in following lines below:

              While in the year 1920 he was working in his lab he burned his hand and then to get relief from this severe pain he plunged his arm in lavender essential oil that was the only cold substance around him at that time. This action healed his hand rapidly and here it gave birth to a new science. This French chemist devoted his remaining life in exploring the healing power of natural essential oils and medicinal values of herbs.

What are applications of Aromatherapy?

 Aromatherapy is widely used in treatment. It is an accepted system of treatment in many countries. Some of applications of aromatherapy are as:

It can give immediate relief from severe pain as soon as the wounded or burned portion of a person body is brought in contact of cold of herbs and essential oils. Products like lavender are used to treat burn victims while scents are used to recover a person from anxiety and depression.

              Essential Oils are high concentrated extracts of plants which are hundred times powerful than the plant itself and can be very efficiently used in treatment. Many types of essential oils are used for their smell only. Example: The scent from plant Eucalyptus is used to provide relief from problems like chest congestion.

               Many essential oils are used for their anti-fungal, anti-bacterial and anti-inflammatory property. Tea tree oil is used to recover from ringworm and fungal infections etc.

Essential Oils

About Essential Oils

                Essential Oils are the basis of Aromatherapy treatment to diseases in a patient. Essential Oils are used to alter or enhance emotional state of mind to achieve goals. The connection of mind with body is a powerful force and Essential Oils are used to make use of this force in their way to providing treatment to a patient. Aromatherapy is branch in herbal medicine that makes use of the medicinal properties of herbs and plants. Aromatherapy consists of two words Aroma and Therapy where the word aroma refers to the fragrance or smells a group of chemical compounds, wines, flowers from which essential oils are extracted and therapy refers to any of measures adopted for treatment of disability or disease, it is a generic term to use and describe any psychological or medical system of treatment designed to promote the physical health and mental well being of a person. It is the attempted recovery from any of health problem.

Presence of Aroma:  

              The aroma you can find every where in all your surroundings. You can find aromas in fruits, plants, barks, roots, roses in gardens, tangy limes, lavender and lemons. Soaps and shampoos include essences of plants, fruits and flowers.

Carrier Oils: 

           Aromatherapy requires use of pure essential oils. Since some Essential oils are toxic so they must be utilized carefully with attention to receive benefits of this natural gift. The Essential Oil obtained after distillation from essences of plants, flower and fruits is highly concentrated so it must be first diluted with the carrier oil. Carrier Oil allows the Essential Oil to slowly to penetrate through skin, and prevents from any inflammation. The most common types of carrier oils used are jojoba, sweet diamond, rose hip, olive, sunflower, sesame, safflower, hazelnut etc.

 Storing of Essential Oils: 

              Essential Oils should be stored in jars or glass vials and plastic containers should be avoided for this purpose. These bottles should be colored cobalt or amber. Store these Essential Oils in cool and dry place. Generally Essential Oils lasts from 1 to 3 years but few are exceptions like Citrus Oil which last in 6 months to 1 year.

         Multi purpose Essential oils are Lavender, Rosemary, Tea tree, Chamomile, Eucalyptus, Rose, Pine, Sandalwood, Peppermint and Lemon.

RISK OF DIABETES

            Psychological and emotional stress among mothers may trickle down to their kids and increase their children’s risk of having diabetes. Mothers who experienced a stressful event such as divorce, domestic violence, mental tension and work pressure have an increased risk of developing diabetes. Parents who are often stressed out or are having problems is the number one stressor among children. Without the parent’s knowledge, children may get stressed, raising level of cortisol-also called the “stress hormone”.

            Cortisol is found adjacent to the kidneys and is released in response to either physical or psychological stress. It breaks down muscle protein into its component amino acid which then circulates the bloodstream. These amino acids are used by the liver in the manufacture of glucose for energy increasing blood sugar level and at the same time lowering the use of glucose as fuel. The excess and deficiency of cortisol in the body may trigger some system disorders such as autoimmunity damaging the insulin-producing beta cells thus resulting in insulin deficiency.

             Children with diabetes who experience frequent episode of severe low blood sugar or hypoglycemia particularly at an early age may have reduced long-term memory performance than diabetic children who experience severe hypoglycemia at a later age. A diabetic children’s spatial memory performance may be greatly affected by episodes of extreme low blood sugar. Hypoglycemia is an abnormally low level of glucose in the blood or low blood sugar.

             Anti-diabetic medicines that are taken orally by the mouth are effective as insulin injection in controlling symptoms of diabetes. The number of people with diabetes continues to rise while their ages at the time of diagnosis drop. Type 2 diabetes, which used to be called adult - onset diabetes, is now striking children, due largely to the obesity epidemic. Overweight and obese kids that present identifying symptoms like darkness around neck and armpits area are those who frequently get urinary tract infection (UTI).

             Diabetes if not properly managed can lead to many complications such as amputation and damage to key organs of the body like the eyes, kidney and the heart. It takes every ounce of restraints and discipline on the part of the patient to be able to follow the rigid diet and medication regimen required for the management of disease.

 
            Having diabetes requires careful examination of ones sugar level. Besides watching for sign of high blood sugar, they also have to be aware of warning signs of blood sugar or hypoglycemia. Using blood glucose meter, a person who has diabetes can tell his/her sugar level is low. Normal fasting blood sugar is 70 to 100 mg/dl.

Headaches due to Tension

What are tension headaches?

              Tension headaches are headaches caused in people due to tension in mind. Most people describe it as a constant achy feeling on either side of head. Some people also feel tightness in their head and neck muscles. It often starts in middle of day and begins gradually and slowly. Some people also call it as stress headaches that means when people say that they have stress headaches they mean by saying this that they have tension headache. It may be severe or mild, but when it is severe it sometimes may be more painful and dangerous and do more harm than migraine headaches.

 Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain

How to diagnose?

           Tension headaches can be analyzed and diagnosed by the inspection of your doctor. Your doctor can tell the nature of your headaches by an examining you and studying the description of pain given by you. And to diagnose this problem technique like Blood Tests, X-Ray or brain scans are usually not required.

Living Well with Migraine Disease and Headaches: What Your Doctor Doesn't Tell You...That You Need to Know

What treatment to take in which situations?

              When your tension headaches are occasionally then simple pain reliever which can be taken without prescription can be useful. But while choosing these pain relievers you should first of all check the label for possible side effects which may be caused due to interactions with other medicines you are taking. So to avoid any such possibilities you must read the instructions on the label and follow them carefully. If you are still facing any problems regarding how to take the dosage you must consult your reliable doctor or pharmacist.

              But if your tension headaches are not occasionally and occur everyday or at regular short intervals of time then these pain relievers will not give you the right treatment and so in this type of situation you should consult your doctor this is because the medicine which he will prescribe you will be more beneficial for relieving the pain at the time of these tension headaches. These medicines referred by your doctor not only help in relieving the pain but sometimes also useful in preventing these headaches to take serious forms. It is always advisable to treat the tension headaches when they are mild before they take some serious forms this is because in earlier stages these headaches can be cured more easily.

 
Fixing You: Neck Pain & Headaches: Self-Treatment for healing Neck pain and headaches due to Bulging Disks, Degenerative Disks, and other diagnoses.

What other techniques could be useful to relive pain from tension headaches besides using medicines?

          Besides taking medicines you can also use several other techniques to get relieve from pain in tension headaches. These techniques include:

• Take enough sleep or rest
• Put an ice pack on your neck or head at the time of these headaches
• Regular exercises of 30-60 minutes 6 times a week will be useful in relieving the pain
• Take everyday walk after meal or move on a long vacation to relieve yourself from your busy life.

 

 

 

    

How to Prevent a Migraine

There's a new wrinkle on headache cures : botox. It often works when nothing else does By Sanjay Cupta,M.D.

                        Half the 28 Million Americans who get migraines never see a doctor about them. That is a shame, because not only are there plenty of drugs that can alleviate the often debilitating pain of migraines, but there are also whole classes of medication that can prevent them in the firste place. These include ceta and calcium-channel blockers that improve the flow of blood to the brain ? Anti-depressants that regulate levels of the brain chemical serotonin and various anti-inflammatory drugs and anti-seizure medicines (epilepsy and migraines, for reasons no one yet understands, seem to have common origins).

                        Unfortunately, a large group of migraine suffers-perhaps as migraine sufferers –perhaps as many as 9 million in the U.S. alone –find no protection or relief in today’s drugs. That is why there was so much excitement at American Headache Society last month in Seattle about the news that socalled refractory migraine patients respond well to treatment with Hollywood’s new favorite drug :botox.

      

                        The discovery that botox can prevent migraine was a lucky accident. Plastic surgeons using diluted botulism toxin to remove wrinkles started hearing about a secondary effect. « Patients, » remembers Dr. William Binder? ‘’came back saying, Not only have my wrinkles disappeared, but my headaches are also gone. ‘’

                        As word spread in the medical community, more doctors began offering botox to their migraine patients. Finally, two years ago, a team of scientists at Wake Forest University in North Carolina decided to put the treatments to a scientific test. They administered potox shots to 134 patients who had not responded to standard treatments. Eighty-four percent reported some improvement; among patients who got the full four-session treatment, the success rate was 92%.

                        Dr. Todd Troost, chairman of neurology at Wake  Forest and lead research on the botox study, says he is not entirely sure why botox works. ‘’It appears to relax muscles in the head, neck and jaw that when inflamed may trigger migraines, ‘’ he says. But Troost adds that it also seems to interfere directly with the brain’s pain-signaling mechanism.

                        The FDA, which in April approved botox injections for wrinkle removal only, has not yet endorsed botox as a treatment for migraines-although doctors are able to administer it to patients ‘’of label.’’  The treatments are neither easy nor cheap. They involve 30 or 40 injections around the head, temple, jaw, neck and shoulders, caste $1,000 or more and wear off after three or four months. Some patients will still prefer less invasive preventive measures, such as getting plenty of sleep and cutting back on red wine, chocolate and aged cheese.

Yet Shirley Kennedy, 52, speaks for many patients when she swears by her botox shots. For 30 years, she says, she suffered from migarines so severe that she felt  ‘’as if every hair on my head was about to blow off’’ that has all changed . ‘’Botox was a lifesaver ,’’ she says. ‘’I no Ionger have migraines.’’ She probably has fewer wrinkles too.

With reporting by Miriam C. Falco/Atlanta (TIME magazine July 2002)

                       

Benefit from fantastic savings on best writing service reviews , just by taking a look at http://topofbestpaperwritingservices.com

Prepaid Debit Card Payoneer

Hi,

            Have you checked out Payoneer? Get paid directly to your very own Payoneer Prepaid Debit MasterCard® Card, available to over 200 countries worldwide!

       No bank account required, and the card can be used to make purchases or withdraw cash worldwide where MasterCard® is accepted. Their My Account tool allows you to fully manage your account online, and multilingual customer support team is available via telephone, e-mail and live chat.

Sign up now and receive a payment, and we both earn $25! Check it out

 http://share.payoneer-affiliates.com/a/clk/2nLmcm

Best,

- Yassine

Cancer de la Prostate (suite 2)

EVOLUTION

 Invasion locale et loco-régionale.
               La tumeur s’étend directement dans les tissus péri-prostatiques envahissant rarement le rectum en raison de la présence de barrière naturelle dont le fascia de Denonviller. Entre 10 et 35 % des patients vont présenter ne obstruction urétérale en relation le plus souvent avec une extension loco-régionale. Le cancer peutégalement se développer vers le col vésical et l’urètre responsable d’une dysurie voire d’une rétention d’urine complète.

 Extension lymphatique
Se fait vers les chaines ilio-obturatrices, pré-sacrées et péri-sciatiques. Secondairement peuvent
apparaitrent des ganglions para-aortiques ou bien iliaques.
 Extension hématogène
Les métastases osseuses sont habituellement ostéoblastiques, envahissant le pelvis, le sacrum et le plus souvent elles sont présentent chez 85 % des patients en phase terminale. Les métastases viscérales, le poumon, le foie et les glandes surrénales sont rares.


DIAGNOSTIQUER

 SIGNES ET SYMPTÔMES
Le diagnostic du stade précoce repose sur le toucher rectal systématique et le dosage du PSA.
           Au stade localisé, il n’existe habituelement aucun symtôme mictionnel. Les circonstances de découvertes sont le plus souvent:
            _ toucher rectal lors d’un examen systématique qui retrouve un nodule prostatique ou une induration prostatique.
            _ une élévation du PSA (prostatic serum antigen) marqueur spécifique réalisé à titre systématique ou dans e cadre du bilan pour adénome de prostate.

Au stade avancé localement, le diagnostic doit être évoqué devant
          _ Une obstruction vésicale : dysurie et les symptômes en relation avec une hypertrophie prostatique (plus rarement que l’hypertrophie bénigne de la prostate).
          _ Des douleurs lombaires en relation avec une dilatation des cavités pyelocalicielles.
          _ Un épisode hématurique (moins courante que lors de l’hypertrophie bénigne).

Au stade plus tardif des métastases
        Devant des douleurs osseuses de type inflammatoires ou bien asymptômatiques lors d’un examen systématique radiologique (maladie métastatique).
        _ Plus rarement, dans le cadre d’un bilan étiologique pour métastases hépatiques, retropéritonéales, pulmonaires, et cérébrales

Quelle que soient les circonstances, le diagnostic repose sur la biopsie de prostate
           _ Le diagnostic histologique est parfois fortuit, lors de l’examen des copeaux de résection pout hypertrophie bénigne.
           _ La biopsie transrectale de prostate doit être réalisée lorsqu’il existe
                        une élévation du PSA (supérieur à 4 ng/ml)
                        une induration au toucher rectal ou la palpation d’un nodule
                        à l’échographie transrectale qui montre des zones hypoéchogènes
        Les biopsies prostatiques peuvent être réalisées en hôpital de jour, sous anesthésie locale. Il s’agit de biopsies transrectales qui sont réalisées en cadran (de 6 à 9) guidées par échographie transrectale.
           Les complications des biopsies transrectales ou bien des aspirations à l’aiguille fine sont minimes. Les complications infectieuses sont prévenues par une prophylaxie antibiotique (fluoroquinolones). l’hématurie microscopique ou bien macroscopique sans retentissement est la règle souvent associée à une hémospermie. Ces signes s’atténuent au cours de la première semaine.

Diagnostic histologique et grading et définition du grade
          Différents systèmes de grade prostatique ont été développé dans le but de définir avec précision le potentiel biologique de progression du cancer de prostate. Il existe une corrélation entre le grade tumoral et le volume tumoral. La plupart des petites tumeurs sont bien différenciées et la plupart des tumeurs faiblement différenciées sont de grand volume.
           Le grade de Gleason est basé sur le dégré de différenciation glandulaire et les caractères de la croissance des cellules glandulaires tumorales dans le stroma.
le grade 5 est le plus mauvais pronostic et correspond à un aspect très indifférencié où la structure glandulaire n’est plus reconnue.
            Le grade 1, au contraire représente une structure glandulaire parfaitement organisée et caractéristique des glandes prostatiques. Les deux grades les plus communs sont additionnés ensembles ce qui donne le score allant de 2 à 10. Ce score est corrélé à l’incidence d’envahissement lymphatique, au risque de progression loco-régionale, à la survenue de métastases à distance.
Le système de Mostofi définit le dégré d’anaplasie cellulaire et de différenciation glandulaire. Il existe 3 grades, le grade 3 représentant les tumeurs les plus anaplasiques et prédictifs de pronostic sombre.

La définition du stade est essentielle
         C’est la classification TNM qui est actuellement en vigueur pour définir les différents stades pronostics des cancers de prostate.

Le système TNM comprend :
      _ la définition du T. T0 : absence de tumeur;
      _ T1a: tumeur mise en évidence lors d’une résection endoscopique avec moins de 5 % des copeaux envahis;
       - T1b: tumeur mise en évidence lors d’une résection endoscopique avec plus de 5 % des copeaux envahis  ou bien score de Gleason supérieur à 7 ;
       _ T1c: tumeur mise en évidence par une élévation du PSA sans nodule palpable ;
       _ T2a: nodule palpable uni-latéral et envahissant moins de la moitié d’un lobe ;
       _ T2b: tumeur envahissant un lobe ;
       _ T2c: tumeur envahissant les deux lobes ;
       _ T3: tumeur avec un envahissement loco-régional palpable ou bien associée à une dysurie ;
       _ stade T4: envahissement loco-régional (obstruction urétérale, rétention d’urine complète, oedème des membres inférieurs).

L’envahissement glandulaire est défini par :
       _ N. N0: pas de ganglion;
       _ N1: ganglions envahis.

Envahissement métastatique défini par:
       _ M. M+ ou M-.

La définition du stade repose sur :

L’examen clinique
           Environ 30 % des patients se présentent avec une maladie localement avancée et 40 % avec des métastases.
           Le but de la stadification est de définir au mieux le risque d’envahissement capsulaire et l’existence de métastases.
          Un examen attentif par le toucher rectal est essentiel. La palpation d’un nodule ou bien d’une différence de consistance dans une partie de la glande doivent faire pratiquer des biopsies. Au fur et à mesure que la maladie progresse, il existe une perte de la palpation du sillon médian et ultérieurement la tumeur est palpable au-dessus, en-dessous ou en-dehors de la loge prostatique qui définie le T3 clinique.
         L’examen clinique comprend également la recherche de ganglions palpables, l’examen de l’appareil locomoteur, hépatique et pulmonaire.

Les examens de laboratoire et sérologie
         - un bilan sanguin complet
         -  créatinémie plasmatique
         -  Le dosage du PSA qui est le marqueur du cancer prostatique et dont l’intérêt se place aux différents niveaux du diagnostic, du bilan et de l’évolution sous traitement.

Radiographie de thorax
          A la recherche de métastases pulmonaires. La lymphangite carcinomateuse est plus fréquente que le classique lacher de ballon pulmonaire. Il est très rare d’avoir des métastases pulmonaires comme l’évidence de maladie métastatique.

Le scanner abdomino-pelvien
essentiellement utilisé:
      _ au stade localisé tant à analyser les extensions loco-régionales qui restent difficiles à apprécier par cet examen que l’extention lymphatique (adénopathie supérieure à 1 cm) qui peut orienter vers la cytoponction à visée diagnostic. L’utilité de cet examen est discutable lorsque le PSA est inférieur à 10 ng/ml du fait de la faible fréquence des métastases ganglionnaires.
     _ au stade localement avancé fait le bilan de l’extension loco-régionale en particulier l’extention au niveau des deux uretères, l’existence de dilatation pyélocalicielle et l’existence de métastases viscérales.

La scintigraphie osseuse
          permet d’identifier les lésions métastatiques osseuses. Permet pour les stades localisés de mettre en évidence des lésions osseuses infra-cliniques et infra-radiologiques.
Avant qu’une lésion soit vue sur une radiographie conventionnelle, elle doit être d’au moins 10 à 15 mm de diamètre et avoir remplacé la masse osseuse de 30 à 50 %.
La scintigraphie osseuse est toujours négative lorsque le PSA est inférieur à 10ng/ml.

Suite.....

Cancer de la Prostate (suite1)

Etiologie
Il est admis que le cancer se développe aux dépens de la zone périphérique mais certains cancers se
développent dans la prostate centrale. L’envahissement de la capsule postérieure est le premier stade de progression locale. Suivi de l’envahissement des structures loco-régionales : l’urètre prostatique, le col vésical, les pédicules vasculo-nerveux prostatiques latéralement et en arrière, les ganglions lymphatiques ilio-obturateurs et à un stade plus tardif, le retropéritoine,  le rectum et les métastases à distance essentiellement osseuses ou hépatiques, pulmonaires et cérébrales.

 Le facteur endocrine
Le cancer de prostate se développe aux dépens d’un épithélium glandulaire actif (les patients castrés
avant la puberté ne développe pas de cancer de prostate). La croissance et les fonctions de la prostate sont dépendants de la testostérone et de la dihydrotestostérone (métabolite de la testostérone par la 5 alpha hydroxylase).

Prédisposition génétique
Une prédisposition familiale du cancer de prostate a été mis en évidence. Le risque relatif est augmenté lorsqu’il existe des antécédents familiaux, de la fratrie directe ou du père.
 Epidémiologie
Age.
Alors que les études autopsiques des patients de 90 ans, montrent que 70 % d’entre eux ont un cancer
de prostate, l’incidence des cancers cliniquement diagnotiqués est de 0,02 % chez les hommes âgés de 50 ans, à 0,8 % des hommes âgés de 80 ans. La médiane globale pour tous les stades de cancer cliniquement diagnotiqués est de 70,5 ans. Il existe donc une grande disparité entre l’incidence et la mortalité, ce qui est l’expression directe d’un grand spectre d’activité biologique de ce cancer. Certains patients vont souffrir d’une progression rapide de leur maladie avec un risque de décès important alors que d’autres auront une progression très lente sans expression clinique et dont la cause de décès sera différente.
Les études de surveillance simple pour les stades localisés de cancer de prostate, ont mis en évidence la progression de ces stades entre la 5ème et la 10ème année qui suivent le diagnostic.
La race
Le cancer de prostate est essentiellement présent dans les pays occidentaux. La mortalité aux Etats-Unis est de 15,5 pour 100000 chez les blancs et de 28,7 pour 100000 chez les noirs américains. Les groupes orientaux, les indiens d’Amérique et les groupes hispaniques ont une incidence basse. L’importance des facteurs d’environnement est démontrée par une augmentation de l’incidence de 6 fois des populations immigrantes d’Asie.

 AnatomopathologieSeul l’examen histologique des biopsies confirme le diagnostic. Il présente également un intérêt
pronostique dans l’evaluation du grade histologique. Il s’agit de la prolifération d’un contingent de cellules épithéliales de différenciation glandulaire organisé en canaux et à disposition tubulo alvéolaire dans un stroma conjonctif contenant des cellules musculaires lisses. Les glandes prostatiques normales sont composées d’une couche de cellules sécrétoires et une assise de cellules basales qui les sépare du tissu conjonctif adjacent. A l’inverse, les glandes tumorales sont souvent irrégulières, constituées d’une seule couche de cellules dont le noyau augmenté de volume contient un ou plusieurs nucléoles. D’autre part, la couche de cellules basales a disparu. Les adénocarcinomes représentent plus de 95% des carcinomes prostatiques. Ils sont classés selon leur différenciation. (Grade 1 bien différencié, 2 moyennement, 3 indifférenciés) selon qu’ils reproduisent plus ou moins les structures glandulaires normales.
L’aspect de la structure histologique de la glande tumoral est corrélée au pronostique de la maladie. La classification de Gleason est utilisée, elle repose sur l’évaluation des deux aspects histologiques: les anomalies de la différenciation: taille, forme, fusion des glandes, espacement, et leur relation avec le stroma: espacement des glandes, invasion apparente du stroma en périphérie de la tumeur (de I à V). Le score totalise les deux contingents les plus fréquents .
Le diagnostic différenciel de l’adénocarcinome est essentielement l’hyperplasie atypique à larges glandes ou la dysplasie intracanalaire (PIN néoplasie intraépithéliale) dont les atypies nucléaires ressemblent à celles de l’adénocarcinome. La différence est la conservation de la couche de cellules basales. La dysplasie sévère de grade III est souvent associée à l’adénocarcinome.
En dehors du grade, la mesure du foyer tumoral sur la biopsie et le franchissement de la capsule prostatique dont l’identification est parfois possible à partir du matériel receuilli constituent des éléments suplémentaires pour apprécier le pronostic.

Diagnostic final du stade
Il n’est possible que par l’examen de la pièce opératoire. Lorsque le patient est traité par prostatectomie radicale. Cet examen permet d’apprécier les limites de la résection chirurgicale et de calculer le volume tumoral. Les limites de l’exérèse sont évaluées par l’identification de l’envahissement de l’apex, du col vésical, de la capsule prostatique et des marges de la résection latérale. Enfin par la définition de l’envahissement des vésicules séminales, et des ganglions lymphatiques obturateurs.

Suite.......

Cancer de la prostate

RETENIR

          Première cause de cancer chez l’homme , deuxième cause de décès par cancer .
Le diagnostic précoce est possible par le toucher rectal et le dosage du PSA.
        Dans les stades localisés (T1 a,b,c ou T2 a,b,c) les options thérapeutiques dépendent essentiellement de l’espérance de vie du patient. Les différentes options thérapeutiques à ce stade sont: la prostatectomie radicale, la surveillance et la radiothérapie.
        Le traitement au stade des métastases repose sur la castration (chirurgicale ou chimique). L’efficacité du traitement du cancer au stade des métastases est limité puisque la majorité des patients récidivent (échappement hormonal) sous une forme résistante à tout traitement.

COMPRENDRE

         Le cancer de la prostate est devenu le premier cancer diagnostiqué chez l’homme et la deuxième cause de mortalité chez ces patients. Les options thérapeutiques au stades localisés sont toujours à débattre: prostatectomie radicale, radiothérapie, surveillance simple. Il est difficile de déterminer quels sont les patients qui vont présenter une morbidité substantielle liée à la maladie, les patients qui n’auront aucun symptôme et dont la cause de décès sera différente. Le principal facteur déterminant du traitement radical est l’espérance de vie d’au moins 10 ans, une tumeur au stade localisé, et un PSA inférieur à 20 ng/microlitre.
         A un stade ultérieur (étendu localement ou métastases), le traitement repose sur la suppression hormonale androgénique (castration) du fait de la dépendance du tissu prostatique aux hormones mâles (androgènes).
        L’effet reste cependant limité dans le temps et la plupart des patients décèdent de progression tumorale hormono-indépendante résistante à tout traitement (chimiothérapie et ou radiothérapie).

Incidence
          L’adénocarcinome est la première cause de cancer chez l’homme et la deuxième cause de mortalité par cancer dans les pays occidentaux. Environ 21500 nouveaux cas sont diagnostiqués en France, ce qui représente environ 19 % des cancers diagnostiqués chez l’homme et 10 % des causes de décès chez l’homme.
         L’incidence de ce cancer est certainement plus importante. Si l’on tient compte des études sur autopsie, 30 % des patients d’un âge supérieur à 50 ans ont des lésions microscopiques d’adénocarcinome prostatique.
          L’incidence des cancers de prostate mise en évidence lors d’une résection endoscopique varie de 10 à 15 % des cas à 60 ans et dépasse les 40 % au-delà de 90 ans.

suite......