February 2011
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February 13, 2011

The child who has a first seizure with a fever does not necessarily need special x-rays or brain scans.
Fever lowers the brain’s threshold for seizures and thus may provoke them. Indeed, as noted earlier, a seizure can be induced in anyone if the temperature is sufficiently high. Young children have a lower seizure threshold anyway, and thus are more susceptible to a seizure when a rapidly rising fever further lowers this already low threshold. This is the reason why such seizures tend to occur in young children. The threshold gradually increases over the first years of life as the brain becomes more mature, which is why these infants and young children outgrow the tendency to febrile seizures as they grow older. Febrile seizures are very uncommon after age five or six.
Susceptibility to febrile seizures appears to have a genetic base. Such seizures tend to occur in certain families.
These three factors—the lower threshold of the infant (ages three months to two or three years), the height and rapidity of rise of the fever, and the genetic threshold—all three in combination may lower the seizure threshold sufficiently to cause a seizure. A higher fever or more rapid rise in fever in an infant without a family history of seizures may be enough to trigger a seizure; a lower fever in an infant with such a family history may be enough. In an older child, whose threshold is higher, a high fever may be sufficient with a family history of febrile or afebrile (nonfebrile) seizures, but insufficient to trigger a seizure without a family history of seizures.
The first seizure with fever can be terrifying to a parent. Occasionally the seizure may be mild and brief (no more than slight slumping and loss of consciousness, or a rolling of the eyes back in the head), but often there is stiffening, a jerking, and loss of consciousness. Nine out of ten febrile seizures last only a few minutes, usually fewer than ten, but even they seem to last a lifetime to parents who have never seen a seizure before and who believe that their child is choking, or swallowing his tongue, or even dying.
*31\208\8*

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February 8, 2011

The effect of insulin on various body tissues is interesting. Muscle tissue requires insulin in order to absorb sugar, which it uses as a food and bums to produce energy. Muscles are composed mainly of protein, which is constructed from amino acids. Amino acids may be thought of as building blocks for the production of protein. Muscle tissue apparently requires insulin also in order to use amino acids for the production of more muscle cells. If a person has severe diabetes and is not receiving insulin injections, his muscles will waste away because he is not able to rebuild the tissue, and furthermore, he will experience weakness because his muscles are not able to function properly without adequate food.
The liver ordinarily stores sugar in the form of glycogen. If the blood sugar level falls below normal (as would occur when a person is fasting or if there was an excess production of insulin), then the liver releases sugar into the bloodstream. The source of the sugar is twofold. Glycogen is broken down into glucose (sugar), and the liver is able to convert amino acids (the building blocks for protein) into sugar.
The liver will also release sugar (glucose) in the absence of normal amounts of insulin. Therefore, in the diabetic person, who has inadequate amounts of insulin circulating in his system, the liver will respond by increasing the amount of sugar circulating in the blood. Thus the elevated blood sugar in diabetics is caused by this liver mechanism, and by the tissues, mainly muscle and fat, which do not use up sugar as they normally would if adequate insulin were present.
Although fatty tissue is composed mainly of fat, it also contains a quantity of glucose (sugar). When adequate amounts of insulin are present, sugar is incorporated into the fat deposits of the body. If there is a deficiency of insulin, then sugar cannot be taken up by the fat deposits, and furthermore, the fat deposits break down. Thus, the diabetic loses weight, and he ends up with an excess amount of fat substances circulating in his bloodstream. This may be one reason for the accelerated development of atherosclerosis in the diabetic person. The excess fats may be deposited in the walls of the arteries, forming atheroma, or patches that constitute the disease of atherosclerosis.
Most persons who develop diabetes mellitus are overweight or have been at some time in their lives. This does not mean that every fat person will develop diabetes. However, if a fat person has a hereditary tendency to develop diabetes, the extra weight may cause it to occur sooner.
*3/309/5*

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February 3, 2011

The question the reader will ask at this point is ‘Given all this epidemiological study, do we know the causes of cancer?’ Broadly the answer is ‘yes’ in many circumstances and for many cancers, and the opportunities for prevention that this understanding generates are there to be taken. We do not always know how the factors that have been identified by the epidemiological studies discussed in this chapter link up to what is being learned in the laboratories of the molecular biologists. This connection is being made rapidly and will be increasingly clear by the end of the century. Epidemiology has been very successful in discovering or confirming which features of our lives in the Western world can be now identified as causes of cancer.
Very few medicines have been implicated as causing cancers but there are three groups of drugs where cancer is probably an important and often unavoidable side effect. Hormones have already been mentioned. The very drugs that are used for treating cancers by chemotherapy include some (particularly those known as alkylating agents) which interfere with DNA and, hence, with some genes. Cases of leukaemia and other cancers are being discovered as a delayed after-effect of such drugs in patients who have been cured of their first cancer by such chemotherapy. Not all the drugs used in chemotherapy have this effect and modem treatments appear to have reduced the risks considerably. The third group which may put people at risk are those drugs which are used to suppress the body’s immune function. These are used for patients who have had transplants and in such patients, particularly those with kidney transplants, certain rare kinds of cancer, including those known as lymphoma, have been found. As a result of the risks, these patients have to be monitored very carefully.
*35\194\4*

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